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Objective: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. Its treatment often requires a surgical approach. The aim of our study was to evaluate the occurrence of post-surgical complications following a new standard of surgical management. This included presurgical lesion mapping by ultra-high frequency ultrasound (UHFUS) with a 70MHz probe. Postoperative management was based on the principles of HS-TIME (time, inflammation/infection, moisture, edges). Method: A single-centre, retrospective study was conducted by the Department of Dermatology of the University of Pisa. Patients with moderate and severe HS, refractory to previous medical and surgical therapies, were enrolled. All of the patients were treated with wide surgical excision of lesions, previously explored through a UHFUS evaluation with VEVO MD (Fujifilm VisualSonics, Inc., Canada) using a 48MHz and a 70MHz ultrasound probe. Following surgery, all patients were treated with secondary intention healing following the principles of HS-TIME. For each patient, we assessed the occurrence of post-surgical complications at follow-up visit six months after surgery. For each patient we assessed the occurrence of early post-surgical complications at every follow-up visit after surgery until complete wound healing. The occurrence of delayed complications was then assessed in all patients with an observation time after complete healing of >3 months (n=23). Results: A total of 26 patients were enrolled in the study. There were no reported cases of post-surgical bleeding or haematoma occurrence, while three (11.5%) patients developed minor surgical site infection. The average severity of pain decreased from a numerical rating scale of 5.3 immediately after surgery to 1.3 after four weeks. The average healing time was 33.3±16.8 days, and only five (19.2%) patients reported a complete wound healing time of >6 weeks. Focusing on delayed complications: 1/23 (4.3%) patient had hypertrophic scarring; 2/23 (8.7%) patients reported dysaesthesia; and 2/23 (8.7%) cases of clinical relapse were reported. No cases of limited mobility at the surgery site were registered. Conclusion: The findings of the study demonstrated the efficacy of a novel surgical protocol, including a preoperative ultrasound evaluation and appropriate postoperative wound management. Further prospective studies are needed to validate the observed results; however, we conclude that the low recurrence rates and post-surgical complications confirmed that our proposed protocol would represent an effective strategy for the management of patients with HS eligible for surgical therapy. [ABSTRACT FROM AUTHOR]

Calciphylaxis is a rare but highly disabling disease, occurring both in chronic kidney disease (CKD) with renal replacement therapy (RRT) and in normal renal function. Given the frequent coexistence of atrial fibrillation (AF) and CKD, anticoagulation is often required. Warfarin, as a promoter of vascular calcification, is frequently reported as a triggering factor of calciphylaxis. Here, we present the case of a 71-year old male patient with a history of AF and a previous ischaemic stroke, on RRT for three years and warfarin therapy. The patient presented with two painful necrotic skin ulcers over the right leg and a skin biopsy confirmed calciphylaxis. After discontinuation of warfarin, the lesions completely healed with sodium thiosulfate intravenous infusion and local wound treatment. A literature search was performed up to 1 September 2022 through PubMed. The following terms were searched in different combinations: 'calciphylaxis'; 'VKA' [vitamin K antagonist]; 'warfarin'; 'haemodialysis'; 'end-stage renal disease'; and 'ulcer'. In our opinion, in patients requiring anticoagulant therapy, the introduction or continuation of vitamin K antagonists (VKAs) should be carefully balanced when calciphylaxis develops, and other options, such as enoxaparin or apixaban, should be considered. Clinical decisions for patients requiring haemodialysis and requiring anticoagulant therapy should take into account the possible risk of warfarin-induced calciphylaxis. Further studies are needed to clarify the safety, tolerability profile and outcomes of each currently available treatment in this patient population. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical impact and acceptance of an infection management (IM) pathway, designed to improve the consistency of care of wound infection when introduced, and supported by an educational programme. Method: An education and evaluation programme (T3 programme) was-conducted in Portugal, Spain and Italy. This consisted of a two-hour educational, virtual seminar, followed by a four-week evaluation of an IM pathway during which survey data were collected on the impact of this pathway on clinician-selected patients. Finally, all participants reconvened for a virtual meeting during which the combined results were disseminated. The pathway provided guidance to clinicians regarding the targeted use of antimicrobial wound dressings according to the presence and absence of signs and symptoms of wound infection. Results: Responses relating to 259 patients treated according to the IM pathway, 139 (53.7%) of whom had received previous antimicrobial treatment, were captured. Signs and symptoms of infection resolved within four weeks of treatment in >90% of patients. All 25 patients who had received prior antimicrobial treatment for ≥3 months experienced a resolution in the signs and symptoms of infection within four weeks. The majority of participating clinicians agreed that the IM pathway improved decision-making (94.9%) and confidence (97.3%), and helped to determine the correct antimicrobial treatment (91.4%) in the context of wound infection. Conclusion: The T3 programme was an efficient way to deliver a structured educational programme. The use of the IM pathway resulted in >90% of patients achieving resolution of their signs and symptoms of wound infection. [ABSTRACT FROM AUTHOR]

Objective: As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing. Method: Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas—in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol ('control'). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2–T6) after the baseline evaluation (T1). Results: A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2–T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002). Conclusion: From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Treatment of infected wounds remains a major challenge for clinicians. Antimicrobial stewardship is an important pillar in wound treatment and, as the role of bacteria in wound repair is not well understood, new treatment options and products are constantly being developed to tackle local infection and biofilm. This case report describes a case of antibiotic-resistant Burkholderia cepacia skin infection and subsequent leg ulceration in an 86-year-old man during the COVID pandemic in Italy, which was successfully treated in a conservative way using 1% acetic acid and silver oxysalts in conjunction with compression bandage. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic affected the care of people with chronic leg ulcers (CLUs). Aims: To understand how people with CLUs perceived illness, health care and the public health emergency during the second wave of the COVID-19 pandemic. Methods: Twenty people attending a wound care clinic in Northern Italy participated in semi-structured interviews and a thematic analysis was conducted using the software Atlas.ti 9. Findings: Results show that most of the participants evaluated their healthcare experience as positive but differed in their perceptions of the changes brought about by the pandemic according to their varied illness experiences and perceived social support. Participants were grouped in four trajectories that provided insight into the construction of personalised support strategies for people with CLUs. Conclusion: These results may help inform healthcare interventions and policies in the care of long-term conditions such as CLUs during a widespread emergency in future. [ABSTRACT FROM AUTHOR]

A study found that specialized nurse-led care of patients with chronic wounds quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. [ABSTRACT FROM AUTHOR]

