Advances in wound care最新文献

{"title":"Long-Term Efficacy of Guideline-Followed Treatment in Patients with Livedoid Vasculopathy: A Single-Center Study.","authors":"Carina Hillgruber, Carolin Mitschang, Maria Eveslage, Karen Fischhuber, Michael Storck, Christian Drerup, Tobias Goerge","doi":"10.1177/21621918251395013","DOIUrl":"10.1177/21621918251395013","url":null,"abstract":"<p><strong>Objective: </strong>Livedoid vasculopathy is a skin disease characterized by recurrent painful ulcerations of the lower leg leading to scar formation (atrophie blanche). Ulceration results from thrombosis of the cutaneous microcirculation and is often preceded by irregular broken circles of skin discoloration (livedo racemosa) in the lower extremities. Intense local ischemic pain, ulcerations, and irreversible scarring have a severe impact on patients' quality of life. There are currently no approved treatments for livedoid vasculopathy, making off-label therapy the only option. The German S1 guideline for treatment of livedoid vasculopathy recommends anticoagulation with low-molecular-weight heparins, rivaroxaban, and other direct oral anticoagulants as first-line therapy.</p><p><strong>Approach: </strong>We present a single-center follow-up study of 26 patients with livedoid vasculopathy (following STROBE). Patients treated according to the German S1 guideline consented to be monitored with a cross-sectional study questionnaire providing data on demographics, treatment protocol, disease course (pain, disease activity, and relapses), quality of life (Dermatology Life Quality Index score), and daily life impact.</p><p><strong>Results: </strong>Prolonged guideline-followed treatment of livedoid vasculopathy leads to effective management of pain and disease activity. Patients report therapy satisfaction and profit by sustained benefits in quality of life.</p><p><strong>Innovation: </strong>In this study, we analyzed the long-term efficacy of guideline-followed treatment in patients with livedoid vasculopathy over a period of up at least 3 months to more than 24 months.</p><p><strong>Conclusion: </strong>Guideline-followed treatment with anticoagulants like rivaroxaban is an effective long-term therapy option for patients with livedoid vasculopathy.[Figure: see text].</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"898-906"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Nutritional Index as a Predictor of Mortality in Intensive Care Unit Patients with Pressure Injuries: Insights from a Large Cohort Study.","authors":"Wen Gao, Jia-Tong Zhou, Ke Shi, Jian-da Zhou","doi":"10.1177/21621918251387643","DOIUrl":"10.1177/21621918251387643","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between the Prognostic Nutritional Index (PNI) and mortality risk in intensive care unit (ICU) patients with pressure injuries (PIs) to provide a basis for early risk stratification and clinical decision-making.</p><p><strong>Approach: </strong>This retrospective cohort study used data from the Medical Information Mart for Intensive Care IV database, which included 972 ICU patients diagnosed with PI. Patients were stratified by median PNI levels, and Kaplan-Meier survival analysis, Cox regression, logistic regression, restricted cubic splines, and propensity score matching (PSM) were performed to assess the relationship between PNI and 28-day, 90-day, and ICU mortality.</p><p><strong>Results: </strong>A higher PNI was significantly associated with lower 28-day (hazard ratio [HR] = 0.702, 95% confidence interval [CI] 0.551-0.895), 90-day (HR = 0.722, 95% CI: 0.576-0.905), and ICU mortality (odds ratio [OR] = 0.644, 95% CI: 0.474-0.872). An L-shaped relationship between the PNI and all-cause mortality was observed. This association remained robust after multivariate adjustment, subgroup analysis, and PSM.</p><p><strong>Innovation: </strong>This study is the first to evaluate the prognostic significance of the PNI in ICU patients with PIs, addressing the gap in current research by identifying a simple and accessible marker associated with mortality risk in this vulnerable population.</p><p><strong>Conclusion: </strong>PNI can be calculated from routine laboratory results and may guide early nutritional or wound care interventions in ICU patients with PI. A PNI value below 19.02 is associated with an increased risk of mortality (<i>i.e.