Search

The ever-increasing problem of chronic, non-healing wound treatment is a challenge in contemporary medicine. This study aims to verify the effect of a designed dressing containing a coating involving oxygenating factors on the promotion of wound healing in all healing phases in a single clinical case. An alginate-based coating, which incorporates the oxygenating factor, was produced. The obtained surface physicochemical features were examined using FTIR and AFM. The bandage support was modified with the developed coating and applied to patients who suffered from chronic wounds (treated with non-modified commercially available bandages) and had required treatment at least 3 months before starting the study. During bandage application, the chosen characteristics of the wound-healing process were examined. A histological evaluation of granulation tissue confirmed the presence of fibroblasts, hemorrhage, and lymphocytes during the second week of treatment. Moreover, epithelization tissue in the third week of treatment exhibited the presence of keratinocytes. A 100% wound reduction was observed between 3 and 4 weeks of treatment with the modified dressing. It can be recommended that the applied coating, which provides a supportive effect through oxygenating elements, inducing the remodeling phase in up to 4 weeks of treatment, be developed for use in hard-to-heal wound treatment. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Despite favourable outcomes in recurrence after off‐midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed‐incision negative‐pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing.Patients were randomized to either NPWT for 4–7 days or loop‐vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining.Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI −0.12 to 0.11), p = 1.00]. After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = −0.03 (95% CI 0.19 to 0.13), p = 0.82]. There was no significant difference in pain experienced postsurgery. In a symptom‐based questionnaire, the control group reported self‐esteem to be less affected (p = 0.015).Closed‐incision negative‐pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify outcomes of wound healing after using Plasma rich platelet therapy METHODOLOGY: A prospective cross-sectional study was conducted at ISRA University Hospital, Hyderabad, from July to December 2022, with a sample size of 50 and a non-probability sampling technique. Both genders aged 45 to 75 years, Diabetes mellitus type II, Chronic or Non-healing wounds/ulcers for 3 to 6 months, and Wound size 2cm to 6cm were included. Participants who were not willing to study, Patients on steroid and Anticoagulant therapy and Immunosuppressive drugs, Pregnant females, those with Cardiovascular Disorders, and Associated Lymphoedema were excluded. Data was analyzed by SPSS version 21. RESULTS: Fifty patients were enrolled after matching the inclusion and exclusion criteria. The age range was 40 years to 70 years. Thirty-one were males, and 19 were females. Co-morbid conditions included were diabetes mellitus type II and hypertension. The most common cause of lower limb ulcers was diabetic foot, and the most common site was the dorsum of the foot. 52% of patients had

OBJECTIVE: To identify outcomes of wound healing after using Plasma rich platelet therapy METHODOLOGY: A prospective cross-sectional study was conducted at ISRA University Hospital, Hyderabad, from July to December 2022, with a sample size of 50 and a non-probability sampling technique. Both genders aged 45 to 75 years, Diabetes mellitus type II, Chronic or Non-healing wounds/ulcers for 3 to 6 months, and Wound size 2cm to 6cm were included. Participants who were not willing to study, Patients on steroid and Anticoagulant therapy and Immunosuppressive drugs, Pregnant females, those with Cardiovascular Disorders, and Associated Lymphoedema were excluded. Data was analyzed by SPSS version 21. RESULTS: Fifty patients were enrolled after matching the inclusion and exclusion criteria. The age range was 40 years to 70 years. Thirty-one were males, and 19 were females. Co-morbid conditions included were diabetes mellitus type II and hypertension. The most common cause of lower limb ulcers was diabetic foot, and the most common site was the dorsum of the foot. 52% of patients had <2cm size ulcers, and they responded well to plasma-rich platelet therapy in a single session. PRP is a cost-effective, advanced therapy and safe procedure to manage wound healing. It improves quality of life, reduces hospitalization, and decreases hospital visits, which would lessen the patient burden. It works on cellular regeneration, so it helps in faster recovery and avoidance of old traditional methods and excessive or misuse of antibiotics. CONCLUSION: Plasma Rich Platelet therapy is a safe method for treating chronic and non-healing ulcers. [ABSTRACT FROM AUTHOR]

Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. 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.)

The ever-increasing problem of chronic, non-healing wound treatment is a challenge in contemporary medicine. This study aims to verify the effect of a designed dressing containing a coating involving oxygenating factors on the promotion of wound healing in all healing phases in a single clinical case. An alginate-based coating, which incorporates the oxygenating factor, was produced. The obtained surface physicochemical features were examined using FTIR and AFM. The bandage support was modified with the developed coating and applied to patients who suffered from chronic wounds (treated with non-modified commercially available bandages) and had required treatment at least 3 months before starting the study. During bandage application, the chosen characteristics of the wound-healing process were examined. A histological evaluation of granulation tissue confirmed the presence of fibroblasts, hemorrhage, and lymphocytes during the second week of treatment. Moreover, epithelization tissue in the third week of treatment exhibited the presence of keratinocytes. A 100% wound reduction was observed between 3 and 4 weeks of treatment with the modified dressing. It can be recommended that the applied coating, which provides a supportive effect through oxygenating elements, inducing the remodeling phase in up to 4 weeks of treatment, be developed for use in hard-to-heal wound treatment.

