The successful use of polylactide wound dressings for chronic lower leg wounds: A retrospective analysis

Chronic wounds are a challenging medical entity for patients, medical professionals and healthcare systems. Frequently, patients present themselves to wound specialists after months or even years of unsuccessful treatment. Recent developments have resulted in a multitude of different advanced wound dressings created to treat complex, chronic wounds, one of which is the polylactide dressing Suprathel. This study aimed at investigating the healing potential of Suprathel in chronic wounds and differentiating between old and “young”, diabetic and non‐diabetic chronic wounds. A prospective, multicentric, non‐controlled intervention study was conducted, treating patients with chronic lower leg ulcers (>3 months) with Suprathel and assessing them weekly. Afterwards, a retrospective analysis was performed analysing the wound size initially, after 4 and after 8 weeks of treatment. Furthermore, a differentiation between diabetic and non‐diabetic, and chronic wounds older and younger than 12 months, was assessed. A significant reduction in wound size was observed in the study population after 8 weeks of treatment. The effect size in the diabetic wound and the old chronic wound group even reached more than one, with the other groups still showing a large effect of the intervention. This study shows that Suprathel is a valuable tool in the armamentarium of a wound specialist. Not only could we show a positive effect on chronic wounds, we could even demonstrate a significant wound size reduction in chronic wounds of old and young, as well as diabetic wounds, with the treatment of older chronic and diabetic wounds yielding an even larger effect size. Further randomised, controlled studies are necessary to show the full potential of advanced wound dressing materials in large patient cohorts.     

两种银敷料对慢性伤口愈合及渗液酸碱度影响的比较

目的比较两种银敷料辅助治疗慢性感染伤口的效果及对伤口渗液酸碱度的影响,以指导银敷料在慢性伤口治疗中的合理使用。方法将糖尿病足溃疡、压疮、下肢静脉溃疡、创伤性溃疡、烧伤残余创面5类慢性伤口患者104例随机分为A、B两组,每组52例。两组患者均按照统一方法评估、清洗和清创后,A组使用银离子藻酸盐敷料、B组使用纳米银敷料,分别接受30d的伤口局部辅助治疗。观察比较两组伤口治疗前及治疗后不同时间段的伤口愈合评分及渗液pH值。结果随着治疗时间的延长,两组伤口愈合计分和渗液pH值均较治疗前下降,A组患者伤口愈合计分显著优于B组(P0.01);两组伤口渗液pH值比较,差异无统计学意义(P0.05)。结论两种银敷料辅助治疗慢性感染伤口均能促进伤口愈合,但银离子藻酸盐敷料的效果更优;两种银敷料均能降低伤口渗液pH值且作用相当。     

Poor survival of dialysis patients with unhealed wounds because of critical limb ischemia: Limb salvage and survival requires wound healing

Maintenance of blood flow in the wound area is required to heal wounds of critical limb ischemia (CLI) in dialysis patients. However, many dialysis patients have both a stenotic lesion in below‐knee blood vessels and a cardiovascular event as complications, and thus, it may be difficult to ensure sufficient blood flow. Therefore, many deaths occur because of problems with wound healing. The aim of this study is to identify the optimal treatment, including revascularisation and amputation, from the perspective of wound healing by analysing the survival of hemodialysis patients with CLI who had healed or unhealed wounds in a lower extremity. The subjects were 52 patients who received maintenance dialysis at our clinic, including 27 with healed CLI wounds and 25 with unhealed CLI wounds. The Kaplan‐Meier method was used to compare survival between the two groups. Multivariate analysis was conducted to examine the effect of an unhealed wound on mortality. The mean follow‐up period was 1.7 ± 1.1 years. In the unhealed wound group, the 1‐, 2‐, and 3‐year survival rates were 48%, 20%, and 12%, respectively. The overall survival rate was significantly lower in the unhealed wound group compared with the healed wound group (12% vs 63%, P = .0002 by log‐rank test). In multivariate analysis, unhealed CLI wounds had a significant independent association with mortality (hazard ratio 3.32; 95% confidence interval [CI]: 1.41‐8.77, P = .0054). In this study, the 3‐year survival rate suggested a significantly poorer prognosis of hemodialysis patients with unhealed CLI wounds compared with those with healed wounds. An unhealed wound is an independent risk factor for mortality in hemodialysis patients with CLI.     