Objective: The burden of chronic wounds did not disappear during the Covid-19 pandemic, so new ways to address healthcare practitioner (HCP) education had to evolve. The Teach, Try, and Talk (T3) programme was conceived in 2021 with HCPs in southern Europe (Italy, Spain and Portugal). Method: Virtual education sessions with experienced HCP guest speakers were held and a five-layer hydrocellular polyurethane foam dressing (HPFD) was introduced as a way of reducing dressing change frequencies and improving clinician satisfaction. HCPs recorded their experience of the HPFD using an online form and participated in a further virtual session with experienced HCPs to discuss the results. Results: There were a total of 190 responses. A significant dressing change reduction from 3.6 changes per week to 1.8 with the HPFD (p<0.001) was observed in Italy, Spain and Portugal and within different care settings (hospital, wound clinic/health centre and the patient's home). Nearly one-third of participants stated one more day of dressing wear time was achieved by the ability of the HPFD to lock in and manage exudate, with nearly a quarter of responses stating it was due to fewer than three dressing lobes being full. The majority (97.8%) of HCPs stated they would recommend the HPFD to colleagues and patients. Conclusion: The T3 programme is a highly successful method of training delivery and practice improvement across a variety of healthcare settings in southern Europe, helping support HCP engagement and ongoing development in challenging times during the Covid-19 pandemic. The programme can be adapted considering the needs of different HCPs and payor and/or healthcare systems. [ABSTRACT FROM AUTHOR]

Objective: With an ageing population and a rising number of people with chronic conditions and disabilities, pressure ulcers (PUs) are a frequent problem. Prevention and treatment, especially targeted at older people, frail and non-self-sufficient patients, are central to care provided by nurses. The objective of this study is to establish the incidence of PUs in hospital inpatients and identify possible associated risk factors. Method: A clinical observational study was conducted from May to November 2019 in a sample of patients admitted to Azienda Sociosanitaria Ligure 2 in Italy. Clinical and sociodemographic data were collected at admission and at discharge, through a questionnaire or collection card. The analysis was done using SAS 9.4 2017 software. Results: In 7% of the 515 participating patients, PUs occurred during hospitalisation; PUs at stages I and II were predominantly in the coccyx, heels and malleolus. Conclusion: Significant associations were found between the development of lesions and age, certain pathologies, the degree of patient autonomy and the level of skin integrity. [ABSTRACT FROM AUTHOR]

Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: It is widely agreed that infection and the formation of biofilms play a major role in increasing inflammation and delaying wound healing. The aim of this study was to evaluate, in vitro, the antimicrobial activity of the wound irrigation solution, Granudacyn (Mölnlycke Health Care AB, Sweden) against planktonic bacteria and mature biofilms of clinically relevant bacterial species. Method: Quantitative evaluation of bacterial numbers and confocal and/or scanning electron microscopy were used to evaluate the wound irrigation solution's antimicrobial/antibiofilm activity in standard laboratory conditions as well as in a three-dimensional (3D) collagen wound infection model. Results: The wound irrigation solution exhibited a rapid and strong antibacterial activity against both Gram-positive and Gram-negative strains isolated from infected wounds in planktonic form, with a reduction in bacterial number of >4 Logs after as little as one minute of treatment. The wound irrigation solution also exerted an evident activity against preformed biofilms of Pseudomonas aeruginosa and Staphylococcus aureus (>3 Log and >1 Log reduction in colony forming unit number, respectively, after 15 minutes of incubation). Although the wound irrigation solution was partially inhibited in the presence of simulated wound fluid, it maintained a marked antibiofilm activity in in vivo-like conditions (ie. in a 3D collagen wound infection model) with a strong killing and a mild debridement effect, which was superior to standard saline. Conclusion: The results obtained in this study suggest that although the wound irrigation solution used might be partially inhibited by wound exudate, it has the potential to effectively kill wound infecting planktonic as well as biofilm bacteria. [ABSTRACT FROM AUTHOR]

Wounds are a major public health challenge for nurses, and poor wound care has important implications for patients and health care systems. The aim of this study is to assess the Italian registered nurses' (RNs) perception in the area of wound care, regarding their knowledge, tasks of care delivery, wound management, values, and attitudes, exploring also the previous specific education received during nursing education. An observational online web-based survey was used to assess learning goals and content for wound care education in undergraduate nursing education and the skills and level of self-efficacy in this area during clinical practice. The data were collected between April and May 2022. A total of 210 RNs were interviewed and divided into five national geographic areas. Northwestern RNs showed a better education about the wound care area during university courses: the rate of RNs that did not receive any training in the wound care area was lower than in other Italian geographical areas. Southern RNs presented a better knowledge about factors that expose the wound to becoming chronic, wound drains care, and the ability to assess diabetic foot. This study showed that, in Italy, education in wound care among nursing students is relatively poor, and many skills are achieved during an RN's career in an empirical way. [ABSTRACT FROM AUTHOR]

Aim: The goal of this case series is to highlight the use of Dehydrated Human Amnion Chorion Membrane allografts (DHACM) in the treatment of three patients in Saudi Arabia with various hard-to-heal ulcers. Method: Case 1: 46 y/o male post road traffic accident resulting in a spinal cord injury. Admitted to the ICU for 16 days. Hospital course complicated with a stage 4 occipital pressure injury ulcer (PIU) (Figure 1). Case 2: 63 y/o bedbound male with the following comorbidities: DM, HTN, ischemic stroke. During his medical course he developed a Stage 3 sacral PIU (Figure 2). Case 3: 43 y/o diabetic male with a diabetic foot ulcer (DFU) complicated with osteomyelitis (figure 3). A below knee amputation was initially recommended by another provider. Fortunately, the patient was referred to a wound care specialist who appropriately proceeded with a 5th ray amputation and continued antibiotics (Figure 4). Results/Discussion: Case 1: The stage 4 occipital PIU stalled with standard of care (SOC). After treating a mild wound infection, DHACM was applied only once and kept in place for at least 7 days. Afterwards, SOC was resumed. Closure was achieved 20 days after applying DHACM (Figure 5). Case 2: The stage 3 sacral PUI had devitalized tissue that required surgical debridement over a 10-day period. Due to delayed closure DHACM was applied (Figure 6). Conclusion: Application of a DHACM allograft barrier was effective in promoting wound closure in the treatment of two patients with hard-to-heal PIUs and a third DFU patient. [ABSTRACT FROM AUTHOR]

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI 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.)

