Advances in Skin & Wound Care最新文献

Abstract:

Objective: The perioperative setting presents unique challenges that contribute to the development of pressure injury (PI). In this study, the authors explore the incidence and baseline characteristics of perioperative patients (adult, inpatient, and surgical patient population with at least 3 days' hospital stay) who undergo surgery and have PI outcomes.

Methods: This descriptive retrospective study was conducted using electronic medical record data of 55,270 patients from an academic health care system. Differences in baseline characteristics between patients with versus without PI were examined using the Fisher exact test, χ2 tests, and t tests.

Results: The incidence of perioperative pressure injury (PPI) was 0.5%. Of the PPI group, 65.7% developed PPI after cardiovascular surgery. The most prevalent PPI stage was unstageable, followed by Stage 2 and deep tissue injury. The most common locations for PPI were the back, followed by the buttocks and heels. The PPI group was older and had a higher average comorbidity score (P<.001). Comorbidity differences of those with and without PPI were observed in congestive heart failure (28.1% vs. 15.2%, P<.001), diabetes (28.5% vs. 19.2%, P<.001), renal disease (27.7% vs. 18.8%, P<.001), and severe liver disease (8.0% vs. 3.4%, P<.001). There were no differences in race, body mass index, or history of tobacco use between the PPI group and the non-PPI group.

Conclusions: This study identified that cardiovascular surgery remains a high risk for PPI in perioperative patients. Among the demographic characteristics, race is not a sufficient category for identifying risk for PPI as it lacks the accuracy in skin tone measurement.

Objective: To investigate the prevalence, risk factors, and protective measures of occupational contact dermatitis (OCD) among nurses in Hefei, China; create a predictive model for nurses' experiencing contact dermatitis; and assess the model's effectiveness.

Methods: A cross-sectional survey using the Nordic Occupational Skin Questionnaire 2002 was conducted among 273 nurses at a hospital in Hefei, China, from December 2022 to February 2023. Predictive factors for nurses' contact dermatitis were identified through regression analyses. A predictive model, represented by a nomogram, was established based on these factors, and its predictive performance was evaluated by calibration curve and the decision curve analysis plot.

Results: Contact dermatitis was found among 20.51% of nurses. Those with allergies were 4.34 times more likely to develop OCD (95% CI = 2.29-8.24), whereas individuals with dry skin had a 2.82 times higher risk (95% CI = 1.07-7.47). Using protective gloves and uniforms reduced the risk by 50% to 60%. The established nomogram model exhibited an area under the receiver operating characteristic curve of 0.734 (95% CI = 0.661-0.807), demonstrated satisfactory calibration, and showed a favorable net benefit.

Conclusions: Nurses with allergies or dry skin are more likely to develop OCD, but wearing gloves is a helpful preventive measure. The created model predicts nurses' OCD risk, which can identify high-risk individuals for early intervention.

Objective: The surgical site infection (SSI) rate is reportedly higher with foot and ankle surgeries than with other parts. This is problematic for rheumatoid arthritis and diabetes mellitus patients. Ultrafine bubble (UFB) technology is expected to elongate the duration for which the surgical site can remain disinfected, thanks to its stable nanobubble structure and disinfection effects by its own radical actions. This study evaluated the feasibility and safety of preoperative skin cleaning utilizing UFB water before foot/ankle surgery.

Methods: This observational study retrospectively examined 219 extremities in 217 patients who had undergone foot/ankle surgery. Preoperative skin cleaning was performed using either conventional alcohol (concentration 80%) (conventional group; 113 extremities) or 500 mL of UFB water and conventional alcohol (UFB group; 106 extremities). Frequencies of postoperative events such as blister formation, eschar formation (width >10 mm) on the wound, and wound dehiscence after suture removal were compared, as was the time until suture removal.

Results: Rates of eschar formation and wound dehiscence after suture removal were significantly reduced in the UFB group. Time to suture removal was significantly shorter in the UFB group (12.9 d) than in the conventional group (15.5 d). All 3 cases with infected open wounds in the UFB water group achieved complete cure with wound closure within 2 weeks.

Conclusions: Preoperative skin cleaning using air UFB water appears safe and might help prevent eschar formation and wound dehiscence after foot/ankle surgeries. These effects could improve wound healing for patients undergoing foot and ankle surgery.

Objective: To systematically review in vivo animal studies and randomized clinical trials (RCTs) analyzing the effects of electrical currents on cytokine and growth factor levels involved in wound healing.

Data sources: PubMed, EBSCO, Ovid, Elsevier, and online gray literature databases were searched for relevant studies.

Study selection: Eligible studies were full-text, English-language in vivo reports or RCTs comparing at least 10 electrically stimulated (ES) wounds with 10 control wounds left untreated or treated with sham ES or nonphysical interventions.

