Volume 26 Number 2

English E-posters

ACUTE WOUNDS

EP0001 Surgical management of rare autoimmune disease -  suppurative myositis in a 21 year old male with novel fish skin graft

Michael Romberg^1
1SAS Surgical, Ltd, 1967 S. La Grange Road, Mokena, United States

Aim: Suppurative myositis is a rare type of autoimmune disease that inflames and weakens muscle fibers. In myositis, the immune system attacks healthy muscle tissue, which results in inflammation, swelling, pain, and weakness. An acute inflammation characterized by neutrophil-rich infiltrates. To date, there is no cure. Management of disease is critical in order to reduce inflammation caused by myositis and to prevent muscle weakness from progressing. Weakness, swelling, pain are the most common myositis symptoms. Treatment of myositis varies according to cause.

Fish skin graft (FSG) is a unique biologic scaffold resembling the dermal extracellular matrix. FSG is rich in Omega3 that anti-inflammatory, promotes cellular ingrowth, neovascularization and aids tissue infill and remodel. We hypothesize that FSG, can be used as part of the surgical intervention for suppurative myositis aiding in tissue formation, vascularization and cellular ingrowth.

Method: A stand alone study was conducted on a 21 year old male. Debrided infected necrotic liquefying muscle tissue from wrist to above the elbow of arm.  One application of FSG and wound vac applied.

Results / Discussion: Complete healing achieved. Patient with good ROM to arm with no deficits. One time application of FSG led to successful healing time. Patient noticed significant scar reduction. Pt. experienced no pain.

Conclusion: The use of FSG on this rare and acute autoimmune disease stimulated wound healing process, reduced scar formation, alleviated pain, and enhanced the patient’s quality of life. Patient has complete ROM to left arm with no deficits.

 

EP0002 Clinical study on the treatment of complex lower limb traumatic osteomyelitis using the 5-combination technique

YiTong Chai^1
1Hand Surgery of NingBo NO.6 Hospital, NingBo, China

Aim: To investigate the clinical efficacy of the 5-combination technique (Enblock technique, Masquelt technique, microsurgical technique, mixed bone grafting technique, and PRP technique) in the treatment of lower limb traumatic chronic osteomyelitis.

Method: A retrospective analysis was conducted on 18 patients with chronic osteomyelitis after tibial and fibular fracture surgery from September 2018 to September 2024. The bone healing index (BHI) was used to evaluate the ossification of the new bone, and the Paley score was used to evaluate the therapeutic effect.

Results / Discussion: All patients were followed up for 10 to 24 months, with an average of 15.5 months. The patients all achieved good healing and complete infection control, with a total healing time of (40.6 ± 10.6) weeks. According to the Paley score standard, the bone results were: excellent in 15 cases and good in 3 cases; the functional results were: excellent in 9 cases, good in 6 cases, and fair in 3 cases.

Conclusion: This study used the 5-combination technique to treat complex lower limb traumatic osteomyelitis, aiming to investigate its clinical efficacy. Through clinical observation and data analysis, it was found that this technique showed significant effects in the treatment of this disease, effectively alleviating the patients’ symptoms and promoting healing. The results of this study provide an important reference for clinical practice and offer a new approach and method for the treatment of lower limb traumatic osteomyelitis.

 

EP0003 Microscopic flap repair of chronic refractory wounds

Jianwu Qi^1
1Hand Surgery, NingBo, China

Aim: To investigate the clinical efficacy of microscopic flap repair in chronic refractory wounds.
Method: From January 2018 to December 2023, a total of 135 cases of chronic refractory wounds were treated in hospital and repaired with microscopic flaps after thorough debridement, VSD or bone cement tamponade. There were 87 cases of post-traumatic wounds of the lower limbs, 24 cases of chronic osteomyelitis, 5 cases of diabetic foot, 10 cases of sacrococcygeal pressure ulcers and 9 cases of other chronic refractory wounds. 92 cases were repaired with free flaps, 43 cases with perforator pedicled propeller flaps or island flaps, most of the donor sites were directly sutured, and some of the donor sites were repaired with free skin grafts. The blood supply, survival and wound healing of the flap were observed within 1 week after surgery. Follow-up was carried out at 3 weeks, 1.5 months, 3 months, 6 months, and 1 year after surgery.

Results / Discussion: 131 of the 135 cases of flap survived, 4 cases of flap had arterial crisis after surgery, 2 cases survived after conservative treatment, and 2 cases had partial skin necrosis. After 0.5-1 year of follow-up, the wound in the recipient site healed well, and the appearance and texture of the flap were good.

Conclusion: Microscopic flap repair is one of the ideal methods for the treatment of chronic refractory wounds.

 

EP0622 The use of external fixation for soft tissue healing in open extremity fractures:
A literature review

Ismini Kountouri¹, Afroditi Faseki², Dimitrios Chatzinas², Ioannis Katsarelas², Christina Sevva¹, Eleni Paschou¹, Panagiota Roulia¹, Marios Dagher¹, Vasilis Stergios¹, Amyntas Giotas³, Panagiotis Nachopoulos², Konstantinos Papadopoulos¹, Vasileios Alexandros Karakousis¹, Athanasios Polychronidis², Alexandra  Panagiotou², Mohammad Husamieh², Georgia Maria Ntoulia³, Stylianos Mantalovas¹, Militiadis Chandolias², Periklis Dimasis^2
1Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ²Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ³Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece

Aim: The aim of this study is to review the international literature regarding the application of external fixators for soft tissue healing in open extremity fractures.

Method: We reviewed the international literature regarding the application of external fixation in open extremity fractures. For this study, three databases, Cochrane, PubMed, and Scopus, were methodically searched using specific keywords. External fixation used in open fractures was found to be associated with infection control, wound access and care, minimization of soft tissue disruption and compartment syndrome, immediate stabilization and facilitation of wound healing.

Results / Discussion: Our review revealed that in open fractures external fixation is a safe and minimal invasive method, with low complication rates as compared to other methods. It allows for stabilization of the fracture without the need for internal hardware, reducing the risk of infection associated with implanted devices and it provides easy access to the open wound, allowing better monitoring of the healing process. It also promotes better wound healing by minimizing trauma to the already compromised soft tissues and thus the risk for soft tissue disruption and damage.  External fixators in extremities provide stabilization of the fracture and reduce the risk for further injury while allowing early mobilization. 

Conclusion: Our review revealed that in cases of open wound fractures of extremities, stabilization using external fixation can contribute to better wound healing and is generally recommended in the presence of open fractures.

 

EP0004 Medial gastrocnemius flap for the management of infected knee prostheses:
A retrospective study

Giuseppe Rovere¹, Amarildo Smakaj¹, Francesco Liuzza¹, Pasquale Farsetti², Giulio Maccauro¹, Elisabetta Pataia^1
1Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy, Roma, Italy, ²Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Rome, Italy, Roma, Italy

Aim: Muscular flaps may represent a valid treatment option for prosthetic infection after knee arthroplasty.

Method: We present the results of 20 consecutive patients treated with the use of medial gastrocnemius flap for the management of different types of injuries or integumentary defects after total knee arthroplasty. Tissue necrosis or dehiscence occurred within 1 and 2 months after arthroplasty. The mean follow-up was 23.4 (12-60) months. Clinical outcome was evaluated according to the infection control rate and post-operative Knee Society Score (KSS).

Results / Discussion: Prosthesis salvage and complete restoration of skin coverage were achieved in all patients. Functional assessment was performed using the KSS score. The final knee KSS score was classified as excellent (score: 80-100) in 0 patients, good (score: 70-79) in 17 patients, fair (score: 60-69) in 2 patients, and poor (score: 60) in 1 patient. Residual Extension Deficit: 0-20°; Very Satisfactory in 17 patients. 30-70° Satisfactory in 2 patients, 80-90° Unsatisfactory in 1 patient. Patients who successfully underwent flap treatment experienced a much greater increase in both components of the KSS score.

Conclusion: The results highlight the effectiveness of medial gastrocnemius muscular flap for the treatment of prosthetic knee infection, in terms of function, limb salvage, cost-effectiveness and post-surgery quality of life. Further larger studies may consolidate these findings.

 

EP0006 Iodoform-impregnated gauze – Post-market surveillance on a well-established device for treating abscesses and fistulas

Christine Böhm¹, Sabrina Koschel², Claudia Feldkamp¹, Martin Abel^1
1Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany, ²CRI - The Clinical Research Institute GmbH, Munich, Germany
Aim: Use of iodoform as antiseptic is well-established for treating successfully abscesses or fistulas. The use of iodoform in cotton impregnated gauze today was evaluated as part of the Post-Market-Surveillance (PMS).

Method: A site selection survey was conducted amongst general surgery centers for their interest in participating in a post-market clinical follow-up (PMCF) study. 50 general surgery centers in Germany were contacted. In this context, PMS data on the use and application of the product was also collected. The questionnaire asked for level of experience in wound treatment after surgical treatment of infected tissue (abscesses, fistulas); the number of patients treated within the last year for those indication and the average treatment duration with iodoform gauze.

Results / Discussion: Out of the 50 centers contacted, 12 sites completed the survey. On average those centers treated 150 patients in the last year with iodoform gauze. The sites had more than 5 years of professional experience. All of them used the iodoform gauze for the treatment of abscess, followed by fistula associated abscess and fistula. Patients were treated on average for about 5 days with the iodoform gauze. The clinics of the 12 sites had been using all together more than 12,000 pieces of iodoform gauze within one year. With regard to the safety there has been no medically relevant complaints for the product within the recent years.

Conclusion: In our days iodoform gauze is still successfully and safe used after surgical removal of infected tissue, particularly in abscesses and fistulas.

 

EP0007 Wound care management for open fasciotomy wounds

Suseela  Devi¹, Sivagame Maniya^1
1Sengkang General Hospital, Singapore, Singapore

Introduction: Fasciotomy is performed for acute compartment syndrome, aimed at relieving intramuscular pressure by releasing the skin and muscle fascia. Fasciotomy incisions are often left open till secondary closure later. As there is no consensus on effective wound management method, dressing selection depends on exudate amount, surgeon preference, patient condition, and resource availability.

Aim: The aim of this case report is to explore a combination of antimicrobial dressing initially and followed through with disposable negative pressure wound therapy (NPWT) in open loosely sutured fasciotomy wounds.
Method: Four patients underwent fasciotomy surgery for acute limb ischemia in the last 6 months. Three patients underwent shoelace suturing technique over the fasciotomy incision, while one patient had complete closure done with staples with standard post-surgical dressing. The three patients were reviewed twice weekly to facilitate gradual suture approximation and received silver alginate or iodine-based dressings over a period of 1-2 weeks. Subsequently, they were then placed on disposable NPWT after complete tightening of suture.
Results / Discussion: Wound healing progressed with no complications in patients with antimicrobial dressings over gradual suture approximation and negative pressure wound therapy. In contrast, the patient with fully closed incision experienced full wound dehiscence with infection, requiring antibiotics and debridement.
Conclusion: The use of gradual wound closure, combined with antimicrobial dressing and disposable NPWT, has been effective for fasciotomy wound management. This approach may minimize risk of wound infection and delayed wound healing.

 

EP0008 Impact of wound hygiene incorporating an advanced antimicrobial gelling fiber dressing on surgical wounds: real-world evidence

Rachel Torkington-Stokes¹, Daniel Metcalf^1
1Convatec, Deeside, United Kingdom

Aim: To evaluate the impact of the Wound Hygiene Protocol (WHP), a 4-step (cleanse, debride, refashion, and dress) wound management protocol on surgical wounds.

Method: A prospective, real-world subgroup analysis of surgical wounds managed with the WHP incorporating a carboxymethylcellulose dressing containing ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride* for approximately 4 weeks or as deemed clinically appropriate. The primary endpoint in this analysis was change in surgical wound status from baseline to final assessment, while secondary endpoints were changes in exudate levels, suspected biofilm, and local infection.

Results / Discussion: 59 surgical wounds were included in the subgroup analysis, of which 56% were dehisced surgical wounds, 25% were open surgical wounds, and 19% were closed surgical wounds. Most healthcare professionals were general nurses (56%) or advanced practitioners (32%). Community clinics (31%) and hospitals (26%) were the most common clinical settings. Median treatment duration with the WHP was 32 days. At baseline, 57% of surgical wounds were either static (37%) or deteriorating (20%). At final assessment, 97% of the surgical wounds improved (58%) or healed (39%). Exudate levels were predominately moderate (49%) to predominately low (27%) at final assessment. Biofilm was suspected in 73% of surgical wounds at baseline, which fell to 7% at final assessment. Local wound infection decreased from 46% at baseline to single case (1.7%) at final assessment.

Conclusion: Management of surgical wounds with the WHP resulted in healing or improvement in almost all surgical wounds by final assessment, with notable decreases in exudate level, suspected biofilm, and local infection.

*Aquacel® Ag+ Extra™ (Aquacel Ag Advantage in the United States).

 

EP0009 Use of hyperbaric oxygen therapy in severe earthquake injuries

Levent Demir¹, Mustafa Öztürk^1
1Kayseri City Training and Research Hospital, Kayseri, Turkey

Aim: Earthquakes can cause severe injuries, including crush injuries, fractures, and tissue damage. Hyperbaric oxygen therapy (HBOT) has recently gained attention as a treatment option. This therapy administers pure oxygen at high pressure, promoting tissue healing by increasing cell oxygen levels. It may help accelerate recovery, reduce inflammation, and control infections in severe injuries. This study retrospectively evaluated the effects of HBOT in 35 patients after the earthquake, aiming to improve emergency intervention strategies.

Method: This study received ethics committee approval and involved a retrospective analysis of earthquake victims with a mangled extremity severity score (MESS) between 7 and 14 treated in the HBOT Unit for severe injuries. We collected demographic information, patient data distribution, mean values, number of HBOT sessions, and functional outcomes from their medical records.

Results / Discussion: Of the 35 HBOT patients, 31.4% were male and 68.6% female. Almost half of the patients (45.7%) were 18 or younger, with the most common injuries affecting the lower extremities. Following treatment, sensory recovery was observed in 54.3% of patients, while functional recovery was noted in 51.4%. Minor amputations were recorded in 20.0% of cases, while major amputations occurred in 11.4%.

Conclusion: This study examined the effects of HBOT on patients with severe earthquake injuries in Turkey. The findings suggest that HBOT may enhance sensory and functional recovery while reducing amputation rates, particularly for those who commence treatment at an early stage.

 

EP0010 Effective method to heal the donor site for STSG using remnant skin regrafting

WooYoung Choi¹, Jiseon Cheon^2
1Chosun University hospital, Gwangju, Rep. of South Korea, ²Chosun University Hospital, Gwangju, Rep. of South Korea

Aim: Split–thickness skin graft (STSG) is one of the most common reconstructive methods to cover the open wound. Sometimes delayed wound healing at donor site for STSG can be a problem such as prolonged hospital time, pain, scarring. Punch graft is the traditional method to heal the wound that placing pieces of skin on the wound surface in order to stimulate epithelization. We devised that regulary regrafted remnant skin pieces can accelerate the healing at donor site.

Method: 15 patients who were conducted STSG were enrolled from May 2023 to August 2024. The regrafted skin pieces located on the donor site according to the donor site size and amount of remnant skin at the regular intervals immediately. Regrafted skins were fixed with soft silicone-coated wound contact layer (Mepitel One®) and covered with polyurethane foam dressing (Biatain® Non-Adhesive). The dressing was replaced daily. We investigated the demographics, healing time, scar condition.

Results / Discussion: They were 6 males and 9 females with an average age of 66.8 years (27 ~ 85 years old). The mean wound size was 45.5 cm² (6.25 ~126 cm²). The mean follow-up duration was 9.5 months (3 ~ 15 months). The mean healing time was 13.7 days (8 ~ 20 days). Mean scores of Vancouver Scar Scale: vascularity 2.93, pigmentation 4.86, pliability 4.06, height 1.73.

Conclusion: Regrafted remnant skin at donor site for STSG is can be useful option to heal faster and remain reasonable scar.

EP0011 Case series: treatment of skin tears class 3 with blue light

Elia Ricci¹, Monica Pittarello^1
1Policlinico di Monza, Clinica Eporediese, Clinica S Rita, Ivrea, Italy

Aim: A new interest on skin tears is noted in literature. The average resolution time is indicated in literature between 4 and 5 weeks with dressings and 4 weeks with grafting.

Method: We treated 36 skin tears category 3, involving 25 patients who were treated weekly for 4 weeks using a Blue light system using LED at 400-430 (*) nm for 120 seconds. Local treatment with advanced dressings. We divided the lesions into those that had occurred less than 4 weeks ago (30) and those that had occurred more than 4 weeks ago (6). We also evaluated the presence of inflammatory and/or autoimmune comorbidities in the lesions that had occurred less than 4 weeks ago.

Results / Discussion: The average resolution time was 4.2 weeks. However, analyzing the onset period, it is 2.9 weeks (Range 1 – 6) for lesions that arose less than 4 weeks, while for those that arose more than 4 weeks, it is 5.3 weeks (range 3-12). For lesions with inflammatory pathologies (21 pts) it was 3.3 weeks, while in the absence of pathologies (9 pts) it was 2.3 weeks.

Conclusion: Blue light treatment is effective. A timely approach should be considered in the treatment of skin tears, avoiding the onset of local inflammatory factors, it is also underlined by the evidence that pro-inflammatory pathologies slow down repair.

(*) Emoled

 

EP0012 Carrageenan-based spray (Carragen®) for treating acute skin defects:
A randomized controlled trial (RCT)

Seong Hwan Kim¹, In Suck  Suh^1
1Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Rep. of South Korea

Aim: Effective wound dressings are essential for promoting healing, as they help maintain moisture, adhere to tissues, prevent bacterial growth, and are easy to use. This study assesses the efficacy and safety of a carrageenan-derived liquid spray (Carragen®) for the treatment of acute skin defects and wound healing.

Method: A randomized controlled trial was conducted on patients with skin defects confined to the dermal layer. Participants were divided into two groups: the first group received ofloxacin-based antibiotic ointment (Ofloxacin®) with foam dressing every two days, while the second group was treated with Carragen® spray, followed by the same foam dressing. Epithelialization outcomes, reflecting wound healing progress, were evaluated on the 5th, 10th, and 15th days following treatment initiation.

Results / Discussion: A total of 60 patients were included (28 treated with antibiotic ointment and 32 with Carragen®), with wound sizes ranging from 10 to 90 cm². These wounds were further classified into small (<25 cm²) and medium (>25 cm²) categories. Skin defect was not significantly different if small group was less than 25 cm². Compared to the antibiotic ointment group, the Carragen® group in medium (>25 cm²) showed significantly higher rates of epithelialization on the 10th and 15th days (p<0.05), suggesting enhanced healing. Importantly, no complications, such as infections, contact dermatitis, or maceration, were observed in either treatment group.

Conclusion: The carrageenan-based spray Carragen® demonstrates both efficacy and safety for treating skin defects, offering a promising new option for wound care applications and future clinical use.

 

EP0013 Photobiomodulation in wound healing: Effects of different wavelengths on NFκB, Nrf2, and TGF-β expression

Marcos Teixeira¹, Beatriz Furlan¹, Aguinaldo Garcez¹, Giovana Tofoli^1
1São Leopoldo Mandic, Campinas, Brazil

Aim: This study aimed to evaluate the effect of photobiomodulation on wound healing and the involvement of NFκB, Nrf2, and TGF-β in this process using red, green, blue, or violet wavelengths.

Method: An excision wound model on the posterior neck of Wistar rats (n=12) was used to assess the healing efficacy of various photobiomodulation treatments. The wounds were treated daily for 5 days (9 J/cm²) with red, green, blue, or violet wavelengths. Twelve rats were used as negative controls. After 3, 7, and 14 days, wound samples were collected, and gene expression of NFκB, Nrf2, and TGF-β was analyzed using RT-PCR.

Results / Discussion: The substances analyzed in this study play a complex role in wound healing, integrating pro-inflammatory, pro-fibrotic, and anti-inflammatory signals to promote efficient and balanced healing. Nrf2 expression levels were approximately twice as high in the green laser group after 14 days compared to the other groups (p<0.05). The increased Nrf2 levels indicate the potential of the green wavelength to promote healing, possibly through cellular proliferation and ROS reduction. No significant differences were observed in NFκB expression between the groups (p>0.05). TGF-β levels were higher in the blue and violet laser groups at all time points (p<0.05). These results suggest that blue and violet wavelengths may lead to faster wound healing, but with a risk of excessive healing and keloid formation due to increased TGF-β.

Conclusion: The increase in Nrf2 expression, along with lower TGF-β levels in the green laser group, highlights the potential of this wavelength to improve wound healing.

 

EP0014 Peristomal complications in pediatric patients with enterostomy: A systematic review

Enes Simsek¹, Eyşan Savaş¹, Ayşe Demir¹, Remziye Semerci¹, Ayişe Karadağ^1
1Koç University, Istanbul, Turkey

Aim: This systematic review aims to determine the rate and type of peristomal complications in pediatric patients with enterostomies.

Method: This study is in a systematic review design. Data search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, CINAHL, Google Scholar, and Medline (OVID) from inception until January 19, 2024. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies that met predefined inclusion criteria. Data extraction were independently performed by two reviewers.

Results / Discussion: Fifteen studies were included, encompassing a total of 2270 pediatric patients with colostomies or ileostomies. The methodological quality of the included studies was low to moderate for non-randomized studies. As for the randomized controlled studies, most studies demonstrated low risk of bias. The overall incidence of stoma-related complications was 33.8%, with 34.2% of these being peristomal complications. The most common PSCs were peristomal dermatitis (35.3%), peristomal excoriation (28.1%), and wound infection (21.1%). The studies reported varying follow-up periods, with early complications typically occurring within the first few months post-surgery and late complications developing over longer follow-up periods.

Conclusion: The most prevalent complications were peristomal dermatitis, excoriation, and wound infection. These findings emphasize the crucial necessity for postoperative care and bespoke interventions to manage and prevent these complications. Given the high prevalence of these issues, there is a clear necessity for further research focusing specifically on pediatric populations to develop standardized care protocols and improve outcomes.

 

EP0015 Observation of treatment effect in a case of complete horseshoe perianal abscess

Yue Zhao¹, Jun Yang², Hao Xia³, Yuqing Chen^2
1Department of proctology The Eighth Hospital of Wuhan, Wuhan, China, ²Department of Rehabilitation Medicine of Hankou Hospital of Wuhan, Wuhan, China, ³Department of Proctology of The Eighth Hospital of Wuhan, Wuhan, China

Aim: Postoperative management is critical in reducing surgical wounds, recovery time and risk of anal function impairment in patients with perianal abscess. This study aims to explore treatment strategies to quicken wound healing, lower recurrence, reduce complications and improve clinical outcomes.

Method: A patient diagnosed with complete horseshoe perianal abscess was included. Radical surgery was performed under Enhanced Recovery After Surgery (ERAS) management. Sacral canal anesthesia was used during surgery. After surgery, on the basis of routine treatment and wound condition, hydrogen peroxide plus ulcer powder was used for early dressing changes, and homemade swelling and muscle growth lotion for wet compress plus moist burn ointment were used at mid-stage, following by Huangbai liquid plus moist burn ointment. Cooperating with bowel movement management, multimodal analgesia and pelvic floor rehabilitation were also performed.

Results / Discussion: After postoperative management, the patient’s symptoms gradually improved. Four weeks post-surgery, the pain score dropped from 8 to 0. Seven weeks post-surgery, the Wexner fecal incontinence score decreased from 16 to 3. The wound was completely healed and anal function recovered with the quality of life returning to pre-surgery levels. The Fecal Incontinence Quality of Life scores returned to pre-surgery levels at Week 12.

Conclusion: ERAS-based perioperative management for perianal abscess is feasible and effective. Optimized preoperative preparation, rational selection of anesthesia methods, meticulous operations and comprehensive rehabilitation can accelerate the recovery process, reduce suffering and increase patient satisfaction.

 

Figures:

 

EP0016 Hyperbaric oxygen therapy in the treatment of postoperative wound infection

Mia Grkovic Sandalic¹, Emanuela Marcucci¹, Vedrana Dujanić Njegovan², Ante Plješa², Asmir Hurem^3
1Department of Underwater and Hyperbaric medicine, Clinical Hospital Center Rijeka, Faculty of health studies in Rijeka, City of Rijeka, Rijeka, Croatia, ²Department of Underwater and Hyperbaric medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia, ³Clinic for Surgery, Department of operating room and sterilization, Clinical Hospital Center Rijeka, Clinic for Surgery, Department of operating room and sterilization, Clinical Hospital Center Rijeka, Rijeka, Croatia

Aim: Wound infections remain a major source of postoperative morbidity, accounting for about one-quarter of all hospital infections. The pathogens involved in the development of wound infections are primarily human microorganisms from the exogenous environment and endogenous microbial flora. Avoiding these factors, along with the appropriate use of perioperative antibiotic prophylaxis, has reduced the incidence of wound infections. In this case, we describe a 48-year-old patient with an infection of a postoperative abdominal wound following complications from an endoscopic colonoscopy.

Method: Hyperbaric oxygen therapy is applied as a primary or support therapy for various conditions, including infections. It diffusely increases the amount of oxygen in tissues based on the physically dissolved oxygen in plasma, thereby alleviating or eliminating hypoxia and reducing the tissue inflammatory response. We applied 30 treatments of hyperbaric therapy with 100% oxygen inhalation.
Results / Discussion: Due to the complications, a surgical intervention was performed, resulting in a fistula below the umbilicus measuring 5x3 cm with a depth of 5 cm. The patient presented to the Department for Underwater and Hyperbaric Medicine with complications. During his stay at the Department, the patient received nearly daily dressings and completed 30 hyperbaric treatments. After completing the planned therapy, the patient’s wound healed.

Conclusion: The treatment of hyperbaric oxygen therapy represents an innovative approach to the management of acute wounds, offering numerous clinical improvements and advantages compared to traditional methods. The integration of this approach into everyday practice can significantly enhance treatment outcomes and help achieve better results for patients, as we have described in this case.

 

EP0017 Thrombophlebitic injury caused by extravasation of the cytostatic agent Bendamustine-Rituximab

Adrián Fuentes Agúndez¹, Alejandro del Rio Merino¹, Laura Morcillo Diaz¹, Sandra Mas Servan^1
1Hospital Universitario Quironsalud Madrid, Pozuelo de Alarcón, Spain

Aim: Optimize treatment plan in a patient with thrombophlebitic lesion in the left wrist.

Method: A 73-year-old patient diagnosed with Waldestrom’s disease with associated anemia and supra- and infradiaphragmatic involvement for which a Bendamustine-Rituximab treatment regimen was decided. After receiving fifth cycle of treatment, he went to the Emergency Department several days later due to mild erythema in the flexure and after no improvement from treatment with a broad-spectrum antibiotic and re-evaluation, an ulcer with a purulent lesion measuring more than 5 cm, irregular edges with loss of Skin integrity secondary to blister with spontaneously drained collection. Samples were taken for microbiology with negative results, but after consultation with the infectious disease service, treatment with intravenous antibiotics and hospital admission were decided.

After consulting the Wounds Committee, it was decided to interconsult vascular surgery for Doppler ultrasound, where superficial thrombophlebitis secondary to cytostatic extravasation was confirmed and we began local treatment of the lesion.

Taking into account the characteristics of the injury described above, we began treatment with hypochlorous acid gel, hydrocolloid hydrofiber with silver, and hydropolymeric dressing as a secondary treatment for exudate management.

Results / Discussion: After 15 days of treatment we stopped using hydrocolloid hydrofiber with silver due to the improvement of the wound, continuing treatment only with cleaning with hypochlorous acid for promotion and hydropolymer as secondary.

Conclusion: Wound Committees in hospitals that act as links with the rest of the departments allow wounds to be treated more efficiently and reduce the length of hospital stay.

 

EP0623 Acute care nurses’ experience in providing evidence-based care for patients with laparotomy wounds: a scoping review

Sarah Montalto¹, Auxillia  Madhuvu¹, Victoria Team^1
1Monash University, Melbourne, Australia

Aim: To methodically search and integrate the available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses.

Method: The Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents guided the review. The scoping review process utilised the methodology framework created by Arksey and O’Malley, updated by Levac et al., and the Joanna Briggs Institute. We focused on wound assessment, dressing application, documentation, infection control techniques, escalation of care, wound products, and holistic care. The Theoretical Domains Framework directed data synthesis. Six mixed-methods and qualitative studies were included in the review.

Results / Discussion: The predominant barriers were nurses’ suboptimal time management skills, restricted access to and use of assessment tools and clinical practice protocols for wound management. Laparotomy wound care delivery varied and was influenced by ward culture and nurses’ limited knowledge and skills in surgical wound assessment and aseptic non-touch technique. The reported enablers were appreciation of wound education, reflective debriefing, awareness of multifaceted risk factors for surgical wound regeneration, and positive sentiment that combining guidelines and comprehensive wound assessments complements evidence-based wound care. 

Conclusion: Evidence-based recommendations for laparotomy wound management are not embedded in acute care nurses’ routine practice. Further research on the clinical practice and behaviours in managing laparotomy wounds is required. Findings of this review highlight the necessity of standardising laparotomy wound management practices and recognising the obstacles in clinical ward settings.

 

EP0018 Use of dialkylcarbamoyl chloride (DACC) coated dressings for perineal wound management

Chin Yen Lee^{1 2}, Yun Ying Ho¹, Ummu Atirah Muhammad¹, Chin Yiun Lee¹, Jacob Abraham^1
1Ministry of Health Malaysia, Kuantan, Malaysia, ²Monash University Malaysia, Subang Jaya, Malaysia

Aim: Wound management in the genitalia and perineal region presents unique challenges due to anatomical complexity, exposure to constant moisture and excretory products, and therefore higher risk of infection. These wounds are often prone to complications like maceration, delayed healing, and infection due to their close proximity to bodily fluids. Dialkylcarbamoyl chloride (DACC) coated wound dressing utilizes a unique hydrophobic interaction to bind and inactivate microbes, offering a promising solution for managing wounds in these challenging areas.

Method: This case series aimed to evaluate the efficacy of DACC wound dressings in promoting healing and preventing infection in genitalia and perineal wounds. Specifically, we assessed its impact on wound healing rates, infection control, patient comfort, and overall ease of use in clinical practice.

Results / Discussion: A prospective, observational study was conducted involving patients with wounds located in the genitalia and perineal regions. Patients received standard wound care along with DACC dressing applications. Wound assessments were conducted regularly to monitor healing progress, trend of inflammatory markers, and patient-reported outcomes such as pain and comfort levels. Data collected were analyzed to compare the effectiveness of DACC dressings with conventional dressings used in these regions.
Conclusion: DACC wound dressings did not only provide effective infection control but also contribute to accelerated wound healing in genitalia and perineal regions. The combination of faster healing rates, reduced infection risk, and improved patient comfort make DACC dressing a viable option for managing wounds in these areas.

 

EP0019 Postoperative hyperbaric oxygen therapy for fireworks facial injury: Case report

Antônio Pessoa¹, Caio Lopes¹, Priscilla Alves da Silveira F Pinheiro¹, Karine Silva¹, Bruno Silva¹, Lucas Melo¹, Bianca Oliveira^1
1Cicatriclin, Vitória da Conquista, Brazil

Aim: To report the use of Hyperbaric Oxygen Therapy (HBOT) in the postoperative care of facial reconstruction in a patient with fireworks-related injuries.

Methods: This case report was prepared in accordance with the CARE case report guidelines, using data from the patient’s medical record and photographic documentation of the injury. Patient and guardian consent were obtained through an Informed Consent Form.

Results / Discussion: A 13-year-old male patient with a history of a fireworks accident was admitted to the emergency department with severe, extensive, and deep lacerations in the perioral region and upper airway burns. Initial treatment included surgical wound edge approximation, orotracheal intubation, and prophylactic antibiotics. The patient was discharged after three days and referred to a specialized wound clinic, where examination revealed sutures in the injury region, with areas of crusting, necrosis, and the presence of edema on the upper lip. The multidisciplinary team’s hyperbaric physician prescribed HBOT at 2.5 atmospheres absolute pressure for 90 minutes per session. After 14 days, with 10 sessions completed, the patient demonstrated favorable wound healing, allowing for uncomplicated stitch removal.

 

Conclusions: Fireworks accidents can result in injuries of varying severity, including hearing and vision impairment, limb mutilation and even death. This case underscores the potential of combined surgical intervention and postoperative HBOT to achieve notable aesthetic and functional outcomes.

 

EP0020 Uncovering incontinence-associated dermatitis: A multicenter study on prevalence and associated factors in adult intensive care units

Amanda C.M.A.G. Brandão¹, Aline Ramalho², Vanessa Abreu da Silva³, José Souza⁴, Ticiane Faustino⁵, Soraia Rabeh^6
1Hospital Israelita Albert Einstein, São Paulo, Brazil, ²Hospital Sírio Libanês, São Paulo, Brazil, ³Clinical Hospital - University of Campinas, Campinas, Brazil, ⁴Instituto de Gastroenterologia de São Paulo, São Paulo, Brazil, ⁵Instituto do Coração, São Paulo, Brazil, ⁶Escola de Enfermagem da USP de Ribeirão Preto, Ribeirão Preto, Brazil

Aim: To evaluate the prevalence of incontinence-associated dermatitis (IAD) in intensive care units (ICUs) and the factors associated with its occurrence in adult patients.

Method: This was a one-day observational point-prevalence study conducted in ICUs of six hospitals in the State of São Paulo, Brazil. The sample consisted of 192 patients. Data were analyzed using descriptive and inferential statistics, as well as multiple logistic regression models to identify factors associated with incontinence-associated dermatitis, considering a significance level of α = 0.05.

Results / Discussion: A total of 192 ICU patients were evaluated, revealing a significant IAD prevalence of 28.3% (n=54). Category 1A IAD was the most prevalent at 55.6% (n=30), followed by Category 2A at 37% (n=20). The majority of cases were located in the inguinal area (n=19, 35.2%), right inguinal area (n=17, 31.5%), and vulvar/penile region (n=14, 25.9%). Age was identified as a factor associated with a higher likelihood of IAD (p = 0.015), with each additional year increasing the chance of IAD by 2.7%.

Conclusion: This study underscores the urgent need to address incontinence-associated dermatitis in ICUs, emphasizing the importance of early identification and proactive management strategies. By enhancing awareness and implementing targeted interventions, we can significantly reduce IAD prevalence, ultimately improving patient outcomes and quality of care. This initiative serves as a model for future research and practical improvements in wound management across healthcare settings.

EP0021 Moisture-associated skin damage: Incidence and risk factors in critically ill patients

Taís Milena Pantaleão de Souza¹, Paula Nogueira¹, Vera Lucia Conceição Gouveia Santos¹, Raissa Deliberai², Maria  Trancolin², Bianca Frustaci², Caroline Maria Alcantara^1
1Universidade de São Paulo, São Paulo, Brazil, ²Hospital Vila Nova Star, São Paulo, Brazil

Aim: To analyze the general incidence and subtypes of MASD and associated demographic and clinical risk factors.

Method: Prospective cohort epidemiological study conducted in the Intensive Care Unit (ICU) for 125 days, covering 223 patients. Data was collected from medical records; physical examination was performed, and instruments/scales were applied. Descriptive and inferential statistics with a significance level of 5% were adopted and the incidence of MASD and its subtypes was calculated.

Results / Discussion: The incidence of MASD was 17.04% and the incidence of DAI 28.12%, DIT 2.70%, pMASD 1.72% and peristomal MASD 12%. Predictors of MASD were urinary incontinence (OR 1.08; 95% CI 0.335-3.186) and mixed (OR 1.37; 95% CI 0.112-35.208), high score on the Perineal Assessment Tool (PAT) Scale (OR 1.18; 95% CI 0.862-1.607) and advanced age (OR 1.01; 95% CI 0.993-1.041). Fecal incontinence (OR 0.82; 95% CI 0.035-8.713), higher Braden Scale score (OR 0.93; 95% CI 0.050-0.846) and higher BMI score (OR 0.98; 95% CI 0.028-0.935) decreases the chance of MASD. These variables do not present statistical evidence of significantly altering the chance of MASD. In CART, the factors associated with MASD: Score less than 4.5 on the PAT Scale (Nix), use or not of immunosuppressants, score on the Braden Scale less than 11.5, use or not of oxygen catheter, smoker or former smoker and main diagnosis.

Conclusion: The results of this study contribute to understanding the profile of critically ill patients who develop some type of MASD and inspire new studies.

 

EP0022 Excellent exudate management in acute wounds with a next-generation advanced multi-layered foam dressing: Prospective, multi-center study

Cristin Taylor¹, Alisha Oropallo², Christina Del Pin², Marisa Ranire-Maguire², Regina Matatova², Anne Marie Lanza-Bisciello², Russell Caprioli², Rebecca Rodger³, Cristin Taylor^4
1ConvaTec, Lexington, United States, ²Northwell Health, Lake Success, United States, ³Convatec, Deeside, United Kingdom, ⁴Convatec, Lexington, United States

Aim: The aim of this study was to assess the efficacy and performance of next generation advanced multi-layered foam dressings* in the management of surgical and traumatic wounds. 

Method: A prospective, multi-center, interventional, non-comparator, open-label study of surgical and traumatic wounds, managed with either a border, silicone or non-adhesive version of a next-generation advanced multi-layered foam dressings.* Evaluation of the dressing and peri-wound skin occurred during dressing changes at study visits. Excellent wound exudate management was defined by a lack of strike-through and no maceration of the peri-wound skin. The effectiveness of the dressing when used for 7 days was assessed. 

