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Objective: Venous leg ulcers (VLUs) comprise 80% of leg ulcers. One of the key parameters that can promote healing of VLUs is tissue oxygenation. To date, clinicians have employed visual inspection of the wound site to determine the healing progression of a wound. Clinicians measure the wound size and check for epithelialization. Imaging for tissue oxygenation changes surrounding the wounds can objectively complement the subjective visual inspection approach. Herein, a handheld noncontact near-infrared optical scanner (NIROS) was developed to measure tissue oxygenation of VLUs during weeks of treatment. Approach: Continuous-wave-based diffuse reflectance measurements were processed using Modified Beer-Lambert's law to obtain changes in tissue oxygenation (in terms of oxy-, deoxy-, total hemoglobin, and oxygen saturation). The tissue oxygenation contrast obtained between the wound and surrounding tissue was longitudinally mapped across weeks of treatment of four VLUs (healing and nonhealing cases). Results: It was observed that wound to background tissue oxygenation contrasts in healing wounds diminished and/or stabilized, whereas in the nonhealing wounds it did not. In addition, in a very slow-healing wound, wound to background tissue oxygenation contrasts fluctuated and did not converge. Innovation: Near-infrared imaging of wounds to assess healing or nonhealing of VLUs from tissue oxygenation changes using a noncontact, handheld, and low-cost imager has been demonstrated for the first time. Conclusion: The tissue oxygenation changes in wound with respect to the surrounding tissue can provide an objective subclinical physiological assessment of VLUs during their treatment, along with the gold-standard visual clinical assessment.

Latar Belakang : Diabetes Melitus (DM) adalah penyakit kronis serius yang terjadi ketika pankreas tidak menghasilkan cukup insulin (hormon yang mengatur glukosa darah), atau ketika tubuh tidak dapat secara efektif menggunakan insulin yang dihasilkannya. Menurut International Diabetes Federation, terdapat 425 juta orang yang menderita diabetes di dunia dan akan meningkat sebesar 629 juta orang pada tahun 2045. Terdapat lebih dari 10.276.100 kasus diabetes di Indonesia pada tahun 2017 dari total populasi dewasa sebesar 166.531.000 yang berarti terdapat prevalensi penderita diabetes sebesar 6,7% dan menduduki peringkat 6 dari 10 negara teratas untuk jumlah penderita diabetes. Penderita diabetes memiliki peningkatan risiko sejumlah masalah kesehatan yang serius. Banyak yang mengeluhkan terjadinya ulkus diabetik yaitu luka terbuka pada penderita DM sehingga diabetes melitus menjadi penyebab terjadinya amputasi kaki pada penderita DM. Amputasi terjadi 15 kali lebih sering pada penderita diabetes daripada non diabetes. Pada tahun 2032, seiring dengan peningkatan jumlah penyandang diabetes di dunia, terjadi peningkatan kaki diabetik. Perawatan kaki yang dilakukan secara efektif dapat mencegah resiko ulkus menjadi amputasi. Dengan dilakukan manajemen yang komprehensif, sebagian besar amputasi yang berkaitan dengan diabetes dapat dicegah. Bahkan ketika amputasi berlangsung, kaki yang tersisa dan kehidupan orang tersebut dapat diselamatkan dengan perawatan tindak lanjut yang baik.Tujuan : Untuk memberikan gambaran perawatan luka serta menilai proses perawatan dan perkembangan luka kaki diabetes pada pasien diabetes melitus selama 5 minggu perawatan.Metode : penelitian ini merupakan jenis penelitian yang dilakukan secara prospektif yang dimulai dari tanggal 10 September – 9 Oktober 2018 di Klinik Perawatan Luka Griya Afiat, Makassar. Status Demografi dan pengkajian luka didapatkan melalui wawancara langsung kepada pasien dan keluarga serta menilai luka menggunakan format Asuhan Keperawatan Luka dari Klinik Griya Afiat.Hasil : Pada minggu pertama perawatan, Keadaan luka memiliki banyak undermining. Berdasarkan struktur lapisan kulit, luka berada pada full thickness. Penampilan klinis lain ditemukan adanya slough/infeksi, disertai odor, kulit sekitar luka mengalami maserasi, serta edema. Teknik debridemen yang digunakan yaitu Conservatif Sharp Wound Debridement (CSWD) dan autolysis. Dressing yang digunakan pada perawatan luka yaitu hidrofobik dan salep zink sebagai dressing primer, kasa steril dan diaper sebagai balutan sekunder, serta kasa gulung sebagai balutan tersier. Untuk perawatan periwound digunkan salep zink. Terjadi perubahan ukuran yang berbeda-beda pada tiap luka dan meningkatnya proses granulasi dan epitelisasi tiap minggu perawatan hingga minggu kelima perawatan, keadaan luka mulai mengalami peningkatan epitelisasi dan mengalami perubahan ukuran luka terutama pada undermining, presentasi slough menurun, tanda infeksi lokal mulai berkurang.Kesimpulan : Selama proses perawatan luka selama 5 minggu, Proses penyembuhan luka mengalami progress yang baik. Pada minggu pertama dan kedua mengalami fase inflamasi, pada minggu ketiga hingga kelima mengalami proses poliferasi. waktu proses penyembuhan luka berjalan lambat, terjadi perubahan ukuran dan kedalaman yang berbeda-beda pada beberapa luka di setiap minggu perawatan, luka tidak berpotensi amputasi dengan tidak terdapatnya luka nekrotik selama 5 minggu perawatan, tanda-tanda infeksi lokal pada luka semakin berkurang di setiap minggu perawatan, terdapat edema pada kaki kiri yang mengalami luka diabetik serta kaki kanan sehingga diperlukan pemeriksaan lebih lanjut untuk mengatasi faktor lain yang menghambat proses penyembuhan.Keywords : Diabetes Milletus, Luka Kaki Diabetes, Post Autoamputasi.

