Wounds : a compendium of clinical research and practice最新文献

Background: Cutaneous infections due to nontuberculous mycobacteria (NTM) are rare, and they can be challenging to treat, often requiring prolonged therapy with multiple antibiotics. Although recent literature challenges the idea of routine acid-fast bacilli (AFB) testing in diabetic foot infections, this report presents a case of Mycobacterium chelonae (M chelonae) infection in a patient with nonhealing ulceration.

Case report: A 64-year-old female with no history of immunocompromise and no recent surgical history presented with a rapidly growing ulceration despite appropriate antibiotic therapy based on routine aerobic culture results. After AFB cultures were obtained, she was found to have NTM infection with M chelonae, and the ulceration was healed without recurrence after treatment for 4 months with linezolid and clarithromycin.

Conclusion: This case highlights the potential inoculation of M chelonae, even in immunocompetent patients without known inoculation injury, and it highlights the value of AFB cultures in patients who do not progress with standard wound care therapies and routine aerobic cultures.

Background: Obstructive sleep apnea (OSA) is an underdiagnosed and undertreated disease that has been significantly associated with diabetes, cardiovascular disease, peripheral arterial disease, and poor wound healing.

Objective: To determine whether or not OSA is an independent risk factor for split-thickness skin graft (STSG) failure in patients with chronic lower extremity (LE) wounds, given OSA's disease burden to common comorbidities in the LE wound population.

Methods: A retrospective chart review of chronic LE wounds managed with STSG between December 2014 and December 2022 was conducted. Patients with a diagnosis of OSA ("OSA") were compared with patients without an OSA diagnosis ("Non-OSA").

Results: Overall, 14.9% of patients had OSA (n = 25) and 85.1% (n = 143) did not have OSA. Patients with OSA had a significantly higher median body mass index than the Non-OSA group (32.9 and 28.2, respectively; P = .013) and a higher rate of chronic obstructive pulmonary disease (16.0% and 4.2%, respectively; P = .043). Compared with patients without OSA, patients with OSA had more superficial wounds (P = .027) and received thinner skin grafts (P = .016). Compared with the Non-OSA group, wounds in the OSA group had significantly higher rates of graft failure (OSA 30.6% vs Non-OSA 15.9%; P = .034), infection (OSA 27.8% vs Non-OSA 10.6%; P = .005), and reoperation (OSA 52.8% vs Non-OSA 31.1%; P = .010). On multivariate logistic regression, OSA remained a significant risk factor for graft failure, increasing the odds of graft failure by 8.6 times (P = .040).

Conclusion: OSA is an independent predictor of graft failure in a highly comorbid population with chronic LE wounds. Preoperative identification of these high-risk patients should be undertaken by anesthesia, sleep medicine, and surgical teams to improve outcomes.

Background: Chronic wounds are a growing public health concern, particularly among individuals with diabetes and other comorbidities. These wounds often lead to prolonged treatment, pain, and psychological distress, significantly impairing patients' quality of life (QoL).

Objective: To evaluate the QoL of patients with chronic wounds and identify the factors that influence their health-related QoL (HRQoL), using the Arabic-language version of the 17-item Wound-QoL questionnaire.

Materials and methods: A cross-sectional study was conducted between June and September 2023, involving 60 patients with chronic wounds treated at a diabetic foot center. Participants were interviewed independently using the Arabic-language version of the Wound-QoL-17, a questionnaire used to assess QoL in patients with chronic wounds.

Results: The study sample had a mean (standard deviation) age of 50 (16.19) years, with 60% female (40% male) and 95% Saudi Arabian participants. Diabetic foot ulcer was the most common wound etiology, present in 30% of cases. Wound etiology affected patients' fears of worsening and their levels of frustration. Participants with diabetes reported higher levels of distress and fear. Longer wound duration was associated with greater limitations in social activities. Additionally, differences between males and females were observed in the perception of wound pain and the burden of treatment.

Conclusion: This study highlights the significant effect of chronic wounds on patients' QoL, with specific factors, such as wound location, etiology, and duration, playing critical roles. These findings underscore the need for targeted interventions to improve HRQoL in this patient population.

