Wound Assessment Research Articles

Hyperbaric Oxygen Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma: A Prospective Study.

Background Non-union,chronic pain,functionaldisability, and infectionare all things that have been associated with open fractures with severe soft tissue damage leading to the need for additional hospitalization, and sometimes even subsequent surgeries and weeks or months of rehabilitation. Open fractures and severe musculoskeletal injuries are occasionally treated with hyperbaric oxygen therapy (HBOT) in an effort to reduce the risk of complications and increase the likelihood of a successful recovery. Methods A prospective randomized controlled study was done between January 2019 and August 2022 at a tertiary health care center including 60 patients with a severe soft tissue injury (Grade II and III) divided into two groups - group-CT (30 patients who received conventional treatment) and group HT (30 patients, who received HBOT in addition to conventional treatment). The outcome was measured according to the Bates-Jensen Wound Assessment Tool. Results The wound size, depth, and granulation were significantly reduced in group-HT patients. In the final session, the patient's severity of the wound in group-HT was significantly reduced (P = 0.0001) compared to group-CT. Conclusions Patients who received HBOT reported a significant improvement in their wounds.

EFFECTS OF NURSING INTERVENTIONS ON SELF CARE AND WOUND MANAGEMENT AMONG POST- CORONARY ARTERY BYPASS GRAFTING PATIENTS

Coronary Artery Bypass Grafting (CABG) is a standard cardiac procedure with potential post-operative challenges, including wound management and self-care deficiencies. The role of nursing interventions in improving self-care among these patients remains crucial. This study aimed to determine the effects of nursing interventions on self-care and wound management among post-coronary artery bypass grafting patients. Employing a quasi-experimental design, the study conducted pre-post comparisons in a single group of 36 post-CABG patients. The participants, predominantly middle-aged with a mean age of 61, were profiled based on various demographic and health parameters. Nursing interventions were assessed using pre-defined scales and the Bates-Jensen Wound Assessment Tool to determine the pre- and post-intervention status of the individuals. The interventions revealed significant improvements in several care dimensions: Physical Care improved from a pre-intervention mean score of 51.61 (SD=1.82) to 61.97 (SD=2.55), witnessing a mean difference of -10.36 (95% CI: -10.79 to -9.93, p=0.000). Emotional care experienced a surge from 31.61 (SD=1.82) to 38.72 (SD=2.34), resulting in a mean difference of -7.11 (95% CI: -7.42 to -6.80, p=0.000). Spiritual care enhanced from 43.64 (SD=1.82) to 50.94 (SD=2.70) with a mean difference of -7.31 (95% CI: -7.78 to -6.84, p=0.000). Workplace Self-Care marked an increase from 36.61 (SD=1.82) to 45.06 (SD=2.03), having a mean difference of -8.44 (95% CI: -8.90 to -7.99, p=0.000). Balance scores bettered from 5.06 (SD=0.98) to 7.58 (SD=0.73), showing a mean difference of -2.53 (95% CI: -2.70 to -2.36, p=0.000). In contrast, Psychological Care saw a decline from 51.11 (SD=2.38) to 41.61 (SD=1.82) with a mean difference of 9.50 (95% CI: 9.06 to 9.94, p=0.000). The nursing interventions positively affected several self-care dimensions, aiding in the holistic recovery of post-CABG patients. However, a decrease in psychological care scores suggests the necessity for an integrated approach that equally addresses all care dimensions, including psychological care.

Wound assessment – the foundation of wound care

Alexandra Bishop looks at the fundamentals of assessing wounds in primary care settings

Evaluation of Bacteriological Contamination Pattern of Open Fractures of Extremities- A Study from Tertiary Centre at Western India

Background and Aim: In underdeveloped countries, open fractures are fairly prevalent. Open fractures can be caused by a variety of factors, including a car accident, a fall from a great height, a gunshot, an attack, machine injuries, and others. Infection is a typical side effect of open fractures. The goal of our study was to describe the pattern of bacterial contamination, antibiotic susceptibility, and possible antibiotic resistance in open fractures that arrived at our institute within 6 hours after injury. Material and Methods: A one-year prospective study was undertaken on 200 patients with open fractures of the extremities admitted to the accident and emergency department of Tertiary Care Teaching Institute of India. The first swab is obtained at the primary wound assessment, followed by the second culture swab shortly after debridement, the third culture swab on the day of the first aseptic dressing, and the fourth culture swab if the infection persists or the asepsis score is greater than 20 for a period of four days. Reports on culture and sensitivity were collected in order to analyse the pattern of bacterial isolates and their sensitivity. Results: The majority of the patients in this study were men (83%). We discovered 144 (72%) open fractures in the lower limb, with the tibia being the most often fractured bone, with 76 (38%) occurrences with right sided predominance (58%). Out of 200 patients, 78 (39%) had Gustilo II open fractures, followed by type IIIA (33%). Pre-debridement swabs were collected from all 200 patients with open fractures of the extremities upon admission. 26 (13%) of the patients were determined to be culture positive. Conclusion: In the therapy of patients with open fractures of the extremities, cultures acquired during the first aseptic dressing are considerably more predictive than pre- and post-debridement cultures, and are important in developing an antibiotic policy. It is thus recommended that cultures acquired during the first aseptic dressing provide direction in the selection of antimicrobial therapy, which, when paired with complete wound debridement, will allow for early wound closure and fewer problems.

