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

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.

Background: Marjolin ulcer is an SCC arising from chronic inflammatory tissue. Such ulcers pose a high risk for metastasis; the 5-year survival rate of 40% to 69% suggests that improvement is possible with early diagnosis.

Objective: To raise awareness and update education in the medical community regarding this manifestation of SCC.

Methods: The authors performed a retrospective literature review specifically for SCC arising in the context of HS. A PubMed search yielded 81 articles reporting SCC in the context of HS from 1958 to November 2022, with a total of 123 cases. The authors' additional patient, who was treated in practice, is included as Case 1, bringing the total number of patients to 124.

Results: Seventy-three percent of patients were male. The mean age at the time of SCC diagnosis was 53 years ± 10.25 standard deviation. The mean interval between HS diagnosis and SCC development was 24.4 years ± 11.33. Thirty-six percent of patients had metastatic disease. Of the 102 cases that included details on life and death, 58 were noted to have died; of those 58, 60% died within the first year following diagnosis.

Conclusion: Given the poor prognosis of Marjolin ulcer, with rapid progression after diagnosis, frequent visual examination and biopsies with a high index of suspicion for HS are recommended to identify SCC prior to metastatic transformation and subsequent unresectable disease. If surgical intervention is performed in the management of HS, tissue should always be sent for pathologic examination.

Introduction: Diabetic foot infection is a serious and painful process for patients with diabetes, and the considerable morbidity associated with the condition warrants attention. Effective inflammatory markers may become important in the detection of diabetic foot infection.

Objective: The goal of the research was to systematically assess the function of inflammatory markers in the detection of diabetic foot infection.

Methods: Online databases including PubMed, SpringerLink, and Web of Science were searched. The quality of research and data was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to compare changes in inflammatory markers between patients with infected diabetic foot (IDF) and patients with non-infected diabetic foot.

Results: Ten studies with 785 participants were included in the systematic review. The study analyzed 3 inflammatory markers: white blood cell (WBC) count, C-reactive protein (CRP) level, and procalcitonin (PCT) level. The meta-analysis indicated that mean WBC count (standardized mean differences [SMD]: 0.51, 95% CI: 0.23, 0.79; P < .0001), mean CRP level (SMD: 1.05, 95% CI: 0.60, 1.50; P < .0001) and mean PCT level (SMD: 0.80, 95% CI: 0.36, 1.24; P < .0001) were higher in patients with IDF. The differences were statistically significant, but the funnel plots indicated the existence of publication bias.

Conclusions: The meta-analysis further confirmed the significant association between inflammatory markers and diabetic foot infection. It also confirmed that WBC count, CRP level, and PCT level can be used as laboratory auxiliary indexes in the detection of diabetic foot infection, providing information for improved diagnosis and prevention.

Background: Most chronic wounds contain biofilm, and debridement remains the centerpiece of treatment. Enzymatic debridement is an effective tool in removing nonviable tissue, however, there is little evidence supporting its effect on planktonic and biofilm bacteria.

Objective: This study evaluated the effects of a novel BBD agent on removal of nonviable tissue, biofilm, and microbial loads in patients with chronic ulcers.

Materials and methods: Twelve patients with DFU or VLU were treated with up to 8 once-daily applications of BBD and then followed for an additional 2 weeks. Punch biopsy specimens were collected and analyzed for biofilm, and fluorescence imaging was used to measure bacterial load.

Results: Ten patients completed treatment, and 7 achieved complete debridement within a median of 2 applications (range, 2-8). By the end of the 2-week follow-up period, the mean ± SD reduction in wound area was 35% ± 38. In all 6 patients who were positive for biofilm at baseline, the biofilm was reduced to single individual or no detected microorganisms by the end of treatment. Red fluorescence for Staphylococcus aureus decreased from a mean of 1.09 cm² ± 0.58 before treatment to 0.39 cm² ± 0.25 after treatment. BBD was safe and well tolerated.

Conclusion: Preliminary data suggest that BBD is safe and that it can be used to effectively debride DFU and VLU, reduce biofilm and planktonic bacterial load, and promote reduction in wound size.

