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Negative pressure wound therapy (NPWT) and antibiotic‐loaded bone cement (ALBC) are commonly used treatments for diabetic foot ulcers (DFUs). However, the combined efficacy of these two modalities remains unclear. This clinical study aimed to assess the effectiveness and underlying mechanisms of NPWT&ALBC in the management of DFUs. A total of 28 patients were recruited, 16 of whom served as controls and received only NPWT, whilst 12 received NPWT&ALBC. Both groups underwent wound repair surgery following the treatments. Blood samples were obtained to detect infections and inflammation. Wound tissue samples were also collected before and after the intervention to observe changes in inflammation, vascular structure and collagen through tissue staining. Compared with the NPWT group, the NPWT&ALBC group exhibited a superior wound bed, which was characterised by reduced inflammation infiltration and enhanced collagen expression. Immunostaining revealed a decrease in IL‐6 levels and an increase in α‐SMA, CD68, CD206 and collagen I expression. Western blot analysis demonstrated that NPWT&ALBC led to a decrease in inflammation levels and an increase in vascularization and collagen content. NPWT&ALBC therapy tends to form a wound bed with increased vascularization and M2 macrophage polarisation, which may contribute to DFUs wound healing.

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.

Background and Objectives: Wound healing is a complex process involving cellular, anatomical, and functional repair, often hindered in chronic wounds associated with diseases like diabetes and vascular disorders. This study investigated the efficacy of conventional and regenerative wound healing approaches in a sheep surgical wound model. Materials and Methods: Six female Bergamasca sheep underwent five full-thickness skin lesions treated with various methods: sterile gauze (control), chlorhexidine, sodium hypochlorite, micronized dermis system application, and dermal matrix. Wound healing progression was monitored over 42 days through wound dimension measurements, exudate analysis, and histopathological evaluations. Results: The results indicated that all wounds healed completely by day 42, with significant reductions in wound size and exudate over time. Notably, Micronized dermis system application and dermal matrix treatments showed a faster evolution in exudate characteristics and improved collagen reorganization compared to other treatments. Histological analysis revealed earlier neovascularization and better reconstitution of hair follicles in these groups. Despite the lack of significant differences in healing time, both regenerative approaches enhanced wound healing phases, contributing to exudate control, angiogenesis promotion, and reduced scar formation. Conclusions: The findings suggest that while micronized dermis system application and dermal matrix do not accelerate acute wound healing compared to conventional methods, they offer potential benefits in managing exudate and improving tissue regeneration, warranting further investigation in chronic wound scenarios.

The wound dressings market in South Africa follows the worldwide growth of products, and healthcare practitioners must acquire knowledge of the basics of wound healing and wound bed preparation for a cost-effective indication of those products. Based on the Wound Bed Preparation (WBP) paradigm, the author suggests a framework comprising most of the products in the basic classification, which has been updated yearly for the Wound Healing Association of Southern Africa (WHASA).

Background: The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically. Objective: The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey. Materials and Methods: Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25. Results: Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya. Conclusion: The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay.

Wound Bed Preparation is a paradigm to optimize chronic wound treatment. This holistic approach examines the treatment of the cause and patient-centered concerns to determine if a wound is healable, a maintenance wound, or nonhealable (palliative). For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation. In maintenance and nonhealable wounds, the emphasis changes to patient comfort, relieving pain, controlling odor, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control. In this fourth revision, the authors have reformulated the model into 10 statements. This article will focus on the literature in the last 5 years or new interpretations of older literature. This process is designed to facilitate knowledge translation in the clinical setting and improve patient outcomes at a lower cost to the healthcare system.

Ischaemic skin ulcer occurred on the foot of a 73-year-old man who had a history of fulminant myocarditis with severe cardiac dysfunction. We attempted wound bed preparation by maggot debridement therapy and salvaged his limb. It can be one of the adjuvant treatment strategies for critical limb ischaemia.

Conservative sharp wound debridement, as part of the wound bed preparation paradigm, can be performed in a wide variety of settings including the patients’ home or community clinic settings, by health care professionals who perform within their scope of practice and have been certified to be competent. This paper reviews the components that must be in place to ensure safe delivery of conservative sharp wound debridement for an increased number of clinicians, with organizational support, based on practices in a Canadian context. Expected goals are a cleaner wound bed, with an increased percentage of viable tissue, decreased amount of wound exudate, corresponding decreased risk of wound infection and malodor, and improved periwound skin.

The aim of the study was to evaluate the efficacy of ultrasonic-assisted wound debridement (UAW) used for wound bed preparation of chronic wounds prior to skin grafting. Initially, 140 patients were enrolled into study. Group 1 patients (n=53) with critically colonized wounds underwent a single UAW procedure before skin grafting. Group 2 patients (n=87) with colonized wounds received two UAW sessions, skin grafting followed by the second UAW treatment. Initial wound classification in colonized and critically colonized wounds did not correlate with results from microbiological analysis of wound swab samples. Hence, comparison of efficacy of one or two debridement sessions was conducted solely for a similar group of patients, that is, patients with colonized wounds of group 1 (n=40) and group 2 (n=47). In wounds of group 1 patients, a single debridement session resulted in reduction of bacteria from >104 to <104CFU/mL. However, bacteria remaining at wound site showed minor differences in biofilm slime production, with skin graft failure being observed in 25% cases. In wounds of group 2 patients, two debridement sessions significantly reduced bacterial presence up to <102 CFU/mL. Bacteria remaining at wound site showed low capacity for biofilm slime production and high accumulation of biomass; a complete graft healing was observed in all patients. We suggest two to three debridement sessions with UAW to be most effective in wound bed preparation before skin grafting of chronic wounds. UAW showed to be effective in cleaning the wound bed, destroying the extracellular substances in biofilms, and influencing biofilm slime building capacity of bacteria left at wound site.

Objective: To assess the cost-effectiveness of a polyacrylate (PA)-based hydrogel compared to an amorphous hydrogel in wound bed preparation for venous leg ulcers. Method: A cost-effectiveness analysis was undertaken alongside a multicenter, randomized controlled trial performed in France. A total of 75 patients with venous leg ulcers extensively covered with fibrin and necrotic tissue were randomized to a PA-containing hydrogel or an amorphous hydrogel. Wounds were treated for 14 days and costs were estimated from the German payer's perspective. Medical costs included study treatment, wound treatment supply, and labor time. The clinical benefit was expressed as the number of patients with wounds >50% covered with granulation tissue within 14 days. The incremental cost-effectiveness ratio (ICER) was expressed as the additional cost spent with >50% granulation tissue per day per patient within 14 days of leg ulcer care. Results: Because of individual pricing of wound dressings in hospitals, cost data were derived from the outpatient sector. A total of 33 patients were treated using the PA-based hydrogel and 37 patients using the amorphous hydrogel. The estimated total direct costs per patient and per 14 days of therapy were €306 for both treatment groups. However, with the PA-based hydrogel, 2.5 additional days with wounds covered >50% with granulation tissues were gained within 14 days of leg ulcer care compared to the comparator. The ICER was €0 per additional day spent with >50% granulation tissue. Conclusion: Although there were a greater number of dressing changes in the PA-based hydrogel treatment, the total treatment cost for 14 days of leg ulcer care was the same for both the PA-based-hydrogel and amorphous-hydrogel treatment modalities. The cost benefit favored the PA-based hydrogel because of its greater clinical efficiency in producing a viable wound bed.