Advances in wound care最新文献

Objective: To determine whether frailty, as quantified using the Five-Item Modified Frailty Index (mFI-5), independently predicts postoperative complications in patients undergoing surgery for diabetic foot ulcers (DFUs), and to assess its utility as a clinical risk stratification tool.

Approach: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2015-2021). Adults with type 2 diabetes and International Classification of Diseases, 10th Revision-coded DFUs (E11.621) undergoing elective surgery were identified and stratified into frail (mFI-5 >2) and prefrail (mFI-5 ≤2) groups. Preoperative variables, perioperative characteristics, and 30-day postoperative outcomes were compared using univariate tests, followed by multivariable logistic regression adjusting for clinically relevant confounders. The study design, reporting, and analysis followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for observational cohort studies.

Results: Among 2,819 patients, 714 (25.3%) were classified as frail. Frail patients had significantly higher rates of overall complications (50.6% vs. 32.9%), mortality (4.1% vs. 1.6%), and medical complications, including reintubation and urinary tract infection. In adjusted models, frailty independently predicted any postoperative complication (odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.05-1.70, p = 0.02) and medical complications (OR = 1.53, 95% CI: 1.12-2.07, p = 0.007).

Innovation: This is the first large-scale study applying the mFI-5 to DFU surgery, demonstrating that frailty provides prognostic information beyond traditional comorbidity-based assessments and offers a rapid, objective tool for perioperative risk evaluation.

Conclusion: Frailty, as measured by the mFI-5, independently predicts postoperative morbidity and mortality after DFU surgery. Incorporating preoperative frailty screening may improve surgical decision making, resource allocation, and enhance outcomes in this high-risk population.

Significance: Diabetic foot ulcers (DFUs) represent one of the most devastating complications of diabetes, leading to high rates of amputation and mortality. Their multifactorial pathogenesis-including neuropathy, ischemia, infection, and immune dysfunction-creates a chronic inflammatory microenvironment that impairs tissue repair and regeneration.

Recent advances: Emerging regenerative strategies using stem cells and extracellular vesicles (EVs) have demonstrated potential to restore vascularization and modulate inflammation. In particular, miRNA-enriched EVs regulate key wound-healing pathways such as angiogenesis, extracellular matrix remodeling, and oxidative stress response. Meanwhile, small-molecule drugs targeting hypoxia and inflammatory cascades are being explored to enhance re-epithelialization and fibroblast migration. Parallel advances in artificial intelligence (AI) and optical sensing-using visible, infrared, or hyperspectral imaging-enable automated wound detection, tissue classification, and healing prediction with high accuracy.

Critical issues: Despite these developments, translation remains limited by unstable therapeutic efficacy, variable biomarker expression, and the absence of standardized evaluation systems. AI-based wound assessment requires robust datasets and clinical validation to ensure reliability across diverse populations.

Future directions: Integrating molecular-targeted therapies with AI-assisted diagnostic platforms could establish a next-generation DFU management framework-combining precise molecular intervention, automated wound monitoring, and personalized treatment planning-to achieve reliable, real-time, and patient-centered wound care.

Objective: The expected increase in age-related health care costs over the coming decades underscores the need to characterize the effects of biological aging in our cells and tissues. Our objective is to use in vivo multiphoton microscopy (MPM) to find endogenous biomarkers of skin aging.

Approach: MPM was performed on the skin of 2- and 21-month-old mice to measure the autofluorescence of metabolic cofactors, nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD), and second-harmonic generation signal from collagen. A suite of quantitative biomarkers with sensitivity to age-related changes in bioenergetic demands, mitochondrial organization, and collagen composition and organization was evaluated using these optical sources of contrast.

Results: An optical redox ratio of FAD/(NADH + FAD) autofluorescence, NADH fluorescence lifetime imaging, and mitochondrial fractal dimension measurements indicated that aged keratinocytes have more fragmented mitochondria that undergo less catabolism of carbon substrates. Analysis of the dermal regions indicated that aged collagen has more nonenzymatic cross-links and has a more fragmented organization.