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

Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Results: Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). Conclusion: The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the short-term effects on tear film parameters and ocular symptoms of a novel eye mask producing heat and vibration developed for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods. This is a pilot study including the first 20 consecutive patients (6 males, 14 females; mean age 52.4 ± 16.8 years) who were treated with a novel eye mask producing heat (42°) and vibration (up to 20 Hz) (Activa, SBS Sistemi, Turin, Italy) for 15 minutes. The treatment incorporates 2 phases in the following chronological order: 5 minutes of heating (phase I); 10 minutes of combination of heating and vibration (phase II). Noninvasive ocular surface examination was carried out before (T0) and 30 minutes after the mask session (T1) by means of Idra (SBS Sistemi, Turin, Italy) for the measurement of noninvasive break-up time (NIBUT) and lipid layer thickness (LLT). Patients' satisfaction after treatment was ascertained by asking the patients whether they perceived improvement from their baseline symptoms according to a 5-grade scale: none = 0; trace = 1; mild = 2; moderate = 3; high = 4. Results. All patients completed regularly the mask session and no device-related adverse events were noted. NIBUT improved significantly from T0 to T1 (from 7.2 ± 1.8 s to 8.1 ± 2.1; P = 0.014). In parallel, also LLT improved from from T0 to T1 (72.5 ± 13.9 nm to 83.1 ± 16.1; P = 0.016). Seven patients (35% of the total) had a moderate satisfaction (grade 3) while 13 patients (65%) had a high satisfaction (grade 4) with treatment. Conclusions. This eye mask represents a novel well tolerated tool in the armamentarium of MGD treatments. Thirty minutes after the session, NIBUT and LLT increased significantly; furthermore, all patients reported an improvement of discomfort symptoms with a moderate to high satisfaction with treatment. [ABSTRACT FROM AUTHOR]

Objective: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decisionmaking on antiseptic therapy or decolonisation. Method: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. Results: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. Conclusion: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe. Declaration of interest: JD has received research support, lecture fees and travel-cost reimbursements from 4M, Coloplast, Convatec, Draco, Engelhardt, Paul Hartmann, KCI, Lohmann&Rauscher, Mölnlycke, SastoMed and Urgo. RL has received research support, lecture fees and travel-cost reimbursements from Mölnlycke and Urgo. AK has received research support, lecture fees and travel-cost reimbursements from 3M, B. Braun Melsungen, Bode/Paul Hartmann, Ethicon, Lohmann&Rauscher, Mundipharma, Oculus, SastoMed Schülke&Mayr, SERAG-WIESSNER and Urgo. JVS has received research support, lecture fees and travel-cost reimbursements from Mundipharma, Histocell, Quesper and Urgo. This work was supported by an unlimited grant from Urgo Medical. The views expressed are those of the authors and do not necessarily reflect those of Urgo Medical. The company had no direct influence on the content of this paper. [ABSTRACT FROM AUTHOR]

Objective: To report the clinical validation of an innovative, artificial intelligence (AI)-powered, portable and non-invasive medical device called Wound Viewer. The AI medical device uses dedicated sensors and AI algorithms to remotely collect objective and precise clinical data, including three-dimensional (3D) wound measurements, tissue composition and wound classification through the internationally recognised Wound Bed Preparation (WBP) protocol; this data can then be shared through a secure General Data Protection Regulation (GDPR)- and Health Insurance Portability and Accountability Act (HIPAA)-compliant data transfer system. This trial aims to test the reliability and precision of the AI medical device and its ability to aid health professionals in clinically evaluating wounds as efficiently remotely as at the bedside. Method: This non-randomised comparative clinical trial was conducted in the Clinica San Luca (Turin, Italy). Patients were divided into three groups: (i) patients with venous and arterial ulcers in the lower limbs; (ii) patients with diabetes and presenting with diabetic foot syndrome; and (iii) patients with pressure ulcers. Each wound was evaluated for area, depth, volume and WBP wound classification. Each patient was examined once and the results, analysed by the AI medical device, were compared against data obtained following visual evaluation by the physician and research team. The area and depth were compared with a Kruskal--Wallis one-way analysis of variations in the obtained distribution (expected p-value>0.1 for both tests). The WBP classification and tissue segmentation were analysed by directly comparing the classification obtained by the AI medical device against that of the testing physician. Results: A total of 150 patients took part in the trial. The results demonstrated that the AI medical device's AI algorithm could acquire objective clinical parameters in a completely automated manner. The AI medical device reached 97% accuracy against the WBP classification and tissue segmentation analysis compared with that performed in person by the physician. Moreover, data regarding the measurements of the wounds, as analysed through the Kruskal-- Wallis technique, showed that the data distribution proved comparable with the other methods of measurement previously clinically validated in the literature (p=0.9). Conclusion: These findings indicate that remote wound assessment undertaken by physicians is as effective through the AI medical device as bedside examination, and that the device was able to assess wounds and provide a precise WBP wound classification. Furthermore, there was no need for manual data entry, thereby reducing the risk of human error while preserving high-quality clinical diagnostic data. Declaration of interest: The project was funded by a Proof of Concept grant from Politecnico di Torino and the Start Cup grant from I3P and Regione Piemonte. The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Objective: A common and frequent complication of diabetes is diabetic foot ulcers (DFU), which can have high treatment costs and severe adverse events. This study aims to evaluate the effects of wound duration on wound healing and the impact on costs, including treatment with a new sucrose octasulfate dressing compared with a control dressing. Method: Based on the Explorer study (a two-armed randomised double-blind clinical trial), a cost-effectiveness analysis compared four different patient groups distinguished by their wound duration and additionally two DFU treatment options: a sucrose octasulfate dressing and a neutral dressing (as control). Clinical outcomes and total direct costs of wound dressings were evaluated over 20 weeks from the perspective of the Social Health Insurance in Germany. Simulation of long-term outcomes and costs were demonstrated by a five cycle Markov model. Results: The results show total wound healing rates between 71% and 14.8%, and direct treatment costs for DFU in the range of €2482–3278 (sucrose octasulfate dressing) and €2768–3194 (control dressing). Patients with a wound duration of ≤2 months revealed the highest wound healing rates for both the sucrose octasulfate dressing and control dressing (71% and 41%, respectively) and had the lowest direct treatment costs of €2482 and €2768, respectively. The 100-week Markov model amplified the results. Patients with ≤2 months' wound duration achieved wound healing rates of 98% and 88%, respectively and costs of €3450 and €6054, respectively (CE=€3520, €6864). Sensitivity analysis revealed that the dressing changes per week were the most significant uncertainty factor. Conclusion: Based on the findings of this study, early treatment of DFU with a sucrose octasulfate dressing is recommended from a health economic view due to lower treatment costs, greater cost-effectiveness and higher wound healing rates. [ABSTRACT FROM AUTHOR]

This pilot study examined the effect of recombinant type I human collagen on post- surgical diabetic foot lesion healing by secondary intention. Twenty-four patients (17 male, 7 female; mean age 66.2±2.4 years; duration of diabetes 9.7±4.2 years, HbA1c 7.3±1.5%) were randomised to receive type 1 recombinant human collagen plus standard treatment (n=12) or standard treatment (n=12). They were evaluated weekly for 6 months or until complete healing had occurred. Rate and time of healing, recurrence and adverse reactions/hypersensitivity to treatment were recorded. The group that received type 1 recombinant human collagen had a significantly higher healing rate (83.3% versus 58.3%, P<0.01) and shorter healing time (64±4 days versus 90±11 days, P<0.02) than the group receiving standard treatment. There were no between-group differences in adverse events, recurrence or re-interventions during follow-up. The addition of type I recombinant human collagen to standard treatment increased healing rate and shortened healing time in patients with post-surgical diabetic foot wounds. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to illustrate the journey of the Private-Public Partnership (PPP) between the Philippine Air Force - Armed Forces of the Philippines (AFP) and WoundPedia™ in implementing an annual wound care educational series for the Nursing Service Personnel of the AFP and health care professionals of the Philippines as a whole. Method: Crucial to the PPP was fostering collaboration between WoundPedia and the AFP. Establishing a partnership with a university brought credibility and accreditation to the course. While enhancing benefactor partnership was the element in the sustainability of the PPP. Results / Discussion: The current state of wound care in the AFP has a big potential for improvement. There is an increased number of combat wounds due to insurgencies as well as unusual wounds encountered during humanitarian missions, locally and abroad. There is no current formal training on wound care management as well as a lack of wound care training among the health care personnel of the AFP and the Philippines in general. Since 2013, the WoundPedia Basic and Intermediate Courses are valued educational programs in the Philippines. Conclusion: The AFP have: • Increased wound care capacity for health care workers who are taking care of the injured solders in battle & other military personnel • Started to develop an interprofessional team of local wound care champions for patient care, education, & research • Linked education to accreditation & university programs • Established a Memorandum of Understanding with a premier university in the Philippines for future interprofessional collaboration in education, the care of patients, and research. [ABSTRACT FROM AUTHOR]