Objective The study aimed to determine the clinical effectiveness of honey dressings in the management of non-healing wounds in elderly persons receiving home care. Material and methods Design: a prospective interventional study. The sample comprised 40 Czech home care clients (aged over 65 years) with non-healing wounds who were randomly assigned to two groups. Wounds were treated with honey (intervention group) or conventional (controls) dressings. Each wound was studied for three months. A detailed description of a wound (location, size, wound bed, edges, amount of exudate, odor, adjacent skin) were recorded. Wounds were assessed with the Wound Healing Continuum and pain intensity with the Visual Analog Scale. Results Over the 3-month period, 16 (80%) individuals in the intervention group had their wounds completely healed, as compared with only six (30%) controls. There was no statistically significant difference in wound size between the groups on Day 1 (p = 0.1801). Ninety days later, the difference in wound size between the groups was statistically significant (p = 0.0041). There was a statistically significant difference in pain intensity between the two groups (p = 0.0007), with higher pain scores being indicated by controls. Conclusion The study results showed that the application of honey dressings to non-healing wounds resulted in faster healing, wound size reduction and lower pain intensity.

Background Zinc deficiency is believed to be a predisposing factor for the development and intractable healing of pressure ulcers (PUs); however, the mechanisms of this association have not been elucidated. Objective Objective was to elucidate the mechanisms of the formation of severe and prolonged PUs under the zinc deficiency condition. Methods We assessed PUs formation after cutaneous ischemia-reperfusion (I/R) injury in mice fed with a zinc-adequate (ZA) or a zinc-deficient (ZD) diet from 2 weeks before I/R injury. Wound size, vascular damage, apoptotic cells, adenosine triphosphate (ATP) amount, and the number of Langerhans cells (LCs) in I/R area were analyzed. We evaluated the extent of oxidative stress in I/R area in OKD48 mice through bioluminescence detection. Results We found that dietary zinc deficiency caused the formation of severe and prolonged PUs in mice. Zinc deficiency increased the vascular disorder, oxidative stress, and apoptosis induced by cutaneous I/R injury. I/R injury-induced oxidative stress signals were significantly higher in ZD OKD48 mice than in ZA OKD48 mice. Additionally, zinc deficiency reduced the number of LCs and increased the amount of ATP in cutaneous I/R-injured skin. Oral supplementation of zinc improved zinc deficiency-associated PUs. Conclusion Zinc deficiency might increase cutaneous I/R injury-induced vascular damages, oxidative stress, and apoptosis, as well as ATP amount in I/R area due to the loss of LCs. These mechanisms might partly account for zinc deficiency-induced formation of severe and prolonged PUs. Oral supplementation of zinc might be a reasonable therapeutic choice for patients with PUs and zinc deficiency.

Objective: Tissue expanders are widely used in the reconstruction of tissue wounds. This study aims to demonstrate how to choose the correct size of rectangular expander in relation to wound size and the maximum advancement technique for wound coverage in order to achieve a successful outcome. Methods: The present study included patients who were operated on between January 2013 and January 2017. The expander height chosen was more than half the length of the wound and the expander width was chosen to be as wide as possible, based on the width of the wound. The expander was placed in a site adjacent to the wound. Maximum advancement method was used to achieve coverage of the wound. Results: A total of 19 patients were included in the study, mean age 17.5 (range: 11–25) years. Indication included burn scar (n=14) and congenital nevus (n=5). The tissue expander was inserted into the scalp in 17 patients and supraclavicular area in two patients. A successful wound repair was achieved with the planned flaps in all patients. Conclusion: In expansion using rectangular expanders, the required expanded skin is gained through the height of the expanded tissue. Thus, expander size should be preoperatively planned to ensure the height of expanded tissue would be, at least, half of the wound length. Maximum benefit will be achieved from the expanded tissue through the correct placement of expanded tissue lateral flaps.

Background While negative pressure wound therapy (NPWT) has been used for decades, there is a paucity of data regarding the appropriate length of time between dressing changes. Methods This was a prospective, randomized control trial examining time to wound closure in open midline laparotomy wounds treated with NPWT. The control group received the standard thrice weekly sponge changes (thrice) and the treatment group received once weekly sponge changes (once). Results 44 patients met study criteria over a 3-year period. There was no difference in NPWT duration between the two groups (37.1 vs 34.7 days, p = 0.7324), even after adjusting for potential confounders (p = 0.8091). No differences were found in initial wound size or reduction. The wound complication profile was similar for both groups. Conclusion There is no difference in time to wound closure or complications with NPWT dressing changes once a week compared to the standard three times a week.

To compare the influence of laser and LED on tissue repair and neuropathic symptoms during treatment of diabetic foot. An intervention survey conducted in a health center located in Brazil, contemplating ten sessions, twice a week, with randomization in two groups. In one group, the wounds were treated with GaAlAs laser, with a wavelength of 830 nm, 30 mW, and power density 0.84 W/cm2, the other group by LED 850 nm, 48 mW, and power density 1.05 W/cm2. For the analysis of wound size, photographic records analyzed by the ImageJ® software were used, and the neuropathy evaluation card examined. With regard to the laser group, a reduction in wound extension of 79.43% was observed at the end of the 10th session; the patients in the LED group had a 55.84% decrease in the healing process; comparing the two therapies was observed a better healing in the participants of the laser group, with 81.17%, in relation to the LED after the end of the sessions; regarding the evaluation of the neuropathic condition, there was a significant improvement in both therapies. There was improvement of the neuropathic signs and symptoms, also improvement of the tissue repair in the two therapeutic modalities; however, the laser presented a higher rate of speed in relation to the LED.