Results: Fifty-two patients (median patient age, 48.2 years) were included in the study, 53.8% of which had traumatic wounds, and 46.2% had surgical wounds. Five patients did not have their wound exudate analyzed.   Of the 224 dressing changes, 209 (93.3%) were associated with excellent exudate management. Of the 15 dressings that were not associated with excellent exudate management, 14 exhibited strike-through alone, and one was associated with both strike-through and peri-wound skin maceration. Overall, 65/224 dressings were used up to the maximum duration per IFU (7 days ± 2 days). Of these, 63/65 (97%) had excelled in exudate management. Two dressing performance evaluations were associated with strike-through, one of which was also associated with maceration of the peri-wound skin.

Conclusion: The results suggest that the next-generation advanced multi-layered foam dressings* are safe and effectively manage exudate in acute wounds. 

*ConvaFoam™ Silicone, ConvaFoam™ Border and ConvaFoam™ Non-adhesive 

 

EP0023 Case series of podiatric injuries-skin and appendages in paralympic athletes

Juliana Azevedo Soares ¹, Ana Paula dos Santos Albuquerque², Monica Gamba^3
1Comitê Paralímpico Brasileiro, São Paulo, Brazil, ²Hospital Regional do Agreste Dr. Waldemiro Ferreira, Caruaru, Brazil, ³Universidade Federal de São Paulo, São Paulo, Brazil

Aim: Report the experience of a podiatric nurse working with high-performance athletes in the Paralympics.

Method: This study highlights a series of cases arising from the work of a podiatric nurse during the 2024 Paralympic Games. The Brazilian delegation had access to a health clinic that offered comprehensive care services to athletes in the Paralympic Village. The following were identified during nursing care: traumatic and pressure ulcers, as well as foot conditions such as onychocryptosis, painful onychophosis, blisters, calluses, tylomas, nail trauma, interdigital fissures and onycholysis.

Results / Discussion: A total of 25 athletes with pre-ulcerative lesions, ulcers and foot complaints were treated, of which 60% were male. In total, 33 complaints were diagnosed among these athletes. Of the complaints observed, 79% were classified as pre-ulcerative lesions, totaling 26 occurrences, while 21% were diagnosed as ulcerative lesions, totaling 7 cases. Regarding the distribution of complaints, the following were identified: onycholysis 12%, hyperkeratosis 21%, onychocryptosis 15%, pressure ulcer 9%, traumatic ulcer 9%, burn ulcer 3%, subungual hematoma 6%, blisters 12%, interdigital fissures 6%, painful onychophosis 3% and onychogryphosis 3%. It is worth noting that each athlete could present more than one complaint.

Conclusion: The results of this study show a predominance of pre-ulcerative lesions among the athletes evaluated, suggesting the need for preventive measures and specific podiatric care for this population. The podiatric nursing procedures implemented allowed meeting the necessary demands and contributing to the victorious performance of athletes with physical disabilities.

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EP0024 Emerging therapies: The role of oral collagen stimulator supplements in wound healing and burns

Dan Cristian Moraru¹, Andra Bulgaru Iliescu², Alexandru Amarandei³, Mihaela Pertea^1
1”Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania, ²”Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iasi, Romania, ³”Sf. Spirion” Emergency Hospital, Iasi, Romania

Aim: Collagen, a key component of the extracellular matrix, plays critical roles in the regulation of the phases of wound healing either in its native, fibrillar conformation or as soluble components in the wound milieu. Oral collagen supplementation has gained attention for its potential to enhance mechanical strength in skin elasticity, hydration, and overall texture, thereby improving final appearance. This paper aims to explore the emerging therapies and the role of oral collagen stimulators supplements in wound healing and burns.

Method: We included 10 patients, both male and female, aged above 18 years with IIA-IIB burns between 20-30% total body surface area. Group A (n=5) received standard wound dressings only, while Group B (n=5) received the same wound dressings supplemented with oral collagen stimulators based on silicic acid. Wound healing was assessed over a 4-week period through weekly evaluations. The primary endpoint was the rate of wound closure, measured by comparing the initial and final wound sizes. Secondary endpoints included qualitative assessments of wound granulation and epithelialization. Participants received standardized instructions for wound care and were followed up weekly to ensure protocol adherence.

Results / Discussion: Participants in the collagen supplement group demonstrated improved rates of wound closure, reduced pain levels, and enhanced qualitative assessments of granulation and epithelialization.

Conclusion: Given the positive outcomes observed, integrating collagen oral supplements into standard wound care protocols could provide a valuable therapeutic strategy to enhance healing outcomes in burn patients. Further research with larger sample sizes and diverse wound types is warranted to confirm these findings.

 

EP0025 Healing action of three glycidic agents in the treatment of infected wounds

Isabel Cristina Santos¹, Marilia Valenca¹, Jabiael  Carneiro da Silva Filho¹, Simone Maria  Bezerra¹, Emanuela Batista Ferreira e Pereira¹, Igor Ferraz¹, Bruna Silva^1
1University of Pernambuco, Recife, Brazil

Aim: To compare 3 glycidic agents (Manuka honey, white sugar and brown sugar) regarding contraction rate and level of histological composition in infected wounds.

Method: Preclinical study with 144 male and female Swiss mice, randomly divided into six groups: negative control (saline), PHMB, silver sulfadiazine, Manuka honey, white and brown sugar. A circular wound was made on the back of the rats and inoculated with strains of Staphylococcus aureus MRSA, Pseudomonas aeruginosa and Enterobacter aerogenes. The wounds were treated 3 times a day for 3, 7 and 14 days, being photographed on the first and last day of treatment to evaluate the contraction rate and a tissue section was removed after euthanasia for analysis of the histological composition. The results obtained were analyzed using the GraphPad Prism program and processed through ANOVA and Tukey’s post-test. The development of the study met the national and international standards of ethics in research involving animals (approval no. 00002/280820).

Results / Discussion: The contraction rates of the wounds treated with the three glycidic agents were: brown sugar (15.22%), white sugar (52.06%) and Manuka honey (86.20%). A smaller amount of inflammatory infiltrate was observed, in addition to an increase in the amount of fibroblasts and a denser tissue matrix, indicating a non-pathological healing process in the three glycidic agents.

Conclusion: The 3 glycidic agents can be used as effective and safe alternatives in the treatment of infected wounds, especially in low-income settings.

 

EP0624 The wound bed preparation in a patient with traumatic wound on the right thigh

Barbara Forino¹, Carmen Gentile¹, Stefania Lagana’¹, Francesca Crisafi¹, Laura Turina¹, Antonino Lombardo², Sarah Schiena¹, Laura Penco¹, Monica Cairo¹, Orsola Morrone^3
1A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero CTO, Turin, Italy, ²A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Turin, Italy, ³City of Health and Science CTO presidium, Turin, Italy

Aim: Use the Wound Bed Preparation approach for autologous grafting of extensive post-traumatic necrosis with a dynamic approach to wound treatment.

Method: Female patient, 22 years old, weight 56 kg and 170 cm in height, presents an extensive post-traumatic necrotic wound on the right thigh, classified as Stage IV (NPUAP-EPUAP), measuring 30 x 10 cm.

Treatment:

- Cleansing: Polyhexanide (PHMB) + Propyldetaine

- Debridement: Surgical, mechanical (polyester-polyacrylate pad), autolytic (PHMB gel with polyhexanide and propyldetaine), chemical (EDTA and Benzethonium Chloride)

- Exudate management: Hydrofiber, five-layer silicone foam with silicone border

- Infection management: Polyhexanide gel + Propyldetaine, hydofiber with silver + EDTA and Benzethonium Chloride

- Nutrition: Enteral free diet with 1.8 g protein/kg, followed by a regular diet of 1500/2000 kcal and 100 g protein per day

- Pain management: Premedication with Fentanyl 100 micrograms/2 ml, followed by intraprocedural hypnosis,

Results / Discussion:

• Necrotic tissue removal: 1 week
• Average dressing change interval: every 72 hours
• Infection resolution: 2 weeks
• Flattening and reactivation of wound edges: 4 weeks
• Wound bed healing for grafting: 5 weeks
• Pain: NRS 9 premedication with Fentanyl, NRS 4 post-medication, NRS 0 with hypnosis.

Conclusion: The multidisciplinary approach enabled the accurate assessment of necessary interventions for preparing the wound bed. The use of various treatments for complete escharotomy, selected based on observed efficacy, accelerated the timeline for autologous grafting, avoiding the need for negative pressure wound therapy and reducing the wound size to 27 x 9 cm.

 

EP0026 Combination of extracellular matrix (ECM) and hyperbaric oxygen therapy (HBOT) in treatment of mutilated foot injury - a winning combination?

Marin Marinovic¹, Tanja Batinac², Goran Slivsek³, Ivica Jendrašic⁴, Endi Radović⁵, Vedrana Mužić⁶, Ante Bandalović⁷, Klara Radović⁸, Dean Markic⁹, Davor Primc¹, Enesa Kadiric¹, Melita Kukuljan^{1 10
1}CHC Rijeka, Rijeka, Croatia, ²Faculty of medical sciences, Department of clinical medical sciences Rijeka, Rijeka, Croatia, ³Institute for Anthropological Research, Centre for Applied Bioanthropology, Gajeva ulica 32, 10000 Zagreb, Croatia, Zagreb, Croatia, ⁴Private General Practice Ivica Jendrašic, Đurđevac, Croatia., Department of traumatology General Hospital Bjelovar, Bjelovar, Croatia, Đurđevac, Croatia, ⁵Hospital for Medical Rehabilitation Thalassotherapia Crikvenica, Crikvenica, Croatia, Crikvenica, Croatia, ⁶Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism-Thalassotherapia Opatija, Opatija, Croatia, Opatija, Croatia, ⁷Surgery Department, Orthopaedics and Traumatology Division, University Hospital of Split, Croatia, Split, Croatia, ⁸Sapienza University of Rome, Rome, Italy, Roma, Italy, ⁹Department of Urology, CHC Rijeka, Rijeka, Croatia, ¹⁰Department of Radiology, Rijeka Clinical Hospital Centre, Rijeka, Croatia

Aim: Mutilated foot injuries with the disruption of soft and bone tissues are result of high energy trauma in industrial injuries or more likely, traffic accident’s injury. Thus result the skin and subcutaneous tissue to be detached from the underlying bony structures. Disintegrity of the overlying tissue over the bones of the foot and the compromise of blood circulation, could potentially develop to the necrosis which requires plastic reconstructive procedures and often even mutilation surgery.

Method: Treatment with hyperbaric oxygen therapy (HBOT) is a supportive method in various fields of medicine where the pathophysiological substrate is compromised tissue blood supply, especially with compromised microcirculation. Early administration of HBOT after primary surgical treatment results in a reduction of the anaerobic condition in the traumatized tissue and a sufficient supply of oxygen. The extracellular matrix (ECM) is a fundamental component of biological tissues and is composed of an intricate network of complex protein and carbohydrate-based macromolecules that are organized in a tissue-specific manner.

Results / Discussion: We present a case of the motorcycle injury patient. He had an injury of ​​the ankle joint area and foot. Necrectomy, fixation of the fragments K-wires was performed. The patient immediately continues to be treated in the hyperbaric chamber. After demarcation of the necrotic tissue on the seventh day after trauma, a wide necrectomy was performed and an extracellular matrix was applied along with a partial thickness skin graft. In the period from one month, a therapeutic HBOT series of 27 treatments were carried out, which the patient tolerated without difficulty.

Conclusion: Satisfactory healing occurred locally, and we can say that we had a good combination of supportive therapy and surgery treatment.

 

EP0028 Follicular micrograft platelet-rich fibrin combination to improve the secondary intention wound healing after axillary wide excisional surgery for hidradenitis suppurativa

Ayşenur Botsalı¹, Umut  Ünal¹, Ercan Caliskan^1
1University of Health Sciences, Gülhane Faculty of Medicine, Department of Dermatology, Ankara, Turkey

Aim: In assessing our outcomes of wide excisional surgery for hidradenitis suppurativa (HS), we discovered that cases with a baseline wound size exceeding 50 cm² pose significant challenges. This case series aims to define a regimen for creating an autologous wound dressing while evaluating its therapeutic potential in promoting re-epithelialization, minimizing contractures, and improving scar resilience in wide excisional axillary HS wounds larger than 50 cm².

Method: Six patients participated in the analysis. On the second day following their procedures, follicular micrografts were harvested and processed using microlyzer blades (T-lab Regenerative Medicine, Türkiye). Concurrently, platelet-rich fibrin (PRF) was prepared in a separate syringe. The follicular micrografts and PRF were then combined and passed through a connector several times until achieving a viscous consistency. This mixture was applied to the wound area and covered with a transparent dressing, which remained in place for five days. The procedure was conducted once, followed by standard wound care.

Results / Discussion: The average size of the wounds measured 66.75 (min-max: 58.9-73.2) cm². The mean duration for complete epithelialization was 10.8 weeks, with a range of 7 to 15 weeks. Three patients underwent procedures on both axillary skin but received treatment on only one side. The duration for complete re-epithelialization was similar for two of these patients; however, the third case exhibited a faster re-epithelialization at the treated site (12 weeks vs 18 weeks). In two instances, the control sites displayed noticeable contractures, whereas the treated areas preserved a full range of motion.

Conclusion: These preliminary results point out the combination of PRF and follicular micrograft as a promising approach for promoting re-epithelization with better scar appearance and functioning.

 

EP0029 Using data science for collecting, managing, and disseminating skin injury indicators in the hospital setting

Aline Ramalho¹, Claudia Rentes², Eliane Mazocoli², Danielle Barreto², Renata Gonçalves², Alessandra Marin², Nilda Rosa Prado², Paula Nogueira^3
1Sirio Libanes Hospital, Universidade de São Paulo, Sao Paulo, Brazil, ²Sirio Libanes Hospital, sao paulo, Brazil, ³Universidade Federal do Espirito Santo, Sao Paulo, Brazil

Objective: To detail the process of digitizing the collection, management, and dissemination of skin injury indicators in a hospital using Redcap® software.

Method: This experience report covers the implementation of software to create skin integrity indicators in a large São Paulo hospital. Around 40 trained nurses conduct monthly skin assessments for inpatients, recording findings in a form covering physical exam results, patient records, and preventive measures. Historically, these paper forms presented challenges, including incomplete data, interpretation issues, delays between collection and analysis, and storage inefficiencies. A quality improvement project was launched to address these issues, utilizing PDSA cycles and Ishikawa diagrams to guide problem-solving. REDCap software, initially designed for research purposes, was adapted for clinical monitoring. A custom digital form with mandatory, interdependent fields was developed alongside the software support team. Usability tests and a pilot implementation in one sector were conducted, followed by team training. The hospital transitioned fully to the digital system in January 2023.

Results and Discussion: Approximately 7,000 evaluations have been digitized to date. The digital approach has improved data validation by specialists, as data is updated in real-time. Moreover, the digital method has reduced manual data handling costs by an estimated R$65,000 over five years and decreased the need for over 10,000 printed pages, advancing sustainable practices.

Conclusions: Integrating data science into clinical workflows has enhanced the generation of reliable care indicators informed decision-making, highlighted areas for improvement, and strengthened patient safety.

 

EP0030 A novel approach to full-thickness skin defects: Full-thickness skin micro-column implantation

Rodney Chan¹, Anders Carlsson^1
1Metis Foundation, San Antonio, United States

Aim: Full-thickness and split-thickness skin grafts are effective modalities for managing full-thickness skin defects, but both have significant limitations. Split-thickness grafts often fail to restore important skin functions, such as thermoregulation, elasticity, and natural pigmentation, and donor sites can be plagued by scarring and pain. Full-thickness grafts, while potentially restoring more skin functions, are frequently limited by donor site availability.

Full-thickness skin micro-column implantation introduces a novel, orthogonal harvest method that captures key skin components, including reticular dermal fibroblasts, hair follicles, adnexal structures, and adipose tissue, yet minimizes donor site morbidity as the site of the harvested micro-columns will heal without obvious scars.

Method: We retrospectively reviewed the outcomes of nine patients with open wounds treated using full-thickness skin micro-column implantation.

Results / Discussion: Five of these patients had conventional dressings placed over the full-thickness skin micro-columns, while the remaining four had advanced dressings placed using a bilayer dermal substitute. All wounds eventually healed with minimal donor site morbidity. The rate of healing was, as expected, prolonged (30 to 60 days) compared to a conventional split-thickness skin grafts (3 to 7 days).

Conclusion: The findings highlight the use of full-thickness micro-column grafting as a way to reduce the invasiveness associated with traditional graft methods, with the potential for improved functional and aesthetic outcomes, though at the cost of a prolonged duration of an open wound.

 

EP0031 Wound bed preparation in hospital-associated colonization by carbapenem-resistant acinetobacter baumannii after fasciotomy: Two case reports

Po-Chun Huang¹, Yun-Nan Lin^1
1Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Aim: The global rise of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) has become a critical concern, especially in ICUs. Designated by the WHO as a priority for antibiotic research, current CRAB treatments face limitations due to low plasma levels and high toxicity. This report presents two cases where wound bed preparation (WBP) was applied to treat CRAB-colonized limb wounds post-fasciotomy.

Method: Case 1: A 46-year-old male, post-fasciotomy for compartment syndrome, tested CRAB-positive. After anti-biofilm dressing and IV antibiotics, Hydroclean was used, achieving wound healing within 5 months.
Case 2: A 71-year-old male with necrotizing fasciitis, also CRAB-positive post-fasciotomy, continued with debridement, negative pressure dressing, and Hydroclean, achieving CRAB-negative results in 2 weeks.

Results / Discussion: Local infections impair grafting due to bacterial biofilms and toxins. Hydroclean’s Ringer’s solution and polyacrylate particles facilitate autolysis, absorb MMPs, and disrupt biofilms, fostering granulation tissue development.

Conclusion: Hydroclean effectively supports WBP by reducing bacterial load, MMPs, and biofilms, proving beneficial for complex wound management.

 

EP0032 Optimized four-step approach for pediatric facial trauma management

Chao Lian¹, Xuelei Li², Baolin Zhang³, Xuanfen Zhang^1
1The Second Hospital & Clinical Medical School, Lanzhou University, Gansu, China, ²Affiliated Changzhi People’s Hospital of Changzhi Medical College, Shanxi, China, ³First Hospital of Shanxi Medical University, Shanxi, China

Aim: Pediatric facial trauma is common due to children’s natural activity levels, yet conventional local anesthesia often falls short, as young patients may struggle to cooperate, and many families reject general anesthesia due to perceived risks. To address these issues, our team developed an innovative “Four-Step Approach” for the emergency management of pediatric facial trauma. This study aims to evaluate its safety and effectiveness.

Method: A 2-year-old girl with a right eyebrow laceration was treated following the “Four-Step Approach” comprising: (1) local anesthesia administered with parental assistance, (2) psychological counseling to reduce pain perception, (3) rectal administration of chloral hydrate for effective sedation, and (4) swaddling to facilitate high-quality aesthetic suturing. Postoperative care included sterile dressings, adhesive fixation, regular dressing changes, and follow-up to monitor for complications.

Results / Discussion: The “Four-Step Approach” successfully provided stable sedation, enabling smooth and uninterrupted aesthetic suturing. The patient promptly awoke post-procedure, demonstrating clear responsiveness and exhibiting no discomfort or adverse effects. Thereafter, regular dressing changes were performed, along with the application of Mebo ointment to facilitate rapid wound healing. A three-month follow-up confirmed no visible scarring, and family satisfaction was reported as high.

Conclusion: The “Four-Step Approach” presents a safe, efficient, and cost-effective alternative to general anesthesia for pediatric facial trauma. By effectively managing pain and sedation, this method reduces both family concerns and financial burdens, while enabling high-quality cosmetic outcomes. The method’s streamlined steps improve clinical efficiency, offering significant potential for broader application in pediatric emergency care.

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EP0033 Design and application of a hemostasis kit for acute facial wounds

Chao Lian¹, Xuelei Li², Baolin Zhang³, Xuanfen Zhang^1
1The Second Hospital & Clinical Medical School, Lanzhou University, Gansu, China, ²Affiliated Changzhi People’s Hospital of Changzhi Medical College, Shanxi, China, ³First Hospital of Shanxi Medical University, Shanxi, China

Aim: The face, being the most exposed part of the body with abundant blood supply, often experiences significant bleeding from trauma. Rapid hemostasis is crucial in managing acute facial wounds. Current methods, such as traditional dressings and high-frequency electrosurgery, have limitations in efficacy and cost. In response, a patented team developed a burning kit for effective hemostasis in acute facial wounds, aimed at improving efficiency and reducing patient costs.

Method: The kit comprises a burning rack, alcohol lamp, and protective cylinder, enhancing traditional cauterization techniques. The design focuses on simplifying operations for improved usability and safety, with a burning rod that maintains a continuous hot state for immediate use, ensuring timely hemostasis. Its cost-effective design allows for versatile application in various clinical settings.

Results / Discussion: Clinical validation shows that the kit effectively reduces bleeding from facial injuries, accelerates hemostasis, and lowers risks compared to traditional methods. The product is low-cost, alleviating the financial burden on patients. It has been granted a national utility model patent and successfully integrated into clinical practice.

Conclusion: This innovative burning kit enhances hemostatic efficiency for acute facial wounds, providing a safer treatment option. Its design offers potential applications in routine surgeries within plastic and cosmetic surgery, indicating broad utility.

Figures:

 

EP0034 Reconstruction of an octogenarian major pretibial degloving injury utilizing negative pressure wound therapy and subsequently combining fenestrated-type artificial dermis without skin grafting

Hsu-Tang Cheng^1
1Division of Plastic Surgery, Department of Surgery, Asia University Hospital, Taichung City, Taiwan

Aim: Major pretibial degloving injuries are complex and challenging to treat, often requiring extended healing times and, in severe cases, resulting in amputation. Despite advancements in reconstructive techniques, the management of these traumatic injuries remains difficult, and there is limited literature on effective treatment strategies.

Method: This article details the case of an elderly, frail patient in their 80s who sustained a significant pretibial degloving injury. The treatment approach involved multiple surgical debridements combined with negative pressure wound therapy (NPWT) to preserve the avulsed tissue. To achieve sufficient soft tissue coverage, a fenestrated-type artificial dermis was used in conjunction with NPWT.

Results / Discussion: The patient experienced an uncomplicated recovery, being discharged 22 days after the injury. Remarkably, the wound healed by secondary intention, and no skin grafting was necessary, highlighting the efficacy of the combined therapy approach in facilitating wound closure.

Conclusion: This case underscores the potential benefits of integrating artificial dermis and NPWT for managing major pretibial degloving injuries, especially in frail, elderly patients. The successful outcome suggests that this combined therapy can be a valuable option for promoting healing and avoiding more invasive procedures.

 

EP0035 Fish skin xenograft assisting in achilles wound management

Richard Bruno^1
1EVMS, Norfolk, United States

Aim: The Achilles tendon region is noted to be a historically complex area to heal wounds due to its known poor vascular supply. Multiple different theories have been proposed of the exact angiosome supply to this region.

Method: Twenty-one patients exhibiting heel wounds from a multitude of pathologies including surgical wounds, pressure injuries, or infections were included. All twenty-one patients underwent formal surgical debridement and at least one graft placement. Single grafts were cut and layered as needed in cases which were indicated. For cases requiring more than one graft application, this was completed on average every three weeks. Negative pressure wound therapy was implemented as needed for severe soft tissue deficits. Wounds were considered healed after reulceration was not encountered after 3 months.

Results / Discussion: All twenty-one patients proceeded to undergo complete healing with implementation of at least one fish xenograft application. The graft showed excellent success in various wound types as noted previously, showing versatility for multiple wound types, especially those with suboptimal vascular supply. At time of most recent follow-up, patients were healed on average for 15.2 months with one patient undergoing reulceration 8 months following complete and sustained healing.

Conclusion: This case series displays great success in the healing of complex wounds in a known area of difficult healing. Future retrospective studies with a higher study population and perhaps a more standardized patient population could provide further insight on the success of fish skin xenografts with success in healing Achilles wounds with tendon exposure.

 

EP0036 Clinical observation and mechanism of skin regenerative medical technology in treating postoperative wounds of anorectal diseases

Yuedong Liu^1
1The Third Affiliated Hospital, Liaoning University of Traditional Chinese Medicine, Liaoning, Lebanon

Aim: To observe the clinical effect of moist exposed burn treatment in the treatment of wound recovery after anorectal surgery.

Method: 60 patients with mixed hemorrhoids and anal fistula were divided into two groups according to random number table method. Observation group was treated with moist exposed burn treatment on the basis of surgical intervention, while the control group was treated with routine dressing change on the basis of the same operation.

Results / Discussion: Total cure rate of both groups was 100%, and the effective rate of observation group and control group was 83% vs. 57%(P<0.05). The scar status of both groups was evaluated. During treatment, pain relief of patients in observation group was better than control group, and the results were statistically significant. In the process of wound healing, the exudation of wound in observation group was better than control group. The positive rate of bacterial culture of wound secretion in the observation group was better than control group. The growth of granulation tissue in observation group was significantly better than control group, and the cell activity in the observation group was higher in the comparison of the number of fibrous cells and the new capillaries. All the above results were statistically significant.

Conclusion: Clinically, the problems of long treatment period, severe pain and infection of wound after anorectal surgery have always been the key content of the treatment of anorectal surgery. Applying the moist exposed burn treatment after anorectal surgery can reduce pain, shorten the treatment period, improve the growth of wound and reduce infection wound. It is worthy of clinical promotion.

 

ANTIMICROBIALS

EP0489 Reconstruction of orbital wall fractures with a combination of resorbable plates and antibiotic-impregnated collagen sheets

Jongweon Shin^1
1Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Rep. of South Korea

Aim: Artificial implants are often used for reconstruction of orbital wall fractures. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets and to determine whether it had an effect in reducing postoperative antibiotic use.

Method: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery.

Results / Discussion:  No significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02).

Conclusion: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

 

EP0490 Antimicrobial and cytotoxic activities of antimicrobial substances used in wound care dressings: an in vitro study

Ismena Mardani¹, Tina Hamberg¹, Sulman Shafeeq^1
1Mölnlycke Health Care, Göteborg, Sweden

Aim: To evaluate the antimicrobial and cytotoxic activities, of antimicrobial substances used in wound care dressings, and to calculate biocompatibility index (BI) of the substances.

Method: Antimicrobial properties of 8 antimicrobial substances, namely benzalkonium chloride (BAC), benzethoniun chloride (BEC), chlorhexidinge gluconate (CHG), crystal violet (CV), elemental iodine (EI), gentian violet (GV), polyhexamethylene biguanide (PHMB) and silver sulfate (SS) were evaluated using microdilution techniques against Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans species in serum-containing medium. Incubation times of 24h and 48h were used for bacteria and fungi, respectively. Cytotoxicity of the substances was determined at 24h by measuring the cell viability of normal human epidermal keratinocytes in keratinocyte growth medium (serum-free). BI was calculated by dividing the half maximal inhibitory concentration (IC₅₀) with the minimum bactericidal/fungicidal concentrations.

Results / Discussion: MB (>50 mM) and EI (25 mM) required the greatest concentrations, while PHMB (0.00357 mM) and CHG (0.1558 mM) required the lowest concentrations, to completely kill all three microorganisms. IC₅₀ levels indicated PHMB (0.0004 mM) and BAC (0.0011 mM) as the most cytotoxic, and EI (0.34 mM) and SS (0.023 mM) as the least cytotoxic. BI was lowest for MB (0.00007) and BAC (0.000044) and highest for SS (0.21) and PHMB (0.11). Some toxicity of antimicrobial substance is inevitable due to the non-specific mode of action, however, a higher BI indicates efficient antimicrobial activity with relatively little cytotoxic effect.

Conclusion: SS and PHMB were the most effective antimicrobial substances with least cytotoxicity when compared to the other tested compounds.

EP0625 Evaluation of the sensitizing potential of common antiseptics in wound care using a modern bioassay developed for medical devices

Elisabeth Riegel¹, Karin Riedl², Christoph Klaus², Thomas Czerny^1
1University of Applied Sciences, FH Campus Wien, Vienna, Austria, ²Schuelke & Mayr Ges.m.b.H., Vienna, Austria

Aim: To guarantee safety of medical devices used on skin or wounds, products have to be assessed for adverse reactions, such as the allergic potential, which is still based on animal testing according to current regulations. We recently developed and validated an in-vitro protocol for detecting low amounts of sensitizers in medical devices. Similar assays are already OECD-approved, providing an alternative for animal experiments. The study aimed to investigate the sensitizing potential (i.e. risk for allergic contact dermatitis) of antiseptics, which are frequently used in wound care, on human cells.

Method: The highly sensitive in-vitro MDA-ARE is a cell-based reporter gene assay focused on the ARE-Nrf2 pathway, involved in the dermal sensitization process. Compared to published results of the gold-standard animal test (local lymph node assay), the MDA-ARE bioassay allows for a ~25,000-fold increased analytical sensitivity. Briefly, optimal experimental conditions were established by determining its ability to detect positive signals in the presence of different concentrations of octenidine (OCT), polyhexamethylenebiguanide (PHMB) and PVP-iodine. The detection limit was specified at 10μM using cinnamaldehyde and benzylideneacetone as positive controls.

Results / Discussion: PVP-iodine showed a high sensitizing potential already at 0.01%, whereas tolerated concentrations of OCT and PHMB were determined at 0.0003%.

Conclusion: In contrast to PVP-iodine, no sensitizing potential was detected for OCT and PHMB in the MDA-ARE assay. Based on applied concentrations, absence of sensitizing potential can be extrapolated for OCT and PHMB for in-vivo applications to at least ~7.5%, far higher than those used in commercially available products, facilitating patient safety.

 

EP0491 Efficacy of dialkyl carbamoyl chloride (DACC) in wound treatment in patients with epidermolysis bullosa: A case study analysis

Luciana Mendes¹, Flavia Nakamura², Leticia Giaconia³, Ana Beatriz Mendes^4
1lm Medical, de Pauli, Salvador, Brazil, ²Instituto Nakamura, São Paulo, Brazil, ³de Pauli, São Paulo, Brazil, ⁴Universidade Nove de Julho (UNINOVE), São Paulo, Brazil

Aim: Epidermolysis bullosa (EB) is a rare genetic condition that manifests itself by the extreme fragility of the skin and mucous membranes, resulting in the formation of blisters and painful lesions. These lesions often evolve into chronic wounds, whose healing is slow and complicated by secondary infections. In order to provide and implement adequate therapeutic care and avoid serious complications, DACC (Dialkyl Carbamoyl Chloride) technology is a promising innovation in this field and uses a physical mechanism for wound treatment and stands out as a safe antimicrobial. This is a relevant aspect in EB due to the need for lifelong care.

Method/ Results / Discussion: Frequent infections in EB complicate wound healing. The use of DACC prevents these infections and promotes rapid healing, reducing the need for interventions. The results observed in the case study of M.L., a 7-year-old diagnosed with epidermolysis bullosa, showed significant improvements. During the 14 (fourteen) days of treatment, lesion reduction, absence of infection and a differentiated appearance of the lesion were observed. Its superiority as an antimicrobial is highlighted by its ability to prevent and heal wounds, without causing bacterial resistance.

Conclusion: The case study demonstrated that Dialkyl Carbamoyl Chloride (DACC) is an effective and safe antimicrobial for the treatment of people with epidermolysis bullosa, reinforcing its potential as a valuable therapeutic innovation for prevention and treatment in the management of lesions in Epidermolysis Bullosa.

 

EP0492 Reduced macrophage activation by endotoxin exposure after treatment with dialkylcarbamoyl chloride-coated wound dressing in vitro

Sara Sjögren¹, Anna Arvidsson¹, Johanna Husmark^1
1Essity Hygiene and Health Ab, Mölndal, Sweden

Aim: Infected wounds can harbor bacteria that trigger inflammation and delay healing. Endotoxins from the outer membrane of Gram-negative bacteria are released during bacterial stress or lysis. Macrophages in dermal tissue become activated upon endotoxin release, as this is an indicator of infection. Endotoxins then act as potent immune activators, via secretion of pro-inflammatory cytokines like TNF-α from macrophages, which is crucial for activating an immune response. This study investigates the effect of a dialkylcarbamoyl chloride (DACC)-coated wound dressing on endotoxin-mediated immune cell activation.

Method: The DACC-coated wound dressing efficiently binds endotoxins and to further study the inflammatory effects of endotoxin scavenging, test samples of DACC-coated dressings and control material were incubated with endotoxin overnight. The supernatants, containing residual unbound endotoxin, were transferred to human THP-1 cells differentiated into macrophages. TNF-α secretion from THP-1 cells, indicating endotoxin-mediated macrophage activation, was quantitated using ELISA.

Results / Discussion: Endotoxin causes a robust induction of TNF-α secretion from differentiated THP-1 cells. Further, macrophages exposed to cell culture media containing endotoxin pre-treated with a DACC-coated wound dressing showed significantly reduced TNF-α release compared to cells exposed to cell culture media pre-treated with control material. The reduction of TNF-α secretion aligns with previous findings where a DACC-coated wound dressing binds endotoxin.

Conclusion: The data demonstrate that the DACC-coated wound dressing significantly reduces endotoxin-induced TNF-α secretion by macrophages in vitro, compared to control. This reduction indicates a potential to mitigate the macrophage inflammatory response induced by endotoxin when treated with a DACC-coated wound dressing in vitro.

 

EP0493 Non-medicated hydrophobic wound dressings facilitate bacterial growth and do not irreversibly bind bacteria

Matthew Malone^{1 2}, Michael Radzieta^{2 3}, Erik Nygren⁴, Tina Hamberg^4
1Clinical Medical and Professional Affairs Woundcare, Molnlycke Healthcare AB, Goteborg, Sweden, ²Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia, ³South Western Sydney Limb Preservation and Wound Research, Sydney, Australia, ⁴R&D Woundcare, Molnlycke Healthcare AB, Goteborg, Sweden

Aim: To determine bacterial attachment and growth on test dressings, whether the test dressings irreversibly bind bacteria, and if the bound bacteria remain metabolically active.

Method: Dressings were pre-soaked in an in vitro wound milieu (IVWM) to mimic host fouling/exudate and then exposed to Pseudomonas aeruginosa (PAO1, 10³ or 10⁵ CFU/ml) for 3 or 24 hrs. A modified direct contact IVWM suspension model was used to determine attachment, growth, binding, and metabolic activity on dressings, inoculum IVWM suspensions and sterile test mediums in a series of experiments.  NMHWD were washed in PBS for a total of 6x, 9x, 12x, 15x or 18x wash steps, and then placed onto sterile test medium. Viable cell counts (CFU/ml) were determined for each experimental design.

Results / Discussion: The number of bacteria recovered from NMHWD at 24 hrs and their corresponding IVWM suspensions significantly increased compared to 3h. By comparison, the silver-containing dressing demonstrated significantly less bacteria. Bacterial detachment was consistently observed during 18 serial washing steps. Additionally, the conversion of tetrazolium salts to red formazan dye was clearly observed on NMHWD and in the surrounding media demonstrating marked metabolic activity. Variable Exotoxin A levels were detected on the three test dressings but lower on the silver-containing dressing.

Conclusion: Bacterial growth occurs on NMHWD. Bacteria are not irreversibly bound and remain metabolically active, contaminating sterile surrounding media. The in vitro antimicrobial potential of NMHWD is low and our findings support previous observation. We question whether non-antimicrobial wound dressings are acceptable alternatives to traditional antimicrobials.

 

EP0494 Nitric oxide-releasing solution vs. placebo for diabetic foot ulcers: A phase 1/2 clinical trial

Scott Schumacher^1
1Achilles Foot Health Centre, Surrey, BC, Canada

Aim: The purpose of this study was to evaluate the safety and efficacy of a nitric oxide-releasing solution (NORS) as an adjunctive footbath treatment compared to placebo in patients with diabetic foot ulcers. The primary focus was on wound closure rates, reduction of microbial load, and adverse events.
Methods: This randomized, double-blind, placebo-controlled Phase 1/2 clinical trial included 40 participants with diabetic foot ulcers. Participants were randomly assigned to receive either NORS (n=26) or a hypotonic saline placebo (n=14) in a 2:1 ratio. Treatments involved twelve 30-minute footbaths over four weeks. Wound closure, microbial load, and safety were assessed through digital imaging, cultures, and clinical evaluations. Adverse events, vital signs, and methemoglobin levels were monitored to assess safety.
Results: Of 40 participants, 84.6% in the NORS group and 92.9% in the placebo group completed the study. By Day 29, the complete wound healing rate in the NORS group (15.4%) was approximately double that of the placebo group (7.1%). Furthermore, 20% of participants in the NORS group showed complete resolution of pathogens, compared to none in the placebo group.  No systemic infections or serious AEs were reported, though four in the NORS group and one in the placebo group terminated early due to infections that required protocol-prohibited antibiotic treatment.  No significant changes in vital signs or methemoglobin levels were observed.
Conclusions: NORS footbath treatment appears safe and shows potential benefits in pathogen resolution and wound closure. The promising results suggest further studies with extended treatment durations are warranted.

 

EP0495 Microbiological profile of diabetic foot ulcers

Imen Mezoughi^1
1Military hospital of Tunis, Tunis, Tunisia

Aim: Lower limb infection is a common complication in diabetic patients. Different germs can be involved. Several antibiotic treatment protocols are prescribed. The aim of our work is to determine the microbiological profile of patients treated in our department for diabetic foot and describe the antibiotic prescription.

Method: It is a retrospective and descriptive study. We collected data from all records during ten years (From January 2012 to December 2022). We reviewed the results of 609 bacteriological samples collected in patients treated fo diabetic foot ulcers.

