Healing Process Of Pressure Ulcers Research Articles

Pressure Ulcers and Nutrients: From Established Evidence to Gaps in Knowledge.

Pressure ulcers (PUs) are caused by continuous pressure or friction on the skin that damages tissue, especially over bony prominences. A critical factor in the development and progression of PUs is poor nutritional status, which often involves deficiencies in essential nutrients such as proteins, vitamins (A, C, D, E, K, and the B complex), and trace elements (including zinc, selenium, copper, iron, and manganese). These micronutrients are vital for effective wound healing, as they play significant roles in cellular repair, immune function, and tissue regeneration. Laboratory tests for serum albumin, prealbumin, transferrin, retinol-binding protein, and anthropometric measures like height, weight, and body mass index (BMI) are used to evaluate a patient's nutritional status. Screening tools such as the Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), LPZ questionnaire, and Subjective Global Assessment (SGA) are commonly employed. Emerging evidence from various studies, including in vitro, in vivo, and clinical trials, underscores the importance of personalized nutritional interventions in managing PUs. Unlike generic dietary plans, tailored nutrition that addresses the specific needs of individuals shows greater potential in promoting wound healing and improving clinical outcomes. This synthesis of existing research highlights the critical influence of micronutrients on the healing process of PUs. It suggests that a personalized approach to nutrition, which takes into account individual patient requirements and deficiencies, is likely to be more effective than a one-size-fits- all strategy in the management of these complex wounds.

Doxycycline-loaded carboxymethyl cellulose/sodium alginate/gelatin hydrogel: An approach for enhancing pressure ulcer healing in a rat model.

Pressure ulcers, or bedsores, are created by areas of the skin under prolonged pressure and can lead to skin and underlying tissue damage. The present study evaluated the effects of carboxymethyl cellulose/sodium alginate/gelatin (CMC/Alg/Gel) hydrogel containing doxycycline (DOX) on improving the healing process of pressure ulcers. The magnet was used to apply pressure on the dorsum skin rat to induce a pressure ulcer model. Then sterile gauze, CMC/Alg/Gel, and CMC/Alg/Gel/1% w/v DOX hydrogels were used to cover the wounds. Blood compatibility, weight loss, cytocompatibility, drug release rate, cell viability, wound closure, and re-epithelialization were evaluated in all animals on the 14th day after treatment. In vivo results and histopathological evaluation showed 56.66% wound closure and the highest re-epithelialization in the CMC/Alg/Gel/1% w/v DOX hydrogel group (14 days after treatment). Furthermore, real-time PCR results indicated that the hydrogel containing DOX significantly decreased the expression of the MMP family consisting of MMP2 and MMP9 mRNA and also increased the expression of vascular endothelial growth factor VEGF mRNA. This study suggested that the addition of DOX, an antibiotic and MMP inhibitor, to hydrogels may be effective in the healing process of pressure ulcers.

Effectiveness of glutamine and arginine in wound healing of pressure ulcers: A systematic review protocol

IntroductionVarious nutrients play a physiological role in the healing process of pressure ulcers (PUs). Nutritional interventions include the administration of enteral nutritional supplements and formulas containing arginine, glutamine, and micronutrients. The aim of this systematic review is to evaluate the effectiveness of enteral nutritional supplements and formulas containing arginine and glutamine on wound-related outcomes. These include (1) time to healing, (2) changes in wound size, (3) local wound infection, (4) PU recurrence, and (5) PU-related pain. Materials and methodsThis protocol was developed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A search will be conducted in the Cochrane Library, EMBASE, PubMed (MEDLINE), CINAHL (EBSCOhost interface) and Web of Science. In addition, a manual search will be conducted to identify relevant records. Except for systematic reviews, no restrictions will be placed on the study design, the population studied or the setting. Studies that do not address PUs, in vitro studies and studies that do not report wound-related outcomes will be excluded. Study selection, risk of bias assessment and data extraction will be performed independently by three researchers. Depending on the extent of heterogeneity of interventions, follow-up time and populations, results will be summarised either by meta-analysis or narrative synthesis. ConclusionsThis is the first systematic review to identify, evaluate and summarise the current evidence for enteral arginine and glutamine supplementation on wound-related outcomes in PUs. The review will provide a solid basis for deriving valid and clinically relevant conclusions in this area.

The efficacy of continuing nursing interventions on intraoperative pressure ulcer-related complications in breast cancer patients: systematic review and meta-analysis.

