Wound Healing Center Research Articles

Weight Surveillance and Heart Failure Self-assessment in Patients with Chronic Leg Wounds: A Pilot Study.

To determine if a weight check and heart failure symptom evaluation with each wound care visit could impact wound healing in patients with heart failure and chronic leg wounds. This was a descriptive, correlational study at an outpatient wound healing center in the Pacific Northwest. A convenience sample of individuals currently enrolled at the center with leg wounds and heart failure was identified from standardized electronic medical records. The comparison group received standard care. The intervention group received a body weight check via digital scale and heart failure self-assessment via a standardized assessment tool. Outcome measures included healing rates with weight exacerbation, number of referrals, and hospitalizations for exacerbations. A total of four participants received the intervention, and three were in the control group. Descriptive analysis showed no significant differences between groups or between weight and left ventricle ejection fraction to wound surface area change. A significant positive correlation was observed between past referrals and past hospitalization (rs = 0.79; P = .033; 95% confidence interval, 0.10-0.97). The intervention group had abnormal spikes in wound size that coincided with weight gain. There were no referrals or hospitalizations during the intervention phase, and it is possible that heart failure self-assessment with every wound care visit prevented exacerbations. Despite the use of an evaluation tool, the intervention and comparison groups had no significantly different outcomes. It is unclear if the intervention was not effective because of the methodology or study limitations. Further research with a larger sample, standardized tools for wound assessment, and a lengthier intervention phase is recommended.

A Retrospective Analysis of Clinical Use and Outcomes Using Viable Placental Membrane Allografts in Chronic Wounds

Viable placental membrane (vPM) has been shown to decrease time to healing, adverse wound events, and wound-related infections. Wound research exclusion criteria commonly exclude wound types other than diabetic foot ulcers and venous leg ulcers (VLUs), comorbidities including peripheral arterial disease (PAD) and uncontrolled diabetes mellitus (DM), and wounds with exposed bone or tendon. This retrospective research study evaluated the clinical use and outcomes of the vPM with living mesenchymal stem cells used in chronic wound management in the community hospital outpatient department setting with the goal of comparing real-world use and outcomes of the product with use and outcomes described in the chronic wound literature. A retrospective analysis on vPM treatments at a Wisconsin academic health system's community hospitals. Participants included all patients who received vPM therapy between July 1, 2016, and August 21, 2019. A total of 89 patients received vPM treatment during the study period (mean age, 70 years; 69% male [n = 61], 31% female [n = 28]). Wound types were 54% diabetic or neuropathic foot ulcers (n = 48), 17% VLUs (n = 15), 7% pressure injuries (n = 6), and 22% atypical wounds (n = 20). The average wound duration prior to vPM initiation was 104 days. Average wound size at presentation was 6.9 cm2. Of study participants 54% had PAD (n = 48), 63% had DM (n = 56), 33.7% had DM and PAD (n = 30), and 17% had exposed bone or tendon (n = 15). Average adjusted time to healing after initiation of vPM was 81.2 days. The percentage of wounds healed 12 weeks after initiation of vPM treatment was 57%. Effectiveness of vPM observed in controlled trials also was observed in this real-world study on vPM for multiple wound types, patients with comorbidities including PAD and uncontrolled DM, and wounds with exposed bone or tendon. Results of this study were not statistically different from those reported in the literature. More randomized controlled trials are needed to explore the efficacy of vPM on patient presentations common to wound healing centers.

Implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center

BackgroundThe role of the pharmacist in wound healing management among patients with diabetic and nondiabetic foot ulcers (DFU) is unclear. We sought to implement and evaluate an integrated pharmacist-driven comprehensive medication management (CMM) program in a multidisciplinary podiatrist-led wound healing center (WHC). ObjectivesThe objectives were to determine the role of the clinical pharmacist in a WHC and evaluate the impact of CMM interventions on prescribing rates and wound healing rates. MethodsA pharmacist-driven CMM program was implemented in a podiatrist-led WHC, and an evaluation spanning 6 years was conducted. ResultsOverall, 1018 patients were treated over 6 years, and 515 received wound treatment after the CMM period, of which, 309 received CMM services. A total of 441 medication related problems (MRPs) were identified; most were related to medication safety (35.1%) and inappropriate or ineffective therapy (31.3%), and problems with adherence accounted for 22.5% of documented MRPs. An average of 3.41 interventions per patient were documented, and most were related to patient education (40.8%). Only metformin (20.3 vs. 34.2%; P < 0.001) and insulin prescription (57.3 vs. 73.8%; P < 0.001) prevalence increased after CMM implementation. Other prescriptions were not significantly different among patients presenting in the pre- and post-CMM periods, respectively. Wound healing rates among patients with DFU were similar before and after implementation (55 vs. 52%; P = 0.49). Likewise, wound healing rates among those with non-DFUs were similar before- and after implementation (56 vs. 53%; P = 0.56). ConclusionThe implementation of a novel pharmacist-driven CMM program embedded within a multidisciplinary podiatrist-managed WHC provided the initial evidence of the potential benefits of providing pharmacist-driven CMM services to patients with lower extremity ulcers. Prospective studies of CMM in this patient population are needed.

AUTOLOGOUS PLATELET - RICH PLASMA (PRP) THERAPY AND CHANGEMENTS OF TOPICAL BIOLOGICAL MARKERS (EGF, VEGF AND MMP12) OF CHRONIC WOUNDS

Objective: Our aim was to evaluate topical EGF, VEGF, MMP12 concentrations of ​​chronic wounds which after Autologous Platelet - Rich Plasma(PRP) therapy.&#x0D; Methods: The study conducted a descriptive longitudinal study at the Wound Healing Center of the Vietnam National Burn Hospital from 11/2018 to 2/2020. 24 patients with chronic wounds and aged 18 years old or older were enrolled in this study. These patients were injected autologous PRP at wound bed. We biopsied chronic wound bed tissue for evaluating EGF, VEGF and MMP12 by the Elisa technique at the first, second and third week of follow-up.&#x0D; Results: After PRP therapy, topical EGF and VEGF concentration increased after 1 week of treatment. MMP12 concentraiton significantly reduced compaired to before PRP therapy.&#x0D; Conclusion: In addition to PRP therapy had a beneficial effect on cutaneous regeneration and wound healing of the chronic wound. The autologous PRP promoted the wound healing process byincreating topical EGF and VEGF, reducing MMP12 which known as a pro-inflammatiory mediator.

Application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes

Objective: To explore the application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes. Methods: A retrospective observational study was conducted. From January 1 to December 23, 2019, a total of 46 patients with chronic sinus tract wounds, who met the inclusion criteria were admitted to the Wound Healing Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 23 males and 23 females, aged 18-81 (48±21) years. On admission, computer tomography (CT) imaging and three-dimensional reconstruction were performed to examine the shapes of wound sinus tract and classify the wounds, with the lengths of wound sinus tract by CT imaging examination (hereinafter referred to as reference lengths) recorded. The lengths of wound sinus tract were examined and measured by rigid endoscopy and flexible endoscopy. The wounds with and without obviously curved sinus tract were classified into curve group and linear group respectively, and the deviation rates between the lengths of wound sinus tract measured by flexible endoscopy or rigid endoscopy and the reference lengths (hereinafter referred to as deviation rates of lengths) in each group were calculated. The difference between the deviation rates of lengths examined by flexible endoscopy and rigid endoscopy and the differences between the above two and the deviation rate of reference lengths (0) in each group were compared. Data were statistically analyzed with paired sample t test and Wilcoxon signed rank sum test. Results: CT imaging and three-dimensional reconstruction showed that there were 4 types of wound sinus tract, including tubular (36/46), lamellar (4/46), club-mallet (4/46), and irregular (2/46) shape. Tubular wounds were further divided into type I (23/36), type L (4/36), and type Y (9/36). Wounds with type I tubular, lamellar, and club-mallet sinus tract were classified into linear group (31/46), while those with type Y tubular, type L tubular, and irregular sinus tract were classified into curve group (15/46). In linear group, the deviation rates of lengths examined and measured by rigid endoscopy and flexible endoscopy were 0. In curve group, the deviation rate of lengths examined and measured by flexible endoscopy was 0 (0, 0.58%), which was significantly lower than 41.18% (31.68%, 48.41%) examined and measured by rigid endoscopy, Z=-3.408, P<0.01; the deviation rate of lengths examined and measured by rigid endoscopy (40±19)% was significantly higher than the deviation rate of reference lengths (t=8.343, P<0.01), while the deviation rate of the lengths examined and measured by flexible endoscopy was similar to the deviation rate of reference lengths (Z=-1.342, P>0.05). Conclusions: Compared with rigid endoscopy, flexible endoscopy can observe the internal characteristics of chronic sinus tract wounds in a wider range in the clinical examination of this kind of wound, especially for the exploration of curved chronic sinus tract wounds. The promotion of this method will be conducive to the diagnosis and treatment of chronic sinus tract wounds.