Results / Discussion:  Among the 1050 patients referred to our facility ,only 58% had initial bacteriological examination  obtained by swabbing of the ulcer. The purpose of this  sampling was to adapt a probabilistic antibio therapy  or to look for a cause of delayed healing. Bacteriological screening was negative in 34% of the samples.  Echirichia Coli and Klebsielle Pneumoniae were the two most common bacteria found, respectively 39% and 33%. Two or more pathogenic germs were detected in 27% of cases. The results showed multi-resistance to the different antibiotics tested in 3% of patients.

Regarding treatment protocols , Amoxicilline/clavulinic Acid was the most prescribed antibiotic in monotherapy mode, and it is also the most frequently used in bi-therapy associated with ciprofloxacin

Conclusion: Bacteriological examination allowing adequate antibiotic treatement is an essential tool in the management of diabetic foot ulcers. It may diminish the emergence of antibiotic resistant germs due to probabilistic and prolonged antibiotherapy.

 

EP0496 A portable hyperbaric chamber: an innovative and alternative approach to allograft by topical haemoglobin spray (topical oxygen therapy)

Francesca Pasquali¹, Ilaria Cerino Badone², Giuseppina Demartis², Carmen Rita Rizzella^2
1ASLAL, AL, Italy, ²ASLAL, Alessandria, Italy

Aim: Chronic wounds impact healthcare costs and patients’ quality of life. Patients with hard to heal wound may experience pain. So, in that cases, patients treated with a bioactive dressing, a topical haemoglobin spray designed to improve the oxygen supply. Haemoglobyn spray is isolated and purified hemoglobin derived from porcine erythrocytes through a synthesis process. Finally, we have a portable hyperbaric chamber for use in outpatient settings or at home for patients.

Method: From January 2020 to 2024, we identified a significant sample of 146 clinical cases with wounds of various etiologies:

• Diabetic foot ulcers 
• Burns
• extravasation injuries
• Post surgical wounds
• Pressure ulcers
• Vascular ulcers

Topical oxygen therapy is an innovative and alternative approach to allograft. The product is sprayed onto the wound, the haemoglobyn binds oxygen from the surrounding air and transports it to the wound bed where it diffuse into the wound

It is sprayed from the distance of 10 cm, each spray covering 9 cm square and after the wound is covered with secondary non-occlusive dressing, a breathable dressing that facilitates gas exchange

Results/Discussion: Oxygen is a vital requirement for every step in the wound healing process; the oxygen supply increases of the 20% in a patient with a clean wound and of the 50%in a patient with an infected wound

Conclusion: In this study of my team, I am the principal investigator for the Ethics Committee. It has given its approval for a 4-year study.

 

EP0497 Invitro effect of ultrasound clove aqueous extract and clove-silver nanocolloid on multidrug-resistant bacteria collected from postoperatively infected wounds

Amin Elkallaf¹, Sohier El-Kholey², Dalia Metwally³

¹Alexandria University, Medical Research Institute, Biomedical Physics Department, Alexandria, Egypt, ²Medical Research Institute, Alexandria University, Alexandria, Egypt, ³Medical Research Institute,Alexandria University, Alexandria, Egypt

Aim: Invitro effect of ultrasound clove aqueous extract and clove-silver nanocolloid on multidrug-resistant bacteria collected from postoperatively infected wounds.
Method: agar well diffusion of clove extract and clove-silver nanocolloid  against several multidrug resistant bacterial isolates.
Results / Discussion The primary bacteria that colonize wounds are Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli (E. coli), and Pseudomonas aeruginosa. These infections may cause substantial tissue damage and the development of nonhealing wounds. Forty multidrug-resistant bacterial isolates were gathered over a nine-month period for this study. Clove’s ultrasonic aqueous extract exhibits strong antibacterial activity against MRSA isolates but no effect on the others. A stable colloidal system of clove extract in distilled water is indicated by the colloid’s zeta potential of -21.5. An excellent dispersant dielectric constant for forming clove-Ag nanocolloidal systems is 78.5. Excellent antibacterial activity is demonstrated by the clove-silver nanocolloid against all isolates that are resistant to multiple drugs. The nanocolloid was prepared using silver electrolysis of two silver electrodes in a medium of clove colloid.
Conclusion: Clove ultrasonic aqueous extract has a good antimicrobial effect on MRSA only, and the clove-silver nanocolloid has a promising antimicrobial effect on all isolates.

 

EP0498 Complementing our immune system: The antimicrobial mode of action of exogenous nitric oxide and its potential in wound care

Jonny Roberts¹, Scarlet Milo¹, Daniel Metcalf^1
1Convatec Ltd, Deeside, United Kingdom

Aim: To evaluate nitric oxide (NO) as an antimicrobial agent and assess the potential use of a NO-generating wound dressing* for the management of hard-to-heal wounds. The presence of microorganisms plays a significant role in the pathogenesis of hard-to-heal wounds. Systemic antimicrobial therapy plays a crucial role in infected hard-to-heal wound care, while antimicrobial dressings are used to manage wound bioburden. However, there is emerging recognition of biofilm tolerance to standard antimicrobials, which, coupled with the prevalence of antibiotic resistance, presents a challenge to effective treatment. NO and reactive nitrogen species (RNS) are imperative antimicrobial components of the host immune response, which, when uncompromised, significantly diminish the risk of development of bacterial resistance.

Method: We conducted a narrative review of the evidence underlying the antimicrobial mechanisms of NO and assessed its potential as an antimicrobial agent to treat hard-to-heal wounds.

Results / Discussion: We identified and reviewed key antimicrobial mechanisms of NO and RNS. NO freely penetrates the cell wall, where RNS inactivates extracellular and internal cell wall proteins. RNS destroy microbial DNA while NO inhibits DNA synthesis and repair, destabilising the genome resulting in cell disfunction and eventual death. RNS inactivate iron-sulphur cluster containing proteins essential to metabolic processes, resulting in bacterial cell death.

Conclusion: NO generation from a wound dressing represents a promising strategy as an antimicrobial agent for the treatment of hard-to-heal wounds due to the multiple mechanisms of action reducing the risk of bacterial resistance.

* EDX 110/ConvaNiox (Convatec Ltd, UK)

 

EP0554 Novel antimicrobial quaternary polyethyleneimine compounds for the treatment of infected wounds

Sandro Ferrari¹, Jose Manuel Rey¹, Markus Rothmaier¹, James Thornicroft², Gareth Wynn-Jones², Graeme Kettlewell², Ran Frenkel^1
1Polaroid Therapeutics AG, Zurich, Switzerland, ²SFM Ltd., Coventry, United Kingdom

Aim: Quaternary polyethyleneimine (QPEI) compounds were designed with unique functional groups to enhance antimicrobial potency and prevent leaching into the wound bed, when incorporated into a gelling fiber wound dressing. We sought to determine the potential of QPEI-incorporated dressings to disrupt biofilm formation, reduce bacterial load, and address challenges posed by antimicrobial-resistant pathogens.

Method: QPEI compounds were evaluated for minimum bactericidal concentration (MBC) against a panel of clinically-relevant bacterial strains. Bacterial morphology post-QPEI treatment was visualized by scanning electron microscopy (SEM). Antibiofilm activity of QPEI was tested on biofilm-infected porcine skin samples by quantifying the remaining microbial load after treatment with a QPEI-incorporated gelling fiber wound dressing.

Results / Discussion: QPEI compounds demonstrated antimicrobial efficacy comparable to vancomycin, with similar MBC against both Gram-positive and Gram-negative bacteria. SEM revealed concentration-dependent antibiofilm effects of QPEI, including significant physical disruption of bacterial cell wall morphology. In porcine skin models, QPEI-incorporated gelling fiber wound dressings markedly reduced bacterial growth compared to control dressings. Additionally, QPEI dressings exhibited antifungal activity, with no evidence of QPEI leaching into the wound bed.

Conclusion: These findings demonstrate that QPEI-incorporated wound dressings offer a broad-spectrum approach to prevent bacterial infections and manage wound biofilms. Unlike traditional silver dressings, QPEI compounds act through a unique physical mechanism that may effectively bypass antimicrobial resistance. The ex vivo data further highlight the potential of QPEI compounds as a promising alternative to existing antimicrobial dressings.

 

EP0555 Affordable nanocolloidal based silver dressing for chronic wound in developing country perspective

Pipit Lestari¹, Eviyanti  Numalasari¹, Khairul Bahri¹, Widasari Sri Gitarja¹, Munasirah Ismail¹, Kana Fajar^1
1Wocare Indonesia, Bogor, Indonesia

Aim: This study evaluated nano-colloidal silver (NCS), a locally developed silver-based dressing, in promoting healing in chronic wounds. 

Method: This study was employed using prospective observational case series by following up five patients for two weeks at Wocare Center in Bogor, Jawa Barat. The patients were patients exhibiting local infection and adhered to the care protocol. The wound care framework used was TIMERS wound management with locally developed nano-colloidal silver (NCS) based dressing. We evaluated signs and symptoms of wound infection according to the International Wound Infection Institute (IWII). We also evaluated the average of wound dressing cost in reducing bioburden compared to others existing antimicrobials. 

Results / Discussion: Findings indicate that NCS may reduce bacterial burden shown by improvement of infection sign and symptoms. 100% patients treated with NCS show improvement of wound infection symptoms by two weeks of treatment, particularly on exudate types, periwound induration, and periwound skin tissues. The cost of dressing changes using NCS is 50% lower compared to the other antimicrobial dressing available in Indonesia. 

Conclusion: This research underscores the potential of locally produced options of silver-based dressing in enhancing wound care management and reducing healthcare costs.

 

EP0556 Additive effect of hydrogen sulfide and amphotericin in treating fungal biofilms

Costanza Pregnolato^{1 2}, Barry Panaretou², Tony Lockett^{1 2}, Alex Dyson^{1 2
1}Centre for Pharmaceutical Medicine Research, Kings College London, London, United Kingdom, ²Institute of Pharmaceutical Science, Kings College London, London, United Kingdom

Aim: Biofilms, present in 90% of chronic wounds, hinder healing due to their strong adherence, immune evasion, and resistance to antimicrobial treatments. Amphotericin B is an antifungal agent that has severe side effects when administered systemically e.g. nephrotoxicity. We investigated its utility in combination with hydrogen sulfide (H₂S), a small gaseous signalling molecule, in preventing formation and enabling degradation in biofilms of Candida albicans.

Method: An in vitro 96-well plate assay was used to assess biofilm formation and degradation. C. albicans (SC5314; 1x10⁶ cells/mL) were plated in each well with biofilm formation assessed by absorbance spectrophotometry (λ: 600 nm). Prevention of biofilm formation by amphotericin (1 ug/ml) and sodium hydrogen sulfide (NaHS; 10 μM), alone or in combination, was assessed following addition of these drugs to freshly plated planktonic cells, and incubated for 24 hours at 37°C. In separate experiments, drugs were added to established (24h) biofilms, with a further 24h incubation (37°C) and subsequent measurement.

Results / Discussion: Amphotericin was effective at preventing biofilm formation with or without addition of NaHS but had no significant impact on established biofilms. While NaHS (at 10 μM) alone could not prevent formation or degrade established biofilms, it enabled a significant (p<0.05) additive effect in combination with amphotericin.

Conclusion: The combination of H2S and a traditional antifungal agent showed an additive effect in degrading fungal biofilms. This outlines a potential clinically utility for H2S as an adjunct antifungal agent that could enable greater efficacy and spare the use of traditional antifungal agents.

 

EP0557 Pain reduction after application of polyhexanide and propilbetaine solution and gel

Giulia Vidotto¹, Bertulli Gianluca¹, Sara Maria Lupi², Lina Carmela Ognibene¹, Umberto Cazzaro¹, Gaetano De Angelis^2
1Ospedale San Raffaele, Milano, Italy, ²Ospedale San Raffele, Milano, Italy

Aim: The cases analyzed demonstrate how the application of polyhexanide and propilbetaine gel solution reduces pain by acting on the reduction of the presence of biofilm on the ulcer bed and consequently improving the patient’s quality of life.

Method: 10 patients with chronic leg ulcers of various etiologies presenting with intense pain were treated.

Patients had the dressing change twice a week; the treatment consisted of an application of a thin layer of gel covered with a secondary dressing. A compression bandage was applied to all.

At each dressing change, pain was assessed with the Numerical Rating Scale for pain and the wound bed preparation score.

Results / Discussion: Pain decreased by 2 points at the first dressing change and by 4 points at the second change. The reduction in pain was related to an activation of the edges and an improvement of the wound bed, increasing the WBPscore by 30%.

Conclusion: The polyhexanide and propilbetaine gel solution reduces pain during the first applications in ulcers with different etiologies, significantly influencing the quality of life.

 

 

EP0558 Silver-zinc EDTA complexes demonstrated significant antibiofilm activity in a complex wound environment with in an in vitro model

Rui Chen¹, Marcus Swann¹, Jeanne Saint Bezard¹, Fergus Watson¹, Steven Percival^1
15D health Protection Group Ltd., Liverpool, United Kingdom

Aim: Slough, which covers the wound bed, harbors microorgansisms and biofilms, prevents the formation of new healthy tissue, and delays wound healing, is hallmark feature of chronic wounds. The aim of this study is to understand the effects of chronic wound environment on the activities of silver-containing complexes (Ag-Zn MMC) in an in vitro slough model.

Method: An in vitro artificial wound slough (AWS) -biofilm model which involved a pre-formed Pseudomonas aeruginosa biofilm under a layer of AWS was applied to evaluate the antibacterial/antibiofilm efficacy of Ag-Zn MMC and AgNO₃ solutions. The test samples were added directly onto the AWE-biofilm substrate with different thicknesses. The bacterial cell density in the medium was determined by taking a sample and serial diluting in PBS, before plating each dilution onto Tryptone Soya Agar in duplicate after 0, 2.5, 6 and 24 hours. The penetration of the antimicrobial composition (e.g. silver ions) through the AWE membrane was monitored electrochemically using a printed carbon sensor. The disruption of P. aeruginosa biofilm by the treatments was imaged by LSM 780 Zeiss confocal microscope.

Results / Discussion:  The results showed that silver ions penetrated through the AWS membrane aided by EDTA (chelating agent) to reach the biofilm underneath. The penetration rate of silver ion was inversely proportional to the AWE thickness. The antibiofilm test results indicated that the Ag-Zn MMC had higher antibiofilm efficacy and penetration rates than the AgNO₃ solution with same silver concentration.

Conclusion: The results demonstrated the potential for the EDTA metal complexes, such as Ag-Zn MMC to be used for treatment and disruption of biofilms, such as those that covered by the slough of chronic wounds.

 

 

EP0559 Novel antibiofilm silver-cerium EDTA complexes

Rui Chen¹, Marcus Swann¹, Jeanne Saint Bezard¹, Freya Griffiths¹, Rebecca Catton¹, Fergus Watson¹, Steven Percival^1
15D health Protection Group Ltd., Liverpool, United Kingdom

Aim: Biofilms targeted silver-cerium EDTA complexes (Ag-Ce MMC) were formulated and their antibacterial/antibiofilm efficacies were evaluated on different in vitro models.

Method: A variety of in vitro microbial and biofilm models were utilized to evaluate the ability of Ag-Ce MMC in different platforms (liquid/gel) to sequester microbes, prevent dissemination, and manage bioburden. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Ag-Ce MMC and it’s the mixtures with surfactant Poloxamer P188 and P407 were determined using a broth microdilution method against Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans. CDC bioreactor, drip-flow model, contact lens model and artificial wound slough biofilm (AWS-biofilm) models were used to evaluate antibacterial killing efficacy towards established P. aeruginosa and Staphylococcus aureus biofilms.

Results / Discussion: Following MIC and MBC testing of Ag-Ce MMC and the components alone, increased antimicrobial potency was found with all complexes tested. Checkerboard assays showed synergistic interactions between Ag-Ce MMC with poloxamer P188 and P407 against P. aeruginosa, S. aureus, and C. albicans. CDC, drip-flow model, contact lens model and AWS-biofilm model demonstrated strong antibiofilm activity of Ag-Ce MMC against P. aeruginosa and S. aureus. The Ag-Ce MMC loaded gels (Carbopol and poloxamer) demonstrated superiority in both CDC and AWS biofilm models, as reduced P. aeruginosa growth to the limit of detection (completely killed).

Conclusion: The data generated within the in vitro biofilm models demonstrate that the Ag-Ce MMC complexes are the promising reagents for effective biofilm management and control in wound care.

 

EP0560 Application of polymeric films based on polyvinyl alcohol, clays, and tannins in the treatment of infected skin ulcer

Silvia Fiani¹, Natascia Mennini¹, Livia Gjergji¹, Fatima Garcia Villén², Raquel  de Melo Barbosa², Silvia Molino³, César Viseras^2
1University of Florence, Florence, Italy, ²University of Granada, Granada, Spain, ³Silvateam, R&D Unit, Cuneo, Italy

Aim: The aim of this study was to develop polymeric films based on polyvinyl alcohol (PVA), propylene glycol (PG), and clays (Montmorillonite (MNT) and Sepiolite (SEP)), loaded with tannins capable of providing antimicrobial coverage for 72 hours.

Method:

1) Selection of the qualitative/quantitative composition of the formulation to obtain peelable, uniform, elastic polymeric films that can remain at the lesion site for at least 48 hours.

2) Evaluation of the antimicrobial action of 6 tannin-containing plant extracts (1) against Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli.

3) Loading the optimized films with tara tannin (CO/T) and their characterization in terms of disintegration time in artificial exudate, content uniformity, thickness, pH, moisture vapor transmission rate, release profile, tensile strength, and ex vivo adhesion.

Results / Discussion: Based on the preformulation studies in which 40 formulations were developed, the following two films with optimized composition, loaded with tannins, were prepared:
Film 1: PVA 5% (w/w), PG 9% (w/w), MNT 2% (w/w), CO/T 1% (w/w)
Film 2: PVA 5% (w/w), PG 13% (w/w), SEP 5% (w/w), CO/T 1% (w/w)
The optimized films were found to be uniform in content, with good breathability and mechanical resistance, capable of ensuring a prolonged and controlled release of tannins for up to 72 hours, with values always above the MIC.

 

Conclusion

The study enabled the development of an innovative dressing film made from biocompatible polymers, loaded with natural substances for prolonged antimicrobial action, featuring good mechanical and physicochemical properties.

Kindly gifted by Silvateam S.p.A.

 

EP0561 Novel antibiofilm bi-metal EDTA/DTPA complex lavages

Rebecca Catton¹, Fergus Watson¹, Freya Griffiths¹, Jeanne Saint Bezard¹, Rui Chen¹, Marcus Swann¹, Steven Percival^1
15D health Protection Group Ltd., Liverpool, United Kingdom

Aim: Wound irrigation solutions are commonly used to prevent the colonization of implants and reduce biofilm formation on the surface. The aim of this study was to evaluate a novel antimicrobial wound irrigation solutions using multifunctional metal complexes (MMC) comprising of silver, cerium, EDTA and/or DTPA against biofilm formation on titanium surfaces.

Method: Biofilm prevention capabilities of Ag-Ce MMC solutions were assessed using a 12 well assay, Ti coupons were placed into 4mL of the MMC solution, then inoculated with 1mL of Staphylococcus aureus and incubated for 24 hours at 37°C, shaking at 125rpm.  After 24 hours, coupons were transferred into Dey-Engley neutraliser and sonicated on full power for 30 minutes, before being serially diluted and plated out onto TSA.

A 24 hour S.aureus biofilm was established on titanium coupons using a standard drip flow model, before removal of planktonic cells and exposure to the treatment solution. After being exposed for 24 hours the coupons were enumerated to confirm total viability counts and subject to microscopy using fluorescent staining.

Results / Discussion: Ag-Ce MMC demonstrated biofilm prevention capabilities, when challenged with a 24 hour contact time, showing a >4 log reduction when compared to the untreated control (NaCl 0.9%).

Ag-Ce MMC also demonstrated potent antibiofilm activity against S. aureus in the drip flow biofilm model.

Conclusion: The results outlined in this study suggest that Ag-Ce MMC could be used in the clinic to prevent biofilm formation or eradicate pre-formed biofilms, such as those in the wound or on titanium implants.

 

EP0562 DACC technology: Safety and effectiveness as antimicrobial dressing for wounds in pediatric

Elaine Monteiro¹, Natalia Barros^2
1European Wound Managment Association, Sobende - Brazylian Society Of Dermatology Nurse, Sbq - Brazylian Society Of Burns, Osasco, Brazil, ²SOBEST - Stomatherapy Brazilian Society, SOBENDE - Brazilian Society of Dermatology Nurse, São Paulo, Brazil

Introduction: In newborns and children, wound can be caused by traumatic injuries, pressure, adhesives or leakage of hypertonic/vesicant solutions. An open wound in child causes pain, activity deprivation and prolonged hospitalization, mainly due infection¹. Chemical antimicrobial dressings are the most widely used in infected wounds. However, many of agents present in these products cause adverse effects and their use must be careful in neonates and pediatrics, with attention to contraindications, time of use and toxicity. In physical/passive dressings (hydrophobic interaction), such as DACC (Dialkyl Carbamoyl Chloride), microorganisms are attracted by hydrophobic interaction, where they adhere and become inert in the dressing (irreversible mechanism), they don’t release endotoxins, don’t multiply and are removed from the wound with dressing change^2, reducing the microbial load. This mechanism of action is safe and has no adverse effects.

Aim: Demonstrate safety and effectiveness of DACC technology dressings on the wounds in pediatric.

Method: A literature review with publications from 2004 to 2024 with DACC technology. Articles were selected according to the inclusion criteria: publications in Spanish, English and Portuguese; intervention in pediatric, experimental, cohort, case-control and systematic review studies, in databases: BIREME; Medical Literature and Web of Science.

Results/Discussion: According to the literature the use of a passive, highly hydrophobic dressing, such as DACC technology, reduces the microbial load and offers a safe and effective alternative for all patients, without restricting age groups or any other specifications and can be used to manage infection instead of using chemical agents.

Conclusion: Through this literature review, it was concluded that dressings with DACC technology are safe, effective and without contraindications for pediatric patients, since they have no restrictions and do not cause cytotoxicity due to their passive microbial control action.

Keywords: DACC, pediatrics, wounds, antimicrobial, cytotoxicity, dressings

 

EP0563 Use for of one year of a sodium chlorite, sodium hypochlorite and hypochlorous acid solution (Granudacyn^®) for treatment and prevention of ssi in a single center study

Giovanni Guercio¹, Sefora La Sala¹, Roberto Gullo², Giuseppe Carollo², Francesco Maltese², Valentina Lombardo², Gianfranco Cocorullo¹, Marco Marcianò^1
1Università degli studi di Palermo, Palermo, Italy, ²A.O.U.P. Paolo Giaccone, Palermo, Italy

Aim: Surgical site infections (SSIs) remain a major clinical concern, leading to increased patient morbidity and healthcare costs. While traditional prevention and treatment strategies have been employed, the emergence of novel antimicrobial agents like Granudacyn® offers a promising approach. This solution, composed of sodium chlorite, sodium hypochlorite, and hypochlorous acid, has demonstrated efficacy in both treating and preventing SSIs. Its unique safety profile, enabling its use on sensitive tissues like the peritoneum, pleura and mucous membranes, underscores its potential to significantly impact clinical outcome.

Method: We conducted a one-year study involving 104 patients in our department. Intraoperative irrigation was applied to two groups: 31 patients with contaminated surgeries (preventive) and 73 with infected surgeries (therapeutic). Surgical sites included the abdomen, perineum, and lower extremities such diabetic foot.

Results / Discussion: This study highlights the clinical benefits of the solution in both preventive and therapeutic settings. Prophylactic use significantly reduced SSI incidence by 9.67% in high-risk patients (NNIS score >2). In the therapeutic setting, the solution effectively treated infected wounds, resulting in a 74.65% improvement rate. Comprehensive follow-up, including wound assessments, laboratory tests, and economic analysis, further underscored the solution’s efficacy and potential cost-effectiveness.

Conclusion: The use of this solution in our clinical practice has allowed us to achieve an improvement in wound healing capacity and a reduction in the incidence of SSI.

 

EP0564 Algae ointment for infection prevention

Georg Daeschlein¹, Gerold Lukowski^2
1Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Dessau, Germany, ²Institut for Marine Biotechnologie e.V., Greifswald, Germany

Aim: Wound infection arise from skin contaminating and colonizing staphylococci of the patient, mainly S.aureus. Avoiding transmission of these pathogens into the wounds by algae ointment seems a key advantage compared to antibiotic use and its side effects, when infections can be prevented.

Method: Fresh mouse ears and cow udder teats were artificially contaminated with high amounts of pathogenic staphylococci (MRSA). Before contamination, skin was treated with skin emollient (controls) or emollient with an innovative algae extract (cyanobacterial strain) [1]. 20min after contamination, cfu were recovered from test skin using agar contact plate technique. Extracts of Spirulina, Chlorella, Nostoc and Oscillatoria redikei served as controls. In a second assay to simulate clinical skin contamination risks ears and udder teats similarly contaminated were pressed for 60 s directly on fresh acceptor ears and teats pretreated with pure emollient or emollient with algae extract. After 20 min the receptor organs were identically checked for bacterial growth as in the prior tests.

Results / Discussion:  Whereas all other algae like pure ointment had no impact on bacterial recovery, ointment containing cyanobacterial extract significantly reduced cfu recovery of all strains by at least 2 logsteps. In donor-acceptor tests pathogenic transmission was reduced to 0 cfu only by the cyanobacterial strain. Number, repartition and composition of normal flora remain unchanged.

Conclusion: The innovative algae extract effectively blocks pathogen transmission to skin and thereby could prevent wound infections at the source without harming skin microbiome.

1. Lukowski G, Lindequist U, Mundt S, Jülich WD:2003 PCT-03/00747

 

EP0499 Octenidine penetration in dermis and acute wounds

Vojtěch Pavlík¹, Tereza Hromádková¹, Barbora Brtková¹, Veronika Praxová¹, Kateřina Lehká¹, Monika Vacková¹, Kristina Nešporová^1
1Contipro, a.s., Dolní Dobrouč, Czech Republic

Aim: Octenidine (OCT) is a widely used antiseptic for treating both acute and chronic wounds. Although prior studies show minimal OCT penetration through tape-stripped skin, its behavior in epidermis-free skin remains unexplored. This study aimed to evaluate OCT penetration in dermis when applied as part of a commercial OCT-phenoxyethanol solution (OCT+PE) or hyaluronan-based nanofibers containing OCT (OCT+HA).

Method: Using a Franz cell model, skin samples with mechanically removed epidermis were used to assess OCT penetration. OCT levels in the dermis, donor, and receptor compartments were measured via HPLC. Parameters mimicking chronic wound environments, such as neutral/alkaline pH and the presence of proteins, were studied. The antimicrobial activity of OCT+HA was tested at concentrations of 2.5 and 7.5 µg/cm². Additionally, OCT penetration in mouse acute wounds (n=6) and its systemic distribution in organs were evaluated.

Results / Discussion: OCT showed no significant metabolism in either skin or wounds. The majority of OCT was detected in the dermis across all experimental conditions, with only minimal amounts detected in the receptor solution. Importantly, no OCT was found in the bloodstream or organs (liver, kidney, spleen). In mouse acute wounds, OCT penetration was minimal, with no adverse effects observed on wound healing when OCT+HA (7.5 µg/cm²) was applied.

Conclusion: These findings suggest that repeated, long-term application of OCT is safe for chronic wound management, as minimal systemic absorption occurs, and the compound does not accumulate in tissues or organs.

 

BASIC SCIENCE

EP0241 Antispasmotic agent loaded injectable and smart hydrogel system for prevention of vascular problem to improve flap survival in rat skin flaps

Hwanjun Choi¹, Hyun Kim^1
1Soonchunhyang University Hospital, Cheonan, Rep. of South Korea

Aim: Vasospasm during reconstructive microsurgery is a common, uncertain and devastating phenomena concerning flap survival. Topical vasodilators as antispasmodic agents are widely used to reduce vasospasm and enhance microvascular anastomosis in reconstructive microsurgery.

Method: In this study, thermo-responsive hydrogel (CNH) was fabricated by grafting chitosan and hyaluronic acid to Poly(N-isopropylacrylamide) PNIPAM where, Papaverine an anti-spasmodic agent was loaded (CNHP0.4) to evaluate rat skin flap survival. Mobility during application and injectability through small orifice that can fill spaces after surgery are the clinical advantages of thermo-responsive hydrogels. Physicochemical characteristics of grafted hydrogel and in-vitro biocompatibility of papaverine loaded hydrogels were studied.

Results / Discussion: Post-operative flap survival area and water content of rat dorsal skin flap were measured after 7 days of intradermal application of control hydrogel (CNHP0.0) and Papaverine loaded hydrogel (CNHP0.4) groups. Tissue malondialdehyde (MDA) content and superoxide dismutase (SOD) activity was estimated to determine oxidative stress in the flaps by enzyme linked immunosorbent assay (ELISA). H&E staining and immunohistochemistry (IHC) was used for evaluating flap angiogenesis and inflammatory markers. Results showed that, CNHP0.4 hydrogel could reduce tissue edema, improve flap survival area, increase SOD activity and decrease MDA content. Furthermore, it also significantly increased mean vessel density with upregulated CD34 and VEGF expression and decreased macrophage infiltration with reduced CD68 and CCR7 expression via IHC staining.

Conclusion: Overall, these results indicate that papaverine loaded hydrogel (CNHP0.4) possesses enhanced angiogenesis, anti-oxidative and anti-inflammatory effects which promote skin flap survival by preventing vascular spasm.

 

EP0242 GV1001 enhances wound healing by modulating inflammatory cytokine production and collagen expression in mice and keratinocytes

Kunyong Sung¹, Hongsil Joo², Seungho Lee^3
1Department of Plastic Surgery, School of Medicine, Kangwon National University, Chuncheon-si, Rep. of South Korea, ²Department of Plastic Surgery, Hanil Hospital, Seoul, Rep. of South Korea, ³Kangwon National University Hospital, Seoul, Rep. of South Korea

Aim: Background: GV1001, originally developed as a cancer vaccine, has demonstrated potential in various medical conditions, but its effects on wound healing remain unclear. This study investigates GV1001’s impact on wound healing in a mouse model.

Method: Male C57BL/6 mice were assigned to a control group receiving phosphate-buffered saline or a treatment group receiving GV1001 (1 mg/kg/day). Excisional wounds were created on the dorsal skin, and wound healing was monitored. Inflammatory cytokines were measured by ELISA, and collagen expression was analyzed using Western blot. In vitro assays on primary epidermal keratinocytes (HEKa) evaluated cell viability and wound healing.

Results / Discussion: GV1001 significantly accelerated wound closure starting from day 3, with pronounced differences by day 12. ELISA showed reduced levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) in GV1001-treated mice on day 3. Western blot analysis revealed increased collagen types I and III and decreased TGF-β1 levels on day 12. In vitro, GV1001 enhanced HEKa cell proliferation, migration, and collagen synthesis.

 

 

Conclusion: GV1001 enhances wound healing in mice by promoting collagen synthesis and reducing inflammation, suggesting its potential as a therapeutic agent for wound healing and tissue regeneration.

 

EP0243 Keratinocyte autophagy-mediated self-assembling tetrahedral framework nucleic acid induces scarless healing of full-thickness skin defects

Jian Jin^1
1Fudan University, Shanghai Depeac Biotechnology Co., Ltd, Shanghai, China

Aim: Tetrahedral framework nucleic acid (tFNA) efficiently treats various diseases; however, its effect on wound healing is unknown. We investigated tFNA’s impact on HaCaT cells and wound healing through in vitro and in vivo experiments.

Method: Co culture of tFNA and HaCaT was performed, and the formation of autophagosomes in the cells was observed by transmission electron microscopy (TEM). The degree of autophagy activation was further evaluated by autophagy flow. Through immunofluorescence and Western blot detection of autophagy related proteins microtubule-associated protein 1 light chain 3I (LC3I), LC3II, prostacyclin (P62), anti-thymocyte globulin 5 (ATG5), and ATG7, and Adenosine 5’-monophosphate-activated protein kinase (AMPK) and ULK1 (Ser555) activation, and mechanistic target of rapamycin (mTOR), further confirmation of autophagy activation and exploration of related signaling pathways was obtained. Reverse validation of HaCaT with ATG5/ATG7 gene knockout. Evaluate the activity of tFNA in promoting wound healing and reducing scar hyperplasia through animal wound and scar models.

Results / Discussion: TEM and autophagic flux assays showed that HaCaT cell autophagy activation. Immunofluorescence and western blotting results indicated decreased LC3I and P62 levels, and increased LC3II, ATG5, and ATG7 levels, suggesting increased autophagic activity. AMPK and ULK1 (Ser555) activation, and mTOR inhibition were also observed, suggesting their involvement in tFNA-induced HaCaT cell activation. ATG5 and ATG7 knockdown in HaCaT cells reverse confirmed these results. Animal experiment results mirrored the cellular findings, revealing autophagy induction, wound healing promotion, and effective scar score reduction.

Conclusion: These results suggest that tFNA promotes HaCaT cell autophagy activation through mTOR pathway inhibition, promoting wound healing, reducing hypertrophic scarring, and potentially inducing scarless healing.

 

EP0244 Effects of dry extract of stryphnodendron adstringens 50% on the healing of acute wounds in wistar rats

Helio Galdino Junior¹, Kassya Epaminondas Martins², Ruy Lino Júnior^2
1Nursing School of Federal University Of Goiás, Goiânia, Brazil, ²Institute of Tropical Medicine and Public Health of Federal University of Goiás, Goiânia, Brazil

Aim: to evaluate the effects of dry extract of stryphnodendron adstringens 50% on different wound healing events induced in Wistar rats.

Method: The experiments were performed using male Wistar rats, weighing 250 to 300 grams. The wounds were surgically induced in the upper region of the animal’s back using a 4 cm² acrylic mold as a parameter. The   dressing   was   performed   immediately   after   surgery,  and   according   to   each experimental group. The animals were divided into two groups: control: wound cleaning with warm 0.9% saline solution (39° to 40°C) and treated with dry extract of Stryphnodendron adstringens 50%, subdivided into 04 subgroups, corresponding to 3, 7, 14 and 21 days of experimental period. Morphometric, macroscopic and microscopic analyzes were performed. The   collagen   quantification   was   performed   on   histological   sections   stained   with picrosirius, observed under a binocular microscope (Zeiss Axiostar Plus).  The photographs were digitalized and analyzed through the ImageJ 1.3.1 software

Results / Discussion: Dry extract of Stryphnodendron adstringens 50% influenced fibroblast migration and stimulated angiogenesis at days 3 and 7 respectively. While there was greater intensity of miofibroblasts at day 14. At 21 days dry extract of Stryphnodendron adstringens 50% induced more crustand hypergranulation. The collagen quantification showed significant increase in the group treated with at 21 DAI.

Conclusion: Dry extract of Stryphnodendron adstringens 50% may favor wound healing, leading to fibroblast migration and angiogenesis during the inflammatory and proliferative phases in acute experimental wounds.

 

EP0245 Revisiting the role of platelets: Are plateletsomes extracellular vesicles derived from megakaryocytes?

Cheng Biao^1
1General Hospital of Southern Theater Command of PLA, Guangzhou, China

Aim: Despite playing critical roles in numerous pathological and physiological processes, particularly in blood coagulation homeostasis, it remains challenging to classify platelets into any specific cell type due to the absence of a cell nucleus.

Method: With this question, we make some efforts to revisiting the role of platelets. First,the morphological characteristics of platelet-like particles (PLPs) and the transient event of recipient cells endocytosing platelets were observed for the first time.

Results / Discussion:  Our research indicates that platelet-like particles (PLPs)/platelets exhibit characteristics similar to those of extracellular vesicles (EVs), including size, morphology, and the presence of vesicular features, which prompts us to propose a reclassification of platelets.

Conclusion: We suggest that platelets, which have long been recognized as solely conventional haemocytes, may in fact be a unique subset of extracellular vesicles, which we introduce as the term ‘plateletsomes’. Summarily, the proposed reclassification of platelets as “plateletsomes” challenges traditional views and offers a new framework for studying these important cellular components. If supported by future research, this concept could have far-reaching implications for the study and clinical application of platelets, as well as for our broader understanding of EVs and their roles in physiologic and pathologic processes.

 

EP0246 Hyaluronic acid based adipose tissue-derived extracellular matrix scaffold in wound healing

Dong Yeon Kim¹, Jun Young Joon^2
1The Catholic University of Korea, College of Medicine, St. Vincent’s Hospital,, Seoul, Rep. of South Korea, ²The Catholic University of Korea, College of Medicine, St. Mary’s Hospital, Seoul, Rep. of South Korea

Aim: In this study, we explored the potential of human adipose tissue-derived extracellular matrix (adECM) sheets augmented with crosslinked hyaluronic acid (HA) as advanced wound dressings. We aimed to enhance healing efficacy while optimizing cost efficiency.

Method: The adECM was processed from healthy donor tissue and combined with crosslinked HA to form ECM-HA sheets. In vitro experiments involved seeding adipose-derived stem cells (ASCs) onto these sheets and assessing cell survival and cytokine production. In vivo testing utilized a rat wound model, comparing ECM-HA sheet with HA-based dressing and polyurethane foam dressing. Re-epithelialization and collagen deposition were examined through histopathological examinations, whereas immunohistochemistry was used to assess CD31, alpha smooth muscle actin (a-SMA), and Tenascin C expression as contributing factors to wound healing.

Results / Discussion: Results indicated that ECM-HA sheets were produced efficiently, with enhanced growth factor production and ASC survival observed in vitro. In vivo, ECM-HA sheets demonstrated accelerated wound healing, evidenced by improved epithelialization, thicker dermis, increased collagen deposition, and enhanced vascularity. Notably, they exhibited reduced myofibroblast activity and increased expression of Tenascin C, suggesting a favorable healing environment.