Digital Twin in Healthcare: A Study for Chronic Wound Management.

Although the concept of digital twin technology has been in existence for nearly half a century, its application in healthcare is a relatively recent development. In healthcare, the utilization of digital twin and data-driven models has proven to enhance clinical decision support, particularly in the treatment and assessment of chronic wounds, leading to improved clinical outcomes. This paper proposes the implementation of a digital twin in the domain of healthcare, specifically in the management of chronic wounds, by leveraging artificial intelligence techniques. The digital twin is composed of data collection, data processing, and AI models dedicated to wound healing. A novel AI pipeline is utilized to track the healing of chronic wounds. The digital twin, serving as a virtual representation of the actual wound, simulates and replicates the healing process. Furthermore, the proposed wound-healing prediction model effectively guides the treatment of chronic wounds. Additionally, by comparing the actual wound with its digital twin, the system enables early identification of non-healing wounds, facilitating timely adjustments and modifications to the treatment plan. By incorporating a digital twin in healthcare, the proposed system enables personalized and tailored treatments, potentially playing a crucial role in proactive problem identification.

Wound assessment fundamentals for nurses

Knowing how to describe a wound is essential for quality assessment, documentation, and monitoring of patient healing.

Factors influencing dressing choice in wound care: a discussion.

Dressing choice can be challenging for clinicians, with many different product types and makes now available. The cost of wound care products is 93% higher for unhealed wounds than for those that heal, so planning appropriate care is essential. Wound care planning requires wound assessment and identification of the aim of care. In turn, this supports dressing selection. Using an assessment framework can help ensure that this is done in a structured way. Reassessment and review of the care plan at agreed intervals is also recommended. In addition to the aim of care, other factors influence the choice of dressing. These include local formulary requirements and allergies and sensitivities. An extensive range of dressings is available and these can be grouped into 10 types: hydrocolloid; wound contact layer; hydrogel; gelling fibre; alginate; foam; absorbent pads; film; odour absorbent; and antimicrobial. Clinicians should use available resources to support decision making and consider continuity of care when selecting the dressing to be used.

NURSING CARE FOR GRADE II DIABETIC ULCUS

Background –Uncontrolled diabetes mellitus will cause various complications, one of which is diabetic ulcers. The incidence of diabetic ulcers in DM patients is still high, namely in 2020 it has reached 25% throughout their lives. Patients will be susceptible to severe infections if they do not understand how to properly care for wounds, so that patients with diabetic ulcers can experience problems in the form of impaired tissue integrity. The development of wound care with modern dressing methods has become a trend now, because this wound treatment uses the moist concept so that it speeds up the wound drying process.Objectives –The case study aims to provide nursing care to patients with grade III diabetic ulcers with the main problem being impaired tissue integrity.Method –This type of case study uses a qualitative research design with a case study approach. The sample in this study consisted of 2 diabetic ulcer patients with conventional wound care for 6 days.Results –The results of case management for 6x8 hours showed that the wound condition had decreased in the BJWAT assessment score, but the wound healing process had not been resolved, namely patient 1 on the first day the BJWAT score was 38 then the sixth day it became 28 , while patient 2 on the first day was 39 then days sixth to 27. The wound healing process does take quite a long time, which can reach 12-20 weeks.Conclusion– The conclusion of this scientific paper is that after treating the wound using 0.9% NaCl solution compressed with metronidazole and gentamicin ointment for 6x8 hours, the wound healing process has not been resolved, but the BJWAT wound assessment score has decreased

Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial.

Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital. This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG. In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher's exact, and Mann-Whitney U tests. The intervention group had significantly lower mean scores-indicating favorable wound healing-for SVG donor site wound healing level than the control group on days 14-21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores-indicating good wound healing-than the control group. The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge. Thai Clinical Trials Registry (TCTR20211112002).

Recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds.

Chronic wounds are among the major healthcare issues affecting millions of people worldwide with high rates of morbidity, losses of limbs and mortality. Microbial infection in wounds is a severe problem that can impede healing of chronic wounds. Accurate, timely and early detection of infections, and real time monitoring of various wound healing biomarkers related to infection can be significantly helpful in the treatment and care of chronic wounds. However, clinical methodologies of periodic assessment and care of wounds require physical visit to wound care clinics or hospitals and time-consuming frequent replacement of wound dressing patches, which also often adversely affect the healing process. Besides, frequent replacements of wound dressings are highly expensive, causing a huge amount of burden on the national health care systems. Smart bandages have emerged to provide in situ physiochemical surveillance in real time at the wound site. These bandages integrate smart sensors to detect the condition of wound infection based on various parameters, such as pH, temperature and oxygen level in the wound which reduces the frequency of changing the wound dressings and its associated complications. These devices can continually monitor the healing process, paving the way for tailored therapy and improved quality of patient's life. In this review, we present an overview of recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds in order to assess infection status. We have elaborated the recent progress in quantitative monitoring of several biomarkers important for assessing wounds infection status and its detection using smart biosensors. The review shows that real-time monitoring of wound status by quantifying specific biomarkers, such as pH, temperature and tissue oxygenation to significantly aid the treatment and care of chronic infected wounds.

MIBA Osteotomy vs Open Technique in Hallux Valgus Surgery: Results of a Randomized Prospective Study

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: In Hallux Valgus (HV) surgery, the open technique has traditionally been used, which implies aggressive and extensive approaches, not without complications. The goal of surgical treatment of HV is to correct the anatomical deformity and achieve a satisfactory long-term result, without interrupting the biomechanics and weight-bearing function of the first metatarsophalangeal joint complex. In recent years, the use of minimally invasive techniques (MIS) has been a valid alternative due to less soft tissue trauma. The purpose of this study is to compare short-medium term clinical results of the MIBA technique versus the traditional open technique in patients with mild-moderate HV. Methods: A randomized, multicenter clinical trial of patients with HV, operated between January 2019 - January 2022, with a minimum of 1-year follow-up. A total of 39 patients were included; 20 MIBA and 19 with the open technique (Chevron osteotomy). It was evaluated if there were statistically significant differences between: demographic variables; radiologic measurements: Intermetatarsal Angle (IMA); Metatarsal Length (ML); visual analog scale (VAS); Foot and Ankle Ability Measure (FAAM), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal- interphalangeal (MTP-IP) and operative wound healing through Photographic Wound Assessment Tool (PWAT) and ASEPSIS score were analyzed. The radiologic measurements and functional scores were collected preoperatively, at 2-6 weeks and 1-year follow-up, while wound scores were at 3 weeks, 3 months, and 1-year follow-up. Results: There were no significant differences concerning age, hypertension, diabetes mellitus, or smoking between both groups. The average follow-up time of the MIBA group was 14 months and the open technique group 12.9 months. In relation of postoperative soft tissue, MIBA group showed significant differences at 6 weeks in PWAT score (0.06 ± 0.24) but no statistically significant differences at 3 weeks and 1 year of follow-up. There were no significant differences in IMA and ML values at 6 months (p=0.57 vs 0.40) and 1 year (p=0.35 vs 0.11). Regarding functional scores, no significant differences were found preoperatively, at 6 months, and 1-year follow-up. Complications in both groups did not have significant differences either. Conclusion: The MIBA technique is a reliable alternative to the classical technique, with significant differences at 6 weeks in a better evolution of postoperative soft tissue according to the PWAT score, but correcting in the medium term. Concerning radiological, functional outcomes and complications, no significant differences were found at 1-year follow-up. Further follow-up and casuistry are necessary to obtain definitive results.

A protocol for a scoping review to identify methods used in clinical practice to assess wound odour.

