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Hyperbaric oxygen therapy (HBOT) is an established adjunctive treatment for selected diabetic foot ulcers, although evidence regarding its effectiveness remains heterogeneous. We conducted a retrospective, single-center, observational study of adult diabetic patients receiving HBOT (2.5 ATA, 100% oxygen) for a lower-limb wound at the only hyperbaric center in Guadeloupe, a French Caribbean territory, between January 2020 and June 2023. Among 257 patients treated with HBOT, 71 diabetic patients met inclusion criteria (mean age 63.1 ± 12.7 years; 69% male). Peripheral arterial disease and osteitis were highly prevalent, while the proportion of current smokers (7.9%) was notably lower than in previously published HBOT cohorts, a distinctive feature of this population. HBOT was considered a last resort, after failure of prolonged conventional therapy, in 63% of patients, likely contributing to the modest six-month healing rate of 34% (18/53 evaluable patients) and 19% rate of major amputation occurring during or after HBOT. Patients referred through the multidisciplinary Diabetic Foot Care Unit had fewer major amputations despite older age and greater vascular burden, though this comparison may reflect referral-related selection bias. No candidate factor, including glycemic control, referral pathway, or delay to HBOT, reached statistical significance in univariable analysis. This descriptive, single-arm finding cannot establish HBOT efficacy but is consistent with a role for HBOT within coordinated multidisciplinary diabetic foot care, highlighting the importance of earlier referral and optimised patient selection.
Venous leg ulcers are a common manifestation of chronic venous disease and are associated with substantial morbidity and impaired health-related quality of life (HRQoL). Patient-reported outcome measures are essential for capturing the patient perspective of disease burden and treatment outcomes in wound care management. The Sheffield Preference-based Venous Ulcer questionnaire (SPVU-5D) is a concise preference-based instrument designed to assess the quality of life in individuals with venous leg ulcers and to support health-economic evaluation. However, its measurement properties have not been extensively examined in different linguistic contexts. This study aimed to evaluate the psychometric properties of the Spanish version of the SPVU-5D in patients with venous leg ulcers. A methodological validation study was conducted involving 132 patients (264 observations from pre- and post-treatment assessments) with a mean age of 63.76 ± 10.02 years. Cross-cultural adaptation followed the established guidelines for translation and cultural equivalence. Content validity was assessed using Aiken's V coefficient. Structural validity and reliability were examined using multilevel confirmatory factor analysis and measurement performance was further evaluated using a multilevel graded response model based on item response theory. Floor and ceiling effects, minimum detectable change and convergent validity with the RESVECH 2.0 clinical scale were also evaluated. Confirmatory factor analysis supported a unidimensional structure with excellent fit indices and satisfactory internal consistency. Item response theory analyses showed high item discrimination and well-distributed difficulty thresholds for the items. The floor and ceiling effects were minimal, indicating adequate sensitivity across the latent trait continuum. The Spanish version of the SPVU-5D demonstrates satisfactory validity, reliability and measurement precision and represents a useful instrument for assessing the health-related quality of life in patients with venous leg ulcers.
This study examines factors associated with deep tissue pressure injury and develops interpretable machine learning models for early risk prediction in adult ICU patients. This retrospective observational cohort study included 336 adult intensive care unit patients, of whom 211 developed deep tissue pressure injury and 125 remained pressure injury-free. For patients who developed deep tissue pressure injury, haemodynamic, laboratory and nursing variables from the 24 h before injury onset were analysed using a physiological time-at-risk framework. For pressure injury-free patients, corresponding variables from the first 24 h after intensive care unit admission were used. Six supervised machine learning classifiers were developed and internally validated using cross-validation and hyperparameter optimization. All models showed good predictive performance. Extreme gradient boosting achieved the highest discriminative ability, with an area under the receiver operating characteristic curve of 0.976. The most influential predictors across feature selection methods were low-molecular-weight heparin use, norepinephrine duration, lower blood pressure values, immobility, nutritional risk, antiplatelet therapy and chronic disease profile. Routinely documented nursing and haemodynamic indicators obtained within a clinically relevant 24-h risk window can support accurate early risk stratification for deep tissue pressure injury in adult intensive care unit patients. A physiology-informed and interpretable machine learning approach may improve recognition of patients at imminent risk.
