Conectar
Wound care in calciphylaxis remains poorly defined without evidence-based consensus on timing and technique of surgical intervention. We demonstrate that surgical debridement and subsequent wound closure are safe and effective in calciphylaxis and describe a systematic multidisciplinary approach to intervention. We retrospectively reviewed a cohort of patients with calciphylaxis at our institution. Those who underwent surgical debridement and wound closure were analysed with emphasis on wound healing, progression to amputation and mortality. Sixty-two patients with calciphylaxis underwent surgical debridement. Twenty patients had wound closure by skin grafting, five were excised with primary wound closure, and 37 were debrided and allowed to heal by secondary intention. There were excellent rates of healing in all groups, and no patients demonstrated wound progression or new lesions following operative intervention. Surgical debridement and wound closure are safe and effective in treating wounds related to calciphylaxis.
Pressure ulcers (PUs) (also termed pressure injuries [PIs]) remain a major patient safety issue, particularly in critical care and other high-risk healthcare settings. Nurses are central to PUs/PIs prevention; however, deficiencies in knowledge, attitudes, and preventive practices among nursing staff may negatively affect patient outcomes. To systematically synthesise global evidence on nurses' knowledge, attitudes, and practices related to PUs/PIs prevention, and to identify factors influencing preventive performance. A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases including PubMed, CINAHL, EBSCO, MEDLINE, PsycINFO, and Springer were searched for studies published between 2011 and 2025. Eligible studies were primary research articles examining registered nurses' knowledge, attitudes, and/or practices regarding PUs/PIs prevention, using cross-sectional, observational, or non-experimental designs. Data extraction focused on study characteristics, settings, samples, assessment instruments, and key outcomes related to knowledge, attitudes, and preventive practices. Due to methodological heterogeneity, a narrative synthesis was performed. Twenty-nine studies from diverse geographical regions were included, with sample sizes ranging from 28 to 950 nurses. Overall, nurses' knowledge of PUs/PIs prevention was frequently inadequate, particularly in prevention-specific domains. In contrast, attitudes toward prevention were generally positive across studies. Preventive practices, however, were often suboptimal. Commonly reported barriers included staff shortages, high workload, limited resources, and insufficient institutional support. Higher educational attainment, specialised clinical experience, recent training, and professional seniority were consistently associated with better knowledge, more positive attitudes, and improved preventive practices. Although nurses generally demonstrate positive attitudes toward PUs/PIs prevention, persistent gaps in knowledge and practice remain. These findings underscore the need for structured education programmes, simulation-based training, and strengthened organisational support to enhance adherence to evidence-based prevention strategies. Future research should employ experimental and longitudinal designs, standardised measurement tools, and broader international representation to support sustainable improvements in PUs/PIs prevention and patient safety.
Skin failure is increasingly recognised across healthcare settings, yet its definition, diagnostic criteria and relationship to pressure injuries remain inconsistent with little interdisciplinary consensus. This lack of clarity complicates bedside assessment, documentation and quality reporting. Historically, pressure injuries were viewed as preventable events associated with inadequate care, but growing evidence shows that some wounds develop despite optimal preventive measures, particularly in patients with multimorbidity or limited physiological reserve. This article will review the historical development of skin failure and how it is intertwined with contrasting theories of pressure injury formation that began in the 19th century. We will track the proliferation of definitions and overlapping terms that muddle contemporary documentation and classification, and demonstrate why a unified definition is urgently needed. Skin failure represents the intersection of tissue deformation with systemic vulnerability including hypoperfusion, inflammation, vascular dysfunction, oedema, medication effects, immune compromise, nutritional depletion and age-related changes. A meaningful and practical definition must span all healthcare environments and patient populations, supporting accurate diagnosis and equitable evaluation of care quality. We outline a call to action that includes interdisciplinary consensus, standardised terminology and the development of predictive tools that integrate physiologic data, advanced analytics, and patient-centered outcomes across the healthcare continuum.