This study systematically reviewed the effects of continuous nursing intervention on intraoperative pressure ulcers (PUs) and related complications in breast cancer patients. The effectiveness of continuous nursing intervention for intraoperative pressure ulcers related complications in breast cancer patients is highly controversial. Therefore, it is necessary to systematically review and address this issue by means of meta-analysis. By searching the Cochrane Library, PubMed, Web of Science, Embase, and Chinese Biomedical Literature Database (CBM) were screened. Quality evaluation and data extraction were performed for the included studies, and meta-analysis was performed for the included RCTs using Review Manager 5.2 software. Literature was included in strict compliance with the PICOS principle, and bias risk was analyzed by t-test and funnel plot. A total of 1,431 patients were enrolled in 9 studies, and meta-analysis showed that there was a significant statistical difference between the experimental group and the control group in the incidence of PUs [odds ratio (OR) =0.18, 95% confidence interval (95% CI): 0.13-0.24, P<0.00001], the Braden pressure ulcer risk score after nursing [mean difference (MD) =2.64, 95% CI: 1.47-3.81, P<0.0001], and the quality of life after nursing (MD =9.76, 95% CI: 6.82-12.69, P<0.00001). Continuous care can reduce the incidence of PUs in patients with advanced breast cancer, reduce the severity of wounds in the healing process of PUs, and improve the knowledge of PUs in patients with advanced breast cancer risk.

The Impact of Stress on Pressure Ulcer Wound Healing Process and on the Psychophysiological Environment of the Individual Suffering from them.

Introduction:The occurrence of a pressure ulcer constitutes a major psychological and physiological burden and it has been linked with a reduced quality of life and increased stress of the individual.Objective:The main objective was to investigate the impact that stress has on pressure ulcer healing process and on the psychophysiological environment of the individual suffering from them.Method:The scientific literature was reviewed through Cinahl, Pub-med, EBSCO, Medline and Google scholar. The articles were chosen due to their direct correlation with the objective under study and their scientific relevance.Results:Increased stress has been demonstrated to increase the glucocorticoids levels affecting negatively the production of wound healing cytokines (IL1α, IL1β and TNFα). Matrix metalloproteases has been identified to be unregulated in occasions of increased stress in acute wounds. Stress has also been correlated with poor health behaviors that may not have a direct link on the wound healing process, although they can in part explain or enhance some of the effects of stress on wound healing.Conclusion:The correlation between stress and wound healing in acute wounds has been thoroughly investigated and its negative effects have been established. The presence of a pressure ulcer can have a detrimental impact on the stress level of an individual although further investigation is needed to establish the role of stress in chronic wounds such as pressure ulcers.

Grafting with Cryopreserved Amniotic Membrane versus Conservative Wound Care in Treatment of Pressure Ulcers: A Randomized Clinical Trial

To compare the healing process of pressure ulcers treated with cryopreserved human amniotic membrane allograft and routine pressure ulcer care in our hospital.From January 2012 to December 2013, in a prospective randomized clinical trial (IRCT201612041335N2), 24 patients with second and third stage of pressure ulcers were enrolled in this study. All patients needed split-thickness skin grafts for pressure ulcer-wound coverage. Selected patients had symmetric ulcers on both upper and lower extremities. The patients were randomly divided into two groups: amnion and control. In the amnion group, the ulcer was covered with cryopreserved amniotic membrane and in the control group it was treated with local Dilantin powder application. The duration and success rate of complete healing was compared between the two groups.The study group was composed of 24 pressure ulcers in 24 patients (19 males and 5 females) with a mean age of 44±12.70 years. The demographic characteristics, ulcer area, and underlying diseases were similar in both groups. The early sign of response, such as decrease in wound discharge, was detected 12-14 days after biological dressing. Complete pressure ulcer healing occurred only in the amnion group (p< 0.001). Partial healing was significantly higher in the amnion group (p< 0.03). Healing time in this group was faster than that the control group (20 days versus 54 days). No major complication was recorded with amniotic membrane dressing.Cryopreserved amniotic membrane is an effective biologic dressing that promotes re-epithelialization in pressure ulcers.

Grafting with Cryopreserved Amniotic Membrane versus Conservative Wound Care in Treatment of Pressure Ulcers: A Randomized Clinical Trial.

