Berberine (BBR) is a natural isoquinoline alkaloid with antibacterial, anti-inflammatory and pro-angiogenic properties. This study aimed to investigate the therapeutic efficacy and underlying mechanism of a conditioned medium (CM) derived from berberine-preconditioned bone marrow-derived mesenchymal stem cells (BMSCs-BBR). BMSCs were isolated and phenotypically characterised by flow cytometry. A burn wound model was established in Wistar rats, and the model rats were randomly allocated to four groups treated with placebo gel, standard BMSCs-CM gel, BMSCs-BBR CM gel, or silver sulfadiazine cream. Wound healing rates were monitored macroscopically. On Day 21, skin tissues were harvested for histological analysis (H&E and Masson's trichrome staining), followed by immunofluorescence staining (CD31) and Western blot analysis (Collagen I, Collagen III and key proteins in the PI3K/AKT/eNOS signalling pathway). Among all treatments, BMSCs-BBR CM accelerated wound closure the most significantly, accompanied by improved epidermal regeneration, enhanced collagen deposition and organisation and a marked increase in capillary density. Furthermore, wounds treated with BMSCs-BBR CM exhibited notably upregulated Collagen I and Collagen III, and activation of the PI3K/AKT/eNOS pathway, as evidenced by increased phosphorylation of PI3K and AKT and elevated eNOS protein levels. Our findings demonstrate that the topical application of BMSCs-BBR CM gel potently promotes burn wound healing by improving the quality of tissue regeneration and stimulating angiogenesis via the activation of the PI3K/AKT/eNOS signalling pathway. This preconditioning strategy represents a promising acellular therapeutic approach for burn wound management.
Adherence to compression stocking wear is essential for reducing venous leg ulcer recurrence, yet adherence rates remain low. This study examined the relationship between a novel digital clinical decision-aid (the Personalized and Multidimensional Compression Assessment and Intervention [PAMCAI]), clinician practice, and patient adherence with compression stocking use, by embedding a prospective comparative cohort study within a pilot randomized controlled trial. The clinical notes of occupational therapists using PAMCAI were compared with those not using PAMCAI on their documentation of adherence and frequency of wear, identification of patient-specific barriers and attempts to address barriers. The relationship between higher documentation scores and patient adherence was also explored. Thirty-six medical records from 18 patients demonstrated significantly higher documentation scores when PAMCAI was used for all three categories (p < 0.001). Improvements in adherence were positively associated with documentation quality in the targeted categories (p < 0.001). These findings indicate that PAMCAI supports practice changes that translate to improved patient adherence, highlighting the potential value of clinician-focused decision-aids in venous leg ulcer care.
Diabetic foot ulcers are an important cause of morbidity, amputation, disability and healthcare expenditure in sub-Saharan Africa, where limitations in preventive foot care, referral pathways, vascular services, multidisciplinary wound care and financial protection may contribute to poor outcomes. This critical narrative review evaluates the potential role of systemic hyperbaric oxygen therapy as an adjunct to standard diabetic foot ulcer care in sub-Saharan Africa by integrating evidence on clinical effectiveness and safety with health-system, economic, equity and implementation considerations. Evidence was drawn from clinical studies, systematic reviews, clinical guidelines, economic evaluations and literature relevant to diabetic foot care and health-system capacity in the region. Global evidence suggests that systemic hyperbaric oxygen therapy may improve wound healing in selected patients whose ulcers fail to heal with best standard care, but findings remain heterogeneous; evidence for reducing amputation is uncertain, and direct regional evidence is sparse. Implementation in sub-Saharan Africa would require reliable oxygen, electricity, trained staff, safe maintenance systems, multidisciplinary care, referral pathways, sustainable financing and feasible treatment completion. The therapy should therefore not be considered routine or first-line treatment. Where appropriate infrastructure exists, carefully monitored referral-centre pilots should assess clinical outcomes, safety, treatment completion, affordability, budget impact and equity before wider implementation.