Impact of white balance adjustment on evaluation of photographs of atopic dermatitis lesions

Skin Research and TechnologyVolume 27, Issue 6 p. 1174-1175 LETTER TO THE EDITOR Impact of white balance adjustment on evaluation of photographs of atopic dermatitis lesions Zarqa Ali, Corresponding Author Zarqa Ali [email protected] orcid.org/0000-0003-2411-7177 Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark Correspondence Zarqa Ali, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark. Email: [email protected]Search for more papers by this authorAnders Daniel Andersen, Anders Daniel Andersen orcid.org/0000-0002-4784-0010 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorAleksander Lauge Eiken, Aleksander Lauge Eiken orcid.org/0000-0001-9067-548X Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorAri Pall Isberg, Ari Pall Isberg orcid.org/0000-0002-7957-6285 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorCharlotte Amalie Pind Laugesen, Charlotte Amalie Pind Laugesen orcid.org/0000-0003-2851-6482 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorTheis Bjerre-Christensen, Theis Bjerre-Christensen orcid.org/0000-0002-1613-2978 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorSimon Francis Thomsen, Simon Francis Thomsen orcid.org/0000-0002-4838-300X Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark Department of Biomedical Sciences, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorJohn Robert Zibert, John Robert Zibert orcid.org/0000-0002-3220-8303 Studies&Me, Copenhagen, DenmarkSearch for more papers by this author Zarqa Ali, Corresponding Author Zarqa Ali [email protected] orcid.org/0000-0003-2411-7177 Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark Correspondence Zarqa Ali, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark. Email: [email protected]Search for more papers by this authorAnders Daniel Andersen, Anders Daniel Andersen orcid.org/0000-0002-4784-0010 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorAleksander Lauge Eiken, Aleksander Lauge Eiken orcid.org/0000-0001-9067-548X Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorAri Pall Isberg, Ari Pall Isberg orcid.org/0000-0002-7957-6285 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorCharlotte Amalie Pind Laugesen, Charlotte Amalie Pind Laugesen orcid.org/0000-0003-2851-6482 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorTheis Bjerre-Christensen, Theis Bjerre-Christensen orcid.org/0000-0002-1613-2978 Studies&Me, Copenhagen, DenmarkSearch for more papers by this authorSimon Francis Thomsen, Simon Francis Thomsen orcid.org/0000-0002-4838-300X Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark Department of Biomedical Sciences, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorJohn Robert Zibert, John Robert Zibert orcid.org/0000-0002-3220-8303 Studies&Me, Copenhagen, DenmarkSearch for more papers by this author First published: 10 June 2021 https://doi.org/10.1111/srt.13073Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume27, Issue6November 2021Pages 1174-1175 RelatedInformation

Closing of surgical wounds on ala nasi with an autologous patch: A case series and in vivo wound imaging using Reflectance Confocal Microscopy