Aim: Whether the wound is caused by direct trauma or a burn, proper management is one of the essential concerns for early wound healing. Acellular dermal matrix (ADM) is one of treatments which accentuating spontaneous healing at molecular levels. We introduced a newly-approved ADM[1], which is a piscine acellular dermal xenograft and has specific bioactive lipid mediators called omega-3 polyunsaturated fatty acids. We therefore aimed to investigate the utility of this novel material as a dressing material, comparing healing rates between applied group and a control group. Method: A total of 48 Patients who visited the hospital with acute or chronic deep dermal wounds were enrolled in the study. All wounds in the experimental group were treated only once with the novel ADM[1] and a non-adherent absorptive foam material to cover the ADM. In the control group, daily conventional dressings were provided. We compared the initial wound size when ADM was applied, with the wound size at 7th post-application day. The healing rate was calculated by the change in epithelialization over the course of a week in each group [Fig.1]. Results / Discussion: The average healing rate of all wounds with the ADM application in this study was 77.7%±18.2% and 53.3%±22.0% for the control group, demonstrating statistical significance with a P-value of <0.05[Table 1,2]. In particular, our stratification analysis revealed that managing burn wounds with the ADM had much better results(P<0.05). Conclusion: This study establishes that managing wounds with the novel ADM[1] is likely to heal wounds faster than traditional dressings especially to the burn wounds. [ABSTRACT FROM AUTHOR]

Aim: Evaluate the impact of the frequency of debridement along with the concurrent use of a skin substitute in the management of chronic lower extremity diabetic ulcers (LEDUs). Method: Debridement adequacy in the prospective RCTs was adjudicated by three wound care specialists (Figure 1). Treatments included two placental-derived allografts compared with standard of care (SOC). Additionally, a retrospective analysis of 2015-- 2019 Medicare claims for LEDUs that received routine debridement at intervals ranging from every 1--7 days, 8--14 days, and every 15 days or greater was performed. Examples of inadequate debridement: significant callous and epibole present (a) and adequate debridement: evidence of pairing of callous and removal of epibole (b). Results: Within the RCTs, adequate debridement occurred in 202/265 (76%) of patients, 90/110 (82%) SOC ulcers, 45/54 (83%) of DHACM* treated ulcers, and in 67/101 (66%) of DHUC† treated ulcers. Closure occurred in 74% of adequately debrided ulcers, and in only 21% of ulcers without adequate debridement, p<0.0001. Debridement was the most significant factor for closure even when controlling for other clinical characteristics (Table 1). Within the Medicare claims data 21% of episodes treated with SOC only had debridement intervals of ≤7 days. Short debridement intervals in combination with the use of DHACM demonstrated statistically better outcomes than SOC including 65% fewer major amputations (p<0.0001). Conclusion: Prospectively collected data examining the quality of debridement and retrospectively analyzed data examining the frequency of debridement supports routine adequate debridement, particularly at intervals of seven days, as an essential component of wound care. *DHACM=Dehydrated Human Amnion Chorion Membrane †DHUC=Dehydrated Human Umbilical Cord [ABSTRACT FROM AUTHOR]

Aim: Ulcerated tophaceous gout is an uncommon presentation of wounds on the lower limbs. Treatment of these wounds can be a challenge, as their optimal management remain to be determined. Method: A retrospective analysis of electronic medical charts between 2015 and 2021 was conducted at a wound clinic of a university-affiliated hospital to determine the characteristics of patients treated with tophaceous wounds, their evolution and treatment. Results / Discussion: We present a case series of five patients with ulcerated tophaceous gout of the foot (Table 1). At baseline, all patients had either a soft tissue infection or osteomyelitis. All progressed well with local wound care, including conservative sharp debridement of the tophi and rapid initiation of urate-lowering therapy. Conclusion: A diagnosis of tophi should be considered in the presence of an ulcer over the first metatarsophalangeal joint or other toes when whitish-chalky material is present, even if the patient is not previously known to have gout. Tophi ulceration is a rare complication, but prompt diagnosis and management are important to avoid destruction of the underlying bone structures. [ABSTRACT FROM AUTHOR]

Aim: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, opportunistic and severe angioinvasive fungal infection that despite relevant treatment has high mortality. Here, I describe a patient with ROCM unresponsive to surgical debridement who has treated successfully with irrigation of Amphotericin B (AmB) and ALT free composite flap. Method: I present the case of a 69-year-old Korean diabetic male with ectropion, epiphora, hemifacial deformity with foul odor from fungal ball at March, 2017 (Fig. 1. (a), (b)). He was diagnosed with ROCM due to Aspergillus and Mucor spp. and underwent maxillectomy in January 2016. Despite the surgical debridement, the ROCM was not regulated and all of the soft tissues covering the cheek were lost. To treatment of the ROCM, 25 mg (6 ml) of liposomal AmB was injected directly into the wound for 4 weeks, and 25 mg (6 ml) of remaining AmB was used for irrigation. At the same time, intravenous AmB (1.5 mg/kg/day) was administered. Infection was controlled and granulation tissue began to appear within the maxillary sinus (Fig. 2). On the MRI, infection was no longer spread and stable. ALT-FL free flap was performed to reconstruct the defect in the face, intravenous liposomal AmB was administered for 4 weeks. Results / Discussion: The patient is survived without complication such as ectropion as well as infection (Fig. 3). The aggressive nature of this disease requires rapid diagnosis, early intervention with antifungal therapy, and the reversal of the underlying immunocompromising conditions. Conclusion: This is the first documented case of treatment-resistant ROCM that was successfully treated with local L-AmB irrigation and injections, in conjunction with systemic antifungal therapy and surgical debridement. [ABSTRACT FROM AUTHOR]