Background: Chronic lower extremity wounds in patients with diabetes are a significant clinical and economic burden. Traditional dressings have poor healing rates and require frequent changes, burdening patients and caregivers.

Objective: To evaluate if transforming powder dressing (TPD), a hydrophilic polymer powder that forms a moisture-retentive gel conforming to the wound surface, can address these limitations, as clinical data remain limited.

Materials and methods: This retrospective, multinational case series evaluated TPD in 17 patients with diabetic lower extremity wounds across Egypt, India, the United Arab Emirates, and the Palestinian territories. Wound types included diabetic foot ulcers (DFUs), venous ulcers, and postamputation wounds. For all patients, previous standard of care efforts had failed.

Results: TPD was associated with consistent wound size reduction (mean [standard deviation (SD)] 80% [10%]), granulation tissue formation, and pain relief. DFUs and non-DFUs showed comparable outcomes, with no significant differences in healing time (7.1 weeks and 5.9 weeks, respectively; P = .39). Dressings were changed every 5 to 10 days, and no complications were reported.

Conclusion: TPD appears to be a safe, well-tolerated, and effective adjunct for managing diabetic lower extremity wounds. Its ability to promote healing while reducing pain and dressing frequency offers clinical and logistical benefits. Larger, prospective studies are needed to validate these findings and guide treatment protocols.

Background: The considerable health and economic burden of hard-to-heal wounds has become increasingly prominent. Diabetic foot ulcers (DFUs), as a representative type of these wounds, pose substantial challenges for health care professionals in both treatment and long-term management.

Objective: To evaluate the efficacy of a standardized wound hygiene protocol in promoting healing outcomes for DFUs and to provide supplementary clinical evidence to inform wound care practices.

Materials and methods: Diabetic foot care specialists administered a wound hygiene protocol to 20 patients with DFUs. The protocol comprised 4 key components: cleansing, debridement, wound edge refashioning, and dressing coverage. Wound healing progress was monitored and documented over a 12-week observation period.

Results: After 12 weeks of treatment with the wound hygiene protocol in the multidisciplinary diabetic foot clinic, 16 of the 20 patients achieved complete wound healing, while the remaining 4 patients showed significant wound improvement, resulting in a healing rate of 80%. Wound area, exudate level, and pain scores all showed significant improvement compared to baseline, with statistically significant differences (P < .001). The overall mean (SD) wound area reduction rate was 95.11% (10.46%), with a mean healing rate of 1.32 (0.36) cm² per week. The average healing time for patients with complete healing was 56.44 (25.12) days.

Conclusion: This case series demonstrates that the implementation of a wound hygiene protocol significantly enhances healing outcomes in patients with DFUs. These findings provide critical insights for the management of diverse hard-to-heal wounds in clinical practice.

Background: Scalp arteriovenous malformation (AVM) and its clinical course associated with ulcerative hemorrhage and local alopecia are rarely reported.

Case report: An 18-year-old male presented to a vascular anomalies center with scalp AVM and ulcerative hemorrhages over a 6-month period due to post-excision recurrence, initially associated with thinning hair and scalp erythema around the AVM lesion. After meticulous debridement, the patient was immediately given an ethanol embolization. He was advised against home wound care to prevent possible hemorrhage. After several effective interventional sessions over an 18-month period, not only was the AVM lesion extensively eliminated, but restoration of hair growth around the lesion was observed. This phenomenon may be attributed to the alleviation of deep, high-flow AVM steal phenomenon, which in turn restored normal blood supply to superficial layers, promoting ulcer healing and hair regrowth.

Conclusion: This report suggests that scalp AVMs can be accompanied by AVM-related alopecia, which may recover after ethanol embolization. This report also suggests that restrictive debridement during multiple intervention sessions can be feasible in ulcerated AVMs with a high risk of hemorrhage.

Background: Heel reconstruction following wide resection of Marjolin ulcer represents a challenge for surgeons. Local or free flaps are usually used, but they present some disadvantages, such as donor site morbidity, high risk of necrosis, and long surgical time and hospital stay.

Objective: To use a combined multistep protocol of heel reconstruction after wide resection of Marjolin ulcer using a biosynthetic extracellular matrix and negative wound pressure therapy.

Materials and methods: Demographic, clinical, and surgical data for 4 patients treated at a single institution were retrospectively collected.

