Wounds : a compendium of clinical research and practice最新文献

{"title":"Proteolytic enzymes and wound debridement: a literature review.","authors":"Evdoxia Mathioudaki, Andreas Vitsos, Michail Christou Rallis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Wound debridement is crucial for effective wound management and essential for removing necrotic tissue, reducing bacterial load, and encouraging granulation. While surgical debridement is prevalent, it can be traumatic and can potentially delay healing by enlarging the wound area.</p><p><strong>Objective: </strong>To summarize the existing literature on the role of proteolytic enzymes in wound debridement, with a focus on their applications, benefits, limitations, and future potential in wound care management.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed (National Library of Medicine) and Google Scholar, reviewing English-language publications from 1974 to 2023. Keywords included \"enzymatic debridement\", \"wound healing\", \"collagenase\", \"bromelain\", \"proteolytic enzymes\", and \"debridement\".</p><p><strong>Results: </strong>Enzymatic debridement has emerged as a promising, less invasive alternative to surgical debridement. Bromelain, which targets heat-denatured proteins, shortens healing times and improves scar quality. Collagenase and papain have been widely used globally, highlighting their efficacy in various wound types, although concerns have been noted about papain's safety. Preliminary studies on enzymes such as chymotrypsin, aurase, actinidin, Antarctic krill (Euphausia superba) enzymes, and dispase also show encouraging results. A limited number of studies comparing various debriding enzymes in the literature were identified, revealing significant differences between them, highlighting the need for additional comparative research studies.</p><p><strong>Conclusions: </strong>The advantages of enzymatic debridement over surgical debridement, particularly in nontraumatic applications and with enhanced healing times with the former, underscore its potential in clinical settings. Further research is warranted to optimize use of enzymatic debridement and understand the full scope of benefits and limitations of these enzymes in wound management.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"357-365"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing ultrasonography with magnetic resonance imaging in the detection of deep tissue injury.","authors":"Yasuhiro Sakata, Takanori Namba, Yasunori Umemoto, Tatsuya Yoshikawa, Kazunari Furusawa, Shinichi Asamura","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Deep tissue injury (DTI), a pressure-related injury to the subcutaneous tissue under intact skin, has been featured in several recent studies. DTI is hard to detect, and by the time the injury becomes visible, extensive injury to the underlying tissue has often already occurred, resulting in a potentially serious and difficult-to-heal full-thickness pressure injury. Thus, early detection of subcutaneous injuries is essential, and previous reports describe the use of ultrasonography and magnetic resonance imaging (MRI) for this purpose. The current report compares ultrasonography with MRI for detection of subcutaneous injuries.</p><p><strong>Case report: </strong>In the 2 cases reported herein, the use of ultrasonography and MRI led to the detection of DTI and intervention before the injuries reached the skin surface. In case 1, DTI was suspected on MRI, and ultrasonography confirmed findings typical of DTI, leading to the diagnosis. In case 2, MRI was used to detect abnormal findings at a stage in which no abnormalities were found on ultrasonography.</p><p><strong>Conclusion: </strong>In both cases, MRI clearly identified abnormal findings, which suggests that it is superior to ultrasonography for visualizing deeper tissue. Consequently, the authors of the current report propose that compared with ultrasonography, use of MRI for the detection of DTI would lead to earlier intervention and healing.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"366-370"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive landscape analysis for usable real-world wound care data.","authors":"Lucian G Vlad, Joseph Rolley, Shabnam Vaezzadeh, Lisa Gould, Caroline E Fife, Vickie R Driver, Anokhi J Kapasi, John C Lantis Ii, Sharmila A Kamani, Burak K Pakkal","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Wound Care Collaborative Community (WCCC) aims to assess current usable real-world data (RWD) sources to determine which real-world databases (DBs) are suitable and usable for studying the natural history of chronic wounds. Randomized controlled trials (RCTs) do not fully reflect the complexity of patients with chronic wounds. Using RWD, establishment of a scientifically grounded \"road map\" for RCTs is needed to better navigate the real-world complexity of the patients with chronic wounds. The long-term objectives include identifying patients ineligible to receive evidence-based advanced treatment and diagnostic options, reducing patient suffering, and providing decision support for regulatory bodies, payers, and clinicians.