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Negative pressure wound therapy is currently one of the most popular treatment approaches that provide a series of benefits to facilitate healing, including increased local blood perfusion with reduced localized oedema and control of wound exudate. The porous foam dressing is a critical element in the application of this therapy and its choice is based on its ability to manage exudate. Industry standards often employ aqueous solutions devoid of proteins to assess dressing performance. However, such standardized tests fail to capture the intricate dynamics of real wounds, oversimplifying the evaluation process. This study aims to evaluate the technical characteristics of two different commercial polyurethane foam dressings during negative pressure wound therapy. We introduce an innovative experimental model designed to evaluate the effects of this therapy on foam dressings in the presence of viscous exudates. Our findings reveal a proportional increase in dressing fibre occupancy as pressure intensifies, leading to a reduction in dressing pore size. The tests underscore the pressure system's diminished efficacy in fluid extraction with increasing fluid viscosity. Our discussion points to the need of establishing standardized guidelines for foam dressing selection based on pore size and the necessity of incorporating real biological exudates into industrial standards. [ABSTRACT FROM AUTHOR]

Background and aims: Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation. Patients and methods: Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed. Results: A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time. Conclusions: It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate. [ABSTRACT FROM AUTHOR]

Summary: Recognition of the role that biofilms play in the persistence of wounds and lack of response to therapy in horses is increasing. Prevention of biofilm development in the early stages of wound care involves three primary strategies: wound debridement and cleansing to reduce bacterial counts in the wound bed, appropriate use of advanced wound dressings and implementation of topical antimicrobial agents. Once formed, eradication of biofilms requires elimination to improve the wound environment for contraction and epithelialisation while not further harming the native cells integral to the healing process, which is achieved predominantly through repeated lavage and debridement combined with topical antimicrobial therapy. Pseudomonas, Enterococcus and Staphylococcus bacterial species have been most commonly identified in equine wounds with delayed healing. This review will establish why and how biofilms form, how to recognise clinical indications that biofilms have formed in equine wounds and review current diagnostic options and biofilm‐based wound care strategies to eradicate biofilms. Clinical scenarios for cases in which biofilms developed and were successfully treated will be presented. This review will advance practitioners' understanding of the presence and role of biofilms in equine wounds and provide an updated summary of recommended treatment strategies. [ABSTRACT FROM AUTHOR]

WOUND‐Q is a condition‐specific patient‐reported outcome measure developed for all types of chronic wounds, located anywhere on the body. To establish reliability and validity of a patient‐reported outcome measure, multiple pieces of evidence are required. The purpose of this study was to examine the measurement properties of 9 of the 13 WOUND‐Q scales and perform a test–retest reproducibility study in an international sample. In August 2022, we invited members of an international online community (Prolific.com) with any type of chronic wound to complete a survey containing the WOUND‐Q scales, the Wound‐QoL and EQ‐5D. A test–retest survey was performed 7 days after the first survey. It was possible to examine the reliability and validity of eight of the nine WOUND‐Q scales by Rasch Measurement Theory (RMT). To examine test–retest reproducibility intraclass correlation coefficients (ICCs), the standard error of the measurement and the smallest detectable change were calculated. In total, 421 patients from 22 different countries with 11 different types of chronic wounds took part in this study. Our analyses provided further evidence of the reliability and validity of the scales measuring wound characteristics (assessment, drainage, smell), health‐related quality of life (life impact, psychological, sleep, social) and wound treatment (dressing). [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare inflammatory condition with an immense disease burden that remains understudied. With limited approved treatments and low-quality clinical evidence, PG continues to have poor patient outcomes. Unfortunately, improvement in PG treatments and patient care is based on additional research endeavors that can only be developed from existing high-quality data. The following protocol outlines the development of the Minimum Data Set for Treatment Effectiveness in Pyoderma gangrenosum (MIDSTEP), a core set of domains and domain items for the Pyoderma Gangrenosum Treatment Effectiveness (PyGaTE) international registry. The outcomes and benefits are focused on providing real-world data for physicians to improve their clinical decisions on PG treatment and inform clinical trial design, promoting clinical research among the international scientific community. MIDSTEP is a multi-phase project. The first phase will produce a domain item list from a literature review to take into the second phase which would finalize the core data set by an e-Delphi exercise. There will be a single stakeholder group participating together in the e-Delphi consisting of PG experts (healthcare providers, researchers, methodologists, industry representatives, and regulators), ulcerative PG patients, and PG patient advocates. The methodology outlined in the protocol is a systematic method based on several guidelines through COMET and established dermatologic registries and outcome sets with systematic methodologies of their own. The third phase will identify the instruments for the items, the 'when to measure' the items, and the platform for the registry. The last phase is the implementation and continued maintenance of the international registry PyGaTE. By solidifying a consensus on standardized outcomes and collecting information on PG treatment effectiveness in a centralized database, existing treatments can be compared more systematically and analyzed with increased evidence. MIDSTEP and the PyGaTE international registry will have the ambitious goal to generate and disseminate real-world data that can be used by all stakeholders to improve health outcomes for PG patients. Future potential for the outcome of this project includes the development of a gold-standard PG treatment. [ABSTRACT FROM AUTHOR]

Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point‐of‐care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120‐min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20‐min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one‐way repeated measures analysis of variance and an independent t‐test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P =.03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods. [ABSTRACT FROM AUTHOR]

A new recombinant proteolytic enzyme, isolated from maggot saliva, with fibrinolytic action has been investigated through a series of non‐clinical toxicology and in‐vitro/in‐vivo pharmacology studies to explore its potential safety and efficacy as an enzymatic debridement agent for use in chronic wounds. Studies indicate that the enzyme has a good safety profile. When locally administered, it is not detrimental to wound healing, is non‐sensitising and is rapidly inactivated in the systemic circulation. Adverse effects are limited, at very high concentrations, to transient erythema at the site of application. In‐vitro testing indicates that the enzyme, whilst selective for fibrin, has additional proteolytic action against collagen and elastin, with enzymatic action for all three substrates being dose dependent. In‐vivo, we used an established MRSA biofilm model, in which microbiological counts were used as a surrogate for debridement efficacy. Here, we showed that higher concentrations of the enzyme in a formulated proprietary gel, significantly reduced MRSA counts over a period of 2 to 14 days, and significantly improved the vascularity of the wound at 14 days. Together, these data support the potential for this maggot‐derived proteolytic enzyme as a clinically effective debriding agent. [ABSTRACT FROM AUTHOR]

Copyright of Cultura del Cuidado Enfermería is the property of Revista Cultura del Cuidado Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Pre-operatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as 310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional wellbeing 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol. [ABSTRACT FROM AUTHOR]