Acute wounds with high exudate output, such as split-thickness skin-graft donor sites, require dressings that effectively manage fluid, reduce pain, and support timely epithelialization. Foam dressings are widely used, but superabsorbent materials may provide advantages in exudate handling. This study compared the absorption performance, wound healing, and pain outcomes of foam versus superabsorbent dressings in donor-site wounds. Thirty patients undergoing split-thickness skin grafting were enrolled, with no exclusions or loss to follow-up. Each donor site was divided into two equal zones, with one receiving a foam dressing and the other a superabsorbent dressing according to randomized allocation. Data were collected using coded identifiers. Clinical outcomes, including absorption capacity, wound epithelialization, pain scores, and complications, were evaluated at 3-day intervals through postoperative day 15. Experimental testing showed that a 10 × 10 cm foam dressing weighed 7.5 g and absorbed 75 mL of saline, whereas the superabsorbent dressing weighed 5.5 g and absorbed 93 mL. Clinically, absorption power was significantly higher with the superabsorbent dressing on day 3 (104.09 vs. 71.87 mg/cm2/day; p = 0.034), day 6 (84.45 vs. 40.91 mg/cm2/day; p < 0.001), and day 9 (76.59 vs. 19.74 mg/cm2/day; p = 0.022). Pain scores tended to be lower with the superabsorbent dressing on days 6 and 9, although the differences were not statistically significant. Wound epithelialization was comparable between groups, with no allergic reactions, infections, or other complications observed. Superabsorbent dressing demonstrated superior absorption capacity compared with foam dressing, while achieving comparable epithelialization and healing outcomes. Pain scores tended to be lower with the superabsorbent dressing during the early postoperative period, although the differences were not statistically significant. LEVEL OF EVIDENCE: 1.
Mid-deep dermal burns have traditionally been treated with nonoperative management and split-thickness skin grafting, but minimally invasive excision with epidermal autografting and poly-lactic acid skin substitute (MEP) has offered an alternative approach. Comparative outcomes have remained incompletely defined. We conducted a retrospective cohort study of adult patients with mid-deep dermal burns treated with MEP compared with a propensity score-matched standard-of-care (SOC) cohort. The primary outcome was achievement of ≥ 90% wound healing by postoperative day 10, with secondary outcomes including length of stay, complications and hospital financial outcomes. Among 39 pairs analysed, MEP-treated patients were significantly more likely to achieve early wound healing compared with SOC (82.1% vs. 45.5%, p = 0.001) and experienced fewer complications, without an increase in length of stay. Although MEP was associated with higher upfront hospital costs, reimbursement rates were comparable. MEP was associated with superior early wound healing and fewer complications without prolonging hospitalisation.
Diabetic foot ulcers (DFUs) are difficult to manage in resource-limited settings, where access to standard offloading devices is limited for healing of plantar diabetic foot ulcers. This is due to the cost, limited availability, and the need for specialised expertise. Toa Uzito is a low-cost offloading device developed to address this gap. We evaluated the effectiveness of a low-cost offloading device (Toa Uzito) in improving healing outcomes in patients with plantar ulcers. A matched case-control clinical study was conducted at a specialised diabetic foot centre in Dar es Salaam, Tanzania. Patients with a single plantar DFU were enrolled. Those treated with Toa Uzito were compared with matched controls who received standard care without offloading. Controls were matched based on age, body mass index, and diabetes duration. The primary outcome was time to complete ulcer healing. Healing were analysed using Kaplan Meier survival analysis and Cox regression. A total of 621 patients were included (128 intervention, 493 controls), with a mean follow-up of 133.8 days. Ulcer healing was significantly better in the intervention group: 44.9% healed (versus 34.9% in controls) by 12 weeks, and increasing to 85% (versus 75.2% in controls) by 24 weeks. All patients in the intervention group healed, with a shorter mean healing time (125.7 vs. 137.5 days). Toa Uzito also demonstrated significantly superior healing efficacy compared with standard care after stratification by SINBAD classification (χ2 = 71.2, p < 0.01) . The low-cost Toa Uzito significantly improves healing rates and reduces time to healing. Its affordability and simplicity makes it an effective offloading strategy for promoting DFU healing in resource-limited settings.