After a tissue is wounded, cells surrounding the wound adopt distinct wound-healing behaviors to repair the tissue. Considerable effort has been spent on understanding the signaling pathways that regulate immune and tissue-resident cells as they respond to wounds, but these signals must ultimately originate from the physical damage inflicted by the wound. Tissue wounds comprise several types of cellular damage, and recent work indicates that different types of cellular damage initiate different types of signaling. Hence to understand wound signaling, it is important to identify and localize the types of wound-induced cellular damage. Laser ablation is widely used by researchers to create reproducible, aseptic wounds in a tissue that can be live-imaged. Because laser wounding involves a combination of photochemical, photothermal and photomechanical mechanisms, each with distinct spatial dependencies, cells around a pulsed-laser wound will experience a gradient of damage. Here we exploit this gradient to create a map of wound-induced cellular damage. Using genetically-encoded fluorescent proteins, we monitor damaged cellular and sub-cellular components of epithelial cells in living Drosophila pupae in the seconds to minutes following wounding. We hypothesized that the regions of damage would be predictably arrayed around wounds of varying sizes, and subsequent analysis found that all damage radii are linearly related over a 3-fold range of wound size. Thus, around laser wounds, the distinct regions of damage can be estimated after measuring any one. This report identifies several different types of cellular damage within a wounded epithelial tissue in a living animal. By quantitatively mapping the size and placement of these different types of damage, we set the foundation for tracing wound-induced signaling back to the damage that initiates it.

Background Distal limb wounds in horses often show aberrant healing due to a slow inflammatory response. In human medicine, negative pressure wound therapy (NPWT) is used for the treatment of chronic wounds with a similar inflammatory response. Objectives To compare the effect of NPWT to calcium alginate dressings on the healing of (non) contaminated equine distal limb wounds. Study design Controlled experiment. Methods Circular wounds were created on the left and right dorsomedial metacarpus of 10 horses. In five horses, the wounds were contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. In all horses, one limb was treated with NPWT, the other with calcium alginate dressings. Treatments were applied during nine days for noncontaminated wounds and six days for contaminated wounds. Noninvasive (clinical assessment, bacteriology swabs, thermographic images and wound dimensions) and invasive (biopsies for histology and growth factor analysis) measurements were taken regularly for 71 and 29 days respectively. Effects of selected parameters on continuous dependent variables were analysed using ANOVA, while for discrete dependent variables, logistic regression was applied. Results In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages. Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds. Bacterial load and the presence of growth factors did not differ between treatments in noncontaminated wounds. In contaminated wounds, no differences between treatments were observed in wound size, histological parameters, bacterial load or growth factor concentration. Main limitations Sample size is small. Conclusions No long-term advantage was detected with NPWT compared with calcium alginate dressings in noncontaminated or contaminated equine distal limb wounds healing by second intention.

There are various causes related to the appearance of wounds in people that are cause several health problems. Earlier detection and easy monitoring is essential for the correct treatment of this problem. The pandemic time that we live in is causing the people not to go to the hospital to treat the various wounds. This paper performs the revision of the methods for measuring the wound size, but the wounds' color can detect other parameters. This study also proposed a technique for further implementing the detection of wounds with the camera available in off-the-shelf mobile devices. As future work, the method will be implemented to correct wound size in an Android application.

As more therapeutic clinical trials focus on treatment of individual wounds in patients with recessive dystrophic epidermolysis bullosa, it has become crucial to understand the baseline clinical characteristics of these wounds. To investigate these features, we administered an RDEB-specific wound survey. Forty participants reported on location, size, pain, infection frequency, wound type, and duration of 189 wounds; a subset of 22 participants reported on pruritus in 63 wounds. Increased wound size was significantly associated with increased pain, increased pruritus, longer wound duration, increased infection frequency, and patients with mutations resulting in truncated type VII collagen.

Understanding the tissue and cellular changes that occur in the acute injury response as well as during the wound healing process is of paramount importance when studying diseases of the gastrointestinal (GI) tract. The murine colonic pinch biopsy model is a useful tool to define these processes. Additionally, the interplay between gut luminal content (e.g., microbes) and the colon can be studied. However, wound induction and the ability to track wound closure over time in a reliable manner can be challenging. Moreover, tissue preparation and orientation must be carried out in a standardized way to optimally interrogate histologic and molecular changes. Here, we present a detailed method describing biopsy-induced injury and the monitoring of wound closure through repeat colonoscopies. An approach is described that ensures consistent and reproducible measurements of wound size, the ability to collect the wound bed for molecular analyses as well as visualize the wound bed upon sectioning of tissues. The ability to successfully carry out these techniques allows for studies of the acute injury response, wound healing and luminal-host interactions within the colon.

The accurate measurement of diabetic foot ulcer (DFU) wound size is essential as the rate of wound healing is a significant prognostic indicator of the likelihood of complete wound healing. Mobile phone photography is often used for surveillance and to aid in telemedicine consultations. However, there remains no accurate and objective measurement of wound size integrated into these photos. The NDKare mobile phone application has been developed to address this need and our study evaluates its accuracy and practicality for DFU wound size assessment. The NDKare mobile phone application was evaluated for its accuracy in two- (2D) and three-dimensional (3D) wound measurement. One hundred and fifteen diabetic foot wounds were assessed for wound surface area, depth and volume accuracy in comparison to Visitrak and the WoundVue camera. Thirty five wounds had two assessors with different mobiles phones utilizing both applications to assess the reproducibility of the measurements. The 2D surface area measurements by NDKare showed excellent concordance with Visitrak and WoundVue measurements (ICC: 0.991 [95% CI: 0.988, 0.993]) and between different users (ICC: 0.98 [95% CI: 0.96, 0.99)]. The 3D NDKare measurements had good agreement for depth and fair agreement for volume with the WoundVue camera. The NDKare phone application can consistently and accurately obtain 2D measurements of diabetic foot wounds with mobile phone photography. This is a quick and readily accessible tool which can be integrated into comprehensive diabetic wound care.

Objective:Endoscopic resection (ER) is more difficult and has a higher rate of complications, such as perforation and bleeding. The aim of this study was to evaluate the safety and feasibility of a bipolar polypectomy snare for ER.Methods:Initial ER procedures in live pigs were carried out. Then, a human feasibility study was performed in patients with colorectal polyps. Finally, the finite element method was used to evaluate the safety and effectiveness of the new bipolar snare.Results:In the live animal model, there were no significant differences in wound size and cutting time between monopolar and bipolar groups. The histological results (histological scores) of the two groups in porcine experiments were almost the same except that the incision flatness of bipolar group was better than that of the monopolar group. Incidence of bleeding and perforation was similar between the two groups in pigs' and patients' study. At last, the finite element model showed that the vertical thermal damage depth produced by bipolar snare system was approximately 71–76% of that produced by monopolar snare system at the same power.Conclusions:The novel bipolar snare is feasible in patients with colorectal polyps and can be an alternative choice for ERs.

