BACKGROUND:Hard-to-heal wounds remain a major healthcare challenge due to persistent inflammation, extracellular matrix (ECM) degradation, impaired angiogenesis and failure to progress through normal healing pathways. Standard wound care alone often fails to achieve timely wound closure, necessitating biologically active therapies that restore the wound microenvironment. High-purity type I collagen (HPTC) (Helicoll, EnColl Corp, Fremont, CA, US) is a uncrosslinked skin substitute designed to function as a biologically active ECM scaffold that supports tissue regeneration rather than serving solely as a passive wound covering. METHODS:A comprehensive literature review was conducted of the clinical, mechanistic, technical and economic evidence supporting HPTC. The evidence base included six randomised controlled trials (RCTs), pooled analyses, comparative studies, observational investigations and health-economic evaluations spanning diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure ulcers (PUs), burns, donor sites, surgical wounds and complex wounds. RESULTS:Across hard-to-heal wound studies, HPTC consistently demonstrated improved healing outcomes compared with active comparators and standard therapies. DFU studies demonstrated complete closure rates up to 83.3% compared with approximately 51.7% in comparator groups, with ≥50% wound reduction observed in 85-88% of patients at 4 weeks. VLU studies demonstrated closure rates approaching 70% compared with 43.3% for comparators, while PU studies demonstrated closure rates of approximately 75%. Mechanistically, preserved native collagen structure enabled physiological cell adhesion, growth factor binding, protease modulation, angiogenesis, fibroblast recruitment and ECM restoration. No significant safety concerns or serious adverse events attributable to HPTC were reported. Economic analyses further demonstrated favourable cost-effectiveness, reduced application frequency and lower overall treatment costs relative to competing advanced wound therapies. CONCLUSIONS:HPTC is supported by multiple clinical studies that demonstrate efficacy across multiple hard-to-heal and acute wound types. Preservation of native collagen architecture, absence of chemical crosslinking, physiologically relevant scaffold structure and favourable safety and economic profiles collectively support its role as an evidencebased advanced wound therapy. Evidence supports HPTC's clinical utility and integration into routine wound care practice for management of complex wounds. These findings validate HPTC's medical necessity and economic value, underscoring its status as an advanced wound therapy with emerging supportive evidence rather than an experimental or investigational intervention. STATEMENT OF INTEREST:Funding for the preparation of this manuscript was provided by Encoll Corp (Fremont, CA, US), manufacturer of HPTC. The author reports receiving support related to development of this review. The sponsor reviewed the manuscript for scientific accuracy but did not control the final interpretation or conclusions.
OBJECTIVE:To describe the incidence density of pressure injuries (PIs) in neonatal intensive care unit patients and their temporal trends over a seven-year period. The secondary aim was to describe the incidence density of medical device-related pressure injuries. METHOD:A retrospective interrupted time-series analysis was undertaken using routinely collected surveillance data from a 30-bed tertiary-level neonatal intensive care unit in Northern Italy between 2018 and 2024. PI incidence density (events per 1000 patient-days) was calculated annually and monthly. RESULTS:Overall, 121 PIs were identified in 83 neonates, corresponding to an overall incidence density of 2.46 events per 1000 patient-days. Annual incidence density declined from 4.80 in 2018 to 1.08 per 1000 patient-days in 2024. Interrupted time series analysis identified an immediate 62.2% reduction in incidence density at the January 2020 breakpoint (incidence rate ratio: 0.378; 95% confidence interval: 0.148-0.963; p=0.044), with no significant changes in temporal trend before or after the breakpoint. Most injuries (93.4%) were related to use of medical devices, predominantly associated with non-invasive respiratory support and monitoring devices, and the head and face were the most frequently affected anatomical sites. CONCLUSION:The incidence density of pressure injuries decreased substantially during the study period, but medical device-related pressure injuries remained the predominant type of injury in the neonatal intensive care unit. Routine surveillance may facilitate the early identification of unexpected changes in reported incidence density, prompting timely evaluation of whether these reflect genuine improvements in patient outcomes or changes in clinical attention and reporting practices.
