Journal of wound care最新文献

Ankaferd Blood Stopper (ABS; Imumm Gida Ilaç Kozmetic San. ve.Tic. Ltd., Turkey) is a unique blend of traditional medicinal plant extracts historically used in Turkish folk medicine as a haemostatic agent. In addition, it has antimicrobial and wound healing properties. This case study describes the treatment of a patient with a burn injury lasting >2 months. During the healing process, the patient was evaluated for suspected malignancy and was diagnosed with pancreatic cancer. Under these new circumstances, the decision was made, with the patient's consent, to try ABS with the aim of optimising the patient's metabolic and physical conditions before starting cancer treatment. Complete wound closure was achieved 18 days after the start of treatment, after only 14 days of ABS treatment. It is therefore concluded that the use of ABS was beneficial, allowing complete wound closure prior to the start of chemotherapy and subsequent surgery, in the patient who had characteristics that made healing difficult.

Objective: The prevalence of leg ulcers (LUs) increases with age. Nevertheless, a significant number of working-age individuals are affected by hard-to-heal (chronic) wounds that last throughout their adult lives, impacting work capacity and leading to absenteeism, unemployment and subsequent financial burden.

Method: A retrospective observational study was carried out between January 2022 and June 2024 at a Portuguese tertiary hospital, which included working-age patients living with LUs. Patients who were unemployed and retired for reasons other than LUs were excluded from the study. Clinical data on wound care and work activity were registered, and the Work Productivity and Activity Impairment questionnaire General Health version 2 (WPAI-GH) was applied. Results: A total of 24 patients were included, with a mean age of 53.6±11.0 years. LUs had a median evolution of six years (interquartile range: 3-20) and 19 (79%) patients had recurrent ulcers. A total of 11 (46%) patients were unemployed or had retired early due to their LUs. A reduction of monthly income after developing the ulcer was noted in 43.5% of patients. The median number of work days missed by employed patients in the previous year was 39 (interquartile range: 2.5-317.5); three patients were on leave for ≥1 year.

Conclusion: LU was related to incapacity for work and loss of income in almost half of the study cohort. Longer duration of the ulcers, recurrence rates and work that required prolonged standing were positively associated with unemployment and retirement. By establishing earlier and more efficient treatment plans, clinicians can reduce duration of treatment and work incapacity in people with LUs.

Pressure injuries (PIs) represent a major healthcare challenge due to their high prevalence, impact on quality of life, and associated clinical and economic burden. Delayed healing is frequently linked to the presence of biofilm, now recognised as a key barrier to wound resolution. The Wound Hygiene protocol, developed at an international level, proposes a structured approach to disrupt and prevent biofilm through early and repeated local interventions. This article presents the French adaptation of this protocol for the management of PIs, developed by experts from the Société Française de l'Escarre (SFE). The adapted framework integrates a comprehensive initial assessment followed by four key steps-cleansing; debridement; refashioning of the wound edges; and appropriate dressing selection-applied systematically throughout the care pathway. This approach promotes a proactive and standardised management of wounds, addressing both local and systemic factors that influence healing. By providing clinically relevant and context-specific guidance, this adaptation aims to support healthcare professionals in improving care practices, optimising healing outcomes, and reducing the burden associated with PIs.

Objective: This study evaluated the effectiveness of silicone superabsorbent polymer (SAP) dressings in patients with venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), with emphasis on wound area reduction (WAR) and improvement in wound bed characteristics over a six-week observation period.

Method: This prospective, single-arm study evaluated two silicone SAP dressings-RespoSorb Silicone Border (RSSB; also marketed as Zetuvit Plus Silicone Border) and RespoSorb Silicone (RSSil; also marketed as Zetuvit Plus Silicone) (both PAUL HARTMANN AG, Germany)-in patients with exuding VLUs or DFUs across eight clinical sites in Poland. The primary endpoint was relative WAR, measured using centralised digital planimetry, with ≥20% WAR defined as clinically meaningful. Secondary endpoints included: complete re-epithelialisation; changes in granulation and slough tissue composition; exudate management; periwound skin condition; dressing wear time; and safety.