Each year, 27.5% of the 150 000 people in the United States who require lower extremity amputation experience significant postoperative complications, including pain, infection, and need for reoperation. Postamputation pain, including RLP and PLP, is debilitating. While the causes of such pain remain unknown, neuroma formation following sensory nerve transection is believed to be a major contributor. Various techniques exist for management of a symptomatic neuroma, but few data exist on which technique is superior. Furthermore, there are few data on primary prevention of neuroma formation following injury or intentional transection. The TMR technique shows promise for both management of PLP and RLP and prevention of neuroma formation. Following amputation, transected sensory nerves are coapted to nearby motor nerve supplying remaining extremity musculature. Not only does this procedure generate increased myoelectric signals for improved prosthesis control, TMR appears to neurophysiologically alter sensory nerves, preventing formation of painful sensory neuromas. The sole RCT to date evaluating the efficacy of TMR showed statistically significant reduction in PLP. TMR is not limited to use in the setting of major limb amputation. It has also been used in the setting of post-mastectomy pain, abdominal wall neuromas, digital amputations, and headache surgeries. This article reviews the origin of TMR and provides a brief description of histologic changes following the procedure, as well as current data regarding the efficacy of TMR with regard to postoperative pain relief. It also seeks to provide a concise, comprehensive resource for providers to facilitate better discussions with patients about treatment options.

Background: The long-term chronic effect of radiotherapy is commonly referred to as LRTI. Clinical complications such as skin atrophy, tissue fibrosis, endothelial damage, ulcer formation, and compromised wound healing are common sequela. Despite advances in medicine over the past decade, there remains a need for effective treatments for LRTI skin necrosis and ulcerations.

Materials and methods: This case series discusses cTOT in 3 patients of advanced age with LRTI wounds having undergone Mohs surgery. All wounds had been recalcitrant to multiple wound care treatments. All patients suffered with significant wound pain as well.

Results: cTOT resulted in complete wound healing in all 3 patient cases. Additionally, all 3 patients reported a significant reduction in wound pain during the course of therapy.

Conclusions: The positive outcomes exhibited in this case series suggest that cTOT is an effective treatment in the management of Mohs surgery patients with compromised wound healing due to radiation, advanced age, and comorbidities.

Background: Small-area burn is a common but specific type of injury that can still lead to serious complications if not managed properly. Researchers have introduced a number of interventions.

Objective: The objective of this study was to compare the effects of eCASH concept-based care (ie, eBCare) with those of standard treatment on wound healing in patients with small-area burns.

Methods: In this prospective randomized controlled trial, patients with small-area burns received either eBCare (n = 35) or standard burn treatment (n = 35) for 2 weeks. Pain, anxiety, heart rate, exudate, and wound area were measured during and after dressing changes. Scar color and thickness were assessed 4 years or longer after discharge.

Results: The eBCare group had a lower median pain score, anxiety score, and heart rate compared with the control group (P < .001). The eBCare group also had a higher median wound healing rate on day 14 than the control group (P < .05). At follow-up 4 years or more after discharge, the eBCare group had better scar color and thickness than the control group (P < .05).

Conclusion: The use of eBCare reduced pain and anxiety, accelerated wound healing, and improved scar outcomes in patients with small-area burns, which suggests that eBCare may be a feasible option for this population.

Background: Plantar hallux IPJ ulcers are common and challenging to manage, with many available treatments. One newer technique called SPFR has been used in the management of plantar forefoot ulcers.

Objective: This case series reports the clinical results of SPFR for treatment of strictly plantar hallux IPJ ulcers.

Materials and methods: A retrospective chart review was conducted on patients that underwent SPFR procedure by a single foot and ankle surgeon from 2018 to 2023. The primary study outcome was to identify the rate and time of healing associated with SPFR for hallux IPJ ulcers. Only the initial surgery was evaluated for time of healing for the ulcer, healing rate, and complications. Subsequent surgeries were reviewed as well. Patient charts were further reviewed to determine the presence or absence of a postoperative complication.

Results: A total of 17 feet from 17 patients were studied. The hallux IPJ ulcers healed in an average of 3.0 months. The average follow-up time was 26.9 months. Fifteen patients (88.2%) healed after the SPFR procedure. Five patients (29.4%) developed transfer lesions, and 7 patients (41.2%) developed postoperative complications.

Conclusions: The authors believe that SPFR can be utilized in the treatment of hallux IPJ ulcers if both surgeons and patients are aware of the potential complications and limitations of this procedure. Further research is warranted to evaluate the efficacy and reproducibility of these results.