Objective: Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy. Method: This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles. Results: Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC. Conclusion: Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort. [ABSTRACT FROM AUTHOR]

The occurrence of extensive non-healing and chronic skin defects with loss of tissue substance in companion animals are a frequently solved problem. The management of the therapy of large-area defects and absent tissues is a challenge for setting up successful therapeutic management and achieving wound closure, satisfactory cosmetic effect, and restoration of the functionality of the damaged area. In veterinary medicine, we often encounter the failure of wound therapy methods commonly used in closing defects, as a result of which the defect closure time is prolonged. The longer the time required to close the defect, the greater the risk of microbial infection and complications associated with healing in the case of extensive damage to the surrounding soft tissues. Direct influence of the individual phases of healing with supportive alternative therapy appears to be a very suitable solution for the treatment of chronic wounds. To overcome the shortcomings related to partially efficient conventional wound dressings, efforts are oriented toward developing new and effective platforms for wound healing applications. Five patients referred to the Small Animal Clinic of the University Veterinary Hospital were included in this clinical study.

The treatment of traumatic wounds with exposed bone or tendons is often challenging. An induced membrane (IM) is used to reconstruct bone defects, as it provides an effective and sufficient blood supply for bone and soft‐tissue reconstruction. This study explored a novel two‐stage strategy for wound management, consisting of initial wound coverage with polymethyl methacrylate (PMMA) and an autologous split‐thickness skin graft under the IM. Fifty inpatients were enrolled from December 2016 to December 2019. Each patient underwent reconstruction according to a two‐stage process. In the first stage, the defect area was thoroughly debrided, and the freshly treated wound was then covered using PMMA cement. After 4‐6 weeks, during the second stage, the PMMA cement was removed to reveal an IM covering the exposed bone and tendon. An autologous split‐thickness skin graft was then performed. Haematoxylin and eosin (H&E) staining and immunohistochemical analysis of vascular endothelial growth factor (VEGF), CD31 and CD34 were used to evaluate the IM and compare it with the normal periosteal membrane (PM). The psychological status and the Lower Extremity Function Scale (LEFS) as well as any complications were recorded at follow‐up. We found that all skin grafts survived and evidenced no necrosis or infection. H&E staining revealed vascularised tissue in the IM, and immunohistochemistry showed a larger number of VEGF‐, CD31‐ and CD34‐positive cells in the IM than in the normal PM. The duration of healing in the group was 5.40 ± 1.32 months with a mean number of debridement procedures of 1.92 ± 0.60. There were two patients with reulceration in the group. The self‐rating anxiety scale scores ranged from 35 to 60 (mean 48.02 ± 8.12). Postoperatively, the LEFS score was 50.10 ± 9.77. Finally, our strategy for the management of a non‐healing wound in the lower extremities, consisting of an IM in combination with skin grafting, was effective, especially in cases in which bony structures were exposed in the elderly. The morbidity rate was low. [ABSTRACT FROM AUTHOR]

Introduction: Wounds that cannot be treated with conventional wound care procedures or those that do not become sufficiently smaller with 6 weeks of treatment are usually considered for reconstructive procedures. The present study reviews surgical procedures based on the reconstructive ladder used for the treatment of difficult wounds that contain cavities or are located on vital organs or tissues and do not heal with standard wound care. This review, which highlights that using conventional techniques in such wounds may be a waste of time and money, is intended to guide health professionals dealing with difficult wounds. Material and methods: Between 2018 and 2023, 37 patients with full-thickness wounds due to various aetiologies were retrospectively investigated. The aetiologies, associated comorbidities, the timing, and the choice of surgical techniques were reviewed. The wounds that did not demonstrate a decrease in wound diameter with conventional wound care in 6 weeks were included in the study. Results: The mean age of patients was 56.11 years (range 32-80), and the sex was predominantly male (75%). The number of surgeries were between 1 and 3 (mean 2). The length of hospital stay after surgery was 3-7 days (mean 4.2). Surgical wound infection (7), flap failure (3), and haematoma (2) were seen as complications. Conclusions: Full-thickness wounds with deep cavities and wounds over vital structures usually do not respond to conventional wound care efficiently. A wound care specialist should be able to decide when to refer or perform surgery for the wound care patients. In wounds where wound closure is not possible with wound care alone, the patient should be delivered the most ideal method as soon as possible, taking into account surgical complications. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease (PSD) is a frequent disorder. Treatment failure and recurrence are common, leading to significant morbidity. The aim of this study was to investigate the impact and need for repeated treatment of injected autologous adipose tissue into non-healing PSD wounds and primary anal-near PSD or anal-near recurrence. Methods: At the Department of Surgery, Randers Regional Hospital, Denmark, a prospective pilot study was conducted on consecutive PSD patients with lack of healing 3 months after surgery (Bascom's cleft lift) or with primary or recurrent anal-near pilonidal sinus disease from December 2018 to March 2020. The primary endpoint was time to healing. Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision. Patients were examined 2 and 12 weeks after surgery. Patients with lack of healing after 12 weeks (undermining or no skin coverage) were offered re-injection. Results: We included 30 patients [26 men and 4 women, median age 24 years (range 18–59 years)]. Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9–96.7)]. Two patients had recurrence (6.7%). The median time to complete healing was 159 (189) days. The mean operation time was 70.6 ± 23.7 min and the mean amount of injected autologous adipose tissue was 19 ± 10 ml. There were no major complications. Conclusion: Freshly collected autologous adipose tissue injected into chronic non-healing or primary and recurrent PSD lesions near the anal verge is safe and efficient. [ABSTRACT FROM AUTHOR]