Objective: The objective of this scoping review is to map, from wound assessment tools and other literature, the current methods used to assess wound odour in order to answer the following question: Which methods of assessment, validated or otherwise, are currently used in wound assessment tools to assess wound odour? Introduction: Wound assessment includes not only details of the condition of the wound bed but also evaluation of symptoms associated with the wound including that of odour. Odour is cited by clinicians, patients and carers as one of the most distressing wound symptoms. However, there is no consensus on a preferred method to assess odour thus negatively impacting the internal and external validity of many clinical trials and minimising the ability to perform meta-analysis. Eligibility criteria: Any wound assessment tool or framework that includes assessment of wound odour in any wound aetiology and in any care setting. Any systematic or scoping review that includes assessment of wound odour in any wound aetiology and in any care setting. No limits on date of publication or language will be applied. Methods: We will employ the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines for this scoping review and base its structure on the framework proposed by Arksey and O'Malley. Results: A narrative format will summarise extracted data and provide an overview of tools used to assess wound odour. A PRISMA diagram will outline the results of the search strategy. The identified tools will be summarised in table format and stratified according to methods used. Conclusion: The result of this scoping review will be a list of methods used to assess odour in wounds and will be used to inform a subsequent Delphi study to gain consensus on the preferred method to assess wound odour.

Validating Wound Severity Assessment via Region-Anchored Convolutional Neural Network Model for Mobile Image-Based Size and Tissue Classification.

Evaluating and tracking the size of a wound is a crucial step in wound assessment. The measurement of various indicators on wounds over time plays a vital role in treating and managing crucial wounds. This article introduces the concept of utilizing mobile device-captured photographs to address this challenge. The research explores the application of digital technologies in the treatment of chronic wounds, offering tools to assist healthcare professionals in enhancing patient care and decision-making. Additionally, it investigates the use of deep learning (DL) algorithms along with the use of computer vision techniques to enhance the validation results of wounds. The proposed method involves tissue classification as well as visual recognition system. The wound's region of interest (RoI) is determined using superpixel techniques, enabling the calculation of its wounded zone. A classification model based on the Region Anchored CNN framework is employed to detect and differentiate wounds and classify their tissues. The outcome demonstrates that the suggested method of DL, with visual methodologies to detect the shape of a wound and measure its size, achieves exceptional results. By utilizing Resnet50, an accuracy of 0.85 percent is obtained, while the Tissue Classification CNN exhibits a Median Deviation Error of 2.91 and a precision range of 0.96%. These outcomes highlight the effectiveness of the methodology in real-world scenarios and its potential to enhance therapeutic treatments for patients with chronic wounds.

Nurses Application of the "TIME" Framework in the Wounds Assessment and Its Impact on the Wound Care Competences

Nurses Application of the "TIME" Framework in the Wounds Assessment and Its Impact on the Wound Care Competences

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Abstract Objective Surgical procedures manifest immense risks to patients. One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection (SSI). Although several efforts are being undertaken to determine the proper means to reduce such complications, there is still a high incidence of SSI worldwide. Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site. This study tested the effectiveness of an operating room (OR) bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery. Methods A quasi-experimental pretest and posttest design was utilized to determine its effectiveness. The study was composed of 60 participants divided into two groups: 30 subjects were selected to receive the OR bundle of care, while the other 30 subjects received the usual care. The groupings were determined through a systematic random sampling technique. The OR bundle of care had three interventions, namely: (1) maintaining perioperative normothermia, (2) no pre-operative surgical site hair removal, and (3) changing gloves before abdominal wall closure. These patients were evaluated using the standard instrument, Bates–Jensen Wound Assessment Tool (BWAT) in the post-intervention phases of the wound healing process, which are as follows: hemostasis, inflammatory, and proliferative phases. To describe the difference in the patients’ wound status after implementation of the OR bundle of care in each post-intervention phase, Friedman’s test was used. To describe the difference in the patients’ wound status in both groups after implementation of the OR bundle of care, the Mann–Whitney U test was used. Results The patient’s wound status was lower, indicating a more healing process. Differences between the wound status of the control and the experimental group were observed on the third postoperative day. This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring. A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed. Conclusions The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital, if there is uniform and consistent implementation of the said intervention.

Unveiling the role of artificial intelligence for wound assessment and wound healing prediction

Wound healing is a very dynamic and complex process as it involves the patient, wound-level parameters, as well as biological, environmental, and socioeconomic factors. Its process includes hemostasis, inflammation, proliferation, and remodeling. Evaluation of wound components such as angiogenesis, inflammation, restoration of connective tissue matrix, wound contraction, remodeling, and re-epithelization would detail the healing process. Understanding key mechanisms in the healing process is critical to wound research. Elucidating its healing complexity would enable control and optimize the processes for achieving faster healing, preventing wound complications, and undesired outcomes such as infection, periwound dermatitis and edema, hematomas, dehiscence, maceration, or scarring. Wound assessment is an essential step for selecting an appropriate treatment and evaluating the wound healing process. The use of artificial intelligence (AI) as advanced computer-assisted methods is promising for gaining insights into wound assessment and healing. As AI-based approaches have been explored for various applications in wound care and research, this paper provides an overview of recent studies exploring the application of AI and its technical developments and suitability for accurate wound assessment and prediction of wound healing. Several studies have been done across the globe, especially in North America, Europe, Oceania, and Asia. The results of these studies have shown that AI-based approaches are promising for wound assessment and prediction of wound healing. However, there are still some limitations and challenges that need to be addressed. This paper also discusses the challenges and limitations of AI-based approaches for wound assessment and prediction of wound healing. The paper concludes with a discussion of future research directions and recommendations for the use of AI-based approaches for wound assessment and prediction of wound healing.

