Advances in Skin & Wound Care最新文献

Introduction: Military maneuvers represent a health care challenge: They are essential for preventing occupational accidents and providing rapid and appropriate care for injuries and conditions resulting from physical exertion and extreme environments.

Objective: To describe and analyze medical support during military maneuvers and evaluate morbidity, treatments applied, and evacuation protocols in units from the Ceuta Command.

Methods: A prospective, observational, and analytical study was conducted over 2 weeks of maneuvers in Zaragoza, Spain. Demographic and clinical variables were included (type of injury, treatment, need for evacuation, and follow-up). Statistical analysis employed descriptive statistics and comparative tests (χ2 test and Student t test), considering P < .05 as the level of significance.

Results: A total of 219 medical consultations were recorded. Traumatic injuries accounted for 46.1% of the cases, followed by infections (20.1%). Only 6.8% required medical evacuation, and 14.2% required subsequent follow-up, demonstrating the effectiveness of in-field management (P < .05).

Conclusions: Medical support deployed during the maneuvers presented a high rate of in-field resolution (93%) and confirmed that traumatic injuries are the leading cause of consultation. These findings highlight the need to maintain robust health care protocols and strengthen preventive measures to reduce morbidity in future exercises, directly addressing the objectives set.

Objective: Pressure injuries (PIs) are common yet preventable complications in surgical patients, but the effectiveness of prevention strategies remains uncertain. This review systematically evaluates randomized controlled trials to synthesize the available evidence and inform evidence-based prevention strategies in surgical settings.

Data sources: A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and CINAHL for studies published from January 1, 2000, to June 1, 2024. Additional records were identified by hand-searching reference lists of included articles.

Study selection: Randomized controlled trials evaluating interventions to prevent PIs in surgical patients were included. Of 5242 records screened, 21 studies met the predefined inclusion criteria.

Data extraction: Two reviewers independently performed study selection and data extraction, with the third reviewer resolving any discrepancies through discussion. Extracted data included study and participant characteristics, type and timing of interventions, control measures, and outcomes.

Data synthesis: Interventions were classified into 7 categories: support surfaces, position management, prophylactic dressings, localized pressure protection, warming therapy, education intervention, and nutrition support. Meta-analyses indicated that support surfaces, position management, localized pressure protection, and warming therapy significantly reduced PI incidence. The effectiveness of prophylactic dressings was observed only in intraoperative subgroups. Position management did not significantly affect health care staff satisfaction.

Conclusions: Several interventions are effective in reducing PI incidence among surgical patients. Findings underscore the relevance of phase-specific prevention strategies and may inform clinical practice, especially for high-risk procedures and patient populations.

Objective: To develop and validate an educational game to guide nurses in the assessment, prevention, and treatment of intestinal peristomal skin complications.

Methods: The game was evaluated by 67 nurses using the Delphi technique and the Content Validity Index (CVI) test.

Results: In the first evaluation, the majority of judges considered the game to be between inadequate and totally adequate, and the CVI ranged from 80.60 to 97.01. After making the corrections, the judges reevaluated the game and found it to be between adequate and totally adequate, and the CVI ranged from 95.52 to 100.00, characterizing excellent content.

Conclusions: Following an integrative literature review, the "Game: Intestinal Stoma" was developed and validated in the second round, which characterizes the game as having excellent content.

Objective: This study aimed to explore the experiences of orthopedic patients undergoing negative pressure wound therapy (NPWT).

Methods: This study used a descriptive qualitative design. The authors conducted semi-structured, in-depth interviews with 13 patients who received NPWT in the orthopedic ward of a university hospital between February and June 2025. They analyzed the data using content analysis and reported the study according to the Consolidated Criteria for Reporting Qualitative Research.

Results: Data analysis revealed 3 main themes describing patients' experiences with NPWT: (a) participation in the treatment and information process, (b) experiences related to the device, and (c) emotional experiences. Patients described NPWT as a complex process that began with physical and emotional challenges-such as discomfort, limited mobility, and anxiety-and gradually progressed toward adaptation, trust, and hope through effective nursing communication and care.

Conclusions: The findings suggest a need for patient-centered educational protocols, nurse-led support programs, and user-friendly NPWT devices to address patients' information needs and the physical and emotional challenges experienced during treatment.

Objective: Taking a split-thickness skin graft (STSG) is a common reconstructive procedure, but the donor site often causes patients significant pain and bleeding. The authors investigated whether the tumescent technique is a better, safer method for harvesting these grafts.