Acute and chronic wounds affect people of all ages around the world. Monitoring the size of open wounds has been proven to be effective for the diagnosis and prognosis of several medical complication such as ulcers, chronic wounds, and a variety of infections. This work presents an image-based approach to calculate the percentage of growth or shrinkage of wounds at the dermal layer. Image segmentation is applied to determine the region of interest in the wound image. Changes in the wound size (area) are computed to quantify the healing percentage.

Evaluating and tracking wound size is a fundamental metric for the wound assessment process. Good location and size estimates can enable proper diagnosis and effective treatment. Traditionally, laboratory wound healing studies include a collection of images at uniform time intervals exhibiting the wounded area and the healing process in the test animal, often a mouse. These images are then manually observed to determine key metrics —such as wound size progress– relevant to the study. However, this task is a time-consuming and laborious process. In addition, defining the wound edge could be subjective and can vary from one individual to another even among experts. Furthermore, as our understanding of the healing process grows, so does our need to efficiently and accurately track these key factors for high throughput (e.g., over large-scale and long-term experiments). Thus, in this study, we develop a deep learning-based image analysis pipeline that aims to intake non-uniform wound images and extract relevant information such as the location of interest, wound only image crops, and wound periphery size over-time metrics. In particular, our work focuses on images of wounded laboratory mice that are used widely for translationally relevant wound studies and leverages a commonly used ring-shaped splint present in most images to predict wound size. We apply the method to a dataset that was never meant to be quantified and, thus, presents many visual challenges. Additionally, the data set was not meant for training deep learning models and so is relatively small in size with only 256 images. We compare results to that of expert measurements and demonstrate preservation of information relevant to predicting wound closure despite variability from machine-to-expert and even expert-to-expert. The proposed system resulted in high fidelity results on unseen data with minimal human intervention. Furthermore, the pipeline estimates acceptable wound sizes when less than 50% of the images are missing reference objects.Author summaryKnowledge of the wound size changes over-time allows us to observe important insights such as rate of closure, time to closure, and expansion events, which are key indicators for predicting healing status. To better perform wound measurements it is essential to utilize a technique that returns accurate and consistent results every time. Over the last years, collecting wound images is becoming easier and more popular as digital cameras and smartphones are more accessible. Commonly, scientists/clinicians trace the wound in these images manually to observe changes in the wound, which is normally a slow and labor-intensive process and also requires a trained eye. The clinical goal is to more efficiently and effectively treat wounds by employing easy to use and precise wound measurement techniques. Therefore, the objective should be devising automatic and precise wound measurement tools to be used for wound assessment. To this end, we leveraged a combination of various state-of-the-art computer vision and machine learning-based methods for developing a versatile and automatic wound assessment tool. We applied this tool to analyze the images of wound inflicted lab mice and showed that our developed tool automated the overall wound measurement process, therefore, resulting in high fidelity results without significant human intervention. Furthermore, we compared results to two expert measurements. We found variability in measurement even across experts further validating the need for a consistent approach. However, qualitative behavior, which is most important for predicting wound closure, is preserved.

Healing rate is the most accurate method to predict healing; however, there are no data in atypical ulcers. We retrospectively analyzed clinical features, associated comorbidities, and therapies of 159 patients with atypical ulcers. In a subgroup of 59 patients, we analyzed the areas, perimeters, and the healing rate (mm/d) as prognostic indicators of wound healing. Atypical ulcers were more frequent among women (n = 98) with an average age of 76 years. Confirmed by biopsy, the etiologies were as follows: inflammatory diseases (38%), neoplastic ulcers (29%), vasculitis (21%), drug-induced ulcers (7%), and infectious ulcers (4%). Systemic therapies were applied based on the different etiologies. Wound bed preparation principles guided the local treatment. The average reduction of the area during the observation interval was 36%, while the average reduction in the perimeter was 41%. Overall, 51 ulcers showed a reduction in wound size and 8 ulcers showed an increase. Neoplastic ulcers were the group with the fastest healing rate, with an average speed of 0.24 mm/d. The slowest healing occurred in the inflammatory group with an average healing rate of 0.032 mm/d. The initial area and perimeters influenced wound healing; however, ulcer etiology and comorbidities significantly altered the healing rate.

Recurring damage to the aerial organs of plants necessitates their prompt repair, particularly their vasculature. While vascular regeneration assays for aerial plant parts such as the stem and inflorescence stalk are well established, those for leaf vasculature remain unexplored. Recently, we established a new vascular regeneration assay in growing leaves and discovered the underlying molecular mechanism. Here, we describe the detailed stepwise method for the incision and regeneration assay used to study leaf vascular regeneration. By using a combination of micro-surgical perturbations, brightfield microscopy, and other experimental approaches, we further show that the age of the leaf as well as the position and size of the injury determine the overall success rate of regeneration. This easy-to-master vascular regeneration assay is an efficient and rapid method to study the mechanism of vascular regeneration in growing leaves. The assay can be readily combined with cellular and molecular biology techniques.

BackgroundRecurring damage to aerial organs of plants necessitates their prompt repair, particularly their vasculature. While vascular regeneration assay in aerial plant parts such as stem and inflorescence stalk are well established, those on leaf vasculature remained unexplored. Recently we established a new vascular regeneration assay in growing leaf and discovered the underlying molecular mechanism.ResultsHere we describe the detailed stepwise method of incision and the regeneration assay used for studying the leaf vascular regeneration. By using a combination of micro-surgical perturbations, brightfield microscopy and other experimental approaches, our new findings show that the regeneration efficiency decreases with aging of the leaf, and increases with the nearness of the wound towards the proximal end of the leaf.ConclusionThis easy-to-master vascular regeneration assay is an efficient and rapid method to study the mechanism of vascular regeneration in growing leaves. It can be readily adapted for other plant species and can be combined with cellular and molecular biology techniques.

Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.

Background: Platelet-rich plasma (PRP) and its derivatives are an emerging biotechnology whereby concentrated platelets provide damaged tissue with growth factors, cytokines, and other mediators to improve healing outcomes. Although there is strong evidence in the benefits of autologous PRP for both acute and chronic wounds, allogeneic PRP has been studied far less in comparison. Summary: In this mini-review, we discuss critical steps of allogenic PRP (and its derivatives) preparation. We performed a non-systematic review of the literature to identify animal and human subject studies testing allogenic PRP for wound treatment. We searched OVID Medline and PubMed for articles using the keywords “wound, ulcer, lesion, skin, and cutaneous” and “PRP, or platelet-rich plasma, or platelet-rich fibrin, or PRF, or platelet releasate” and “homologous, allogeneic or allogenic,” which were limited to non-review articles and English language. Two studies in animal models and 8 studies in patients were reviewed. There were inconsistencies in preparation methods, treatment regimens, and some lacked a control group in their studies. Despite these variations, none of the studies identified any major side effects or adverse events. The treatment resulted in a reduced time to heal and/or reduced wound size in most cases. Key Messages: In situations where autologous PRP is not available or suitable, allogeneic PRP appears to provide a safe alternative. Its efficacy, however, requires larger-scale studies with appropriate controls. Standardization in PRP preparation and treatment regime are also needed to be able to interpret allogenic PRP efficacy.

Background Chronic wounds have a major impact on patients’ health-related quality of life (HRQoL). Therefore, measuring HRQoL is an indispensable part of the treatment of patients with chronic wounds. The aim of this study was to translate and validate the Wound-QoL, a wound-specific HRQoL questionnaire, in a Dutch population. Methods The Wound-QoL was translated into Dutch according to the international standards. Patients with chronic wounds were asked to complete questionnaires at baseline (T0) and after six weeks (T1), including Wound-QoL, EQ-5D-3L (a generic questionnaire to measure HRQoL) and a visual analogue scale (VAS) measuring wound pain. If patients were not able to complete the questionnaire by themselves, it was read out to them by a nurse. Further data were obtained from medical records. Results Of the 120 patients included, 64 (53.3%) completed the questionnaire by themselves. To 55 patients (45.8%), the questionnaire was read out. The internal consistency of the Wound-QoL global score was high at both time points (T0: Cronbach’s α = 0.89, T1: Cronbach’s α = 0.92). The item selectivity for global score ranged from r = 0.25 to r = 0.77 at T0 and from r = 0.40 to r = 0.79 at T1. Overall, the self-completion and read-out subgroups showed similar internal consistency and item selectivity scores. With regard to convergent validity, significant correlations were found between Wound-QoL and EQ-5D-3L (T0: r = − 0.45, p p p = 0.012, T1: r = 0.37, p = 0.001) at both time points. Responsiveness analyses showed significant correlations between changes in Wound-QoL and changes in EQ-5D-3L (r = − 0.37, p p = 0.044) and wound size (r = 0.24, p = 0.013). The self-completion and read-out subgroups showed differences in convergent validity and responsiveness. Conclusions The results indicate that the Dutch version of the Wound-QoL has positive psychometric properties. However, more research is needed to further explore the differences between self-completed and read-out questionnaires.

Backgroun Blue light (400 and 450 nm) contributes to bringing the inflammatory phase under control, increases angiogenesis, stimulates the metabolism of all cellular processes, reduces scar formation, increases collagen production, and decreases the bacterial burden. Methods The aim of this study was to promote the healing process in 20 hard-to-heal wounds using a portable light-emitting diodes device that emits blue light (Emoled™). The primary endpoint of the study was to calculate in the three etiologic groups the reduction in wound size by the average delta area in square centimeters and as a percentage, and by the average healing rate (mm/Days). The secondary endpoint was to assess the wound bed score and to assess patients' pain (numerical rating scale). Results At week 4 the average healing rate was 0.098 mm/days for venous leg ulcers, 0.353 mm/days for traumatic ulcers, and 0.09 mm/days for vasculitis. Overall 16 patients had a reduction in wound size, two patients were completely healed, and there was no improvement in two patients. At week 4, the average wound bed score had increased to 12.8 and average pain had decreased to 2.35. Almost all patients (n=19) showed pain reduction, and all the patients increased wound bed score. Conclusions The blue LED device is promising in terms of promoting wound healing, improving WBS and reducing pain in patients affected by long-term wounds that do not respond to standard treatment.

Chronic wound assessment and wound healing are important for diagnostic, follow up and wound treatment. However, this growing disease affecting nearly 2 thousand million and 5.7 million people in the USA and Europe, costing around $20 billion and $8 thousand million USD per year, still relies on subjective human assessment of wounds. A scoping review allowed us to identify 109 articles that map the literature on the topic of computer vision for chronic wound assessment and healing. These results were carefully analyzed and mapped into relevant clinical challenges associated with this field, identifying the maturity of each different computer vision challenge that needs addressing. Results show that wound size and tissue type classification already have interesting work, but various other clinical areas are in need of larger datasets and computer vision research efforts for achieving a relevant impact in today's clinical routine.

