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Surgical site infections (SSI) and surgical site complications (SSC) significantly impact surgery outcomes, increasing hospital stays and mortality rates, and negatively affecting patients' quality of life. Closed-incision negative pressure therapy (ciNPT) emerged as a prophylactic strategy to reduce these complications. However, its applicability across different surgical procedures remains unclear. A scoping review was conducted to synthesise the available evidence on the use of ciNPT in different surgical contexts. A multidisciplinary panel of experts from different surgical specialties was assembled to identify patient risk factors for SSCs specific to each modality. Surgical procedures were categorised based on anticipated SSC rates and the impact of SSI. A decision diagram was finally developed, providing tailored recommendations for ciNPT use according to individual surgical circumstances. The findings of the review indicate that ciNPT effectively reduces SSI and SSC in most surgical procedures. Key patient-related factors influencing outcomes, such as age, obesity, and malnutrition, were outlined. Additionally, a specialty-based list of surgical procedures was compiled, specifying whether ciNPT is recommended, not recommended, or conditionally recommended based on specific criteria. This study underscores the benefits of ciNPT and provides a comprehensive guide to its application across several surgical specialties, aiming to optimise patient management and inform clinical practise.
Soft silicone multi-layer dressings are commonly used for pressure ulcer (pressure injury) prevention, yet their effectiveness varies based on design, construct, and material properties. This study evaluated the protective efficacy of a new multi-layer dressing, ALLEVYN COMPLETE CARE (ACC, Smith & Nephew Limited), which incorporates an advanced structure facilitating the dissipation of shear forces through internal layer-on-layer frictional sliding within the dressing. Using a combination of experimental frictional energy absorber effectiveness (FEAE) testing and computational finite element modelling, we quantified the capacity of this dressing to mitigate strain and stress concentrations in the soft tissues of the supported posterior heel. The dressing demonstrated considerable frictional sliding between its adjacent layers, resulting in FEAE = 93% under simulated, clinically relevant usage conditions. This was associated with the dissipation of shear forces and alleviation of strain/stress concentrations in the skin and underlying soft tissues below the dressing. The dressing completely eliminated the stress and strain peaks at the top quartiles of the strain/stress domain (with reference to a no-dressing case). This work provided valuable insights into advanced testing methods and beneficial design principles for pressure ulcer prevention dressings. Earlier investigations concluded that a previous-generation ALLEVYN LIFE dressing achieved high levels of FEAE and thus provided protection. Our findings here establish that the next-generation dressing, ACC, demonstrates even greater protective capacity.
The treatment of a chronic diabetic foot osteomyelitis (DFO) is challenging and often necessitates a surgical intervention. When the soft tissues are preserved from infection, an internal pedal amputation (IPA) defined as the excision of the totality of at least one bone could yield excellent results in terms of infection control and limb preservation. The diabetic sausage toe is an under-researched form of DFO. Therefore, the aim of this preliminary study is to report the outcomes of IPA for the treatment of chronic diabetic sausage toes. This is a case-series of six patients presenting as chronic diabetic DFO of the toes in the form of sausage toe. Five patients presented with an open ulcer and one with a healed wound. All patients were treated with IPA. Infection healing, x-rays and MRI findings, microbiology and pathology results, postoperative complications and patient satisfaction were recorded. Four out of the six cases (66.7%) presented clear radiological signs of chronic OM. All cases showed signs of OM on MRI. A bacterial micro-organism was found in 5 out of the 6 cases (83.3%) and all specimens showed signs of chronic inflammation on pathology. No infection recurrence was noted at the last follow-up. All postoperative wounds healed within 6 weeks. All patients were extremely satisfied with the surgical result. For chronic diabetic toe osteomyelitis in the form of a sausage toe, the toe-preserving technique of internal pedal amputation has the potential to control the infection while conserving an aesthetic and functional toe.