</i>, PNI <19.02 = high risk) and serves as a critical threshold for identifying patients at elevated risk.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"871-882"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Deficiency in the Electrical Current of Injury a Barrier to Healing in Hard-to-Heal Wounds? A Systematic Review with Implications for the TIMERS Paradigm.","authors":"Jenny Smith, Richard Nuccitelli, Min Zhao, Leanne Atkin, Caroline Dowsett, Hervé Maillard, Terry Swanson, Jacqui Fletcher, Harikrishna K R Nair, Keryln Carville, Robin Martin, Emma Woodmansey","doi":"10.1177/21621918251373053","DOIUrl":"10.1177/21621918251373053","url":null,"abstract":"<p><strong>Objectives: </strong>Endogenous bioelectric signaling (including transepidermal potential [TEP] and the current of injury) plays a fundamental role in normal wound repair. Despite this, commonly used wound management frameworks do not consider this important driver of healing. The objectives of this review are to explore whether the patient characteristics/pathologies common in delayed healing are associated with weakened electrical properties of the skin and to consider whether compromised currents of injury are a barrier to healing that could be addressed with electrical stimulation therapy (EST) and incorporated into existing frameworks.</p><p><strong>Approach: </strong>This systematic review of PubMed was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and aimed to explore the impact of three characteristics associated with delayed healing (older age, diabetes, and chronic inflammation) on the electrical properties of skin/wounds.</p><p><strong>Results: </strong>Twelve relevant studies were identified, revealing that TEP in older or diabetic people is significantly lower, and the current of injury is approximately half that of young, healthy controls.</p><p><strong>Innovation: </strong>Lower currents of injury are associated with slower wound healing; therefore, the reduced current of injury/TEP identified here can be considered a barrier to healing. EST is designed to boost the weakened current of injury, back up to normal levels, stimulating a healing response. The incorporation of EST into existing wound management frameworks is therefore proposed.</p><p><strong>Conclusion: </strong>Endogenous bioelectrical signaling in the wound healing process appears to be compromised particularly in older people and those with diabetes. Patients may benefit from incorporating treatment with EST, which boosts bioelectrical signaling, into relevant wound treatment frameworks.[Figure: see text].</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"907-920"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Gene to Scar: Proteome-Wide Causal Insights into Keloid Pathogenesis and Prevention.","authors":"Yantao Xu, Jia-Chen Liu, Zixi Jiang, Jingheng Zhang, Renliang He, Miaojian Wan, Shuang Zhao","doi":"10.1177/21621918251387987","DOIUrl":"10.1177/21621918251387987","url":null,"abstract":"<p><strong>Objective: </strong>Keloids (KLs) and hypertrophic scars are common fibroproliferative disorders that cause significant functional and psychosocial distress. The lack of effective prevention and treatment strategies underscores the urgent clinical need to identify novel therapeutic targets and modifiable risk factors to improve patient outcomes.</p><p><strong>Approach: </strong>We conducted a comprehensive large-scale Mendelian randomization study to systematically assess the causal effects of 4,907 plasma proteins and 8,155 lifestyle and disease-related traits on KL risk. To validate our findings and explore the underlying cellular mechanisms, we analyzed the largest to-date single-cell RNA sequencing dataset for KLs, comprising 194,366 cells from 30 patients. Mediation analysis was used to dissect the pathways through which the identified proteins exert their effects.</p><p><strong>Results: </strong>Our proteome-wide analysis revealed R-spondin 3 (RSPO3) as a potent causal risk factor for KL development. These findings were corroborated at the tissue level, where RSPO3 expression was significantly upregulated specifically in KL-derived fibroblasts. Furthermore, our phenome-wide association screen revealed that several lifestyle and psychological factors, including alcohol intake, depression, and sleep disorders, are causally associated with an increased risk of KLs, whereas higher adult education status was identified as a protective factor.