Preventing pressure injuries among nursing home residents is a significant challenge that necessitates understanding the barriers and facilitators from the perspective of staff. This qualitative study aimed to describe these factors within Sri Lankan nursing homes. Semi-structured interviews were conducted with 15 nursing home staff members from nine nursing homes in and near the Colombo district, Sri Lanka. The study was informed by the capability, opportunity, motivation, and behaviour model that guided both data collection and analysis. Data were analysed using content analysis. Using deductive coding based on capability, opportunity, and motivation, followed by inductive analysis, four primary categories emerged: focusing on skincare is foundational for pressure injury prevention, pressure injury knowledge is critical for prevention, pressure injury prevention is a low organisational priority, and overcoming challenges to enact pressure injury prevention. Key facilitators included access to skincare products, maintaining clean and dry skin, recognising risk factors, proactively managing risks, and understanding the broader implications of pressure injuries on residents and their families. Conversely, barriers encompassed limited training, varying staff support, inadequate resources, and the complexities of managing multiple tasks. This research highlights that enhancing knowledge and allocating resources effectively can improve the implementation of pressure injury prevention strategies in Sri Lankan nursing homes.
The aim in this human trial is to compare the efficacy and safety of polygalacturonic–caprylic acid (PG–CAP) ointment to MediHoney in chronic wounds at three international medical centres. In this prospective open-label study, patients with chronic full-thickness wounds were randomised to daily treatment with PG–CAP ointment or MediHoney. Assessments were obtained weekly for 6 weeks. The validated Pressure Ulcer Scale for Healing (PUSH) score was used to track healing. Efficacies were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables. Twenty-six patients with chronic wounds were included. Baseline characteristics were comparable between the groups; however, the history of diabetes mellitus was higher in the PG–CAP group (p = 0.011). All 13 PG–CAP patients showed improvement (100%), compared to only 69% of the 13 MediHoney patients (p = 0.023). Half of the failures in the MediHoney arm were associated with death (15%). No failures, adverse events or deaths occurred in the PG–CAP arm. PG–CAP wound ointment is a novel combination of two plant-based compounds that pose minimal risk of promoting antimicrobial resistance, was highly effective for eradicating wound-pathogen biofilms in vitro and promoted chronic wound healing in vivo with minimal inflammatory reactions. Our findings support PG–CAP as safe, noninferior and possibly more effective than MediHoney in healing chronic contaminated wounds.
A comprehensive skincare regimen involves cleansing, moisturising, and using skin barrier protectants. Cyanoacrylate-based protectants safeguard vulnerable skin from damage caused by moisture, friction, and shear. This research involved two ex vivo and two clinical studies comparing the wear duration and wash-off resistance of a 100% cyanoacrylate and a solvent-cyanoacrylate mixture. Effectiveness was assessed using an ex vivo porcine skin model simulating urinary incontinence, evaluated with Lucifer yellow dye penetration and Corneometry, and a clinical model using Corneometry. Two single-blind clinical studies measured skin surface electrical capacitance in healthy volunteers. Study 1 (n = 42) evaluated the wear duration over 8 days, while Study 2 (n = 52) examined wash-off resistance after nine washes with various cleansers. Ex vivo results showed that both products were effective under repeated moisture and abrasion conditions, with the 100% cyanoacrylate outperforming the solvent-cyanoacrylate mixture. In clinical studies, both products maintained barrier protection throughout Study 1 (p < 0.007) and none of the cleansers significantly degraded either product in Study 2. In conclusion, the 100% cyanoacrylate provided superior protection compared to the solvent-cyanoacrylate mixture. Both products demonstrated comparable wear duration and wash-off resistance in clinical studies, but the 100% cyanoacrylate was more effective in ex vivo testing under harsh conditions.
Patients with combat wounds and injuries, presented as extensive infected and purulent defects with antibiotic-resistant microflora, were treated in a surgical inpatient setting. Closure of extensive soft tissue defects of the limbs is possible using methods of plastic and reconstructive surgery and requires preoperative infection control. The lack of effect from preoperative treatment for purulent limb defects with antibiotic-resistant microflora leads to limb amputation. This clinical study proposes a method of treatment by hyperbaric oxygenation with an ozone-containing steam–water mixture as an anti-bacterial agent. Eighteen male patients, aged between 20 and 60 years, were categorised into three groups based on the time elapsed since the injury. All patients were treated using the proposed method. The high effectiveness of the proposed method was demonstrated in all groups and resulted in saving limbs from amputation, establishing suitable conditions for closing the soft tissue defects of the limbs and achieving significant progress in the recovery.