The species Jatropha gossypiifolia, popularly known as "pinhão-roxo", is distributed throughout Brazil, is commonly employed for topical or oral administration in treating wounds, inflammations, and snake bites. Given the significant impact of snakebites on public health and the limitations of antivenom, coupled with the diverse molecular composition of this plant species, investigating its healing and antidermonecrotic capacities is relevant. This study aimed to develop a topical nanoemulsion incorporating the hydroethanolic extract of J. gossypiifolia leaves, to evaluate its therapeutic potential, particularly in terms of its efficacy in wound healing and inhibition of dermonecrosis induced by B. erythromelas venom (BeV). The extract of J. gossypiifolia (JgE) leaves was obtained by maceration and remaceration. The phytochemical analysis was conducted and J. gossypiifolia nanoemulsion (JgNe) was obtained, characterized and assessed for stability. The cytotoxicity was determined in normal cells (erythrocytes and 3T3) using hemolytic assay and cell viability assay using crystal violet staining. The antioxidant activity was evaluated by the reduction of ABTS and DPPH radicals. The evaluation of wound healing was conducted in vivo following treatment with JgNe, wherein the percentage of wound closure and inflammatory mediators. The skin irritation test was assessed in vivo by applying JgNe directly to the animal's skin. In vitro , the antivenom capacity was evaluated through enzymatic inhibition assays (phospholipase A 2 and hyaluronidase) of BeV. Additionally, the in vivo antidermonecrotic activity of JgNe was evaluated by measuring the reduction of the dermonecrotic halo. The HPLC-DAD analysis identified flavonoids, specifically vitexin, luteolin derivatives and apigenin derivatives. In addition, 95.08 ± 5.46 mg of gallic acid/g of extract and 137.92 ± 0.99 mg quercetin/g extract, was quantified. JgNe maintained stability over a 4-week period. Moreover, JgE and JgNe demonstrated no cytotoxicity in human erythrocytes and murine fibroblasts at tested concentrations (32.25–250 μg/mL). Additionally, exhibited significant antioxidant activity by reducing ABTS and DPPH radicals. The treatment with JgNe did not induce skin irritation and accelerated wound healing, with significant wound closure observed from 5th day and reduction in nitrite levels, myeloperoxidase activity, and cytokine. Both JgE and JgNe demonstrated in vitro inhibition of the phospholipase and hyaluronidase enzymes of BeV. Moreover, JgNe exhibited antidermonecrotic activity by reducing the dermonecrotic halo caused by BeV after 24 h. JgNe and JgE exhibited no cytotoxicity at the tested concentrations. Additionally, our findings demonstrate that JgNe has the ability to accelerate wound closure and reduce dermonecrosis caused by BeV, indicating to be promising formulation for complementary therapy to antivenom treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Fournier's gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment's strategies of FG.Materials and Methods: This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient's age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1-5.Results: The study group consisted of all men (n=35) aged 24-85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier's syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2. The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23 days) than in group 1 (mean, 26 days).Conclusion: HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury. [ABSTRACT FROM AUTHOR]

[Display omitted] Diabetic wounds (DWs) pose a significant health burden worldwide, with their management presenting numerous challenges. Biopolymeric formulations have recently gained attention as promising therapeutic approaches for diabetic wound healing. These formulations, composed of biocompatible and biodegradable polymers, offer unique properties such as controlled drug release, enhanced wound closure, and reduced scarring. In this review, we aim to provide a comprehensive overview of the current state of research and future prospects regarding the application of biopolymeric formulations for diabetic wound healing. The review begins by highlighting the underlying pathophysiology of DWs, including impaired angiogenesis, chronic inflammation, and compromised extracellular matrix (ECM) formation. It further explores the key characteristics of biopolymeric materials, such as their biocompatibility, biodegradability, and tunable physicochemical properties, which make them suitable for diabetic wound healing applications. The discussion further delves into the types of biopolymeric formulations utilized in the treatment of DWs. These include hydrogels, nanoparticles (NP), scaffolds, films, and dressings. Furthermore, the review addresses the challenges associated with biopolymeric formulations for diabetic wound healing. In conclusion, biopolymeric formulations present a promising avenue for diabetic wound healing. Their unique properties and versatility allow for tailored approaches to address the specific challenges associated with DWs. However, further research and developments are required to optimize their therapeutic efficacy, stability, manufacturing processes, and regulatory considerations. With continued advancements in biopolymeric formulations, the future holds great promise for improving the management and outcomes of DWs. [ABSTRACT FROM AUTHOR]