Accurate classification and staging of pressure injuries (PIs) are essential competencies for nursing students, yet traditional teaching methods may not sufficiently support retention and clinical decision-making. Digital game-based learning has emerged as an innovative strategy to enhance engagement and knowledge acquisition in health professions education. This study aimed to examine the effect of the Pressure Injury Digital Game (PI-DGAME) mobile application on nursing students' knowledge of PI classification and staging, their staging accuracy and short-term knowledge retention and to evaluate usability and learner satisfaction. A quasi-experimental single-group pre-test-post-test design with a 4-week follow-up. The study was conducted with 60 undergraduate nursing students between May and July 2025. Following baseline assessment using the Pressure Injury Test (PI-TEST), participants accessed the PI-DGAME mobile application and completed at least one full gameplay session during a one-week self-directed intervention period. Repeated gameplay was permitted. Game engagement and performance indicators were automatically logged. The PI-TEST was re-administered immediately after the intervention and at 4-week follow-up. Data were analysed using non-parametric tests. PI-TEST scores increased significantly from pre-test to post-test and were maintained at the 4-week follow-up (p < 0.001). Pairwise comparisons showed significant improvements from pre-test to post-test and from pre-test to follow-up, with no significant decline between post-test and follow-up. In-game performance improved with repeated gameplay; total scores and correct responses increased, while incorrect responses and completion time decreased (p < 0.05). Achievement level and gameplay frequency did not differ by academic year. Students evaluated the game positively; over 90% reported ease of use and clarity of content. PI-DGAME was associated with improved knowledge, staging accuracy and short-term retention among nursing students. Digital game-based learning may provide a complementary educational strategy to support learning related to PI classification and staging in nursing education.
Cobra envenomation frequently results in progressive soft-tissue necrosis of the hand, posing significant challenges for reconstruction. While flap-based reconstruction is often recommended for severe defects, the role of skin grafting in appropriately selected cases remains poorly defined. A retrospective study was conducted on 52 patients who underwent skin grafting for cobra bite-induced hand defects between January 2021 and November 2025. Patients with exposed critical structures or defects requiring flap reconstruction were excluded. A staged reconstructive strategy with serial debridement and wound-bed optimization was applied. The primary outcome was graft viability at postoperative day 10. Secondary outcomes included functional assessment using the QuickDASH, wrist range of motion and total active finger motion. Among 52 patients, complete graft survival was achieved in 46 (88.5%), partial graft loss in 4 (7.7%) and total necrosis in 2 (3.8%). The proportions of immediate grafting and finger defects were significantly higher in the graft necrosis group than in the complete graft survival group (p = 0.008 and p = 0.001, respectively), while NPWT for wound-bed preparation was more common in the complete survival group (p = 0.050). At follow-up, most patients had mild to moderate QuickDASH disability, with acceptable motion outcomes, although finger defects showed poorer functional recovery. Skin grafting is a reliable and less invasive option for cobra bite-induced hand defects when performed on a well-prepared wound bed. A staged, mechanism-based reconstructive strategy is proposed. NPWT may contribute to wound-bed optimization, whereas finger defects appear to represent a higher-risk subgroup.
The aim of this study was to evaluate the cost-effectiveness of treating patients with Venous Leg Ulcers (VLUs) with the Muscle Pump Activation device (MPA, geko) in Canada. This is a cost-effectiveness analysis of the treatment of patients with VLUs, using MPA for 4 weeks in addition to standard of care compression therapy (SOC), compared to SOC alone using Canadian costs of VLU treatment. The authors determined the Canadian costs for each visit for a patient with a VLU to have their dressings performed at a nursing clinic. The total costs of treatment were determined based on healing rates from a randomized controlled trial from Wales that demonstrated a significant improvement in the healing of VLUs when MPA was used for 4 weeks in addition to SOC, compared to SOC alone. The cost per visit to a nursing clinic for the treatment of a VLU was estimated to be $109.71 CAD and dressing frequency was estimated to be an average of every 2.5 days. Using projected healing rates over a 12-month period based on the UK paper, the model indicated that treatment with MPA resulted in a cost savings of $983.61 CAD per patient. The average increase in ulcer free days was 56.6 days per patient. The Incremental Cost Effectiveness Ratio (ICER) identified a saving of $17.38 per ulcer free day. This model based on Canadian costs resulted in faster healing of VLUs and a reduced average Direct Wound Care Cost of $983.61 per patient for the whole of their ulcer treatment when the MPA is used for 4 weeks in addition to SOC. This treatment has the potential for patient benefit as well as significant cost savings for the Canadian Health Care system.
Delayed wound healing is a major complication of diabetes, with its core pathological process being pathological fibrosis driven by persistent inflammation, metabolic disorders and vascular dysfunction under hyperglycemia. This process involves pathological retention of inflammatory cells, abnormal expression of pro-fibrotic factors, and excessive deposition of extracellular matrix. As a traditional Chinese medicine, leech possesses multiple pharmacological effects including anticoagulation, anti-inflammation and improvement of microcirculation, exerting its therapeutic roles through regulating coagulation, modulating inflammatory responses, and enhancing vascular microcirculation. Simultaneously, leech can reduce epithelial-mesenchymal transition and extracellular matrix deposition by synergistically inhibiting multiple key signalling pathways associated with fibrosis. Future research should focus on elucidating the bioactive components of leech and their synergistic regulatory networks across multiple signalling pathways, providing a theoretical reference for developing leech-based anti-fibrotic drugs.