To compare the healing process of pressure ulcers treated with cryopreserved human amniotic membrane allograft and routine pressure ulcer care in our hospital. From January 2012 to December 2013, in a prospective randomized clinical trial (IRCT201612041335N2), 24 patients with second and third stage of pressure ulcers were enrolled in this study. All patients needed split-thickness skin grafts for pressure ulcer-wound coverage. Selected patients had symmetric ulcers on both upper and lower extremities. The patients were randomly divided into two groups: amnion and control. In the amnion group, the ulcer was covered with cryopreserved amniotic membrane and in the control group it was treated with local Dilantin powder application. The duration and success rate of complete healing was compared between the two groups. The study group was composed of 24 pressure ulcers in 24 patients (19 males and 5 females) with a mean age of 44±12.70 years. The demographic characteristics, ulcer area, and underlying diseases were similar in both groups. The early sign of response, such as decrease in wound discharge, was detected 12-14 days after biological dressing. Complete pressure ulcer healing occurred only in the amnion group (p< 0.001). Partial healing was significantly higher in the amnion group (p< 0.03). Healing time in this group was faster than that the control group (20 days versus 54 days). No major complication was recorded with amniotic membrane dressing. Cryopreserved amniotic membrane is an effective biologic dressing that promotes re-epithelialization in pressure ulcers.

Effectiveness of enteral nutritional therapy in the healing process of pressure ulcers: a systematic review

To evaluate the effectiveness of enteral nutritional therapy (ENT) in the healing process of pressure ulcers (PU) in adults and the elderly. A systematic review whose studies were identified through the databases of Cochrane, MEDLINE/PubMed, SciELO, LILACS, EMBASE, CINAHL, Web of Science, and manual searches. It included randomized clinical trials (RCTs) without delimiting the period or language of publication, which addressed adults and elderly patients with pressure ulcers in a comparative treatment of enteral nutritional therapy and placebo or between enteral nutritional therapy with different compositions and dosages. We included ten studies that considered different interventions. It resulted in more pressure ulcers healed in the groups that received the intervention. The included studies were heterogeneous with regard to patients, the type of intervention, the sample and the follow-up period, all of which made meta-analysis impossible. Although the enteral nutritional therapy demonstrates a promotion of pressure ulcer healing, sufficient evidence to confirm the hypothesis was not found.

Morphological characteristics and healing process of pressure ulcers in terminal cancer patients and identification of worsening factors

Morphological characteristics and healing process of pressure ulcers in terminal cancer patients and identification of worsening factors

Efficacy of Topical Atorvastatin for the Treatment of Pressure Ulcers: A Randomized Clinical Trial

To evaluate the effects of topical atorvastatin on the healing process of pressure ulcers in critically ill patients. Randomized, double-blind, placebo-controlled clinical trial. Medical-surgical intensive care unit of a university-affiliated teaching hospital in Tehran, Iran. One hundred four patients with stage I or II pressure ulcers, graded according to the 2-digit Stirling Pressure Sore Severity Scale. Patients were randomized to receive topical atorvastatin 1% ointment (51 patients [atorvastatin group]) or placebo ointment (53 patients [control group]) applied once/day to pressure ulcers for 14 days in addition to standard care for pressure ulcers. The efficacy of each treatment was assessed on days 7 and 14. Efficacy was determined based on the degree of healing of the existing pressure ulcer by using the 2-digit Stirling scale. The baseline stage of the pressure ulcers did not differ significantly between the control and atorvastatin groups. However, the mean ± SD stage of pressure ulcers significantly decreased in the atorvastatin group compared with the control group on day 7 (0.97 ± 0.76 vs 1.74 ± 0.75, p<0.01) and day 14 (0.42 ± 0.67 vs 1.71 ± 0.78, p<0.01) of treatment. In addition, the mean ± SD surface areas of ulcers in the atorvastatin group were significantly declined compared with the control group after 7 days (5.55 ± 4.55 vs 9.41 ± 5.03 cm², p<0.01) and 14 days (3.72 ± 4.45 vs 10.41 ± 6.41 cm², p<0.01) of treatment. Topical application of atorvastatin ointment 1% for 14 days in addition to standard care significantly accelerated the healing of stage I or II pressure ulcers in critically ill patients.

Predictive validity of weekly monitoring of wound status using DESIGN‐R score change for pressure ulcer healing: A multicenter prospective cohort study

There are few studies on predictive validity of methods to monitor the healing process of pressure ulcers. We evaluated whether the change of DESIGN-R (rating) score could predict subsequent healing, and determined the optimal cutoff points. In a multicenter prospective cohort study, patients were followed until wound healing or censoring. Wound severity was evaluated by the DESIGN-R tool every week, and the score change was calculated over 1-4 weeks (n = 411, 286, 224, and 170, respectively). In the multivariate analyses stratified by depth, a one-point improvement in DESIGN-R score over any period was positively associated with healing within the next 30 days independent of initial wound severity (hazard ratios over each 1-4 weeks ranging from 1.16 to 1.33 for superficial ulcers and from 1.21 to 1.27 for deep ulcers; all p < 0.05). The optimal cutoff points over 1-4 weeks were set as negative change for superficial ulcers and as positive change of ≥two points for deep ulcers. Nonhealing rate was higher for ulcers with DESIGN-R score change below the cutoff points than that aforementioned for both depths. Weekly monitoring by the DESIGN-R tool will be advantageous for evaluating prognosis of pressure ulcers independent of initial wound severity and depth.