Objective: To examine risk factors for pressure ulcer (PU) development among adults undergoing surgery. Method: A total of five electronic databases were searched from inception to March 2024. Study selection, data extraction and quality appraisal were performed by two independent reviewers, using the Crowe Critical Appraisal Tool (CCAT v1.4; Michael Crowe, James Cook University, Australia), with scores ≥75% indicating high methodological quality. Results were categorised and reported as preoperative, intraoperative and postoperative risk factors, with percentages representing the proportion of studies assessing each risk factor in which it was statistically significant. Due to methodological heterogeneity, findings were synthesised narratively. Results: A total of 41 studies were included, 20 (48.8%) of which had retrospective designs. Among the preoperative risk factors, Braden score was statistically significant in 11 (68.8%) of the 16 studies assessing this factor, age in 19 (61.3%) of 31 studies, and diabetes in 11 (61.1%) of 18 studies. Among intraoperative risk factors, duration of surgery was statistically significant in 15 (53.6%) of 28 studies assessing this factor, patient positioning in nine (60.0%) of 15 studies, and type of surgery in nine (60.0%) of 15 studies. Postoperatively, Braden Scale score was statistically significant in five (83.3%) of six studies, while sepsis and pneumonia were each statistically significant in all three (100%) studies assessing these factors. The mean methodological quality score was 82±9.7%. Conclusion: This systematic review identified several risk factors for PU development across the included studies during the preoperative, intraoperative, and postoperative surgical period. Due to the complex interplay between competing factors that impact PU development during surgery, the development of a core outcome set of risk factor variables for inclusion in future studies may enhance homogeneity and support risk stratification alongside optimisation of modifiable exposure factors.
OBJECTIVE:To evaluate the effectiveness of a simulation-based educational programme designed to support evidence-based pressure ulcer/injury (PU/I) prevention and management among undergraduate nursing students (P.J. Šafárik University in Košice, Slovakia) and to examine the relationship between perceived educational effectiveness and objectively demonstrated clinical competence. METHOD:A single-group post-intervention observational study was conducted among second-year undergraduate nursing students. The educational programme was developed according to international PU/I clinical practice guidelines and the Healthcare Simulation Standards of Best Practice. Students' perceived educational effectiveness was assessed using the simulation effectiveness tool-modified (SET-M), while clinical competence was evaluated using an objective structured clinical examination (OSCE). Associations and group differences were examined using non-parametric tests. RESULTS:The experimental cohort comprised 61 second-year undergraduate nursing students. Students demonstrated high levels of psychomotor competence, with >90% correct performance across all assessed OSCE competencies. The SET-M total score was 46.13±6.54, indicating highly positive perceptions of the simulation experience. No significant association was found between the SET-M total score and OSCE performance (ρ=-0.129, p=0.321), nor between individual SET-M domains and objectively assessed competence. Previous simulation experience and previous secondary education were not associated with either educational outcome. CONCLUSION:The simulation-based educational programme was associated with high levels of objectively demonstrated psychomotor competence and highly positive learner perceptions. However, perceived educational effectiveness was not associated with objectively assessed clinical competence, highlighting the importance of combining learner-reported and performance-based outcome measures when evaluating simulation-based education. These findings support simulation as a strategy for teaching evidence-based PU/I management in undergraduate nursing education.
A call for global recognition from the International Society for Neonatal and Paediatric Wound Healing (ISPeW): Our purpose is to drive a global transformation in the prevention, assessment, treatment, education and research of neonatal and paediatric wounds. Through this document, ISPeW calls for the formal recognition of paediatric wound healing as a unique and vital discipline, deserving dedicated attention in clinical practice, scientific research and healthcare policy.
Objective: To identify, map and synthesise, available contemporary evidence on multidisciplinary team roles and approaches in delivering person-centred prevention and management of pressure injuries (PIs) across the lifespan. Method: A scoping review was conducted. Searches were undertaken in MEDLINE/PubMed, CINAHL Ultimate, APA PsycInfo, Cochrane Library, PEDro, and Web of Science, alongside grey literature searches and reference screening. Studies published in English between 2016 and 2026 were included if they addressed multidisciplinary team roles in person-centred prevention and management of PIs. Results: Eight studies published between 2018 and 2025 were included, with most focusing on adult inpatient populations. Multidisciplinary teams commonly included nurses, wound care specialists, physicians, dietitians, physiotherapists and quality improvement professionals. Nurses held central roles in assessment, prevention implementation, education, coordination and monitoring, while wound care specialists provided leadership and clinical expertise. Multidisciplinary team approaches incorporated staff education, skin care champion programmes, standardised risk assessment, quality surveillance and rapid response systems. Only two studies demonstrated patient and family engagement through education, digital communication and shared care planning. All studies reported reductions in PI incidence or prevalence, supported by leadership engagement, embedded multidisciplinary team structures and continuous quality improvement processes. Conclusion: Sustainable person-centred prevention and management of PIs require integrated multidisciplinary team approaches that promote shared accountability, clinical expertise and ongoing improvement. Future research should explore the development and support of expanded person-centred multidisciplinary team models across broader age groups and community settings to enhance clinical implementation of PI prevention and management strategies.
