The international journal of lower extremity wounds最新文献

The study aimed to evaluate the mid-term outcomes of patients admitted for a diabetic foot attack (DFA). It is a retrospective observational study including a population of patients admitted for diabetic foot ulcers (DFUs) into a specialized multidisciplinary diabetic foot service. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA and those without DFA (chronic diabetic foot, CDF). The DFA was considered in case of ischemia (acute or chronic), infection and Charcot foot requiring urgent hospitalization. Once discharged, patients were regularly followed as outpatients with the following six-month outcomes: healing; major amputation; mortality; hospital readmission; non-fatal major adverse limb and cardiovascular events (MALCE) including nonfatal myocardial infarction (MI), nonfatal stroke, and limb ischemia requiring revascularization. Overall, 141 patients were included. The mean age was 70 ± 12 years, most patients were male (76.6%) and had type 2 diabetes (93.6%) with a mean duration of 22 ± 13 years; 81 (57.4%) patients presented DFA while 60 (42.6%) presented CDF. No cases of admitted Charcot foot were recorded. The DFA group reported 81.5% cases of severe/moderate infections, while the CDF group presented 50% of mild infections. The DFA group reported higher HbA1c values (67 ± 22 vs 56 ± 14 mmol/mol, p = 0.0008) and more cases of first assessment for DFUs (59.3 vs 13.3%, p < 0.0001) when compared to the CDF group. The six-month follow-up outcomes for DFA and CDF were: healing (65.4 vs 60.0%, p = 0.3); major amputation (4.9 vs 1.7%, p = 0.2); mortality (8.6 vs 11.7%, p = 0.5); hospital readmission (27.2 vs 26.7%, p = 0.8); non-fatal MALCE (9.9 vs 23.3%, p = 0.1). Six-month outcomes did not show significant differences between the DFA and CDF groups in terms of healing, major amputation, mortality, readmission, and non-fatal MALCE. Adequate management of DFA seems to ensure favourable mid-term outcomes, even if compared to patients with CDF.

Length-dependent distal symmetrical polyneuropathy (DSPN) represents a highly prevalent complication associated with diabetes. Current standards for clinical diagnosis, severity assessment, and comprehensive staging of DSPN remain ambiguous. Numerous guidelines advocate for a qualitative evaluation of DSPN, primarily to identify loss of protective sensation (LOPS), without clearly enunciating its temporal importance. This approach has resulted in a lack of recognition of the earlier stages of DSPN within diabetes clinics. Our objective has been to establish a straightforward staging system for DSPN, taking into consideration the temporal trends in the pathogenesis of the condition. We categorise DSPN into five stages: Stage 1 represents absence of evident neuronal disease; Stage 2 involves small fibre changes with or without associated symptoms; Stage 3 comprises large fibre changes, with or without associated symptoms; Stage 4 denotes advanced DSPN characterised by LOPS; and Stage 5 includes LOPS with either a current or past history of neuropathic foot ulceration. We believe that this system may enable appropriate risk screening and significantly stratify DSPN, ideally enhancing the organisation of diabetic foot care through suitable counselling and referral.

AimsBurn injuries cause significant mortality, morbidity, and financial and psychological burdens for patients and families. Platelet-rich plasma (PRP) has shown some benefits in burn wound healing, but its efficacy is unproven. This meta-analysis aimed to evaluate PRP's effects on burn wounds.MethodA comprehensive search of Scopus, PubMed, Web of Science, and Cochrane Library was conducted until January 22, 2025, for randomized controlled trials (RCTs) on PRP's effect on burn wounds. The mean difference (MD), standardized MD (SMD), or odds ratio (OR) of the studies was calculated.ResultsNine RCTs with 413 participants were included. PRP significantly reduced wound healing time (MD: -6.68 days, 95% CI (-10.96, -2.39)), wound infection incidence (OR: 0.18, 95% CI (0.04, 0.88)), and dressing change frequency (MD: -14.50 times, 95% CI (-16.45, -12.55)). There was a significant increase in the healed area percentage in the intervention group (MD: 6.82%, 95% CI (2.58, 11.06)). However, there was no significant difference between the intervention and control groups in pain score or graft take percentage.ConclusionsThis review shows that PRP enhances wound healing and reduces adverse events like wound infection in burn patients. Future studies should further explore PRP's effects to support its broader clinical use.