Innovation: This study identifies a suite of biomarkers from label-free MPM sensitive to intrinsic aging and provides the first in vivo demonstration of sensitivity to age-dependent metabolic changes in skin through multiple independent optical parameters.

Conclusion: Our results demonstrate that surrogate markers of metabolic function, mitochondrial organization, collagen cross-linking, and fiber organization are sensitive to a loss of homeostasis with advanced age and may be used in future studies to longitudinally assess the progression of aging.

Objective: The meta-analysis was performed to evaluate the efficacy and safety associated with the application of human amniotic membrane (HAM) in individuals with chronic nonhealing wounds.

Approach: The research conducted a comprehensive search of nine electronic databases from their inception to August 1, 2024, aiming to identify randomized controlled trials (RCTs) that evaluated the efficacy of HAM compared with conventional management alone in individuals suffering from chronic wounds. The risk of bias of included studies and the certainty of the evidence in the meta-analysis were evaluated by two investigators and confirmed by a third. The meta-analysis was performed using RevMan 5.4 software.

Results: We identified 14 RCTs encompassing a total of 1,056 participants. The potential risk of bias was determined to be moderate. HAM therapy demonstrated significantly greater efficacy than conventional treatment alone in achieving complete wound healing among patients with chronic ulcers (relative risk [RR] = 1.82; 95% confidence interval [CI]: 1.48-2.24; moderate-quality evidence). In patients with diabetic foot ulcers, HAM reduced the mean time to complete healing by 22 days compared with standard care alone (mean difference = -22.09 days; 95% CI: -39.13 to -5.05; low-quality evidence) and increased the rate of complete healing at 6 weeks (RR = 3.02; 95% CI: 2.04-4.47; moderate-quality evidence) and at 12 weeks (RR = 1.74; 95% CI: 1.37-2.21; low-quality evidence). Similarly, in patients with venous leg ulcers, HAM was associated with more than twice the likelihood of complete healing (RR = 2.03; 95% CI: 1.45-2.86; moderate-quality evidence). No statistically significant differences were noted in the incidence of adverse events among patients with chronic ulcers (moderate-quality evidence).

Innovation: Our study suggests that HAM represents a promising and viable therapeutic strategy for the management of chronic wounds, including lower-extremity diabetic ulcers and venous ulcers.

Conclusion: The application of HAM provides a safer and more effective therapeutic approach compared with conventional management alone for patients suffering from chronic refractory ulcers.

Significance: Keloids represent a persistent clinical challenge, with recurrence rates approaching 100% after conventional surgical excision. Historically viewed as fibroblast-driven scars, emerging evidence positions immune dysregulation as a central driver of keloid pathogenesis, reshaping diagnostic and therapeutic paradigms.

Recent advances: Multi-omics and single-cell analyses reveal profound alterations in immune cell populations and cytokine networks within keloid tissue. M2 macrophages, mast cells, Th2 and Th17 subsets, and dendritic cells dominate the inflammatory microenvironment, sustaining fibroblast activation and excessive extracellular matrix deposition. Key signaling axes-including transforming growth factor-β (TGF-β)/Smad, IL-4/IL-13, IL-6/JAK-STAT-3, and PI3K/AKT/mTOR-intersect with mechanical stress pathways, creating a self-perpetuating fibrotic loop. Notably, soluble human leukocyte antigen-E emerges as a predictive biomarker for disease progression and recurrence, while tissue-resident memory T cells may underlie postoperative relapse.

Therapeutic implications: Beyond corticosteroids and silicone gel, immune-targeted strategies are gaining traction. Dupilumab (IL-4/IL-13 blockade) demonstrates clinical efficacy in reducing keloid burden and pruritus. Experimental approaches targeting TGF-β signaling (Fresolizumab, AVID200), NKG2A/CD94 checkpoints (Monalizumab), IL-6 (Tocilizumab), and TSLP (Tezepelumab) hold promise for precision immunotherapy. Localized delivery and combination regimens may optimize outcomes while minimizing systemic toxicity.