Md A Nahid,1 Jaclyn M Griffin,2 Michael B Lustik,3 Jordan J Hayes,3 Keith SK Fong,3 Timothy S Horseman,3 Massimo Menguito,4 Erik C Snesrud5 ,† Jason C Barnhill,4,6 Michael A Washington4 1Department of Dental and Craniomaxillofacial Trauma Research, United States Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX 78234, USA; 2Department of Vascular Surgery, Tripler Army Medical Center, Honolulu, HI, 96859, USA; 3Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI 96859, USA; 4Department of Chemistry and Life Science, United States Military Academy, West Point, NY 10996, USA; 5Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; 6Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA†Dr Erik C Snesrud passed away on February 10, 2020Correspondence: Md A NahidUnited States Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX 78234, USATel +1 210-539-6419Fax +1 210-539-3877Email md.a.nahid.mil@mail.milPurpose: The biology of chronic wounds is complex and many factors act concurrently to impede healing progress. In this study, the dynamics of microflora changes and their antibiotic susceptibility patterns were evaluated longitudinally over 30 days using data from 28 patients with a total of 47 chronic lower extremity wounds.Materials and Methods: In this study, colonized wound isolates were characterized using cultural, biochemical, and VITEK 2 methods. Antibiotic susceptibility patterns of the wound isolates were analyzed using various phenotypic assays. Furthermore, antimicrobial resistance patterns and the presence of mutations were evaluated by a genotypic assay, whole-genome sequencing (WGS).Results: Staphylococcus aureus and Pseudomonas aeruginosa were found to be the most common strains at early time points, while members of Enterobacteriaceae were prevalent at later stages of infection. Antimicrobial resistance testing and whole-genome sequencing revealed that the molecular and phenotypic characteristics of the identified wound pathogens remained relatively stable throughout the study period. It was also noted that Enterobacter and Klebsiella species may serve as reservoirs for quinolone resistance in the Pacific region.Conclusion: Our observations showed that wounds were colonized with diverse bacteria and interestingly their numbers and/or types were changed over the course of infection. The rapid genetic changes that accompanied the first 4 weeks after presentation did not directly contribute to the development of antibiotic resistance. In addition, standard wound care procedures did not appear to select for resistant bacterial strains. Future efforts should focus on defining those genetic changes associated with the wound colonizing microorganisms that occur beyond 4 weeks.Keywords: anti-microbial resistance, antimicrobial susceptibility profiling, non-healing wound, wound microflora, wound healing

Copyright of KONTAKT - Journal of Nursing & Social Sciences related to Health & Illness is the property of University of South Bohemia in Ceske Budejovice, Faculty of Health & Social Sciences 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.)

This study aimed to explore the treatment effect of Z‐plasty on a non‐healing wound. A total of 72 patients diagnosed with a chronic non‐healing wound in Peking University Third Hospital from November 2009 to August 2019 were retrospectively analysed. Among them, 27 patients were treated with Z‐plasty, and 45 patients were treated with the general method. Detailed patient information was retrieved from medical records, including age, gender, body mass index (BMI), alcohol, smoking, and comorbidities (diabetes mellitus, hypertension, heart disease). Surgical parameters included operation time and intraoperative blood loss. Wound swelling, epidermal blisters, wound edge colour, and skin temperature at 1 day after surgery were assessed to evaluate the blood supply of the wound. Surgical complications included infection, haematoma, dehiscence, and non‐healing within 2 weeks postoperatively. Student t test (for continuous data) and Chi‐square test (for categorical data) were conducted to determine the statistical difference. We found no significant differences in age, gender, BMI, alcohol, smoking, and comorbidities between the two groups. Z‐plasty did not show any advantages in the surgical time, invasive blood loss, hospital days, and hospitalisation expenses. The incidence of abnormal wound edge colour with Z‐plasty was significantly lower than that with the general treatment (P <.05), and the Z‐plasty enables better healing of the patient's wound (P <.05). Z‐plasty promoted better recovery of chronic non‐healing wounds than direct suturing. [ABSTRACT FROM AUTHOR]