</p><p><strong>Objective: </strong>To identify available and usable RWD on US chronic wound care patients, as an early step toward the WCCC's objectives.</p><p><strong>Methods: </strong>Using B.R.I.D.G.E. TO DATA® methodology, the WCCC conducted a comprehensive RWD landscape analysis and systematically screened 34 potential sources for chronic wounds. Multiple data elements helped determine suitability and usability.</p><p><strong>Results: </strong>Four clinical US DBs have \"high potential\" for elucidating the natural history of chronic wounds; a fifth met the WCCC criteria but has data access restrictions.</p><p><strong>Conclusion: </strong>Identifying suitable, usable real-world DBs for research is complex. Only 1 DB was found that is fit for purpose and matches the goals to study the natural history of patients with chronic wounds.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"384-391"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency of new smart instillation technology with negative pressure wound therapy in managing complex chronic and surgical wounds: a case series.","authors":"Rosemary H Hill","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical wound solution has been limited in some settings due to perceptions of setup complexity. Typically, some guesswork was needed to estimate an adequate volume of solution to instill without causing leaks. A novel smart technology is recently available in certain NPWTi-d systems that automatically estimates and instills a solution volume according to wound dimensions.</p><p><strong>Objective: </strong>To report experience with this smart instillation NPWTi-d system technology in managing 4 complex wounds containing large areas of devitalized tissue and/or yellow fibrinous slough.</p><p><strong>Materials and methods: </strong>NPWTi-d was applied via a reticulated open cell foam dressing with through holes (ROCF-CC). The smart instill button was selected to automatically determine a volume of topical solution to instill, followed by a 10-minute dwell time and 2-hour cycle of -125 mm Hg negative pressure.</p><p><strong>Results: </strong>The average NPWTi-d duration was 17.0 days, and no air or solution leaks occurred during therapy. Dressings were changed 3 times per week. All wounds were converted to clean granulating wounds during therapy.</p><p><strong>Conclusion: </strong>In this case series, smart technology simplified setup and facilitated regular cleansing and removal of devitalized tissue through the ROCF-CC dressing.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"397-401"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent cellulitis caused by a hidden abscess: a case report.","authors":"Chi Young Bang, Seung Ho Lee, Kunyong Sung, Chanho Jeong, Sang-Yeul Lee, Suk Joon Oh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Skin and soft tissue infections are commonly encountered in clinical practice, and they are typically responsive to antibiotics and drainage. In most cases, cellulitis can be diagnosed via physical examination by a health care professional, based on the typical appearance of the skin and on symptoms such as redness, swelling, warmth, and pain. However, persistent cellulitis or nonresolving abscesses may require in-depth evaluation. When encountering refractory skin and soft tissue infections, clinicians should consider factors such as nontuberculous mycobacterial infection, underlying osteomyelitis, foreign bodies, and malignancy, among other factors.</p><p><strong>Case report: </strong>A 65-year-old male underwent 5 incision and drainage procedures at 2 different hospitals over 8 months without resolution of cellulitis. At the patient's presentation to the hospital of the authors of the current report, the authors successfully identified and removed a hidden abscess pocket, resulting in healing.</p><p><strong>Conclusion: </strong>In cases of recurrent skin and soft tissue infections that are unresponsive to standard treatments, preoperative imaging and hematologic studies are crucial to exclude underlying causes such as malignancy, atypical infections, foreign bodies, osteomyelitis, and hidden abscesses outside the initial surgical field. The current case highlights the importance of a comprehensive intraoperative examination to identify and remove any hidden abscesses to aid in the successful resolution of chronic infection. This report highlights the importance of a thorough approach in managing intricate cases of skin and soft tissue infections when standard interventions are not successful.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"371-374"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative infection of the spine: management and outcomes at a single institution. A retrospective study.","authors":"Keyvan Mostofi, Kamran Shirbache, Gianluca Caragliano","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a potential complication of spine surgery and a significant cause of readmission and surgical revision. Furthermore, the presence of comorbidities, along with the rising frequency of spinal surgeries, may result in secondary infections, thereby elevating the risk of these infections and affecting overall health.