Background: Health systems globally are facing unprecedented challenges in attempting to balance sharply rising demand against constraints on the availability of financial and other resources. These challenges have led to pressures to constrain expenditure growth through cost containment. But cost containment alone cannot be a sustainable solution if focus on short-term costs ignores the effect on long-term outcomes. Aim: The aim is to raise awareness of the concept of value-based healthcare (VBH) and to illustrate its application to the procurement of wound care products. VBH is about achieving the best possible health outcomes with available resources: either by producing better outcomes with the same resources or by producing the same outcomes with less. Minimising short-term costs is not consistent with the principles of VBH if it leads to higher costs on the long run or if the potential to improve patient outcomes is lost. Method: The impact of different dressing characteristics on the costs of nurse time, dressing spend, and the total annual costs of treating a cohort of patients is estimated. Conclusions: Dressing characteristics other than price are an important factor in determining the total cost of healing a wound. For example: fluid handling capacity impacts wear time that in turn impact the frequency of dressing change. Reducing dressing change frequency adds value by releasing nurse time for other uses and reducing annual dressing spend. Similar considerations apply to other dressing characteristics. The lowest cost dressing is not necessarily the one which adds most value. [ABSTRACT FROM AUTHOR]

Background: Clinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflict-related extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds. Methods: We derived outcome data from a randomized, controlled superiority trial that enrolled adult (≥ 18 years) patients with acute (≤ 72 h) conflict-related extremity wounds at two civilian hospitals in Jordan and Iraq. Primary endpoint was mean treatment-related healthcare costs (adjusted to 2019 US dollars). Results: Patients were enrolled from June 9, 2015, to October 24, 2018. A total of 165 patients (155 men [93.9%]; 10 women [6.1%]; and median [IQR] age, 28 [21–34] years) were included in the analysis. The cost per patient treated with NPWT was $142 above that of standard treatment. Overall, results were robust in a sensitivity analysis. Conclusions: With similar clinical outcomes compared to standard care, our results do not support the use of NPWT in routine treatment of conflict-related extremity wounds at civilian hospitals in resource scarce settings. Trial registration NCT02444598. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of antiseptic solutions to that of non-antiseptic solutions in reducing wound infection rate, reducing bacterial load and improving wound healing. Method: We searched PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Medical Database and medRxiv for randomised controlled trials (RCTs) comparing antiseptic solutions with non-antiseptic solutions in simple, uncomplicated acute traumatic wounds. Qualitative data synthesis was employed. Risk of bias was assessed and GRADE assessment was used to evaluate quality of evidence. Results: In this systematic review, four studies with a total of 875 participants were included, of which two studies showed a significant reduction of wound infection rate using povidone-iodine (p=0.001 and p=0.03). The use of non-antiseptic solutions significantly increased bacterial load on acute traumatic wounds (p=0.0001). The quality of evidence was very low. No studies reported on wound healing outcome. Conclusion: No robust conclusions can be implemented in clinical practice. Future studies are needed to compare the use of antiseptic and non-antiseptic solutions in acute traumatic wounds. [ABSTRACT FROM AUTHOR]

Background: In recent years, resistance to antibiotics has become a global threat, and alternatives to antibiotics have become an area of research. The main alternative methods are briefly described in this review. However, the main focus is bacteriophage-related therapy. Bacteriophages are viruses which, due to the production of the enzyme endolysin, are able to kill bacterial host cells. Bacteriophage therapies have a long tradition. Their potential to function as antibiotics lies in their bactericidal activity and specificity in killing bacteria without infecting or affecting eukaryotic cells. Objective: To systematically review the outcomes of bacteriophage therapy in patients with bacterial infections. Methods: The MEDLINE, EMBASE, Web of Science and CENTRAL databases were searched electronically using search terms referring to bacteriophages, endolysins and antimicrobial resistance. After the literature was screened for their titles and abstracts, full-text reviews considering inclusion/exclusion criteria were performed. Data concerning patients with bacterial infections, treatment with either bacteriophages or its enzyme endolysin and their outcomes were extracted and analysed. Results: Thirteen publications were identified that met all inclusion criteria. Data extraction shows that bacteriophages or endolysins have the potential to combat bacterial infections and significantly reduce inflammatory mediators. However, 3 out of 4 randomized controlled trials revealed that there was no significant difference between phage/endolysin treated patients and control group. Significant clinical improvements were seen in cohort and case studies. A few minor side effects were reported. Conclusions: Although there are countries in which bacteriophages are prescribed as an alternative to established antibiotics, this valuable experience has yet to be examined sufficiently in clinical trials conducted to modern standards. Despite improvements in symptoms shown in the reviewed clinical trials, the infection and the bacteria themselves were rarely completely eradicated. Therefore, no definite answer can be given as to effectiveness, and further clinical trials are necessary. [ABSTRACT FROM AUTHOR]