急性创面无干扰伤口愈合的护理研究进展

介绍无干扰伤口愈合的概念及其在急性创面处理中的应用现状,分析无干扰伤口愈合在急性创面愈合中的促进因素及效果评价,以期为医护人员在临床实践中重视将急性创面处于无干扰愈合环境,结合患者情况,制定最佳的创面处理方案提供参考。     

Predicting wound healing rates and survival with the use of automated serial evaluations of burn wounds

Healing of burn wounds is necessary for survival; however tracking progression or healing of burns is an inexact science. Recently, the relationship of mortality and wound healing has been documented with a software termed WoundFlow. The objective of the current study was to confirm various factors that impact burn wound healing, as well as to establish a timeline and rate of successful healing. A retrospective analysis was performed on adults (n = 115) with at least 20% TBSA burn that had at least two computer-based wound mappings. The % open wound (%OW) was calculated over time to document healing trajectory until successful healing or death. Only 2% of patients in the group with successful wound healing died. A decrease in the %OW of 0.8 (IQR: 0.7–1.1) was associated with survival. Disparities in wound healing trajectories between survivors and non-survivors were distinguishable by 2 weeks post-injury (P < 0.05). When %TBSA was stratified by decile, the 40–49% TBSA group had the highest healing rate. Taken together, the data indicate that wound healing trajectory (%OW) varies with injury severity and survival. As such, automated mapping of wound healing trajectory may provide valuable information concerning patient/prognosis, and may recommend early interventions to optimize wound healing.     

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the impact of negative pressure wound therapy (NPWT) on wound infection and healing in patients with open fracture wounds. Computer searches were performed in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the application of NPWT in open fracture wounds, with the search period covering the databases inception to September 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1814 patients with open fracture wounds were included. The analysis revealed that compared with other treatment methods, NPWT significantly shortened the wound healing time (standardized mean difference [SMD] = −2.86, 95% confidence intervals [CI]: −3.51 to −2.20, p < 0.001) and fracture healing time (SMD = −3.14, 95% CI: −4.49 to −1.79, p < 0.001) in patients with open fracture wounds. It also significantly reduced the incidence of wound infection (odds ratio [OR] = 0.36, 95% CI: 0.23–0.56, p < 0.001) and complications (OR = 0.29, 95% CI: 0.20–0.40, p < 0.001). This study indicates that in the treatment of open fracture wounds, NPWT, compared with conventional treatment methods, can accelerate the healing of wounds and fractures, effectively control infections and reduce the occurrence of complications, demonstrating high safety.     

Prognostic factors for delayed healing of complex wounds in adults: A scoping review

Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.     

Ozone therapy for the treatment of chronic wounds: A systematic review

Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially acting by eliciting mild oxidative stress or disinfection. The purpose of this systematic review is to evaluate the potential benefits and harms of ozone therapy as an advanced care intervention for chronic wounds. Studies were extracted from Google Scholar, PubMed, the Cochrane Library, and reference lists. General inclusion criteria included English‐language randomised human trials reporting the use of ozone therapy in the topical treatment of chronic wounds. Primary outcome data included the extent of chronic wound healing, and secondary outcomes included adverse effects. Studies were assessed for level of bias and data quality. Nine studies (n = 453 patients) matched the inclusion criteria and underwent meta‐analysis. Overall, there was a significant improvement in wound closure with ozone therapy. Results consistently favour the application of ozone as a treatment for chronic wounds; however, there is no conclusive evidence of ozone therapy as superior compared with standard treatments. Compared with standard care, ozone therapy as an advanced wound care treatment may improve the proportion of chronic wounds healed in a shorter amount of time, but further research is required.     

TIME伤口床准备联合封闭式负压引流用于慢性伤口护理

目的探讨基于TIME原则的伤口床准备联合封闭式负压引流治疗慢性伤口的效果。方法将80例患者随机分为观察组和对照组各40例。观察组采用TIME原则进行伤口床准备,并应用封闭式负压引流,对照组在TIME原则指导下采用传统清创联合无菌敷料换药方法进行伤口护理。比较两组干预前和干预后7d、14d、21d的伤口面积缩小率、深度缩小率、局部症状体征以及观察期内伤口愈合率及所有愈合伤口的愈合时间、伤口换药时数、伤口换药费用。结果观察组伤口面积、深度缩小率和局部症状体征改善显著优于对照组(均P0.01);观察组90d内伤口愈合率显著高于对照组,伤口愈合时间、护理时数和换药费用显著低于对照组(均P0.01)。结论基于TIME原则的伤口床准备联合封闭式负压引流能够显著促进慢性伤口愈合,减少护理工作量及患者经济负担。     

Fetal wound healing using a genetically modified murine model: the contribution of P-selectin

Purpose

During early gestation, fetal wounds heal with paucity of inflammation and absent scar formation. P-selectin is an adhesion molecule that is important for leukocyte recruitment to injury sites. We used a murine fetal wound healing model to study the specific contribution of P-selectin to scarless wound repair.