Skin Research and TechnologyVolume 27, Issue 5 p. 988-990 LETTER TO THE EDITOR Closing of surgical wounds on ala nasi with an autologous patch: A case series and in vivo wound imaging using Reflectance Confocal Microscopy Marie K. Hjorth, Corresponding Author Marie K. Hjorth [email protected] orcid.org/0000-0002-3794-8407 Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Correspondence Marie K. Hjorth, Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 9, indgang 4, Copenhagen DK-2400, Denmark. Email: [email protected]Search for more papers by this authorEwa A. Burian, Ewa A. Burian Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorMartin Glud, Martin Glud Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorMette Mogensen, Mette Mogensen Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorTonny Karlsmark, Tonny Karlsmark Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorKatrine E. Karmisholt, Katrine E. Karmisholt Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this author Marie K. Hjorth, Corresponding Author Marie K. Hjorth [email protected] orcid.org/0000-0002-3794-8407 Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Correspondence Marie K. Hjorth, Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 9, indgang 4, Copenhagen DK-2400, Denmark. Email: [email protected]Search for more papers by this authorEwa A. Burian, Ewa A. Burian Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorMartin Glud, Martin Glud Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorMette Mogensen, Mette Mogensen Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorTonny Karlsmark, Tonny Karlsmark Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorKatrine E. Karmisholt, Katrine E. Karmisholt Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this author First published: 04 March 2021 https://doi.org/10.1111/srt.13024Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume27, Issue5September 2021Pages 988-990 RelatedInformation

17986 A novel approach to creating a chronic wound on lower extremity nonmelanoma skin cancers

Brachytherapy therapy as treatment of nonmelanoma skin cancer is a minimally invasive modality for skin cancer treatment. For elderly patients with medical comorbidities, this is an appealing option. However, in the distal third of the lower extremity, skin tension, poor vascularity, and higher incidence of peripheral arterial disease contribute to poor wound healing. The pathophysiology of radiation exposure to the skin causes endarteritis obliterans, fibrosis, and a hypovascular wound bed serving as poor foundation for wound healing. Our case series suggests skin cancer on the distal third of the leg treated with brachytherapy results in poorly or non-healing wounds as compared with other treatment modalities. Its use should be limited and may require collaboration with a wound healing center in order to manage postprocedural wound healing. We present a series of 10 patients with lower extremity nonmelanoma skin cancers treated with brachytherapy, resulting in nonhealing fibrotic wounds between 3-5 cm in size, taking an average of 2-12 months to heal. Multiple modalities of wound care including advanced dressings, debridement, multilayer compression therapy, and hyperbaric therapy were often employed and necessary to heal the majority of these wounds.

Use of Topical Timolol Maleate as Re-Epithelialization Agent for Treatment of Recalcitrant Wounds of Varying Etiologies.

Background: Chronic wounds remain a challenge for the clinician and healthcare system. It is therefore vital for additional therapies that target steps involved in wound recalcitrance. Recently, topical timolol has shown promising results for use in wound healing. Objective: The goal of this study was to assess timolol’s effectiveness in healing wounds of varying etiologies. Methods: This multi-center series took place from 2016¬–2019 at the wound healing centers at the University of Miami Health System and the Veterans Affairs Northern California Healthcare. We identified all wound patients who received treatment with topical timolol maleate 0.5% for at least 4 weeks after failing previous treatments. Timolol drops at a dose of 1 drop per cm2 of wound area were instilled with dressing changes twice a day, once a day, every other day, or continuous application. Once they began the study, they stopped all concurrent therapies aside from standard of care. Healing outcomes were classified into 3 categories: healed, defined as complete re-epithelialization of the wound and closure, improved, defined as decreasing wound size area (WSA), and worsening, defined as increasing WSA. Results: We identified 39 patients, 32 males and 7 females that had a total of 55 chronic wounds of varying etiologies. Thirty-four of the wounds had completely healed, 15 wounds improved in WSA, 4 wounds were unchanged in WSA, and 2 wounds worsened in WSA. Conclusions: In line with our previous experience, we found topical timolol to be a safe, cost-effective, and efficacious treatment for recalcitrant wounds of varying etiologies.