Data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 major databases were searched.

Study selection: Randomized controlled trials (RCTs) comparing tumescent versus standard non-tumescent STSG harvesting were selected for inclusion.

Data extraction: Data were analyzed using random-effects models. The Cochrane RoB 2 tool was used to assess bias, and the GRADE method was used to rate the certainty of the evidence.

Data synthesis: Nine RCTs (n = 429) were included. The tumescent technique reduced intraoperative blood loss [standard mean difference (SMD): -2.68, 95% CI: -3.41 to -1.94; P < .001] and postoperative analgesic needs (SMD: -1.75, P < .001), with a consistent direction of effect despite high heterogeneity (I2 = 96%). Donor sites healed 1.2 days faster (P < .01); hematoma/seroma risk dropped (RR: 0.28, P = .04). Graft take showed no difference (P = .07). GRADE: high for hematoma reduction; moderate for blood loss/analgesics; low for graft take.

Conclusions: The tumescent technique is associated with clinically meaningful reductions in donor-site blood loss, hematoma formation, postoperative analgesic requirements, and time to epithelialization, without adversely affecting graft take. The consistency of the effect direction supports its role as a safe and effective donor-site strategy.

Objective: This study prospectively aimed to evaluate the validity and reliability of the Turkish language version of the Intensive Care Unit-Specific Pressure Injury Risk Assessment Scale (RAPS-ICU), designed to assess pressure injury (PI) risk among critically ill patients in intensive care units (ICU).

Methods: This methodological study was conducted with 39 patients hospitalized in ICUs in a university hospital in Turkey. The original scale was translated into the Turkish language using a standardized forward-backward translation process. Subsequently, its content and construct validity were assessed. Construct validity was assessed using confirmatory factor analysis (CFA) and further supported by correlations with the Norton and Braden Risk Assessment Scales. Internal consistency was evaluated with Cronbach α.

Results: The content validity index of the RAPS-ICU was found to be between 0.9 and 1.0. The analysis showed that the scale comprised 6 items. According to the confirmatory factor analysis (CFA) results [χ 2 /degrees of freedom ratio (χ 2 / df ) = 1.904, Non-Normed Fit Index (NNFI) = 0.96, root mean square error of approximation (RMSEA) = 0.050, root mean square residual (RMR) = 0.057, Comparative Fit Index (CFI) = 0.99, Goodness-of-Fit Index (GFI) = 0.92], the model demonstrated a good fit. The scale's Cronbach α coefficient was calculated as 0.85, indicating high internal consistency. In addition, based on the parallel-forms reliability method, a significant positive correlation ( P <.01) was found between the RAPS-ICU and the other risk assessment scales, supporting its reliability.

Conclusions: The Turkish language version of the RAPS-ICU is a valid and reliable measurement tool that can be used to assess the risk of PIs among patients in the ICU.

Chronic wounds remain a significant clinical challenge despite advances in dressings, biologics, and adjunctive therapies. Patients referred to advanced wound centers following unsuccessful treatment often demonstrate recurring and potentially correctable factors that contribute to delayed healing. Drawing upon observations from a quaternary referral wound center, this article focuses on recurring and potentially correctable factors encountered during evaluation of wounds that have failed to progress despite prior care. Although these patterns are neither novel nor unexpected, they continue to recur despite well-established wound care principles and treatment guidelines. This article highlights common pitfalls identified in patients referred for advanced wound care evaluation. Commonly encountered issues include inadequate implementation of compression therapy and lower extremity elevation, ineffective offloading in diabetic foot ulcers, limited attention to patient adherence and behavioral factors, and incomplete evaluation of underlying contributors to wound chronicity. Additional patterns include continued use of outdated or nonevidence-based topical agents, misapplication of debridement principles (particularly removal of stable eschar), and incomplete evaluation of underlying pathophysiology such as vascular insufficiency. Patients are frequently referred after undergoing advanced interventions, including hyperbaric oxygen therapy and grafting procedures, before optimization of fundamental wound care principles. In these settings, suboptimal patient selection and sequencing of therapy, particularly in the presence of uncontrolled edema or inadequate offloading, may contribute to prolonged treatment without clinical benefit. These observations highlight recurring gaps between recommended care and real-world execution. Recognition of these recurring pitfalls may improve wound healing outcomes, promote more effective use of advanced therapies, and reduce the need for escalation of care.