Chronic limb-threatening ischemia (CLTI) compounded by diabetic foot ulceration remains a leading precursor to major lower-extremity amputation. Transverse tibial transport (TTT) can improve perfusion but requires corticotomy and bulky external fixation. We report what is, to our knowledge, the first application of fully automated tibial periosteal distraction (PD) for limb preservation. A 65-year-old man with recurrent forefoot gangrene underwent tibial PD using a miniaturised, programmable motor to gradually elevate the periosteum. Through a 1 cm incision, a low-profile subperiosteal plate was implanted and linked to the motor, which advanced 0.031 mm hourly (0.75 mm/day) up to 10 mm. Distraction was completed uneventfully over 13 days, and the device was removed at the bedside on Day 21. Skin temperature increased by 2°C, and digital systolic (toe) pressure rose from 22 to 50 mmHg. The wound progressed to healing without complication. Automated PD may offer a minimally invasive, biologically driven alternative for high-risk CLTI patients, eliminating the need for patient-adjusted screws and standardising adherence. Prospective studies are required to validate its safety, durability, optimal distraction parameters and cost-effectiveness.
Patient participation improves patient outcomes, but factors that predict participation in pressure injury prevention (PIP) are relatively unknown. This study aimed to identify patient-related factors predictive of patient participation in pressure injury prevention (PPPIP) in hospitalised medical and surgical patients and to assess the psychometric properties of the PPPIP scale. This observational substudy recruited consenting adults at risk of pressure who participated in a parent trial. The seven-item PPPIP scale was administered within 48 h of recruitment, with higher scores reflecting more participation. Multiple regression was used to identify patient-related factors predictive of patient participation. The scale's psychometric properties were assessed using confirmatory factor analysis and Cronbach's alpha. In total, usable data were obtained from 856 patients. Mean PPPIP scale scores were relatively high, with 571 (66.7%) scores reflecting agreement or strong agreement. The Cronbach's alpha was 0.81, and most confirmatory factor analysis criteria for construct validity were met. Only the use of mobility aids was statistically significant in the model, but it predicted a small amount of variability in PPPIP score (adjusted R 2 = 0.017; p < 0.001). Targeting patients with limited mobility may be a useful strategy when trying to engage patients in PIP if resources are limited.
There is an urgent need for effective interventions to aid diabetes-related foot ulcer (DFU) healing. This study aimed to test the deliverability of a proposed trial of extracorporeal shockwave therapy (ESWT) for DFU healing. A pilot double-blinded randomised controlled trial. Patients with a DFU present for ≥ 4 weeks were randomised to high dose (500 shocks/cm2), low dose (100 shocks/cm2) or sham (0 shocks/cm2) ESWT, plus standard care. Follow-up was for 24 weeks. Primary outcome was deliverability of the trial. Secondary outcomes were healing, quality of life and healthcare resource use. One-hundred and forty-one (15.6%) screened patients were eligible and 74 (52.5%) patients were recruited. Follow-up attendance was 97.3% (72/74), 93.2% (69/74) and 87.8% (65/74) at 6, 12 and 24 weeks. The median DFU healing time was high dose: 54.0 (IQR 119.0), low dose: 78.5 (IQR 61.0) and sham: 83.0 (IQR 85.0) days. The mean EQ-5D-5L utility value at 24 weeks was high dose: 0.621 (95% CI 0.438–0.804), low dose: 0.779 (95% CI 0.683–0.876) and sham: 0.806 (95% CI 0.717–0.895). Healthcare resource use was lowest in the low-dose ESWT arm. The pilot trial has demonstrated that patients with a DFU are willing to engage in the proposed trial and suggest the optimal way to deliver the definitive trial.
FreshRSS 