Perspectives on the Process of Negative Pressure Wound Therapy at Home in Patients With Chronic Wound: A Qualitative Descriptive Study.

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

Wound healing center establishment and new technology application in improving the wound healing quality in China.

Wound healing, tissue repair and regenerative medicine are in great demand, and great achievements in these fields have been made. In recent years, many of these successes have benefitted patients, especially in the field of chronic skin wounds. However, perfect tissue repair and regeneration of damaged tissues and organs are still great challenges in the management of trauma and diseases. In this paper, the main achievements in wound healing, tissue repair and regeneration in China are reviewed and the establishment of wound healing centers and new technology application in improving wound healing quality in patients in China is highlighted.

Diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract (trial version)

The " exploration of treatment technology of chronic wound with sinus tract supported by endoscope and related auxiliary methods" study had been conducted by Wound Healing Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The feasibility and effectiveness of this technique have been confirmed, and good clinic results have been achieved. In order to further promote the new technology and its related research, the theoretical knowledge and technical experience accumulated in the early stage are summarized as diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract, including four parts: the applicable subjects, the diagnosis and treatment procedures and classification criteria, the healing criteria, and the risk assessment and prevention measures. The purpose of this standard is to facilitate the application of standardized endoscopy technique, to make the most of its technological advantages, prevent risks, and provide a reference for the official version of the diagnosis and treatment standard.

Atypical Ulcers: Diagnosis and Management.

Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012.

Aim To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p = 0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p = 0.6), 14% were amputated (p = 0.2), and 12.8% were dead within one year in 2011/2012 (p < 0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. Conclusion The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.

Study on the clinical benefits of endoscopy combined with contrast fistulography in the diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity

Objective: To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity. Methods: Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher's exact probability test. Results: (1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ(2)=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ(2)=21.6, P<0.01]. Conclusions: Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.

Mortality and complications after treatment of acute diabetic Charcot foot

AimsCharcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications. MethodsThe study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. ResultsIn total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce. ConclusionMore patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.

Use of a National Electronic Health Record Network to Describe Characteristics and Healing Patterns of Sickle Cell Ulcers.

Objective: Sickle cell ulcers affect as many as 15% of patients with sickle cell disease in the United States and severely impact quality of life. An understanding of baseline healing patterns is important to inform study design for future trials that test therapies for this disease. Approach: In this study, an electronic wound management system was leveraged to analyze retrospective data on 133 unique sickle cell patients who were treated across 114 wound healing centers, and to describe their characteristics and healing patterns as compared with those of venous ulcer patients. The data included 198 care episodes for 427 wounds. Results: Patients with sickle cell ulcers were younger and had fewer comorbid diseases than those with venous ulcers. Larger size and longer duration were predictors of poor healing. Between the first and fourth assessments, mean change in area for sickle cell ulcers showed a 58% increase, compared with a 13% decrease for venous ulcers. Kaplan-Meier curves showed poorer healing in sickle cell ulcers than in venous ulcers across all categories of size and duration. Patients with sickle cell ulcers had longer care episodes and were more likely to re-present for care. Innovation: This study reports on the largest data set of sickle cell ulcer patients analyzed to date in the published literature to provide a more detailed understanding of wound healing patterns of this disease. Conclusion: A national network of electronic health records can effectively identify a large number of patients with sickle cell ulcers to support analysis of epidemiology, healing patterns, and health care utilization.

Application value of endoscope in probing chronic wound with sinus tract in clinic

Objective: To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic. Methods: Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope. Results: The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05). Conclusions: Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.

Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers: registry-based studies of healing time and of waiting time

ObjectivesTo investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers.SettingPatients treated at Blekinge Wound Healing Centre, a primary care...

The wound pie

John O. Waits (board-certified, general surgery/colon and rectal surgery) is a Wound Care Physician at the Wound Healing Center in Tuscaloosa, Ala., and an Assistant Professor at the Cahaba Family Medicine Residency in Centreville, Ala. The author has disclosed no financial relationships related to this article.