Aim: Illustrate two cases of treatment of surgical wound infection, in order to prepare the wound bed for the treatment of dehiscence. Method: Case 1. Patient suffering from tetralogy of Fallot and esophageal atresia, operated with extrapleural approach to the posterior mediastinum by subperiosteal right axillary thoracotomy. On the 11th postoperative day (POD), evidence of dehiscence of the surgical wound, with important topical infection and inflammatory component. Case 2. Patient suffering from esophageal atresia operated with the same surgical approach. In the 15th POD evidence of dehiscence of the surgical wound with minimal inflammatory component. The two wounds were assessed according to the STONEES criteria and managed according to the TIMERS. Results: Case 1. The management of the infection and the inflammatory component required approximately 1 week of specific treatment, using advanced dressings, specifically bacterial and hydrogel uptake dressing. Subsequently, application of platelet gel (details in the figure). Complete healing of the surgical wound in 2 weeks. Resignation to 46th POD. Case 2. The inflammatory component required 2 days of specific treatment, with the same treatment. Subsequently treatment with Neem and Hypericum oil (details in the figure). Complete healing of the surgical wound in 3 weeks. Conclusion: In patients with complicated surgical wounds, the management of the infection with specific dressing for the management of the microbial load, has allowed an optimal preparation of the wound bed, with the consequent possibility of promptly undertaking treatment aimed at complete healing. [ABSTRACT FROM AUTHOR]

Aim: Soft-tissue defects of upper extremities can be managed by various options including locoregional flaps, skin grafts and free flaps. However, if tendon exposure is accompanied, skin graft is not an advisable procedure owing to the complications such as graft failure. Instead of skin graft, dual-layer graft using intermediate graft between tendon and skin graft would be a preferable option. In this study, deep temporal fascia was used as an intermediate layer because of the manageability and inexpensiveness. Method: Retrospectively review of patients from January 2011 to December 2020 who underwent coverage of upper extremity wound with tendon exposure using deep temporal fascial graft. Fascia was taken from temporal area and the split-thickness skin graft (STSG) was harvested from thigh (Fig. 1). After the fascia was placed over the tendon, the skin graft was fixed. Retrospective review was done to analyze the postoperative complications (Table. 1). Results / Discussion: Grafts were taken well, and no major complications including total graft failure was occurred (Fig. 2). Complications related to the impediment of motor functions owing to adhesion are not seen except for only one patient. Conclusion: The grafted of deep temporal fascia between the skin graft and the tendon of upper extremity can function as a gliding plane, while the process of harvest is manageable and the procedure is costless compared to the allograft. The durability and thickness of soft-tissue can also be reinforced by deep temporal fascial graft. [ABSTRACT FROM AUTHOR]

Aim: To reduce time spent on ritualistic documentation. A review of what and how nurses are documenting care provided... to ultimately reduce incidence of avoidable pressure ulcer categorisation due to poor documentation. Method: This project involved four different methods: 1. Focus groups with clinical staff 2. Examination of time spent on documentation 3. Case note review 4. Audit. Outcome of the pre-implementation study using the above methods revealed the following: 1. Up to 45 minutes were spent by each nurse, each shift documenting in the continuation sheet. 2. Up to 100% of what was recorded was recorded elsewhere or not required. 3. There was a recognition that the process was ritualistic. 4. Opportunity to save time was identified. 5. Realisation to only record what is required and not duplicate. 6. Insight into what needed to be recorded -- only 20% of documentation met the set standard. To address the above six points an improvement project was implemented whereby nurses only documented under four categories headed A, B, C, D: • Abnormal • Bedside Charts updated • Communication that is essential • Deviation from person centred care plan. Results / Discussion: 1. Time spent on documentation reduced by 78%. 2. 100% of documentation reached required standard. 3. Pressure ulcer rate per 1000 occupied bed days < 0.4. 4. No avoidable damage due to poor documentation. 5. Time released to provide direct patient care. Conclusion: Nurses should reflect on what and why they are documenting and focus on only documenting what is required, otherwise they are wasting valuable time which could be spent on direct patient care. It's as easy as ABCD.. [ABSTRACT FROM AUTHOR]

Aim: Although bacterial biofilms are better understood in the oral care setting, we have a lot to learn about biofilms in wound care. It is well understood that Wound biofilms are polymicrobial and can stall the inflammatory phase of wound healing. Wound biofilms are densely packed with an exopolysaccharide matrix (EPS). The EPS is a complex mixture of polysaccharides, proteins, DNA, RNA, and lipids. Furthermore, the biofilm is a deep-layered community of microbes, many of which are senescent deep in the biofilm, making them resistant to an antibiotics and antimicrobials. Advances in antibiofilm research have been slow to progress in wound care, because the is no ideal model system available in vitro and in vivo for high throughput screens (HTS). Method: Our lab has developed a 3D printed polymicrobial biofilm that is resistant to antibiotic and antimicrobial treatments and has less than 2% standard deviation among replicates. This 3D printed model system is ideal for testing compound libraries to destroy bacterial biofilms in vitro and in this study, we demonstrate results are reproducible in vivo in a diabetic mouse delayed healing model system. The 3D biofilms have 107 CFU per 2 mm disks of S. aureus and P. aeruginosa which can be implanted and absorbed into a wound. We have developed a battery of fluorescent biomarkers to measure the integrity of the biofilm as well as the live/dead ratio of the bacteria which correlates well with sonicated biopsies of the tissue samples. Results / Discussion: Based on analysis of fluorescence using ImageJ, the 3D printed biofilms have an average relative fluorescent intensity of 152,826 + 1,752 while the pig explants have a comparable average signal but a high standard deviation of 18.2% (124,011+ 22,604). The 3D printed biofilms have a p value of 0.0259 using a two-sample unequal variance t-test suggesting that the new model system is superior to the classic pig explant model. Conclusion: Our evidence suggests that these new 3D printed biofilms are robust, reproducible, and significantly translatable to studying complex biofilms in preclinical models and actual biofilms in clinical settings. With this foundational work we hope to accelerate drug discovery for polymicrobial biofilms to provide patents with better outcomes in chronic wound healing. [ABSTRACT FROM AUTHOR]

Aim: Fournier's gangrene, traumatic lesions and excision of scrotal skin lesions can all lead to significant scrotal defects. The perineum's diverse bacterial flora, difficulties in providing immobilization, and achieving a natural surface of the testes make testicular cover challenging. Several methods have been described to reconstruct the penoscrotal area. This report aims to present the medial circumflex femoral artery perforator (MCFAP) flap technique in this difficult area. Method: From January 2019 to September 2022, 12 male patients underwent scrotal reconstruction in our clinic using the MCFAP flap due to Fournier's gangrene. These patients were retrospectively evaluated according to age, gender, comorbidities, defect size, donor area, perforators, length of hospital stay, follow-ups and complications. Results / Discussion: In all cases complete scrotal coverage was accomplished with the MCFAP flap. The resulting scrotal shape was satisfactory (Fig. 1). Contamination was controlled by colostomy. In two patients venous insufficiency, and in three patients wound dehiscence was seen. Venous insufficiency improved with leech therapy. Detachments were healed by secondary suturing. Conclusion: For perineoscrotal defects, the MCFAP flap offers a minimal donor site deformity, a one-stage procedure, and an acceptable scrotum-like shape. Additionally, it can be used as a chimeric flap, that includes the gracilis muscle. According to our findings, MCFAP is a superior local flap amongst the limited reconstructive options in this challenging area. Because this flap protects the testicle without raising its temperature, it also gives the testes a pliable local flap without being bulky. Figure 2. The MCFAP flap can reach an axial rotation of 180°. [ABSTRACT FROM AUTHOR]