There are many circumstances where individuals with limited mobility are exposed to prolonged postures increasing the risk of pressure ulcers. Technologies have been developed to monitor posture, mobility and pressure exposure; however, their effectiveness in different clinical settings is unknown. The aim of this scoping review was to assess clinical studies using continuous pressure monitoring for the prevention and/or treatment of pressure ulcers. A scoping review of the literature was conducted using the PRISMA-ScR framework. Clinical-based studies were included which used continuous pressure monitoring for assessment and treatment over a minimum of a 2-h period. The outcomes included quantitative measures such as pressure distribution and mobility data, qualitative insights relating to patient comfort and acceptability, and the perceptions of healthcare staff regarding usability and clinical integration of the technology. Twenty-four studies were identified and included in the scoping review, conducted across eight countries spanning three continents. Most studies were undertaken in a hospital setting (67%, n = 16). Following review of the included papers, five core themes were identified: clinical outcomes, pressure metrics, posture and mobility, nurse feedback and patient experience. There was high heterogeneity in study design, outcome measures and different risk of bias limited the scope to synthesise the outcomes. Collectively, the studies indicate that CPM can enhance awareness of interface pressures, support clinical decision-making and inform repositioning strategies for individuals at risk of tissue damage. Reported benefits include greater staff confidence and patient engagement. However, consistent reductions in ulcer incidence have yet to be demonstrated, with larger trials with standardised outcomes required.
This study aimed to identify the prognostic markers for Diabetic Foot Ulcer (DFU) healing using routinely collected clinical data. A prospective cohort study of 1075 (M/F: 664/411) patients who attended the foot clinic with a DFU was conducted. At baseline, detailed clinical data were collected and ulcer characteristics were systematically assessed and classified. During 167 ± 408 days follow-up, ulcers of 1039 patients healed and 36 did not. Ulcers with SINBAD classifications 4, 5 and 6 (compared to SINBAD-3) showed 50%, 60% and 70% increase in the risk of not healing and 2.2, 2.8 and 3.3 folds increase in healing duration respectively. Also, deeper ulcer and having previous ulcer history showed 68% and 47% increase in the risk of ulcer not healing and 57% and 20% increase in healing duration respectively. Each day delay in presentation increased the risk of ulcer not healing by 0.5%. The duration of healing was 2.4 times longer for bigger ulcers (> 1 cm2) and 24% longer in patients with peripheral arterial disease. SINBAD score was the strongest predictor of ulcer healing. Among SINBAD constitutive components, ulcer depth (deep-vs-shallow) was the strongest predictor of risk of ulcer not healing, while ulcer size (bigger-vs-smaller than 1 cm2) was the strongest predictor of ulcer healing duration.
Hard-to-heal wounds place a major burden on patients and the Canadian health system, underscoring the need to strengthen workforce capacity in skin health and wound management. This mixed-methods program evaluation examined two education programs implemented in Ontario home and community care: one for regulated interprofessional providers and one for personal care providers. Quantitative data were collected through pre-, mid- and post-program surveys, and qualitative data through open-ended survey responses and focus groups. Between 2022 and 2025, 164 regulated providers and 203 personal care providers graduated. Across both programs, participants reported increased confidence in prevention, assessment, treatment, communication, teamwork and application of best practices. Importantly, confidence was interpreted as a proxy indicator for readiness to change practice rather than a stand-alone endpoint. Survey and focus group findings indicated that participants applied learning in practice through earlier identification of skin concerns, more effective escalation and communication with interprofessional colleagues, increased use of best practices and greater attention to prevention. Confidence gains ranged from 30% to over 50% in the regulated-provider program and 20% to 45% in the personal care provider program. Qualitative findings reinforced the impact of increased confidence in practice and included improved prevention focus, communication and changes in practice. Thus, these programs, by increasing confidence and self-reported changes in practice, enhanced learners' capacity to deliver quality skin health and wound care. Practice capacity was operationalised in this study as a multidimensional construct that includes role-appropriate knowledge, confidence, readiness to apply evidence-informed practices, communication and escalation behaviours and participation. These programs offer a scalable model to enhance wound care capacity and support health-system sustainability in Canada. Economic outcomes, while not formally measured in this work, should be examined in future studies, as the findings reflect a promising approach to cutting the cost curve in skin health and wound care.