This single-centre, randomised, controlled study assessed the wound healing efficacy of adhesive bandages in eligible healthy adults (N = 36) aged 25–55 with Fitzpatrick skin types II and III using a model of laser-induced wounds. Here, we report data for wounds that were randomised to treatment with either a hydrocolloid bandage for multi-day use (BAND-AID Adhesive Bandage Hydroseal), standard of care (SoC) (BAND-AID Adhesive Bandage Tru-Stay Sheer) or an uncovered control. Primary endpoints included the time to complete healing and a composite wound healing score. Hydrocolloid bandage-treated wounds healed twice as fast as the uncovered control or SoC-treated wounds. Median time (days) to complete healing was significantly faster for the hydrocolloid bandage-treated wounds (6.9) versus SoC (11.9) and uncovered control (11.8). Hydrocolloid bandage-treated wounds had significantly better composite wound healing scores versus SoC and versus uncovered control over 2 weeks. At Day 28, cosmesis was better with hydrocolloid bandage treatment (0.3) versus SoC (0.6) and uncovered control (2.1) (change from baseline in a composite scar score; higher score = worse outcome). Multi-day wound occlusion with a hydrocolloid bandage promoted faster healing and improved cosmesis compared with daily SoC dressings or uncovered control.
Chronic lower limb ulcers remain difficult to manage when unresponsive to conventional treatment. This study evaluated the clinical and physiological effects of vacuum compression therapy on wound healing and quality of life. Fifty patients with chronic lower limb ulcers were randomised to receive 12 sessions of vacuum compression therapy plus standard care or standard care alone over 4 weeks. Wound dimensions, exudate, pain intensity and quality of life were assessed at baseline and post-treatment. Estimated wound volume was calculated as length × width × depth. Tissue oxygenation was measured at the dorsum of the foot in the experimental group. The vacuum compression therapy group showed greater improvements in wound width, depth, volume and quality of life. Estimated wound volume decreased by 61% in the intervention group, whereas no statistically significant volume reduction was observed in controls. Local tissue oxygenation in the experimental group increased by 43%. Baseline wound size was associated with poorer quality of life. Vacuum compression therapy may enhance wound healing and quality of life in patients with chronic lower limb ulcers. Observed increases in local tissue oxygenation represent exploratory physiological findings within the treated cohort that warrant controlled comparative evaluation.
Trial Registration: ClinicalTrials.gov identifier: NCT07737184.
The Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded eligibility for community-based care particularly for Veterans facing geographic or capacity-related barriers. Patients with diabetic foot ulcers (DFU) require timely specialty management and are vulnerable to fragmented care, yet little is known about how the MISSION Act reshaped patterns of DFU-related specialty care within and outside the VA. We conducted a retrospective cohort study of Veterans aged 65 or older with a new DFU diagnosis in VA between 2016 and 2022. We identified DFU-related specialty encounters (podiatry, vascular surgery, infectious diseases and endocrinology) and categorised community encounters as VA-paid or Medicare-paid. We assessed annual trends in community specialty care and changes in the proportion and payer type of care before and after the MISSION Act. Among 76 398 patients, VA-paid community specialty care increased substantially following the MISSION Act, with larger relative growth among rural Veterans (rural: +119%; urban: +96%). In contrast, Medicare-paid DFU specialty care declined during the same period (rural: −12%; urban: −13%). Following the MISSION Act, reliance on VA-paid community specialty care increased markedly for Veterans with DFU, particularly in rural areas, while reliance on Medicare-paid care decreased.
Venous ulcers are the most common lower-limb lesions (60%–80%), affecting about 0.3% of the population. Their chronic nature leads to high recurrence rates (up to 70% within 12 months), impacting quality of life and healthcare costs. Although several factors associated with venous leg ulcer recurrence have been identified, evidence integrating clinical, sociodemographic, functional, and behavioural characteristics in relation to both recurrence occurrence and recurrence risk remains limited. This study aimed to analyse factors associated with venous leg ulcer recurrence within the previous 12 months and with 12-month recurrence risk among people with a history of venous leg ulcer recurrence living in inland Portugal. A quantitative, cross-sectional, correlational study was conducted with 208 adults recruited from three Portuguese healthcare institutions. Data were collected using questionnaires and analysed using descriptive statistics, non-parametric tests, binary logistic regression and ordinal logistic regression. Participants were mostly older adults (72.86 ± 12.18 years), had a high mean body mass index, and presented multiple comorbidities. Recurrence within the previous 12 months occurred in 70% of participants with available data. In the adjusted binary logistic regression model, older age (aOR = 1.061; 95% CI: 1.022–1.102), history of deep vein thrombosis (aOR = 17.275; 95% CI: 3.154–94.624), presence of sadness (aOR = 2.558; 95% CI: 1.077–6.075), non-use of preventive compression (aOR = 3.836; 95% CI: 1.584–9.291), and educational attainment were associated with recurrence within the previous 12 months. In the ordinal logistic regression model, older age (aOR = 1.046; 95% CI: 1.013–1.081), walking independently (aOR = 0.286; 95% CI: 0.097–0.844), daily skin hydration (aOR = 0.396; 95% CI: 0.176–0.889), and recurrence within the previous 12 months (aOR = 57.7; 95% CI: 19.5–170.9) were associated with recurrence-risk level. Venous leg ulcer recurrence is a multifactorial phenomenon associated with clinical, functional, behavioural and psychosocial characteristics. These findings support individualised, multidimensional prevention strategies that integrate clinical assessment, functional capacity, preventive behaviours and continued care after ulcer healing.