Aim: The aims in in this study was to evaluate the effectiveness of using cold plasma in the treatment of chronic wounds with a conservative Therapie in term of Wound- and Germ-reduction. Method: There were 60 patients monitored for a period of 8 Weeks. The wounds were treated 4 weeks without and 4 weeks with cold plasma. Treatment was with cold plasma three times a week for 3 minutes per area. All the participating Patients did not take oral Antibiotics during this time. A microbiological culture was taken at the start of the treatment and after ten treatments. Results / Discussion: There was a significant improvement in wounds during the first two treatments. The results showed that wound reduction of at least 10% and a maximum of 60% after one treatment session and an interval of two days under cold plasma treatment with simultaneous germ reduction, which took place without the additional oral intake of antibiotics and / or cortisone-containing preparations, decreased by up to 50% after ten treatments. The greatest reduction was observed in moist wounds during treatment. [ABSTRACT FROM AUTHOR]

Aim: Chronic inflammation and impaired neovascularization play critical roles in delayed wound healing in diabetic patients. To overcome the limitations of current diabetic wound (DBW) management interventions, we investigated the effects of a catecholfunctionalized hyaluronic acid (HA-CA) patch combined with adipose-derived mesenchymal stem cells (ADSCs) in DBW mouse models. Method: Diabetes in mice was induced by streptozotocin. Mice were divided into four groups: control group, ADSCs group, HA-CA group, and HA-CA + ADSCs group. Fluorescently labeled ADSCs were transplanted into healthy tissues at the wound boundary or deposited at the HA-CA patch at the wound site. The wound area was visually examined. Collagen content, granulation tissue thickness and vascularity, cell apoptosis, and re-epithelialization were assessed. Angiogenesis was evaluated by immunohistochemistry, quantitative real-time polymerase chain reaction, and Western blot. Results / Discussion: DBW size was significantly smaller in the HA-CA + ADSCs group (8% ± 2%) compared with the control (16% ± 5%, p < 0.01) and ADSCs (24% ± 17%, p < 0.05) groups. In mice treated with HA-CA + ADSCs, the epidermis was regenerated, and skin thickness was restored. CD31 and vWF-positive vessels were detected in mice treated with HA-CA + ADSCs. The mRNA and protein levels of VEGF, IGF-1, FGF-2, ANG-1, PIK, and AKT in the HA-CA + ADSCs group were the highest among all groups, although the Spred1 and ERK expression levels remained unchanged. Conclusion: The combination of HA-CA and ADSCs provided synergistic wound healing effects by maximizing paracrine signaling and angiogenesis via the PI3K/AKT pathway. Therefore, ADSC-loaded HA-CA might represent a novel strategy for the treatment of DBW. [ABSTRACT FROM AUTHOR]

Aim: Fastened by the COVID-19 pandemic, more wounds with complex pathologies are being treated at home. Innovative and easy-to-use treatment solutions are needed to support community nurses during phase-adapted wound-healing efforts at patient's home. This case series focused on assessing the wound healing effect of COMS therapy in addition to standard wound care, as well as the feasibility and the confidence of application in the community health and home care sector. Method: Four exemplary patients were chosen to be presented as an excerpt of a case series of 22 community-dwelling patients. Patients received COMS therapy as an adjunctive to standard wound care at home. The therapy was performed for up to 12 weeks or until complete wound closure. Feasibility and confidence of COMS application was assessed using a standardized questionnaire. Results: The ratings of the feasibility and confidence of COMS application were high with averages of 9.75 and 9.25 on a scale from 1 to 10. COMS showed positive effects on wound healing, i.c. reduction in wound surface area (WSA), in all different etiologies of the wounds being treated. Since COMS is an adjunct to standard wound care, it was consuming extra overall treatment time in the setting applied. Conclusion: This case series adds to a growing body of evidence confirming that COMS therapy is an effective treatment option in the different wound etiologies investigated. The device's simple, user-friendly design allows for use in both ambulatory and home care settings and can be applied with minimal training efforts by health care professionals involved in wound treatment policies depending on the point of care, such as nurses and community care takers. [ABSTRACT FROM AUTHOR]

Aim: Evaluate an in-situ electrospun nanofiber scaffold in terms of wound healing, reduction of exudate, odour, wound size, infection and pain. Method: 12 patients with hard-to-heal wounds, average duration 32 months were included. 3 recurring VLU, 1 DFU and 8 PU. A thorough medical and social assessment of the patient's history, concerns, and a detailed wound assessment based on the TIMERS principle was performed. Education of both the patient, patients' family and nurses was part of the treatment plan. An electrospun nanofibrous scaffold was in-situ printed on the wounds and covered with non-adherent absorbent dressing in conjunction with supporting therapies (offloading, compression, etc.), changes according to need. Results / Discussion: All hard-to-heal wounds included in the study were previously treated unsuccessfully with other wound care products such as collagen, silver, and silicon-foams. All patients were in the past treated with i.v. antibiotics due to recurrent infections. All patients showed a gradual reduction of wound size with no re-infection. VLU patients showed no re-occurrence after 3 months. Depending on wound size, healing was achieved between 3 to 12 weeks. Both odour and exudate levels reduced almost immediately. Peri-wound skin improved by 75% in 2 weeks. Patient pain reduced significantly from 6 to 3 after a week, to 0 after 3 weeks (VAS scale). Conclusion: Very promising findings in our small study indicates that in-situ electrospun nanofiber scaffolds may be an important tool for accelerating healing of hard-to-heal wounds, while also decreasing the risk of infection. More research is needed to statistically confirm findings. [ABSTRACT FROM AUTHOR]

Purpose: This study aim was to assess effectiveness of ultrasonic maintenance debridement on biofilm removal process and consequently on chronic wounds healing, by implementing a standardized wound care procedure. Methods: The procedure consists of: * TIME evaluation * evaluation with Push Tool Scale 3.0 (PTS); * application of anaesthetic cream (lidocaine 5%) for 15/20 minutes; * cleansing with surfactant; * mechanical ultrasonic debridement at 15-day intervals * dressing * Wound re-assessment at regular intervals of 7 days using the Push Tool Scale 3.0. Results: This standardized procedure was performed on 10 patients with chronic vascular ulcers: * Average age 78.6 years * 5 females * 4 with co-morbidities (diabetes and/or arteriopathy) * 6 in the perimalleolar site * 4 on the leg * 6 recurrent wound (onset on average 492 days before the start of treatment, in a range from 120 to 1080) - details in table 1. All 10 subjects show improvement with an average reduction of 7.6 PTS points (range 1-15) over an average treatment period of 120 days (range 30-150). The average PTS score at intake was 13.2 (range 16-8), at re-evaluation 5.6 (range 14-0). In 4 subjects full recovery was achieved within an average of 134 days (range 150-120). Conclusions: although cautiousness is required when analysing the data, due to the number of cases observed being too small to be statistically meaningful, the results show the effectiveness of the procedure and encourage undertaking a more extensive study, examining a greater variety and number of difficult ulcers and possibly testing different interval between the debridement sessions. [ABSTRACT FROM AUTHOR]