</p><p><strong>Innovation: </strong>This study establishes a pioneering multilayered causal inference framework by systematically integrating large-scale proteomics, phenomics, and single-cell transcriptomics. It moves beyond traditional association studies to first perform an unbiased, proteome-wide search for causal drivers of KL pathogenesis and then validate the top candidates at single-cell resolution. This \"gene-cell-phenotype\" strategy is the first to robustly link a genetically validated protein target (RSPO3) to its specific cellular origin (fibroblasts) in KLs.</p><p><strong>Conclusions: </strong>This study identifies RSPO3 as a promising, fibroblast-derived therapeutic target for KLs. In addition, we established a causal link between modifiable lifestyle factors and KL risk. These findings integrate genetic, proteomic, and single-cell data to significantly advance our understanding of KL pathogenesis.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"883-897"},"PeriodicalIF":5.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Negative Pressure Wound Therapy Combined with Topical Oxygen Therapy in Treating Chronic Refractory Wounds: A Systematic Review and Meta-Analysis.","authors":"Junwei Su, Dong Zhang, Jincheng Du, Ruozu Xiao, Zhe Liu, Yuqian Li, Haowei Zhou, Jing Li","doi":"10.1177/21621918251366606","DOIUrl":"10.1177/21621918251366606","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy (TOT) for chronic refractory wounds (CRWs), addressing potential hypoxia limitation of NPWT through oxygen supplementation, thereby offering an innovative therapeutic approach for CRWs.</p><p><strong>Approach: </strong>The study was performed according to the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. A comprehensive search was conducted in PubMed, Cochrane, Embase, Web of Science, CNKI, VIP, and Wanfang databases for randomized controlled trials (RCTs) on the treatment of CRWs with NPWT combined with TOT (inception to October 2024). Studies were screened based on predefined criteria, and data were extracted and assessed using RevMan 5.4. Meta-analysis, sensitivity analysis, and publication bias assessment were performed using Stata 15.0.</p><p><strong>Results: </strong>Eleven RCTs (844 patients) were included. Compared with NPWT, the combination therapy was associated with the following outcomes: increased healing rate (risk ratio [RR] = 1.51, 95% confidence interval [CI]: 1.36-1.69, <i>I</i>² = 18.1%), reduced time from debridement to skin grafting (mean difference [MD] = -2.82 days, 95% CI: -3.15 to -2.50, <i>I</i>² = 4%), shortened healing time (MD = -9.09 days, 95% CI: -11.98 to -6.20, <i>I</i>² = 91.2%), enhanced granulation coverage (MD = 7.56%, 95% CI: 6.09-9.03, <i>I</i>² = 0.0%), and decreased bacterial positivity (RR = 0.27, 95% CI: 0.18-0.41, <i>I</i>² = 0.0%).</p><p><strong>Innovation: </strong>This study provides evidence-based medical research supporting NPWT plus TOT as a synergistic strategy for CRWs.</p><p><strong>Conclusion: </strong>Combined therapy may offer benefits over NPWT alone in CRW treatment, suggesting a promising approach to improve healing outcomes.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"801-811"},"PeriodicalIF":5.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective Autophagy: A Potential Player in Cutaneous Wound Healing.","authors":"Weixue Jin, Danyang Ren, Meirong Yu, Yi Li, Wei Zhang, Songxue Guo","doi":"10.1177/21621918251372954","DOIUrl":"10.1177/21621918251372954","url":null,"abstract":"<p><strong>Significance: </strong>Refractory wounds are complicated multistep biological processes that can lead to severe complications in patients. Selective autophagy plays a crucial role in precisely controlling the quality of intracellular components and regulating biological behavior. This review explores the features and underlying mechanisms of various types of selective autophagy and highlights their implications in burn injury and wound healing.</p><p><strong>Recent advances: </strong>In-depth studies have underscored the critical role of selective autophagy, including mitophagy, endoplasmic reticulum (ER)-phagy, pexophagy, xenophagy, lysophagy, ferritinophagy, and lipophagy, in effectively controlling the quality of intracellular components and regulating biological behavior, which may enhance wound-healing process.