This study aimed to comprehensively analyze the factors affecting the healing time of chronic refractory wounds, then establish a clinical prediction model and verify its performance. A retrospective analysis was conducted on the clinical data of 166 patients with chronic refractory wounds who met the inclusion criteria at a tertiary hospital in Changsha (from October 2021 to December 2023). The wound healing time was defined as the days of hospital stay until meeting the discharge standard. The collected information includes: diabetes status, average daily hospital expenses, wound type, admission route, availability of medical insurance, age, gender, education level, average daily dressing changes during hospitalization, smoking status, blood platelet level at admission, albumin level at admission, hemoglobin level at admission, creatinine level at admission, and prothrombin time. Then, univariate and multivariate logistic regression analyses were conducted to explore the risk factors affecting the healing time. Subsequently, a risk prediction model was constructed in the form of nomogram based on the risk factors identified, and the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were employed to evaluate the prediction performance and calibration of the model. The results of multivariate logistic regression analysis indicate that the factors affecting the healing time of chronic refractory wounds include male gender (OR: 2.86, 95% CI: 1.03-7.93, P < .05), diabetes history (OR: 4.05, 95% CI: 1.11-14.85, P < .05), reduced average daily dressing changes during hospitalization (OR: 0.54, 95% CI: 0.31-0.96, P < .05), elevated blood platelet level (OR: 1.01, 95% CI: 1.00-1.01, P < .05), lowered albumin level (OR: 0.87, 95% CI: 0.78-0.97, P < .05), lowered hemoglobin level (OR: 0.97, 95% CI: 0.95-1.00, P < .05), and lowered creatinine level (OR: 0.99, 95% CI: 0.99-1.00, P < .05). The ROC curve shows that the area under the curve (AUC) of the model is 0.761, indicating good prediction. The DCA curve suggests good clinical applicability.

Wound healing consists of inflammatory, proliferation and remodeling phases. The objective of the current study was to investigate the effect of β-Cryptoxanthin on wound healing. Thirty healthy adult male Wistar rats were randomized into three groups of ten animals each (5 for excisional and 5 for incisional wound model): (1) SHAM group with only wound creation. (2) OINTMENT group: As a control group with wound creation as well as 5 g ointment (Vaseline/ Eucerin) administered locally to the wound bed. (3) BCX group: As a treatment group with wound creation as well as 5 g ointment (Vaseline/ Eucerin) containing β-Cryptoxanthin (25 mg/g ointment) administered locally to the wound bed. An incisional wound model was used for biomechanical studies, while an excisional wound model was used for biochemical, histopathological, and planimetric assessments. The wound area was significantly reduced in the BCX group compared to other groups (P > .05). Biomechanical indices from the BCX group were significantly improved compared to other experimental groups (P > .05). Biochemical and quantitative histopathological analyses revealed a significant difference between BCX and other groups (P > .05). β-Cryptoxanthin showed the potential to improve wound healing significantly. This appeared to work by angiogenesis stimulation, fibroblast proliferation, inflammation reduction, and granulation tissue formation during the initial stages of the healing process. This accelerated healing led to earlier wound area reduction and enhanced tensile strength of the damaged area due to the reorganization of granulation tissue and collagen fibers.

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes mellitus, contributing substantially to patient morbidity, reduced quality of life, and healthcare costs. Accumulating evidence highlights the potential benefits of exercise across various stages of DFUs. This review summarises current evidence on the role of exercise in DFUs management and emphasises the need for well-designed clinical trials to inform future rehabilitation guidelines. Exercise has been shown to improve glycaemic control, promote cardiovascular health, ameliorate neuropathic symptoms, and improve well-being. Importantly, appropriately selected and supervised physical activity may be safely implemented before ulcer onset, during the active ulceration phase, and following wound healing. Data show that exercise provides stage-specific benefits in DFUs by improving risk factors, reducing plantar pressures and foot pain prior to ulceration; enhancing wound healing as adjunctive therapy during ulceration; and lowering the risk of recurrence in the post-healing period. However, current research is limited by heterogeneity in exercise protocols, lack of consensus on training parameters, and exclusion of high-risk populations from trials.

PurposeTo evaluate the safety and efficacy of cadaveric skin and dermal grafts from skin banks in the management of hard-to-heal wounds (HHWs), particularly of vascular etiology, in a frail patient population.MethodsThis prospective, single-center study enrolled 48 patients with HHWs unresponsive to conventional care. Patients underwent vascular assessment, revascularisation if indicated, and wound bed preparation prior to application of cryopreserved, glycerol-preserved, or lyophilized cadaveric grafts. Outcomes were assessed at predefined intervals up to 10.5 months.ResultsA total of 48 patients were enrolled. Arterial etiology was the most prevalent (33 patients, 68.7%). Complete wound healing was achieved in 47.9% of patients, with a mean time to re-epithelialization of 106.6 days. Limb salvage was attained in 97.9% of cases. Significant pain reduction was observed, with VAS scores dropping from 6.8 ± 1.9 at baseline to 1.5 ± 2.7 at six months (p < 0.0001). The Falanga A wound bed category increased from 42.5% at baseline to 84% at 6 months, and infection rates declined from 42.5% to <12% during follow-up. Subgroup analysis showed superior healing outcomes among arterial HHWs compared to non-arterial HHWs (p < 0.05).ConclusionCadaveric skin bank bioproducts offer an effective and safe option for the treatment of hard-to-heal wounds, particularly in patients with vascular disease. In this cohort, the approach led to a high rate of complete healing and limb salvage with significant pain reduction and enhanced wound bed quality. These results highlight the therapeutic value of allografts when used as part of an integrated protocol that includes revascularisation and meticulous wound bed preparation.