Cold atmospheric plasma (CAP) was shown to decrease bacterial load in chronic wounds. It was also presented as a novel approach to healing wounds in both in vitro and in vivo experiments. We aimed to examine the first randomized clinical trial for the use of CAP in diabetic foot ulcers. Patients (n = 44) were randomly double-blinded, and assigned to receive standard care (SC, n = 22) without or with CAP, to be applied three times a week for three consecutive weeks (SC + CAP, n = 22), using block randomization with mixing block sizes of four. The trial was conducted at the Diabetes Research Center in Tehran, Iran. CAP was generated from ionized helium gas in ambient air, and driven by a high voltage (10 kV) and high frequency (6 kHz) power supply. Primary outcomes were wound size, number of cases reaching wound size of

Significance: We introduce and evaluate emerging devices and modalities for wound size imaging and also promising image processing tools for smart wound assessment and monitoring. Recent Advances: Some commercial devices are available for optical wound assessment but with limited possibilities compared to the power of multimodal imaging. With new low-cost devices and machine learning, wound assessment has become more robust and accurate. Wound size imaging not only provides area and volume but also the proportion of each tissue on the wound bed. Near-infrared and thermal spectral bands also enhance the classical visual assessment. Critical Issues: The ability to embed advanced imaging technology in portable devices such as smartphones and tablets with tissue analysis software tools will significantly improve wound care. As wound care and measurement are performed by nurses, the equipment needs to remain user-friendly, enable quick measurements, provide advanced monitoring, and be connected to the patient data management system. Future Directions: Combining several image modalities and machine learning, optical wound assessment will be smart enough to enable real wound monitoring, to provide clinicians with relevant indications to adapt the treatments and to improve healing rates and speed. Sharing the wound care histories of a number of patients on databases and through telemedicine practice could induce a better knowledge of the healing process and thus a better efficiency when the recorded clinical experience has been converted into knowledge through deep learning.

Objective: While myriads of studies have suggested that a survey of wound pH environment could indicate wound healing activities, it is not clear whether wound alkalinity can be used as a prognostic indicator of nonhealing wounds. Currently available systems cannot reliably assess the pH environment across wounds, which is the objective of this study. Approach: A disposable device, DETEC® pH, was developed and characterized on its ability to map wound alkalinity by pressing a freshly recovered wound dressing against its test surface. By comparing the wound's alkalinity and size reduction rates (∼7 days) following pH measurement, we assessed the capability of wound alkalinity to prognosticate subsequent short-term wound size reduction rates. Results: The device had high accuracy and specificity in determining the alkalinity of simulated wound fluids soaked onto wound dressing. The type of wound dressing type had an insignificant effect on its detection sensitivity. Upon testing discarded wound dressings from human patients, the device quickly determined alkaline and acidic wounds. Finally, statistical analyses of wound size reduction rates in wounds with various alkalinities confirmed that wound alkalinity has a strong influence on, at least, short-term wound healing activity. Innovation: Without directly contacting the patient, this device provides a quick assessment of wound alkalinity to prognosticate immediate and short-term wound healing activities. Conclusion: DETEC® pH may serve as a prognosis device for wound care specialists during routine wound assessment to predict wound healing progress. This information can assist the decision-making process in a clinical setting and augur well for chronic wound treatment. DETEC® pH can also be used as an aid for home health care nurses or health care providers to screen nonhealing wounds outside clinics.

After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%–100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.

We investigated the accuracy of pressure injury evaluation using tele-devices and examined the concordance between automatically generated recommendations and primary manual recommendations. Caregivers took photos and videos of pressure injuries using smartphones with built-in cameras and uploaded the media to the application. The wound team evaluated the wound using a specially modified version of the Pressure Sore Status Tool. This was compared with the Pressure Sore Status Tool score assessed during the actual examination of the patient. We developed an automatic algorithm for dressing based on the Pressure Sore Status Tool score, checking for consistency between this and the primary manual recommendation. A total of 60 patients diagnosed with pressure injuries were included. The κ coefficients indicated substantial agreement for wound size and total score, and excellent for all other items. We found that the overall concordance rates were statistically significant for all items (p < 0.001). For the primary dressing, the κ coefficient for the concordance rate of automatic algorithm and manual recommendation was 0.771, while that of teleconsultation system and manual recommendation was 0.971. For the secondary dressing, the figures were 0.798 and 0.989, respectively. All values were statistically significant (p < 0.001). We presented strong evidence documenting the utilization of a smartphone, patient-driven system, and demonstrated that the measurements obtained were comparable to the ones obtained by a trained, on-site, wound team. Furthermore, we confirmed agreement between automatically generated recommendations and primary manual recommendations.

Chronic non‐healing wounds are a burden in the Long‐Term Care (LTC) sector, increasing costs, morbidity, and mortality and causing pain and suffering. The objective of this LTC Innovation pilot was to test the value of a promising new neuromuscular stimulation device in elevating the experience and satisfaction of the residents, engaging and empowering the nursing staff, and improving healing and/or reducing costs. Small, wireless, and worn at the knee, this muscle pump activator is self‐contained, wearable, and battery‐powered to increase lower‐leg blood circulation (up to 60% of that achieved by walking). It has no wires, weighs just 10 g, and is easy to use. Nurses in four LTC homes identified residents with non‐healing lower leg wounds. Consent was obtained, and on‐site training was delivered. Eleven residents were recruited. Only seven met the inclusion criteria for venous/mixed or diabetic foot ulcers. Of the seven who met the criteria and were adherent with best practices and the muscle pump activator, four healed 100%, and one healed 90%. Two patients with other aetiologies, who were also adherent, healed. All adherent residents had an average weekly decrease in wound size of 9.75% and were extremely happy with the results. Three residents who were non‐adherent had a 9.25% increase in wound size per week. One patient with diabetic foot ulcers developed skin changes at the end of life and passed away. Nursing staff and cognisant residents can easily adjust the pulse of muscle pump activator, and application and removal are simple. Most residents feel engaged with the therapy “because they feel it working”. The LTC corporation feels that it is a great adjunctive solution for many types of lower‐leg wounds (venous, mixed, diabetic, pressure) in addition to best practices in the LTC and Retirement home sectors.

Adipose‐derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet‐rich plasma (PRP), there may be enhanced healing effects due to the pro‐angiogenic and anti‐inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm(2). Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.