</p><p><strong>Critical issues: </strong>Autophagy is a housekeeping and self-renewal process that utilizes lysosomal machinery to degrade and recycle cellular components, thereby enhancing cellular adaptability to stressful conditions. In addition to nonselective bulk degradation, autophagy selectively recycles specific cell constituents, including mitochondria, ER, peroxisomes, pathogens, lysosomes, lipid droplets, and ferritin. The effective management of the quality of cellular components during wound healing remains a challenge in clinical practice.</p><p><strong>Future directions: </strong>Understanding the basic mechanisms and intricate crosstalk underlying selective autophagy may facilitate the development of comprehensive strategies and therapeutic targets for wound healing.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"812-846"},"PeriodicalIF":5.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-State Modeling of Pressure Injury Staging Transition Trajectories to Inform Next-Generation Clinical Decision Support.","authors":"Wenyu Song, Min-Jeoung Kang, Luwei Liu, Michael Sainlaire, Graham Lowenthal, Veysel Karani Baris, Sandy Cho, Diane L Carroll, Debra Furlong, Wadia Gilles-Fowler, Luciana Goncalves, Stuart Lipsitz, Beth Melanson, Lori Morrow, Jacqueline Massaro, Tanya Martel, Paula Wolski, Linying Zhang, David W Bates, Patricia C Dykes","doi":"10.1177/21621918251372959","DOIUrl":"10.1177/21621918251372959","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the location-specific and time-sensitive trajectories of pressure injuries (PrIs) stages using real-world electronic health record (EHR) datasets.</p><p><strong>Approach: </strong>Using a dataset of 29,475 patients with records of PrIs documented from 2015 to 2023, we developed four PrI patient sub-cohorts with common PrI locations, including coccyx, buttocks, sacrum and heel. We estimated transition intensities between three PrI states: stage 1, stage 2, and a severe stage in each group. Stages and transition paths were derived from domain knowledge provided by clinical experts and The National PrI Advisory Panel (NPIAP) guidelines.</p><p><strong>Results: </strong>The trajectory analysis suggested that stage 2 serves as a \"gateway state\" in all four locations, meaning that once a PrI reaches stage 2, the likelihood of transiting to severe stages increases significantly. The commonly used Braden Scale and its sub-components are more likely to be associated with transitions from stage 2 to severe stages, suggesting that manual risk assessment tools are suboptimal for predicting early-stage PrI transitions. Further, we observed race-dependent variations across injury location groups.</p><p><strong>Innovation: </strong>To our knowledge, this is the first study to introduce multi-state trajectory analysis in PrI research. Our model can investigate PrI status in a dynamic manner, which fills an important gap in the field.</p><p><strong>Conclusion: </strong>Our findings underscore the lack of time-sensitive information in existing PrI risk assessment tools, revealing a critical gap in their ability to capture the dynamic nature of PrI progression. Clinical decision support using time sensitive data is needed for delivering personalized, timely, and effective PrI prevention.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"791-800"},"PeriodicalIF":5.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Pressure Injury Diagnosis: A Critical Appraisal for Clinical Practice.","authors":"Yuting Wei, Xiaodan Liu, Juhong Pei, Hongyan Zhang, Lin Han","doi":"10.1177/21621918251388015","DOIUrl":"10.1177/21621918251388015","url":null,"abstract":"<p><strong>Significance: </strong>Pressure injury is one of the most common health problems among hospitalized patients worldwide, and accurate and timely diagnosis is crucial for its treatment. Research on the application of artificial intelligence in the diagnosis of pressure injury is increasing, but there is currently no comprehensive meta-analysis to evaluate the accuracy of artificial intelligence in diagnosing different pressure injury stages.