</p><p><strong>Objective: </strong>To assess the study authors' approach for preventing and managing postoperative infections in their center and identify the spine surgeries most susceptible to infection.</p><p><strong>Materials and methods: </strong>The authors conducted a retrospective study of 2559 patients at a single clinical center who underwent various lumbar spine surgeries, including interlaminar device plus diskectomy, diskectomy, interlaminar device plus recalibration, unilateral recalibration, and bilateral recalibration, among others, between March 1, 2015, and March 31, 2023.</p><p><strong>Results: </strong>Of these 2559 patients, 54 (2.11%) were readmitted due to infection and underwent reoperation. The most common isolated microorganism was Staphylococcus aureus. Infection occurred in 1.9% of instrumentation surgeries and 2.3% of non-instrumentation surgeries; this difference was not statistically significant. Infected patients received empiric dual antibiotic therapy after sampling of the surgical site and before identification of the causative organisms.</p><p><strong>Conclusion: </strong>The results of this study indicate that comorbidities increase the risk of infection. However, the authors did not find that instrumentation in spinal surgery escalates this risk. Empiric dual antibiotic therapy was effective in managing SSI prior to identification of the microorganisms via culture.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"402-406"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total capsulectomy and NPWT for management of a Mycobacterium abscessus breast implant infection unresponsive to antimicrobial therapy: a case report and literature review.","authors":"Andrea Aniello Cimmino, Giovanni Francesco Marangi, Gianluca D'Onofrio, Marco Gratteri, Daniela Porso, Fara Desiree Romano, Carlo Mirra, Paolo Persichetti","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nontuberculous mycobacteria (NTM) periprosthetic infections after breast augmentation procedures are increasingly common worldwide and should raise suspicion after empirical antimicrobial therapy fails but clinical signs of infection persist. In this case experience, the authors suggest the use of negative pressure wound therapy (NPWT) for NTM-infected wounds to obtain a faster periprosthetic space closure, shorten healing time, and anticipate breast reimplantation.</p><p><strong>Case report: </strong>This case report describes the successful application of NPWT to manage wound healing after breast removal in a 60-year-old female who underwent secondary breast augmentation 7 years before. The patient presented with an M. abscessus infection of the left breast after lung segmentectomy that persisted post-implant removal and targeted antibiotic therapy. Based on clinical and laboratory findings, the authors opted for a debridement of the periprosthetic space associated to a radical capsulectomy. Application of NPWT for wound drainage and closure allowed a faster recovery, reduced interval from implant removal to reimplantation, and led to a pleasant cosmetic result.</p><p><strong>Conclusion: </strong>The use of NPWT for wound management after NTM peri-implant infection may help to encourage faster periprosthetic space drainage and closure, thus expediting the timing of a negative culture and breast reimplantation.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 11","pages":"392-396"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simplified treatment of chronic scalp wounds with exposed skull.","authors":"John E Gatti, Robert B Sollitto","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Exposed cranial bone can present a considerable challenge to the reconstructive surgeon. Removal of the outer cortex of exposed skull bone has proven effective in the management of complex scalp wounds for which traditional reconstruction efforts were limited.</p><p><strong>Objective: </strong>To demonstrate a simplified approach for management of scalp wounds with exposed skull.</p><p><strong>Methods: </strong>Chronic wounds with exposed skull bone in elderly patients who were poor candidates for complex reconstructions were treated with removal of the exposed, outer bone cortex. The wounds involved desiccated, exposed bone and sites of superficial osteomyelitis with surrounding thin, atrophic skin that negated local skin flap reconstruction. Conscious sedation and local anesthesia were used during outpatient procedures. A rotating drill with a grinding burr was used to remove the outer cortical bone. The uncovered medullary bone was managed conservatively with moisturizing ointments and light dressings. The patients were followed as outpatients to document progress of wound healing. Skin grafting was not used.