Objective This retrospective clinical application observation study shall demonstrate the effect of a wound debridement using micro water jet technology (MWT) as an efficient method promoting wound healing. The final goal is to accomplish a decrease in wound size (reepithelization) due to debridement with MWT. Through the application of MWT, the wound shall receive a healing stimulus. Besides the use of MWT, there are other water-based cleaning/rinsing systems available. Method From two wound care centers (Kantonsspital Obwalden, Spital Lachen), all data from patients treated with MWT and different types of wound, over a time period of 3 years, were retrospectively analyzed. All patients, except one, could be treated in an outpatient setting. Fewest of the patients did receive a local anesthetic. Included were all patients, independent from gender and age. Results The retrospective data analysis was carried out on 90 patients (46 m/44 f) with an average age of 68.5 years (17/93 years) and a total of 95 different wounds. 58 wounds were completely closed at exit from the wound care center within a median treatment time of 59 days (8.4 weeks). The average treatment time for all 95 wounds was 39 days (5.6 weeks) per wound at the end of debridement, the average wound size 6.1 cm2. The reduction of healing time compared to traditional methods was approximately 30%. Conclusion The result of the retrospective data analysis on patients with predominantly chronic and persistent wounds shows that debriding with micro water jet technology is an efficient, tissue-preserving, precise and time-saving method for outpatient wound care – with excellent healing outcomes. Patient safety was high and we have seen no adverse effects. The MWT is comparable to other water jet-based cleaning/rinsing systems.

Background When a skin defect occurs, clinicians must work to restore the original skin quality as soon as possible. Accordingly, an artificial dermis can be used to supplement the wound and prevent severe scar contracture formation. The Terudermis is an artificial dermis that is simple and easy to use. We investigated the effectiveness of the Terudermis in the treatment of facial skin defects by analyzing previous relevant cases treated in our institution. Methods We retrospectively examined 143 patients who were treated with the Terudermis graft in facial skin defect at Dong Kang General Hospital in 2015 and 2016. The patients' age, sex and location, wound size, complications were analyzed. In addition, the patients were asked to complete a self-satisfaction questionnaire after 18 months from the completion of treatment. The results were compared with that of autologous full-thickness skin graft (FTSG) and split-thickness skin graft (STSG) patients in same period. Results The mean self-satisfaction scores evaluated by patients were 4.1±1.0, 4.0±1.3 and 3.5±1.8 for the Terudermis graft, FTSG and STSG patients, respectively. With respect to complications, there were fewer incidences of hematoma, partial skin loss and complete skin loss in the Terudermis graft patients. Conclusion In the present study, the Terudermis, when used to treat post-traumatic facial skin defects, is a good alternative option to obtain satisfactory aesthetic outcomes. Also, the Terudermis grafting is a simple and easy treatment method to perform.

Introduction Predictive in vitro testing of novel wound therapeutics requires adequate cell-based bio-assays. Such assays represent an integral part during preclinical development as pre-step before entering in vivo studies. Simple “scratch tests” based on defected skin cell monolayers exist, however these can solely be used for testing liquids, as cell monolayer destruction and excessive hydration limit their applicability for (semi-)solid systems like wound dressings. In this context, a cell-based wound healing assay is introduced for rapid and predictive testing of wound therapeutics independent of their physical state in a bio-relevant environment. Methods A novel wound healing assay was established for bio-relevant and predictive testing of (semi-) solid wound therapeutics. Results The assay allows for physiologically relevant hydration of the tested wound therapeutics at the air-liquid interface and their removal without cell monolayer disruption. In a proof-of-concept study, the applicability and discriminative power could be demonstrated by examining unloaded and drug-loaded wound dressings with two different established wound healing actives (dexpanthenol and metyrapone) and their effect on skin cell behavior. The influence of the released drug on the cells´ healing behavior could successfully be monitored over time. Wound size assessment after 96 h resulted in an eight fold smaller wound area for drug treated models compared to the ones treated with unloaded fibers and non-treated wounds. Discussion This assay provides valuable first insights towards the establishment of a valid screening and evaluation tool for preclinical wound therapeutic development from liquid to (semi-)solid systems to improve predictability in a simple, yet standardized way.

BACKGROUND: Low cost Negative Pressure Wound Therapy (NPWT) dressings have been considered as an alternative to traditional daily dressings. There is scanty literature evaluating the change in the percentage area of wound covered by granulation tissue following application of low-cost NPWT. The change in the bacteriological flora following application of low-cost NPWT devices has also not been evaluated. METHODS: Patients above the age of 18 years with acute musculoskeletal injuries of

In the Northwest Atlantic fisheries management is adapting to emerging fisheries. The fishery for Jonah crab (Cancer borealis) is rapidly expanding resulting in a quadrupling of landings over the past 20 years. In response to this increased fishing effort, management plans have begun adopting a suite of regulatory measures, one of which allows the live removal of claws at-sea. The overall goal of this project was to determine if claw removal has an impact on crab mortality. Results from a series of laboratory trials with individual crabs (n = 240) indicate that double-claw removal incurs markedly more mortality (70 %) compared with single-claw removal (51 %). Mortality was significantly correlated with wound size, temperature, and shell condition (GLM, p

Platelet-rich fibrin (PRF) has a lot of benefits in the process of healing. The new generation of PRF, namely advanced PRF plus (A-PRF+), has a different fibrin structure and more growth factors compared to Advanced PRF (A-PRF), the generation before A-PRF+. Objectives:To compared the effects of A-PRF and A-PRF+ on the IIB degree burn. Methods: This experimental study used 20 male Sprague Dawley rats. All rats were given IIB degree burn and divided into four groups. Group 1 was treated with saline, Group 2 was treated with silver sulfadiazine 1%, Group 3 was treated with A-PRF, and Group 4 was treated with A-PRF+. Wound size reduction will be calculated every two days and measured with ImageJ and the wound would be made into a histological slide on day 14 to calculate angiogenesis. Results: Changes in the wound surface area for the group that was given A-PRF dan A-PRF+ are 2,333cm and 4,827cm. The wound surface area’s data were analyzed using Kruskal-Wallis and the results are statistically not significant (p>0,05). The number of angiogenesis for the group that was give A-PRF and A-PRF+ as followed are 5,88 and 4,867. The angiogenesis data were analyzed using one-way ANOVA and the results are statistically not significant (p>0,05). Conclusion: There is no difference between the effect of A-PRF and A-PRF+ towards changes in wound surface area and angiogenesis in IIB degrees burn wounds.Keywords: A-PRF, A-PRF+, burn wound, angiogenesis, wound surface area