Berberine (BBR) is a natural isoquinoline alkaloid with antibacterial, anti-inflammatory and pro-angiogenic properties. This study aimed to investigate the therapeutic efficacy and underlying mechanism of a conditioned medium (CM) derived from berberine-preconditioned bone marrow-derived mesenchymal stem cells (BMSCs-BBR). BMSCs were isolated and phenotypically characterised by flow cytometry. A burn wound model was established in Wistar rats, and the model rats were randomly allocated to four groups treated with placebo gel, standard BMSCs-CM gel, BMSCs-BBR CM gel, or silver sulfadiazine cream. Wound healing rates were monitored macroscopically. On Day 21, skin tissues were harvested for histological analysis (H&E and Masson's trichrome staining), followed by immunofluorescence staining (CD31) and Western blot analysis (Collagen I, Collagen III and key proteins in the PI3K/AKT/eNOS signalling pathway). Among all treatments, BMSCs-BBR CM accelerated wound closure the most significantly, accompanied by improved epidermal regeneration, enhanced collagen deposition and organisation and a marked increase in capillary density. Furthermore, wounds treated with BMSCs-BBR CM exhibited notably upregulated Collagen I and Collagen III, and activation of the PI3K/AKT/eNOS pathway, as evidenced by increased phosphorylation of PI3K and AKT and elevated eNOS protein levels. Our findings demonstrate that the topical application of BMSCs-BBR CM gel potently promotes burn wound healing by improving the quality of tissue regeneration and stimulating angiogenesis via the activation of the PI3K/AKT/eNOS signalling pathway. This preconditioning strategy represents a promising acellular therapeutic approach for burn wound management.
Adherence to compression stocking wear is essential for reducing venous leg ulcer recurrence, yet adherence rates remain low. This study examined the relationship between a novel digital clinical decision-aid (the Personalized and Multidimensional Compression Assessment and Intervention [PAMCAI]), clinician practice, and patient adherence with compression stocking use, by embedding a prospective comparative cohort study within a pilot randomized controlled trial. The clinical notes of occupational therapists using PAMCAI were compared with those not using PAMCAI on their documentation of adherence and frequency of wear, identification of patient-specific barriers and attempts to address barriers. The relationship between higher documentation scores and patient adherence was also explored. Thirty-six medical records from 18 patients demonstrated significantly higher documentation scores when PAMCAI was used for all three categories (p < 0.001). Improvements in adherence were positively associated with documentation quality in the targeted categories (p < 0.001). These findings indicate that PAMCAI supports practice changes that translate to improved patient adherence, highlighting the potential value of clinician-focused decision-aids in venous leg ulcer care.
Diabetic foot ulcers are an important cause of morbidity, amputation, disability and healthcare expenditure in sub-Saharan Africa, where limitations in preventive foot care, referral pathways, vascular services, multidisciplinary wound care and financial protection may contribute to poor outcomes. This critical narrative review evaluates the potential role of systemic hyperbaric oxygen therapy as an adjunct to standard diabetic foot ulcer care in sub-Saharan Africa by integrating evidence on clinical effectiveness and safety with health-system, economic, equity and implementation considerations. Evidence was drawn from clinical studies, systematic reviews, clinical guidelines, economic evaluations and literature relevant to diabetic foot care and health-system capacity in the region. Global evidence suggests that systemic hyperbaric oxygen therapy may improve wound healing in selected patients whose ulcers fail to heal with best standard care, but findings remain heterogeneous; evidence for reducing amputation is uncertain, and direct regional evidence is sparse. Implementation in sub-Saharan Africa would require reliable oxygen, electricity, trained staff, safe maintenance systems, multidisciplinary care, referral pathways, sustainable financing and feasible treatment completion. The therapy should therefore not be considered routine or first-line treatment. Where appropriate infrastructure exists, carefully monitored referral-centre pilots should assess clinical outcomes, safety, treatment completion, affordability, budget impact and equity before wider implementation.