Conclusion: ECM-HA sheets offer a promising approach for wound management, combining the benefits of adECM and HA. They present improved stability and cost-effectiveness while promoting essential aspects of wound healing such as angiogenesis and collagen formation. This study underscores the therapeutic potential of ECM-HA sheets in clinical applications aimed at facilitating wound repair.

 

EP0247 Research on the strategy and mechanism of regenerative medicine technology to repair wounds from the perspective of multi-omics

Caixiang Chen¹, Penghong Chen^2
1Fujian Medical University Union Hospital, Fuzhou, China, ²No.2 Hospital of Fujian Medical University, Quanzhou, China

Aim: Umbilical cord mesenchymal stem cell-derived extracellular vesicles (UCMSC-EVs) are potential therapeutic strategies for skin wounds. This study intends to explore the repair effect and mechanism of UCMSC-EVs on diabetic wounds, and provide a theoretical basis for clinical transformation.

Method: (1) UCMSC-EVs were extracted by molecular size exclusion combined with ultrafiltration concentration. The skin wound model of diabetic mice was established and divided into PBS group, UCMSC-EVs group and Normal group, with 6 mice in each group. An equal volume of PBS or UCMSC-EVs was injected around the wound edge. The wound healing rate of mice was observed. The histological changes of skin wounds were observed by HE and Masson staining. The expression of TGF-β, ICAM-1 and VEGF in skin wound tissues was detected by immunohistochemistry. (2) Single-cell transcriptome sequencing (scRNA-seq) was used to analyze the skin of the three groups.

Results / Discussion: Compared with PBS group, the wound healing rate of mice treated with UCMSC-EVs was significantly increased, the wound tissue structure was significantly improved, and the dermal thickness, number of new hair follicles and collagen deposition rate were significantly increased. It was found that Trps1 + Fib highly expressed stemness-related genes, which could be transformed into the other three cell types as the starting point of pseudo-timing, while Gsn + Fib participated in the phenotypic transformation of Fib as a transition state.

Conclusion: UCMSC-EVs can effectively promote the repair of diabetic wounds by mediating Fib phenotype conversion.

 

EP0248 The effect of adipose derived stem cells for early suture removal

Sang Wha Kim^1
1Seoul National University, Seoul, Rep. of South Korea

Aim: Wound tensile strength recovery is an important part of the healing process. Faster recovery may enable fewer wound sutures and early removal. Not much study has been done to identify the effect of ADCSs on wound tensile strength regeneration. Here, we determined the efficacy of ADSC on skin tensile strength recovery using a customized tensiometer.

Method: Seven skin excisions were made on the backs of the pigs which required different amount of tension for wound closure. The wounds were closed and treated with either normal saline or ADSC. Tensile strength was evaluated after 3, 4 and 9 weeks using a customized tensiometer. Quantitative PCR analysis of cytokines along with histologic evaluation of scar width was also performed.

Results / Discussion: Tensile strength recovery was enhanced in the ADSC injected group compared to that of the control. PCR analysis showed lower levels of TGF-β1, HSP-47 and higher levels of MMP-2, MMP-9 in the ADSC injection group. Scar width was also greater in the control group compared to the ADSC injected specimen.

Conclusion: ADSCs not only accelerate tensile strength recovery but also modifies cytokine levels that lead to scar tissue attenuation. These positive effects will make it possible for early removal of sutures.

 

EP0249 Effects of dexpanthenol (DP) and potassium sucrose octasulfate (PSO) on keratinocyte and fibroblast scratch wound models under delayed wound healing conditions

Cornelia Wiegand¹, Alyssa Sänger¹, Erik Heinicke¹, Jörg Tittelbach^1
1Department of Dermatology, University Hospital Jena, Jena, Germany

Aim: Non-healing wounds represent a major challenge in hospitals and health care settings and chronic inflammation and steroid therapy are known to impair wound healing. In this study, the effects of dexpanthenol (DP) and potassium sucrose octasulfate (PSO) on wound healing in scratch wound models using fibroblasts and keratinocytes under conditions simulating chronic inflammation (cTH1) and steroid treatment (dexamethasone, DM) were investigated. Both substances are frequently used in wound care, yet their effects under impaired healing conditions remain unclear.

Method: Scratch wound assays were conducted with fibroblasts and keratinocytes. The physiological environment was modified to reflect chronic inflammation (cTH1) and steroid therapy (DM) to simulate healing impairment. Wound closure rates as well as secretion of IL-8 and TGF-β were measured.

Results / Discussion: Chronic inflammation and steroid treatment significantly reduced wound healing, especially in keratinocytes. Under normal conditions, PSO negatively affected keratinocyte healing in a dose-dependent manner, while DP had a slight positive effect. Fibroblasts were unaffected by either treatment. In the cTH1 model, DP improved wound healing in fibroblasts, while PSO had positive effects on both cell types. Under DM conditions, DP promoted healing in keratinocytes but had no effect on fibroblasts. PSO negatively impacted keratinocytes but enhanced fibroblast healing. Both treatments reduced IL-8 secretion under all conditions, while DP and PSO also reduced TGF- β secretion in keratinocytes.

Conclusion: These results suggest that DP and PSO may influence wound healing differently in chronic inflammation and steroid treatment scenarios, with varying effects on keratinocytes and fibroblasts. This could have clinical implications for treating wound healing disorders in patients under similar conditions.

 

EP0250 Malignant melanoma; case analysis of 55 patients over 22 years

Hyemi Lee¹, Na Young-cheon¹, Choonsoo Kim¹, Seoul Lee^2
1Wonkwang University Hospital, Iksan, Rep. of South Korea, ²Wonkwang University, Iksan, Rep. of South Korea

Aim: This study aimed to analyze the characteristics of malignant melanoma patients from 2000 to 2022 to identify contributing factors to this rise.

Method: A retrospective review of 1,011 skin cancer cases at a single medical center from 2000 to 2022 identified 56 patients with malignant melanoma. Patients were grouped by diagnosis period: Group A (2000-2017) and Group B (2018-2022). Data included age, gender, lesion location, and medical and social history.

Results: The prevalence of malignant melanoma among skin cancers rose from 5.1% to 6.0%, with a marked increase in male patients (5.3% to 9.2%), while remaining stable among females (4.9% to 4%). Most patients (71%) were over 70 years old. Incidence on the trunk and lower extremities increased notably (trunk: 8% to 23%, lower extremities: 40% to 55%). Group B patients had higher rates of comorbidities, including hypertension (32% to 65%), diabetes (8% to 35%), and degenerative disease (12% to 26%). Smoking and alcohol use also rose in Group B (12% to 23% for smoking; 0% to 19% for alcohol).

Conclusion: Male skin cancer patients, particularly those with melanoma on the trunk or lower extremities and a history of chronic disease, smoking, or alcohol use, should be carefully evaluated for melanoma risk. Further research is warranted to explore the links between melanoma, gender, and comorbidities.

 

EP0251 Personalized vulnerability to mechanical stress: A computational approach to predict skin damage in individuals

Daphne Weihs^{1 2 3
1}Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel, ²Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Gent University, Gent, Belgium, ³Department of Mathematics and Statistics, Faculty of Sciences, Hasselt University, Hasselt, Belgium

Aim: The skin, the body’s largest organ, acts as a barrier against external mechanical stress, pathogens, and environmental threats. However, the sensitivity of the skin to mechanical stress varies significantly among individuals due to factors such as age, gender, genetics, and lifestyle, making certain populations more prone to skin damage and ulceration. Identifying expected variations in individuals can facilitate personalized prevention and treatment strategies for patients. We thus developed computational models to emulate different effects of mechanical stress on skins of individuals.

Method: We developed computational, finite element models of the skin layers (epidermis, dermis, and hypodermis) and the underlying muscle and bone, to represent specific populations with varying age and gender. The models varied in skin-layer thickness and its mechanics, based on previously published experimental and modelling data. We used the models to simulate the biomechanical behavior of the skin under different external mechanical stresses, to evaluate the stress levels and timescales under which skin damage was likely to occur in individuals, for example under medical device delivered forces.

Results / Discussion: Our models revealed differences in biomechanical and mechanobiological responses to mechanical stress, indicating when injury may occur depending on individual characteristics relating to age and gender. We demonstrate the model sensitivity to variations in these parameters, highlighting effects of the different evaluated factors.

Conclusion: Computational models of skin layers offer a valuable tool that can specify the potential sensitivity of individuals to mechanical stress and could direct to personalized strategies for prevention and treatment of skin damage.

 

EP0252 Self oxygen-generating subdermal hydrogel implants enhance flap regeneration through mitochondrial biogenesis and oxidative stress modulation

Ji-Ung Park^{1 2
1}Seoul National University Boramae Hospital, Seoul, Rep. of South Korea, ²Seoul National University College of Medicine, Seoul, Rep. of South Korea

Aim: Random pattern skin flaps are widely used in reconstructive surgery for tissue defect repair, but distal tip necrosis often occurs due to insufficient blood perfusion. Managing tissue ischemia in surgical flaps remains a critical challenge in regenerative medicine, as inadequate blood flow can lead to necrosis.

Method: This study investigated the therapeutic potential of catalase-coated oxygen-generating microparticles (cOMP) embedded in a gelatin methacryloyl (GelMA) hydrogel to optimize tissue regeneration. Using a 3 × 9 cm² rat random pattern skin flap model, four groups were evaluated: control, GelMA hydrogel, and cOMP-GelMA hydrogels with 0.2% and 0.5% cOMPs.

Results / Discussion: The 0.2% cOMP-GelMA hydrogel significantly improved angiogenesis, arteriogenesis, mitochondrial biogenesis, and antioxidant capacity while reducing inflammation more effectively than the 0.5% concentration

Conclusion: Mild hypoxia, enabled by controlled oxygen delivery, proved advantageous for tissue regeneration through PGC-1α and HIF-1α signaling pathways. This study highlights the potential of using cOMPs to enhance long-term recovery in ischemic tissues by promoting a balanced oxygen environment.

 

EP0253 Effects on thyroid function of topical liposomal hydrogel with 3% povidone-iodine dressing

Na Young-cheon¹, Hyemi Lee¹, Choonsoo Kim¹, Seoul Lee^2
1Wonkwang University Hospital, Iksan, Rep. of South Korea, ²Wonkwang University, Iksan, Rep. of South Korea

Aim: This study aimed to evaluate the effect of a topical liposomal hydrogel with 3% povidone-iodine (PVP-I) on thyroid function, given concerns that iodine in PVP-I could impact thyroid health. Safety considerations for its clinical use were also assessed.

Method: Thyroid function was evaluated in patients before and after treatment with a topical liposomal hydrogel containing 3% PVP-I, from January 2017 to January 2023, over a minimum period of two weeks. Patients were stratified by age, sex, and medical history.

Results: No significant changes in thyroid function were observed in the 61 patients up to two weeks post-application. However, T3, T4, and free T4 levels significantly increased at four weeks. Comparison of thyroid function tests (TFT) at baseline and four weeks post-application revealed mean T3 levels of 71.12 ± 17.55 ng/dL and 59.84 ± 18.60 ng/dL, mean T4 levels of 6.48 ± 1.49 µg/dL and 5.50 ± 1.36 µg/dL, and mean free T4 levels of 1.08 ± 0.39 ng/dL and 0.90 ± 0.19 ng/dL, respectively.

Conclusion: Thyroid function changes were noted following the application of the topical liposomal hydrogel with 3% PVP-I. Regular thyroid function assessments are recommended before and after treatment. Clinicians should carefully monitor patients with pre-existing thyroid abnormalities and consider follow-up TFTs at four weeks.

 

 

EP0254 3D cell printed muscle tissue for functional muscle recovery

Jun Young Joon^1
1The Catholic University of Korea Seoul St Mary Hospital, Seoul, Rep. of South Korea

Aim: Reported tissue engineered skeletal muscle repair constructs remodeled into a fibrotic tissue and showed limited functional improvement in volumetric muscle loss (VML) model. Therefore hydrogel-based 3D engineered muscles and the decellularized extracellular matrix (dECM) have been considered for VML treatment, but they also have shown limited efficacy. The authors established the skeletal muscle construct composed of cell-laden dECM bioink generated with a granule-based printing reservoir.

Method: To mimic the hierarchical architecture of vascularized muscles, coaxial nozzle printing method was used. Human umbilical vein endothelial cell (HUVEC) and human skeletal muscle (hSKM) were printed with the muscle and vascular dECM bioink. In vitro studies revealed well aligned and striated muscle fibers with high cell viability without hypoxia of the 3D cell printed muscle constructs. About 15x6x4mm sized vascularized skeletal muscle constructs were implanted to 40% defect of tibialis anterior (TA) muscle of Sprague-Dawley rats.

Results / Discussion: After 4 weeks, the coaxial printing group showed a significantly improved TA muscle weight than other control groups and achieved recovery at 78.6 ± 3.2% of the contralateral native TA muscle. Masson’s trichrome staining demonstrated very few fibrotic tissues with well-organized de novo muscle fibers in the coaxial printing group. In situ force production showed that the coaxial printing group yielded an isometric torque of 87.2 ± 3.44 N mm/kg, which corresponds to 85% of the uninjured muscle, superior than other groups.

Conclusion: Our present results suggest that a 3D cell printing and tissue-derived bioink-based approach could effectively generate biomimetic engineered muscles to improve the treatment of VML injuries.

 

EP0628 Cellular and transcriptomic changes in skin and oral keratinocytes after thermal injury

Chen Han¹, Amy Chen², Heidi Yuan¹, Luisa DiPietro¹, Lin Chen^1
1Center for Wound Healing and Tissue Regeneration, University of Illinois Chicago, Chicago, United States, ²Naperville Central High School, Naperville, United States

Aim: Skin and oral tissues are constantly exposed to harsh environments. Oral wounds heal faster, with less scarring and inflammation compared to skin wounds. The aim is to investigate whether skin and oral keratinocytes respond differently to thermal injury at the cellular and transcriptomic levels.

Method: Human skin keratinocytes (HaCaT) and human gingival keratinocytes (TIGK) were exposed to 60°C for 20 minutes and -25°C for 60 minutes. Cell morphology and viability were examined. Total RNA was extracted, and RNA sequencing and bioinformatics analyses were subsequently performed.

Results / Discussion: HaCaT and TIGK cells maintained their morphology under heated conditions. TIGK cells, but not HaCaT cells, became smaller under frozen conditions. A substantial number of TIGK and HaCaT cells died after thermal injury. However, TIGK cells showed significantly higher viability than HaCaT cells under heated conditions. Both TIGK and HaCaT cells exhibited similarly decreased viability under frozen conditions. RNA sequencing revealed hundreds of genes that were either up- or downregulated compared to uninjured cells. Several shared or exclusively expressed heat shock protein (HSP) genes were identified in HaCaT compared to TIGK following thermal injury. Additionally, a few common regulated gene ontology terms were observed in both HaCaT and TIGK cells after injury.

Conclusion: Oral keratinocytes were more resistant to heat treatment. Thermal injury induced significant transcriptomic changes in both skin and oral keratinocytes. The molecular mechanisms activated in response to thermal damage may differ between the cell types. However, both hot and cold thermal damage seemed to elicit some similar molecular responses in skin and oral keratinocytes.

 

EP0255 Effects of Qui/HPMC/insulin hydrogel on Wnt signaling and tissue regeneration in hyperglycemic animals

Flávia Zanchetta¹, Antonio Thiago Campos², Maria Esméria Corezola³, Thais Paulino do Prado¹, Joseane  Ricciardi de Aguiar⁴, Beatriz Barbieri¹, Ariane Zanesco¹, Licio Velloso⁴, Eliana P Araújo¹, Maria Helena Lima^1
1School of Nursing of University of Campinas, Campinas, Brazil, ²Universidade Federal do Ceará, Fortaleza, Brazil, ³Centro Universitário da Fundação Hermínio Ometto, Araras, Brazil, ⁴Obesity and Comorbidities Research Center,, Campinas, Brazil

Aim: To investigate the Qui/HPMC/Insulin hydrogel effect on the Wnt signaling pathway and its crosstalk with other pathways.

Method: Excisional wounds were made on the backs of hyperglycemic animals, which were divided into three experiemental groups: SAL, treated with saline solution; Qui/HPMC, treated with hydrogel without insulin and Qui/HPMC/Ins treated with hydrogel with insulin. The tissues were extracted on the 7th (D7), 14th (D14), 17th (D17) and 20th day (D20) post-wound and immunohistochemical and molecular experiments were performed.

Results / Discussion: in the analysis of gene expression of cytokines of the Wnt pathway, the SAL group showed higher expression of β-catenin, Wnt7a, Wnt3a, Wnt5a on D7. On D20, the Qui/HPMC/Ins group showed higher expression of Wnt3a. Protein expression analysis showed that there was no difference between the groups in the expression of β-catenin. In contrast, immunostaining was more pronounced in the Qui/HPMC/Ins group in the epidermis and around hair follicles on D7. Regarding Wnt7a and ERK, there was higher expression of these proteins in the Qui/HPMC/Ins group compared to the other experimental groups on D17.
Conclusion: The participation of the Qui/HPMC/Insulin hydrogel on the Wnt signaling pathway is evidenced by the increased expression of Wnt7a and ERK in the Qui/HPMC/Ins group on D17 with possible crosstalk between the Wnt and ERK signaling pathways, since there was an increase in the expression of both proteins during this period.

 

EP0256 The effects of silicone-based agents massage on scar tissue thickness after burns in rats

Hyemi Lee¹, Na Young-cheon¹, Choonsoo KIM¹, Seoul Lee^2
1Wonkwang University Hospital, Iksan, Rep. of South Korea, ²Wonkwang University, Iksan, Rep. of South Korea

Aim: This study compared the effects of topical silicone agents (silicone gel sheet and scar gel) with massage on scar healing in burn wounds of SD rats, specifically targeting collagen synthesis and granulation tissue formation.

Method: Second-degree burns (200°C, 10 seconds, 20 mm diameter) were applied to the backs of 15 SD rats. After epithelialization, rats were divided into four groups: A) Control, B) Petroleum jelly (without massage), C) Silicone gel sheet with massage, D) Silicone-based scar gel with massage. Massage was applied twice daily. Histological analysis occurred at 4, 10, and 16 weeks.

Results: At 4 weeks, silicone-treated groups (C and D) showed moderate collagen levels and more fibroblasts than the control (A) and petroleum jelly (B) groups. By 10 weeks, Groups C and D showed reduced collagen thickness, increased fibroblast activity, and less inflammation than the control, which still had granulation tissue. At 16 weeks, only Groups C and D maintained reduced collagen and mature scar tissue with fewer signs of granulation, while petroleum jelly moderately reduced scarring.

Conclusion: Silicone-based treatments combined with massage promote scar maturation and reduce inflammation more effectively than petroleum jelly alone. These findings recommend silicone treatments and massage for managing contact burn scars.

 

Figure 1. Histological findings at 4, 10, and 16 weeks (H & E stain, x100-400) illustrate collagen structure and inflammation differences among groups. Control group (Above, left) petroleum jelly group (Above, right) silicone gel sheet group (Below, left) silicone-based scar gel group (Below, right)

 

EP0257 Mechanisms of Sox9 sequential influence on the direction of hairfollicle stem cell differentiation and promotion of extensive wound repair

Chang-Min Lin¹, Wenzi Liang^1
1Shantou University Medical School, Shantou, China

Aim: The primary objective of this study is to investigate the mechanisms by which hair follicle stem cells (HFSCs) contribute to wound healing, particularly in the context of large skin wounds where traditional autologous skin grafting may be limited by a lack of skin sources.

Method: Autologous hair follicle transplantation models were established in rats and Bama pigs to investigate the effect of removing hair shaft and dermal papilla hair follicles and intact hair follicles in wound repair. Cell lineage tracing and spatial transcriptome analysis were used to explore the role of Sox9 in the differentiation fate of HFSCs and its relevance to wound repair.

Results / Discussion: The results indicated that hair follicles with removed hair shafts and dermal papillae were more effective in repairing wounds than intact hair follicles. This led to the proposal of the “physical barrier-hair shaft” and “biological barrier-dermal papilla” theory regarding the migration of HFSCs. The study observed a correlation between Sox9 and wound repair, suggesting its importance in HFSC differentiation. The sequential regulation of the TGF-β/Sox9, Sox9/Wnt, and Sox9/Activin/pSmad2 signaling pathways were confirmed, providing insights into how HFSCs are initiated to migrate, activated to transdifferentiate, and ultimately contribute to regeneration.

Conclusion: The findings suggest that scalp transplantation, potentially leveraging the transdifferentiation capacity of HFSCs, could be a more effective treatment for large skin wounds than traditional body skin grafting. The discovery of the role of Sox9 and the identified signaling pathways in HFSC migration and transdifferentiation presents a promising avenue for addressing the clinical challenge of insufficient skin sources for wound repair.

 

EP0271 Histological and ihc characterization of chronic burn wounds in Göttingen minipigs (GMP)

Avital  Schauder ¹, Elizabeth Eisenach², Sigal  Meilin¹, Stephanie Horn^1
1MD Biosciences Innovalora, Rehovot, Israel, ²Business Development Associate, NS, Israel

Aim: To develop and characterize a chronic burn wound model in GMP.

Method: Female GMP pigs, provided by Ellegaard, Denmark, underwent partial-thickness burn induction using a heated metal (137–139°C, 20 seconds) at multiple back locations under anaesthesia. Painkillers and antibiotics were administered before and after the procedure. Pigs were culled either at 30 or 90 days post-insult. Tissue samples were stained with HE, MTC, and Herovici stains for pathology and collagen analysis, and immunohistochemically stained for CD31 (blood vessels) and PGP9.5 (intraepidermal nerve fibers, IENF). All slides were analyzed using AI-based software (STUDIO™ by DeepPathology).

Results: All pigs gained weight during the study. Wound area reduced by over 50% at 35 days and by 75%–80% at 90 days. Staining and AI analysis showed that on study day 35, the mean collagen density was 61.81 ± 4.12%, and the scar width was ~21mm. The mean number of blood vessels per tissue area was 14.58 ± 1.91. IENF presence was minimal at this stage, as nerve regeneration typically occurs later.

At 90 days post-insult, the mean percentage of freshly formed collagen was 5.49 ± 1.02%, and the IENF count was 13.69 ± 1.26 nerve endings per mm of tissue, suggesting renewal of the nerve endings at this time point.

Conclusion: This model provides a platform to study burn wound healing, including collagen maturation, blood vessel formation, and nerve regeneration, making it suitable for therapeutic evaluation.

 

EP0273 Exploring the effect of ADM on macrophage infiltration and polarization in chronic wound healing based on RNA-seq

Binghui Li¹, Zhi Wang¹, Gongchi Li^2
1Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, ²Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Aim: To investigate the promotional effect of ADM on chronic wound recovery inflammation and macrophage regulation in mice

Method: Acellular dermal matrix (ADM) is the decellularized skin tissue by removing of the cellular components and reserving the extracellular matrix structure derived from porcine. Mouse model of chronic wound was established. Control group were covered with gauze, ADM group were covered with gel-like ADM. The wound healing was analyzed on days 0, 7, 14, 21 and 28 by ImageJ, H&E and Masson staining. WGCNA and GO enrichment analysis was used to compare the multi-time healing tissues after RNA-seq. Ccl2, Ccr1, F4/80, Mmp12, Fn1, CD206 and Arg-1were evaluated by IF and gene expression levels to explore macrophages in the tissues.

Results / Discussion: GO enrichment analysis suggested that the duration of inflammatory response was shortened in the early ADM group. In the gene modules screened by WGCNA, the rich genes of ADM group were concentrated in keratinization, epidermal development and epithelial cell differentiation. The expression of inflammatory factors Ccl2 and Ccr1 in the early two groups decreased after reaching the peak on 7th day. The expression level of F4/80 in ADM group was higher than that in control group. On 14th day, the expressions of Mmp12 and Fn1 in ADM were higher. The expression and abundance of M2 macrophages in the ADM group were higher than those in the control group.

Conclusion: ADM can promote epidermal development, re-epithelialization and regulate the inflammatory process of chronic wound. The specific mechanism may be that ADM promotes wound inflammation in the early stage, influences macrophage infiltration and M2-type polarization by stimulating Ccl2 release.

 

EP0258 Effect of umbilical cord mesenchymal stem cell-derived mitochondrial transplantation on ischemia-reperfusion injury in a rat model

Eunsoo Park¹, Galina Khan¹, Hangyu Cha¹, Seungmin Nam^1
1Soonchuhyang University Bucheon Hospital, Bucheon, Rep. of South Korea

Aim: Despite advancements in reconstructive procedures, ischemia reperfusion(I/R) injury remains a significant challenge in reconstructive surgery, with mitochondrial dysfunction playing a pivotal role. This study aims to evaluate the impact of umbilical cord mesenchymal stem cell-derived mitochondrial transplantation on skin flap I/R models in rats.

Method: Twenty male rats underwent I/R injury on skin flaps, with or without mitochondrial transplantation administered via intravenous or subcutaneous routes. Analysis encompassed histopathology, inflammatory, apoptotic, oxidative stress, and hypoxia markers.

Results / Discussion: Results revealed a reduction in inflammation, apoptosis, oxidative stress, and hypoxia in the transplantation group compared to controls.

Histological analysis using H&E staining demonstrated a notable decrease in inflammatory cell infiltration in the transplantation group compared to the control, indicating a significant reduction in inflammation. In the TNF-alpha immunohistochemical staining, fewer cells showing a brownish color were observed in the transplantation group in comparison to the control group. Additionally,

RT-qPCR analysis revealed statistically significant decrease in TNF-alpha, IL-1β, and IL-6 expression within the transplantation group (“I/V before”, “I/V after”, “S/C before”, “S/C after”) compared to the control group. In the Casp3 immunohistochemical staining, a discernible decrease in the number of positively stained cells was observed in the transplantation group compared to the control group.

SOD1 immunohistochemical staining revealed a higher count of brown-colored positive cells in the transplant group compared to the control group.

HIF-1-alpha immunohistochemical staining revealed a lower count of positive cells in the transplantation group compared to the control group.

Conclusion: The findings suggest that umbilical cord mesenchymal stem cell-derived mitochondrial transplantation shows promise in enhancing flap viability and attenuating I/R injury, offering valuable insights for improved outcomes in reconstructive surgery.

 

EP0259 The usefulness of S incision in the mass excision

Yu Jin Kim^1
1Gachon University Medical Center, Incheon, Rep. of South Korea

Aim: Skin and soft tissue pathologies such as lipomas often require surgical intervention. Skin tension refers to the tightness of the skin required for the incision during the surgery. Human skin of back is thick and tough, so it needs a larger incision to remove the large masses. In this study, we evaluate the skin tension to separate the skin the depending on the incision type.

Method: Fresh porcine skin was harvested with skin, subcutaneous layer, and muscle of 40*50cm. We made the 10*10cm grids, which were randomized into three groups. A 5cm straight incision was made in group A, a 5cm S incision was made in group B, and a 5.8cm straight incision was made in group C. The depth of the incision was the subcutaneous layer. The hooks of the digital Newton meter (Newton meter GN-1, Narika Corp, Japan) were applied in the middle of the incision, and traction force was measured by pulling it to both sides so that the incision window was opened 3cm.

 

Results / Discussion:

 

 

Conclusion: The most commonly used method to remove a subcutaneous mass is the straight incision. According to this study, the S incision provides easy exposure of the large mass, so the surgeon can dissect the mass meticulously without hurting the vessels and nerves.

 

 

EP0260 Electrochemical impedance of skin barrier function

Krystal Le Doare¹, Toby Jenkins¹, Natalie Maguire², Leah Conway², James Clarke^2
1University of Bath, Bath, United Kingdom, ²Gama Healthcare Ltd, Halifax, United Kingdom

Aim: Ammonia is linked to many human diseases including dermatitis. The pathological mechanisms of diseases caused by ammonia on skin are various, as seen below. Skin models can be useful for modelling ammonia-related diseases, such as incontinence associated dermatitis (IAD).

 

Tape stripping is a simple and effective technique to induce impaired skin barrier function and to facilitate transdermal penetration studies. In this example, tape stripping was used to assess the integrity of the stratum corneum via electrochemical impedance spectroscopy (EIS) and transepidermal waterloss (TEWL) measurements to compare which method is most effective at measuring skin barrier impairment.

Method: 6 volunteers were used in this study.

EIS and TEWL were taken before applying treatment to skin to measure baseline resistance. Tape stripping was performed by applying Sellotape to the desired skin region using mild pressure. Tape is then stripped off skin. EIS and TEWL were then measured.

After Tape stripping, skin emollients from competitor continence wipes were placed on skin to assess their ability to improve skin barrier function. EIS and TEWL were then taken 5 minutes after application to assess the effectiveness of the wipes.

Results / Discussion: When assessing the effectiveness of EIS vs TEWL, it was found that EIS is a more sensitive technique than TEWL. The participant who experienced the greatest skin damage after tape stripping had > 1000 times decrease in normal skin resistance in EIS by only 4.5-fold increase with TEWL after 30 strips, suggesting impedance is more sensitive than TEWL at detecting skin damage.

Conclusion: Impedance spectroscopy appears to be a more sensitive technique than TEWL at detecting skin damage.

 

EP0261 An in vitro study investigating the impact of perspiration on the coefficient of friction between multilayered wound dressings and a skin substitute

Amit Gefen^{1 2 3}, Jordan Fisk⁴, Lauren Bagshaw⁴¹Tel Aviv University, Faculty of Engineering, Department of Biomedical Engineering, Tel Aviv, Israel, ²Ghent University, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), Ghent, Belgium, ³Hasselt University, Faculty of Sciences, Department of Mathematics and Statistics and the Data Science Institute, Hasselt, Belgium, ⁴Convatec, Research & Development, Deeside, United Kingdom

Aim: A high coefficient of friction (COF) between dressings and skin can increase soft tissue exposure to shear forces, raising the risk of pressure injuries. Many dressings used for pressure injury prevention (PIP) include an adhesive silicone skin-contact layer that transfers frictional forces inward, potentially counteracting their PIP effect. This study compared COFs of two multilayer dressings, one with a silicone skin-contact layer and one with a Hydrofiber skin-contact layer, in an in vitro model which accounted for perspiration.

Method: COFs were measured using a sled test based on ASTM D1894-14. Dragon skin was cast at 3.5 mm. Dressings were applied to a 63.5x63.5 mm sled weighing 200 g, with an additional 3 kg for silicone dressings due to their high COFs. Simulated perspiration used a water/sodium/calcium ions solution, sprayed at 0.3 g increments. Sled speed was 150 mm/min.

Results / Discussion: At 5% and 10% dressing saturation, Hydrofiber COFs were 0.52 ± 0.05 and 0.28 ± 0.03 (static), and 0.47 ± 0.05 and 0.25 ± 0.02 (kinetic), showing no statistically significant changes as moisture levels increased.   Regardless of dressing saturation level the COF values were significantly higher for silicone, at a 100% dressing saturation the COF values were 2.07 ± 0.20 (static) and 1.47 ± 0.17 (kinetic).

Conclusion: A novel multilayer dressing with Hydrofiber skin-contact layer demonstrated significantly lower COFs compared to silicone, reducing tissue shear exposure. Even in low-sweat areas, natural moisture accumulation could further minimise Hydrofiber COFs, making this beneficial for direct skin contact in a PIP dressing.

 

EP0272 Antibiofilm reduction on a scratched-3D skin tissue model using nano-encapsulated mupirocin

Ziba Najmi¹, Alessandro Calogero Scalia¹, andrea cochis¹, Juliana de Souza Nunes², Jon Lacunza², Lia Rimondini^1
1Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases CAAD, Università Del Piemonte Orientale (UPO), Novara, Italy, ²CIDETEC, Basque Research and Technology Alliance (BRTA), Parque Cientìfico y Tecnològico de Gipuzkoa, Donostia - San Sebastián, Spain

Aim: Current wound management, including (i) wound debridement, (ii) off-loading to release pressure in the wound, and (iii) application of skin dressings, is insufficient. Additionally, the treatment of chronic wounds and the self-regeneration of the skin are complicated by bacterial infections, and formation of biofilm. Therefore, the aim of this study is to evaluate the potential antibacterial activity of Mupirocin (MUP) encapsulated in methacrylated hyaluronic acid (HA-MA) polysaccharide-stabilized emulsion on a 3D skin tissue model infected by Staphylococcus aureus.

Method: SkinEthic^TM Human Epidermidis (Figure 1A), purchased from EPISKIN and histologically similar to human epidermidis, was infected by S. aureus biofilm. Infections were performed after creating a scratch on the 3D model to mimic an infection in a skin scar (Figure 1B). After 24 hours of incubation at 37 °C, a solution of nano-encapsulated MUP (HA-MA-MUP) containing 1.2 µg/mL of MUP was added to the 3D skin models and incubated again. Morphology of bacterial biofilm formed in the presence of HA-MA-MUP was compared to that of the control samples (HA-MA) using scanning electron microscopy.

Results / Discussion: As shown in Figure 1C, the release of MUP from the HA-MA led to a decrease in the number of bacterial aggregations compared to the control samples, as shown by the disappearance of the blue-stained bacteria after treatment.

Conclusion: This promising result indicates the potential of this encapsulation technique to conserve MUP’s antibacterial activity at low concentrations. Further experiments, such as stability and antibacterial activity of HA-MA-encapsulated MUP loaded into hydrogels against bacterial pathogens are ongoing.

 

 

EP0262 The role of iron in wound chronicity: A narrative review

Raúl Orozco Irles¹, Maria Jose Gil Mosteo², Arturo Miravet Gómez³, Marta Corbalán Díaz¹, Sara Martín-Sauceda Sánchez¹, María Sánchez Maestre¹, Isabel Beviá Romero^1
1SAN-GVA, Alicante, Spain, ²Servicio Aragonés de Salud, Zaragoza, Spain, ³Mutua Terrasa, Rubí, Spain

Aim: To investigate the role of iron in the chronicity of wounds and explore underlying biological mechanisms.

Method: This descriptive narrative review analyzed studies on the relationship between iron levels and chronic wound healing, focusing on inflammatory pathways, oxidative stress, and clinical implications. Literature was systematically searched in PubMed, Cochrane, and CINAHL using “Chronic Wounds” and “Iron” as search terms, including only full-text studies from the last 10 years (2014-2024) in English and Spanish. Inclusion criteria encompassed observational studies, randomized controlled trials, systematic reviews, and meta-analyses involving humans and relevant animal models.

Results / Discussion:  A total of 14 studies met the inclusion criteria, covering various topics: (1) iron’s role in reactive oxygen species (ROS) production, promoting inflammation and delayed healing; (2) macrophage and fibroblast modulation via ROS, impacting tissue repair; (3) iron deficiency anemia, driven by hypoxia-inducible factor-1 (HIF-1), linked to slower venous ulcer healing; (4) oxidative stress and lipid peroxidation delaying diabetic ulcer healing; (5) iron accumulation from myoglobin in pressure ulcers correlating with wound size; (6) excess iron in venous ulcers exacerbating inflammation and slowing healing; and (7) hemosiderin buildup inducing chronic inflammation in affected skin.

Conclusion: This review confirms a correlation between iron dysregulation and wound chronicity, highlighting the need for precise iron modulation in treatment strategies. Evidence supports exploring iron-chelation therapies to mitigate oxidative stress and promote healing in chronic wounds. Further research is crucial to quantify prevalence and guide targeted therapeutic developments.

 

EP0263 Fat graft survival requires metabolic reprogramming toward the glycolytic pathway

Taehee Jo^1
1Keimyung University School of Medicine, Daegu, Rep. of South Korea

Aim: Fat grafting presents a promising approach in chronic wound management, offering regenerative potential. However, the mechanisms underlying fat graft survival are poorly understood. Here, we performed an unbiased transcriptomic analysis in a mouse fat graft model to determine the molecular mechanism underlying free fat graft survival.

Method: We conducted RNA-sequencing (RNA-seq) analysis in a mouse free subcutaneous fat graft model on days 3 and 7 following grafting (n = 5). High-throughput sequencing was performed on paired-end reads using NovaSeq6000. The calculated transcripts per million (TPM) values were processed for principal component analysis (PCA), unsupervised hierarchically clustered heat map generation, and gene set enrichment analysis.

Results / Discussion: PCA and heat map data revealed global differences in the transcriptomes of the fat graft model and the non-grafted control. The top meaningful upregulated gene sets in the fat graft model were related to the epithelial-mesenchymal transition and hypoxia on day 3, and angiogenesis on day 7. Mechanistically, the glycolytic pathway was upregulated in the fat graft model at days 3 (FDR q = 0.012) and 7 (FDR q = 0.084). In subsequent experiments, pharmacological inhibition of the glycolytic pathway in mouse fat grafts with 2-deoxy-D-glucose (2-DG) significantly suppressed fat graft retention rates, both grossly and microscopically (n = 5).

Conclusion: Free adipose tissue grafts undergo metabolic reprogramming toward the glycolytic pathway. Future studies should examine whether targeting this pathway can enhance the graft survival rate.

 

EP0264 Developing antibiofilm wound dressings using nitric oxide releasing MOFs

Morven Duncan¹, Marcus Swann², Rui Chen², Steven Percival², Russell Morris^1
1University of St Andrews, St Andrews, United Kingdom, ²5D Health Protection Group Ltd., Liverpool, United Kingdom

Aim: Chronic wounds are notoriously difficult to heal, with many long-term infections resulting in amputation (135 per week in England). Nitric oxide (NO) plays a critical role in the wound-healing process via its antimicrobial properties, modulation of platelet/cytokine function, vasodilatory effects, and promotion of angiogenesis and matrix deposition. However, because of its gaseous nature and toxicity in high concentrations, storage and delivery of biologically active concentrations of NO for exogenous delivery remains a significant challenge. The aim of this study was to explore the feasibility of producing an NO releasing wound dressing and to test its antimicrobial and anti-biofilm properties.