Objective: The placement of skin-protective products on the skin is a technique that nurses can easily carry out as a nonpharmacological method of pain reduction. The aim of this study was to determine the effect of hydrocolloid dressing and terpolymer-based alcohol-free barrier film on pain during the removal of silk tape placed in nasogastric tube fixation in 4- to 6-week-old infants.

Methods: This is a single-blind randomized controlled study. The research was carried out with 120 4- to 6-week-old infants. Terpolymer-based alcohol-free barrier film, hydrocolloid skin barrier, and silk medical tape were compared to reduce pain during the removal of adhesive products. Pain level was evaluated with the Neonatal Infant Pain Scale.

Results: Tube fixation with silk tape was 3 times higher than that of the terpolymer-based alcohol-free barrier film, and 3 minutes following the procedure. The pain level following a hydrocolloid dressing was 2 times higher than the group that had a silk tape applied to the skin before tube fixation ( P <.001). Even 3 minutes after the end of the procedure, it was found that pain persisted in the group in which tube fixation was performed with silk tape without using a barrier product ( P <.01).

Conclusions: It was found that the pain level of infants during tape removal was reduced when medical tapes were used together with protective products. In the comparison of the different types of skin-protective products, it was seen that the terpolymer-based alcohol-free barrier film was superior to the hydrocolloid dressing in terms of reducing the pain felt by the infant.

Objective: This systematic review aimed to evaluate the effectiveness of pressure mapping (PM) systems in preventing hospital-acquired pressure injuries (HAPIs).

Data sources: A comprehensive search was conducted across PubMed, Cochrane Library, Medline (OVID), Scopus, Web of Science, and CINAHL databases. The search strategy utilized English keywords including "pressure ulcer," "pressure injury," "pressure wound," "bedside mapping system," "pressure mapping sensor," "pressure mapping pad," and "pressure mapping mat," etc.

Study selection: The study was a systematic review of intervention trials conducted in accordance with PRISMA guidelines (Register number: CRD42024609214). Inclusion criteria were defined based on the PICO(TS) framework.

Data extraction: The methodological quality of the included studies was assessed using the RoB2 and ROBINS-I tools.

Data synthesis: Among the 2177 initial records, 29 studies underwent full-text review, and 3 were included in the final analysis. Two studies reported that PM systems reduced the incidence and prevalence of HAPIs, whereas 1 found no significant changes. The findings suggest that PM systems may be most beneficial in patients who are critically ill or immobile, as well as in acute care settings where continuous monitoring facilitates repositioning and early intervention.

Conclusions: Pressure mapping systems show promise as innovative technologies for preventing HAPIs. However, the limited evidence restricts their broader clinical application. More high-quality randomized controlled trials are needed to better understand their clinical effectiveness and economic feasibility. In addition, integrating these systems into clinical guidelines and increasing awareness among health care staff are crucial for optimizing their use.

Objective: This study aimed to investigate the relationship between fatalism, death anxiety, and compliance with type 2 diabetes mellitus (T2DM) treatment in patients who had undergone limb amputation due to diabetic complications.

Methods: A mixed-method design was used, combining quantitative and qualitative data. The sample consisted of 93 patients with diabetes who had undergone amputation and who completed surveys, and 20 who participated in in-depth interviews. Qualitative data were analyzed using a phenomenological approach. Scales included the Fatalism Scale, Thorson-Powell Death Anxiety Scale, and the T2DM Treatment Compliance Scale.

Results: Significant differences were observed across education levels in death anxiety, treatment compliance, and fatalism ( P <.05). The quantitative analysis revealed a significant positive effect of fatalism on treatment compliance (β=0.427, P <.001). Because higher scores on this scale indicate lower adherence, this result suggests that higher fatalism is associated with reduced treatment compliance. Death anxiety did not have a statistically significant direct effect on treatment compliance (β=-0.177, P =.072). Qualitative findings supported these results and identified 3 main concepts: challenges in adapting to amputation, managing diabetes treatment, and psychological and belief-based challenges. Three themes were identified: issues with adapting to the condition, treatment adherence, and fatalism, death anxiety, and psychological effects.

Conclusions: Fatalism plays a crucial role in treatment compliance for diabetic foot and amputation-related DM, whereas the impact of death anxiety is less direct. To improve compliance, addressing fatalistic beliefs and providing psychological support is essential. Tailored interventions, including psychological counseling and patient-specific educational programs, could significantly enhance adherence in amputated diabetic patients.