Results: A total of 80 patients took part in this study. Participants were predominantly male (62.5%) with a mean age of 67.1 years; 53 received RSSB and 27 received RSSil. At the final visit, ≥20% WAR was achieved in 59/79 (74.7%) patients before cleansing/debridement and in 66/79 (83.5%) after cleansing/debridement (p<0.001 for superiority) (one baseline image for both before and after cleansing/debridement was missing and unavailable for planimetry assessment). The median relative WAR was 69.6% (interquartile range (IQR): 28.9-100%) following cleansing/debridement. The median granulation tissue coverage decreased by 75.2% (IQR: 24.3-100%) and slough coverage decreased by 98.6% (IQR: 46.7-100%) after cleansing/debridement, while median exudate volume reduced by 0.38ml (IQR: -0.1-1.75ml) from baseline (all p<0.001). Complete re-epithelialisation occurred in 21/80 (26.9%) patients. Median dressing wear time was four days (IQR: 3-6 days) over all six follow-up visits.

Conclusion: In this study, the two silicone SAP dressings used demonstrated clinically meaningful improvement in wound outcomes in chronic VLUs and DFUs, with most patients achieving ≥20% WAR alongside effective exudate management and improved wound bed quality.

Objective: To determine the effectiveness of Biodress (a petroleum-based hydrogen-calcium salt of oxidised cellulose dressing made of organic materials; Bottu, Morocco) against both honey and povidone-iodine ointment on wound closure, the incidence of wound complications, the cost of wound care, ease of use, and the outcome of acute wounds.

Method: A single-blinded randomised controlled trial (RCT) was performed among patients with acute wounds selected from two hospitals in southeast Nigeria. Participants were randomised with computer-generated numbers into one of three equally-sized groups: the petroleum-based dressing used as the intervention, and either honey or povidone-iodine which were used as two independent control groups.

Results: A total of 42 patients were included in this RCT, median age 32.5 years, with 22 male and 20 female patients. No significant difference was observed in the effectiveness of the petroleum-based dressing over honey or povidone-iodine ointment on wound closure (p=0.288). However, considering injury type, Biodress showed some advantage over honey in burns injuries (p=0.017). None of the participants in the intervention group had wound infection at any of the follow-up visits. No significant difference was noted in the cost of dressing materials (dressing packs and cleansing solutions) (p=0.717), or in the cost of dressing agents (Biodress/honey/ povidone-iodine) (p=0.222). Similarly, there was no significant difference in the ease of use of the different materials. The petroleum-based dressing, however, was significantly less painful than the other dressing agents and required significantly fewer dressing materials per episode compared to the other dressings (p=0.001).

Conclusion: In this RCT, Biodress demonstrated its potential as a promising dressing agent for acute wounds, particularly burns injuries; however, further studies will help to substantiate or disprove this finding.

Objective: This study aimed to assess the incidence of pressure ulcers (PUs) in two Italian emergency departments (EDs) in a cohort of patients cared for with a standardised preventive care bundle, and to identify risk factors associated with PU development during the ED stay.

Method: In the RUNTIME Study-a prospective observational cohort study-patients with any critical illness, ≥18 years of age and at risk of developing a PU were included. Those with a pre-existing PU and significant cognitive decline were excluded. Sociodemographic and clinical characteristics were collected at baseline and follow-up. PU risk was ascertained at admission with the Braden scale. Cumulative survival and risk factors associated with PU were estimated with Kaplan-Meier curves and Cox proportional regression.

Results: A total of 201 patients (mean age: 81±8.3 years; male: 53%) were included. After a mean of 84.7±46.6 hours, 12 patients developed a PU (incidence: 6%). Lesions were at the first stage and located at the sacrum. The probability of remaining free from PUs dropped from 98% at 24 hours to 80% at 168 hours. Risk of PU increased with age (hazard ratio (HR): 1.13; p=0.004) and decreased with longer ED stays (HR: 0.36; p<0.001).

Conclusion: The findings of this study offer additional knowledge about PU incidence and risk factors in ED patients followed by a standardised preventive bundle. The low incidence and presence of risk factors suggests that a preventive protocol led by ED nurses trained in wound care can reduce the incidence and risk factors for PUs. However, the study included only 12 cases of PU development, which limits the robustness of the statistical conclusions. Therefore, the findings should be interpreted with caution and confirmed in studies with larger populations.