OBJECTIVE:To describe a performance-based framework for support surface selection that integrates contemporary understanding of pressure injury aetiology with standardised engineering performance testing, and to demonstrate its clinical application using engineering performance data from commercially available support surfaces. Method: Current evidence describing pressure injury (PI) aetiology, support surface biomechanics and standardised engineering performance testing was synthesised to develop a framework for individualised support surface selection. Seven commercially available full-body support surfaces representing technologies commonly used in acute care were evaluated using American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America Support Surfaces-1 (ANSI/RESNA SS-1) standardised engineering test methods. Engineering performance characteristics, including pressure redistribution, immersion, envelopment, shear management and microclimate management, were compared and interpreted in representative clinical scenarios. RESULTS:Engineering testing demonstrated substantial variability among support surfaces across all measured performance characteristics, despite similarities in product category, construction or marketed features. Support surfaces with comparable design intent frequently exhibited markedly different performance profiles, while products using different technologies on occasion demonstrated similar biomechanical performance. No support surface demonstrated superior performance across all engineering domains, illustrating that support surface performance is multidimensional and cannot be reliably inferred from product construction, operating principles or marketing terminology. Clinical interpretation of these findings demonstrated how standardised engineering performance data can be integrated with contemporary understanding of pressure ulcer aetiology to support individualised support surface selection. CONCLUSION:Support surface selection should be based on measurable engineering performance characteristics rather than product categories or construction alone. Standardised engineering testing provides an objective basis for comparing support surfaces, and matching performance characteristics to the biomechanical and physiological needs of the individual user. This performance-based framework offers clinicians a practical approach for selecting the right support surface for the right user and provides a foundation for future studies relating engineering performance to clinical outcomes.
Objective: Effective pressure ulcer (PU) prevention requires the timely identification of patients at risk and the prompt implementation of appropriate preventive interventions. However, many PU risk assessment instruments are complex, time-consuming and difficult to integrate into routine clinical workflows, potentially limiting their uptake in practice. Method: In Belgium, these challenges led to the initiation of the Belgian Pressure Ulcer Risk Assessment project in 2016, which aimed to develop a clinically feasible approach to PU risk assessment and prevention. Building on the experiences of the earlier local assessment tools BEPU2016 and UZL-RWD2017, BEPU2025 was developed as a nationally aligned pressure risk assessment and prevention approach that integrates risk assessment, daily reassessment and structured PU prevention pathways within routine care processes. Results: Rather than generating numerical risk scores, BEPU2025 focuses on supporting prevention-oriented clinical decision-making through rapid and repeated assessment of risk. Developed through almost a decade of Belgian quality improvement initiatives, BEPU2025 combines a concise assessment framework with workflow integration, electronic patient record implementation and a strong emphasis on nurse-led prevention. Conclusion: This viewpoint argues for a shift from score-based risk assessment towards a dynamic, prevention-oriented approach embedded within routine care processes. Further research is needed to evaluate its impact on clinical outcomes and its applicability in other healthcare settings.