Background: Chronic non-healing wounds are a major problem after closed incision pilonidal surgery. Freshly collected autologous adipose tissue injected into perianal fistulas in patients with Crohn's disease seems to promote healing. We investigated this technique in patients with non-healing wounds after cleft-lift surgery for pilonidal sinus disease (PSD). Method: In a prospective interventional pilot study conducted at our institution autologous adipose tissue from the abdominal wall was harvested, and injected into chronic non-healing PS wounds after surgical revision, healing rate being the primary outcome. The wounds were left open. Patients were followed every 2 to 3 weeks until complete healing (skin coverage, no undermining). Results: 7 male patients were included (mean age 24 ± 0,6 SD years) and complete healing was achieved in 6 patients (86%). Median time to healing was 90 days (range 36-403 days) and mean follow-up time was 388± 45 days. All patients reported major symptom relief shortly after the procedure. The mean operation time was 80 ± 23 minutes and the mean amount of freshly collected adipose tissue injected was 27.4± 12 ml. There were no complications. Conclusions: Freshly collected autologous adipose tissue injected into chronic non-healing pilonidal wounds seems safe and efficient. [ABSTRACT FROM AUTHOR]

Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non‐healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self‐management, thereby greatly reducing health care costs. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. 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.)

Introduction: Non-healing wound causes significant morbidity and mortality of patients. One of the rare causes behind non-healing wound infection is M. tuberculosis which often remains undiagnosed. Aim: The aim of this study was to determine the tuberculosis as one of the causes of non-healing wound. Methods: Wounds that did not heal even after secondary suturing and tissue biopsies were sent for histopathological examination. The cases diagnosed with tuberculosis received anti-tubercular treatment. Follow-up was done after 7 and 14 days of treatment, and response was seen in terms of reduction in inflammation and discharge. Results: Of the 36 patients, five patients had tubercular infection out of which one patient revealed tubercular granuloma, two revealed epitheloid cells, Langhans cells, whereas two revealed non-specific chronic inflammation in histopathology. Conclusion: A high degree of suspicion and tissue biopsy is required in case of delayed or non-healing wounds to diagnose tuberculosis as a cause. Even if typical tubercular granuloma is not visible in histopathology, the presence of epitheloid cells, giant cells, Langhans cells or predominant lymphocytic infiltrate equally suggests tubercular tissue infection. [ABSTRACT FROM AUTHOR]

The development of molecular biology and other new biotechnologies helps us to recognize the wound healing and non-healing wound of skin in the past 30 years. This review mainly focuses on the molecular biology of many cytokines (including growth factors) and other molecular factors such as extracellular matrix (ECM) on wound healing. The molecular biology in cell movement such as epidermal cells in wound healing was also discussed. Moreover many common chronic wounds such as pressure ulcers, leg ulcers, diabetic foot wounds, venous stasis ulcers, etc. usually deteriorate into non-healing wounds. Therefore the molecular biology such as advanced glycation end products (AGEs) and other molecular factors in diabetes non-healing wounds were also reviewed.

The study aimed to determine the clinical effectiveness of honey dressings in the management of non-healing wounds in elderly persons receiving home care. 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. 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. 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. • Honey is one of naturally occurring remedies that can be used in the treatment of non-healing wounds. • Honey-impregnated dressings significantly reduced the healing time of non-healing wounds in home care setting. • Honey-impregnated dressings reduced wound pain intensity in elderly. [ABSTRACT FROM AUTHOR]

Pilonidal sinus disease is a chronic inflammatory condition that consists of cycles of healing and wound breakdown often for many years. It is predominantly found in young males. Clinical presentation can be of an acute abscess formation or a non-healing wound in the natal cleft. The latter, chronic version of the disease significantly impacts on an individual's quality of life due to the extended need for ongoing wound care and recurrent wound infection. There is great variation in the treatment options in the chronic form of the disease such as surgical intervention and subsequent healing by secondary intention or flap formation, with the off-midline surgical closure method is recommended for the prevention of recurrence. This article gives an overview of the condition. [ABSTRACT FROM AUTHOR]