Recessive dystrophic epidermolysis bullosa (RDEB) is a devastating, genetic blistering condition caused by the absence of type VII collagen (C7), affecting the mucosa and skin. Patients often have recurrent and chronic open wounds, but one of the major barriers to the development of clinical trials is the lack of understanding of the natural history of RDEB wounds, as the measurement of target wound change has not been studied prospectively or validated. We conducted a longitudinal, clinical observational study of 10 patients with RDEB who used a mobile phone photography application, with built-in machine learning, to outline and track RDEB wounds autonomously. Patients used this mobile application to capture photographs weekly, alongside reporting associated pain and itch. 507 photos of 10 participants with RDEB were collected: 202 of chronic open wounds (unhealed >12 weeks) and 290 of recurrent wounds (heal but re-open), with an average of 44.7 wound photos per participant. The top three locations recorded were hips or legs (n=241), feet (n=115) and upper extremity (n=82). For chronic open wounds, there was a statistically significant positive correlation for both wound size and pain (0.76, p

Background: Chronic venous ulcers (CVUs), demanding specialized care, are still a major socioeconomic problem facing health care systems worldwide. This study’s main goal was evaluating the efficacy of ESWT application as an AT in the treatment of wounds for curing CVUs. Materials and Methods: 50 patients presenting with CVUs were divided into two groups of ESWT and control randomly. Then, ESWT was applied one session per week, during four weeks, along with routine CB. The control group also received sham ESWT together with CB. In this respect, pain score, wound size, patient satisfaction and quality of life (QoL) using the Charing Cross Venous Ulcer Questionnaire (CCVUQ) were consequently assessed at baseline, week four, and week eight and then compared between both groups. Results: The findings showed that patients receiving ESWT along with CB had significantly lower pain and were also feeling more satisfied than the cases undergoing CB alone (P

Laboratory and field studies were conducted to determine the effects of wounding of nut exocarp, susceptibility period after wounding, and sap nut on infection of pistachio nut by Neofusicoccum mediterraneum, the main causal agent of panicle and shoot blight of pistachio. Under controlled conditions and in the field, detached nuts were inoculated with a conidial suspension 30 min before or after wounding. In addition, a 30-µl drop of pistachio sap was placed on the surface of noninjured nuts 30 min before or after they were wounded and then inoculated. Wounding increased the disease severity under both controlled and field conditions. The addition of sap increased the susceptibility of nuts under controlled conditions but not in the field, possibly due to dried sap blocking the pathogen infection. When nuts of Kerman, Kalehghouchi, and Golden Hills pistachio were wounded and inoculated at different time periods after wounding; the nuts of the three cultivars were highly susceptible to pathogen infection during at least the first 24 h after wounding. Under field conditions, there was not a clear effect of increasing the number of inoculated nuts per panicle or the inoculation position (basal or apical) in killing (blight) of the panicle. Conversely, inoculations conducted with mycelial plugs resulted in higher disease, increased the proportion of dead panicles, and resulted in faster symptom expression than inoculations conducted with a conidial suspension. To determine the temporal infection pattern, leaves and panicles were regularly collected from different orchards from 2004 to 2007 and the pathogen was isolated on medium. Important differences in latent infection were detected between years and orchards, with nut and rachis being, in general, the tissues most susceptible to infection. Results of this study help in better understanding the dynamic of infection and colonization of pistachio by N. mediterraneum.

The bursting strength is a key parameter to assess hemostatic ability of tissue sealants. It is associated to mechanical property of the materials, the binding strength of the materials to the tissues as well as the applied conditions of the materials, such as temperature and wound size. Few works have systematically investigated the relationship of the hemostatic ability of hydrogels with the factors listed above. This study introduced a method to systematically investigate the effect of the thickness, covered area and components of hydrogels, and the applied conditions on the bursting strength of hydrogels. The gelatin hydrogel and fibrin glue were used in this study. The method quantitatively investigated the effect of material properties and applied conditions on the bursting strength of materials. It also suggested a minimum dosage of tissue sealant used in both animal study and clinical practice. This study proved that the method we proposed is reliable to assess the bursting strength of materials for the hemostatic application.

Hydrogen peroxide (H2O2) has dual roles in the biological system, which are determined by the respective intracellular concentration. Abnormal level of H2O2 could inactivate enzymes, affect the cell viability and impair wound healing. Vanillyl alcohol (VA) is known for antioxidant, angiogenic and anti-inflammatory properties. We previously developed H2O2-scavenging vanillyl alcohol-incorporating polyoxalate (PVAX) and reported their therapeutic activities in various oxidative stress-associated conditions. However, no attempts were made to explore PVAX nanoparticles as therapeutic agents for wound healing. We hypothesized that PVAX nanoparticles scavenge excessive H2O2 in the wound site to prevent H2O2-induced tissue damage, promoting the wound healing process. The therapeutic activity of PVAX nanoparticles were systemically evaluated using a mouse model of excisional wound. PVAX nanoparticles could effectively control the level of H2O2 and accelerate wound healing process. PVAX nanoparticles significantly reduced the wound size and induced reepithelization and collagen deposition. We therefore anticipate that PVAX nanoparticles hold great potential as wound healing agents.

Objective: To investigate wound healing after application of adjunctive topical haemoglobin spray in patients with chronic wounds. Method: Consecutive patients with a diversity of chronic wounds (defined as Results: We evaluated 50 patients for a 26-week evaluation period, during which 45/50 patients (90%) treated with haemoglobin spray were completely healed compared with 19/50 retrospective control patients (38%) (pConclusion: Haemoglobin spray resulted in a higher number of healed wounds and a faster rate of healing, as well as a positive impact on other wound parameters. These results are in accordance with other published data and supports the adjunctive use of haemoglobin spray in patients with a wide variety of chronic wounds of all sizes and origins.