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This study aimed to compare the 3-year recurrence rates of diabetic foot ulcers (DFU) and the rate of endovascular reintervention for chronic limb-threatening ischaemia (CLTI) to recurrence rates of advanced-stage cancers. We systematically collected original data reporting 3-year DFU recurrence from studies published through 2024 and calculated a pooled mean. These findings were compared to recurrence rates for advanced breast, prostate, colorectal, and lung cancers using contemporary sources from the National Cancer Institute and American Cancer Society. CLTI reintervention data were drawn from the BEST-CLI trial. The pooled 3-year DFU recurrence rate was 58%, while the CLTI reintervention rate was 50%—comparable to cancer recurrence rates: breast (25%–40%), prostate (30%–40%), colorectal (30%–50%), and lung (60%–80%). Despite these comparable risks, DFU and CLTI remain underrecognized in terms of their recurrent burden on individuals, families, and health systems. The data presented here underscore the need to reframe healed DFU and post-intervention CLTI not as an endpoint but as a remission—a state requiring structured surveillance and proactive management, much like in oncology. Developing interdisciplinary survivorship care plans for individuals with DFU and CLTI, modelled on those used in cancer care, may improve communication, enhance secondary prevention, and foster more ulcer-free, hospital-free, and activity-rich days.
Functional tests commonly assess athletes' readiness to return to sports after knee surgery. Despite this, there are still more studies on clinical and patient-reported outcomes. The purpose of this study was to determine differences and combinations of various functional performances within and between athletes 6 months after anterior cruciate ligament (ACL)-reconstruction (ACLR) for the first time (ACLR-I group) versus second ACL injury on the same knee (ACLR-II group) versus ACLR procedures on both legs (ACLR-III group). A total of 88 patients with ACLR performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), Functional Movement Screen (FMS) and dynamic postural balance (Y Balance Test – YBT). Data were recorded during return-to-sport testing (6 months post-surgery). For each variable, a mixed-model analysis of variance, with a between-subjects factor of group (primary ACL injury, recurrent ACL injury and bilateral ACL injury) and a within-subjects factor of limb (involved, uninvolved), were conducted. Differences between the groups were found in different degrees of inter-limb asymmetry in the single-leg hop (p < 0.001) and side hop test (p < 0.02). There was a main effect of limb for the anterior and posteromedial YBT distances, and the single-leg hop and side hop test distances (p ≤ 0.04). For each variable, performance was worse for the involved limb compared to the uninvolved limb. Individuals after recurrent ACLR showed greater functional asymmetries at 6 months of treatment. Jumping tests detected greater performance deficits compared to YBT and FMS.
The aim of this scoping review was to map the literature pertaining to the use of eHealth interventions to prevent pressure injuries in populations at risk of the complication, and describe the interventions encountered with the help of Greenhalgh et al.'s Nonadoption, Abandonment, Scale-up, Spread and Sustainability framework. Articles were retrieved using database queries to CINAHL, Medline, ScienceDirect and the Cochrane library with a search string strategy that considered articles from the inception of each database until the 29th of January 2024. The interventions from the 27 included studies were then evaluated using the Nonadoption, Abandonment, Scale-up, Spread and Sustainability framework. The included studies had a publication date range from 1997 to 2023 and included diverse study designs encompassing experimental trials, qualitative designs, mixed-methods, cohort studies and randomised control trials (including secondary analyses). There was a preference for app-based interventions (15/27) that are installed on smartphones, while other interventions encompassed a bed with sensors that automatically adjusted air cell pressure, clinical support algorithms and continuous sensing devices. In conclusion, this scoping review provides an overview of the various technological solutions currently available for pressure injury prevention as well as recommendations for improving the long-term adoption of future eHealth interventions.