Critical issues and future directions: The absence of validated keloid models and large-scale trials limits translation. Future research must integrate immune profiling, biomarker validation, and mechanistic modeling to enable personalized interventions. Immune dysregulation is not merely an epiphenomenon-it is the Achilles' heel of keloids, offering unprecedented opportunities for targeted therapy and recurrence prevention.

Objective: Burn injuries affect over 11 million people annually, and methicillin-resistant Staphylococcus aureus (MRSA) infection significantly delays healing by sustaining inflammation and promoting scarring. This study evaluated N-benzyl benzenamine 4k-a novel dual-action compound with antibacterial and anti-inflammatory properties-in a murine model of MRSA-infected burn wounds. Approach: Skin safety of 4k was assessed through acute toxicity, sensitization, and irritation tests in BALB/c mice. A full-thickness burn model infected with MRSA2858 (1 × 10⁸ CFU/mL) was treated topically with 4k, vancomycin (VAN), or vaseline. Outcomes included wound closure, bacterial load, histology, collagen organization, macrophage polarization markers (CD86/inducible nitric oxide synthase [iNOS] for M1; CD206/vascular endothelial growth factor [VEGF] for M2), cytokine levels, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway proteins. Results: 4k demonstrated excellent dermal tolerability with no toxicity or irritation. Topical 4k reduced MRSA colonization and accelerated wound closure (residual wound area at day 15: 4k = 8.4 ± 2.2%, VAN = 17.8 ± 3.5%). Histology revealed organized collagen deposition and minimal scarring in the 4k group (scar score: 2.33 ± 0.58 vs. 13.33 ± 0.58 for vaseline). Mechanistically, 4k suppressed NF-κB activation, downregulated M1 markers (CD86, iNOS, tumor necrosis factor-alpha, and interleukin [IL]-6), and upregulated M2 markers (CD206, VEGF, transforming growth factor-beta 1, and IL-10), promoting a prohealing immune environment. Innovation: This study introduces a dual-action topical therapy that combines potent antibacterial activity with immunomodulation, offering a promising strategy to overcome antibiotic resistance and improve burn wound outcomes. Conclusions: N-benzyl benzenamine 4k effectively eradicates MRSA, accelerates wound healing, and minimizes scarring through NF-κB inhibition and macrophage polarization, supporting its potential as a next-generation burn care agent.

Objective: To evaluate wound healing with a novel bandage with hydrocolloid pad designed for daily use/replacement in a new model of laser-induced burns/wounds. Approach: In this randomized, controlled, single-center, 16-day study, healthy adults aged 25-55 years of age with Fitzpatrick skin type I-III and who met all eligibility criteria (N = 34) had four laser-induced wounds generated on each arm and were randomized as follows: (1) uncovered wound (control); (2) standard of care bandage (SoC); (3) petrolatum-based antibiotic ointment + SoC (petrolatum + SoC); (4) bandage with hydrocolloid pad. Primary endpoint: composite healing score (sum of scores for general wound appearance, smoothness, and epithelial confluence, minus scores for erythema, edema, and crusting/scabbing) on Days 1-7. Results: Mean composite healing score was significantly better with the hydrocolloid pad (Days 1-7) and petrolatum + SoC (Days 2-7) than SoC, and with either treatment than untreated controls (Days 1-7), and significantly better with the hydrocolloid pad than petrolatum + SoC (Days 1 to 2 and 7). The hydrocolloid pad and petrolatum + SoC both significantly reduced crusting/scabbing while improving epithelial confluence, smoothness, and general wound appearance, compared with untreated controls and SoC. Innovation: A laser-induced burn model producing consistent wounds was used to evaluate healing with a novel bandage with hydrocolloid pad versus other typical treatments. Conclusion: Wound healing with the novel bandage with hydrocolloid pad used daily was superior to SoC (Days 1-7), untreated wound (Days 1-7), and petrolatum + SoC (Days 1 to 2 and 7). [Figure: see text].