Objective: Maggot debridement therapy (MDT) has seen a resurgence in recent years in the treatment of hard-to-heal wounds, as a result of rising antibiotic resistance. The sterilised larvae of Lucilia cuprina have been used in MDT in Malaysia since 2003, with encouraging results for the treatment of hard-to-heal diabetic wounds. We report a case series of 30 patients selected from our clinic by convenient sampling with diabetic lower limb ulcers treated with MDT. The average age of patients receiving MDT was >50 years. Of the 30 patients in the study, nine were female and 21 were male. All patients had underlying diabetes, two patients had leg ulcers and 28 patients had diabetic foot ulcers. Sterilised Lucilia cuprina larvae were applied via a standard method of 10 maggots per square centimetre and dressed with sterile gauze. The study endpoint was defined as ≤5% coverage with slough or necrotic tissue following three successive applications of MDT. In this study, maximum debridement of wounds was achieved in 96.6% (29 patients) of our patients, with ≤5% coverage with slough or necrotic tissue, in addition to a reduction in wound-related pain, as assessed by a visual analogue scale. No adverse events were reported. The findings of this study support the use of MDT as a safe, efficacious, and cost-effective method of managing diabetic wounds. [ABSTRACT FROM AUTHOR]

Chronic wounds are a common and debilitating condition associated with aging populations that impact more than 6.5 million patients in the United States. We have previously demonstrated the efficacy of daily topical 1% valsartan in treating wounds in diabetic mouse and pig models. Despite these promising results, there remains a need to develop an extended‐release formulation that would reduce patient burden by decreasing the frequency of daily applications. Here, we used nanotechnology to self‐assemble valsartan amphiphiles into a filamentous structure (val‐filaments) that would serve as a scaffold in wound beds and allow for steady, localised and tunable release of valsartan amphiphiles over 24 days. Two topical treatments of this peptide‐based hydrogel on full‐thickness wounds in Zucker Diabetic Fatty rats resulted in faster rates of wound closure. By day 23, all val‐filament treated wounds were completely closed, as compared to one wound closed in the placebo group. Mechanistically, we observed enrichment of proteins involved in cell adhesion and energetics pathways, downregulation of Tgf‐β signalling pathway mediators (pSmad2, pSmad3 and Smad4) and increased mitochondrial metabolic pathway intermediates. This study demonstrates the successful synthesis of a sustained‐release valsartan filament hydrogel, its impact on mitochondrial energetics and efficacy in treating diabetic wounds. [ABSTRACT FROM AUTHOR]