Methods

Linear excisional wounds were created on the dorsa of E15.5 and E17.5 gestation fetuses in wild-type and P-selectin (-/-) mice (term = 19 days). Wounds were harvested at various time-points after wounding and analyzed using histology and immunohistochemistry.

Results

The E15.5 wounds in both wild-type and P-selectin (-/-) fetuses healed scarlessly and with minimal inflammation, whereas E17.5 wounds healed with fibrosis and inflammation. However, the scars of the P-selectin (-/-) wounds appeared slightly different than wild-type. There were significantly more inflammatory cells in E17.5 wild-type wounds 6 hours after injury (P < .001), but the difference was no longer significant by 24 hours. Finally, reepithelialization was slower in the E15.5 knockout wounds compared to their wild-type counterparts.

Conclusions

Absence of P-selectin delays inflammatory cell recruitment and reepithelialization of fetal wounds; however, scar formation still occurs in late gestation wounds. The contribution of specific molecules to fetal wound healing can be elucidated using murine knockout or transgenic models.     

Splint-free line drawing model: An innovative method for excisional wound models

The physiological phenomenon of wound contraction in mice cannot completely imitate the process of human skin regeneration, which is primarily attributed to reepithelialisation. As such, excisional wound models in mice are considered to be imperfect comparisons. This study aimed to enhance the correlation of mouse excisional wound models with that of humans, and to offer more practical and accurate ways to record and measure wound areas. We present evidence that simple excisional wounds produce a robust and stable wound model by comparing splint-free and splint groups. We monitored reepithelialisation and contraction in the C57BL/6J mouse excision wound model at different time points and prove that excisional wounds heal by both contraction and reepithelialisation. Some parameters were measured and a formula was used to calculate the area of wound reepithelialisation and contraction. In our results, reepithelialisation accounted for 46% of the wound closure of full-thickness excisional wounds. In conclusion, excisional wound models can be used as wound-healing models and a straightforward formula may be used to determine the process of reepithelialisation over a wound bed created by a simple excisional rodent wound model.     

Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta‐analysis

This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English‐language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration''s “risk of bias” tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow‐up duration were extracted. The fixed or random‐effects model was used to calculate the pooled effect sizes according to studies’ heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta‐analysis. The meta‐analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73‐fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30‐6.04, P < .001) and improved wound‐healing area percentage by 30.45% (Standardized Mean Difference (SMD) = 30.45; 95% CI: 23.79‐37.12; P < .001). ESWT reduced wound‐healing time by 3 days (SMD = −2.86, 95% CI:‐3.78 to −1.95, P < .001) for acute soft tissue wounds and 19 days (SMD = −19.11, 95% CI: −23.74 to −14.47, P < .001) for chronic soft tissue wounds and the risk of wound infection by 53% (OR = 0.47, 95% CI: 0.24‐0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher‐quality and well‐controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds.     

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

The use of atmospheric low‐temperature plasma (AP) on chronic wounds and its effect on microbial bioburden in open wounds has not been explored with a systematic review and meta‐analysis. PRISMA guidelines were followed and PubMed, Embase, CENTRAL, and CINAHL databases searched for randomised controlled trials (RCTs), which compared AP with no AP for the management of open, chronic wounds. The primary outcomes of reduction of bioburden or wound size were included. Meta‐analyses were performed; odds ratio (OR) and 95% confidence intervals (CIs) were extracted and pooled in a random effects model. Four RCTs investigated the effect of AP on chronic wound healing. Chronic wounds treated with AP did not show a significant improvement in healing (AP vs control: OR = 1.46; 95% CI = 0.89‐2.38; P = 0.13). Five further RCTs investigated the reduction of bioburden in wounds, but AP demonstrated no significant reduction of bioburden (AP vs control: OR = 0.85; 95% CI = 0.45‐1.62; P = 0.63). All nine RCTs recorded the presence of any severe adverse events (SAEs) in the 268 patients studied, with only one unrelated SAE identified in each group (AP vs control: OR = 1.00; 95% CI = 0.05‐19.96; P = 1.00). Use of AP in wound care is safe, but the retrieved evidence and meta‐analysis show that there is no clinical benefit of AP in chronic open wounds using currently available AP device settings.     

