Advances in Skin & Wound Care最新文献

Objective: To analyze the characteristics of postoperative wound complications (WCs) in patients following vulvectomy with flap repair and evaluate the efficacy of negative-pressure wound therapy (NPWT) in wound healing.

Methods: This study retrospectively reviewed 17 patients with WCs following vulvectomy with flap repair at a tertiary comprehensive hospital from January 2016 to December 2022. All patients were treated with NPWT, and the wound healing rate, healing time, and NPWT-related complications were observed.

Results: The most common WCs were seroma and lymphorrhea (52.94%; nine cases), followed by wound infection (35.29%, six cases), fat liquefaction (23.53%, four cases), wound dehiscence (17.65%, three cases), and wound ischemia (5.88%, one case). The main locations for flap WCs were the vulva (64.71%), thigh (35.29%), and pubic symphysis (23.53%). One patient halted treatment; the remaining 16 patients all achieved complete healing with a mean healing time of 43.50 ± 17.92 days. One complication was associated with the use of NPWT: procedural pain (17.65%, three cases).

Conclusions: The use of NPWT may contribute to accelerated wound healing after flap repair in vulvar cancer and is safe for clinical application.

General purpose: To review best practices related to the assessment of irritant contact dermatitis due to fecal, urinary, or dual incontinence (ICD-FIUIDI) among patients with darkly pigmented skin.

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. Identify risk factors for the development of ICD-FIUIDI.2. Describe clinical features and manifestations of ICD-FIUIDI.3. Propose recommendations to improve care related to ICD-FIUIDI.

Abstract: Massive localized lymphedema (MLL) is a benign overgrowth of lymphoproliferative tissue that is primarily observed in adults with class III obesity. Patients present with a painless mass that has usually been present for a considerable period. Consultation of a healthcare professional typically takes place when MLL-related complaints interfere with daily living. Massive localized lymphedema is often termed "pseudosarcoma" due to its clinical similarity to sarcoma. Surgical excision is necessary to improve mobility, prevent recurrent infections, and rule out malignancy, but can be high-risk for individuals with class III obesity and multiple comorbidities. In this report, the authors present the case of a 47-year-old woman with a body mass index of 73 kg/m2 and MLL of the right medial thigh. She was successfully diagnosed and managed by local necrosectomy, wound debridement, maggot debridement therapy, and negative-pressure wound therapy by using a vacuum-assisted closure device. The diagnosis of MLL can be challenging because of its similarity to sarcoma; its pathogenesis and management are not completely elucidated. Despite surgery being the best described treatment, such an intervention itself can be challenging because patients often have multiple comorbidities and delayed diagnosis. The authors recommend that clinicians should consider nonsurgical treatment of MLL in high-risk patients who have necrotic wounds with fluid loss. The use of less invasive methods such as maggot debridement therapy followed by negative-pressure wound therapy can be useful in high-risk patients.

Background: Chronic nonhealing neuropathic foot ulcers affect approximately 15% to 30% of patients with diabetes mellitus and are associated with significant morbidity and mortality. Although current strategies to address these chronic wounds include a multifactorial approach, clinical outcomes remain poor and warrant improvement. Platelet-rich plasma (PRP), derived from autologous or allogeneic blood, is an emerging regenerative product that aims to serve as an adjuvant to standard diabetic foot ulcer (DFU) treatment.

Objective: To examine controlled clinical trials investigating the efficacy of platelet-rich therapies in promoting healing of chronic DFUs.

Data sources: The PubMed/MEDLINE database.

Study selection: Researchers selected 11 controlled clinical trials published between 2011 and 2021 that investigated the efficacy of PRP treatments for chronic DFUs.

Data extraction: Extracted data included study type and size, participant sex and age, duration of diabetes, glycated hemoglobin levels, baseline ulcer area, wound duration, healing parameters, PRP preparation approach, and application type.

Data synthesis: Randomized prospective studies (n = 8), prospective controlled studies (n = 2), and a double-blind, randomized controlled study (n = 1) were included in the review. In general, PRP plus standard of care provided superior wound healing, in both percentage of wound closure and healing rate, compared with standard of care alone.

Conclusions: Use of PRP as an adjuvant for healing chronic DFUs appears to improve wound healing. Further research on optimizing PRP preparation and exploring combinatorial approaches will be important in advancing this avenue for chronic wound healing.

Abstract: Negative-pressure wound therapy (NPWT) is used to promote wound closure or to prepare a wound for definite coverage. However, the anatomy of the hand makes it difficult to apply dressings that require an airtight seal. In this report, the authors describe the case of a patient with an extensive defect of his right hand and forearm who was treated with a free fibula osteocutaneous flap transfer. The remaining defect was covered with a split-thickness skin graft following NPWT. An airtight seal was achieved by placing the whole extremity in a sterile bag and sealing it proximal to the defect. The authors present a simple and innovative way of treating defects on upper extremities with NPWT with excellent results.