Objective: The response of different critical acute and hard-to-heal wounds to an innovative wound care modality—direct application of cold atmospheric plasma (CAP)—was investigated in this clinical case series. Method: Over an observation period of two years, acute wounds with at least one risk factor for chronification, as well as hard-to-heal wounds were treated for 180 seconds three times per week with CAP. CAP treatment was additional to standard wound care. Photographs were taken for wound documentation. The wound sizes before the first CAP treatment, after four weeks, after 12 weeks and at wound closure/end of observation time were determined using image processing software, and analysed longitudinally for the development of wound size. Results: A total of 27 wounds (19 hard-to-heal and eight acute wounds) with a mean wound area of 15cm2 and a mean wound age of 49 months were treated with CAP and analysed. All (100%) of the acute wounds and 68% of the hard-to-heal wounds healed after an average treatment duration of 14.2 weeks. At the end of the observation period, 21% of hard-to-heal wounds were not yet closed but were reduced in size by >80%. In 11% of the hard-to-heal wounds (n=2) therapy failed. Conclusion: The results suggested a beneficial effect of additional CAP therapy on wound healing. Declaration of interest: This work was carried out within the research projects 'Plasma for Life' (funding reference no. 13FH6I04IA) with financial support from the German Federal Ministry of Education and Research (BMBF). In the past seven years AFS has provided consulting services to Evonik and has received institutional support by Heraeus, Johnson & Johnson and Evonik. There are no royalties to disclose. The Department for Trauma Surgery, Orthopaedics and Plastic Surgery received charitable donations by CINOGY GmbH. CINOGY GmbH released the di_CAP devices and electrodes for the study. WV and AH were involved in the development of the used di_CAP device (Plasmaderm, CINOGY GmbH). WV is shareholder of the outsourced start-up company CINOGY GmbH. [ABSTRACT FROM AUTHOR]

Aims: Postoperative tendon adhesions contribute to functional disability and reconstructive failure. In this study, we present the long-term outcomes of a prospective study in which acellular dermal matrix (ADM) was used to prevent postoperative adhesion after tendon injury. Methods: The study was conducted between March 2014 and February 2017. Patients, aged 19–65 years, with an acute single flexor tendon injury in zones 1 or 2, distal to the palmar digital crease were candidates for the study. Patients were allocated to either an ADM treatment group or a control group without ADM treatment. Results: A total of 37 patients were enrolled in the study: 21 patients in the ADM group and 16 patients in the control group. At six months after surgery, the range of motion in the proximal interphalangeal joint was 81.0±5.1 degrees in the ADM group and 75.8±6.9 degrees in the control group. The range of motion in the distal interphalangeal joint was 79.9±7.1 in the ADM group and 71.2±5.7 degrees in the control group, with significant difference (p=0.03 and p<0.05, respectively). In addition, the total active motion was higher in the ADM group than in the control group. The patients' scores on the Patient Satisfaction Questionnaire were also significantly different, with higher satisfaction scores in the ADM group (p=0.02). The minimal follow-up period was six months. Conclusion: The use of ADM after tendon repair has the potential to significantly improve the outcome of tendon surgery in terms of range of motion. Declaration of interest: None of the authors has any financial interest in the products, devices, or drugs mentioned in this article. [ABSTRACT FROM AUTHOR]