Acute wounds with high exudate output, such as split-thickness skin-graft donor sites, require dressings that effectively manage fluid, reduce pain, and support timely epithelialization. Foam dressings are widely used, but superabsorbent materials may provide advantages in exudate handling. This study compared the absorption performance, wound healing, and pain outcomes of foam versus superabsorbent dressings in donor-site wounds. Thirty patients undergoing split-thickness skin grafting were enrolled, with no exclusions or loss to follow-up. Each donor site was divided into two equal zones, with one receiving a foam dressing and the other a superabsorbent dressing according to randomized allocation. Data were collected using coded identifiers. Clinical outcomes, including absorption capacity, wound epithelialization, pain scores, and complications, were evaluated at 3-day intervals through postoperative day 15. Experimental testing showed that a 10 × 10 cm foam dressing weighed 7.5 g and absorbed 75 mL of saline, whereas the superabsorbent dressing weighed 5.5 g and absorbed 93 mL. Clinically, absorption power was significantly higher with the superabsorbent dressing on day 3 (104.09 vs. 71.87 mg/cm2/day; p = 0.034), day 6 (84.45 vs. 40.91 mg/cm2/day; p < 0.001), and day 9 (76.59 vs. 19.74 mg/cm2/day; p = 0.022). Pain scores tended to be lower with the superabsorbent dressing on days 6 and 9, although the differences were not statistically significant. Wound epithelialization was comparable between groups, with no allergic reactions, infections, or other complications observed. Superabsorbent dressing demonstrated superior absorption capacity compared with foam dressing, while achieving comparable epithelialization and healing outcomes. Pain scores tended to be lower with the superabsorbent dressing during the early postoperative period, although the differences were not statistically significant.
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Diabetic foot ulcers (DFUs) are difficult to manage in resource-limited settings, where access to standard offloading devices is limited for healing of plantar diabetic foot ulcers. This is due to the cost, limited availability, and the need for specialised expertise. Toa Uzito is a low-cost offloading device developed to address this gap. We evaluated the effectiveness of a low-cost offloading device (Toa Uzito) in improving healing outcomes in patients with plantar ulcers. A matched case–control clinical study was conducted at a specialised diabetic foot centre in Dar es Salaam, Tanzania. Patients with a single plantar DFU were enrolled. Those treated with Toa Uzito were compared with matched controls who received standard care without offloading. Controls were matched based on age, body mass index, and diabetes duration. The primary outcome was time to complete ulcer healing. Healing were analysed using Kaplan Meier survival analysis and Cox regression. A total of 621 patients were included (128 intervention, 493 controls), with a mean follow-up of 133.8 days. Ulcer healing was significantly better in the intervention group: 44.9% healed (versus 34.9% in controls) by 12 weeks, and increasing to 85% (versus 75.2% in controls) by 24 weeks. All patients in the intervention group healed, with a shorter mean healing time (125.7 vs. 137.5 days). Toa Uzito also demonstrated significantly superior healing efficacy compared with standard care after stratification by SINBAD classification (χ2 = 71.2, p < 0.01) . The low-cost Toa Uzito significantly improves healing rates and reduces time to healing. Its affordability and simplicity makes it an effective offloading strategy for promoting DFU healing in resource-limited settings.
Mid-deep dermal burns have traditionally been treated with nonoperative management and split-thickness skin grafting, but minimally invasive excision with epidermal autografting and poly-lactic acid skin substitute (MEP) has offered an alternative approach. Comparative outcomes have remained incompletely defined. We conducted a retrospective cohort study of adult patients with mid-deep dermal burns treated with MEP compared with a propensity score-matched standard-of-care (SOC) cohort. The primary outcome was achievement of ≥ 90% wound healing by postoperative day 10, with secondary outcomes including length of stay, complications and hospital financial outcomes. Among 39 pairs analysed, MEP-treated patients were significantly more likely to achieve early wound healing compared with SOC (82.1% vs. 45.5%, p = 0.001) and experienced fewer complications, without an increase in length of stay. Although MEP was associated with higher upfront hospital costs, reimbursement rates were comparable. MEP was associated with superior early wound healing and fewer complications without prolonging hospitalisation.