Aim: The aim of the paper was to describe chosen aspects of quality of life in patients with venous leg ulcers treated at home in the Turiec region, and to find differences in assessing quality of life in relation to degree of adherence to external compression therapy. Design: A quantitative cross-sectional study. Methods: There were 61 patients with venous leg ulcers at 68.59 ± 9.49 years of age, with an average length of wound treatment of 6.34 ± 5.51 years. The adapted self-assessment questionnaire, the Freiburg Life Quality Assessment wound module (FLQA-w), was used to gain empirical data. Results: The findings revealed that the worst score was achieved in the category of everyday life (3.61 ± 0.93). Statistically significant differences were found between the group of respondents who apply bandages on a daily basis and those who did not use them at all. Regular bandage application is closely connected with positive assessment of wound therapy (p = 0.043), psychosocial life (p = 0.023), verbalisation of well-being in various categories (p = 0.001), assessment of state of the wound (p = 0.032), assessment of health condition (p = 0.019), and overall quality of life (p = 0.014). Length of wound treatment is related to assessments of quality of life. Conclusion: Non-healing wounds, the associated therapy and financial means required to treat them, and the pain resulting from them, are connected with physical difficulty, experience of negative emotions, and, thus, the worsening of patientsʼ quality of life. The results of the study could form the basis for further studies on similar issues.

Calciphylaxis is a rare and potentially fatal disease that affects the subcutaneous layer of the skin. It is a calcific vasculopathy induced by a systemic process that causes occlusion of small blood vessels. The mortality rate for individuals diagnosed with calciphylaxis is estimated between 52% and 81% with sepsis being the leading cause of death. Uraemic calciphylaxis and its known effective treatments are well documented in the literature. Unfortunately, there is no known effective treatment for non‐uraemic calciphylaxis. Most of the current treatments for non‐uraemic calciphylaxis are derived from uraemic calciphylaxis treatment protocols. We report a case of a 75‐year‐old female with calciphylaxis on the right lower extremity who was successfully treated with four pamidronate infusions in addition to local wound care. This case represents a non‐uraemic calciphylaxis wound successfully treated with pamidronate infusions and standard wound care, and suggests that IV pamidronate can be an effective treatment option. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse pos sibilities for using data from the National Health Information system to monitor the epidemiology of non-healing wounds. Hospital stays related to non-healing wounds (according to ICD-10) in acute and long-term care facilities in the Czech Republic (2007- 2015), medical interventions and causes of death in patients with monitored diagnosis related to non-healing wounds were analysed. Methods and sample: Retrospective observational cros s-sectional study using routinely col lected data from the National Register of Hospitalized Patients and Information System of Deaths (in Czech: IS ZEM). Monitored diagnoses (ICD-10): I70.2, E10.5, E11.5, L89, L97, I83.0, I83.2, L03.0, L03.1, L02.3, L02.4. Results: From a total 19,979,081 hospital records per year, we identified 35,824 (50.7%) with the selected diagnosis related to non-healing wound as a primary diagnosis and 34,785 (49.3%) as a secondary diagnosis. Conclusion: Atherosclerosis of arteries of extremities (I70.2) was recorded most frequently. The least frequently reported diagnosis was ulcer of a lower limb (L97). The most com monly reported medical intervention during hospitalization varied according to the type of the hospital (admission) diagnosis. Surgical interventions were reported mostly in hospitalizations with diagnoses E10.5, E11.5, decubitus ulcer (L89), cutaneous abscess, furuncle and carbuncle of buttock and limb (L02.3, L02.4). Conservative treatment was performed in diagnoses of varicose veins of the lower extremities with ulcer (I83.0, I83.2) and ulcer of lower limb, not elsewhere clas sified (L97). Deaths during hospitalization were reported more often in patients with decubitus ulcers (L89) but for a different diagnosis and cause of death. [ABSTRACT FROM AUTHOR]

The development of molecular biology and other new biotechnologies helps us to recognize the wound healing and non-healing wound of skin in the past 30 years. This review mainly focuses on the molecular biology of many cytokines (including growth factors) and other molecular factors such as extracellular matrix (ECM) on wound healing. The molecular biology in cell movement such as epidermal cells in wound healing was also discussed. Moreover many common chronic wounds such as pressure ulcers, leg ulcers, diabetic foot wounds, venous stasis ulcers, etc. usually deteriorate into non-healing wounds. Therefore the molecular biology such as advanced glycation end products (AGEs) and other molecular factors in diabetes non-healing wounds were also reviewed. [ABSTRACT FROM AUTHOR]