Chronic wounds decrease patients' quality of life and pose an economic burden on healthcare systems and individuals. Wound assessment tools and monitoring technologies may reduce the costs related to chronic wound management. Bioimpedance has attracted growing attention as a quantitative tool for monitoring chronic ulcers, owing to its proven ability to detect tissue changes throughout the wound healing process. The main objective of this study was to review the state-of-the-art literature on the use of bioimpedance in chronic wound monitoring. A systematic review of literature was performed on the 30th of August 2024 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in three electronic databases (PubMed, Scopus and Web of Science). Sixteen studies were included in the systematic review. Studies on bioimpedance measurements for chronic lower leg wound monitoring were analysed, confirming significant differences in bioimpedance between wound and healthy skin, with changes observed throughout the healing process. The variety of electrode types and setups highlights the method's complexity, with electrode configuration playing a critical role in ensuring accurate results. Several challenges remain before it can be effectively implemented in clinical practice. Our review emphasises the potential usefulness of bioimpedance-based methods in monitoring chronic wounds on the lower legs.
The primary aim of this study was to evaluate the impact of the polyhexamethylene biguanide (PHMB) care bundle on the occurrence rates of surgical site infections (SSIs) in paediatric and neonatal cardiac surgery, addressing a critical gap in paediatric-specific infection prevention protocols. A retrospective cohort study included patients under 18 years old who underwent cardiac surgery at IRCCS Policlinico San Donato. Cohort A (n = 117) received the PHMB care bundle from April to December 2023, while Cohort B (n = 801) received conventional care from September 2020 to March 2023. The 1:1 propensity score matching was used to balance covariates between cohorts, resulting in two comparable cohorts (Cohort A = 114 patients and Cohort B = 112). The study found a significant reduction in SSIs among patients receiving the PHMB care bundle compared with those receiving conventional care (1.8% vs. 7.1%, p = 0.048). The comprehensive nature of the PHMB care bundle, including educational programs, preoperative and postoperative antimicrobial treatments, and consistent application of best practices, was instrumental in achieving these outcomes. Implementing antimicrobial care bundles could significantly reduce SSIs in paediatric cardiac surgery. Future research is needed to refine the tested bundle with prospective approaches.
Radiotherapy is recommended for G2-G3 large soft tissue sarcoma in association with radical wide excision in order to improve the local control of disease, but side-effects may develop early after radiation invalidating wound healing. We retrospective evaluated short- and long-term clinically relevant outcomes after surgery of limb STS with or without radiotherapy. All 243 patients with limb STS treated at the Veneto Institute Oncology (Padua, Italy) in 2015–2022 were retrospectively included. Outcome measures were short- and long-term wound complications, length of hospital stay and outpatient care time. Multivariable analyses were performed using linear regression models and logistic regression models. Overall, 87 patients received neoadjuvant radiotherapy, 64 received adjuvant radiotherapy and 92 underwent surgery alone. At short-term, multivariable analysis identified neoadjuvant radiotherapy as a risk factor for prolonged length of hospital stay (MD 6.4 days, 95%CI 3.9 to 9.0 days) and short-term wound complications (OR 3.45, 95%CI 1.82 to 6.62). At long-term, neoadjuvant radiotherapy was a risk factor for long-term wound complications (OR 4.87, 95%CI 2.48 to 9.84), and longer outpatient care time (MD 83 days, 95%CI 41 to 126 days); similarly, adjuvant radiotherapy was also a risk factor for long-term complications (OR 5.20, 95%CI 2.57 to 10.95) and longer outpatient care time (MD 62 days, 95%CI 19 to 106 days). Radiotherapy in limb STS was associated with impaired short- and long-term clinically relevant outcomes, potentially affecting quality of life and healthcare costs. Balancing with its well-known oncological benefits, new clinical strategies are needed to contain cutaneous radiogenic side effects. The use of negative pressure therapy can play a key role in the prevention of wound complications in oncological patients.