</p><p><strong>Results: </strong>Eight patients with exposed skull after treatment for invasive skin cancers were treated with removal of the outer cortex in the areas of exposure. The patients were elderly (mean age, 83 years), had numerous medical problems, and were poor candidates for complex surgery. Osteomyelitis was present in 3 patients. Seven patients with scalp wounds were successfully treated with cortical craniectomy, including a 92-year-old female with a large defect. A different female patient, with recurrent squamous cell carcinoma of the forehead after radiation, experienced disseminated cancer, and her wounds did not heal.</p><p><strong>Conclusion: </strong>Exposed skull bone is prone to desiccation and subsequent osteomyelitis if left untreated. Complex reconstructions may not be appropriate in many situations. Atrophic scalp skin, radiation injury, and scarring from previous skin cancer surgery often limit local skin flap options. Cortical craniectomy of the exposed skull bone is a simple, local technique that allows for healthy granulation tissue to develop. Conservative wound therapy ensuring a moist environment allows for secondary wound healing. Skin grafting may be used after a vascular base develops to shorten healing time.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 10","pages":"342-349"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical corticosteroid powder for peristomal pyoderma gangrenosum: a systematic review.","authors":"Manjit Kaur, Benjamin H Kaffenberger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Peristomal pyoderma gangrenosum (PPG) is a critical complication after surgical ileostomy or colostomy placement. While topical treatments are often effective, most of the available vehicles reduce ostomy pouch adhesion. There are no commercially available corticosteroid powders for topical application; however, using powder from crushed corticosteroid tablets or capsules may circumvent this issue.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of topical corticosteroid powders to treat PPG.</p><p><strong>Methods: </strong>This review was registered with the international prospective register of systematic reviews (PROSPERO) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Embase databases were searched from inception to October 23, 2023, using keywords \"crushed\", \"powdered\", \"tablets\", \"capsules\", and \"pyoderma gangrenosum.\"</p><p><strong>Results: </strong>Of 54 results identified, 5 studies comprising 3 case reports and 2 case series met the eligibility criteria. Risk of bias was assessed using Joanna Briggs Institute critical appraisal checklists. The 5 studies included a total of 13 patients. Twelve of 13 patients (92.3%) achieved complete wound healing, a decrease in pain, and improved pouch adherence. No side effects were reported.</p><p><strong>Conclusion: </strong>Crushed corticosteroid tablets and powder from capsules are potentially useful forms of topical therapy for PPG because of their efficacy and ability to facilitate pouch adhesion. However, there is limited evidence, and future randomized clinical trials are necessary to confirm the findings.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 10","pages":"331-337"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economic and quality effects of wound cleansing with pure hypochlorous acid: evidence-based evaluation and clinical experience.","authors":"Peter J Mallow, Joyce Black, Abigail E Chaffin, Kara S Couch, Elizabeth Faust, Luis G Fernández, Kathy E Gallagher, Loan Lam, Jeffrey A Niezgoda, Dot Weir","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic or hard-to-heal wounds fail to proceed through an orderly and timely healing process, resulting in a lack of anatomic and functional integrity. Infection is a common driver of nonhealing processes; therefore, infection prevention and management are essential components to healing chronic wounds. Inexpensive specialized cleansers, such as pure hypochlorous acid (pHA), can be used to cleanse vulnerable wounds to reduce microbial burden, thereby reducing the risk of infection and significantly decreasing the likelihood of the patient developing a costly wound complication.</p><p><strong>Objective: </strong>To report the findings of an expert panel composed of 10 health care professionals (HCPs) from diverse medical specialties convened to discuss the use of pHA in various care settings.</p><p><strong>Methods: </strong>During the panel discussion, experienced HCPs presented specific case examples in which pHA was used, along with associated costs.</p><p><strong>Results: </strong>A major theme of the panel discussion was the widespread benefit of pHA across various types of wounds and wound care settings. In addition, the patient cases illustrated a negligible economic impact of pHA coupled with positive effects on patient outcomes. This work did not include the development of a consensus statement.</p><p><strong>Conclusion: </strong>Together, the information presented in the panel discussion supports pHA as a dominant strategy (more effective, less costly) compared with standard wound management practices in many treatment settings.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":"36 10","pages":"S1-S13"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}