Contamination of surgical, traumatic, and chronic wounds with microorganisms presents a challenge to successful wound healing. In the present in vitro study, a synthetic electrospun fiber matrix (SEFM) cleared for use in the management of chronic, surgical, and traumatic wounds underwent USP (United States Pharmacopeia) <51> Antimicrobial Effectiveness Testing to determine its in vitro effectiveness against various microorganisms commonly found in non-healing wounds. The SEFM was tested in both sheet (s-SEFM) and micronized form (m-SEFM) against  Escherichia coli, Pseudomonas aeruginosa ,  Staphylococcus aureus ,  Aspergillus brasiliensis ,  Candida albicans,   Proteus mirabilis , and  Enterococcus faecalis . Testing was performed per the USP <51> standard on days 7, 14, and 28. Both the s-SEFM and m-SEFM met the USP <51> acceptance criteria for all microorganisms. The results obtained for s-SEFM demonstrated >1-log 10  reduction against  E. coli, S. aureus, P. aeruginosa, P. mirabilis, E. faecalis,  and  C. albicans  at day 7; >3-log 10  reduction with no detection of these microbes at days 14 and 28, and no increase from initial inoculum at days 7, 14, and 28 against  A. brasiliensis.  The results obtained for m-SEFM demonstrated >3-log 10  reduction with no detectable microorganisms at day 7. The results observed in this study indicate that the SEFM is effective in vitro at inhibiting bacterial and fungal growth and colonization per USP <51> testing., Competing Interests: Matthew MacEwan is the patent owner of the Restrata matrix, (Copyright © 2023, Sallade et al.)

Objective: To investigate the clinical significance of different plastic surgeries in the treatment of poor healing wound after posterior spinal internal fixation., Methods: In this study, 16 patients with poor incision healing after posterior spinal internal fixation were retrospectively included, and dif-ferent plastic surgery treatment plans were determined according to the wound characteristics and defect condition. The measures included debridement, vacuum sealing drainage (VSD), and different tissue flaps according to the location and extent of the defect., Results: A total of 16 patients meeting the criteria were included, of whom 3 were treated with debridement combined with VSD and wound suture directly, 6 were treated with debridement combined with Z-flap for wound repair, 1 was treated with bilateral sacrospinous muscle flap for dural defect repair combined with Z-flap for skin wound repair, 1 was treated with lectus dorsi flap for wound repair, 3 were treated with the fourth lumbar artery perforator flap for wound repair. The wound was repaired with local rotating flap in 1 case and gluteus maximus musculocutaneous flap in 1 case. Among the 16 patients, 7 cases were positive for wound culture, including 3 cases of Staphylococcus aureus , 1 case of Pseudomonas aeruginosa , 1 case of Staphylococcus epidermidis , 1 case of Escherichia coli , 1 case of Klebsiella pneumoniae , and the other 9 cases were negative. After surgery, there were 7 patients with different degrees of poor wound healing, including 3 patients undergoing dressing change, 2 patients undergoing secondary debridement and suture, 1 patient undergoing free scalp skin graft, and 1 patient undergoing local effusion suction treatment. All the above 7 patients were discharged from hospital after improvement, and the remaining 9 patients had good first-stage wound hea-ling after surgery. None of the 16 patients underwent internal fixation., Conclusion: Multiple factors could lead to poor wound healing after posterior spinal internal fixation. Early intervention, thorough debridement, removal of necrotic/infected tissue, and selection of suitable skin flap for effective wound fil-ling and covering were important means to ensure wound healing after spinal surgery and reduce removal of internal fixation.

Uterine necrosis is a very rare condition and most of the reported cases occurred after pelvic arterial embolization for post-partum haemorrhage, embolization of fibroid uterus or application of B–Lynch sutures. A case of delayed myometrial necrosis is reported in post-cesarean patient where no embolization or uterine compression sutures have been applied. Patient presented with foul smelling discharge from the gaped abdominal wound following caesarean section. Abdomen was closed after exploration and lavage. Patient did not have complete healing and area of unhealed wound remained through which subinvoluted uterus was peeping out. Patient was taken for resuturing again but the uterus was found to be completely necrotic and hysterectomy was performed. Patient responded to treatment.

The present study evaluates the effect of hyperbaric oxygen therapy on taste sensitivity, hedonic perception of taste, and food preferences. The studied groups included 197 people in total (79 in the study group; 118 in the control group). All patients from the study group were treated with hyperbaric oxygen therapy due to chronic non-healing wounds. The control group consisted of healthy people, who did not receive hyperbaric oxygen therapy. The taste intensity, recognition thresholds, and hedonic perception were examined using gustatory tests. The aqueous solutions of sucrose for sweet, sodium chloride for salty, citric acid for sour, quinine hydrochloride for bitter, and monosodium glutamate for umami taste were used. The participants fulfilled the questionnaire to examine pleasure derived from eating certain types of dishes. Gustatory tests and analyses of the pleasure derived from eating in the study group were carried out before the first exposure to hyperbaric oxygen and then at the end of therapy, after at least 25 sessions of treatment. In the control group, examination of perception of taste sensations was conducted only once. The results of comparing patients with non-healing wounds with healthy people are characterized by reduced taste sensitivity. After participation in hyperbaric oxygen therapy, the improvement in perception of taste sensations and changes in hedonic evaluation have occurred among patients with non-healing wounds. In terms of food preference, a decreased desire for eating sweet desserts, chocolate, and crisps was observed in those patients who received hyperbaric oxygen therapy. [ABSTRACT FROM AUTHOR]

