Conectar
Chronic wounds pose an increasing burden on the healthcare system and data on wound outcomes and are needed to evaluate and address disparities and reform healthcare policies. In Singapore, data on chronic wounds are fragmented and to address this, we established a Chronic Wounds Registry (CWR) to collect harmonised data on chronic wounds and their outcomes over 6 months. This is a multi-centre prospective cohort study from Nov 2019 to Nov 2021. Patients with chronic wounds were enrolled at multi-speciality acute care hospitals and data were prospectively collected on baseline characteristics, including subject demographics, clinical data, wound images, interventions/treatment, cost burden and patient reported health-related quality of life (HRQOL). Patients were followed up for 6 months and wound outcomes recorded at Month 1, Month 3 and Month 6 time points. Despite the onset of COVID pandemic, a total of 812 patients were recruited in our study. Mean age was 63.5 ± 11.6 years with 66% men and 59% of Chinese ethnicity. Twenty percent of all the wounds were recurrent and patients with venous leg ulcers (VLU) (32%) had the highest recurrence. At 6 months, 225 (46%) of the neuro-ischemic ulcers (NIU), 152 (60%) of the VLUs and 29 (46%) of the pressure injuries (PI) had healed. Major (5%) amputations were highest in patients with NIUs. All-cause mortality was highest (30%) and HRQOL was lowest for patients with PIs (−0.18). Development of a national wound registry is both feasible and essential to consolidate key data elements on chronic wounds. The CWR in its current state captured the local epidemiology, patient journey in acute care hospitals, which will benefit in healthcare policymaking and harmonise care across different levels of healthcare system. The next phase of the CWR aims to track patients in all settings and collect data on the entire patient journey following an episode of wounding.
Diabetic foot wounds (DFW) are notoriously difficult to treat owing to poor vascularity, delayed healing and higher rates of infection. Human-derived acellular dermal matrices (ADM) have been used in DFW treatment, utilizing a matrix scaffold for new tissue generation. We investigate the efficacy of a micronized injectable human-derived ADM in the treatment of DFW. We retrospectively recruited 13 patients with diabetic foot wounds. Wounds were adequately debrided, and a micronized injectable ADM was applied. Wound sizes were recorded prior to treatment, at 2 and 4 weeks post-treatment. The mean defect of wounds treated was 19.21 cm3. Our results showed a statistically significant reduction in wound size of 45% and 59% at 2 and 4 weeks post-treatment, respectively (p < 0.01). ADM was also effective in infected DFW as 84% of our wounds had positive tissue cultures at the time of application. Micronized injectable ADM has proven to be an effective treatment for DFW. Advantages include a ready-to-use injectable, single-stage treatment, minimal pain, mouldable matrix to fit any wound shape, allows for outpatient treatment and simple wound dressings.
This study evaluated the effectiveness of a multi-disciplinary diabetic limb salvage programme in improving clinical outcomes and optimising healthcare utilisation in 406 patients aged ≥80 years with diabetic foot ulcers (DFUs), compared to 2392 younger patients enrolled from June 2020 to June 2021 and against 1716 historical controls using one-to-one propensity score matching. Results showed that elderly programme patients had lower odds of amputation-free survival (odds ratio: 0.64, 95% CI: 0.47, 0.88) and shorter cumulative length of stay (LOS) compared to younger programme patients (incidence rate ratio: 0.45, 95% CI: 0.29, 0.69). Compared to the matched controls, participating in the programme was associated with 5% higher probability of minor lower extremity amputation, reduced inpatient admissions and emergency visits, shorter LOS but increased specialist and primary care visits (all p-values <0.05). The findings suggest that the programme yielded favourable impacts on the clinical outcomes of patients aged≥80 years with DFUs. Further research is needed to develop specific interventions tailoring to the needs of the elderly population and to determine their effectiveness on patient outcomes while accounting for potential confounding factors.
FreshRSS 