Method: In this study, a Metal Organic Framework (MOF) powder, a material which can reversibly bind NO, is mixed with a polymer binder and coated onto wound dressings before loading with NO. The antimicrobial activity of dressings was tested against planktonic Pseudomonas aeruginosa in a direct contact assay, and against biofilm grown in a CDC bioreactor. Fibers inoculated with P.a. were imaged using fluorescence confocal microscopy and live/dead staining.

Results / Discussion: The MOF was successfully coated onto wound dressings and the NO release profile can be controlled by the polymer binder and % MOF loaded. NO releasing dressings were effective against planktonic P.a with <4 Log reduction, similar to a commercial dressing control and more effective than the positive control against P.a biofilms.

Conclusion: The NO-releasing MOF loaded wound dressing provides an interesting demonstration for a novel antimicrobial wound dressing concept, through the action of the naturally occurring antimicrobial and biologically active agent nitric oxide.

 

EP0265 Antibiofilm Efficacy of antimicrobial solutions in an in vitro artificial wound slough (AWS) and artificial wound eschar (AWE) biofilm model

Jeanne Saint Bezard¹, Rui Chen¹, Marcus Swann¹, Fergus Watson¹, Steven Percival^1
15D health Protection Group Ltd., Liverpool, United Kingdom

Aim: Necrotic wounds contain eschar and slough, which act as reservoirs for microorganisms and biofilms. Here, we evaluate the antibiofilm efficacy of two multifunctional metal complexes (MMC) and a commercial antibacterial product (PHMB) on two artificial would biofilm models comprised of eschar (AWE) and slough (AWS). Both models utilize key proteins found in necrotic tissue (collagen, fibrinogen, and elastin) and are distinguished by their water content, where AWS contained more than 90% water, while AWE contained less than 10% water.

Method: A Pseudomonas aeruginosa biofilm was cultured in a 48 well plate for 24 hours, followed by the addition of eschar and slough layer on the top of biofilm. Both models were exposed to the antimicrobials for 24 hours, before being neutralised, enumerated to confirm total viability of the biofilm cultures. The disruption of the biofilm by the treatments was also imaged by LSM 780 Zeiss confocal microscope.

Results / Discussion: Results showed significant differences in the antimicrobial efficacy of the antiseptics within the two models. In the AWE model, both MMCs, and the PHMB product achieved >6 log reductions in microbial cell density. However, in the AWS model only the MMCs achieved a 5 log reduction, with PHMB showing no significant reduction in cell density compared to an untreated control.

Conclusion: These findings suggest that the efficacy of antimicrobial solutions is heavily influenced by wound exudate. The high-water content, shown for AWS, hindered antimicrobial activity possible due to a dilution or quenching affect.

 

EP0266 Measuring Evans blue-bound albumin leakage potentially as an indicator for early edema detection using docetaxel-injected mice

Ayana Mawaki^{1 2}, Masushi Kohta³, Aya Yoshimura⁴, Chiemi Haneda⁴, Toshio  Nakatani⁵, Shizuko Nagao⁴, Junko Sugama^3
1Nursing Medical Sciences, Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan, ²Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan, ³Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Japan, ⁴Advanced Medical Research Center for Animal Models of Human Diseases, Fujita Health University, Toyoake, Japan, ⁵Department of Nutrition, Faculty of Health Science, Hokurikugakuin University, Kanazawa, Japan

Aim: Docetaxel (DTX), a taxane chemotherapeutic agent, is widely used in cancer treatment. Some patients treated with DTX often experience peripheral edema formation due to fluid retention, resulting in a decreased quality of life. In order to develop early edema detection and its preventive measures, we have discovered that DTX administration causes leakage of plasma without proteins from blood vessels into interstitial tissues, in prior to edema occurs. However, it remains unclear when the leakage starts occurring due to the cross-sectional nature of our previous study. Here, we aimed to longitudinally quantify plasma leakage for early edema detection using DTX-injected mice.

Method: Male ICR mice aged 5 weeks were intravenously administered DTX (10 mg/kg/day) (intervention group) or saline (control group) for one, three, or five consecutive days. At each time point after DTX injection, the Evans blue (EB) dye, which bound with plasma albumin, was injected into the tail vein of each mouse to observe the quantity of the plasma extravasated EB at the body surface, by measuring absorbance peak at 620 nm of extracted solution of tissue harvested from skin sites.

Results / Discussion: Compared with control group, intervention group led to decreased Evans blue dye extravasation in a timely-dependent manner. This indicates less albumin leakage from the blood into the interstitial tissue as the cumulative dose of DTX increased.

Conclusion: Evans blue dye-bound albumin leakage can be potentially as an indicator for early edema detection in our docetaxel-injected mice. In the clinical contribution, some intervention may be able to suppress the reduction of the rate of plasma albumin leakage and lead to preventing edema formation.

 

EP0267 Angiogenetic effect of acellular adipose matrix on wound healing in skin defect murine model

Jaewoo Kim¹, Heewoong Yang^1
1SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Rep. of South Korea

Aim: AAM, adipose tissue-derived extracellular matrix, contains various fibers, such as collagen, elastin, proteoglycans, and laminin; therefore, it acts biological scaffold for enhancing neovascularization and reepithelization, leading to potential benefits in wound healing. Injectable AAM can be easily applied on wounds regardless of their size and depth. Therefore, this study aimed to investigate the therapeutic effect of injectable AAM in wound healing using a murine model

Method: Human fat harvested from the fresh abdominoplasty fat, the AAM was manufactured by a mechanical-modified method. Wound healing study was performed on athymic nude mouse model, dressing with either AAM or conventional foam dressing, to the full-thickness skin defect of mice (Circular skin defect 10mm, n=8 per group). Wound evaluation and dressing change was done on postoperative day 2, 5, 7, 9, 12, 14. Immunoflorescence staining of CD31 were done.

Results / Discussion: AAM has been shown to provide better wound healing effect on the 14th day in the aspects of remaining wound size (p<0.05). AAM has been shown to provide better angiogenesis than conventional foam dressing. There were similar inflammatory cells compared to conventional foam dressing.

Conclusion: In summary, AAM as a dressing material is effective in skin defect of murine model, better decreasing size and inducing angiogenesis, compared to conventional foam dressing. This promising bio-dressing has potential to offer a safe and effective alternative in wound management fields.

 

EP0268 The effects of a copper-iodine complex solution wound irrigation solution on persistence long-lasting, clinically relevant pathogens: An in vitro model

Steven Kavros^1
1Vascular Surgery Associates, Minneapolis, United States

Aim: Copper-Iodine Complex Solution (CICS) is an FDA 510(k) cleared medical device as a wound irrigation system. CICS is indicated in wound management, cleansing, irrigating, moisturizing, and debriding of acute and chronic dermal lesions that are partial or full thickness wounds. CICS has been proven to be non-cytotoxic, non-pyrogenic, non-irritating, and non-sensitizing to dermal tissue. The purpose of this study is to quantitatively evaluate the effect of Copper-Iodine Complex Solution on bacteria, yeast, fungi, and SARS-CoV-2 virus in an in vitro model.

Method:

Trial #1 - demonstrates antimicrobial efficacy testing as a preservative in solution using five common organisms at 14 and 28 days.
Trial #2 - addresses time – kill data against 15 clinically relevant pathogens.
Trial #3 - addresses persistent antimicrobial efficacy after re-inoculation using 3 different time points.
Trial #4 - addresses and validates the efficacy of CICS against SARS-CoV-2.

Results / Discussion: The results of all 4 independent in vitro studies will be reviewed in detail. There is significant log reduction of bacteria, yeast, and fungi in all invitro evaluation. This is also evident in a variety of time periods that the organisms are exposed to CICS with the associated log reductions of clinical significance. Long-lasting CICS efficacy against ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter sp) and Candida albicans and Candida tropicalis has been demonstrated up to 3 days.

Conclusion: Copper-Iodine Complex Solution has been shown to create a significant log reduction with kill rate in multiple gram positive and gram-negative bacteria, yeast, and fungi. Additionally, CICS has been shown to be effective against SARS-CoV-2 virus. Further studies are needed to support these findings.

 

EP0269 The effects of a copper-iodine complex-based wound irrigation solution on the reduction of biofilms grown on implant materials and in vivo porcine wounds

Steven Kavros^1
1Vascular Surgery Associates, Minneapolis, United States

Aim: Copper-Iodine Complex Solution (CICS) is indicated in wound management, cleansing, irrigating, moisturizing, and debriding of acute and chronic dermal lesions that are partial or full thickness wounds. The purpose of this study is to quantitatively evaluate the effect of CICS on biofilm in a porcine model and commonly used implant material substrates.

Method: Two implant materials were used in this study to grow biofilms, silicone, and titanium. The silicone trial had mature biofilms of S. epidermidis ATCC 35984 were grown for 48 hours on smooth silicone breast implant shell material coupons (1 cm²) using a CDC Biofilm Reactor.

Results / Discussion:

1. Efficacy of CICS against S. epidermidis mature biofilms - silicone substrate Results: 1.7 log reduction at 30 min, 4.7 log reduction at 2 hours, 6.6 log reduction at 5 hours and 7.0 log reduction at 24h and 72h. No colonies observed at 24h and 72h.
2. Efficacy of CICS against S. aureus mature biofilms on titanium alloy substrate Results: 0.6 log reduction at 5 min, 1.8 log reduction at 0.5 hours, 4.7 log reduction at 2 hours and 7.5 log reduction at 24h. No colonies were observed at 24h.
3. GLP in vivo study (porcine) to assess the anti-biofilm and antimicrobial activity.

Conclusion: Copper-Iodine Complex Solution has been shown to generate a significant log reduction in the growth of both Staph aureus and staph epidermidis biofilms grown on silicon and titanium implant materials.  This solution has the potential to positively impact patient outcomes.  Further studies are needed to show that this can help to prevent and to treat infected implants in humans.

 

EP0270 Keratin-tmao dressing accelerates full-thickness skin wound healing in diabetic rats via PI3K/AKT/mTOR signaling pathway activation and up-regulation of KRT17

Mateusz Rybka¹, Łukasz Mazurek¹, Mikołaj Zajdel¹, Mateusz Szudzik¹, Anna Laskowska², Joanna Czuwara³, Jan Jurak¹, Dorota Sulejczak⁴, Marcin Ufnal¹, Marek Konop^1
1Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland, ²Department of Pharmaceutical Microbiology and Bioanalysis, Medical University of Warsaw, Warsaw, Poland, ³Department of Dermatology, Medical University of Warsaw, Warsaw, Poland, ⁴Department of Experimental Pharmacology, Mossakowski Medical Research Institute Polish Academy of Sciences, Warsaw, Poland

Aim: As the incidence of diabetes rises around the World, so does the problem of impaired wound healing. The mechanism of disturbed healing in diabetic wounds is complex, and proposed therapies are often insufficient. For this reason, my team conducted a study, in which we evaluated the effectiveness of a novel dressing based on insoluble keratin fraction enriched with trimethylamine N-oxide (TMAO) in wound healing in rats with iatrogenically induced diabetes.

Method: An experimental keratin dressing was prepared from rat fur which was enriched with 0.1% trimethylamine N-oxide. Male Sprague-Dawley rats with induced diabetes were used for in vivo studies. Western blotting analysis of the HaCaT cell line was performed.

Results / Discussion: In vivo studies showed that the dressing accelerated wound healing on days 4, 7, 14 and 21 post-injury (p<0.05). Histopathological examination showed that treated wounds had significantly (p<0.05) less extravasated erythrocytes compared to the controls on days 4, 7, 14 and 28 post-wounding. Immunohistochemistry data showed that treated wounds were characterized by increased M2 macrophage infiltration and reduced numbers of pro-inflammatory M1 macrophages. Western blot analysis of keratinocytes incubated with FKDP+0.1%TMAO dressing showed increased PI3K/AKT/mTOR pathway activity which was proved by increased p-RPS6 level. The up-regulation of KRT17 was seen in cells treated with FKDP+0.1%TMAO dressing.

Conclusion: Results show that FKDP+0.1%TMAO is safe, non-toxic and accelerates wound healing process by increasing keratin 17 expression and PI3K/AKT/mTOR signaling pathway activation. The ability of our dressing to modulate immune responses, decrease inflammation, and enhance cell proliferation pathways, highlight its potential in a chronic wound management.

 

BURNS

EP0297 Evaluation of daily cleaning of partial thickness burns induced in rats with antiseptics: Impacts on cellularity, angiogenesis and collagen

Helio Galdino Junior¹, Ana Caroliny Da Silva¹, Ruy Lino Júnior², Suelen Malaquias^1
1Nursing School of Federal University of Goiás, Goiânia, Brazil, ²Institute Of Tropical Medicine and Public Health of Federal University of Goiás, Goiânia, Brazil

Aim: To evaluate the effect of daily use of antiseptic in cleaning burn wounds: analysis of cellularity, angiogenesis and collagen

Method: Experimental study with 60 Wistar rats. After anesthesia, a partial-thickness burn measuring 2x2 cm was performed. The animals were randomized into 4 groups: Control: cleaning with 0.9% saline solution; Group treated with polyhexamethylene biguanide (PHMB); Group treated with chlorhexidine degerming agent; and Group treated with aqueous povidone-iodine (PVP-I). Dressings were applied daily according to the experimental group and the animals were euthanized at 7, 14 and 21 days after burn induction. Two fragments of the lesions were collected, cut and fixed on sheets. The slides stained with the H&E technique were evaluated for the parameters: polymorphonuclear infiltrate (PMN), mononuclear infiltrate (MN), angiogenesis and fibroblasts. For collagen quantification, the slides were stained with the Picrosirius red technique.

Results / Discussion: At 7 days the group treated with chlorhexidine presented a greater quantity of fibroblasts than the control and the other groups. Daily treatment with antiseptics did not alter the quantity of neutrophils and monocytes compared to the control at any of the points evaluated.  At 7 days, the groups treated with antiseptics had significantly more angiogenesis than the control. No differences in angiogenesis were observed on the other experimental days. It was observed that in the group treated with PVP-I and PHMB there was a greater quantity of collagen at 7 days.

Conclusion: Daily cleaning with antiseptics improved several parameters of burn healing in the studied model.

 

EP0298 The use of combined non-surgical techniques for optimizing burn care

Mihaela Pertea¹, Stefana Luca², Malek Benamor³, Bianca Maria Avadani³, Marian Baetu³, Alexandru Amarandei^3
1Grigore T Popa University of Medicine and Pharmacy Iasi, Sf Spiridon Emergency County Hospital Iasi, Iasi, Romania, ²Grigore T Popa University of Medicine and Pharmacy l Iasi, Sf Spiridon Emergency County Hospital, Iasi, Romania, ³Sf Spiridon Emergency County Hospital Iasi, Iasi, Romania

Aim: The aim of this study is to demonstrate the possibility of treating deep burns without resorting to surgery, using only combined non-surgical techniques: the use of specialized moist dressings such as hydrogels, hydrocolloids, or hydrofibers, mechanical or enzymatic debridement and negative pressure wound therapy.

Method: The study group included 32 patients with contact, flame, or hot liquid burn injuries, ranging from 2B to 3rd degree burns, with various anatomical locations and a total burn surface area (TBSA) between 5% and 15%. Negative pressure therapy and enzymatic debridement were employed, followed by local treatments using creams based on hyaluronic acid or silver sulfadiazine.

Results / Discussion: Among the patients included in the study, 35% were women. In all cases, negative pressure therapy was used as a first-line treatment to promote vascularization of the burned area and prevent bacterial contamination/infection. In deep burns, enzymatic debridement was used as the initial step. Wound care after these two main steps involved alternating hydrogels and hydrocolloids with creams containing hyaluronic acid, and in 50% of cases, creams with silver sulfadiazine. Pain management, proper nutrition, and hydration played a significant role in the favorable healing outcomes. The healing time was approximately 15% longer compared to cases treated surgically, but with advantages: reduced bleeding, less emotional trauma for patients, lower costs, and high patient satisfaction, aesthetically pleasing scars.

Conclusion: Advances in techniques, technologies, and materials used in burn treatment make it possible, in certain situations, to avoid surgery with outcomes similar to those achieved through surgical intervention.

 

EP0299 Use of laser as a novel treatment modality for acute burn wounds

Ram Chilgar^1
1Elrevo Clinic, Aurangabad, India

Aim: Use of laser in acute burn Is novel advance in burn management. The aim of the study is to show the efficacy of erbium laser for treating the acute burn wounds as an effective alternative to established treatment protocols.

Method: The study included 13 patients suffering from burn on outpatient clinic from March 2023 to February 2024. The study included the patients with acute burn wounds with varying etiology. The Erbium YAG laser utilized with two steps protocol, where Step 1 involved Erbium YAG laser ablation with 9.95 J/cm² energy. Step 2 involved spatially modulated Erbium YAG laser with 2.30 J/cm² energy. Once weekly laser sessions were performed till wounds were completely healed. Patients were kelp in follow up to evaluate the recurrence of wound. Outcomes were measured in terms of duration for healing, number of sessions etc.

Results / Discussion: The mean wound surface area of 60.96 cm², with an average of 2.92 sessions (ranging from 1 to 6) required for treatment. Of these patients, 13 had wounds that healed completely.

Conclusion: The Erbium YAG laser is an effective therapeutic option for treating burn wounds of diverse etiologies. It retriggers the basic wound healing mechanisms This treatment can be performed in an outpatient clinic setting without the need for surgical procedures. Further multicenter studies are recommended to establish protocol-based treatments.

 

EP0300 Selective autophagy: A potential player in burn wound protection

Weixue Jin¹, Danyang Ren¹, Songxue Guo^2
1Department of Plastic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, 1511 Jiang Hong Road, Hangzhou 310009, Zhejiang, China, Hangzhou, China, ²Department of Plastic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, 1511 Jiang Hong Road, Hangzhou 310009, Zhejiang, China, Zhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou 310009, Zhejiang, China, Hangzhou, China

Aim: Burn wound protection is a complicated, multistep biological process, which could pose a significant risk to patients. Selective autophagy, especially mitophagy, could more accurately control the quality of intracellular components and regulate biological behavior. This study is to clarify the role of selective autophagy to protect burn wounds, which may include the upstream regulation by organelle and hypoxia-related factors.
Methods: Hypoxic stimulation model of human fibroblasts and rat model were established. Transmission electron microscopy (TEM), immunofluorescence staining and western blot were utilized to assess the mitophagy, inflammation, and apoptosis of fibroblasts. Structural and functional homeostasis of mitochondria and mitochondria-associated endoplasmic reticulum (ER) membranes (MAMs) were analyzed by TEM, JC-1 probe, immunofluorescence staining, western blot and commercial kits. Adenovirus-based gene silencing and Voltage-dependent anion channel (VDAC)1/2 selective inhibitor helped identify the role of hypoxia-inducible factor (HIF)-1α as a regulatory mediator.
Results: MAMs were closely correlated with mitophagy and burn wound progression. Under hypoxia, VDAC1/2 mediated the regulation of HIF-1α on MAMs and mitophagy. Mitophagy can preserve the capacity of cells to adapt to harsh conditions, which is potential to engage in the process of burn wound healing.
Conclusion: Selective autophagy recycles certain constituents, including mitochondria, ER, peroxisomes, pathogens, lysosomes, lipid droplets (LDs), and ferritin. Further studies into comprehending the basic mechanisms as well as the crosstalk behind various mitophagy may facilitate the development of more comprehensive selective reagents and therapeutic targets.

 

EP0301 Comparison of the use of alginogel enzyme in the treatment of burnt hands with standard of care

Nesrin Tan Baser¹, Miray Kalınbaçoğlu¹, İlteriş Türkyılmaz^1
1Health Sciences University Gulhane Research and Training Hospital, Ankara, Türkiye

Aim: Deep partial and full-thickness burns of the hand are a significant source of morbidity. As functionalisation of the hand is important at the end of treatment. The aim of burn care is to restore wound healing and movement within 14-21 days.  Different types of dressings and skin grafts are used to achieve this goal.

The aim of this study was to evaluate the results and efficacy of enzyme alginogel application and standard of care (SOC) in patients with deep second and third degree burns of both hands admitted to our burn centre.

Method: In 5 patients with flame burns on both hands, the right hand was treated with SOC (paraffin gauze dressing with chlorhexidine and mechanical debridement), while the left hand was treated with enzyme-algino-gel containing pomade for autolytic debridement. Patients were analysed for number of days to healing, skin graft requirement and wound bacterial load.

Results / Discussion: All 5 SOC-treated hands were grafted on days 13-20. Of the 5 hands treated with enzyme alginogel, 2 (3rd degree burns) were grafted on days 10 and 14. The other 3 hands were epithelialised on days 13-20. In terms of bacterial load, 4 of the 5 hands followed up with SOC had growth (P. Aeruginosa and Enterobacter hormaechei), 2 of the 5 hands with enzyme-alginogel application had P. Aeruginosa growth and the others had no growth.

Conclusion: Our limited patient data show that the use of enzyme-alginogel in partial-thickness deep 2nd and 3rd degree burns of the hand provides antimicrobial protection and rapid healing results. It was also found to be effective in preparing the wound for grafting in 3rd degree burns.

 

EP0302 The use of medical-grade honey to treat burns of the extremities: A multicenter case series

Georgios Papanikolaou¹, Georgios Gousios², Daniela Chrysostomou³, Mary jane Mthanti⁴, Manik Paul Menezes⁵, Niels Cremers^6
1GP-Plastic Surgery Clinic, Ioannina, Greece, ²PharmaLife, Ioannina, Greece, ³Wound Clinic Health@45, Johannesburg, South Africa, ⁴Prime Cure Medical Centre, Johannesburg, South Africa, ⁵Burjeel Hospital, Abu Dhabi, United Arab Emirates, ⁶Maastricht University Medical Center/ Triticum Exploitatie BV, Maastricht, Netherlands

Aim: Burns located at the extremities can evolve into hard-to-heal wounds if not promptly treated. Therefore, effective therapeutic means should be applied. The aim of this multicenter study is to evaluate the healing and antimicrobial properties of medical-grade honey (MGH) for the treatment of burns on the extremities.

Method: Nineteen patients (12♂/7♀) developed burns due to thermal (89.5%), chemical (5.25%), and electrical injury (5.25%). In 13 cases (68.5%) the wounds were present at the upper extremity, and in 6 cases (31.5%) at the lower extremity. The average age of the patients was 36.6 years (range 8 months - 76 years) and the most common comorbidities included type 2 diabetes and arterial hypertension. All wounds were treated with MGH wound gel¹, MGH ointment², MGH-impregnated non-adherent dressing³, and covered with a secondary dressing.

Results / Discussion: Burns were classified as superficial partial thickness (45,5%), deep partial thickness (36.5%), and full thickness (18%). In 15 cases (79%) wounds presented with clinical signs of infection (necrotic eschar, slough, malodor, exudate).  The mean time to healing was 31 days (range 7 - 64 days). There were no adverse effects, and in all patients, wound dressing changes were well tolerated. Minimal scarring, mild hypertrophy or contracture occurred in 5 patients, but overall, the final appearance of the scars was aesthetically and functionally acceptable.

Conclusion: In our study, MGH treatment demonstrated a broad-spectrum antimicrobial activity and promoted a rapid and effective healing process. MGH-based products^1,2,3 are safe, easy to use, and cost-effective for treating burns at the extremities.

References

¹L-Mesitran Soft (Triticum Exploitatie BV, Maastricht, Netherlands)

²  L-Mesitran Ointment (Triticum Exploitatie BV, Maastricht, Netherlands)

³ L-Mesitran Tulle (Triticum Exploitatie BV, Maastricht, Netherlands)

 

EP0303 Pain assessment with epicite hydro nanocellulose substitute versus conventional healing in adult patients with deep second-degree burns

Enrique Chau Ramos¹, Guillermo Wiegering Cecchi², Crhistian Chau Ramos^1
1Skin Medical, Lima, Peru, ²Clinica Javier Prado, Lima, Peru

Aim: Pain assessment using nanocellulose substitute (EPICITE Hydro) versus conventional healing in deep second-degree burns in adult patients.

Method: The study is an interventional, analytical, retrospective, retrospective, comparative clinical history. It involved 142 patients of both sexes, aged between 30 and 75 years, seen in the outpatient clinic between January 2022 and July 2024, carried out in the Skin Medical clinic. All had deep second-degree intermediate burns, affecting less than 20% of the exposed dermis. Pain was measured using the VAS scale for both groups and measurements were taken at 24 hours, 72 hours, one week and three weeks.

Results / Discussion: A comparison between the two groups, nanocellulose (Epicite Hydro) versus conventional treatment, was made using the pain scale. Reflecting lower average pain in the nanocellulose group in the follow-up period compared to conventional treatment. Special attention was given to an improvement in pain in the first 24 hours and in a sustained manner in the 72-hour, one-week and three-week follow-ups, corroborated by statistically significant results (p<0.05).

Conclusion: There was evidence of improvement in pain on the VAS scale with the use of the nanocellulose substitute. The existence of mild pain in the group that used nanocellulose stands out in contrast to the moderate pain that was characteristic in the cases with conventional treatment.

 

EP0304 Comparative study in patients with chronic wounds using conventional wound dressings versus nanocellulose substitutes (epicite balance)

Enrique  Chau Ramos¹, Guillermo Wiegering Cecchi², Crhistian Chau Ramos^1
1Skin Medical, Lima, Peru, ²Clinica Javier Prado, Lima, Peru

Aim: To compare the results with respect to improved wound healing in patients with chronic wounds using conventional wound dressing versus the use of Epicite Balance nanocellulose substitute.

Method: Analytical, retrospective, comparative study. Twenty-three patients with chronic wounds of both sexes, aged 18-79 years, were evaluated, fulfilling exclusion and inclusion criteria. They were seen in the outpatient clinic of the ‘Skin Medical’ Specialised Centre. Measurements were taken in millimetres (mm). With the measurement of basal dimensions (greater length, lesser length and depth); comparing with weekly sequential measurements from the second to the eighth week.

Results / Discussion: Improvement was evidenced by a significant reduction in both the longest and shortest wound lengths at the end of the eighth week of the study, with an additional increase in granulation leading to an improvement in wound depth. With a decrease in the incidence of infection for the group that used nanocellulose. Corroborating with statistically significant results (p<0.05).

Conclusion: It is concluded that the use of nanocellulose provides efficient and effective results for the resolution of complex chronic wounds.

 

EP0305 Treatment of difficult-to-resolve wounds with beta-sitosterol ointment (MEBO) versus conventional wound care during the year 2021-2023

Enrique  Chau Ramos¹, Crhistian Chau Ramos^1
1Skin Medical, Lima, Peru

Aim: To evaluate the healing time in both groups - with use of beta-sitosterol ointment versus conventional wound dressing; measured by longer and shorter length in patients with extremity wounds.

Method: The study is an intervention, analytical, retrospective and comparative study. 26 patients of both sexes, aged between 20 and 95 years, attended in the outpatient clinic between January and December 2023, carried out in the specialised clinic of tissue regeneration ‘Skin Medical’. All cases had chronic wounds of difficult multidimensional resolution. They were classified into two groups. 12 patients were treated with conventional dressing and 14 patients with the use of beta-sitosterol ointment. Sequential measurements were taken at the second, fourth and sixth week. All patients fulfilled the inclusion criteria.

Results / Discussion: It showed better results in the speed of regeneration of complex chronic wounds compared to conventional wound care treatment. No over-aggregated infections were reported in the case of beta-sitosterol treatment. And early reactivation of the scar reaction; corroborated by statistically significant results (p<0.05).

Conclusion: There was evidence of progression in the speed of healing in the beta-sitosterol ointment group compared to conventional healing. There were no super-added infections in the beta-sitosterol group. At the end of the sixth week there was a marked difference with the use of ointment, with characteristics of homogenisation of the regenerated granulation tissue.

 

EP0306 Sequentially linked flaps for correction of extensive post-burn deformity and achieving dynamic reconstruction outcomes

Hyung-Sup Shim^1
1St. Vincent’s Hospital, Seoul, Rep. of South Korea

Aim: Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates, inadequate volume coverage, and limited availability of donor sites. This report aims to describe the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk.

Method: A total of 20 patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. All patients received sequentially linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction.

Results / Discussion: Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact(40%, n=8), followed by flames(25%, n=5), scalds(20%, n=4), electrical contact(10%, n=2), and friction(5%, n=1). The most frequently utilized combinations were the thoracodorsal artery perforator(TDAp) and anterolateral thigh(ALT) flap(11 cases, 55%). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator(DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.

Conclusion: Three-dimensional tissue coverage achieved through the sequential linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.

 

EP0307 Burns treatment using bromelain followed by skin meek micrografts –
A clinical study

Camelia Tamas¹, Radu Tataru¹, Clara Larisa Ibanescu², Ioana Tamas¹, Angela Tecuceanu³, Dan Cristian Moraru¹, Catalina Pintilie^1
1University of Medicine and Pharmacy “Gr. T. Popa”, Emergency Hospital “Saint Spiridon”, Iasi, Romania, ²University of Medicine and Pharmacy “Gr. T. Popa”, Emergency Hospital “Saint John”, Suceava, Romania, ³University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania

Aim: To evaluate the efficiency and limits of using skin Meek micrografts after enzymatic debridement with bromelain, for second and third degree burns treatment.

Method: Our study evaluated 42 patients with second and third degree burns, hospitalized in the Burns Unit from “Sf. Spiridon” Emergency Hospital Iasi, during a 5-year period (2020-2024). The patients suffered injuries extended on 10-45% from the total body skin area (tbsa).We applied enzymatic debridement with bromelain within the first 3-5 days after the injury and we evaluated the burn wound depth, before and after the debridement, using a Laser Doppler Perfusion Imaging System.

For a group of 21 patients we added different devices (negative pressure wound therapy –NPWT, hydroactive nanocellulose-based wound dressings, antibacterial pads based on dialkylcarbamoyl chloride) or topical medication to stimulate the healing process after the debridement (ointments based on low molecular weight hyaluronic acid -LMW-HA).

In other 21 cases, immediately after fast enzymatic debridement (48 hours), we covered 8-20% tbsa with skin Meek micrografts harvested from a surface of 2-3% tbsa, 0.2 mm thickness and expanded 1:4 or 1:6.

Results / Discussion: The wound healing daily rate was comparable for both groups of patients (2.98-2.67% wound surface for the first group, 3.04-2.86% wound surface for the second group), and the survival rate was 85.71% (36 patients).

Conclusion: Combining enzymatic debridement of the burned tissue with skin Meek micrografts we can stimulate the wound healing process, reduce the hospitalization period and improve the survival rate for burned patients.

 

EP0308 Wound healing ability of acellular fish skin and bovine collagen grafts for split-thickness donor sites in burn patients: Characterization of acellular grafts and clinical application

Yong Suk Cho^1
1Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Rep. of South Korea

Aim: Acellular fish skin has emerged as a dermal substitute for the promotion of wound healing as it decreases scar formation while providing pain relief.

Method: In this study, we conducted a comparative study to evaluate the wound-healing ability of acellular fish skin graft (Kerecis®) with that of the widely used bovine collagen skin graft (ProHeal®). The skin grafts were evaluated not only in terms of their biophysical properties, but also their in vitro cellular activities, using fibroblasts, keratinocytes, and human endothelial cells. The clinical study evaluated wound healing in 52 patients with acute burns who underwent skin grafting on donor sites. The study was conducted with two groups; while only Kerecis® was tested in one group, Kerecis® and ProHeal® were compared in the other. In both groups, the application time of the dressing material was one to two days after split-thickness skin grafting to the donor sites.

Results / Discussion: The Kerecis®-treatment group experienced faster healing than the other treatment group. In particular, the average wound healing time using the Kerecis® treatment and the ProHeal® treatment was 10.7 ± 1.5 days and 13.1 ± 1.4 days, respectively.

Conclusion: We believe that the faster healing of the Kerecis® treatment, compared to that of the ProHeal® treatment, maybe due to the synergistic effect of the unique biophysical structure and the bioactive components of acellular fish skin.

 

EP0309 Used polylactic acid dermal matrices application in third degree facial burn

Mario Aurelio Martínez-Jimenez¹, Jose Ramirez-GarciaLuna, Víctor Manuel Loza González^2
1Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, México, San Luis Potosí, Mexico, ²Hospital Central Ignacio Morones Prieto, San Luis Potosí, Mexico

Aim: Poly-lactic acid (PLA) dermal matrix is a synthetic, absorbable, and alloplastic skin subtitle for the treatment of wound, is a microporous, adapts to the surface of the wound, adheres on contact, with degradation hydrolytically.
Method: A 43 year old man sustained burns to his face, after using ethyl alcohol, who came 4 days after the burn. After removal of blizzards and debridement, burn depth was defined as deep. Once the wound is completely clean, used Poly-lactic acid SDRM application to cover the entire burned surface area. Homeless patient who did not sign the informed consent for a skin graft. 5 applications with SDRM in supraciliary and glabella region were made throughout the 6 weeks of hospitalization, membrane becomes translucent, separates with epithelization, placing less surface area in each change. The patient was only covered by the SDRM without any other gauze, ointment and bandage. We ensured that the patient was discharged when he or she had more than 80% hospitalization. Hospital follow-up is carried out for 6 months, observing adequate re-epithelialization without retraction sequelae.
Results / Discussion: Minimally manipulative dressing chances changes without anesthesia. The mobilization can begin 7 – 10 days. Good cosmetic and functional outcomes and scar quality, without surgery and retraction sequelae after long term results.
Conclusion: The Poly-lactic acid  SDRM is a dressing that has suitable characteristics for facial wounds which have a better healing capacity due to its adhesiveness and degradation properties, without any other gauze, ointment and bandage, so that they can have better re-epithelialization without long-term sequelae.

 

EP0310 Innovative burn wound management: herbal ointment combined with modified autologous microskin grafting

Xiaoqian Zhou^1
1Xi ‘an Ninth Hospital, Xi’an, China

Aim: To solve multiple problems that current burn treatment facing such as lack of donor skin, high expenses etc.

Method: In the past 5 years, we have successfully treated 42 cases of burn wounds ranging from 30% to 90% TBSA and deep II-III degree with this combined technique.

Herbal ointment was first applied on wounds to assist debridement and promote granulation tissue growth, and then modified autologous microskin pulp grafting was performed when the fresh granulation tissue was grown.

Preparation of microskin pulp: local anesthesia was performed in donor area and split thickness skin was taken as per the ratio of 1:20-1:30. The skin was cut into small particles (0.8-1mm) with scissors as pulp and evenly applied on wound. After microskin grafting, the herbal ointment was applied again daily until wound was healed.

Results / Discussion: The combination of the two techniques effectively solved the problem of different stages of the treatment of burn wounds, and achieved the whole comfortable treatment.

The survival rate of the skin grafting was very high. 36 out of total 42 patients’ wounds were totally healed after first grafting and the other 6 patients healed after second grafting. The average healing time was 2-3 weeks after skin grafting with no severe scar formation. And average cost was 1/4 to 1/3 lower than traditional skin grafting.

Conclusion: This combined technique has lots of advantages such as saving skin source, reducing the risk of major surgery, and reducing the financial burden of patients, and providing a relatively comfortable treatment procedure.

 

Figures

1. Preparation

 

 

EP0311 It’s time to change for hot, cold and drug burns

Francesca Pasquali¹, Selene Narcisi¹, Ilaria Cerino Badone¹, Alessandra Demartini¹, Mara Roncali¹, Paola Tortarolo^2
1ASLAL, Alessandria, Italy, ²ASLAL, Alessandria, Italy

Aim: Due to the lack of comparative studies on current silver dressings for burn treatment, the Vulnology Unit of the Alessandria Local Health Authority obtained ethical approval to study burns and I was chosen like the principal investigator. The focus is on comparing healing times, pain reduction, and extent reduction of second-degree burns (A and B types) treated with sterile non-woven soft fabric dressings made from highly absorbent and gel-forming polyvinyl alcohol (PVA) fibers coated with silver sulfate, against antimicrobial foam dressings.
Method: Patients treated with PVA fiber dressings were assigned to the experimental group, while those receiving antimicrobial foam dressings were in the control group. Pain and burn surface area were assessed using the Visual Analog Scale (VAS) and Wallace’s Rule of Nines.
Results/Discussion: Initial data indicated that second-degree type A burns (papillary dermis) treated with PVA dressings showed excellent healing results within 14 days to 1 month, without scarring or keloids. Type B burns (reticular dermis) exhibited similar outcomes, allowing for vertical absorption of exudate, regardless of burn location, patient age, or comorbidities.
Conclusion: As of October 1, 2024, eligible subjects were randomized into two groups to ensure balanced treatment. Preliminary results suggest that is important that the clinician determines the degree of infiltration of the dermis in order to use the most appropriate dressing of the two the study burn to reduce healing time, pain, and burn extent more effectively than traditional methods.

 

EP0312 Clinical application of hydrodynamic debridement on infectious wound

Zong Yu Li^1
1Harbin Fifth Hospital, Harbin, China

Aim: To investigate the clinical effect of hydrodynamic debridement on infectious wounds.

Method: Hydrodynamic debridement technique was used to debridement 16 cases of different types and parts of infectious wounds such as high-voltage burn, thermal burn, chronic sinus (cavity) wounds, etc. After debridement, flap or skin grafting was performed to repair the postoperative clinical effect.

Results / Discussion: 16 cases of infected wounds of different types and parts were debrideed by hydrodynamic debridement. After debridement, skin flap or skin graft were used for repair. The postoperative survival of skin flap and skin graft and wound healing were good.