Background: Major trauma patients experience a 20% mortality rate overall, and many survivors remain permanently disabled. In order to monitor the quality of trauma care in the Trauma System, outcomes assessment is essential. Quality indicators on outcome can be expressed as quality of life, functional outcome, and others. The trauma follow-up system was created within the Romagna Trauma System (Italy) in order to monitor the trauma network and assess its long-term outcomes. The aim of this paper is firstly to evaluate the existence of correlations between epidemiological data, severity of injury, and clinical assessment characterizing the acute phase and the long-term outcomes in trauma patients and secondly, to explore the association between outcome variables have been modified. Methods: We conducted a cross-sectional study over a 10-year period, including patients with severe trauma who survived and were discharged from the intensive care unit. The outcome measures were assessed with the use of the Extended Glasgow Outcome Scale and the Euro Quality of Life scale 5 dimension. Demographic data and clinical severity descriptors versus functional outcome were tested in a binary logistic regression model. Results: In all, 428 major trauma patients participated in the study. At 1 year, 50.8% of trauma patients included had a good recovery and 49.2% had some degree of disability. The median value of quality of life was 0.725. At the multivariate analysis, variables showing significant impact on functional outcome were age (p = 0.052, OR 1.025), injury severity score (p = 0.001, OR 1.025), and Glasgow coma scale ≤ 8 (p = 0.001, OR 3.509) The Spearman's Rank correlation coefficient showed a strong correlation between the global level of function variables and quality of life at one year (Spearman's Rho Correlation Coefficient 0.760 (p < 0.0001)). Conclusions: Increased age, increased injury severity score, and severe traumatic brain injury are predictors of long-term disability. Most of these trauma patients show impairments that affect not only the level of functional state but also the quality of life. The degree of functional independence has the greatest positive impact on quality of life. According to our results, after the recovery a prompt recognition of physical and psychological problems with systematic follow-up screening programs can help patients and doctors in defining specific therapeutic-rehabilitation pathways tailored to meet individual requirements. [ABSTRACT FROM AUTHOR]

Objective: The recently completed EUREKA study confirmed the efficacy and safety profile of fluorescent light energy (FLE) in treating hard-to-heal wounds. To supplement the EUREKA prospective, observational, uncontrolled trial results, researchers selected one of the EUREKA clinical centres to conduct a retrospective analysis of matching wound care data for 46 venous leg ulcers (VLU) patients who had received standard wound care over a five-year period, compared with 10 EUREKA VLU subjects. Method: The study centre selected 46 patients with VLUs based on the matching criteria (wound age and size, patient's age and gender). They compared the healing rates of these matching VLUs with 10 VLU patients treated at the same centre during the EUREKA study. Results: The EUREKA patients had larger and significantly older wounds (p<0.05) and significantly more risk factors (p<0.05) than the matching wounds. However, they had better outcomes (EUREKA: 40% versus matching group: 7% for full wound closure by 16 weeks). No wound breakdown was observed at 16 weeks in the EUREKA group, compared with 25% in the matching group. No EUREKA patient developed infections requiring antibiotics, compared with 37% in the matching group. EUREKA wounds had a mean relative wound area regression (RWAR) of 32% at week six and 50% at week 16, compared with −3% at week six and −6% at week 16 for the matching group. Conclusion: These findings show that the system based on FLE was well-tolerated and efficacious, with better clinical outcome results compared with the wounds analysed in this retrospective matching study and treated with standard of care alone. [ABSTRACT FROM AUTHOR]

A foreword to the Associazione Infermieristica per lo Studio delle Lesioni Cutanee (AISLeC) study on the science and art of holistic wound care is presented.

This section offers news briefs related to wound care as of August 2, 2020 including Wounds Canada's celebration of its 25th anniversary in autumn, and the postponement of the joint congress of the World Council of Enterostomal Therapists (WCET) and the Association of Stoma Care Nurses (ASCN).

Objective: To evaluate if cleansing, using a solution containing the antimicrobial polyhexanide and the surfactant betaine (polyhexanide propylbetaine [PP], Prontosan Solution, B. Braun), can aid effective wound bed preparation (WBP). Method: A solution containing the PP was used in two different treatment regimens. Group A was treated with a single application at different time durations (2, 5, 10 and 15 minutes) to evaluate efficacy in the removal of residues from the wound bed. Group B was treated with PP for 10 minutes, followed by application of an inert dressing, at daily dressing changes for 14 days, to evaluate efficacy of debridement. Results: A total number of 70 patients took part in the study. In Group A (n=40), after the two and five minute application, no change was observed. At 10 minutes, an improvement was seen in 4/10 cases and at 15 minutes the improvement was in 5/10 patients. In Group B (n=30), over the 14 days, an improvement in the condition of the tissue, i.e. the wound bed was cleaned and debrided in 73% of cases, was observed. Patients experienced a reduction in pain and no adverse effect or complication was reported. Periwound skin was improved in 29/30 cases, with only one case where the tissue deteriorated, as determined by the presence of maceration. Conclusion: PP is effective in helping debridement during wound cleansing. Efficacy depends on time of application. However, randomisation and further study is required to confirm these results. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the risk of developing pressure injuries (PIs) and their prevalence rate in older adults in Italy who received public funded home care services and who were often living alone. Method: In May 2019, a cross-sectional study was performed according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. The data collection included demographic variables, a PI risk assessment using the Braden Scale score, the type of mobility devices available, the wound description detailing the PI category, body location and ongoing treatment. Data analysis was conducted using non-parametric descriptive statistics. Results: Of the 2223 patients who participated in the study, the risk of developing a PI as measured with the Braden Scale sore was: 'absent' for 37.7%; 'mild' for 25.8%; 'moderate' for 13.8%; 'high' for 15.5%; and 'severe' for 7.1% of patients. The PI prevalence in the sample of home care service patients was 26%, of which 46% were inpatients with a Braden Scale score of <14. Of the PIs that developed during the study, 65% of these developed in patients in home care and of these, 81% had a Braden Scale score of ≤9. Conclusion: PIs developed not only during hospitalisation but at home. Assessing the commitment of patients and caregivers to PI prevention and treatment strategies in home care services could be key to reducing PI prevalence, hospital admissions for PIs, related complications for older people living at home, and the severity of the PI category. [ABSTRACT FROM AUTHOR]