397 The Effects of a Virtual Specialist Nurse-Led Clinic on Plastics Outpatient Services at a Major Trauma Centre: A Closed Loop Audit

Abstract Aim To reduce the number of plastic surgery clinics working over capacity due to the effects of both increasing caseload and the COVID-19 pandemic by implementing a virtual specialist nurse-led clinic. Method Outpatient activity was audited due to the number of patients being overbooked into the plastic surgery outpatient clinics. A virtual specialist nurse-led clinic was implemented to bridge gaps between appointments, maintain early triaging of complications, and reduce clinics working over-capacity. Suitable patients were identified and offered virtual follow-up in place of face-to-face appointments. Outpatient activity was re-audited after implementation, to assess effects on force bookings and number of new/follow-ups seen in consultant clinics. Results Following virtual clinic implementation, there was a significant reduction in consultant clinics working over-capacity (95% to 71.8%, p = 0.002) and forced bookings (54 to 10, p = 0.006) in the audited period. The average number of new patients seen in consultant clinics each month increased by 15.3% (p = 0.019). Conclusions Introduction of a virtual clinic reduced forced bookings and clinics working over-capacity. This increased capacity for new patients to be seen face-to-face, created a manageable clinic while maintaining early identification of complications, and reduced delays between clinic appointments. Early virtual assessment of wounds and identification of complications enabled patients to be booked into urgent face-to-face plastic appointments, triaging them away from A&E and GP services. The virtual clinic also allowed the team to reassure patients with ongoing concerns between appointments, further reducing A&E and GP burden.

Evolution of the Chronic Venous Leg Ulcer Microenvironment and Its Impact on Medical Devices and Wound Care Therapies.

Studies have reported that the constituents of the wound microenvironment are likely to have critical roles in the degradation and fate of the polymeric matrix and the compounds dissolved in the wound dressing matrix. Thus, chronic wound assessment and the design of effective medical devices and drug products for wound care partly rely on an in-depth understanding of the wound microenvironment. The main aim of this review is to identify and discuss the different stages of chronic wound progression, focusing on the changes in the biochemical composition of the wound microenvironment, with particular attention given to venous leg ulcers (VLUs), as they are one of the most prevalent chronic wound aetiologies. The pathophysiology of venous ulcers is detailed, followed by a thorough review of what is known about the VLU microenvironment and its changes as a function of the evolution of the VLU. Simulating conditions for VLU are then discussed with the view of highlighting potentially relevant simulating media as a function of VLU evolution for a better assessment of biological safety, in particular medical devices intended to be in contact with these wounds.

Potential of Honey Hydrogel Modern Dressing in Wound Healing of Patients with Grade II Diabetic Foot Ulcer

Aims: To analyze the potential of honey hydrogel modern dressing in wound healing process in patients with grade II diabetic ulcers. Methods: The research design used a true experiment with a randomized pretest posttestcontrol group design. This study had 36 respondents who were divided into 2 groupsthrough simple random sampling. The intervention group was given honey hydrogel with 4measurements. The first measurement or pretest on day 1, the second measurement orposttest 1 on day 7, the third measurement or posttest 2 on day 14, and the fourthmeasurement or posttest 3 on day 21. The instrument used to measure patient woundhealing using the Bates-Jensen Wound Assessment Tool (BWAT). Results: The increase in the mean wound healing score of patients who were given honeyhydrogel modern dressing from a score of 42.11 on day 1 to 34.56 on day 21 with p = 0.001while the increase in the mean wound healing score of patients who were givenmanufacturer hydrogel modern dressing from a score of 41.67 on day 1 to 37.17 on day 21with p = 0.001. The effect size between the intervention group and the control group is quitestrong with a value of 0.78. Conclusion: Honey hydrogel has the potential to promote wound healing in patients withgrade II diabetic ulcers. Further research is recommended to explore the use of honeyhydrogel by innovating the manufacturing process to ensure consistent dosing in thetreatment of grade II diabetic ulcers.