Chronic wounds pose significant challenges to patients and potentially reduce patients' quality of life. A prospective randomised control trial (RCT) was conducted in Russia between 2018 and 2021 to assess the effectiveness of treating chronic wounds with a high-intensity Erbium: Yttrium Aluminium Garnet (Er:YAG with RecoSMA (Reconstructive Spatially Modulated Ablation module for distributing laser radiation into microbeams) laser technology versus sharp debridement in 144 patients (treatment group N = 71; control N = 73) with diabetic foot, venous and arterial leg ulcers. The median ulcer size at baseline in the treatment and control group was 11 cm2 and 10 cm2 with median ulcer duration of 16 months and 15 months, respectively. The endpoints were the time to achieve a clean wound bed, time to granulation, extent of complete and marginal epithelialisation, change in wound area, presence of bacteria, levels of topical wound pain, and the patients' tolerance of debridement. A difference at p < 0.05 was considered statistically significant. After a 30-day observation period, complete epithelialisation occurred in more than twice as many wounds in the treatment group (56.3%) compared to the control group (26%). The Er:YAG laser was more effective than sharp debridement in clearing wounds of microbial flora, stimulating tissue regeneration, promoting early granulation, marginal epithelialisation and wound healing, suggesting that Er:YAG laser therapy may offer greater benefits than conventional methods of sharp debridement of slow healing wounds.
Empathy plays an important role in delivering healthcare, influencing both patient outcomes and satisfaction. However, its role, impact, and barriers to implementation in wound care remain underexplored. This scoping review aims to synthesise existing literature on empathy in wound care, highlighting its contributions to person-centred healing. Following the Joanna Briggs Institute methodology, a systematic search was conducted across multiple databases in English, French, German and Italian. Eighteen studies published between 1946 and 2024 met the inclusion criteria. The review identified empathy as a fundamental element in wound care, improving adherence to treatment, reducing psychological distress, and enhancing wound healing through physiological and psychological mechanisms. However, systemic challenges including time constraints, lack of training, and resource limitations hinder its consistent application in clinical practise. This review highlights the need for enhanced education, training, and systemic support to integrate empathy into wound care. Future research should focus on developing validated strategies to adopt empathetic care, ensuring a holistic approach to patient management.
Complex magnetic fields (CMFs) represent an emerging frontier in regenerative medicine, offering significant potential for innovative therapeutic strategies. This review examined both the theoretical foundations and practical applications of CMFs, focusing on their roles in tissue regeneration and antifungal activity. A comprehensive review of electronic databases (PubMed, Scopus, and Embase) identified seven pivotal studies on in vitro models concerning the CMF topic. Although the number of studies is limited, they collectively highlighted the promising therapeutic potential of CMFs in enhancing wound healing, reducing oxidative stress, and neuroinflammation in diabetic neuropathy, positively influencing mitochondrial function, modulating immune responses, promoting cellular communication, inhibiting the growth and adhesion of Candida albicans to medical surfaces, and enhancing dental pulp stem cell proliferation under inflammatory conditions. These findings suggested that CMFs may offer an eco-sustainable approach, effectively targeting pathogens while preserving human cell integrity. While the current body of research is insightful, it remains in its early stages. To fully leverage the therapeutic potential of CMFs, more comprehensive studies are needed to refine their application and confirm their effectiveness across diverse clinical scenarios. This is essential for integrating CMFs into clinical practice, where they promise to revolutionise treatment approaches.
Trauma and orthopaedic surgery (TOS) can result in surgical site infections (SSIs), and the repercussions include prolonged and increased cost of treatment. This study investigated the incidence and risk factors of SSI following TOS. A prospective cohort study was conducted at the Tamale Teaching Hospital from September 2023 to May 2024. Data on demographics, comorbidities, preoperative, intra-operative and postoperative parameters were collected from patients, medical records and the operation report. SSI was defined following the Centers for Disease Control and Prevention criteria. The incidence of SSI during the study period was determined, and univariate and multivariate logistic regression analyses were used to identify the independent risk factors of SSI. A total of 210 patients were enrolled of which 6.7% (14) developed SSIs, including 1.0% (2) deep and 5.7% (12) superficial SSIs. The incidence of open fractures and closed fractures in this study was 3.3% (7) and 2.9% (6), respectively. According to multivariate regression analysis, blood transfusion before surgery (p = 0.034; OR = 3.53; 1.10–11.33) was identified as an independent risk factor of SSI following TOS. However, there was a significant association between the type of dressing used on the surgical site after surgery (p = 0.035; OR = 4.08; 1.10–15.08) and SSI. The study reported the overall incidence rate of SSI after TOS to be 6.7% (67 per 1000 surgical operations). Blood transfusion before surgery was an independent risk factor of SSI following TOS. Local and global measures that limit the rates of SSI after TOS should be adopted especially in managing high-risk patients such as those who require pre-operative blood transfusion.