Objective: Wound management poses a substantial economic burden, and the prevalence of hard-to-heal (chronic) wounds is a growing health concern. Negative pressure wound therapy (NPWT), with and without instillation, is an adjunctive therapy commonly used to manage acute and hard-to-heal wounds and has demonstrated positive clinical outcomes. The variety of NPWT modalities, patient needs, wound characteristics and care requirements can make selecting the optimal system challenging, leading to uncertainty and inconsistent practices among new users, increasing the risk of suboptimal outcomes. This article provides practical guidance to help new NPWT users make confident, evidence-based decisions.

Method: An expert panel was convened in Amsterdam, the Netherlands, in November 2023 to review published treatment guidelines and the current literature and to develop simplified recommendations on the use of NPWT in hospital and community care settings.

Results: Expert panel members discussed published wound management evidence and their real-world experiences as wound management specialists to generate recommendations for healthcare professionals to aid them in the selection of NPWT modalities.

Conclusion: This summary presents nine expert panel recommendations, including simplified risk assessment algorithms and guidance to improve NPWT use across clinical settings.

Objective: To assess the clinical effectiveness and cost benefits of negative pressure wound therapy with instillation and dwell (NPWTi-d) compared to standard NPWT and other therapies in managing hard-to-heal wounds.

Method: An observational, retrospective, multicentre study was conducted using data from three hospitals in Italy. Eligible patients included all adults discharged in 2021 with specific diagnoses related to hard-to-heal wounds. Data on healthcare resource use, including length of hospital stay (LoS), number of dressings used and procedures performed, were analysed. The economic evaluation estimated hospitalisation costs based on the average daily rate. The analysis findings were further examined in an expert meeting focused on assessing the impact of continuity of care pathways on treatment outcomes.

Results: A total of 64 patients were enrolled: 38 received NPWT; 16 received NPWTi-d; and 10 received other treatments, including traditional and advanced wound care approaches. The NPWTi-d group demonstrated a significantly shorter average LoS (13.4 days) compared to the NPWT (23.6 days) and other treatments (21.5 days) groups. Patients receiving NPWTi-d also had fewer dressing changes (2.6) than those treated with NPWT (3.5) and other therapies (6.6). This reduction in resource consumption translates to cost savings of >€6000 (-35.1%) per hospitalisation compared to the overall average hospitalisation cost across the study sample and €7645 (-40.7%) compared to other treatments. The findings were confirmed during the expert meeting.

Conclusion: As shown by the findings of this study, by improving patient outcomes and reducing the burden on healthcare systems, NPWTi-d should be considered a key component in modern wound care pathways. Its implementation aligns with current healthcare initiatives focused on optimising resource use and improving patient quality of life.

Objective: Ultrasonography (U/S) is a non-invasive and cost-effective tool for detecting soft tissue and bone abnormalities. However, its use among wound care nurses in Indonesia remains unexplored. This quasi-experimental study aimed to assess the effectiveness of the ULTRA-CARE training programme in enhancing the knowledge, skills and attitude of nurses in using U/S in wound care practice.

Method: A pre- and post-test study (without control) was conducted with wound care nurses attending the ULTRA-CARE training programme. The curriculum consisted of a two-day training exercise: theoretical sessions (day 1) and practical sessions using two portable U/S devices (day 2). The Kirkpatrick model was used to assess training effectiveness across four levels: (1) satisfaction; (2) knowledge/skills; (3) behaviour; and (4) self-perceived clinical outcomes. Pre- and post-training assessments were analysed using the Wilcoxon signed-rank test.

Results: A total of nine wound care nurses were included. Significant improvement in post-test knowledge scores was observed (p=0.012). Participants reported ≥80% satisfaction (Level 1) and positive self-perceived behavioural changes (Level 3). For Levels 2 and 4, two participants reported confidence levels <80%, though overall improvements in perceived diagnostic capabilities were noted.

Conclusion: The findings of this study showed that the ULTRA-CARE programme significantly enhanced participants' knowledge and attitudes toward U/S use in wound care. Scaling up similar programmes or future studies could enhance early osteomyelitis detection, reduce the number of amputations, and improve patient outcomes in resource-limited settings.