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The purpose of this study was to explore the experience of negative pressure wound therapy (NPWT) at home among Chinese chronic wound patients. Qualitative descriptive study design was adopted, and qualitative data were collected through semistructured in-depth interviews. A purposive, sampling method was used. Informants were recruited from one single wound healing center of a teaching hospital and were interviewed following one course of NPWT at home. A thematic content analysis was undertaken in the framework of input-process-output theory to guide analysis. Of the 13 participants interviewed, 9 were female and 4 were male with an age ranging from 20 to 69 years. Two major categories with their corresponding codes were identified. The first, positive experience, had 6 codes: high-degree identity and feeling hope (input); easy operation and convenience (process); improvement of symptoms and effective treatment (output). The second category, negative experience, had 11 codes: high expenditure, defects of the NPWT device, health education deficiency, and lack of independence and rationales in making decision of NPWT (input); poor communication with wound professionals, unexpected circumstances, therapeutic side effects, and a change of self-image (process); impact on physical symptoms and daily life, impact on social activities, and impact on psychological well-being (output). Patients considered the NPWT at home as a promising regimen, but they also had a feeling of not being prepared and lack of health education to make medical decision independently. The participants’ perceptions and experiences would provide valuable information to promote the intervention program of health education and advance service process optimization.

Phosphaturic mesenchymal tumor (PMT) is a rare paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia, and bone calcification disorders. Complete surgical resection of the tumor is believed to be the most effective treatment measure. However, the diagnosis of PMT is very difficult because of its insidious and small size, especially, when it appears in subcutaneous tissue with a chronic non-healing wound. We report a rare case of a 38-year-old man with a chronic non-healing wound on the left hallux for approximately eight months. Plain radiographic images and magnetic resonance imaging (MRI) revealed a cystic radiolucent shadow in the left distal phalanx. Bone scan observations also showed increased uptake in the same location. Histologically, this tumor was composed of numerous spindle cells with clusters of giant cells. The serum FGF23 level was significantly higher before surgery, with higher FGF23 levels closer to the tumor. Reverse transcription polymerase chain reaction and immunohistochemistry further confirmed the high expression of FGF23 in tumors. These data suggest that FGF23 may be a potential causative factor of PMT. The serum FGF23 levels might be useful for the diagnosis of PMT and localization of the tumor. The tumor was CD56- and D2 to 40-positive and CD31-negative. The non-healing wound caused by PMT might be attributed to the invasive growth of the tumor, destruction of intercellular junctions, and decrease in the number of endothelial cells.

The aim of this study was to evaluate the changes of proliferation, apoptosis, homeostasis, and differentiation of human adipose-derived stem cells (hASCs) in the simulated diabetic microenvironment and discuss the potential of the mesenchymal stem cell in the treatment of chronic diabetic wound. We simulated diabetic microenvironment with glycation end products (AGEs) in vitro and studied the changes of hASCs in proliferation and apoptosis. We found that AGEs inhibited the proliferation and lead to hASCs apoptosis, and the endothelial cell directed differentiation was also inhibited. AGEs upregulated growth-related oncogene and monocyte chemoattractant protein-1 and downregulated urokinase-type plasminogen activator receptor, which may inhibit the proliferation and transference of endothelial cells. The simulated diabetic microenvironment affects the proliferation, apoptosis, and homeostasis of hASCs, the endothelial cell migration, and the synthesis of collagen protein, leading to delayed wound healing.

Necrotizing fasciitis (NF) is a severe and rapidly progressive infectious disease that attacks superficial an as well as deep fascia, subcutaneous fat tissue, and muscle. Although the incidence is of relatively low frequency, the median mortality is high. NF is a great burden to patients and hospitals. The most common cause of NF is trauma injuries, followed by other conditions with comorbidity. A classification for NF was presented concerning microbial cause, depth of infection, and anatomy. But the value of classification is not convincing. Early diagnosis of NF is essential and still to be realized by far. Information from clinic or laboratory might contribute to the purpose. Surgery is used in exploration debridement and tissue reconstruction as the main method with NF. Negative pressure wound therapy has proved to be useful in improving wound bed preparation and healing.