The objective of the study was to show the clinical performance and cost-effectiveness of a Silicone foam dressing with 3DFit™ Technology compared to current standard of care. This was an open-labelled, two-arm, randomised controlled multicentre study conducted from February to December 2023. One hundred and two participants with an exuding, non-infected and chronic ulcer were randomised in a 1:1 fashion and treated with either a Silicone foam with 3DFit™ Technology or standard of care (a filler combined with a secondary dressing), stratified by venous leg ulcers and diabetic foot ulcers. After a 4-week study period, wound size and total costs were evaluated. After 4 weeks of treatment, a comparable percentage in wound area reduction was observed in both treatment arms with mean and 95% confidence interval of 54.3% (37.1%; 71.5%) and 43.0% (26.5%; 59.6%) for the investigational and comparator dressing, respectively. This corresponded to a mean difference of 11.3% ([−10.22; 32.86], p = 0.299). Total mean estimated costs were significantly lower for the investigational dressing (£14.3, 95% confidence interval [£9.6; £19.0]) compared to the two-dressing regime (£21.4 [£16.9; £26.0]), corresponding to a 33% price reduction (p = 0.033) after 4 weeks of treatment. With this RCT, a conforming Silicone foam dressing with 3DFit™ Technology was shown to be clinically comparable and a cost-effective alternative to using a filler and a secondary dressing at a significantly lower cost in both venous leg ulcers and diabetic foot ulcers up to 2 cm in depth.
Preventing pressure injuries is a primary objective for care and treatment teams in intensive care units (ICUs). Therefore, the current study aimed to compare the efficacy of Zinc Oxide and Vaseline prophylactic dressings in preventing sacral pressure injuries in patients admitted to the ICU. This clinical trial was conducted in the ICU in 2023. The study population included patients at moderate to high risk for pressure injuries based on the Braden scale criteria. Eligible patients were randomly assigned to one of five groups using random allocation software: (1) the intervention group receiving Zinc Oxide as a prophylactic dressing, (2) the intervention group using Zinc Oxide as a topical application, (3) the intervention group with Vaseline as a prophylactic dressing, (4) the intervention group using Vaseline as a topical application and (5) the control group. Participants were homogenous regarding demographic information in all five groups. The frequency distribution of pressure injuries across the five groups was analysed using the Chi-square test. The results revealed no pressure injuries were observed in the Zinc Oxide and Vaseline with dressing groups. In contrast, the Zinc Oxide without dressing group had five cases, the Vaseline without dressing group had six cases and the Control group had 14 cases of pressure injuries. These differences were statistically significant (p < 0.05). The results of this study showed that Zinc Oxide and Vaseline as preventive dressings in the sacral area of patients admitted to ICUs can be considered an effective and affordable strategy for healthcare providers.
Pyoderma gangrenosum (PG) is a rare, painful neutrophilic dermatosis characterized by rapidly progressing skin ulcers. Despite the importance of local wound care in managing PG, there is no consensus or evidence-based guidelines. This systematic review aimed to investigate local wound care strategies for PG. A comprehensive search of Embase, MEDLINE, and the Cochrane Library yielded 1213 references, from which 269 studies were included, covering 351 patients. The most reported treatment methods included sharp debridement (11%), topical corticosteroids (27%) and non-adherent dressings (12%). However, no clear correlation between these treatments and healing outcomes was found likely due to confounding factors such as varied wound sizes, superinfection and inconsistent reporting. Additionally, directed wound care regimens have not been able to show statistical significance for healing outcomes. Our study describes the current local wound care landscape and underscores a critical gap in the current literature regarding standardized treatment protocols for PG.