Significance: The combination of hydrogel biomaterials with exosomes to facilitate wound healing and skin regeneration is a promising approach. Recent Advances: Recent preclinical animal studies have focused on investigating the efficacy of hydrogel-based delivery systems for exosomes in promoting wound healing and skin regeneration. Critical Issues: Despite encouraging results, critical issues remain unresolved, such as optimizing hydrogel properties to enhance the efficacy of combined therapy with exosomes for wound and bridging the translational gap between preclinical and clinical applications. Future Directions: Future research endeavors should concentrate on refining hydrogel design to enhance exosome delivery efficacy, conducting rigorous clinical trials to assess the safety and efficacy of exosome-loaded hydrogels in human wound healing and skin regeneration, and exploring innovative strategies to maximize therapeutic outcomes.

Objective: To compare the effectiveness of "semiocclusive dressing (SOD)" treatment using plastic wrap or low-adherent absorbent wound dressings with that of occlusive dressing (OD) treatment for National Pressure Injury Advisory Panel stage III/IV pressure injuries in the inflammatory phase. Approach: This 12-week, open-label, randomized controlled trial was conducted at one hospital and three care facilities. Seventy-seven participants were enrolled; 40 comprised the SOD group and 37 comprised the OD group. The primary outcome was the surface area reduction. Secondary outcomes included the Bates-Jensen Wound Assessment Tool (BWAT) score reductions, incidence of adverse events, and material cost. This trial met the recommendations of the CONSORT 2010 statement. Results: The surface area reduction of the SOD group was greater than that of the OD group throughout the study period. The significant interaction was revealed between treatment and time course (p < 0.0001). The 95% confidence interval of the difference at 12 weeks was 3.4 to 21.9. The median BWAT score reduction of the SOD group at 12 weeks was 23, and that of the OD group was 18.5 (p = 0.0077). The incidence of adverse events was comparable between groups. The OD treatment cost was 3.0 times higher than the SOD treatment cost (p = 0.0012). Innovation: Because the SOD does not completely occlude the wound, excess exudate drains from the wound. Therefore, SOD can treat the wound with abundant exudate effectively and safely. Conclusion: SOD treatment is more effective and less expensive than OD treatment for stage III/IV pressure injuries. Clinical Trial Registration: UMIN Clinical Trials Registry [UMIN000023412]. Registered on July 31, 2016.

Objective: Autologous platelet-rich plasma (PRP) has shown promising outcomes in treating wounds, but the profile of patients benefiting most from this therapy is not known. This study aimed to identify influential variables in the success of this therapy, analyzing its personalized therapeutic potential for complex wounds. Approach: A prospective observational study was conducted in elderly patients with complex wounds receiving autologous PRP. Patient's data about sociodemographic parameters, comorbidities, frailty (FI-VIG score), complete blood count including albumin, wound depth, location, chronicity, and etiology were collected at the beginning of the study. The wound area was monitored weekly. The data were analyzed using descriptive and inferential statistics, longitudinal data analysis, and survival analysis. Results: Ninety-seven elderly patients were included. The FI-VIG, baseline wound area, depth, and etiology were significantly correlated with wound outcome. Strong differences in wound area variation from treatment initiation were observed in healed wounds (13% reduction/week) compared with stagnant and complicated wounds (1 and 2% reduction/week, respectively). The healing time analysis showed that nearly 80% of patients required at least 15 weeks for complete healing. In addition, patients with smaller wound sizes, younger age, or lower FI-VIG scores had shorter healing times. Innovation: This is the first study that identifies prognostic indicators for wound outcomes to guide clinician decision-making for using autologous PRP. It also highlights the relevance of patient health baseline and wound features and evolution for the success of this therapy. Conclusion: This study demonstrates that personalizing autologous PRP therapy to treat complex wounds in elderly patients is possible.