To investigate the information of chronic wounds, especially in the aspect of microbiological profile and to explore the relationship between the wound culture result and chronic wounds infection, we retrospectively reviewed the medical records of 107 patients with chronic wounds from January 2011 to December 2013. The sociodemographic data, wound-related information, therapeutic type, and wound infection status were extracted. Microbial specimens were obtained and processed using standard hospital procedure for wound culture. The predominant pathogen isolated was Staphylococcus aureus (n = 11, 26.2%), followed by Escherichia coli (n = 6, 14.3%), Enterobacter cloacae (n = 3, 7.1%), and Pseudomonas aeruginosa (n = 3, 7.1%). Sixty percent of the infectious chronic wounds had positive culture, and 96.2% of the noninfectious wounds had negative culture. In conclusion, the microbial characteristics were mostly in the site of lower extremity, gram-negative bacteria, and monopathogen, respectively. Furthermore, the relationship between the wound culture result and chronic wound infection was not exactly coincident. It may be useful for guiding the empiric therapy of chronic wounds.

The tissue accumulation of advanced glycation end products (AGEs) can be noninvasively assessed as skin autofluorescence (SAF) by the AGE ReaderTM device. We aimed to detect the association between SAF and diabetes-associated vascular complications in diabetic foot ulcer (DFU) patients engaged in this study. This cross-sectional survey consisted of 118 consecutive hospitalized diabetic foot patients. The diabetic microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular referring to coronary heart disease (CHD), cerebrovascular disease (CVD), or peripheral artery disease (PAD) complications were evaluated, and then they were divided into different subgroups based on the assessment of vascular complications. As seen from the results, the mean SAF value was 2.8 ± 0.2 AU. SAF was significantly associated with diabetes duration and blood urea nitrogen ( R2 = 62.8%; P < .01). Moreover, in logistic regression analysis, SAF was significantly associated with retinopathy (odds ratio [OR] = 40.11), nephropathy (OR = 8.44), CHD (OR = 44.31), CVD (OR = 80.73), and PAD (OR = 5.98 × 109). In conclusion, SAF, reflecting tissue accumulation of AGEs, is independently associated with the presence of vascular complications in DFU patients.

The aim of the study was to update the clinical database of chronic wounds in order to derive an evidence based understanding of the condition and hence to guide future clinical management in China. A total of 241 patients from January 1, 2011 to April 30, 2016 with chronic wounds of more than 2 weeks’ duration were studied in wound healing department in Shanghai. Results revealed that among all the patients the mean age was 52.5 ± 20.2 years (range 2-92 years). The mean initial area of wounds was 30.3 ± 63.0 cm2 (range 0.25-468 cm2). The mean duration of wounds was 68.5 ± 175.2 months (range 0.5-840 months). The previously reported causes of chronic wounds were traumatic or surgical wounds (n = 82, 34.0%), followed by pressure ulcers (n = 59, 24.5%). To study the effects of age, patients were divided into 2 groups: less than 60 years (

The increasing numbers of cases of wound disease are now posing a big challenge in China. For more convenience of wound patients, wound management in community health care centers under the supervision of a specialist at general hospitals is an ideal solution. To ensure an accurate diagnosis in community health clinics, it is important that “the same language” for wound description, which may be composed of unified format description, including wound image, must be achieved. We developed a wound information management system that was built up by acquisition terminal, wound description, data bank, and related software. In this system, a 3G mobile phone was applied as acquisition terminal, which could be used to access to the data bank. This documentation system was thought to be an appropriate proposal for community wound care because of its objectivity, uniformity, and facilitation. It also provides possibility for epidemiological study in the future.