Results: All patients healed with a good scar appearance and high satisfaction. No complications or tumor recurrence were observed at 12 months postoperative.

Conclusion: The findings of this clinical series suggest that the combined protocol described is an effective option for the resolution of these complex wounds.

Background: Management of diabetic foot ulcers requires detailed and continuous work. Social distancing and lockdown restrictions instituted during the COVID-19 pandemic of 2020 were essential to saving lives and preventing hospital overflow, but they caused many difficulties for patients and health care providers.

Objective: To show the changes in wound care surgery affected by COVID-19 at a safety net hospital.

Methods: All ulcer-related surgeries performed at a single institution from March 2018 through February 2023-that is, 2 years before, the year of, and 2 years after the first year of the COVID-19 pandemic-were reviewed. Because the imposed outpatient and elective surgery restrictions started in March 2020, the period from March through February was used for the review. Wound-related surgeries included wound debridement, incision and drainage, exostectomy, digit amputations, midfoot amputations, and major amputations.

Results: During the entire period, 1858 ulcer-related surgeries were performed at the authors' institution. A total of 723 surgeries were performed in the 2 years before COVID (pre), with 368 performed in the initial year of COVID (Covid) and 767 in the 2 years after the first year of the pandemic (post).

Conclusion: COVID-19 significantly impacted various aspects of ulcer management at the clinic. The authors' wound clinic remained open on a limited basis, and the number of patients seen was markedly lower. After the restrictions were lifted, wound care visits remained significantly lower than the pre-pandemic level; the fear of COVID-19 had a lasting impact on the number of visits. The number of exostectomy and digit amputations has increased since the first year of the pandemic. Midfoot amputation and major amputation did not change much after the initial year of the pandemic, which may be due to death from COVID-19. The fear and death associated with COVID-19 affected wound care and continue to affect wound care and limb salvage, but determining the actual number affected is challenging.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant global prevalence. Clinically, AD is characterized by xerosis, intense pruritus, and recurrent eczematous lesions. The pathogenesis of AD is complex and multifactorial, involving genetic predisposition, epidermal barrier dysfunction, immune dysregulation, and dysbiosis. These factors collectively increase susceptibility to infections in patients with AD. AD lesions are frequently colonized by Staphylococcus aureus and Staphylococcus epidermidis. An important aspect of Staphylococcus spp is the propensity to form biofilms that exhibit enhanced resistance to antibiotics and host immune responses.

Case report: This report describes 2 cases of AD associated with biofilm formation that was successfully treated with polyhexamethylene biguanide (PHMB).

Conclusion: This report highlights the potential of PHMB in the treatment of AD lesions and biofilm reduction.

Antimicrobial resistance (AMR) presents a growing global health crisis, with significant implications for the management of chronic, hard-to-heal wounds. These wounds often serve as reservoirs for resistant pathogens, particularly when complicated by biofilms that impede healing and shield microbes from host defenses and antimicrobial therapies. In October 2024, a multidisciplinary panel of wound care experts from the United States and Australia convened to develop a consensus document aimed at guiding clinicians in the responsible management of microbial burden throughout wound care. This comprehensive guidance outlines the core physiological processes involved in wound healing, the role of microbial colonization and infection in healing delays, and the mechanisms by which resistance develops and spreads. It provides best practices for wound cleansing, debridement, and the appropriate use of systemic antibiotics, emphasizing that systemic agents should only be used when clinically indicated. The document also explores the use of topical antimicrobials and nonantibiotic alternatives, such as topical oxygen, nitric oxide, probiotics, and chelating agents, to help limit reliance on systemic therapies. A key theme throughout the consensus is the importance of antimicrobial stewardship. The panel calls for targeted therapy guided by culture data, limited treatment durations, and the incorporation of education for clinicians, patients, and caregivers to ensure effective and sustainable wound care practices. By integrating emerging technologies, personalized care approaches, and coordinated interdisciplinary collaboration, these recommendations aim to reduce complications, improve healing outcomes, and slow the spread of AMR in wound care settings. This consensus document serves as a practical, evidence-based guide to support clinicians in making informed decisions that balance infection control with the urgent need to preserve the effectiveness of antimicrobial therapies.