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

Introduction: Emergency laparotomy has become an increasingly more frequent and expensive general surgery procedure in terms of cost and resource utilization. Primary fascial closure at the index procedure may not be feasible in many patients, requiring use of the open abdomen (OA)technique. Patients with OA are most often managed with temporary abdomen closure (TAC). Open abdomen negative pressure therapy (OA-NPT) has been shown to be an effective TAC technique, which facilitates re-exploration, protects visceral organs, mitigates fascial retraction, prevents loss of abdominal domain, and provides effective volumetric abdominal fluid management.

Objective: This study assessed the clinical use and outcomes of a next-generation perforated polyurethane foam dressing that has been developed for use with OA-NPT.

Materials and methods: The authors evaluated a next-generation OA-NPT foam dressing to provide TAC in 4 patients who required OA management. Two surgeons at different facilities exercised their independent surgical discretion in selecting the patients who would receive the next generation OA-NPT foam dressing. Surgical interventions to resolve the underlying pathology were completed using the OA technique. Postoperatively, all patients had intermittent urinary bladder pressures recorded as an indirect method for approximating intra-abdominal pressure (IAP) and to monitor clinical evidence of intra-abdominal hypertension (IAH) or abdominal compartment syndrome.

Results: In these patients, primary fascial closure was achieved and no appreciable increase in IAP was noted. No gastrointestinal complications related to the next generation perforated OA-NPT foam dressing were noted.

Conclusions: Based on the authors' clinical assessment of the 4 patients who required OA management, the new, perforated OA-NPT foam dressing was effective in providing increased medial tension and contraction without an appreciable increase in IAP.

Background: Gastrocutaneous fistula is a rare complication following Roux-en-Y gastric bypass, a commonly performed bariatric surgery. While most ECFs respond to conservative management, some do not close despite adequate nutritional support, infection source control, and drainage management. As such, the chronicity of these difficult-to-treat wounds can be physically and economically costly to patients.

Case report: A 53-year-old female with a history of Roux-en-Y gastric bypass developed a gastrocutaneous fistula secondary to a perforated gastrojejunal ulcer, requiring immediate surgical intervention. After being discharged from the hospital, 37 days of conservative management and NPWT did not reduce the size of the fistula tract. To help control the patient's chronic abdominal pain and increase the rate of wound healing, the patient underwent treatment with HFES (20 kHz) delivered using a handheld transcutaneous electrical nerve stimulator. This electrotherapy was found to reduce the majority of the patient's pain within the first treatment session. The patient's fistula also began to decrease in size within 1 week of initiating treatment.

Conclusion: This case report details the successful closure of a gastrocutaneous fistula after administration of HFES 3 times a week over the course of 25 days. The mechanism of action of HFES and its role in the wound healing process are also discussed.

Background: AS is a malignant tumor that originates from vascular endothelial cells and is known for a high rate of local recurrence and metastasis.

Case report: A 48-year-old male presented with cutaneous epithelioid AS. Cutaneous AS of the foot is quite rare, especially in the absence of predisposing factors, and in this patient it was previously misdiagnosed as a DFU.

Conclusion: Physicians should be aware of this rare presentation of cutaneous AS. The authors of the current report advise regular clinical reassessment of chronic ulcers and biopsies of nonhealing wounds, even when adequate wound treatment has been administered, with the goal of identifying ulcerated skin malignancies and preventing delay in providing appropriate treatment.

Background: NF is a life-threatening soft tissue infection that most commonly occurs in the lower extremity. While presenting symptoms such as erythema, severe pain, sepsis, and wound crepitation are well documented, diagnosis of NF of the breast often is obscured by a low clinical index of suspicion due to its relative rarity as well as by the breast parenchyma that physically separates the underlying fascia and overlying skin. Several risk factors have previously been identified, such as underlying infection, diabetes, advanced age, and immunosuppression. However, the gross morbidity and high mortality associated with NF warrant continued surveillance of contributing factors across any anatomic location. Fifteen cases in the literature document the development of NF following breast surgery.

Case report: The authors of this case report aim to expand on the current literature through the presentation of a unique case of NF of the breast following right breast lumpectomy and oncoplastic closure with left reduction mammaplasty in an immunocompromised patient found to have concurrent perforated sigmoid diverticulitis.