Aim: The aim of the paper was to describe chosen aspects of quality of life in patients with venous leg ulcers treated at home in the Turiec region, and to find differences in assessing quality of life in relation to degree of adherence to external compression therapy. Design: A quantitative cross-sectional study. Methods: There were 61 patients with venous leg ulcers at 68.59 ± 9.49 years of age, with an average length of wound treatment of 6.34 ± 5.51 years. The adapted self-assessment questionnaire, the Freiburg Life Quality Assessment wound module (FLQA-w), was used to gain empirical data. Results: The findings revealed that the worst score was achieved in the category of everyday life (3.61 ± 0.93). Statistically significant differences were found between the group of respondents who apply bandages on a daily basis and those who did not use them at all. Regular bandage application is closely connected with positive assessment of wound therapy (p = 0.043), psychosocial life (p = 0.023), verbalisation of well-being in various categories (p = 0.001), assessment of state of the wound (p = 0.032), assessment of health condition (p = 0.019), and overall quality of life (p = 0.014). Length of wound treatment is related to assessments of quality of life. Conclusion: Non-healing wounds, the associated therapy and financial means required to treat them, and the pain resulting from them, are connected with physical difficulty, experience of negative emotions, and, thus, the worsening of patientsʼ quality of life. The results of the study could form the basis for further studies on similar issues. [ABSTRACT FROM AUTHOR]

Non-healing skin wounds remain a significant clinical burden, and in recent years, the regulatory role of matricellular proteins in skin healing has received significant attention. Periostin and CCN2 are both upregulated at day 3 post-wounding in murine skin, where they regulate aspects of the proliferative phase of repair including mesenchymal cell infiltration and myofibroblast differentiation. In this study, we examined 1) the wound phenotype and expression patterns of periostin and CCN2 in non-healing skin wounds in humans and 2) the regulation of their expression in wound fibroblasts by tumor necrosis factor α (TNFα) and transforming growth factor-β1 (TGF-β1). Chronic skin wounds had a pro-inflammatory phenotype, characterized by macrophage infiltration, TNFα immunoreactivity, and neutrophil infiltration. Periostin, but not CCN2, was significantly suppressed in non-healing wound edge tissue at the mRNA and protein level compared with non-involved skin. In vitro , human wound edge fibroblasts populations were still able to proliferate and contract collagen gels. Compared to cells from non-involved skin, periostin and α-SMA mRNA levels increased significantly in the presence of TGF-β1 in wound cells and were significantly decreased by TNFα, but not those of Col1A2 or CCN2. In the presence of both TGF-β1 and TNFα, periostin and α-SMA mRNA levels were significantly reduced compared to TGF-β1 treated wound cells. Effects of TGF-β1 and TNFα on gene expression were also more pronounced in wound edge cells compared to non-involved fibroblasts. We conclude that variations in the expression of periostin and CCN2, are related to an inflammatory microenvironment and the presence of TNFα in human chronic wounds. [ABSTRACT FROM AUTHOR]

Abstract: With the increasing prevalence of diabetes in the community, morbidity and mortality as a result of diabetic feet has been increasing. Foot complications are one of the most serious and yet preventable complications of diabetes mellitus having an economic impact to the individual and adding the burden to the already inadequate healthcare resources. Complications associated with diabetes are often expensive to treat, and commonly include foot ulceration. While most diabetic foot ulcers heal with standard treatment, when standard treatment measures fail, adjunctive therapies must be considered. Use of systemic Hyperbaric Oxygen Therapy (HBOT) as an adjunctive treatment for chronic lower extremity diabetic ulceration is safe, reasonable and cost effective modality. HBOT in diabetic wounds has confirmed its role in promoting oxygenation; enhance immune mechanisms, neovascular formation, fibroblast proliferation and other beneficial actions. It is now accepted as a useful adjunctive treatment in a select group of diabetic patients with severe or limb threatening wounds. HBOT has been demonstrated to be an effective treatment when combined with careful attention to underlying diseases and wound care including debridement, grafting, and control of infection. This article discusses the role of oxygen in wound healing, and place of HBOT in the modern multidisciplinary approach to the treatment of diabetic foot wounds. [Copyright &y& Elsevier]

Synovial sarcoma is a malignant mesenchymal neoplasm that is frequently misdiagnosed as a benign condition because of its small size, slow growth, and well-delineated appearance. Rapid spread and early death occur rarely. Here we report a case of synovial sarcoma of the buttocks presenting with a non-healing wound and rapid progression after local resection in a 23-year-old woman. She initially found a slightly painful subcutaneous mass in the left buttock and underwent local excision. Postoperatively, she developed a non-healing wound that did not respond to conventional antibiotic therapy and local wound care, and pitting edema of the lower extremities. A magnetic resonance imaging scan revealed a large heterogeneous, irregular mass in the buttocks with regional lymph node involvement. Histological and immunohistochemical analyses suggested the diagnosis of a poorly differentiated synovial sarcoma. Her condition deteriorated dramatically shortly thereafter; she developed systemic edema and died of respiratory failure. This case suggests that synovial sarcoma may be fatal within months of recognition if improperly managed and stresses the importance of adequate pre-surgical evaluation and postoperative pathological analysis in the management of a subcutaneous mass. [ABSTRACT FROM AUTHOR]