OBJECTIVE:Venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) represent major global health challenges, affecting 1-4% of the global population and 25% of individuals with diabetes, respectively. While VLUs arise from chronic venous insufficiency and DFUs from diabetes-related micro/macrovascular complications, both conditions share critical pathophysiological mechanisms. This study explores the vascular and mechanical commonalities between VLUs and DFUs in order to propose an integrated, multidisciplinary approach to sustained ulcer care. METHOD:A structured narrative review was conducted using PubMed (2010-2026), to synthesise evidence on shared vascular and mechanical pathways of VLUs and DFUs, and the evidence was used to construct a framework. In addition, two illustrative clinical cases were analysed to highlight multidisciplinary management strategies. RESULTS:Both VLUs and DFUs exhibit microvascular dysfunction, endothelial damage and chronic inflammation, driven by mechanical stress and vascular abnormalities. The first case study demonstrates the coexistence of neuropathic and VLUs in a patient with diabetes, highlighting the need for comprehensive vascular and biomechanical evaluations. The second case study illustrates how lifestyle modifications (e.g., nocturnal recumbency, increased walking) can resolve hard-to-heal VLUs in a patient with severe post-thrombotic syndrome. CONCLUSION:A unified framework targeting shared vascular and mechanical pathways could improve healing, prevent recurrence and optimise resource allocation for both VLUs and DFUs. Future research should focus on personalised biomechanical assessments and therapies modulating common pathways.
OBJECTIVE:To translate, culturally adapt and evaluate the content validity and preliminary usability of the End-of-Life Wound Assessment Tool (EoL-WAT) for use in the Italian healthcare context. METHOD:A methodological study was conducted between March and May 2026 in collaboration between the Italian Association for the Study of Skin Lesions and the Italian Society of Palliative Care. Following forward and back translation, content validity was evaluated by nine experts, and preliminary usability by seven healthcare professionals. RESULTS:All items exceeded the predefined acceptability threshold for content validity (item-level content validity index (I-CVI)≥0.89). A total of 19 of the 20 evaluations achieved complete agreement (I-CVI=1.00). Overall content validity was excellent (scale-level content validity index (S-CVI)/Ave=0.994; S-CVI/universal agreement=0.95). Usability ratings were favourable across all domains (mean score range: 4.00-4.43). Qualitative feedback led to minor wording refinements without substantial modifications to the instrument. CONCLUSION:The Italian version of the EoL-WAT demonstrated excellent content validity and favourable usability. The instrument is a promising tool for assessing end-of-life wounds, and may facilitate shared clinical understanding and interdisciplinary collaboration in wound care and palliative care settings.
OBJECTIVE:To determine pressure injury (PI) incidence density in a paediatric intensive care unit (PICU) over five years and describe diagnosis-specific anatomical and device-related PI (DRPI) patterns. METHOD:This single-centre retrospective study included patients with stage 2 or higher PIs recorded in a tertiary hospital PICU incidence report from January 2021 to December 2025, using de-identified quality-indicator data. The incidence density was calculated per 1000 patient days. PIs were grouped as superficial (stage 2), severe (deep tissue PI, unstageable, stage 3-4) or mucosal. Patient variables were analysed per patient and injury variables per PI, using Mann-Whitney U and Kruskal-Wallis tests. RESULTS:The study cohort comprised 94 patients. During 12,371 patient days, 107 PIs occurred, giving an incidence density of 8.65 per 1000 patient days. Patients with cardiovascular illness (n=41, 43.6%; median age 15 months) were younger than other groups (U=750.0; p=0.010). The head/neck was the most common site overall, but pelvic/gluteal PIs were more frequent in patients with cardiovascular illness (37.0%), whereas 83.3% of PIs in patients with respiratory and neurological illness occurred at the head/neck. At least one device was in place for every PI (median 5), and 51 PIs (47.7%) were classified as DRPIs. DRPIs accounted for 71.2% of head/neck PIs, of which 95.7% involved respiratory devices. Risk scores did not differ across severity groups (Braden Scale H=2.40; p=0.301, Braden Q H=1.68; p=0.431, Neonatal/Infant Braden Q H=0.70; p=0.705). CONCLUSION:In this study PI patterns differed by diagnostic group, supporting pelvic/gluteal protection for patients with cardiovascular illness and device-related head/neck prevention for patients with respiratory and neurological illness. A risk-assessment tool reflecting device-related risk should be considered.