Sustained-release adrenomedullin ointment accelerates wound healing of pressure ulcers

Pressure ulcers are one of the most common complications in elderly, incontinent or paralyzed patients. For the healing of pressure ulcers, the development of granulation tissue and reepithelialization is required. Adrenomedullin (AM), an endogenous vasodilator peptide, is reported to stimulate the proliferation and migration of various cells including endothelial cells, fibroblasts and keratinocytes. Therefore, we hypothesized that AM might accelerate the healing process of pressure ulcers in which these cells were involved. We developed a sustained-release ointment containing human recombinant AM, and applied it in a mouse model of pressure ulcer twice a day for 14 days. Human AM was efficiently absorbed in wound area, but its blood concentration was negligible. AM ointment significantly reduced the wound area on day 5 to 7 after injury. In addition, AM ointment accelerated the formation of granulation tissue and angiogenesis as well as lymphangiogenesis after 7 days of treatment. Immunological analysis revealed that Ki-67-positive proliferating cells in granulation tissue expressed AM receptors. In summary, sustained-release AM significantly improved wound healing of pressure ulcers through acceleration of granulation and induction of angiogenesis and lymphangiogenesis. Therefore, sustained-release AM ointment may be a novel therapeutic agent for pressure ulcers.

Efeitos da terapia fotodinâmica e de uma única aplicação de laser de baixa potência em bactérias in vitro

O laser de baixa potência vem sendo usado para acelerar a cicatrização em úlceras de pressão devido a seus efeitos cicatrizante, antiinflamatório, antiedematoso e analgésico. No entanto, não há consenso quanto a seu efeito em úlceras infectadas. O objetivo deste estudo foi verificar o efeito bactericida da laserterapia e da terapia fotodinâmica (TFD) com laser de baixa potência, InGaP, 670 nm, em doses de 2, 4 e 6 J/cm², em bactérias gram-positivas e gram-negativas in vitro. Foram preparadas 32 placas de Petri com bactérias, 16 com Pseudomonas aeruginosa e 16 com Staphilococcus aureus. Aleatoriamente dividiu-se cada grupo em oito subgrupos (duas placas cada): três subgrupos tratados só com laserterapia, em doses de 2 J/cm², 4 J/cm² e 6 J/cm²; três subgrupos tratados com TFD, em doses de 2 J/cm², 4 J/cm² e 6 J/cm²; um tratado apenas com fotossensibilizante (azul de metileno a 0,1 µg/ml); e um subgrupo não tratado (controle). Os subgrupos laser e TFD foram irradiados uma única vez e incubados por 24 horas. Os outros dois subgrupos não receberam irradiação. As culturas foram analisadas visualmente para verificação ou não do halo de inibição. Em todos os subgrupos, de ambas as bactérias, não foi observado qualquer halo de inibição nem de crescimento. Conclui-se que a terapia a laser e a fotodinâmica de baixa potência (InGaP, 670 nm) não produziram efeitos bactericidas e/ou bacteriostáticos, tampouco tendo havido efeito bioestimulante sobre as bactérias.

Healing process of pressure ulcers after a change in the nutrition regimen of bedridden elderly: A case series

AbstractAim: The aim of the present study was to describe the healing process of pressure ulcers after a change in the nutrition regimen of seven bedridden elderly patients.Methods: The healing process of pressure ulcers was described and monitored for 4 weeks prior to and 4 weeks following a change in the nutrition regimen in the seven subjects, who were in long‐term care facilities, while controlling for other factors related to pressure ulcer healing. Changes in the nutrition regimen included increased caloric intake, supplements, or tube feeding. The healing process was measured qualitatively using wound sketches and quantitatively using wound surface area and DESIGN score.Results: Pressure ulcers were predominantly stage III (n = 4) and located in the truncal area (n = 6). There were qualitative differences in the healing process before and after the nutrition regimen change. Most notably, in six cases there was early granulation tissue at the wound edge at week 2 after the change, the color of the granulation tissue improved at week 3, and there was a decrease in wound depth at week 4.Conclusions: Based on this description of the process of healing of full‐thickness pressure ulcers in seven elderly subjects, it is suggested that a qualitative assessment of improvement in the wound can be made from the appearance of the granulation tissue following a change in nutrition.