Background: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. Aim: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. Design: Retrospective chart review. Setting/participants: Patients (n = 574) with a life expectancy ≤6 months admitted to a palliative home care service were included in this study. Results: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index (p < 0.001), Braden score at risk (p < 0.001), Karnofsky Performance Scale index <30 (p < 0.001), patients' female gender, patients' age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. Conclusion: The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs. [ABSTRACT FROM AUTHOR]

Background: Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. Efforts should be oriented toward the achievement of the most effective and efficient clinical management. The Angiology Unit at the University Hospital of Padova, Italy, developed a performance improvement project to enhance the quality of practice for vascular ulcers.Methods: The project consisted in a multistep process comprising a critical revision of the previous clinical process management, staff education, tightening connections between operators and services, and creation of a position for a wound care nurse. The previous standard of practice was modified according to the results of revision and the current evidence-based practice.Results: The new standard of practice reached its full application in September 2015. The number of patients treated and the number of visits in 2015 remained almost unvaried from 2014. However, the total annual expenditure for treating vascular ulcers was reduced by ~60% from the previous year.Conclusion: Standardization of guidelines and practice is effective in creating an efficient clinical management and in reducing the economic burden of vascular ulcers. [ABSTRACT FROM AUTHOR]

Aim: Chronic wounds have a high medical and socio-economic impact related with high costs and an impaired quality of life of patients. Therefore, the feasibility of a therapeutic concept with defined outcomes within a routine clinical setting regarding the wound healing rate and benefit for the patient was assessed. Method: The study was performed between 2016 and 2018. Patients ≥ 18 years with leg ulcers of different etiologies were included and treated for 12 weeks according to a systematic therapeutic approach following a decision tree. Follow-up visits were performed 14 weeks and 27 weeks after the last treatment visit (Visit 5). Study endpoints included changes in wound pain and size of edema, assessment of exudate level, wound and wound margins, wound infection and accelerated wound closure. Results / Discussion: 59 patients, thereof 32 males (58.2%) and 23 females (41.8%), were included in the study. The median age was 67 (range 32 - 90 years). Most patients had cardiovascular comorbidities (98.8%) and received non-opioid analgesia (WHO Grade I [41.8%]) and anticoagulants (34.5%). Most patients had a venous leg ulcer (58.8%) or mixed ulcer (11.8%) localized at the lower thigh (70.9%) or ankle (20.4%). Wound area (31.04 ±48.53 cm; 21.71 ±27.93 cm) and depth (0.27 ±0.39 cm; 0.13 ±0.11 cm decreased and wound characteristics (incl. exudate level, infection, wound pain) improved during treatment. Safety incidences were not observed. Conclusion: The use of a standardized decision tree for the treatment of chronic wounds is feasible and facilitates the management of chronic wounds. [ABSTRACT FROM AUTHOR]

Aim: Non-healing wounds are characterized by a high socio-medical impact, with a prevalence of up to 5% after the age of 65, a high rate of non-healing (20% at two years) and a very high rate of recurrences (67%). The purpose of this study is to demonstrate how microsurgery can be a valid therapeutic option in carefully selected patients, guaranteeing complete time-effective healing and functional recovery. Method: Patients were selected on the basis of election criteria, such as the absence of granulation/healing signs after adequate debridement and conservative treatment, no relevant comorbidities, good compliance, restoration of a pre-existing function. All patients underwent accurate instrumental diagnostic classification through Echo-color Doppler, TcPO2, CT Angiogram, deep sampling with consequent targeted antibiotic therapy in presence of signs of local infection, angiography in view of the need for revascularization. Results / Discussion: Patients with non-healing wounds from various aetiologies such as diabetic foot, chronic osteomyelitis, complicated traumatic wounds, surgical dehiscences with exposure of fixation devices were included in the study. The parameters of choice for the most suitable flap were good vascularisation to guarantees adequate blood flow, thickness that allows the use of footwear, load and traction resistance. In all cases treated with microsurgical reconstruction, complete healing was obtained, with restoration of functionality and no recurrence. In no case was there any loss of the free flap. Conclusion: In the treatment of non-healing wounds microsurgery represents the final phase of a broader path, which is in fact based on a multidisciplinary step by step approach that starts from an accurate general classification of the patient, wound preparation, careful surgical planning, patient education and follow up. [ABSTRACT FROM AUTHOR]

Aim: Treatment of some wound defined "hard to heal" due to their aetiology and characteristics is at times limited due to the absence of biomaterials able to provide correct stimulation for healing. In this case series, we demonstrate the potential of acellular fish skin to re-start the tissue repair process. Method: Use of an acellular skin graft of fish origin, in the regenerative treatment of 20 wounds, both acute and chronic, which are considered to be "hard to heal" (Pyoderma Gangrenoso, digital ischemia, sternal surgical dehiscences, scalp wounds with bone exposed, necrotising fasciitis, chronic decubiti). Results / Discussion: All the wounds treated showed strong re-start of the healing process, with a rapid response, and in 75% of cases, complete healing, with the resulting new tissue stable and with characteristics totally similar to the native one. Conclusion: Bio-stimulation with acellular fish skin grafts proved to be effective even when treating "hard to heal" wounds, with optimal response timing and excellent regenerative outcome, both from a functional and an aesthetic point of view. [ABSTRACT FROM AUTHOR]

Aim: Activate all the factors of healing process of pharyngocutaneous fistula through the holistic approach of Wound Bed Preparation (WBP) which actively involves the patient in the treatment process. Method: Were treated 60 patients from 2002 to 2022, 51 men and 9 women aged between 39 and 87 years. Treatment: - Debridement: surgical, autolytic, chemical - Cleansing: Polyhexamethylene Biguanide - Antimicrobial action: silver dressing + Azatiractica Indica + Iphyercum Perforatum, systemic antibiotic (antibiogram) - Fluid management (saliva and exudate): elastic therapeutic tape used to compress and reduce the lumen of the cutaneous fistula; hydrofiber inside the fistulous tract (if diameter > 1 cm); absorbent pad as a secondary dressing - Dressing closure: self -- adhesive dressing - Nutritional intake: 30 kcal/Kg; proteins 1,6 - 2 g/kg; Water 30 ml/kg - Pain management during dressing change: if VAS > 3 intravenous Paracetamol 1 g or Tramadol 50 mg -- 100 mg (based on body weight) - Emotional status management: counseling. Results / Discussion: - Healed: 60/60 - Average healing time: 8 weeks - Average dressing change: 72 hours - Average pain: VAS > 3 - Surgical requirement: 9/60 - Weight loss: 1,2 kg Conclusion: Using the WBP, gained through twenty years of experience, permit us to manage patients holistically and make them active in the treatment process. This methodology, based on a personalized path and on the use of the most advanced technologies in the field of wound care, has made it possible to reach the healing for all the patients (result not guaranteed). All this allowed the patients to be able to feed orally, after a long and difficult clinical pathway. [ABSTRACT FROM AUTHOR]