Objective: Paediatric burns are a major cause of morbidity, with a high risk of infection, complications and poor quality of life. Prompt intervention is indicated to minimise infection and expedite healing. The aim of this retrospective study was to compare clinical outcomes following transition from using gel-forming fibre dressings containing silver (GFFS) to the routine use of dialkylcarbamoyl chloride (DACC)-coated dressings in a tertiary paediatric burns centre. Method: The study followed a retrospective, observational comparative design. Following ethical approvals, clinical outcomes data were extracted from electronic health records of paediatric patients between January and December 2023 during the transition to incorporating DACC-coated dressings into the burn treatment protocols. Results: A total of 63 paediatric patients with burns of various aetiologies were analysed (GFFS group, n=34; DACC group, n=29). Significantly fewer episodes of infection were reported in the DACC group compared to the GFFS group (DACC 20.7% versus GFFS 47.1%; χ 2 p=0.028), combined with less time to infection resolution, while systemic antibiotic requirement was comparable between groups. Persistent infection in four patients in the GFFS group necessitated a change to DACC. These findings aligned with a reduced number of patients with significant bacterial growth (≥10 5 colony-forming units/ml) in the DACC group compared to the GFFS dressing group. No significant difference was reported for surgical debridement requirements and the time to re-epithelialisation; however, overall values were lower in the DACC group. Conclusion: The improved outcomes with DACC-coated dressings, such as reduced rates and duration of infection, shown in this study support re-epithelialisation progression and may reduce the need for systemic antibiotics, ultimately supporting antimicrobial stewardship.
OBJECTIVE:Paediatric and neonate patients are more susceptible to wound infection and skin damage. Dressing interventions for paediatric wounds need to balance effective infection management with patient satisfaction and tolerance. The aim was to evaluate a dialkylcarbamoyl chloride (DACC)-based wound care strategy in paediatric patients with complex wounds using both a cohort comparison with silver hydrofibre (SHF) dressings and a wider non-comparative analysis describing the overall institutional experience with DACC-coated dressings. METHOD:This retrospective comparative study design compared clinical outcomes in paediatric wounds managed with DACC-coated dressings to SHF dressings. Wound and microbiological-related outcomes were analysed. In addition, data on historical DACC-coated dressing use in various paediatric wounds, along with clinical outcomes, procedural information and tolerability were also analysed. RESULTS:A total of 240 paediatric patients (120 in each treatment group) were included, with mean ages of 6.5 years and 5.8 years for the DACC group and the SHF group, respectively. Significantly more patients reported resolution of infection in the DACC-coated group compared to the SHF group (94.8% versus 79.0%, respectively; p=0.05). There were significantly fewer wounds with no progress or deterioration in the DACC-coated dressings group compared to the SHF dressings group (mean no progress: 4.2 versus 13.5, p=0.03; and mean deterioration: 2.5 versus 7.5, p=0.005; respectively). Less time required for dressing changes and counselling as well as for dry removal was shown with DACC-coated dressings compared to SHF dressings. Microbiological examination showed numerous difficult-to-treat infections; frequently polymicrobial and including World Health Organization-priority pathogens. Furthermore, wider historical data from 1502 patients using DACC-coated dressings on various wound aetiologies was analysed. Findings showed that DACC-coated dressings were used under negative pressure wound therapy, and as part of strategies to prevent infection in incontinence associated dermatitis and neurological device wounds, as well as in the management of toxic epidermal necrolysis/Stevens-Johnson syndrome. Overall, the dressing was well tolerated, even in fragile skin, including neonatal and high-risk patients. CONCLUSION:The findings of this retrospective study support the use of DACC-coated dressings in complex paediatric wounds, particularly when infection control, antimicrobial stewardship, atraumatic removal, pain control and preservation of fragile skin are clinical priorities.
The use of silver has a long history in human civilisation, particularly as an antimicrobial agent in infection control and prevention. Although silver was first used to treat wound infection approximately 2000 years ago, issues such as its safety profile, clinical and cost-effectiveness, potential overuse and risk of bacterial resistance, remain topics of discussion. Therefore, this review re-examines these issues in light of contemporary microbiological and clinical evidence. The silver cation (Ag + ) is a broad-spectrum topical antiseptic with a well-established safety profile, supported by regulatory evaluations and extensive clinical use. Concerns around bacterial resistance largely stem from laboratory models that do not reflect real wound environments. Known genetic resistance mechanisms exist but are rare in clinically relevant wound pathogens, and have not resulted in stable resistance, with key organisms remaining susceptible to modern silver-containing dressings. Reduced silver activity observed in vitro, particularly in biofilm models, is often a consequence of extracellular polymeric substance-mediated shielding rather than heritable resistance mechanisms. Within the wound hygiene framework, emphasising cleansing and debridement to disrupt biofilm, silver-containing dressings remain an effective tool for managing bioburden and supporting wound progression. Concerns regarding overuse underscore the need for appropriate, indication-driven application rather than reduced access. Overall, evidence shows that silver remains a highly effective option in antimicrobial wound care and that clinically relevant silver resistance is negligible. When used judiciously, silver-containing dressings remain safe and effective, and are an important component in the management of wounds that are infected or at risk of infection. This review aims to critically re-evaluate the role, benefits and limitations of silver-containing dressings in wound management, and to address questions that have recently arisen.