Dermatological problems in diabetes might play an important role in the spontaneous ulcers and impaired wound healing that are seen in diabetic patients. Investigation of the cause of diabetic skin disorders is critical for identifying effective treatment. The abdominal full-thickness skin tissues of 33 patients (14 nondiabetic and 19 diabetic) were analyzed. The cell viability and malondialdehyde (MDA) production of fibroblasts were measured after advanced glycosylation end product (AGE)–bovine serum albumin (BSA) exposure. Cutaneous histological observation showed reduced thickness of the diabetic abdominal dermis with morphological characteristics of obscured multilayer epithelium and shortened, thinned, and disorganized collagen fibrils with focal chronic inflammatory cell infiltration when compared with controls of the same age. Accumulation of AGEs in diabetic skin was prominent. Less hydroxyproline, higher myeloperoxidase activity, and increased MDA content were detected in diabetic skin. In vitro, the time- and dose-dependent inhibitory effects of AGE-BSA on fibroblast viability as well as the fact that AGE-BSA could promote MDA production of fibroblasts were shown. It is shown that the accumulation of AGEs in diabetic skin tissue induces an oxidative damage of fibroblasts and acts as an important contributor to the thinner diabetic abdominal dermis. The authors believe that diabetic cutaneous properties at baseline may increase the susceptibility to injury, and diabetic wounds possess atypical origin in the repair process.

Surgery complemented by antibiotics forms the backbone of the successful management of necrotizing fasciitis. But it will be very difficult to clear away extensive necrotizing tissue thoroughly in critically ill patients when their vital signs are unstable. The authors report the case of a 33-year-old woman who had extensive necrotizing fasciitis of the right lower limb with septic shock. The patient was severely anemic and malnutrition and had been given conservative debridement at bedside, that is, only detached necrotizing tissues was taken away while some other necrotizing tissue still remained, so that the skin tissue within the same area could be saved as much as possible. After debridement, negative pressure was applied at 125 mm Hg. Broad-spectrum antibiotics and effective supplementation were also complemented, thus controlling the septic shock. All necrotizing tissues were detached, and the sparing vital skin on necrotizing fascia was preserved successfully after negative pressure treatment. The patient was finally saved. In conclusion, negative pressure treatment may help diminish toxin absorbance, detach gangrene tissue, and preserve sparing vital tissue. This case suggests the value of combined use of negative pressure therapy and conservative debridement in critically ill patients with extensive necrotizing fasciitis.

The objectives of the study were to translate the Cardiff Wound Impact Schedule (CWIS), a disease-specific quality-of-life measure, into Chinese, and to evaluate its psychometric properties. The CWIS went through the full linguistic translation process and was evaluated in patients with current diabetic foot ulcers (DFU). Patients were categorized using the Wagner grade. Mean CWIS scores were compared between categories to evaluate the scale’s ability to differentiate ulcer severity (Wagner grade). There were a total of 131 consecutive patients included in the study. Except item A22 (I am confident that the wound I have will heal), the results of item–domain correlation ( r ranged from .391 to .827) and small-group analysis (critical ratio, P < .05) were satisfactory. Furthermore, the Chinese CWIS also demonstrated good criterion validity when correlated with the Short Form-36 ( r = .79, P < .01). After deleting item 22, exploratory factor analysis of the items confirmed the existence of 3 hypothesized domains, physical symptoms and daily living (12 items), social life (7 items), and well-being (6 items), and totally explained 57.194% of the variance. The internal consistency of all scales of the Chinese CWIS was consistently high (Cronbach’s α ranged from .789 to .929). Split-half reliability was 0.748. Sensitivity was demonstrated between patients with different etiologies of diabetic foot ulcer and those with different ulcer severity (Wagner grade). From the authors’ view, the lately validated Chinese CWIS has good psychometric performance and may be appropriately used to assess the health-related quality of life of Chinese patients with DFUs.