Objectives: This study is aimed at assessing the safety and effectiveness of an advanced flowable wound matrix (FWM) in the treatment of hard-to-heal vascular leg ulcers that often involve deep structures, are irregular and/or tunnelled or excavated. Methods: Records of patients seen at our Vascular Surgery Unit, at the University of Campania 'Luigi Vanvitelli', for hard-to-heal vascular leg ulcers between January 2018 and January 2020 were retrospectively reviewed. For each wound aetiology, area and complications were recorded and evaluated. Every patient received one or more applications of FWM and was followed up. Results: A total of 22 patients (18 female/four male), mean age 63±8.5 years, were treated. The initial wound area ranged from 4–58cm2. After wound bed preparation, FWM was applied. Treatment was well tolerated and effective—rate of complications was low, graft take was very satisfactory, and no graft loss, rejection or superimposed infections were observed. Healing time was short: 85% of ulcers healed after 12 weeks. Most importantly, there was a decrease in the rate and level of amputations as compared with standard wound care. Conclusions: The data presented indicate that FWM is an option for the treatment of hard-to-heal vascular leg ulcers, particularly for those with an irregular cavity. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review was to determine the impact of topical oxygen therapy (TOT) on diabetic foot ulcer (DFU) healing. Method: Using systematic review methodology, we considered randomised controlled trials (RCTs), controlled trials, pilot studies and observational studies. The search was conducted in January 2019, using PubMed, CINAHL, Ovid, Cochrane, Web of Science and EMBASE databases. Data analysis was undertaken using RevMan and a narrative synthesis. The article titles were assessed by two authors independently, and the abstracts (when available) of the studies identified by the search strategy were screened for their eligibility, according to the inclusion and exclusion criteria. The full-text version of potentially relevant studies was obtained and two authors independently screened this against the inclusion criteria. Data were extracted using a predesigned extraction tool and all included studies were quality appraised using the Evidence-Based Librarianship checklist. Results: The search returned 565 records of which eight met the inclusion criteria. Of the included studies, three were set in single centre outpatient wound clinics, two studies were set in an outpatient wound care research clinic and three studies were multisite. Meta-analysis of four studies was undertaken. DFUs are >2 times more likely to heal with TOT than with standard care alone. The odds ratio (OR)=2.49 (95% confidence interval (CI): 1.59–3.90, p=0.00001). The remaining four studies also showed that using TOT increased healing rates. An included study reported that time to 50% DFU closure was significantly shorter in participants who received the TOT, mean 18.4 days versus 28.9 days in the sham therapy group (p=0.001). However, the validity of 65.5% of the eight studies was assessed as low. Conclusion: The findings suggest that TOT enhances healing for patients with hard-to-heal DFUs when used with standard care. The results from the trials reviewed also indicate a benefit for patients over standard care alone. However, the sample sizes in the studies were generally small, thus, more RCTs are warranted to further validate these findings. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Objective: This prospective case series aims to evaluate the clinical impact of a hypochlorous acid oxidising solution (AOS) in association with usual standard of care (SoC) on wound bed preparation (WBP) in patients with hard-to-heal ulcers of various aetiologies. The AOS (Nexodyn, APR Applied Pharma Research S.A., Switzerland) comprises three main features: highly pure and stabilised hypochlorous acid, acidic pH and high reduction–oxidation potential. Method: Between February 2015 and February 2017, patients who met the inclusion criteria were treated with AOS and usual SoC. Data collection ran for 70 days: T0–T70. A baseline assessment was undertaken at T0; parameters assessed at fortnightly visits included: WBP score, area and depth of ulcer, duration, pain, Bates–Jensen score and infection status. Results: A total of 60 patients took part in the study. By T70, 68.3% of wounds had healed or improved and a significant wound size reduction of 21% was observed (p<0.001), despite a mean wound duration of 20.6 months. All wounds were free of local infection and cellulitis; 10% were colonised. WBP scores improved, while Bates–Jensen and pain scores fell significantly over time. Conclusion: This evaluation suggests that AOS might represent a valuable therapeutic addition for an optimal WBP in the routine management of hard-to-heal ulcers of different aetiologies. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest. [ABSTRACT FROM AUTHOR]

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Aim: Negative Pressure Wound Therapy (NPWT) devices demonstrated their importance in wound healing process. Our clinical study evaluates the role of NPWT in skin grafts healing, both in acute and chronic wounds. Method: We used NPWT for acute and chronic soft tissue defects therapy (56 cases), before and after reconstruction with skin grafts. We compared the evolution of two groups of patients, with similar wounds, admitted and treated during a 7-year period (2016-2022). For 25 patients we used NPWT only before reconstruction with skin grafts (15 acute, 10 chronic wounds), and for the other 31 patients we used NPWT before and after skin grafting (14 acute, 17 chronic). Results / Discussion: Before local reconstruction, NPWT stimulated wound debridement (16 patients with burn injuries, 8 patients with deep posttraumatic soft tissue defects) or granular tissue development (9 patients with trophic ulcers on the leg, 13 patients with diabetic foot, 5 patients with pressure sores, 5 patients with defects after tumor excision). Immediately after the reconstruction, NPWT offered the best conditions for wound healing by reducing local edema, maintaining graft adhesion to the wound bed, stimulating new vessels to grow and nourish the skin graft. Conclusion: NPWT provided a better quality of local healing, in a shorter time and with lower costs. [ABSTRACT FROM AUTHOR]