Enteroatmospheric fistulas (EAFs) are characterised as an abnormal connection between the gastrointestinal tract and the atmosphere. They present a formidable challenge in surgical practice. Negative pressure wound therapy (NPWT) has become the standard for management of large open abdominal wounds. However, an EAF can make application of this dressing challenging. This case report highlights the authors' experience in managing an EAF-containing large open wound in a 52-year-old male patient following a motorcycle collision. He sustained an 'open-book' pelvic fracture and mesenteric contusions requiring exploratory laparotomy. The patient underwent multiple abdominal surgeries and his abdomen was left open using a temporary abdominal closure device. He had an extended hospital course complicated by a necrotising soft tissue infection requiring large abdominal wall debridement, pelvic hardware infection requiring hardware removal and external fixation, and fascial dehiscence culminating with the development of an EAF. Several iterations of wound care were attempted before succeeding at achieving a fistula-sparing NPWT dressing. Once this was achieved there was rapid improvement in the size of the patient's wound. His wound and overall clinical status continued to improve, with spontaneous resolution of fistula and near complete re-epithelialisation of the wound at eight months. The practice of damage control laparotomy with an open abdomen and temporary abdominal closure devices exposes the bowel to potential damage from iatrogenic serosal injuries, adhesion-induced wall splitting, and serosal irritation from dressing changes. Wound care that minimises soilage of the remainder of the wound from enteric effluent is essential for wound healing. Each wound requires a tailored approach that adjusts for its individual characteristics to ensure optimal patient outcomes.
OBJECTIVE:Medical adhesive-related skin injury (MARSI) represents a significant clinical challenge affecting patient outcomes and healthcare costs, with a reported prevalence of up to 37.15%. Despite growing awareness of MARSI, gaps persist in standardised prevention and management approaches. To assess healthcare professionals' (HCPs) perspectives on the prevalence, impact and management of MARSI, while identifying gaps in education and the application of clinical protocols. METHODS:A cross-sectional, 39-question global survey was conducted among HCPs between 15 March and 9 April 2026. Data were collected from a global subset of 951 self-identified HCPs involved in wound care across 68 countries. Analysis utilised descriptive statistics to determine frequency and identify trends in clinical practice, product usage and MARSI education and guidance. RESULTS:Clinical recognition of MARSI was almost universal (92.8%), with 45.6% of respondents encountering these injuries at least weekly. The most frequent injury types were skin tears (70.4%) and irritant contact dermatitis (68.1%). While existing literature focuses on device fixation, this survey identified wound dressing applications for hard-to-heal (59.6%) and surgical (53.2%) wounds as drivers of injury. A strong clinical preference for silicone-based adhesives was identified (>70%), with 82.3% of HCPs perceiving them as effective in reducing MARSI risk. Despite high awareness, significant institutional gaps persist: 75.7% of respondents lacked formal MARSI risk-assessment protocols, 65.4% relied on informal skin assessment and 36.3% had received no specific MARSI training. CONCLUSIONS:While clinical awareness of MARSI has improved significantly over the last decade, institutional support remains fragmented. The reliance on informal assessment rather than standardised protocols creates a critical implementation gap between clinical recognition and formal practice. The findings of this survey highlight a clear need for the integration of evidence-based prevention strategies alongside formalised institutional frameworks and enhanced professional education to mitigate the clinical and economic burden of MARSI.
