Advances in Skin & Wound Care最新文献

Objective: To determine if intermittent neuromuscular electrostimulation (NMES) of the common peroneal nerve increases microvascular flow and pulsatility in and around the wound bed of patients with combined venous and arterial etiology.

Methods: Seven consenting participants presenting with mixed etiology leg ulcers participated in this study. Microvascular flow and pulsatility was measured in the wound bed and in the skin surrounding the wound using laser speckle contrast imaging. Measurements were made at baseline and when the venous pumps of the leg were activated by 1 Hz intermittent neuromuscular stimulation of the common peroneal nerve. The nerve was stimulated transdermally at the head of the fibula.

Results: When activated by NMES, wound bed flux increased by 38% (95% CI, 11%-73%; P = .023), and periwound flux increased by 19% (95% CI, 9%-32%; P = .009). Pulsatility increased in the wound bed by 214% (95% CI, 51%-985%; P = .017) and in the periwound by 122% (95% CI, 38%-299%; P = .014).

Conclusions: The results indicate that NMES is effective in augmenting microvascular flow in leg ulcers with combined venous and arterial etiology.

Objective: To develop a generalizable and accurate method for automatically analyzing wound images captured in clinical practice and extracting key wound characteristics such as surface area measurement.

Methods: The authors used image processing techniques to create a robust algorithm for segmenting pressure injuries from digital images captured by nurses during clinical practice. The algorithm also measured the real-world wound surface area. They used the hue-saturation-value color space to analyze red color values and to detect and segment the wound region within the entire image. To assess the accuracy of the algorithm's wound segmentation, the authors compared the results against wound image annotations.

Results: The algorithm performed impressively, achieving an intersection-over-union score of up to 0.85 and 100% intersection with the annotations. The algorithm effectively analyzed wound images obtained during clinical practice and accurately extracted the surface area of the documented pressure injuries. These results support the feasibility and applicability of this methodology.

Conclusions: Accurate determination of wound size and healing supports decision-making regarding treatment and is essential to successful outcomes. This innovative approach for visual assessment of chronic wounds highlights the potential of computerized wound analysis in clinical practice. By leveraging advanced computational techniques, healthcare providers can gain valuable insights into wound progression, enabling more accurate assessments to support their decision-making.

Abstract: Calciphylaxis is a rare and potentially fatal condition involving chronic, nonhealing wounds caused by microvascular calcification. There is currently no approved treatment for calciphylaxis, contributing to its devastating impacts on quality of life. In this case series, the authors highlight instances of potentially misdiagnosed calciphylaxis in a cohort of patients and emphasize the importance of accurate diagnosis through multidisciplinary management approaches.The authors report on three patients treated at a large tertiary academic center between March 2021 and March 2023. Consent was obtained from all patients, including for the use of patient images. The first and second patients, a 75-year-old man and 62-year-old woman, respectively, both underwent an extensive course of local wound care as well as sodium thiosulfate therapy. The third patient, a 61-year-old woman, was treated with a combination of medication adjustments, lymphedema therapy, pulse lavage treatment, and cadaveric skin substitute. Tissue biopsy was also obtained in two of the three subjects to aid in the diagnosis of calciphylaxis. Unfortunately, these procedures lead to diagnostic challenges and misadventures, highlighting the risks associated with biopsy of calciphylaxis.This case series demonstrates how correctly diagnosing calciphylaxis relies heavily on providers maintaining a high index of clinical suspicion based on patient history, presentation, and risk factors. The primary goals of treatment for calciphylaxis include appropriate wound care, management of infection and pain, and close monitoring.

General purpose: To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds.

Target audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

Learning objectives/outcomes: After participating in this educational activity, the participant will:1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.3. Apply evidence-based treatment strategies for chronic wound management.

Objective: To evaluate the effect of hyperbaric oxygen (HBO) therapy on the outcomes of patients with chronic refractory osteomyelitis (CRO) when combined with modern antibiotics with modern delivery methods and/or surgical treatments.

Methods: The authors conducted a retrospective review on 58 patients with CRO from a single institution who underwent HBO therapy along with standard treatment between January 2009 and December 2019. To investigate associations with binary outcomes of interest, they estimated logistic regression models. All models were adjusted for sex, smoking status, and pertinent comorbidities. Exponentiated logistic regression model coefficients were interpreted as odds ratios for each outcome of interest. Multivariable logistic regression was used to control for potential confounding variables.

Results: When controlling for multiple confounding factors, patients who completed HBO treatment had 7.76 times the odds of having improvement of their CRO compared with patients who started HBO treatment but did not complete it (P = .015). Further, patients who completed HBO treatment had 7.7 times the odds of experiencing CRO improvement when controlling for CRO stage (P = .006). However, completion of HBO did not statistically significantly impact the resolution of CRO or the odds of further surgery or amputation. Patients with diabetes, peripheral vascular disease, and congestive heart failure had increased odds of having an amputation (Ps = .026, .037, and .024, respectively).

Conclusions: Patients who completed HBO treatment had increased odds of experiencing improvement of their CRO compared with patients who started HBO treatment but did not complete it. Patients with CRO who had diabetes and congestive heart failure had increased odds of undergoing an amputation.

Objective: To assess the healthcare costs of pressure injuries (PIs) among patients with a spinal cord injury (SCI) in a Dutch rehabilitation center and determine if those costs were associated with patients' age or sex.

Methods: The direct healthcare costs of PIs were estimated using data from electronic health records of a Dutch rehabilitation center. This dataset contained demographic, clinical, and resource use information of all patients with an SCI or a PI who were treated at the rehabilitation center because of a PI between 2009 and 2022. Standard prices were used to value inpatient rehabilitation, whereas a micro-costing approach was used to value outpatient consultations and material costs. Using ordinary least squares regression analyses, the authors assessed whether the costs were associated with age and sex, after correcting for the patients' length of PI care.

Results: Between 2009 and 2022, 409 patients with an SCI were treated at the rehabilitation center for a PI. The patients' mean total length of PI care was 883 ± 1,266 days (median, 137 days; interquartile range, 10-1,620). The mean total rehabilitation cost of PIs among these patients was €15,412 (USD $16,836) per patient with a mean total annual rehabilitation cost of €6,368 (USD $6,956) per patient. Costs were not significantly associated with age and sex.

Conclusions: The healthcare costs of PIs among patients with an SCI in a Dutch rehabilitation center represent a significant economic burden. Prevention of PIs seems warranted, not only from a clinical perspective, but also from a health economic perspective.

Abstract: The global pandemic caused by COVID-19 led to numerous novel cases of autoimmune and rheumatologic disorders that developed postinfection. Along these lines, these authors report an unusual case of scleredema following SARS-CoV-2 infection in an individual who lacked any known risk factors. Given the emergence of newer mutant strains of COVID-19 and steadily rising numbers of people receiving COVID-19 vaccinations, physicians should remain alert for as yet unrecognized manifestations of the disease.