Quantitative assessment of the pressure injury size (S) and pocket (P, undermining) is essential for evaluating wound healing. Conventional LabelMe annotations often lead to oversegmentation, whereas object detection with You Only Look Once (YOLO) enables accurate wound localization. Here, we developed a hybrid AI model that combines LabelMe segmentation with YOLO gating. This single-centre retrospective study compared two models: LabelMe-Seeded Auto-Recognition (LSAR) and YOLO-gated LSAR (YGL). Model performance was evaluated by concordance rate and weighted Cohen's κ for DESIGN-R staging and by mean absolute error (MAE) and median (interquartile range) for area error. Overall, 1017 wound images (training: 979; testing: 38) were analysed. For S, the YGL model achieved higher concordance (85.7%, κ = 0.969) and smaller area errors than did the LSAR. For P, the YGL model demonstrated higher concordance and smaller area errors than did the LSAR model. The YOLO-LabelMe hybrid model improved the stage concordance and size accuracy compared with LabelMe alone. Despite the residual outliers in P assessment, this approach represents a promising step towards automated, clinically adaptable wound measurements.
The efficacy of cryosurgery for skin cancers is believed to depend on thaw time, which may be influenced by the presence of adrenaline in local anaesthetics due to its vasoconstrictive effects. This is the first study to perform detailed, non-invasive temperature measurements using infrared (IR) thermography during cryosurgery for basal cell carcinomas (BCCs), evaluating the impact of adrenaline on thaw time. A total of 15 patients with eyelid BCCs underwent cryosurgery with local anaesthetics both with and without adrenaline. Thawing was continuously monitored using a high-resolution IR camera and compared with the surgeon's visual assessment. No significant difference in thaw time was observed between anaesthetics with and without adrenaline. Thermographic mapping revealed a triphasic thawing curve. The surgeon's visual assessment of thawing corresponded well with the point at which tissue temperatures rose above 0°C, likely indicating the onset of reperfusion, thus providing a clinical margin beyond the actual phase transition. This is the first study to use IR thermography to monitor cryosurgery of BCCs, demonstrating that adrenaline in local anaesthetics does not affect thaw time. The findings suggest that deeper tissue perfusion during BCC treatment may counteract superficial vasoconstriction, supporting the effective use of cryosurgery regardless of adrenaline use.
ABSTRACT Early detection of infection in superficial skin wounds remains a critical determinant of healing outcomes, particularly in paediatric populations, where developmental and behavioural factors often limit clinical assessment. Traditional diagnostic approaches, including visual inspection and culture‐based microbiology, are constrained by subjectivity and diagnostic delay. Over the past decade, several innovative technologies have emerged that enable earlier, more objective identification of pathogenic activity in wounds. This focused mini‐review summarizes recent advances in novel imaging, biosensor‐enabled smart dressings, and molecular diagnostics, with an emphasis on the mechanisms, clinical evidence, and applicability to superficial wound care. Collectively, these technologies represent a shift toward precision wound diagnostics that may facilitate earlier intervention, reduce unnecessary antimicrobial exposure, and improve healing outcomes.
This scoping review examined the literature on the roles of healthcare professionals involved in multidisciplinary team (MDT) management of pressure injuries (PIs), as well as the barriers and facilitators influencing team-based care. Pressure injuries represent a significant global disease burden with physical and psychological impacts on individuals, requiring coordinated management from multiple disciplines. Understanding MDT composition, roles, and care delivery is essential to optimise patient outcomes and team performance across the care continuum. Eligible English-language papers on multidisciplinary PI care in hospital and community settings were identified through searching CINAHL, Cochrane, Embase, MEDLINE, and Scopus. After duplicates were removed, the remaining articles were independently screened by two reviewers, with discrepancies resolved by consensus. Data from 41 eligible papers were extracted and analysed thematically. MDT roles spanned wound care, rehabilitation, education, nutritional support, and care coordination, with substantial interdisciplinary overlap. Key facilitators included dedicated leadership, regular meetings, shared documentation, and ongoing training, while barriers encompassed unclear role definitions, inconsistent guidelines, poor hospital-to-community integration, and patient complexity. Critical gaps remained in psychosocial support, telehealth, and care for diverse populations. Multidisciplinary teams must be adaptable, holistic, and guided by patient experiences to optimise both healing and long-term prevention.