ObjectivePressure ulcers seriously affect patient quality of life. The present study aimed to investigate the therapeutic effects of 25% zinc oxide topical cream on treating stage I and II pressure ulcers.MethodsThis randomized, double-blind clinical trial involved 60 patients, divided into the control group (n = 30) receiving a silver-containing dressing and the intervention group (n = 30) treated with 25% zinc oxide cream. Wound assessments were conducted on days 0, 7, and 14, alongside standard care.ResultsIn the end, the intervention group showed significantly higher rates of "partial healing" and "peri-wound erythema reduction" than the control group (p_value < .05). The intervention group's partial healing increased from 3.33% (day 7) to 83.34% (day 14) (p_value < .05), whereas the control group reached from 26.67% to 60%. On day 14, the intervention group experienced a 50% decrease in peri-wound erythema, while the control group only experienced a 9.5% reduction (p_value < .05). Also, 3.33% of the intervention group achieved complete healing, while none in the control group did.ConclusionThe findings suggest that 25% zinc oxide cream may function as an effective and cost-efficient alternative to conventional dressings in managing stage I and II pressure ulcers.Graphical abstract[Formula: see text].

BackgroundDiabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, with high rates of disability and mortality. Early diagnosis and prevention can effectively reduce its incidence. The relationship between hemoglobin, albumin, lymphocyte count, and platelet (HALP) score, which are biomarkers reflecting the inflammatory and nutritional status of the body, and DFU has not been investigated. This study aimed to investigate the association between HALP score and DFU.MethodsThis cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression models assessed the relationship between HALP scores (as both continuous and categorical variables) and DFU, adjusting for confounders. Restricted cubic spline (RCS) analysis was employed to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.ResultsA total of 1604 participants (mean age: 61.67 ± 11.88 years; 52.9% male) were included. Multivariate logistic regression analysis, after adjusting for multiple confounders, revealed a negative correlation between the HALP score and DFU (OR = 0.98, 95% CI: 0.97-0.99, P = 0.041). This association remained significant when the HALP was categorized into quartiles. RCS analysis identified a non-linear relationship, with an inflection point at 44.98 (non-linear P = 0.017). Subgroup analyses confirmed the consistency of these findings across different demographic and clinical groups. Sensitivity analysis excluding extreme outliers confirmed the stability and reliability of the results.ConclusionLower HALP scores are significantly associated with an increased risk of DFU. This study underscores the potential utility of the HALP score as a tool for identifying individuals at higher risk, supporting its use in the prevention and management of DFU.

BackgroundAdvanced wound care dressings are vital in managing the complexities of chronic wound treatment. For instance, Theruptor 3-D composite microbicidal dressing is designed with antimicrobial properties to promote wound healing. Despite the availability of several antimicrobial products in the market such as Bactigras, Allevyn, and Aquacel, their comparative efficacy remains unexplored. This study evaluated the clinical efficacy and safety of Theruptor versus Bactigras and Allevyn dressings for chronic wound healing.MethodsA randomized, parallel-group study was conducted from May 2022 to July 2024 across five centres in India. Patients with chronic wounds were randomized to allocate Theruptor, Bactigras, and Allevyn dressings (diabetic and non-diabetic etiology; n = 35 each). Wound area, bacterial load, clinical signs and symptoms, exudate management, and product performance were assessed.ResultsA total of 210 patients with chronic wound in the age range of 19-87 years, were recruited and followed up for 8 weeks. The mean wound area was significantly reduced from Day 0 to Day 56 in in diabetic Theruptor (17.35 ± 15.08 cm² vs 4.13 ± 10.56 cm²), Bactigras (12.93 ± 12.02 cm² vs 3.6 ± 7.75 cm²), and Allevyn (14.36 ± 9.97 cm² vs 0.74 ± 1.65 cm²) and non-diabetic Theruptor (20.45 ± 16.8 vs 3.01 ± 7.52 cm²), Bactigras (18.16 ± 14.81 vs 2.52 ± 5.48 cm²), and Allevyn (28.41 ± 19.97 vs 5.31 ± 9.94 cm²) groups (p < .0001). Further, bacterial load, exudate scores, and clinical signs and symptoms non-significantly improved with time in all three groups (p > .05). In product performance analysis, Theruptor dressing (n = 33/33) was rated more comfortable to wear than Bactigras (n = 24/28, p = .004) and Allevyn (n = 25/30, p = .02) in diabetic patients. Among non-diabetics, more patients reported "no pain" during application and removal of dressing in Theruptor group (n = 26/29 and 28/29) than in Bactigras (n = 18/31; p = .04 and n = 20/31; p = .02) and Allevyn groups (n = 12/29; p = .001 and n = 16/29; p = .003).ConclusionTheruptor provides a safe and effective alternative for chronic wound management with comparable healing outcomes to Bactigras and Allevyn dressings.