The non-healing wound is encountered by practitioners in multiple clinical situations. It is characterised by a stalled process in the healing trajectory. The non-healing wound is not necessarily a chronic wound, although the two conditions have many similarities. With the advent of improved molecular biological understanding, many cellular events can be recognised as patterns for non-healing, and possible interventions may become evident. Thus, once obvious host disease problems have been excluded, exaggerated inflammation with high matrix metalloproteinase levels and the presence of biofilm are causative factors in many cases of non-healing wounds. Intervention may range from a simple change of dressing type and debridement to more sophisticated wound bed interventions. A systematic approach to the non-healing wound is presented. [ABSTRACT FROM AUTHOR]

Objective: This study observed the degree of neo-vascularisation and differential expression of angiogenesis growth factors and their receptor in deep partial-thickness scald wound with diabetes mellitus. Methods: Sixty Sprague-Dawley rats were randomised into a control group and an STZ-induced diabetic group, inflicted with partial-thickness scalding of 20% total body surface area (20% TBSA) on the back. Wound specimens were harvested immediately after scald and on 1, 3, 7, 10, 14 and 21 post-scald days (PSDs) to observe histological changes, and wound healing rates were calculated. The degree of neo-vascularisation in wound (labelled with blue microsphere) and the quantity of vascular endothelial cells (labelled with red CD31) were also measured by double-labelling immunofluorescence. Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2), Tie-2, vascular endothelial growth factor (VEGF) and Flt-1 messenger RNA (mRNA) were analysed by real-time RT-PCR. Ang-1, Ang-2 and VEGF protein expressions were measured by Western blotting. Results: Wound healing was markedly impaired in diabetic rats. The diabetic rats show inhibited vascularity in the wound edge at every time point (the quantitation of vascularity was 60.0±3.0 in the control group and 12.0±1.4 in the diabetic group, p <0.01 on day 7). Although neo-vascularisation in the number of endothelial cells was not significantly different compared with the normal group, part of new vascular endothelial cells did not form the vascular function. After injury, expression of Ang-2 mRNA and protein were increased in both groups, and the normal group showed decreases on day 7, 14 and 21, whereas the diabetic group showed significant increases. Although the expression VEGF and its receptors before injury was higher than the normal group, the level at 1, 3 and 7 days after injury was significantly lower than that 14 days, and that at 21 days after injury was significantly higher than the normal group. Conclusion: Vascular endothelial cells can proliferate actively in the diabetic wound with deep partial-thickness burns, but it is still poor in blood supply due to lack of functional capillaries. The mechanism may be related to sustained abnormal high expression of Ang-2 and down-regulated VEGF. [Copyright &y& Elsevier]

The article offers information on the ways on how to deal with the psychosocial effects of malignant wounds, and the management of pain and bleeding. It discusses the significance of an individualized pain management protocol in controlling the entire aspects of managing malignant wounds. It mentions several treatment options and methods for chronic wounds including the use topical analgesia, paroxetine, and calamine. It also cites the ways in managing various levels of bleeding.

Abstract: Patients suffering from head and neck cancer often require temporary tracheostomy during therapy. The tracheostomy can usually be closed when postoperative swelling decreases and swallowing ability recovers. However, some patients, especially after adjuvant radiotherapy, may develop severe chronic wounds resulting in persistent tracheocutaneous fistula. Local wound care and plastic reconstruction strategies are required in such cases. We present two patients with head and neck cancer treated with primary surgical regimen including temporary tracheostomy and adjuvant radiotherapy. Both patients developed a persistent, poorly healing wound with persistent tracheocutaneous tissue defect. After local debridement and wound care, the peristomal necrotic tissue was excised down to the level of the trachea. The defect of the anterior tracheal wall was closed with a autogenous ear cartilage graft. The graft was harvested from the cavum conchae and sutured to the tracheal defect. The soft tissue defect was covered by transposition of a well-vascularized, fasciocutaneous deltopectoral flap. In both cases, the flaps healed satisfactorily. The donor defect was closed primarily. Complications were not observed in these two cases. A flexible tracheo-bronchoscopy showed no stenosis of the trachea at the site of cartilage graft transplantation. In conclusion, treatment of persistent radiated tracheocutaneous defects by cartilage graft and deltopectoral flap turned out to be a safe and reliable procedure which can be performed as a one-stage method with low morbidity at the donor site. [Copyright &y& Elsevier]