Comparison of wound healing and patient comfort in partial‐thickness burn wounds treated with SUPRATHEL and epictehydro wound dressings

Among the available dressings for partial‐thickness burn wound treatment, SUPRATHEL has shown good usability and effectiveness for wound healing and patient comfort and has been used in many burn centres in the last decade. Recently, bacterial nanocellulose (BNC) has become popular for the treatment of wounds, and many studies have demonstrated its efficacy. epicite^hydro, consisting of BNC and 95% water, is a promising product and has recently been introduced in numerous burn centres. To date, no studies including direct comparisons to existing products like SUPRATHEL have been conducted. Therefore, we aimed to compare epicite^hydro to SUPRATHEL in the treatment of partial‐thickness burns. Twenty patients with partial‐thickness burns affecting more than 0.5% of their total body surface area (TBSA) were enrolled in this prospective, unicentric, open, comparative, intra‐individual clinical study. After debridement, the wounds were divided into two areas: one was treated with SUPRATHEL and the other with epicite^hydro. Wound healing, infection, bleeding, exudation, dressing changes, and pain were documented. The quality of the scar tissue was assessed subjectively using the Patient and Observer Scar Scale. Wound healing in patients with a mean TBSA of 9.2% took 15 to 16 days for both treatments without dressing changes. All wounds showed minimal exudation, and patients reported decreased pain with the only significant difference between the two dressings on day 1. No infection or bleeding occurred in any of the wounds. Regarding scar evaluation, SUPRATHEL and epicite^hydro did not differ significantly. Both wound dressings were easy to use, were highly flexible, created a safe healing environment, had similar effects on pain reduction, and showed good cosmetic and functional results without necessary dressing changes. Therefore, epicite^hydro can be used as an alternative to SUPRATHEL for the treatment of partial‐thickness burn wounds.     

早期微创性磨削治疗面部深Ⅱ度烧伤

目的:探讨面部深Ⅱ度烧伤治疗的最佳方法。方法:选择140例成人烧伤总面积2%～48(%儿童1%～10%)、头面部以深Ⅱ度烧伤为主的患者,随机分为三组,试验组于伤后2～3天行磨削、搔刮、削痂综合治疗,覆盖异体皮保护创面;对照手术组同期行单纯削痂,0.5%碘伏油纱包扎创面;对照换药组用SD-Ag霜进行换药治疗。分别观察手术去除坏死组织和消除肿胀、术中出血量、创面愈合情况等,并随访观察瘢痕增生情况。结果:患者血容量是否充足的指标、有无并发症的产生,试验组与对照组比较均无差异(P>0.05),试验组在去除坏死组织和消除肿胀方面,与传统削痂术相似,无显著性差异(P>0.05)。在出血量方面,每1%TBSA的出血量试验组(8.1ml±6.4ml)较对照手术组(13.9ml±11.5ml)明显减少(P<0.05)。试验组创面平均愈合时间(13.32±1.57)天,较对照削痂组(22.37±5.39)天及对照换药组(36.89±5.32)天均明显缩短(P<0.05),试验组在愈合质量及瘢痕增生方面,疗效明显优于对照削痂组和对照换药组(P<0.05)。结论:磨、刮、削痂综合治疗面部深Ⅱ度烧伤,不受面部凹凸处的限制,磨削痂的深浅度易掌握,既有效清除坏死组织,又最大程度的保留间生态上皮,比传统削痂术损伤轻,符合整形外科微创手术的技术要求,瘢痕增生明显减少,色素沉着少,提高了创面愈合质量。     

Towards algorithm‐enabled home wound monitoring with smartphone photography: A hue‐saturation‐value colour space thresholding technique for wound content tracking

Automated tracking of wound‐healing progress using images from smartphones can be useful and convenient for the patient to perform at home. To evaluate the feasibility, 119 images were taken with an iPhone smartphone during the treatment of a chronic wound at one patient's home. An image analysis algorithm was developed to quantitatively classify wound content as an index of wound healing. The core of the algorithm involves transforming the colour image into hue‐saturation‐value colour space, after which a threshold can be reliably applied to produce segmentation using the Black‐Yellow‐Red wound model. Morphological transforms are used to refine the classification. This method was found to be accurate and robust with respect to lighting conditions for smartphone‐captured photos. The wound composition percentage showed a different trend from the wound area measurements, suggesting its role as a complementary metric. Overall, smartphone photography and automated image analysis is a promising cost‐effective way of monitoring patients. While the current setup limits our capability of measuring wound area, future smartphones equipped with depth‐sensing technology will enable accurate volumetric evaluation in addition to composition analysis.     