Conclusion: Hydrodynamic debridement has obvious debridement effect on different types and parts of infectious wounds, which can effectively shorten operation time, effectively reduce wound inflammation, control wound infection, retain normal tissue to the maximum extent, reduce residual necrotic tissue, achieve accurate debridement, effectively improve the survival rate of skin grafting and skin flap transplantation, promote wound healing, and help patients recover as soon as possible.

 

EP0313 The fluorescent light energy and the second degree burns: Is it love?
Carlotta Scarpa¹, Franco Bassetto^2
1Plastic surgery unit, Padova, Italy, ²Plastic and Recontructive Surgery Clinic, Padova, Italy
Aim: To verify if Fluorescent Light Energy can be effective on second degree burns.

Method: After informed consent and pictures, we treated 50 patients affected by second degree burns (superficial and deep) with Fluorescent Light Energy, a Led blu lamp which can activate wound healing through the application of a gel containing exogenous chromophores. The mean age was 40 and the majority of the patients was male.  The treatment has been repeated twice a week. We performed VAS score pre and post treatment.

Results / Discussion: The Fluorescent Light Energy has been used in all the patients without any adverse event. The treatment has been performed for a maximum of 3 weeks and the mean number of sessions has been 3 (min 1- max 6).  The mean Vas score was: pre 8- post 2. All the patients reached a complete healing without surgery.  The treatment has been well accepted by the patients.

Conclusion: The Fluorescent Light Energy is very effective on second degree burned patients. The technology is very easy to use and fast bringing the patients to be very compliant. This treatment can be proposed both for in and out patients and it can be associated with all kind of dressings after its application.

 

EP0314 Effective management of infected chemotherapy extravasation injury using polyhexamethylene biguanide and betaine gel

Claudine Lukban¹, Gerald Abesamis^1
1Philippine General Hospital, Manila, Philippines

Aim: Extravasation injuries from chemotherapeutic agents can lead to tissue necrosis and prolonged healing. This report details the successful management of an infected soft tissue injury from chemotherapy extravasation in an immunocompromised patient using polyhexamethylene biguanide and betaine (PHMB-betaine) gel.

Method: A 45-year-old breast cancer patient presented with a chronic wound on the dorsum of her right hand due to chemotherapy extravasation, unresponsive to conservative management. Treatment involved surgical debridement, followed by application of PHMB-betaine gel and sterile dressing. Daily assessments monitored infection control and pain reduction, with systemic antibiotics initiated based on cultures showing multidrug-resistant bacteria.

Results / Discussion: There were significant therapeutic effects with PHMB-betaine gel within 72 hours of application, reducing erythema, swelling, and discharge while enhancing patient comfort. Granulation tissue appeared within a week, and a successful split-thickness skin graft was performed by the third week. In this third-world healthcare context, PHMB gel reduced the need for cost-intensive products, saved staff time, and allowed resources to be allocated to other critical cases. Rapid healing enabled early discharge. By preserving hand function and accelerating recovery, PHMB gel minimized the risk of long-term disability, supporting patient productivity in economies with limited disability support.

Conclusion: PHMB gel shows promise as an adjunctive therapy for managing infected soft tissue injuries from chemotherapy extravasation. Its economic advantages underscore the need for effective antimicrobial treatments to prevent complications and improve healthcare outcomes in resource-limited settings. However, larger clinical studies are needed to confirm the efficacy and safety of PHMB gel in similar complex wound cases.

 

EP0315 Pediatric burns treatment – tertiary center experience  in the cohort of 546 children

Djordje Kravljanac^1
1Faculty of medicine University of Belgrade, Serbia, Institut for mother and child healtcare of Serbia, Belgrade, Serbia

Aim: The evaluation of etiology of injury and treatment procedures in the care of pediartic burns in our cohort during the last ten years.

Method: The retrospective study included pediatric burns patients treated, by different therapeutic approach under analgesia or general anesthesia. Children were reviewed for age, sex, etiology of injury, total body surface area (TBSA) of burn, degree of burn, type of therapeutic procedure and length of healing.

Results / Discussion: Study included 546 children (320 boys, 246 girls), admitted to the tertiary pediatric centre and treated between 2012-2022. The mean age was 11.19 years (range 1 month-17 year). The most of them were injuried by hot liquids (76.22%), followed by flame burns (14.39%), contact burns (8,38%) and electrical injuries (2.01%). Patients had superfitial or deep dermal and full thickness burns. The TBSA of burn was less of the 10% in the most of the patients (86,62%). All burn wounds were cleaned with an antiseptic solution based on octenidine product. The performed therapeutic procedures were: non operative management in 72,71% and operative treatment in 27,29% of the cases. Average time of the burn wound healing after operation were 15.32 (range 7-59) days.

Conclusion: Treatment of pediatric burns implies different operative and nonoperative procedures. The therapeutic approach will depend on the extent and severity of the burn injury including wound dressing lining  in the superfitial or deep dermal burns and surgery in the full thickness burns.

 

EP0316 Advantages of using a nanocellulose-based dressing pre and post enzymatic debridement in facial burns

Panche Taskov^{1 2}, Daniela Corodati¹, Wael El Amine¹, Ruben Palacios¹, Zorin Crainiceanu^{1 2
1}Burn Unit - Plastic and Reconstructive Surgery Department Casa Austria, County Emergency Clinical Hospital “Pius Branzeu”, Timisoara Romania, Timisoara, Romania, ²University of Medicine and Pharmacy “Victor Babes”, Timisoara Romania, Timisoara, Romania

Aim: The management of facial burns represent a challenge due to the functional and aesthetic implications.

We aim to demonstrate the safety, clinical use and advantages of the combination of enzymatic debridement and bacterial nanocellulose for complicated facial burns.

Material and Method: Epicite hydro is a microbial derived nanocellulose, which contains a minimum of 95% isotonic saline solution due to its very dense and homogeneous structure. It creates a supportive moist environment to the wound with a favorable hydrobalance.

It is proved that it reduces the intradermal damage of the skin – the histologic results showed significantly less oat cell degeneration and necrosis, less dermal-epidermal separation, more viable cells.

Observational study on 20 adult patients from the Burn Unit Timisoara from November 2022 to October 2024.

Inclusion criteria: deep dermal and full thickness facial burns.

Mechanism of injury: scald, flame, electricity, deflagration.

The treatment consisted by coverage with a bacterial derived nanocellulose previously immersed in Microdacyn or Prontosan 2 to 24 hours before and after enzymatic debridement.

Results: During the study period, 20 patients were reviewed, observing a decrease in the inflammatory process, pain and edema, reducing the number of dressings change, decreased use of analgesics, good aesthetic and functional results, absence of infection or complications, without any need for additional surgery and a shorter hospitalization period.

Conclusion: The clinical benefits of using nanocellulose-based dressing proved by promoting epithelialization in facial burns with good aesthetic and functional results highlights the importance of this potential treatment option pre and post enzymatic debridement.

 

EP0318 The new approach in the treatment of full-thickness facial burns

Panche Taskov^{1 2}, Daniela Corodati², Andreea Babii², Ahmad El Amine², Wael El Amine², Zorin Crainiceanu^{1 2}, Mihai Glaja², Ancuta Pop Coman^2
1University of Medicine and Pharmacy “Victor Babes”, Timisoara Romania, Timisoara, Romania, ²Burn Unit - Plastic and Reconstructive Surgery Department Casa Austria, County Emergency Clinical Hospital “Pius Branzeu”, Timisoara Romania, Timisoara, Romania

Aim: The use of EDNX has demonstrated excellent debridement capacity, which in the same time preserves the viable surrounding tissues, mainly the dermis.
Even though there is not sufficient available data on its use in the facial area, we consider our protocol for treatment of facial burns to be safe and effective and with superior aesthetic aspects of the scars compared to SOC.

Method: Our study included 10 patients above 18 years old, with full-thickness facial burns from November 2022 to October 2024.
General anesthesia is performed; the most common drugs for induction are benzodiazepines, high dose opioid, hypnotics and muscular relaxant, obtaining a maintenance with inhalatory agents and opioids.
We have used a multimodal treatment protocol for facial burns by means of enzymatic debridement in combination with tissue micrografting technique using autologous micrografts either injected directly into the lesions or on collagen scaffolds, biotechnology microbial derived NanoCellulose, PPP, “smart” topics and dressings.
Attention should be paid to eye protection in order to avoid any accidental contact with the product.

Results / Discussion: We achieved complete epithelization in approximate 2 weeks, without any need for additional surgery and coverage and with excellent cosmetic outcomes.
The quality and aesthetic aspects of the scars are superior in comparison with SOC scar quality.

Conclusion: This novel regenerative technique was used in order to avoid SOC treatment using tangential excision and split-thickness skin graft coverage and has shown promising results in burn healing process, reducing hospitalization and healing time and improving quality of life.

 

EP0319 Nursery care protocol for burn patients treated with meek technique. Single tertiary center experience in spain

Silvia Minguez Abia¹, Naiara Santín Pérez², Patricia Martin Playa^2
1Osakidetza, Cruces - Barakaldo, Spain, ²Osakidetza, Cruces - Barakaldo, Spain

Aim: The use of the modified microexpansion technique, MEEK allows for a full skin coverage in patients with extensive burned areas and scarce donor site areas. It is a specific technique that requires special postoperative care for its proper care.

Method: We are presenting a retrospective study carried out through a literature review as well as our experience treating 12 great burn patients in which we used the MEEK technique since the implementation of the protocol in our center in 2022.

Results / Discussion: The protocol was established to guide the postoperative care carried out by nursery staff to the patients treated with MEEK technique, and it was based both in a literature and our clinical practice. For its elaboration, we identified key points, all regarding the type of dressing change done, its frequency, and the start of patient’s mobilization.

This protocol has shown to be a useful tool for the nursery staff in order to homogenize the postoperative care offered to these patients, making it easier to standardize surgical site progress recording, and presence of any potential complications.

Conclusion: In our experience, due to the specificity of the MEEK technique, postoperative care standardization through customized protocols is key in order to guarantee a higher graft intake as well as provide an standardized protocol for the evolution of the grafts itself.

 

EP0320 5 years experience and statistics in burn unit TM - comparative study between standard of care and enzymatic debridement of deep partial thickness and full thickness burns

Panche Taskov^{1 2}, Gaurav Narad¹, Viviana Narad¹, Daniela Corodati¹, Ancuta Pop Coman¹, Zorin Crainiceanu^{1 2}, Anda Mogosanu¹, Mircea Nemes¹, Eniko Hordovan^1
1Burn Unit - Plastic and Reconstructive Surgery Department Casa Austria, County Emergency Clinical Hospital “Pius Branzeu”, Timisoara Romania, Timisoara, Romania, ²University of Medicine and Pharmacy “Victor Babes”, Timisoara Romania, Timisoara, Romania

Aim: This comparative study aims to highlight the indications and results of whether applying a mixture of proteolytic enzymes enriched in bromelain or using surgical debridment and skin grafting for the treatment of deep partial thickness burns and full thickness burns in adult patients.

Materials and Methods: In this study we included 50 patients with deep partial thickness and full-thickness burns with a TBSA between 10-50% from January 2020 to August 2024. The ones in the first group (25 patients) were treated using early excision and skin grafting while for the second group (25 patients) enzymatic debridement was used (including on the face area). The effectiveness of debridment, the costs of the treatment, the healing and hospitalisation time, the need for another surgery and the aesthetic aspects of the scars were taken into consideration.

Results / Discussion: After enzymatic debridement, in 5 cases out of 25, skin grafting was necessary. Spontaneous epithelization was noticed in the other 20 cases.

The patients aknowleged it was less painful, the healing time was reduced and the aesthetic aspects of the postcombustional scars were better than the group that underwent per primam surgical debridement and skin grafts.

Conclusion: The introduction of enzymatic debridement as a treatment alternative to surgical debridement for IIB- and III-degree burns has changed standard burn care. This method also has the benefit of selectivity — it only removes the burn eschar and preserves the surrounding viable tissue. Using this method reduced the number of surgical interventions, the costs, infection rates and hospitalization period.

 

EP0321 Cutting-edge hybrid dressings: combining silk medical textiles and decellularized biological tissue for advanced burn wound care

Teresa Sousa¹, Inês Vale¹, Marta Rosadas¹, Inês  Silva¹, Viviana Pinto Ribeiro¹, Ana Leite Oliveira^1
1CBQF-Centro de Biotecnologia e Química Fina–Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal, Porto, Portugal

Aim: Burns affect 11 million people globally each year, with 180,000 fatalities [1]. This study investigates a multilayer burn dressing combining silk fibroin (SF) fabric with highly-preserved decellularized porcine small intestine (dPSI) to support tissue regeneration and wound integration [2]. A silk sericin (SS) hydrogel is included as interface for structural integrity and anti-inflammatory benefits, enhancing the hybrid dressing’s biological performance.

Method: An innovative decellularization protocol was proposed to obtain dPSI, maintaining submucosa, serosa, and muscle layers, using cycles of decellularizing agents (SDS, SDC, DMSO), washing agents (upH₂O, PBS), and sterilization (PAA/ethanol). The serosa and submucosa of dPSI were integrated with SF-based textiles using HRP-crosslinked SS hydrogels. Decellularization and integrity were assessed via DNA quantification and histology, while hybrid dressings’ morphology and mechanics were evaluated by SEM and tensile tests. Degradation profile was tested in simulated wound fluid, and biological performance was assessed by culturing human dermal fibroblasts (hDFs) on the submucosa layer up to 10 days.

Results / Discussion: The dPSI was successfully achieved (<50 ng/mg dsDNA). SEM images confirmed the full integration of the dPSI with SF-based textiles, especially when serosa faced the textile. The presence of the textile structure resulted in an enhancement of the mechanical strength. dPSI was able to degrade first in the multilayer dressing, and hDFs adhered and proliferated on the submucosa over 10 days, supporting hybrid structural integrity.

Conclusion: This study is pioneer in confirming promising results for the first multilayer hybrid dressing combining medical textiles and dPSI for burn wound applications.

 

EP0322 Exploring rabbit skin as a novel decellularized dermal substitute for burn wound healing

Marta Rosadas¹, Viviana Pinto Ribeiro¹, Teresa Sousa¹, Inês  Silva¹, Alda Sousa², Ana Leite Oliveira^1
1CBQF-Centro de Biotecnologia e Química Fina–Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal, ²Cortadoria Nacional de Pêlo, São João da Madeira, Portugal

Aim: Burn wounds represent a significant medical challenge. Autografts remain the standard treatment, however, are unsuitable for deep or extensive burns. Decellularized skin xenografts offer a viable alternative, having significantly reduced immunogenicity, still there is currently no skin-derived decellularized xenografic matrix due to its low resemblance to human skin. This study proposes decellularized rabbit skin as a viable mimetic alternative. We describe a novel protocol for valorizing an agro-food by-product, exceeding 5000 skins/day, into highly preserved decellularized rabbit dermal matrices (HP-dRDMs) for burn wound treatment and skin regeneration.

Method: Rabbit skin by-products were processed at Cortadoria Nacional de Pêlo S.A., following pioneer methodologies obtaining rabbit dermis for tannery. Decellularization agents (EDTA, SDS, and SDC) were further applied with varying exposure times. Decellularization efficiency was confirmed through DNA quantification, and extracellular matrix (ECM) preservation evaluated by ECM components quantification, morphological analysis, swelling properties, and mechanical behavior. Biocompatibility was assessed by in vitro culturing human dermal fibroblasts (hDFs) up to 10 days.

Results / Discussion: The results show pH influences the collagen matrix conformation and swelling capability. Differences in the dermis’ topography were observed depending on the decellularization agents and exposure time. Mechanical analysis revealed similar performance to human skin, especially with the SDC protocol. DNA quantification confirmed successful decellularization. In vitro, hDFs adhered, spread, and proliferate within the HP-dRDM over the 10 days of culture.

Conclusion: This study demonstrates a successful protocol for rabbit dermis decellularization, preserving ECM components and yielding high-quality matrices with biological, structural, and biomechanical properties to support skin regeneration in burn wounds.

 

EP0323 Effects of 660 nm and 808 nm laser photobiomodulation on the late repair phase of full-thickness burns: A preclinical study

Juliana  Narcizo¹, Gabriela Saab², Vitória Acerbi², Anne  Missrie², Elaine  Guirro³, Ana Laura Andrade^4
1Universidade Brasil, São Paulo, Brazil, ²Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil, ³Universidade de São Paulo, Ribeirão Preto, Brazil, ⁴Universidade Brasil, Univerisdade São Paulo, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil

Aim: The objective of this study is to evaluate the effects of photobiomodulation therapy (PBMT) with red (630 nm) and infrared (808 nm) lasers on full-thickness burns in a preclinical study.

Methods: Twenty-four Wistar rats were used, which were subjected to the experimental burn model and divided into three groups: treated with a red laser (660 nm) (RLG), treated with an infrared laser (808 nm) (ILG), and a control group where the laser was applied off. The treatment consisted of applying the laser for 30 seconds at five pre-established points, three times a week for 21 days. At the end of the experimental period, samples were collected for evaluation. Histological analyses were performed using hematoxylin and eosin staining, as well as Picrosirius Red staining for collagen quantification. Epidermal thickness and wound contraction analysis were performed using ImageJ software, and statistical analyses were conducted using GraphPad Prism 8.0 software.
Results: The analyses revealed that both groups treated with PBM showed superior results in terms of tissue organization, collagen quantification, and healing speed. However, the group treated with an infrared laser demonstrated even more promising results, especially concerning the quality and quantity of newly formed tissue, as well as a significant reduction in the inflammatory infiltrate. 
Conclusion: Based on the obtained results, both forms of PBM can be effectively used as treatments for skin repair. However, infrared PBM stood out by providing better quality and faster healing.

 

EP0324 Pediatric burn injuries: presentation of a multidisciplinary protocol implemented in a tertiary center in spain

Naiara Santín Pérez¹, Silvia Minguez Abia¹, Patricia Martin Playa^2
1Osakidetza, Cruces - Barakaldo, Spain, ²Osakidetza, Cruces- Barakaldo, Spain

Aim: Burn injuries in the pediatric patient are a source of morbidity and mortality implying a social, physical and psychological impact to the patient and family requiring specialized and standarized treatment. We are presenting Cruces University Hospital’s protocol for the management of pediatric burns and our results after its implementation

Method: The protocol was established in our center in 2021, in order to standarize dressing changes for burn infants. We have reviewed all the patients treated at our center using this protocol from 2021-2024, treated using both enzymatic debridement and standard of care

Results / Discussion: Our center treats 90 burn patients under 14 years per year, of which 8-10 require admission. We use this protocol both at the initial evaluation in the Emergency Department and subsequent dressing changes. Adapting it to the age of the patient, severity of the burns, and need for hospital admission. We reviewed and highlighted six key points: specialized team required for each dressing change, type of sedoanalgesia, selection of type of dressing, use of specific dressing fixation methods, frequency of dressing changes, and attention to parents during the process

Conclusion: In our experience, a multidisciplinary approach taking into account the characteristics of each patient and type of injury is crucial to manage pediatric burns, as it decreases complications and psychological stress derived from the injury and the treatment itself. We believe that a tailored protocol for each center is crucial to properly manage pediatric burn patients.

EP0325 Chemical burn of the face

Olga Kovalenko¹, Anton Kovalenko^2
1Bohomolets National Medical Universiti, Kyiv, Ukraine, ²Burn Clinuc KNP KMKL 2, Kyiv, Ukraine

Acids and salts of heavy metals cause protein aggregation (coagulation) and dehydration of tissues, resulting in coagulation necrosis.

Aim: To evaluate the effectiveness of an ointment containing clostridial collagenase (CCO) in patients with chemical acid burns of the face in comparison with traditional methods treatment.

Method: Five patients were treated at the burn center in 2021-2023. They were compared with the results of the treatment of chemical burns on the face of 7 patients in 2019-2021. All cases were related to accidents at home. Sulfuric and nitric acids were among the chemicals involved. In the main group of white-faced patients, sequential excision, wound preparation with SSO, and skin grafting were performed. In the comparison group, conservative treatment of a facial burn was performed, followed by a graft. Complications were frequent and included chemical eye contact, wound infections, tendon exposure, toe amputation, and systemic reactions from chemical ingestion. One patient died from a chemical burn of 98% of the body surface.

Results: Remnants of necrosis after partial removal in the main group were removed with the help of CSO. Collagenase acts by destroying the denatured collagen molecule present in the burned tissue. Decomposition products were then removed mechanically from the wound bed in order to speed up the treatment of the wound and its healing.

laboratory data showed that collagenase-released protein fragments increased endothelial and fibroblast proliferation, resulting in greater granulation tissue formation than in the control group.

Conclusion: Time to clean the wound bed when using CCO was significantly shorter (23 vs. 32 days, p = 0.0012) and healing time (30 vs. 42 days, p = 0.0012). =.0007) compared to other wounds.

 

EP0326 Fluorescence imaging in burn wound management: a scoping review of diagnostic and surgical applications

Steven Jeffery^1
1Professor of Wound Study, Birmingham City University, Birmingham, United Kingdom

Aim: This scoping review aims to evaluate the current evidence surrounding the use of fluorescence imaging as a diagnostic tool in the assessment of burn wounds, specifically in predicting and managing infections, as well as informing decisions related to grafting and reconstructive procedures.

Method: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Embase, to identify studies published from 2000 to 2024. Inclusion criteria encompassed clinical trials, cohort studies, and case reports that explored the application of fluorescence imaging in burn care. Data were extracted regarding study design, patient demographics, imaging techniques, and outcomes related to infection rates and surgical decisions.

Results / Discussion: The review identified 11 relevant studies demonstrating varying degrees of efficacy for fluorescence imaging in the diagnostics of burn wounds, 8 studies were focused on burns and 3 discussed traumatic wounds of other aetiologies as well. Key findings indicated that fluorescence imaging enhances the detection of infection by exposing bacterial endogenous components, leading to targeted interventions and timely treatments. Additionally, studies reported improved decision-making regarding graft outcomes and proposed this technology could serve to guide the timing of reconstructive strategies.

Conclusion: Fluorescence imaging shows promise as a valuable adjunct in the diagnosis and management of infections in burn wounds, as well as in guiding surgical decisions related to grafting and reconstruction. Future research should focus on interventional studies and establishing robust clinical guidelines to optimize patient outcomes in burn care.

 

EP0327 Nursing management of elderly burn patients: hypnosis as a valid complement to pain treatment

Anna Rosso^1
1Azienda Sanitaria Ospedaliera Santa Croce e Carle, Cuneo, Italy

Aim: To describe the optimal management of the burn patient, from wound assessment to treatment and pain management.

Method: This paper is a literature review based on bibliographic research focused on the adult population with burns. Scientific databases such as PubMed, CINAHL, Joanna Briggs Institute, and Cochrane were consulted. Textbooks and important clinical guidelines were also used, followed by a simple search on burn-related scientific societies.

Results / Discussion: Thirty-four documents were considered for the drafting of the study. It was found that the gold standard for managing burns is surgical treatment, particularly for extensive burns. A valid alternative is enzymatic debridement, which can be applied early and is suitable for areas less than 15% of the total body surface area (TBSA). Effective pain management is also essential for burn patients.

Conclusion: The studies in my paper highlight the complexity of managing a burn patient, as well as the need for timely intervention to minimize the risk of complications and morbidity. The literature reviewed indicates that hypnosis is highly effective for pain management. However, it reaches its maximum efficacy when combined with pharmacological therapy, using opioid and non-opioid analgesic drugs. 

 

 

DEVICES AND INTERVENTION

EP0080 Experimental and clinical study of flap monitoring with analysis of clinical course of the flap using forwar looking infrared thermal camera

Hwanjun Choi¹, Hyun Kim^1
1Soonchunhyang University Hospital, Cheonan, Rep. of South Korea

Aim: Flap surgery is a common method used to cover defects following tumor ablation, trauma, or infection. However, insufficient vascularity in the transferred flap can lead to flap necrosis and failure. Proper postoperative monitoring is essential to prevent these complications. Recently, research has explored the use of infrared thermal imaging in plastic surgery, leading to its clinical application.

Method: This study investigates the use of a forward-looking infrared (FLIR) camera to monitor blood flow in flaps. In the study, 28 rats underwent reverse McFarlane flap surgery, and their flaps were analyzed using a FLIR thermal imaging camera seven days post-surgery. Additionally, thermal images of flaps were taken on postoperative days 0, 1, 2, 3, and 7 in 22 patients.

Results / Discussion: The study focused on temperature differences between normal skin and the perforator compared to the average flap temperature. Results showed that the temperature difference was higher in the necrosis group and increased over time in cases of total necrosis. A lower perforator temperature compared to the flap’s average indicated vascular compromise, potentially leading to flap failure.

Conclusion: The FLIR camera, being contactfree and convenient, shows promise for understanding and inferring the clinical progression of flaps in postoperative monitoring.

 

EP0081 Does the advantage and role of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

Hwanjun Choi¹, Hyun Kim^1
1Soonchunhyang University Hospital, cheonan, Rep. of South Korea

Aim: Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors. So, the authors evaluated the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).

Method: TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.

Results / Discussion: Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg. 

Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF.

Conclusion: Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.

 

EP0082 Comparative study of management of wounds with hyperbaric oxygen therapy and ionic silver

Vishal Mago^1
1AIIMS Rishikesh, Rishikesh, India

Aim: The aim of this study is to evaluate the role of ionic silver and hyperbaric oxygen therapy in chronic wounds.

Method: This is an ongoing clinical trial in the department of Burns and Plastic Surgery in tertiary hospital to evaluate the role of ionic silver and hyperbaric oxygen therapy in chronic wounds. Cases with ulcers were evaluated by history and were examined for the location and classification of non healing ulcers and measurement of length, width, and depth of wound bed was done. Informed consent and ethics approval was taken. Wounds were assessed for exudate, odour, condition of peri-ulcer skin and pain. Wound cultures were taken and sent. Vascular supply of affected limbs was done. The control group was subjected to traditional ionic silver dressings. Photographic documentation of ulcer healing was noted.

Results / Discussion: 34 patients received both HBOT and ionic silver dressing with good results.The controls were given only ionic silver and results were found inferior to patients receiving hyperbaric oxygen therapy. Predominant microorganism isolated was Pseudomonas followed by MRSA.24 patients were sterile post HBOT sessions.

Conclusion: Hyperbaric oxygen therapy is safe effective OPD procedure to manage recalcitrant wounds with ionic silver. It potentiates role of aminoglycosides and quinolones. Good knowledge of indications for hyperbaric medicine is mandatory for anyone treating chronic wounds.  The wound specialists and surgeons can use hyperbaric oxygen preoperatively and postoperatively to improve surgical outcomes.

 

EP0083 Impact of continuous topical oxygen therapy on fluid handling

Windy Cole¹, Dmitry Isaev², Matt Sharp^3
1Kent State University College of Podiatric Medicine, Cleveland, United States, ²Natrox Wound Care, Cambridge, United Kingdom, ³Natrox Wound Care, Cambridge, United Kingdom

Aim: To maintain moisture balance in the wound bed it is important that excess exudate is absorbed away from the wound into an appropriate absorptive dressing. A dynamic fluid handling test system was used to assess fluid transfer from a simulated wound bed through the open structure of the Oxygen Delivery System (ODS) of the continuous topical oxygen therapy (cTOT) device into a secondary dressing.

Method: A cTOT system was placed on the wound bed and covered with an absorbent dressing. Testing simulated exudate through the ODS and into the dressing examining a flow of exudate to a wound dressing over a 24 hr period. The fluid handling capacity of dressings was assessed both within the dressing and through the moisture vapour transmission rate properties at low flow rate (1ml/hr) and higher flow rate (2ml/hr) to simulate different wound exudate levels. A test system without the ODS on the wound bed platform and only the absorbent dressing in place served as the control. Testing was performed in triplicate.

Results / Discussion: No marked difference was observed for fluid handling capacity of the ODS, and dressing system compared to the dressing control at the low or higher flow rate.

Conclusion: cTOT is an adjunctive therapy that supports faster healing and pain reduction in non-healing hypoxic wounds.  This laboratory test simulating clinical use of the cTOT system with an absorbent dressing confirms that the ODS does not impede the flow of fluid from the wound bed to the dressing whilst providing supplementary oxygen to the wound.

 

EP0084 Impact of continuous topical oxygen therapy on wound moisture levels

Windy Cole¹, Dmitry Isaev², Matt Sharp^3
1Kent State University College of Podiatric Medicine, Cleveland, United States, ²Natrox wound care, Cambridge, United Kingdom, ³Natrox Wound Care, Cambridge, United Kingdom

Aim: An ex vivo porcine wound model was used to assess the impact of oxygen flow during application of continuous Topical Oxygen Therapy (cTOT) on the moisture levels at the wound bed.

Method: Simulated wounds were created in decontaminated porcine skin explant. The tissue was then placed onto agar.  Pre-weighed Oxygen Delivery System (ODS) were placed onto the simulated wound bed and covered with a pre-weighed semi-occlusive dressing. The ODS was connected to the cTOT device with either oxygen flow of 11ml/hr (test) or no oxygen flow (negative control). A positive control consisted of simulated wound only (no device) covered with a semi-occlusive dressing. All samples were incubated at 35°C ± 2°C at 80% humidity for 24h or 48h. Both test and control samples were assessed in triplicate. Following incubation, test and control samples were removed from the incubator and ODS and dressings were removed and weighed. A skin surface hydration meter was used to assess moisture levels in the tissue.

Results / Discussion: No significant difference was observed between the test (oxygen flow) or control (no oxygen flow) when assessing moisture levels in the porcine tissue explant or weight of the ODS and dressings following 24h or 48h incubation.

Conclusion: cTOT is a therapy that supports faster healing in non-healing hypoxic wounds.  This laboratory test using an ex vivo model to simulate the wound environment confirms that the oxygen flow of 11ml/hr with the cTOT device does not reduce moisture levels in the wound bed.

 

EP0085 Transforming lower limb wound care in plastic surgery through collaboration, innovation and expert leadership

Stephanie Brown^1
1University Hospitals North Midlands, Stoke on Trent, United Kingdom

Aim: It is widely accepted amongst wound care specialists and expert led agenda that early compression therapy is the gold standard for managing wounds on the lower limb at risk of delayed healing.  A retrospective audit of the types of wounds presenting in the plastic surgery dressings clinic over a 2-week period highlighted that patients with lower limb wounds were amongst those with the highest number of clinic appointments per patient.  In addition to this, there was lack of holistic lower limb assessment and structured wound assessment. The aim of this quality improvement initiative was to align lower limb wound care in the plastic surgery dressings clinic to national wound care standards for lower limb assessment and management.

Method: The commissioning of a wound care specialist role into a plastic surgery service presented an opportunity for quality improvement for this patient cohort.  A referral pathway was developed to support early intervention following haematoma, pre-tibial laceration and failed split thickness skin graft following skin cancer removal. 

Results / Discussion: Collaboration with the expert lower limb group and development of an early intervention pathway resulted in efficiency, productivity and application of evidence-based practice for this cohort of patients with a 50% reduction in outpatient appointments, early intervention with compression therapy and timely onward referral.

Conclusion: Through expert leadership the dressings clinic activity was aligned to evidence-based practice thus improving patient experience and outcomes, efficiency and productivity.  Future service development has been proposed to further reduce outpatient clinic appointments for this patient group, this includes an outreach service to emergency portals, an education programme and recruiting lower limb champions to embed this pathway into practice.

 

EP0087 The use of the fluorescence image in the detection of bacterial load in perilesional skin

Francesca Loglio¹, Francesco Uccelli¹, Alessandra Michelucci¹, Valentina Dini¹, Marco Romanelli¹¹University of Pisa - Department of Dermatology, Pisa,Italy

Aim: The aim is to evaluate the use of a portable handheld device which allows, through endogenous autofluorescence, to obtain real-time images of the presence and distribution of bacteria on the perilesional skin (<104 CFU).

Method: A prospective monocentric study was conducted in a Dermatology Center, enrolling 30 patients suffering leg ulcers.

The detection of bacteria in perilesional skin is based on sampling methods. A comparative analysis was performed with the objective of evaluating the presence and subsequent reduction of bacterial load on the perilesional skin using the imaging device in two types of different therapeutic approaches, short stretch bandage and zinc oxide, depending on the compression therapy applied.

Cohen’s kappa method was used to analyze agreement between dichotomous variables, such as cyan and fluorescence measured at baseline and after 3 weeks.

To analyze the severity of fluorescence, ANOVA was performed for repeated measurements.

Results / Discussion: We observed a reduction in the levels of bacterial colonization of the perilesional skin of 68.67% for group A and 85.54% for group B. All patients had a statistically significant reduction in the bacterial load on the perilesional skin (P<0.001), detectable with the fluorescence imaging device and, in particular, a statistically significant difference was identified between the two groups (P=043).

This study demonstrated that the application of the zinc oxide bandage provided a greater reduction in bacterial load on the perilesional skin.

Conclusion: This study demonstrated that the application of the zinc oxide bandage provided a higher reduction in bacterial load in the perilesional skin.

 

EP0088 The effect of a microcurrent electrical stimulation device* on healing and wound pain in a community setting

Jane Hampton¹, Winnie Schjott¹, Mette Riis^1
1Aarhus Municipality, Aarhus, Denmark

Aim: The aim of the study was to assess the ability of a wearable, easy to use microcurrent electrical stimulation therapy (EST) device* to stimulate healing and reduce wound-related pain in hard-to-heal wounds.

Method: Patients receiving community nursing, with stalled hard-to-heal wounds were included in a single-centre prospective, observational study. Wound area was measured every two-weeks prior to (4-week run-in), during (12-day EST treatment phase), and after treatment, for up to 24 weeks. Wound pain was measured using the 0-10 visual analogue scale (VAS).

Results / Discussion: 20 patients (65% female, mean age 76.6 years) with 22 wounds of various chronic aetiologies were included. Median wound duration was 7.0 months (interquartile range [IQR], 3.3-14.4 months) and all wounds had failed to respond to treatment in the four weeks prior to application of EST.  In the eleven patients with moderate to severe wound pain at baseline, pain reduced within the first 7-days, from a median of 6.0 (IQR, 5.5-7.0, range 5.0-9.0) to 2.5 (IQR 2.0-4.8, range 1.0-5.0), representing a clinically meaningful median reduction of 58% (IQR, 43.3-72.9%). Wound area reduced by a median of 14% after 2-weeks of treatment, (IQR 0.0-34.8), a 33.5% reduction after 4-weeks (IQR, 0-48.8%, n=22) and an 89% reduction after 12 weeks (IQR, 79-100, range 63-100%, n=13). Overall, 11/22 wounds healed within a median of 15.7 weeks (IQR 7.5-18.5).

Conclusion: Microcurrent EST had a rapid and positive impact on wound-related pain and stimulated many previously static wounds onto a healing trajectory.

 

EP0089 Improvised negative pressure wound therapy with instillation and dwell time for treatment of neglected open knee injury: A case report

Martha Camille Dollete^{1 2}, Herman  Hsu Hsieh^{1 2}, Charles Richard Cabuquit^{1 2}, Bianca Criselda Carilo², Justine Andrea Molina^1
1Mandaluyong City Medical Center, Mandaluyong City, Philippines, ²Hilom Wound Care Clinic, Mandaluyong City, Philippines

Aim: To describe the outcome of a case of neglected open knee injury treated with improvised instillation of negative pressure wound therapy followed by flap reconstruction.

Method: N.O. is a 67/M who consulted at the emergency room 9 days from initial injury because of pain and swelling over right knee. He was involved in a motor-vehicular accident, initially seen at a local hospital where wound suturing was done. Due to aforementioned symptoms plus persistent drainage from the wound, he consulted and was subsequently admitted at our institution. Emergency debridement and arthrotomy was done on the first hospital day. Repeat debridement and primary closure was done on the 4th HOD. Still with persistent drainage from the knee, a repeat debridement with application of negative pressure wound therapy was done on the 11th HOD. For 2 weeks, improvised NPWT with instillation and dwell time was done, using 20cc of a solution with hypochlorous acid once a day, allowed to dwell for 15 minutes each session.

Results / Discussion: After 2 weeks of NPWT-iD, patient was scheduled for repeat debridement, noted with decreased biofilm formation over the joint and granulation tissue over capsular defect. Closure of the skin defect was done with a medial hemi gastrocnemius flap and split thickness skin grafting. Two weeks post-op, we noted about 95% take of the skin graft, with no signs of reinfection over the previous wound.

Conclusion: Improvised NPWT-iD followed by flap reconstruction proved to be beneficial for this case of neglected open knee injury.

 

EP0090 The potential of hyperspectral Imaging for diagnosing osteomyelitis in toes

Sandra Maessen¹, Yvonne Bouten - Siebers¹, Romy Stürbl^1
1VieCuri Medisch Centrum, Venlo, Netherlands

Aim: To evaluate the diagnostic accuracy of hyperspectral imaging (HSI) for detecting osteomyelitis in patients with toe wounds.

Histopathology or bone biopsy, considered the gold standard for diagnosing osteomyelitis, is not always feasible. A recent study on MRI as a diagnostic tool revealed that 30% of patients were misdiagnosed with diabetic foot osteomyelitis. While the combination of probe-to-bone (PTB) and plain X-ray has shown high diagnostic accuracy comparable to MRI, proper interpretation requires significant training and experience.

Several studies on HSI have excluded cases of infection and osteomyelitis due to false-positive values in near-infrared (NIR) and Tissue oxygen saturation (StO2) measurements. This study aims to determine whether HSI can differentiate between superficial wound infections and osteomyelitis.

Method: A researcher, blinded to patient information, randomly selected individuals with toe wounds from our database. After applying exclusion criteria, 35 patients with toe wounds were included in the study.