Data extraction: Extracted data included ES-induced changes in cytokine and growth factor levels in wounds or blood. Methodologic quality was assessed using the SYRCLE risk-of-bias tool (animal studies) and the PEDro scale (RCTs).

Data synthesis: Eight studies (6 in vivo with 349 animals and 2 RCTs with 44 patients with diabetic foot ulcers) published between 2011 and 2021 were analyzed. ES protocols included direct current, low-voltage and high-voltage monophasic, biphasic, and alternating currents applied at sub-sensory to motor intensities. Most in vivo studies reported reduced cytokine levels (IL-1β, IL-6, TNF-α, and IL-10) and increased growth factors (VEGF, FGF-2, EGF, and TGF-β1). RCTs found ES increased VEGF in wounds and blood but did not affect soluble VEGF receptor-2 levels.

Conclusions: Electrical stimulation favorably modulates cytokine and growth factor expression, supporting faster wound healing. However, due to the limited number and heterogeneity of studies, further high-quality research is required to establish optimal ES parameters.

Abstract:

Objective: To investigate the effectiveness of the TIME-CDST (Tissue, Inflammation or Infection, Moisture, and Epidermal/Edge status-Clinical Decision Support Tool) in the prevention and management of incontinence-associated dermatitis (IAD) in patients with severe trauma and obesity.

Methods: A total of 50 patients were assigned to the control group from February to April 2023, and 76 patients were designated as the intervention group from May to July 2023. In the control group, routine skin care measures were taken. The intervention group applied TIME-CDST for systematic hierarchical management, which included assessment, collaboration, control, decision-making, and evaluation. The incidence of IAD and fungal dermatitis, the severity of IAD, and healing time were compared between the 2 groups.

Results: The application of TIME-CDST led to a decrease in the incidence of IAD from 44.00% to 26.32% (χ 2 =4.244, P <.05) and a reduction in fungal dermatitis from 27.27% to 0.05% (χ 2 =4.683, P <.05). The intervention also reduced the severity of IAD ( Z =-2.331, P <.05) and shortened the healing time ( Z =-2.321, P <.05).

Conclusions: The use of TIME-CDST in patients with severe trauma and obesity could reduce the incidence and severity of IAD and promote early healing of dermatitis.

Objective: Face masks are essential for disease prevention. However, prolonged use raises dermatological concerns. Addressing these issues can help develop guidelines that minimize risks and enhance comfort and adherence as a public health measure during future outbreaks. This study aimed to evaluate dermatological problems and pathogens related to face mask usage during the COVID-19 pandemic.

Methods: Data were collected through a structured questionnaire covering demographics, face mask usage habits, knowledge of mask use, and dermatological health. A pilot study was conducted to assess the questionnaire's reliability and validity. Microbiological samples were taken from participants' cheeks under the mask to identify common skin pathogens. Biostatistical methods were used to analyze the data.

Results: Dermatological problems, particularly acne and allergies, increased significantly during the pandemic, especially among surgical mask users. A notable rise in the prevalence of various bacteria and yeasts was observed in the samples. Knowledge of proper face mask usage was generally poor, with 81.1% of participants falling into poor/very poor categories. Surgical masks were used by 58.3% of participants, followed by cloth masks (33.1%) and KN95/N95 masks (8.7%). Most participants wore single-layer masks (70.9%), with 25.2% also using face shields. Female participants wore masks for significantly longer durations than males ( P = .04), whereas cloth mask users wore them for significantly shorter periods, regardless of sex ( P = .045).

Conclusions: Prolonged face mask use is associated with increased dermatological issues and growth of skin pathogens. These findings underscore the need for promoting proper mask use, improving knowledge, and addressing skin care needs for future health emergencies.

Abstract:

Objective: Pilonidal sinus disease (PSD) is a common disease that is an important health problem. Using new flap methods in defect closure in PSD surgery may be useful in obtaining ideal surgical outcomes. This study aimed to present the early outcomes of the square excision and transposition flap (SF) technique compared with the modified Limberg flap (LF).

Methods: Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated. Demographics, comorbidity, clinical presentation, pain assessment, hospital stay duration, healing time, time to return to work, and recurrence status were compared between the SF and LF groups.

Results: There was no significant difference between the SF (53 patients) and LF (49 patients) groups regarding demographic and most clinical characteristics. Patients in the SF group experienced shorter healing times of 11 days and quicker returns to work at 13 days compared with patients in the LF group ( P <.001). A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035). Partial wound dehiscence was more observed in the LF group (18.4%), marking a significant difference ( P =.001). Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates. The SF group had a lower recurrence rate.

Conclusions: The SF method had lower wound dehiscence, shorter healing time, and shorter return-to-work time compared with the modified LF. Patients have more cosmetic satisfaction. The SF technique can be considered as an option in the surgical treatment of PSD.