负压封闭结合局部氧疗用于创伤性慢性伤口的效果研究

目的评价负压封闭结合局部氧疗用于创伤性慢性伤口除菌抑菌和改善伤口微环境的效果。方法将64例创伤性慢性伤口患者随机分为两组,每组32例。对照组给予负压封闭伤口治疗;观察组在负压封闭伤口治疗基础上24h局部给氧,持续12d。12d后两组继续按湿性疗法处理伤口或手术治疗,直至愈合或3个月止。两组干预3、6、9、12d评估测量伤口渗液pH、伤口温度,干预前和12d分泌液细菌培养监测伤口细菌阳性率;3个月内的治愈率和愈合时间。结果干预后12d观察组细菌阳性率显著低于对照组(P0.01),两组渗液pH随治疗时间延长而下降,观察组下降更明显(P0.01)。伤口温度随治疗时间增加而升高,观察组升高更明显(P0.01)。观察组治愈率显著高于对照组(P0.05),愈合时间显著短于对照组(P0.01)。结论负压封闭结合局部氧疗治疗优化了伤口微环境,强化了除菌抑菌作用,有助于提高伤口治愈率和缩短愈合时间。     

Knowledge mapping and research trends of stem cell in wound healing: A bibliometric analysis

Wound nonhealing is a common and difficult problem in clinic. Stem cells are pluripotent cells, and their undifferentiated and self-replicating characteristics have attracted much attention in the regenerative medicine-related researches. New treatment approaches might result from an understanding of the function of stem cells in wound healing. Using bibliometric techniques, this study proposed to analyse the research status, hotspots, and research trends in stem cell and wound healing. By using the Web of Science Core Collection (WoSCC), we conducted an in-depth review of publications on stem cells in wound healing from 1999 to 2023. We used scientometric analysis methods to examine annual trends, institutions, countries, journals, authors, keywords, co-occurrence references and their closed relationship, revealing present hotspots and potential future advancements in this field. We analysed 19 728 English studies and discovered a consistent rise in annual publications. The United States and China were the two countries with the most publications. The most three influential institutions in the field were Shanghai Jiao Tong University, Sun Yat-sen University, and University of Pittsburgh. International Journal of Molecular Sciences and Biomaterials were considered the most influential journals in this field. International Journal of Molecular Sciences had the most publications, and the most quantity of citations and the highest H-index were found in Biomaterials. The dual-map overlay revealed that publications in Molecular/Biology/Genetics and Health/Nursing/Medicine co-cited journals received the majority of the citations for studies from Molecular/Biology/Immunology and Medicine/Medical/Clinical. In terms of publication production and influence, Fu X stood out among the authors, and Pittenger MF took the top spot in co-citations. According to the keywords from the analysis, future research should concentrate on the mechanisms through which stem cells promote wound healing. We conducted a thorough analysis of the general information, knowledge base and research hotspots in the field of stem cells and wound healing from 1999 to 2023 by using the VOSviewer, CiteSpace, and other bibliometric analysis tools. It not only provided valuable insights for scholars, but also served as a reliable reference that drives further development in the field and stimulates the interest of researchers.     

Treatment of chronic ulcer with elastic plasma protein and platelet film for wound dressing

Abstract

Experimental results have previously been reported for a new biological dressing consisting of concentrated plasma proteins and platelet-rich plasma (PRP), which is named Platelet-Protein film (PPF). This study reports clinical experience using PPF produced from the patients' own blood by the original technique. Ten patients with chronic wounds underwent PPF treatment and evaluated the transcutaneous oxygen tension (TcPO₂) and vascular density. Eight of the 10 patients received a split-thickness skin graft on induced granulation tissue and have remained free from complications for more than 12 months since treatment. The TcPO₂ values significantly increased at 4 days after treatment (before 38.4 (14.1) mmHg, after 55 (19.9) mmHg, p < 0.01). The vascular density at the ulcer base increased at 14 days after treatment in all the cases. The results showed that PPF has the potential to enhance chronic wound healing.