OBJECTIVE:Prevena (3M KCI, US) is a new incisional negative pressure wound therapy system (iNPWT) for closed surgical incision management. The surgical management of pressure ulcers (PUs) remains challenging. A high rate of recurrence and overall complications have been reported. This study analysed the clinical efficacy of the iNPWT system in patients with PUs. METHOD:In this retrospective study, patients with stage 3 or 4 PUs who were surgically managed by a single plastic surgeon specialising in PUs at Tri-Service General Hospital, Taiwan, between January 2011 and June 2022 were reviewed. The primary outcomes assessed were: wound healing complications; dressing change frequency; and length of hospital stay. Patients were divided into two groups: those receiving the iNPWT system (iNPWT group) and those not receiving the iNPWT system (non-iNPWT group). RESULTS:A total of 187 patients were included (n=161 non-iNPWT group; n=26 iNPWT group). The rate of poor outcomes (defined as partial dehiscence or inadequate wound healing that required a secondary debridement followed by primary closure or additional flap reconstruction) was 19.2% (n=5) in the iNPWT group compared to 31.1% (n=50) in the non-iNPWT group. A lower number of dressing changes was noted in the iNPWT group (p<0.001). Male sex and multiple debridement procedures (≥2 times) were significantly associated with poor outcomes, with odds ratios of 2.10 (p=0.032) and 3.72 (p=0.009), respectively. A higher albumin level (>3.0g/dl) was significantly associated with better outcomes (p=0.009). CONCLUSION:A lower poor outcome rate of wound healing was noted in the iNPWT group. Otherwise, the use of the iNPWT system reduced the number of dressing changes, which potentially reduces the caregiving burden and improves patient comfort. The Prevena system may be a more effective choice for patients with PUs after reconstruction.
OBJECTIVE:Hard-to-heal ulcers, particularly venous ulcers, often fail to heal with standard treatments. Pinch grafting is an effective therapy, though its success may be limited by poor ulcer bed vascularisation. This case series introduces a novel modification-microperforations in the ulcer bed to enhance graft uptake. METHOD:Patients with hard-to-heal leg ulcers (average duration seven years) underwent this technique. Microperforations were made with a 4mm punch before placing pinch grafts, followed by negative pressure therapy (PICO 7 Single Use Negative Pressure Wound Therapy System; Smith+Nephew, UK). RESULTS:This case series describes the treatment of three patients (average age 68.3 years). All ulcers healed completely within an average of 154.3 days, with no hospitalisations. CONCLUSION:This technique shows promise as a simple, effective alternative for improving outcomes in hard-to-heal ulcers, especially in cases with compromised vascularisation.
OBJECTIVE:The objective of the study was to investigate the impact of osteoprotegerin (OPG) on vascular calcification and the severity of diabetic foot syndrome, which is a major public health issue globally due to its significant economic burden, high mortality and morbidity rates. OPG is a glycoprotein that belongs to the tumour necrosis factor receptor superfamily and is secreted by various tissues, such as endothelial and smooth muscle cells, particularly bone. METHOD:In this study, patients who were admitted to Cukurova University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Adana, Türkiye, were included. Serum OPG concentrations were measured using commercial enzyme-linked immunosorbent assay kits. In the serum samples obtained from the patients, simultaneous glycosylated haemoglobin (HbA1c), lipid panel, C-reactive protein (CRP), haemogram, blood urea nitrogen, creatinine, alanine aminotransferase, 25-OH-vitamin D3, calcium, inorganic phosphorus, and the ratio of protein to creatinine in spot urine were also measured. Information, such as anamnesis, demographic information, weight, background information, presence of additional diseases, type and duration of diabetes, drugs used, smoking/alcohol use status, and microvascular/macrovascular complications, were recorded. The calcium (Ca) score was calculated using foot/ankle multislice computed tomography to assess vascular calcification. RESULTS:The experimental cohort included 30 patients with diabetic foot ulcers (DFUs), 27 patients with diabetes but without DFUs, and 28 control group adult patients. OPG levels and lower-extremity Ca scores were significantly higher in patients with DFUs than in those without. Microvascular/macrovascular complications were higher in patients with DFUs than in patients without DFUs. There was a significant relationship between the presence of coronary artery disease (CAD), drug use, CRP and OPG levels in patients with DFUs. CONCLUSION:In this study, there was a statistically significant relationship between OPG level and age, diagnosis date, neuropathy, CAD, peripheral artery disease, white blood cell counts, haemoglobin, haematocrit, blood urea nitrogen, creatinine, low-density lipoprotein, high-density lipoprotein and CRP. However, there was no correlation between the Wagner classification used to evaluate disease severity, and the OPG and Ca scores.