Results / Discussion: Although based on a small sample, initial findings indicate that near-infrared (NIR) scores were slightly higher in patients suspected of having osteomyelitis. Because of the small group it wat not possible to determine an optimal cut-off point. But in confirmed osteomyelitis cases (via X-ray or bone biopsy, no MRI’s preformed), near-infrared values exceeded 81%. False low near-infrared values were often linked to measurement errors outside the wound bed due to difficult wound locations or callus, fibrin or necrosis.

Conclusion: hyperspectral imaging shows potential as an early indicator of osteomyelitis risk, further research is required to validate these findings.

 

EP0091 Enhancing an AI-powered clinical decision support tool for user-centered wound care: A one year follow-up

Tania Santos¹, Lourdes Hidalgo², Elaine Song³, Catherine T. Milne³, Tiffany Hamm³, Jeffrey Mize^3
1ULS Algarve, Albufeira, Portugal, ²ULS Coimbra, Coimbra, Portugal, ³WoundReference, San Francisco, United States

Aim: The integration of artificial intelligence (AI) into clinical decision-making revolutionizes wound care by providing clinicians with rapid access to evidence-based information (1,2). However, there have been usability challenges in our previously reported deployment (3). This secondary study aimed to refine responsible AI-user experience while reducing AI hallucination risk to quickly find evidence-based recommendations.

Method: The initial AI model limited responses for a predefined set of question/prompts via a dropdown menu. Clinicians found this interface restrictive, often struggling to find prompts relevant to their specific clinical queries, especially in complex wound care scenarios. They emphasized the need for usability improvements and expressed a preference for a free-text input.

Results / Discussion: The solution was developed as a module within a decision support platform with a continuously updated evidence-based literature foundation. Clinicians were interviewed and observed interacting with the AI interface in real time to identify both intuitive and challenging areas of the tool. Feedback was incorporated into multiple iterations of the interface to optimize user experience, grouping predefined questions/prompts into categories (e.g., “wound care,” “HBOT”). A new search bar was introduced to manage unexpected queries not covered by the existing prompts.

Conclusion: Clinicians can now perform AI-enhanced free-text searches, retrieving answers exclusively from a trusted source, ensuring all responses are based on editor-vetted, evidence-based information. Following these enhancements, clinicians reported improved satisfaction. These improvements underscore the role of responsible AI in shaping the future of clinical decision-making, providing safer and more effective support for healthcare professionals.

 

EP0092 Clinical experience in the treatment of lower limb ulcers with monocytes, preliminary data

Elia Ricci¹, Monica Pittarello^1
1Policlinico Di Monza, Clinica Eporediese, Clinica S Rita, Ivrea, Italy

Aim: Circulating mononuclear cells are finding an increasingly wider indication in the treatment of arterial skin lesions. Interim results of an observational study aimed at enrolling 500 patients treated with this technique.

Method: Review of arterial disease patients with lower limb ulcer (Fontaine’s IV) undergoing mononuclear graft surgery (*). The treated patients were divided into 4 groups: revascularized, revascularizable, non-revascularizable, arteritis. All patients had double treatment spaced 40 days apart. The observation period was 6 months with monthly evaluation. The results were divided into resolved, improved (Area reduction > 40%), unchanged (area reduction less than 40%), worsened (Area increase), amputated.

Results / Discussion: In total, 247 patients have been treated to date, of which 209 have completed the observational period. In the 209 patients at the end of the observational period, we detected 26 drops and 13 deaths, the total analyzable population is 170. In total, we detected 82 resolutions and 59 improvements with a positive performance of 82.9%, no response in 6.5%, worsening or amputation in 10.5% (table 1). Our experience in line with other authors presents a high performance of results, also considering the difficult typology of ulcer. The pain in patients who have shown an improvement has presented a reduction close to 80%.

Conclusion: Monocyte graft treatment in arterial disease patients with skin ulcers is now a valid alternative. The data, especially comparing the 4 different populations, suggest an early use if possible, this in contrast with the literature, especially aimed at treating non-revascularizable patients.

(*) HighQCell

 

EP0121 Topical oxygen therapy for chronic wound healing

Kyung Ah Lee^1
1Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea, Rep. of South

Aim: Chronic wounds represent a significant healthcare challenge, causing substantial patient morbidity and economic burden due to impaired healing. Topical oxygen therapy (TOT) has emerged as a promising treatment modality for these wounds. This study aimed to evaluate the efficacy and safety of TOT in managing chronic wounds.

Method: This retrospective study analyzed medical records of 10 patients with chronic wounds treated with TOT between January and September 2024. The mean patient age was 62 years, and wound etiologies included diabetic foot ulcers, pressure ulcers, and venous ulcers (Fig. 1). TOT was administered via a portable oxygen delivery device, providing a continuous flow of low-flow oxygen directly to the wound bed. Treatment efficacy was assessed based on wound size reduction, healing time, infection rate, and pain reduction (Fig. 2).

Results / Discussion: Following TOT, the mean wound size decreased from 10.5 cm² to 2.8 cm² (p<0.001), with a mean healing time of 5.4 weeks. The infection rate was 5%, and significant pain reduction was observed.

Conclusion: TOT can be additionally considered as a treatment method for chronic wound management, demonstrating efficacy in reducing wound size, accelerating healing, preventing infection, and alleviating pain.

 

EP0093 Negative pressure wound treatment gives benefits in treating iatrogenic cutaneous tuberculosis infections

Andika Winata^1
1Eka Hospital, BSD Serpong, Indonesia

Aim: Surgical site infections are the infections presented on the surgical sites and tuberculosis is a rare causative organism. The recommended therapy for such infections is the combination of surgical and antimicrobial interventions. This case report describes a rare presentation of tubercular cutaneous fistula after lower-segment caesarean section (LSCS) treated with a negative pressure wound treatment (NPWT).

Method: A 32-year-old patient had undergone LSCS six months ago at a private hospital. Then she presented with non-healing LSCS wound and abscess formation at and above the scar. An ultrasonography revealed multiple connections between the wounds and LSCS scar. Fistulous tracts excision was planned. Intraoperatively there was communication between all of the wounds and LSCS scar with extensive necrosis tissue within the tracts. After debridement, NPWT was applied. The vacuum device was used until granulation tissue formed.

Results / Discussion: Tuberculous infection following LSCS is not commonly reported. The diagnosis is potentially challenging as routine blood cultures are usually performed and it often fails to yield tuberculosis due to insufficient growth in general practice. Treating this wound is also challenging because the recommended theraphy is relatively unknown. NPWT shows some benefits like exhaustive debridement of pus, local improvement in tissue perfusion, mechanical traction and stimulation of granulation tissue with negative pressure, decrease in bacterial levels, and reduction in local edema.

Decreasing in the load of M. tuberculosis after applying NPWT is also reported by some author.

Moreover, NPWT decreased the hospitalization time and the number of daily dressing changes.

Conclusion: Clinicians should be aware of the possibility of infections caused by tuberculosis in patients who develop surgical site infections NPWT gives promising result in tuberculosis wound treatment.

 

EP0094 Minimally invasive onychocryptosis correction using shape memory alloys

Kyung Ah Lee^1
1Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Rep. of South Korea

Aim: Onychocryptosis accompanied by growth plate deformities is conventionally managed through partial growth plate resection, toenail straightening procedures, and ablative techniques. However, these interventions can inflict substantial pain and may result in onycholysis. This study employed a novel approach utilizing a shape memory alloy device, in conjunction with matrixplasty to achieve relatively painless toenail straightening without onychectomy.

Method: Onychoplasty with a shape memory alloy device was conducted on a cohort of eight patients presenting with onychocryptosis. (Fig. 1A, B & 2A, B) Following regional nerve block anesthesia, bilateral stab incisions were made approximately 1cm lateral to the nail margins, and the matrix was meticulously dissected using a cottle elevator. After precise measurement of the nail width, the devices were strategically applied at the lunula and distal nail plate. Dressings were changed every 2-3 days, and the device was removed after 3 weeks.

Results / Discussion: All patients showed improvement with no recurrence, nail dystrophy, or infectious complications. (Fig. 1C & 2C) Patients were followed for an average of 13 months and reported high satisfaction.

Conclusion: Onychoplasty employing a shape memory alloy device offers a promising therapeutic modality for patients with recalcitrant onychocryptosis. The device exhibits malleability at temperatures below 20 degrees Celsius due to its inherent low elasticity, while its strength is augmented at body temperature. Furthermore, its minimal thickness allows for comfortable footwear use. Concomitant matrixplasty significantly mitigates the risk of recurrence.

 

EP0095 Pilot study of Erbium YAG laser therapy for complex wounds: A three-month evaluation

Hajnal-Gabriela Illes¹, Olivier Illes², Lydie Rio¹, Quentin Guerin¹, Emilie Haumont¹, Alexandra Avenier¹, Justine Rissel¹, Emma Turlure¹, Françoise Hemon¹, Simona Zagaria¹, Jean-Paul Lembelembe¹, Cécile Libois^1
1Clinique des Augustines, Malestroit, France, ²Saint Julien College, Malestroit, France

Aim: The Erbium YAG laser, with a wavelength of 2936 nm, has demonstrated potential as an innovative solution for managing chronic wounds of various etiologies. This pilot study aims to evaluate the effectiveness of the Erbium YAG laser as a therapeutic method for treating complex wounds for in-patient clinical setting over a three-month period. The primary goal was to explore a non-pharmacological approach to combat wound infections, reducing the reliance on medication.

Method: A total of 15 patients with complex wounds were included in this three-month pilot study. The treatment involved Erbium YAG laser debridement combined with spatial modulation stimulation (SMA). This approach aimed to clear the bioburden while simultaneously stimulating the wound healing process. The treatment was designed to be comfortable for patients, enhancing their overall experience during therapy sessions. Repeat sessions were performed and the patients were monitored for signs of ulcer recurrence and healing progression. The primary outcome was complete wound closure or healthy granulation tissue, making the wound suitable for further surgical intervention if necessary.

Results / Discussion: Patients reported minimal discomfort, confirming the protocol’s patient-friendly nature. Healing outcomes varied, with patients showing significant progress in granulation, making them candidates for further procedures such as skin grafting. The average number of sessions required for healing was consistent with expectations based on previous studies using similar laser technologies.

Conclusion: This pilot study demonstrates that the Erbium YAG laser, combined with spatial modulation stimulation, is an effective and comfortable outpatient treatment option for complex wounds. By avoiding pharmacological interventions, this method offers a promising alternative for managing non-healing wounds. Further studies with larger sample sizes and extended timelines are recommended.

 

EP0629 Effectiveness of photobiomodulation with blue light in the treatment of infection wound

Su-Wen  Yeh¹, Chia Fan Lin¹, Chi-Ming  Pu^1
1Cathay General Hospital, Taipei, Taiwan

Aim: Blue light biotherapy has proven effective in treating infected wounds. Severe trauma from incidents such as traffic accidents often results in complex fractures, tissue necrosis, and a high risk of infection. Clinically, blue light has shown an ability to eradicate bacterial cells, making it a valuable treatment for chronic infected wounds.

Method: An 81-year-old male patient with diabetes sustained an avulsion injury on the dorsum of his foot from a car accident, accompanied by fractures of the second and third metatarsals. Following open reduction and internal fixation of the fracture, as well as wound debridement, the patient had an approximately 11.0 x 4.5 cm area of necrotic, infected skin. Blue light therapy, using a wavelength of 400-430 nm, was applied over the wound area covered with an artificial biofilm. Treatments were administered twice weekly for 3 minutes each session. After two weeks, the infection improved enough to permit skin graft reconstruction.

Results / Discussion: With a total of 12 minutes of blue light therapy over two weeks, the wound demonstrated substantial healing. The patient was able to walk independently eight weeks after surgery.

Conclusion: Blue light therapy is a non-invasive treatment that effectively penetrates superficial wounds, offering an alternative for patients with diabetes and hard-to-heal infections. This clinical application demonstrates significant benefits in wound healing and infection control in this single case.

 

EP0098 Biomimesis in wound care: innovation inspired by nature

Alessandro Corsi¹, Ornella Forma¹, Mirko Tessari², Carlotta Scarpa³, Franco Bassetto^3
1VulnoLogicaMente, Milano, Italy, ²Tessari Studi Legs Medical Institute, Peschiera del Garda, Italy, ³UOC Chirurgia Plastica Ricostruttiva Azienda Ospedale Università di Padova, Padova, Italy

Aim: In Photodynamic treatment, even today, there is still a certain lack of homogeneity in its use, starting with terminology, which unfortunately also extends to clinical indications: different technologies (various monochromatic lights, fluorescent light) contributes to this ‘confusion’, and the lack of adequate training and information does not help. We thought of drawing up a Position Statement (published in an international journal after independent blind peer review and without any Corporate support) that could be a sort of guide for professionals using these technologies.

Method: A heterogeneous group of professionals (clinicians, physicists, anatomic pathologists, dermatologists, lymphologists) was set up, who could contribute, each for their own competence, to the drafting of the document (from light’s physic to clinical effects - on approximately 15,000 patients, treated with the different technologies available-, supported by microscopic and molecular analyses).

Results / Discussion: All the methods analysed produced the expected clinical results, but it became clear that, for each type (monochromatic for different colours, and fluorescence), a careful assessment of the lesion and the choice of the appropriate treatment, depending on the type of lesion and its clinic, is necessary to obtain the desired effect (control of microbial load, stimulation of angiogenesis, cell stimulation, modulation of inflammation, ...).

Conclusion: The natural response of endogenous chromophores to different wavelengths is the obvious cause of the selective tissue response to different applied lights (monochromatic or fluorescence). Although, at first assessment, fluorescence (complete with the different colours) may seem the most complete and effective technology, the results point towards a selective use of each technology, depending on the complexity of the lesion and the type of biological effect we seek from photobiomodulation.

 

EP0099 Taking a STRIDE to improve wounds through a novel care pathway

Jose Ramirez-GarciaLuna, Brock Liden^1
1Cutting Edge Research LLD, Circleville, United States

Aim: Diabetic foot ulcers (DFUs) pose a significant challenge due to high recurrence rates, often resulting from neuropathy, arteriopathy, and inadequate offloading or metabolic control. Traditional approaches to DFUs emphasize topical treatments, but the complex pathophysiology of DFUs demands a more comprehensive approach to achieve sustained wound closure and prevent recurrence. The STRIDE (Surgical Treatments for Reconstruction & Innovative Deformity Elimination) pathway introduces an aggressive, multidisciplinary surgical approach focused on infection control, biomechanical correction, and sustained ulcer closure. STRIDE integrates advanced wound care techniques with tailored surgical interventions, aiming to address underlying deformities and prevent re-ulceration.
Method: STRIDE incorporates three essential steps: (1) Infection management using antibiotic-loaded flowable cement for localized osteomyelitis treatment, providing high antimicrobial efficacy either as a standalone or adjunct therapy. (2) Wound bed optimization through advanced antimicrobial washes, synthetic skin substitutes, and real-time optical imaging to maintain a healing-conducive physiological environment. (3) Biomechanical correction through reconstructive surgery rather than conventional devices, addressing structural deformities via procedures like endoscopic gastrocnemius recession and Charcot foot reconstruction.
Results / Discussion: In a single-center review of 100 patients treated with STRIDE, outcomes demonstrated a 90% wound closure rate by 20 weeks and a reduction in recurrence to below 5%. Additionally, the amputation rate decreased by 50%, highlighting the pathway’s efficacy in promoting limb preservation and rapid wound healing.
Conclusion: The STRIDE pathway offers an innovative, structured approach to DFUs, emphasizing infection control, biomechanical alignment, and sustainable wound closure. Early findings suggest that STRIDE not only accelerates wound healing but also reduces recurrence and amputation rates, underscoring its potential as a superior solution in chronic wound care.

 

EP0101 Use of hyperozonized fatty acids protector barrier to restore periulceral devitalized skin in hard-to-heal wounds of different etiologies

Clara Masó Albareda^{1 2 3}, Marta Casals Zorita^{1 2 3}, Joan Enric Torra i Bou³, Joan Espaulella Panicot^{2 4 5}, Maria Carme Salomón Elcacho², Marta Ferrer Solà^{2 3 4
1}Doctoral School. University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain, ²Fundació Hospital de la Santa Creu de Vic (FHSC-CHV), Vic, Spain, ³Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, ⁴Hospital Universitari de Vic, Vic, Spain, ⁵Faculty of Medicine, University of Vic – Central University of Catalonia (UVic-UCC), Vic, Spain

Aim: Hyperozonized fatty acids (HOZFA) compound with protector barrier (HOZFA-B) (*) acts as skin protector with a repairing effect using bioactive ozonides and chitin polymers that protects against humidity, rubbing and adhesives, acting on the stratum corneum and between the different layers of the epidermis, managing to combine the protection and repair of the skin. Due to its effect, preserves the hydrolipidic film, and stimulates cell turnover, as well as the barrier against external aggressors such as incontinence or exudate.

Method: We present a case series of 15 patients with wounds of different etiologies in the lower extremity to describe the effect of using a HOZFA-B.

Results / Discussion: To lessen variables that could influence in the evaluation of the protector barrier, all patients were treated with platelet-rich plasma (PRP) advanced therapy. A total of 15 patients were enrolled between October 2023 to January 2024 and followed up until the end of the therapy. Because PRP therapy it is done once a week, the application of the product was conditioned by this premise.

Based on this experience, the periulcer skin of 11 patients was clinically improved and in 4 patients no enhancements were seen throughout the time this study was carried out. Erythema, small periuceral lesions, and maceration were the characteristics this product proved to restore periulceral devitalized skin. On the contrary, with itching and hyperkeratosis no ameliorance was seen.

 

Conclusions: The case series may seem to indicate that the HOZFA-B could constitute an effective product against moisture, friction, and adhesives, with a repairing and strengthening action on devitalized skin.
(*): Abzolem Barrier ^®. Biotelier Labs, Barcelona

 

EP0102 The use of electrospinning in the healing of hard-to-heal wounds. Report of 10 patients treated in a wound care clinic

Marcin Malka^1
1PODOS Wound Care Clinic, Warsaw, Poland

Aim: The goal of the study is to test and analyze if the electrospinning method is useful in a daily practice of wound care clinic and to see in what cases the results are going to be the most noticeable.

Method: 10 patients suffering from hard-to-heal wounds in proliferative phase were invited to participate in the study. Only superficial wounds without visible signs of infection were included in the study. The patients were treated with nano-fibrous transient skin-like layer, one or two times weekly over 4 weeks. The nano-fiber membrane was applied on the first visit and reapplied during future visits if it was damaged. We observed if the use of this method would reliably increase the speed of healing and the ease of use and maintenance of the device for HCP.

Results / Discussion: There are a few cases where the electrospinning considerable accelerated the healing process, and a few when we didn’t observe any noticeable changes in a standard healing time.

Conclusion: We are still searching for new reliable methods of healing the hard-to heal wounds. The electrospinning is not entirely reliable, but it has a lot of potential in some cases. It is necessary to continue the research of this method to indicate the patients who will receive the most value out of this kind of treatment.

 

EP0103 Prevalence of medical device-related pressure injuries in intensive care unit patients

Marilia Valenca¹, Clarissa  Régia e Solva¹, Victor Felipe Leça Sena¹, Emanuela Batista Ferreira e Pereira¹, Jabiael  Carneiro da Silva Filho¹, Isabel Cristina Santos¹, Fabio Luis Gomes Leitão¹, Maria Luisa Sena Farias^1
1University of Pernambuco, Recife, Brazil

Aim: The aim of this study was to identify the prevalence of pressure injuries related to medical devices in patients admitted to an Adult ICU of a public hospital in the city of Recife, Pernambuco - Brazil.

Method: This is a descriptive, cross-sectional study with a quantitative approach. Descriptive statistics were used for analysis. This study was developed in accordance with Resolution 466/2012 of the Brazilian National Health Council, which regulates research with human beings.

Results / Discussion: Data was collected from 73 patients, they were identified using at least one device during the period, including an orotracheal tube, nasoenteral tube, nasogastric tube, indwelling urinary catheter and pulse oximeter. The occurrence was higher in patients using TOT with 70.2% and 61.6% of patients having some comorbidity.

Conclusion: The occurrence of Medical Device-Related Pressure Injuries indicates the need for preventive measures, monitoring and ongoing health education. The importance of involving nurses in scientific production on the topic is highlighted.

 

EP0104 In vitro screening for an optimized low intensity pulsed ultrasound (lipus) protocol for chronic wound healing

Bianca Cioni¹, Francesco Iacoponi¹, Francesco Nocilla¹, Leonardo Ricotti¹, Andrea Cafarelli^1
1The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy

Aim: The pathophysiology of chronic wounds involves complex interactions between different cell types and molecular phenomena. Despite well-established standards of care, the healing time for chronic wounds often remains prolonged and suboptimal. The use of advanced therapies such as low-intensity pulsed ultrasound (LIPUS) is limited, mostly due to lack of standard protocols developed to target multiple cell types and molecular pathways. This work aims to systematically screen in vitro different LIPUS conditions to decrease inflammation and promote tissue regeneration

Method: Human THP-1 monocytes differentiated into M1 pro-inflammatory macrophages (with PMA, IFN-γ, and LPS), human dermal fibroblasts (HDF) and human epidermal keratinocytes (HaCaT) were treated with different LIPUS parameters (frequency from 38 kHz to 5 MHz, intensity up to 500 mW/cm2, duty cycles from 10% to 40%, and different pulse repetition frequencies and durations), by using a patented LIPUS in vitro stimulation setup. Multiplex ELISA, PicoGreen kit and automated scratch analyzer were used to assess pro-inflammatory cytokines and metalloproteinases (MMPs) production, proliferation and migration.

Results / Discussion: Preliminary analysis revealed optimal LIPUS stimulation conditions specific for each cell type. LIPUS treatment significantly decreased, among others, IL-1β, TNF-α and IL-6 production in M1 macrophages, increased HDF proliferation, affected MMPs production and promoted HaCaT migration and KRT16/KRT17 expression.

Conclusion: These data demonstrate the therapeutic potential of LIPUS treatment for chronic wound healing under specific and previously unknown exposure conditions. Current efforts aim to identify the best LIPUS protocol that simultaneously targets the main cell types involved in the pathology toward the clinical application.

 

EP0105 An effective debridement tool for gentle surfaces

Alperen Pala¹, Müge Sert², Gaye Filinte^2
1University of Health Sciences Hamidiye Medical Faculty Kartal Dr.Lutfi Kırdar City Hospital, Istanbul, Turkey, ²University of Health Sciences Hamidiye Medical Faculty Kartal Dr.Lütfi Kırdar City Hospital, Istanbul, Turkey

Aim: Monofilament fiber debridement pads are easy and alternative way to debridement of sensitive body parts such as hands. Purpose of this study is to show alternative methods for precise debridement and comparing them to conventional options to see if this method is a viable option for debridement.

Method: A total of two groups of 16 patients with second degree deep burn in the hand are selected randomly. Two debridement methods of gentle surgical debridement with a curette or scalpel(n=9) and debridement pad(n=7) applied with light sedation. (Figure 1) Both methods were applied twice a week. The amount of necrotic tissue was evaluated using indocyanine green fluorescence imaging. Additionally, patients were given pain scale of 1 to 10 during debridement.

Results / Discussion: The fluorescent images were divided according to the oxygenation results and the average scores were similar in both groups. However, pain scores favored debridement pads. The durations of the procedures were also similar.

Conclusion: Debridement pads may offer a viable alternative to surgical debridement, especially in delicate areas like the hands and face. They can be used by any healthcare professional and results in painless, precise and immediate debridement in outpatient clinics.

 

Figure 1. Debridement by surgical technique and debridement pad

 

EP0107 Use assessment of an interactive patient mobile application to support negative pressure wound therapy

Laura Leyva Casillas¹, Leah Griffin^1
1Solventum, San Antonio, United States

Aim: Patients receiving Negative Pressure Wound Therapy (NPWT)* with and without companion mobile app (MWH)† use were compared. Patient demographics, adherence to therapy, wound progression, and therapy days were assessed.

Method: MWH was developed for use with an NPWT unit for patients in the homecare setting. Patients undergoing NPWT were invited to download the MWH App to track their wound healing progress, receive NPWT and general wound care education, obtain help using the NPWT device, and order NPWT supplies. From January 2022 to February 2024, 4,917 patients used the MWH App compared to 261,667 without MWH.  Data were summarized as means, counts, and percentages. T-tests and chi-square tests were used to test for differences between cohorts with alpha at 0.05.

Results / Discussion: MWH App users were younger (54 years versus 60 years), had a higher rate of commercial insurance (MWH 38.4% versus non-MWH 25.6%), and had a higher percentage of acute wounds (MWH 77.9% versus non-MWH 69.8%). The average hours of therapy per day was 17.9 for MWH versus 15.4 for non-MWH. The rate of patients maintaining an average of 16 or more hours of therapy per day was higher for the MWH cohort (68.8% versus 54.8%). MWH patients had a larger wound volume decrease at 80.9% versus 76.8% for non-MWH. All findings were statistically significant at p<0.05.

Conclusion: MWH patients were more likely to meet minimum required hours on therapy than non-MWH patients. The increased adherence to therapy may result in a greater decrease in wound volume.

*3M™ ActiV.A.C.™ Therapy System ; †My WoundHealing™ Mobile App, Solventum Corporation, Maplewood, MN, USA

 

EP0108 A novel physical scrubbing model for assessing wound cleansing treatments and techniques for biofilm disruption

Jeanne Saint Bezard¹, Rui Chen¹, Marcus Swann¹, Fergus Watson¹, Vincent Peyrou², Debashish Chakravarthy³, Steven Percival^1
15D Health Protection Group Ltd., Liverpool, United Kingdom, ²URGO RID, Chenove, France, ³Urgo Medical USA, Vernon Hills, United States

Aim: Chronic wounds are a significant burden on patient morbidity and hospital finances; >90% exhibit high microbial loading and evidence of biofilm formations. Wound cleansing is critical for removing foreign contaminants, damaged tissue, and opportunistic pathogens for improved healing. This study addresses the need for a standardised in vitro preclinical model for comparing the efficacy of antiseptics with mechanical disruption on biofilms.

Method: A novel scrubbing model was developed to emulate the action experienced during cleansing. The model standardised the forces being applied to the wound, allowing uniform pressure (<15 psi) and scrubbing speed. Bacterial biofilms were formed upon wounded porcine explant, before exposure to an antimicrobial- or saline-soaked gauze applied using standard practice (10 minute soak/30 seconds scrubbing).

Results / Discussion: Following cleansing the antimicrobial cleanser achieved > 4 Log reduction in biofilm whilst the saline demonstrated only <1 log reduction in biofilm. Microscopy imaging, using fluorescent viability stains, indicated significant disruption to the biofilm formation with an abundance of non-viable cells post antimicrobial treatment and an abundance of viable cells post saline which result in biofilm regrowth within the wound. Micrographs provided evidence of a shearing effect on the biofilm because of the physical mechanical scrubbing action which is indicative of clinical practices.

Conclusion: The scrubber model developed provided a realistic and reproducible model for assessing the efficacy of different cleansing treatments and techniques equivalent to clinical practice. The results support those seen in clinical literature for the use of saline during wound cleansing with mechanical forces.

 

EP0109 Evaluating Erbium YAG laser and RecoSMA for chronic leg ulcers: A prospective study

Katarína Szabómihályová^{1 2}, Andrei Mazurenka², Sarah De La Crompe², Ram Chilgar^{2 3}

¹University Hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovenia, ²Linline Medical Systems, Riga, Latvia, ³Elvero Clinic, Chhatrapati Sambhajinagar, India

Aim: The study evaluates the efficacy of Erbium YAG laser with RecoSMA technology as a therapeutic approach for managing non-healing leg ulcers over three months.

Background: Chronic non-healing leg ulcers remain a challenging condition that often resists standard treatments. This study explores a non-pharmacological, laser-based approach to reduce dependence on traditional therapies, targeting wound infections and promoting tissue repair.

Method: A prospective pilot study was conducted, enrolling 16 patients with venous or mixed non-healing leg ulcers unresponsive to conventional treatments. Inclusion criteria: patients 18+ with diagnosed chronic leg ulcers. Exclusion criteria: active infection, uncontrolled comorbidities. Each patient received Erbium YAG laser treatment with spatial modulation (SMA) over 12 weeks.

Treatment Protocol: The Erbium YAG laser (2940 nm) was applied for debridement, focusing on necrotic tissue removal and microbial reduction. RecoSMA technology stimulated the inflammatory phase, promoting wound healing. Weekly treatments monitored ulcer size and granulation, aiming for closure or healthy granulation.

Results / Discussion: Treatment outcomes were positive, with all patients showing improvement in wound surface and granulation. 37,5 % of patients achieved full wound closure, and others had substantial granulation, enabling surgical options. Patients reported minimal discomfort, supporting the treatment’s tolerability.

Conclusion: Erbium YAG laser treatment with RecoSMA is a safe and effective treatment for complex leg ulcers. However, further investigation with larger sample sizes is needed to confirm long-term benefits and refine protocol efficacy.

 

EP0110 Effectiveness of oxygen multi-modality therapy for osteomyelitis and / or atleast diabetic foot Armstrong Wagner 2b

Bernd Gächter^1
1Ospedale Regionale di Locarno,, Spital Oberengadin Samedan, Locarno, Samedan, Switzerland

Aim: Older patients with various previous illnesses (diabetic foot, peripheral arterial disease, requiring dialysis, scleroderma, etc.) are known to have delayed wound healing. The IWGDF have included topical oxygen therapy in the guidelines.

Method: 16 patients: 16 with Osteomyelitis, 15 with wounds, 14 with peripheral arterial disease, 11 with Diabetes mellitus, 4 requiring dialysis, 2 with scleroderma and 1 without wound. Critical ischemia was ruled out in all patients. If the wound showed signs of infection, a swab was taken and then treated with antibiotics for 10 days according to the antibiogram. The oxygen multi-modality therapy was carried out 4 times a week for 3 months.

Results / Discussion: After 3 months, 10 wounds were healed. One wound healed after 9 months. One wound was 90% healed after 9 months. One patient was healed and had an open wound again one month after therapy. One patient discontinued therapy and underwent surgery. One patient suffered critical ischemia and required amputation. One patient suffered from scleroderma and presented with a consistent wound.

Conclusion: This oxygen multi-modality therapy shows good results in diabetic foot without critical ischemia. Since the therapy can also be carried out at home, there is no need for transport to the therapy centers. The therapy can also be done via wound dressing, which means that care costs can also be saved.

 

EP0111 Evaluation of the bluedop device for ankle brachial pressure index measurement in a tissue viability assessment

Adelaide Seemann^1
1The Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom

Aim:

• To evaluate the effectiveness and efficiency of the BlueDop device in assessing ABPI
• To compare the results against the traditional ABPI doppler.

Method:

• A prospective study, sample size of 11 patients pilot study
• Patients were selected based on requiring an ABI, there was no exclusion criteria.
• The BlueDop device operates using pressure from the flow algorithm.

Results / Discussion:

• Assessment Time: the average assessment time was 7 minutes and 30 seconds, significantly less than the rest time required for traditional methods.
• Ulcer Location: 73% of ulcers presented in areas in which traditional cuffs would typically be applied, highlighting the relevance of the cuffless approach.
• Treatment Initiation: 100% of patients had treatment initiated immediately, avoiding a 6-month waiting period typically associated with Vascular assessments.
• Using the BlueDop device within our clinical practice has reduced assessment times significantly and allowed immediate treatment to be initiated, resulting in better patient outcomes.
• The device has many positives for clinical practice as removing the cuff aspect reduces the infection control risks for patients.
• The speed in which results are obtained ensures a full holistic approach can take place within an overburdened service.
• The ease of use means that unqualified clinicians can use the device with confidence.

These factors together mean that treatment can be initiated for patients without delay resulting in advanced outcomes.

Conclusion: The BlueDop device benefits such as reduced assessment time, improved patient comfort, cuffless assessment and streamlining patient care. These factors all contribute to improved patient outcomes and saves Nursing/clinical time.

 

EP0112 The efficacy of physical therapy modalities on quality of life in wound patients

Lenka Krupová¹, Andrea Pokorná^2
1University Hospital Ostrava, Ostrava, Czech Republic, ²Masaryk University, Brno, Czech Republic

Aim: To evaluate the effectiveness of three physical therapy modalities – mechanical lymphatic drainage, VACUMED therapy, and EXTREMITER therapy – on improving the quality of life (QoL) and specific clinical outcomes in patients with leg ulcers.

Method: This qualitative study analyzed detailed case reports of nine patients divided into three groups (n=3 per group). Group 1 received mechanical lymph drainage therapy, Group 2 underwent VACUMED therapy (alternating waves of negative and positive pressure), and Group 3 received EXTREMITER therapy (alternating negative and positive pressure). Patients attended therapy sessions three times a week (Monday, Wednesday, and Friday) for a minimum of one month. Quality of life was assessed weekly using the Wound-QoL questionnaire.

Results / Discussion: All nine patients demonstrated a significant increase in wound-related quality of life and a reduction in wound size. In Group 1, the primary outcome was a reduction in swelling. Group 2 experienced notable pain reduction and enhanced personal comfort (better physical activity). Group 3 showed improvements in tissue oxygenation. These findings suggest that each physical therapy modality offers distinct benefits that contribute to overall wound healing and patient well-being.

Conclusion: In our small cohort in the study, we can conclude that physical therapy holds a justified and beneficial place in wound treatment. While it requires considerable patient commitment and regular attendance compared to standard therapies, the significant improvements in wound healing and QoL outweigh the additional demands on patients and healthcare personnel. The study underscores the importance of integrating physical therapy modalities into comprehensive wound care plans.

 

EP0113 Bimekizumab effect on the need for concomitant rescue interventions by hiscr response level in patients with moderate to severe hidradenitis suppurativa from be heard I&II

Falk G. Bechara^{1 2}, Seth  Forman³, Amit Garg⁴, Philippe Guillem^{2 5}, Hessel van der Zee^{2 6}, Evangelos Giamarellos-Bourboulis^{2 7}, Akimichi Morita⁸, Bart  Lukowski⁹, Bob Rolleri¹⁰, Pratiksha  Dokhe¹¹, Nicola Tilt¹¹, Iltefat  Hamzavi¹², Valentina Dini^13
1Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany, ²European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany, ³ForCare Clinical Research, Tampa, United States, ⁴Northwell, New Hyde Park, New York, United States, ⁵Department of Surgery, Clinique du Val d’Ouest, Lyon, France, ⁶Erasmus Medical Center, Rotterdam, Netherlands, ⁷4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece, ⁸Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan, ⁹Vedim/UCB, Warsaw, Poland, ¹⁰UCB, Morrisville, United States, ¹¹UCB, Slough, United Kingdom, ¹²Department of Dermatology, Henry Ford Hospital, Detroit, United States, ¹³Dept. of Dermatology, University of Pisa, Pisa, Italy

Aim: Hidradenitis suppurativa (HS) lesions require a multifaceted treatment approach, including rescue concomitant interventions alongside conventional therapy.¹ Here, the relationship between HS Clinical Response (HiSCR) levels achieved with bimekizumab (BKZ), a monoclonal antibody that inhibits interleukin (IL)-17A and IL-17F, and concomitant interventions is investigated.²

Method: Data were pooled from BE HEARD I&II; randomisation 2:2:2:1 (initial/maintenance) to BKZ 320mg every 2 weeks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, placebo/BKZ Q2W. Data pooled across all BKZ-randomised patients at baseline (BKZ Total).³ Data are reported over the maintenance treatment period (Weeks16–48). BKZ-randomised patients: grouped by achievement of mutually exclusive Week16 HiSCR levels (

Results / Discussion: BKZ Total (N=868): 76.0%, 83.2%, 89.1% of HiSCR<50, 50–<75, 75–100 achievers, respectively, did not receive rescue intervention (Weeks16–48). Comparable trends across HiSCR bands observed in patients receiving BKZQ2W/Q2W (N=288: 79.8%/90.0%/90.9%), BKZQ2W/Q4W (N=292: 75.0%.78.3%/89.0%) or BKZQ4W/Q4W (N=288: 73.3%/ 81.4%/87.1%) in the HiSCR<50, 50–<75 and 75–100 bands, respectively.

Similar trends observed when separating into medical/procedural interventions.

Conclusion: Majority of BKZ-randomised patients did not require concomitant rescue interventions during maintenance treatment period; proportions increased with increasingly stringent HiSCR bands. These data highlight the additional value to patients of a decreased need for concomitant rescue interventions when achieving higher HiSCR levels.

References:

1. Zouboulis J Eur Acad Dermatol Venereol 2015;619–44;
2. Adams et al. Front Immunol 2020;11:1894;     
3. Kimball et al. Lancet 2024;403:2504–19 (NCT04242446, NCT04242498).

 

EP0114 Blue light therapy: a strategy to reactivate the healing of hard-to-heal wounds

Davide Griffa^{1 2}, Catuscia Orlandi², Francesca Iuliano², Cinzia castagnoli², Bianca Maria Piraccini^{1 3}, Davide Melandri^{1 2
1}Department of Medicine and Surgical Sciences, University of Bologna, Bologna, Italy, ²Dermatology Unit and Burn Center, AUSL Romagna, Bufalini Hospital, Cesena, Italy, ³Dermatology Unit, IRCCS Sant’Orsola-Malpighi Hospital, Bologna, Italy

Aim: To assess the efficacy of photobiomodulation with blue light (410-430nm) in reactivating the healing process of hard-to-heal wounds.

Method: The single-centre observational study enrolled 58 patients with hard-to-heal wounds that did not respond effectively to standard treatments (SoC), from September 2023 to October 2024. The treatment protocol involved the application of blue light therapy for 120 seconds at a distance of 4 cm from the wound bed. Blue light therapy was administered once a week, for 10 consecutive weeks, and combined with the most appropriate dressing according to the wound bed. Response to therapy was assessed by direct observation and the progression of re-epithelialisation documented by photographs.