</p><p><strong>Recent advances: </strong>This study synthesizes evidence on artificial intelligence diagnosis of pressure injury, focusing on evaluating diagnostic performance across different stages using core metrics including sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve.</p><p><strong>Critical issues: </strong>Key findings from 21 included studies (12 contributing 47 eligible datasets) indicate high overall diagnostic accuracy of artificial intelligence for pressure injury, with sensitivity of 0.74 (95% confidence interval [CI]: 0.69-0.78), specificity of 0.93 (95% CI: 0.91-0.94), and area under the SROC curve of 0.92 (95% CI: 0.90-0.94). Moreover, the area under the SROC curve varies across different stages of pressure injury, with area under the curve values for stage 1, stage 2, stage 3, stage 4, unstageable, and deep tissue pressure injury of 0.95 (0.93-0.97), 0.85 (0.82-0.88), 0.88 (0.84-0.90), 0.94 (0.92-0.96), 0.96 (0.94-0.97), and 0.98 (0.96-0.99), respectively.</p><p><strong>Future directions: </strong>Artificial intelligence models based on pressure injury image data show substantial potential for clinical application in pressure injury diagnosis. However, the need for high-quality studies with rigorous reporting and external validation remains critical to address current limitations and advance clinical translation.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"847-866"},"PeriodicalIF":5.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting Issues Limiting Independent Evaluation of Mortality and Major-Amputation Risk Scores in Diabetic Foot Ulcers: Letter to the Editor and Author Response.","authors":"Ji Liu, Feng Liu, Yong Zeng","doi":"10.1177/21621918261498837","DOIUrl":"https://doi.org/10.1177/21621918261498837","url":null,"abstract":"","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"21621918261498837"},"PeriodicalIF":5.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Management Improves Re-Admission, Major Amputation, and Mortality Rates in Patients with Diabetic Foot Ulcers.","authors":"Chi-Wei Chiu, Wen-Teng Yao, Chieh-Ming Yu, Yu-Fan Chen, Ya-Shu Chan, Hsuan-Yu Huang, An-Li Lee, Ying-Chun Liu, Shu-Tien Huang, Liong-Rung Liu, Yueh-Hung Lin, Kung-Chen Ho, Chia-Meng Yu, Wen-Chen Huang, Kwang-Yi Tung, Ming-Feng Tsai","doi":"10.1089/wound.2024.0182","DOIUrl":"10.1089/wound.2024.0182","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the impact of a multidisciplinary team (MDT) approach in the management of diabetic foot ulcers (DFUs).</p><p><strong>Approach: </strong>A multidisciplinary diabetic foot care center (MDDFCC) was opened at our institution in August 2018. Outcomes of DFU treatment, including re-admission, amputation, and mortality rates, were compared before and after opening the MDDFCC.</p><p><strong>Results: </strong>Patients seen after the MDDFCC was opened had a lower risk of 1-year re-admission (hazard ratio [HR] = 0.697, 95% confidence interval [CI]: 0.387-0.988), 1-year major amputation (HR = 0.447, 95% CI: 0.091-0.984), and 1-year disease-specific mortality (HR = 0.277, 95% CI: 0.105-0.730). PEDIS score (HR = 2.343, 95% CI: 1.264-2.971), history of dialysis (HR = 1.858, 95% CI: 1.258-4.053), and consultation with a physiatrist (HR = 0.368, 95% CI: 0.172-0.788), orthopedist (HR = 0.105, 95% CI: 0.042-0.261), or social worker (HR = 0.370, 95% CI: 0.082-0.871) were associated with 1-year major amputation. One-year major amputation (HR = 2.636, 95% CI: 1.586-4.570), age (HR = 1.094, 95% CI: 1.051-1.140), and C-reactive protein level (HR = 1.052, 95% CI: 1.008-1.098) were associated with 1-year disease-specific mortality.</p><p><strong>Innovation: </strong>Plastic surgeons received patients at the MDDFCC, with active participation by all contributing members. This arrangement brought advantages, including more aggressive and timely surgical intervention, a more timely and higher rate of percutaneous transluminal angioplasty, and equally robust integrated medical care by all other members.</p><p><strong>Conclusion: </strong>The MDDFCC approach may be a potential organizational structure with for treating DFUs, resulting in significant improvements in outcomes of DFU including a lower re-admission, amputation, and mortality.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"711-721"},"PeriodicalIF":5.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}