This study evaluated district-wide implementation of a digital wound model of care combining an artificial intelligence–enabled application with a virtual command centre across four hospitals and five community health centres in Australia. A post-implementation multimethods evaluation (January 2024–January 2026) of patients (n = 94), frontline clinicians (n = 75), and senior wound nurses (n = 9) and a product manager (n = 1) using surveys, semi-structured interviews and analysis of governance meeting minutes. Patient satisfaction was high: 91% rated care as ‘excellent’ or ‘good’, 93% 'agreed' or 'strongly agreed' it was effective and 96% 'agreed' or 'strongly agreed' that they felt confident in the care they received from their wound care provider. Just over half (59%) felt they were meaningfully involved in decisions about their own care, an area identified for targeted improvement in future iterations of the model. The most cited virtual care benefits included improved condition understanding (63%), and reduced travel (49%). Among the 28 patient app users, 89% reported improved communication between them and the wound care provider and 79% self-management confidence. Senior wound nurses rated the app highly for ease of use and continuity of care (both 86%), but poor connectivity was a limitation. Frontline clinicians valued enhanced documentation consistency but reported barriers including time pressures and training burden. This multisite implementation demonstrates that digital wound care models are highly acceptable and deliver perceived clinical benefit, while identifying patient involvement in decision-making and clinician workflow integration as priority areas for future investment.
Wound-healing complications (WHCs) remain a significant challenge in soft tissue sarcoma (STS) surgery, contributing to increased morbidity, prolonged hospitalisation, and impaired functional outcomes. This study aimed to identify predictors of WHC development in STS patients to improve therapeutic strategies and patient recovery. We conducted a single-institution, retrospective analysis of 318 STS patients treated between April 2019 and June 2021. Variables assessed included demographic data, tumour characteristics, treatment modalities, surgical interventions, and follow-up outcomes. Statistical analyses used chi-square tests, Kaplan–Meier estimates, and multivariate regression. WHCs occurred in 30.8% of patients. Significant negative predictors included high tumour grade (p = 0.018), presence of metastasis (p < 0.001), bone tissue resection (p = 0.005), number of revision procedures (p < 0.001), secondary wound closure (p < 0.001), and tumour relapse frequency (p = 0.012). WHCs were also associated with increased risk of death (p = 0.004) and longer initial hospitalisation (p < 0.001). Chemotherapy showed a protective effect when stratified by tumour grade. Patients with high-grade tumours and multiple surgical interventions represent a high-risk group for WHC development. These findings highlight the importance of ongoing treatment reevaluation and suggest that chemotherapy may offer beneficial outcomes in selected cases.
Cutaneous angiosarcoma is a rare and aggressive malignancy that may arise in chronic lymphoedema. Its presentation as a non-healing ulcer can lead to delayed diagnosis. We describe an atypical case of angiosarcoma presenting as a chronic lower extremity ulcer in the setting of chronic lymphoedema and to highlight the importance of early biopsy. We report on the clinical course, diagnostic evaluation, treatment, and outcome of a patient with chronic lymphoedema who developed a persistent ulcer. A 74-year-old woman with longstanding lower extremity lymphoedema developed a non-healing ulcer initially managed as cellulitis and venous ulceration. Due to failure of conservative therapy, biopsy was performed and revealed angiosarcoma. The patient underwent surgical resection and adjuvant radiotherapy, remaining disease-free for over 4 years before recurrence and eventual death. Malignancy should be considered in chronic non-healing ulcers, especially in the setting of longstanding lymphoedema. Early biopsy is essential to avoid delayed diagnosis and improve outcomes.
Postoperative wound complications are a major clinical challenge, especially in patients with comorbidities such as overweight and diabetes mellitus. Extensive abdominal wall necrosis after gynaecologic surgery is uncommon but may lead to prolonged healing, increased morbidity and the need for complex reconstructive procedures. Negative pressure wound therapy (NPWT) is an effective option for complex surgical wounds, promoting granulation tissue, improving perfusion and reducing bacterial burden. This report describes the case of a 58-year-old woman with overweight status and Type 2 diabetes mellitus who developed extensive suprapubic wound dehiscence with associated tissue necrosis following hysterectomy and bilateral salpingo-oophorectomy performed for a giant uterine leiomyoma. Following surgical debridement, NPWT was started and maintained with scheduled dressing changes. Progressive improvement was observed, with wound size decreasing from about 20 to 10 cm in 30 days and robust granulation tissue formation. Once the wound bed was optimised, definitive closure was achieved with an autologous skin graft. This case supports the role of NPWT as a bridge therapy in managing complex postoperative gynaecologic wounds in high-risk patients. A multidisciplinary approach involving gynaecologists, plastic surgeons and wound care specialists was essential for a favourable outcome. NPWT should be considered a valuable option for selected gynaecologic patients with extensive wound complications.
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