Conclusion: This case exemplifies how frequent postoperative surveillance, a low threshold for intervention, and efficient coordination of care are vital to minimizing the morbidity and mortality risks associated with NF of the breast.

Neither the CTP sex effect of female CTP derived from cryopreserved human placental membranes, nor male CTP bioengineered from living human keratinocytes and foreskin fibroblasts has been described. Healing in wounds was examined to establish the CTP sex' s role in both males and females. Cisgender CTP wounds had better closure. Overall, male PC, PC-End, and CC rates over time were better than female rates. Outcomes were affected by access, etiology, and follow-up.

Introduction: A large SNF system in the United States adopted a holistic wound care model that included an AI DWMS to improve PI care.

Objective: To compare the trend in PI point prevalence rates and average days to healing linked to adopting technology in practice from 2021 to 2022, and to assess the rate of received PI F686 citations in facilities that adopted the technology compared with those that did not.

Methods: The study used the DWMS database to compare anonymized PI data assessed in 2021 (15 583 patients) vs 2022 (30 657 patients) from all SNF facilities that adopted the technology in 2021 and 2022. F686 citations data were provided by the SNF organization.

Results: There was a 13.1% reduction in PI prevalence from 2021 to 2022 across all PI stages. Facilities that adopted the technology demonstrated a significant reduction in days to healing from 2021 to 2022, with an average of 17.7 days saved per PI or a 37.4% faster healing rate (P < .001). A significant reduction in the average days to healing was noted for all PI stages, with the most significant savings observed for stages 3 and 4, with an average savings of 35 days (stage 3) and 85 days (stage 4) in 2022 vs 2021 (P < .001). From 2021 to 2022, facilities that adopted the technology reported an overall 8.2% reduction in F-686 citations severity >G compared to those that did not adopt the technology.

Conclusion: Use of technology as part of a comprehensive wound care program has the potential to not only improve patient care and quality of life, but to realize considerable annual savings in additional PI out-of-pocket expenses (up to $1 410 000) and of clinicians' time (44 808 hours).

Background: Current literature suggests relatively low accuracy of multi-class wound classification tasks using deep learning networks. Solutions are needed to address the increasing diagnostic burden of wounds on wound care professionals and to aid non-wound care professionals in wound management.

Objective: To develop a reliable, accurate 9-class classification system to aid wound care professionals and perhaps eventually, patients and non-wound care professionals, in managing wounds.

Methods: A total of 8173 training data images and 904 test data images were classified into 9 categories: operation wound, laceration, abrasion, skin defect, infected wound, necrosis, diabetic foot ulcer, chronic ulcer, and wound dehiscence. Six deep learning networks, based on VGG16, VGG19, EfficientNet-B0, EfficientNet-B5, RepVGG-A0, and RepVGG-B0, were established, trained, and tested on the same images. For each network the accuracy rate, defined as the sum of true positive and true negative values divided by the total number, was analyzed.

Results: The overall accuracy varied from 74.0% to 82.4%. Of all the networks, VGG19 achieved the highest accuracy, at 82.4%. This result is comparable to those reported in previous studies.

Conclusion: These findings indicate the potential for VGG19 to be the basis for a more comprehensive and detailed AI-based wound diagnostic system. Eventually, such systems also may aid patients and non-wound care professionals in diagnosing and treating wounds.

Background: Accurate burn wound size estimation is important for resuscitation and subsequent management. It is also important for the development of referral guidelines in Nigeria.

Objective: To establish whether a significant discrepancy exists in burn size estimation between referral centers and burn units.

Methods: A retrospective review of burn patients managed at the burn unit of a premier tertiary hospital in Ibadan, southwestern Nigeria, between January 1, 2016, and October 31, 2019 was conducted. Patients' demographic and other characteristics, inclusive of TBSA estimation from point of referral and the burn unit, were retrieved and analyzed.

Results: A total of 96 burn injury records were found for the study period, with a male-to-female ratio of 1.3:1. Thirty-five records (36.5%) included no burn size estimation by the referring physician. There was a statistically significant difference in TBSA estimation between referring physicians and burn unit physicians (P = .015). Burn wounds were more likely to be overestimated than underestimated (P = .016). Overestimation is more likely with minor burns and in pediatric patients. Underestimation was more likely in adults.

Conclusion: There is a significant difference in burn size estimation between burn unit physicians and referring physicians. This finding underscores the need for continuous education on burn estimation to aid proper referral and management.