The aim of this study was to investigate acute wound healing with dynamic optical coherence tomography (D-OCT). From 22 patients with 23 split skin graft donor sites, vessels at four wound edges, the wound bed, and adjacent and unaffected skin of the contralateral leg were measured by D-OCT at six time points from surgery to 4 weeks of healing. Changes in vessel orientation, density, diameter, morphology and pattern in horizontal, vertical and 3D images were analysed for wound healing and re-epithelialization. At 300 μm depth, there were significant differences of blobs and serpiginous vessels between normal and wounded skin. The wound had significantly more vertically oriented vessels, a higher degree of branching, vessel density and diameter compared with healthy skin. 3D images showed increased angiogenesis from healthy skin towards the wound centre, significantly higher vessel density at the wound than at normal skin and the highest at the interface. During wound healing blobs, coils and serpiginous vessels occurred significantly more frequently in lesional than healthy skin. Vessel density was greatest at the beginning, decreased and then increased by 4 weeks post-surgery. D-OCT helps to evaluate acute wound healing by visualizing and quantifying blood vessel growth in addition to re-epithelialization.
In an ageing society, the incidence of hard-to-heal wounds is rising. Chronic wound healing is a complex process, which requires specialised treatment. Clinical assessment of the wound is essential to establish care approaches but is usually based on visual evaluation and it remains challenging. Therefore, innovative quantitative methods for the assessment of chronic wounds are needed. We conducted a single-centre observational study designed to assess the feasibility of a bioimpedance measurement method conducted with a multielectrode sensor array to monitor the wound healing process in patients with chronic wounds of venous, mixed venous–arterial and diabetic aetiology. In total, 104 measurements of bioimpedance were conducted in 18 ulcers during the study. Across all 7 patients analysed, the bioimpedance of the ulcers was consistently increasing as the wound surface was decreasing. The variables had significant (p < 0.001) and strong negative correlation (r = −0.86). We validated the feasibility of the bioimpedance measurement method for the monitoring of the wound healing process on the lower legs. It may be a promising quantitative method for monitoring the status of the wounds. However, long-term measurements are needed to show the usability of the electrode dressing and bioimpedance measurement in the assessment of chronic wounds.
Diabetic foot ulcer is the most common complication causing lots of admissions among diabetic patients. Understanding patients' level of foot self-care knowledge, practice and associated factors is important for planning interventions to control and prevent diabetic foot complications. This study aimed to assess the level of knowledge and practice of foot self-care among diabetic patients attending diabetic clinics in The Gambia. Two hundred and seventeen patients attending diabetic clinics in two public hospitals were selected using a successive sampling technique. Data were collected using a validated interviewer-administered questionnaire. Descriptive statistics were used to summarize the demographic and clinical data. Multivariate logistic regression was used to identify factors associated with foot self-care knowledge and practice. The findings showed a poor level of foot self-care knowledge (n = 114; 52.5%) and practice (n = 149; 68.7%). Patients' educational level was statistically significantly association with diabetic foot self-care knowledge (p = 0.02). Diabetic foot ulcer history (aOR = 0.23, 95% CI: 0.08–0.63; p < 0.001), diabetic hospitalization (aOR = 2.41, 95% CI: 1.23–4.75, p = 0.01) and diabetic foot care education (aOR = 2.65, 95% CI: 1.39–5.06, p < 0.001) were statistically significantly associated with foot self-care practice. The poor diabetic foot self-care knowledge and practice among these patients emphasize the need for a diabetic health education program in these clinics.
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