Abstract: Increasing healthcare costs, limited healthcare resources, an aging population, and lifestyle-related diseases make wound management a growing clinical, social, and economic burden. This case series investigated the use of a novel, biocompatible, polymer-based transforming powder dressing (TPD) that transforms in situ to a shape-retentive wound matrix upon hydration for treating wounds of various etiologies.In this institutional review board-approved single-center retrospective case series, the researchers evaluated various acute and chronic wounds treated with TPD over a period of 2 years. Wounds were followed from the first TPD application up to 1 month after the last TPD application or until the wound healed or the patient was lost to follow-up, whichever came first. The researchers evaluated wound etiology, location, number of applications, change in wound surface area, and comorbidities.The researchers identified 50 patients who were treated with TPD and had at least one follow-up visit during the retrospective study period. The majority of wounds treated with TPD were venous leg ulcers (n = 27) followed by traumatic wounds (n = 11) and skin tears (n = 7). Normal rates of wound healing (>10% per week) were observed in the majority of patients (36/50, 72%) over their duration of treatment. Complete healing during the study period was observed in 43% of venous leg ulcers, 55% of traumatic wounds, 71% of skin tears, and 80% of other wound types. No adverse effects of TPD administration were observed. Treatment with TPD resulted in significant reductions in wound area of nearly all wounds, regardless of etiology.

Objective: To analyze the occurrence of symptoms and quality of life (QoL) among patients with chronic wounds and the impact of chronic wounds on QoL.

Methods: Researchers evaluated 200 patients with chronic wounds using a general information questionnaire, a modified version of the Memorial Symptom Assessment Scale, and the Chinese version of the Cardiff Wound Impact Questionnaire. They performed correlation and linear regression analyses to explore the impact of symptoms on QoL.

Results: Mean symptoms scores were all moderately severe and ranged as follows: 0 to 7.06 ± 3.85 for mean total symptom, 0 to 2.69 ± 1.33 for mean frequency, 0 to 2.27 ± 1.02 for mean severity, and 0 to 2.29 ± 1.29 for mean distress. Scores on the three dimensions of QoL (daily life, social life, and well-being) were 51.61 ± 14.73, 48.63 ± 17.20, and 47.45 ± 8.65, respectively. Patients' symptoms on each subscale were negatively correlated with the dimensions of QoL (r = -0.383 to -0.559, P < .01). Multiple linear regression analyses showed that 9 symptoms collectively explained 66.1% of the total variance of daily life (P < .01); 7 symptoms explained 59.0% of the total variance of social life (P < .01); and 10 symptoms explained 59.6% of the total variance of well-being (P < .01).

Conclusions: Patients with chronic wounds had high levels of psychological symptoms and moderate QoL, scoring lowest on well-being. Sleep disruption, limitations in activity, and scarring were the main symptoms affecting their QoL. Nurses should prioritize managing these symptoms to improve patients' QoL.

Objective: To evaluate research on medical adhesive-related skin injury (MARSI), focusing on its incidence, prevalence, risk factors, causes, assessments, and prevention.

Data sources: Searches were conducted on Wanfang Data, China National Knowledge Infrastructure, PubMed, Web of Science Core Collection, MEDLINE, EMBASE, and the Cumulative Index of Nursing and Allied Health Literature Plus with Full Text.

Study selection: Using search terms "medical adhesive related skin injury", "MARSI", "adhesive skin injury", and "medical tape-induced skin injury", the authors selected 43 original articles published between January 1, 2001, and May 12, 2022, in English or Chinese.

Data extraction: Extracted details included the first author; publication year; study location; study type; and specifics on MARSI, such as causes, affected body areas, assessment methods, incidence, prevalence, and prevention.

Data synthesis: Medical adhesive-related skin injury frequently occurred on the face and at venipuncture sites. Acrylate-containing adhesives were more likely to cause MARSI. Risk factors include extended hospital stays, lower Braden Scale scores, mechanical ventilation, edema, poor skin condition, and use of certain medications. Incidence or prevalence exceeded 10% across populations, peaking at 60.3% in the pediatric surgical ICU. Mechanical injury had the highest incidence and prevalence among MARSI types. Studied interventions and quality improvement measures were effective in reducing MARSI.

Conclusions: Despite increasing interest, evidence for reducing MARSI is limited. Future research should focus on distinguishing MARSI types, clarifying incidence and prevalence, assessing risk factors, and implementing screening and quality improvement initiatives.