Results / Discussion: The wounds of 52 patients were evaluated and divided into groups according to aetiology (Tab. 1): burns (13=25%), post-traumatic wounds (18=35%) and post-surgical wounds (21=40%). Overall, 87% (=45) of the wounds responded positively to treatment, of which 54% (=28) reported complete re-epithelialisation and 33% (=17) reported progressive improvement (>50% of wound surface area). Only 13% (=7) of the injuries did not receive any benefit from the therapy. In addition, it was observed that burns and post-traumatic wounds showed greater results from blue light stimulation (Fig. 2). In addition, 24 patients received fewer sessions because they were considered healed.

Conclusion: Based on the preliminary results obtained, photobiomodulation with blue light, in addition to SoC, seems effective in reactivating the healing process of hard-to-heal wounds. Furthermore, it is an easy to manage and safe therapy as no related adverse events have been reported.

 

EP0115 Pneumatic compression: Fast and furious?

Kelley van der Meer¹, Tim Wentel^1
1Ceulen Klinieken, Schiedam, Netherlands

Aim: The aim of the study is to evaluate the ease of use of an adaptive pneumatic compression device (APCD). This was performed in addition to an earlier study about the pressure properties of the APCD, in which the researchers found a promising additional role for the treatment of CVD (presented at ICC meeting EMWA London). This presentation will provide new insights into the usability of the pneumatic compression device.
Hypothesis: We expect, regardless of any experience, the application time for APCD to be at least twice as fast as for bandaging.

Method: A total of 42 experienced homecare nurses were asked to perform both the application of the APCD and that of a two-layer bandage of their preference twice. The application time for each leg and compression technique was measured. All actions concerning the application were included in this time measurement.

Results / Discussion: The average application time of the two layer bandages was 154 seconds, compared to 53 seconds for the application of a APCD. The APCD can be applied 3x faster than two layer bandages. It does not require any strength or experience in order to don the APCD, which makes it possible for patients to use the APCD themselves. This saves a lot of valuable time for healthcare workers. Besides, it also saves a lot of waste, as the APCD can be used for six month, whereas most bandages are single use.

Conclusion: This study suggest an interesting role for the APCD in the treatment of CVD.

Image: waste of bandages (6 weeks of bandaging with a 2-layer system) vs. APCD.

 

EP0116 Can you avoid a skin graft with Matriderm biological template in certain size wounds? The ‘no step’ phenomenan explained

Ibby Younis^1
1University College London Hospital, Royal Free Hospital London, London, United Kingdom

Aim: Biological dermal templates such as Matriderm in open wounds need a skin graft either at the same sitting, as ‘single step’ or after several weeks to minimise the contour defect or to bridge over exposed tendon/bone, as ‘two step’. We observed in some wounds epithelisation appeared to have occurred without skin grafting after applying Matriderm! It is widely acknowledged a wound left to heal by secondary intention without a dermal template can lead to an adherent, tethered, contracted and unstable scar. We wanted to establish type and size wounds which could be left to epithelialise and heal be secondary intention with Matriderm but without any of the resultant drawbacks mentioned.

Method: 1mm and 2mm Matriderm dermal templates were placed in wounds with a size range of 4cm² x 20cm² in several anatomical locations and monitored for epithelialisation, wound condition and clinicians’ and patients’ feedback. Non-adherent dressings were changed on a weekly basis.

Results / Discussion: All the wounds epithelialised within 3-6 weeks. There was no visible tethering, contracture, loss of function or unstable scar.

Conclusion: These findings confirm our hypothesis, the Matriderm collagen/elastic scaffold is an ideal template for epithelisation for wounds up to 20cm². This process starts from the wound edge and progresses inwards and explains why long narrow wounds heal quicker than short wide ones. Both ‘one and two step’ Matriderm techniques involve a skin graft, so we have named this  ‘no step’ technique because its has the huge benefit of avoiding another wound (skin graft donor site) and resultant issues. This phenomenon could potentially applied to larger wounds by introducing epithelial islands as a future innovative and exciting research project.

 

EP0120 Use of a fish skin graft (FSG) with synthetic coverting in post-moh’s lower extremity wounds - a longitudinal observational cohort study of efficacy and cost

Eric Lullove^1
1Chief Medical Officer, West Boca Center for Wound Healing, Coconut Creek, United States

Aim: Treatment of complex lower extremity wounds with Fish Skin Graft* with a Synthetic

Cover material in a Longitudinal Observational study of efficacy and cost.

Method: 30 patients with post-Mohs non-healing lower extremity wounds were reviewed and prospectively enrolled in an IRB-Exempt clinical study at a single site center. The population of the wounds were 23 SCC and 7 BCC. Male to Female was 12:18. Average age was 81.4 years.

Patients treated weekly with Fish Skin Graft for 12 weeks to wound closure and measured percent area reduction at week 4 and week 8. Patients with ABI < 0.6 or > 1.2 were excluded from the study. The Fish Skin Graft was anchored with synthetic silicone cover and ó” steri-strips. Wound measurements were all calculated via AI digital application weekly.

Cost analysis was performed post-closure of all patients to show payor accuracy compared to standard of care and time to close.

Results / Discussion: 30 patients completed 12 weeks of therapy. 28 of 30 patients closed prior to week 8. Average number of applications was 6.9 applications. Average PAR at 4 weeks was 55%. PAR at week 8 for the remaining 4 patients was 91%. 29 of 30 patients completed wound closure by week 12.

Conclusion: The use of FSG in this pilot study with synthetic silicone was efficacious in the therapy of post-Mohs wounds of the lower extremities. Overall healing rates for the 12-week course of treatment in this study was approximately 95% (n=29).

 

EP0117 Fluorescence imaging to assess bacterial burden before and after chemical debridement with a topical desiccating agent

Thomas Serena¹, Alberto Cogo², Johannes P. Snels^3
1The SerenaGroup®, Cambridge, MA, United States, ²Villa Berica Hospital, Vincenza, Italy, ³DEBx Medical B.V, Amsterdam, Netherlands

Aim: For decades clinicians have stressed the importance of wound bed preparation including debridement and reduction in bacterial load. Despite the admonitions of wound care specialists, inadequate debridement remains the primary reason for delayed wound healing and the failure of advanced treatment modalities. The inability to recognize clinically significant levels of bacteria based on clinical signs and symptoms has led to the haphazard use of antiseptics. A novel chemical debridement, topical desiccating agent, TDA (DEBx Medical, Debrichem, Amsterdam) reacts with water in the wound bed effectively debriding the wound in a single application. It is proposed that the desiccating action also kills bacteria and disrupts biofilms.  Fluorescence imaging (MolecuLight, Toronto, CA), a tool validated in clinical trials, detects planktonic and biofilm-based bacteria at levels that impede wound healing.

Method: This series evaluated the ability of a topical desiccating agent (TDA) to remove nonviable tissue and reduce bacterial fluorescence in a variety of wound types. The study was conducted at a single center in Italy. TDA was applied for 60 seconds to each wound then removed mechanically.  Fluorescence imaging was obtained before and after chemical debridement.

Results / Discussion: Thirteen patients with diabetic foot, venous leg, and autoimmune ulcers underwent chemical debridement. In all cases, complete granulation was achieved after one application.  Fluorescence imaging demonstrated that TDA reduced or eliminated the bacterial burden in all cases.  The results mirrored studies evaluating sharp surgical debridement.

Conclusion: TDA effectively debrides and reduces the bacterial burden in nonhealing wounds. Randomized clinical trials are ongoing.

 

EP0119 Evaluation of a novel, canister-based, portable negative pressure wound therapy system in the management of low-to-moderately exuding acute and subacute wounds

John Timmons^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: To investigate the performance and safety of a portable, single-use negative pressure wound therapy (suNPWT) system* in the management of acute and sub-acute wounds.

Method: A non-comparative, multi-centre study involving patients with traumatic wounds (n=34), subacute (e.g. dehisced) wounds (n=34), and flaps and grafts (n=34) with low to moderate exudation was undertaken. The suNPWT system was used for up to 28 days (discontinued earlier if graft take was sufficient, flap viability confirmed or healing achieved). The primary endpoint was wound progress (deteriorated, unchanged, or improved) compared to previous assessment. Additionally, wound specific parameters (area, volume, tissue type, exudate amount), peri-wound skin condition, device-specific performance and safety were investigated.

Results/Discussion: Wound progress was considered to have improved (relative to previous assessment) in 80.7% (95% confidence interval (CI) 75.0% to 85.6%) of visits. Wound area/volume decreased from baseline to final visit. The proportion of devitalised tissue also decreased from baseline to final visit, while granulation and epithelial tissue increased. Reports of trauma to the surrounding skin were rare and peri-wound skin condition generally improved.  Patients and clinicians reported high levels of satisfaction with the system; it was found to be easy to use, absorbed and transported exudate well, and had encouraging wear times.  None of the reported adverse events raised unknown or unexpected safety issues or concerns relating to the suNPWT system.

Conclusion: Across the range of wounds evaluated in this study, the suNPWT system supported wound progress towards healing, graft take and flap viability.   

* Avance® Solo (Mölnlycke, Sweden)

 

DIABETIC FOOT

EP0179 Application of novel sheet-type micronized acellular dermal matrix in diabetic ulcer with small bone defect

Hyun Kim¹, Hwanjun Choi^1
1Soonchunhyang University Hospital, Cheonan, Rep. of South Korea

Aim: When treating diabetic foot ulcer (DFU) invading bones, ostectomy or amputation is necessary. A recent study showed positive results of micronized acellular dermal matrix (mADM) treatment for DFU treatment. The purpose of this study was to evaluate the effectiveness of mADM use to reconstruct bony defects that occurred after infected and/or necrotic bone removal.

Method: From January 2022 to June 2023, 38 DFU patients with bone necrosis or osteomyelitis were studied. mADM is a safe ADM currently used in clinical practice and is in the form of a sheet. Unlike conventional ADM, the front and back sides are not separated, so it can be cut freely and filled in the defect area to promote wound healing. After ostectomy was performed where bone necrosis occurred, mADM was applied to the dead space under controlled inflammation and then secondary healing was induced.

Results / Discussion: When the wound was flat and free of infection, negative pressure wound treatment was performed to promote wound healing. There were 36 patients who succeeded in secondary healing, and the remaining 4 patients did not completely heal or relapsed. After complete healing, X-ray showed no further osteonecrosis and no recurrence.

Conclusion: Osteocutaenous free flap for toe reconstruction can be performed, but it is difficult to perform due to the vascular condition of DFU patients and the possibility of recurrence. After removing necrotic bone tissue from DFU patients, bone defects can be reconstructed more easily and simply with mADM.

 

EP0180 Diabetic foot talk-time: framework for effective communication in the management of diabetic foot

Lavinia Cacciatore¹, Marco Meloni^2
1Master Podopatia Diabetica Università degli studi di Roma Tor Vergata, Via Montpellier, 1, 00133 Roma, Roma, Italy, ²Unità Piede Diabetico, Dipartimento di Medicina Interna, Università di Roma “Tor Vergata”, Viale Oxford 81, 00133 Roma, Roma, Italy

Aim: Diabetic foot syndrome is a chronic complication of diabetes mellitus that generates a psychological-social burden that worsens the impact of the disease and emotional impairments that frustrate connection with health care professionals. Therapeutic education (EDT) and effective communication (EC) prove useful in boosting patient “empowerment” and reducing frustration, however, there are no guidelines in the Diabetic Foot field. This study aims to understand the key points to improve adherence to care of the patient with diabetic foot by optimizing therapeutic outcomes and communication skills of Health Professionals in the management and prevention of Diabetic Foot and in Team.

Method: The study included review of literature, from the past 5 years, on EDT and CE in the context of Diabetic Foot prevention and management; manuals on CE; and a descriptive questionnaire model survey with the objective of investigating Professional-Diabetic and Intraprofessional communication challenges, strategies for improvement, and assessing Diabetic Foot awareness. Articles were surveyed in the literature by PICO method, on Medline database using Pubmed. The ‘descriptive survey, lasted four months, including 165 participants, divided into the Professional and Diabetic group to whom two specific questionnaires were proposed.

Results / Discussion: The results of the research show that EDT, EC and Information Technologies, are key points to change adherence to care by improving treatment outcomes, and the importance of online consultation of specific resources to improve adherence to care.

Conclusion: From the data obtained, an online Framework for professionals and diabetics was created, with the future goal of a mobile application.

 

EP0181 Tools used to assess for microangiopathy in the diabetic foot

Ellen Kirwan¹, Anne Clancy^{2 3}, Claire MacGilchrist², Caroline McIntosh^1
1University of Galway, Galway, Ireland, ²Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland, ³National Institute for Prevention and Cardiovascular Health (NIPC), Galway, Ireland

Aim: The aim of this scoping review is to identify tools currently used in clinical practice to assess and diagnose microangiopathy in the diabetic foot and to evaluate associated factors that contribute to their efficacy. This will aid prevention, detection and improve the treatment of microangiopathic complications in patients with diabetes. Early diagnosis of microvascular disease in patients with diabetes is essential to avoid vascular system deterioration.

Method: This review followed the Joanna Briggs Institute (JBI) ‘Manual for Evidence Synthesis: Scoping Reviews Chapter’ and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR). Studies were imported to Covidence and extracted through Microsoft Excel. Discussion and results are influenced by the JBI ‘Template for Scoping Reviews’. This scoping review followed the PCC framework, focusing on tools available to assess microvascular complications in the diabetic foot. Studies published before 2004, not written in English, and that do not meet the inclusion criteria are excluded.

Results / Discussion: Results presented data associated with country, setting, study design, microangiopathy assessment tools. After analysis of 36 studies, factors such as tool specificity, practicality, invasiveness, and cost determined the most effective tools. Magnetic resonance imaging and angiography were the most used tools.

Conclusion: The study revealed that the handheld pulse oximeter, sphygmomanometer cuffs, doppler ultrasonogram machine, and FLIR SC7200 met the ideal criteria for each factor although clinical implications of patient specific factors, budget, and environment must be considered.

 

EP0182 Risk factors for the first-ever diabetic foot ulcers: a systematic review and meta-analysis

Yan Tao¹, Dou Zhang², Ellen Kirwan¹, Caroline McIntosh^3
1Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland, ²Discipline of Nursing, School of Health Sciences, University of Galway, Galway, Ireland, ³Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Alliance for Research and Innovation in Wounds, College of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland

Aim: To systematically review and synthesise risk factors associated with the development of a first-ever diabetic foot ulcer (DFU) in diabetes patients.

Method: We conducted a comprehensive search of four English and three Chinese electronic databases for cohort and case control studies reporting risk factors for first-ever DFU, with no restriction on publication date and location. Two researchers independently screened and selected studies, extracted data, and assessed study quality. Unadjusted odds ratios (ORs), relative risks or rate ratios and standardised mean differences (SMDs) were recorded or calculated for dichotomous and continuous data. A quantitative meta-analysis was performed for risk factors reported in at least two studies to estimate pooled ORs or SMDs, with evidence grated using GRADE system.

Results / Discussion: From 24 included studies, 38 potential risk factors underwent meta-analysis. High-quality evidence linked increased first-ever DFU risk to obesity, male gender, alcohol use, current smoking, longer diabetes duration, retinopathy, neuropathy, elevated triglycerides, and reduced high-density lipoprotein. Moderate-quality evidence supported associations with older age (≥60 years), unmarried status, increased HbA1c and fasting plasma glucose, cerebrovascular disease, nephropathy, myocardial infarction, insulin use, and antihypertensive therapy. Low-quality evidence suggested that decreased eGFR, elevated creatinine, cardiovascular disease, peripheral artery disease, high vibration perception threshold (≥25 volts), foot deformities, and skin dryness were associated with increased first-ever DFU risk. The remaining factors showed no significant association.

Conclusion: We identified 25 significant risk factors for first-ever DFU. Healthcare providers should prioritise these factors for DFU prevention and management in diabetic patients.

 

EP0183 Real-world effectiveness and dose response of ON101 therapy for healing of diabetic foot ulcers

Shun Cheng Chang^1
1Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan

Aim: ON101 cream, a novel treatment for diabetic foot ulcers (DFUs), has shown superior healing efficacy and cost-effectiveness compared with current treatments under trial settings. This study further evaluated the real-world effectiveness and dose response of ON101, especially for high-risk patients with poor healing outcomes.

Method: 80 and 98 DFU patients treated by ON101 and standard care with adjuvant therapy (denoted as non-use), respectively, during 2020/1/1-2022/12/31 were identified from Taipei Medical University-Shuang Ho Hospital, Taiwan. The primary outcome was a compete healing event within 120 days following treatment initiation. Secondary outcomes included ulcer recurrence, amputation, and all-cause mortality within one year of follow-up. Cox proportional hazard model analysis was applied to determine the treatment effect on study outcomes. The dose response of ON101 on healing outcomes was modeled using a regression analysis.

Results / Discussion: Compared with non-use, ON101 use significantly increased the complete healing outcome by 79% (hazard ratio: [95% CI]: 1.79 [1.24, 2.58]), with an average of 1.85 ON101 tubes used per person with healed ulcers. Favourable healing outcomes were consistently shown in the analyses of high-risk patients. The dose-response analysis results suggest 25%, 107%, 33%, and 19% decreases in the ulcer size per additional ON101 tube use for all study patients and those with Wagner grade 1, 2, and 3 ulcers, respectively (all p-values<0.01).

Conclusion: Promising healing outcomes following ON101 therapy at lower doses among real-world DFU patients are corroborated, with a potential therapeutic benefit for clinically disadvantaged patients and practical feasibility for use in routine practice.

 

EP0630 Ultrasound-assisted wound debridement in the treatment of diabetic foot ulcer: Α literature review

Ismini Kountouri¹, Panagiota Roulia¹, Marios Dagher¹, Christina Sevva¹, Eleni Paschou¹, Vasilis Stergios¹, Amyntas Giotas², Ioannis Katsarelas³, Dimitrios Chatzinas³, Panagiotis Nachopoulos³, Afroditi Faseki³, Athanasios Polychronidis³, Konstantinos Papadopoulos¹, Vasileios Alexandros Karakousis¹, Alexandra  Panagiotou³, Mohammad Husamieh³, Georgia Maria Ntoulia², Militiadis Chandolias³, Periklis Dimasis³, Stylianos Mantalovas^4
1Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ²Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ³Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ⁴3rd Surgical Department, AHEPA, AUTH, Thessaloniki, Greece

Aim: This study aims to review the international literature regarding the use of ultrasound-assisted wound (UAW) debridement in the treatment of diabetic foot ulcers.

Method: We present the results from two systematic reviews regarding the efficacy and safety of ultrasound-assisted wound debridement in the treatment of diabetic foot ulcers. In total 19 randomized control studies with 959 participants are reviewed in the two systematic reviews. The use of this technique is thoroughly presented.

Results / Discussion: In UAW Debridement a sterile saline fine mist is administered between 5 and 15 mm from the wound and ultrasonic energy is transferred to the wound bed. By this technique the permeability of cell membranes and the activity of second messengers changes, resulting in an increase in protein synthesis, mast cell degranulation, and growth factor manufacture, which in turn stimulates fibroblasts and neo-angiogenesis at the site of the wound. In the first review,  UAW debridement showed higher healing rates, a greater percentage of wound area reduction, and similar healing times when compared with placebo (sham device) and standard of care in patients with diabetic foot ulcers. In the other systematic review, the subgroup analysis of wound healing rate showed that the UAW debridement group had a higher wound healing rate than the standard wound care group and the placebo group.

Conclusion: Both systematic reviews concluded that UAW debridement can improve wound healing rate, shorten wound healing time, accelerate wound area reduction rate, and improve clinical treatment effectiveness without obvious adverse reactions.

 

EP0184 An eye for a foot: alarming unawareness and presence of diabetic retinopathy among diabetic foot patients

Hikmet Erhan Güven¹, Eyüpcan Şensoy¹, Mehmet Çıtırık^2
1University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey, ²University of Health Sciences, Ankara Etlik City hospital, Ankara, Turkey

Aim: To determine the awareness and incidence of diabetic retinopathy in patients hospitalized for diabetic foot ulcers, examine their clinical and demographic characteristics, and assess their treatment.

Method: In this prospective study, comprehensive anterior and posterior segment examinations were performed on 62 diabetic foot ulcer patients who were hospitalized for treatment, between June-August 2023. Demographic and clinical features were noted.

Results / Discussion: Thirty-nine patients (62.9%) were male. The mean age was 61±11.4 years. Clinical characteristics of patients are summarized in Table 1. Diabetic retinopathy (DR) is classified as non-proliferative and proliferative. Thirty-one patients (50%) were unaware of the presence of their diabetic retinopathy. Of those “unaware”, twenty-six patients (83.9%) had DR. Only 12/62 patients (19.4%) had previous eye exams on a regular basis. Diabetic retinopathy was detected in 56/62 patients (91.9%) (Figure 1). Intravitreal (IV) anti-vascular endothelial growth factor injection was performed in 44 eyes, panretinal photocoagulation (PRP) in 2 eyes, and intravenous injection + PRP + vitreoretinal surgery in one eye. Among 124 eyes, 48 (38.7%) received treatment for retinopathy.

Conclusion: The findings of this investigation changed our routine practice. Currently, as part of the standard wound care for patients with Wagner stages 3 and 4 diabetic foot disease, we perform thorough ophthalmological exams. Diabetic foot surgeons shouldn’t rely on the presumption that endocrinologists are monitoring them in accordance with international diabetes guidelines or that patients are following their doctors’ advice. Routine ophthalmological examinations during follow-up visits should be included in international diabetic foot disease guidelines.

 

EP0185 Validation of the effects of wound dressing using bovine amnion on Streptozotocin induced diabetic wound

Young Koo Lee^1
1Department of Orthopedics, Soonchunhyang University Bucheon Hospital, Bucheon-si, Rep. of South Korea

Aim: The aim of this study is to determine the chronic wound healing effects of wound dressing using bovine amnion.

Method: In vitro and in vivo experiments were conducted using an animal model which is induced diabetes by intraperitoneally injecting streptozotocin diluted in 0.1 M sodium citrate (Ph 4.5). After cell characterization was performed using tissues cultured in diabetic rat, stability and toxicity were confirmed through CCK-8. After that, the wound size of 2.5 cm² was induced in the diabetic rat model and divided into the control group with Vaseline Gauze and the experimental group with wound dressing with bovine amniotic membrane, and the wound size was measured on the 1st, 4th, 7th, and 10th days after the experiment, and the tissue was collected on the 4th, 7th, and 10th days to confirm the wound healing effect through histological analysis.

Results / Discussion: It was confirmed that fibroblasts were separated through the ICC stain, and the cell viability increased compared to the control group at the time of 24 hours when the wound covering material was applied through CCK-8 assay, and there was a significant difference in statistical analysis. In vivo experiments, the wound size of all groups decreased over time, but there was no significant difference. Histological analysis revealed that the experimental group had a higher degree of granulation tissue formation and lower degree of inflammatory cell penetration than the control group.

Conclusion: The results of this study suggest that wound dressing with bovine amniotic membrane is effective in treating diabetic wounds.

 

EP0211 Biomechanical evolution of the Neuropathic Diabetic Foot: Scoping review protocol

Rosa Colella¹, Gaetano Di Stasio², David G. Armstrong³, Howard Danaberg⁴, Andrea Bellingeri⁵, Ferdinando Campitiello^6
1IRCCS Policlinico San Matteo, Phase I Clinical Trial Unit, Scientific Direction Department, Pavia, Italy, ²Univbersità  Degli Studi di Napoli Federico 2, Napoli, Italy, ³Keck School of Medicine of University of Southern California (USC), Los Angels, United States, ⁴Bedford, NH, USA, Bedford, United States, ⁵IRCCS Policlinico San Matteo, Pavia, Italy, ⁶University “Luigi Vanvitelli”, NAples, Italy

Aim: Non-enzymatic glycosylation of proteins in Diabetic Patients (DP), causes soft tissue damage such as thickening, stiffening and shortening. The elastic response and extensibility alteration of lower limb soft tissue induces podalic deformities and determines neuropathic DP gait evolution changes.¹

There is a pathological gait evolution standard model, which always leads to three biomechanical syndrome characteristics of Diabetic Foot (DF). We have postulated the Diabetic Equinus, Pronation, Shuffle Syndromes and the biomechanical origin of Charcot DF, which have never been described before. This thesis is detailed in a narrative review, soon to be published.

This scoping review aims to provide a more robust methodological basis to the proposed biomechanical evolutionary model, in order to develop/support primary prevention strategies.

Materials and methods: The protocol follows the Prisma 2020 Checklist. ²

The PCC (Population, Concept, Context) model is considered.

INCLUSION criteria:

-Adults over 18 years

-DP

-Territory/community patients

-Abstract papers in English in the last 10 years.

EXCLUSION criteria

-Paediatric patients

-Hospitalised patients

-Patient with foot ulcers or in secondary prevention.

Clinical trials, observational studies and reviews will be examined on the following databases:

Pubmed, EMBASE, Cochrane, CINAHL, PEDRO.

Results: Identify/determine the gait pattern of the neuropathic DP and acquired foot deformities.

Additional results: incidence, prevalence, effect, impact, relevance, influence of biomechanical deficits in DP.

Conclusion: Identifying the foot at risk is one of the key elements for prevention, according to the IWGDF 2023 guidelines. Proposing a new model/paradigm that illustrates how DF biomechanic changes, due to the etiopathogenetic factors of diabetic neuropathy, can help developing greater awareness in primary prevention and can be the starting point to build new ideas/intervention strategies.

This will introduce/support the DF prevention services level #0, by the interdisciplinary figures present in the community, such as nurse’s and podiatrist’s local service/assistance and general practioners.

References:

¹ Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update).

² Peters JD et al, 2022 adapted to Scoping Reviews.

 

EP0186 Clinical efficacy of acellular dermal matrix paste in treating diabetic foot ulcers

Donghyuk Shin^1
1Konkuk University Medical Center, Seoul, Rep. of South Korea

Aim: Diabetic foot ulcers (DFUs) are slow to heal because of poor tissue vascularity and regenerative capacity, among various factors, so we use every possible method. In this study, the authors evaluate the efficacy of applying a paste formulation of acellular dermal matrix (ADM) to DFUs. 

Method: Patients with Wagner grade 2 or 3 DFUs (N = 49) received either ADM paste (treatment group; n = 23) or conventional foam dressing (control group; n = 26). All chronic wounds were debrided and irrigated in an attempt to control infection. After paste application, mild compaction was undergone to fill ulcer cavities, and foam dressings were used to cover the surface to absorb any discharge. All DFUs were analyzed with regard to ulcer area, depth, progression, healing rate, and duration to complete healing.

Results / Discussion: At the 60-day primary outcome mark, 56.52% (13/23) of the DFUs in the treatment group were healed, compared with 23.08% (6/26) of DFUs in the control group. Mean rates of wound area resolution in the treatment and control groups were 74.17% ± 30.84% and 51.87% ± 32.81%, respectively (P < .05), with mean times to heal (within 60 days) of 13.54 ± 9.18 days and 21.5 ± 11.98 days, respectively (P < .05). There were no serious adverse events in either group, and no complications related to ADM paste application. 

Conclusion: The ADM paste effectively enhanced tissue regeneration, shortening ulcer duration and preventing associated complications, while eliminating the need for supplemental ulcer management procedures. The paste formulation of ADM provides a matrix for tissue ingrowth, promoting the healing of DFUs and seems to be available enough.

 

EP0188 A randomized controlled Phase 2 trial to evaluate multi-factorial gene therapy AUP1602-C in the management of non-healing diabetic foot ulcer

Alberto Piaggesi¹, Jacek Mikosiński², Elisabetta Iacopi¹, Dirk Lammers³, Christine Kosch⁴, Konrad Pańczak⁵, Malwina Grobelna⁶, Matteo Monami⁷, Alessia Scatena⁸, Marcin Malka⁹, Marco Meloni, Christoph Schindler¹⁰, Mirka Sanio¹¹, Jere Kurkipuro¹¹, Hanna-Riikka Kärkkäinen¹¹, Matleena Piiroinen¹¹, Igor Mierau¹¹, Laurent Décory¹², Juha Yrjänheikki¹², Haritha Samaranayake^11
1Azienda Ospedaliera Universitaria Pisana, Pisa, Italy, ²NZOZ Mikomed, Łódź, Poland, ³Institut für Diabetesforschung Muenster GmbH, Muenster, Germany, ⁴Hausärztliche und Diabetologische Praxis, Pirna, Germany, ⁵Lecran Centrum Opieki Nad Ranami, Wroclaw, Poland, ⁶Med-Polonia SP. Z O.O., Poznan, Poland, ⁷Diabetic Foot Unit, University of Florence, Florence, Italy, ⁸Azienda USL Toscana sudest, Arezzo, Italy, ⁹PODOS Wound Care Clinic, Kałuszyn, Poland, ¹⁰Medizinische Hochschule Hannover, Hannover, Germany, ¹¹Aurealis Therapeutics, Kupio, Finland, ¹²Aurealis Therapeutics, Zug, Switzerland

Aim: To evaluate the safety and efficacy of AUP1602-C, a Gene Therapy Medicinal Product for non-healing diabetic foot ulcers (DFUs), in a randomized, controlled Phase-2 study conducted in 10 Specialized Centres in Italy, Germany and Poland.

Method: AUP1602-C consists of living Lactococcus cremoris bacteria genetically modified to secrete human FGF-2, IL-4 and CSF-1, modulating wound microenvironment and promote wound healing. Safety and efficacy of the recommended Phase 2 dose, derived from a 16-patient open-label, single-arm, dose-escalation Phase-1 study (NCT04281992 / EudraCT 2018-003415-22), were evaluated in a 64-patient multi-centre prospective, randomized, standard-of-care plus placebo-controlled single blinded, Phase-2 “DIAMEND” study (NCT06111183 / EudraCT 2022-502048-10-00). AUP1602-C was administered topically once- or twice-a-week to non-healing, neuro-ischemic DFUs until complete wound closure or maximum for 12 weeks. The comparator was SoC according to IWGDF guidelines. Primary endpoints were incidence of adverse events, and healing rate at 20 weeks.

Results / Discussion: No serious adverse reactions were observed to date. As of October 2024, 16, 15 and 15 patients per group have reached 20 weeks follow-up in the placebo, AUP1602-C once-a-week, and AUP1602-C twice-a-week groups, respectively. The corresponding complete wound closure rate is 44%, 40%, and 67%, respectively in the intention-to-treat population; in patients with DFU older than 3 months, the respective complete wound closure rates were 30%, 37% and 73%.

Conclusion: The intermediate results from the first-ever Phase-2 study with a topical gene therapy, confirm AUP1602-C safety and efficacy in treating non-healing, neuro-ischemic DFUs, warranting further clinical development.

 

EP0189 Clinical outcomes in people with diabetes-related foot infections: Analysis from a limb preservation service infection database

Matthew Malone^{1 2}, Emma Bergamin^{1 3 4}, Kenshin Hayashi^{1 3}, Saskia Schwarzer^{1 3 4}, Hugh Dickson^{4 5}, Namson Lau^{1 4 6}, Lawrence Lavery⁷, Robert  Commons^8
1South West Sydney Limb Preservation and Wound Research, Sydney, Australia, ²Infectious Diseases and Microbiology, School of Medicine, University of Western Sydney, s, Australia, ³Liverpool High Risk Foot Service, South Western Sydney Local Health District, Sydney, Australia, ⁴Ingham Institute of Applied Medical Research, Sydney, Australia, ⁵Ambulatory Care and PIXI, Liverpool Hospital, Sydney, Australia, ⁶Department of Diabetes and Endocrinology, Liverpool Hospital, Sydney, Australia, ⁷Department of Plastic Surgery, University of Texas, Southwestern Medical Centre, Dallas, Texas, United States, ⁸Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia

Aim: Diabetes-related foot infections (DFI) are common and represent a significant clinical challenge. There is scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of DFI.

Method: A tertiary hospital limb preservation service database was established in 2018, and all new episodes of DFI were captured prospectively using an electronic database. Data between January 2018 and May 2023 was reported on including outcomes between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM).

Results / Discussion: Data extraction identified 647 complete DFI episodes in 397 patients. The data reported in two cohorts; SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Half of infections were classified as moderate (PEDIS 3 = 327, 51%), 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) episodes. OM infection failures were more common (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI higher failures were observed with peripheral arterial disease (PAD) (failure in 30% (31/103) of episodes with PAD and 12% (27/223) without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78).

Conclusion: This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It reinforces the need for early intervention to improve PAD in patients with DFI.

 

EP0190 Accelerated wound healing in Korean diabetic foot patients using biologic dressings; Use of keratinocytes, collagen, and fibroblasts

Ahyoung Kim^{1 2
1}Severance Hospital, Yonsei University, Seoul, Rep. of South Korea, ²Korean Wound Management Society, Korean Society for Diabetic foot, Korean Association of Wound Ostomy Continence Nurses, Seoul, Rep. of South Korea

Aim: This study evaluated the clinical outcomes of wound healing and infection control in Korean diabetic foot patients treated with biologic dressings.

Method: Patients diagnosed with diabetic foot ulcers received regular applications of composite biologic dressings containing keratinocytes, collagen, and fibroblasts

Results / Discussion: Treatment efficacy was assessed using wound size reduction, granulation tissue formation, and infection rates. Results demonstrated a significant improvement in wound healing in most of patients, with a notable reduction in wound size and enhanced granulation tissue formation. The biologic dressing, particularly the collagen component, provided structural stability to the wounds, while keratinocytes and fibroblasts promoted cellular regeneration, positively influencing tissue repair. Importantly, the treatment prevented partial amputations, even in severe cases of diabetic foot. No new infections were reported during treatment period.

Conclusion: This case study suggests that biologic dressings are an effective treatment for promoting wound healing and preventing infections in diabetic foot patients. These findings highlight the potential of biologic dressings as a valuable therapeutic option, especially for preventing amputations in severe cases, and support their inclusion in future diabetic foot treatment guidelines.

 

EP0191 Efficacy of combined hyperbaric oxygen therapy and topical hemoglobin spray in treating hard-to-heal sloughy wounds

Levent Demir^1
1Kayseri City Training and Research Hospital, Kayseri, Turkey

Aim: This study examines the effectiveness of a combination of hyperbaric oxygen therapy and topical hemoglobin spray in treating hard-to-heal, sloughy diabetic foot ulcers.

Method: Patients with non-healing diabetic foot wounds that are at least 25% sloughy or necrotic were included in the study. We compared the results of 21 patients who received standard personalized wound care and hyperbaric oxygen therapy with topical hemoglobin spray (oxygen group) to 21 patients who only received standard personalized wound care treatment (control group). We used a historical series as a control group. The initial values of HBA1C and CRP, wound culture results, duration of the wounds, Wagner and SIMBAD scores were documented. Wounds were considered healed when completely closed within 16 weeks.

Results / Discussion: The oxygen group had a SIMBAD score of 5.00 ± 0.89, while the control group had 4.62 ± 0.80 (p: 0.136). After 16 weeks, 85.7% of the oxygen groups showed complete recovery, compared to 52.4% in the control group (p: 0.019).

Conclusion: Combining hyperbaric oxygen therapy with topical hemoglobin spray provides oxygenation to the wound for longer, mainly because patients can receive 90 minutes of HBOT daily. This ensures that patients benefit from both systemic and local oxygen. This combination therapy may effectively address the problem of hypoxia and promote healing in difficult-to-heal wounds. The need for randomised controlled trials with a more appropriate design is highlighted by our promising results.

 

EP0192 Predicting major amputation rates in diabetic hindfoot ulcers

Seung-Kyu Han^{1 2}, Ye-Won  Choi^{1 2}, Ji-Won Son^{2 3}, Eunbi Lim^3
1Department of Plastic Surgery, Korea University College of Medicine, Seoul, Rep. of South Korea, ²Diabetic Wound Center, Korea University Guro Hospital, Seoul, Rep. of South Korea, ³Department of Nursing Service, Korea University Guro Hospital, Seoul, Rep. of South Korea

Aim: The aim of this study was to create an initial risk-scoring system to forecast the prognosis of individuals with diabetic hindfoot ulcers, leveraging assessments of ischemia and infection severity, which are recognized as the principal risk factors for amputation.

Method: Ischemia severity was categorized as iS0, iS1, or iS2 based on transcutaneous partial oxygen tension values, while infection severity was classified as iN0, iN1, or iN2 according to the results of tissue and bone biopsy cultures. Risk scores were determined by summing the scores for ischemia and infection severity, yielding a range of 0 to 4. Wound healing outcomes were graded as either healed with or without major amputation. Wound healing outcomes were assessed based on the assigned risk scores.

Results / Discussion: With ascending risk scores, the proportion of patients subjected to major amputation also increased (*P-value for trend < 0.001). Univariable logistic regression analysis revealed a significant positive correlation between escalating risk scores and major amputation incidence. Patients with a risk score of 4 exhibited a 41-fold higher likelihood of undergoing major amputation compared to those with a risk score of 0.

Conclusion: Risk scores can serve as a reliable predictor of the major amputation rate in patients with diabetic hindfoot ulcers.

 

EP0193 Multiple diabetic foot ulcers (DFUs) caused by self-inflicted heat and cold burn: A fierce battle to avoid amputation

Hikmet Erhan Güven^1
1University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey

Aim: To present the treatment course of a patient who, over the course of 112 days in our clinic, underwent different treatment methods for self-inflicted burn-induced DFU—without performing even minor amputation.

Method: A 51-year-old male who is diabetic for 10 years and 30 pack-year smoker burnt his right foot with a hot water bag and a heater. When his wounds worsened after five days of applying ice to the same area, he sought treatment at the emergency department. He had multiple Wagner 4 DFUs on his right foot, measuring 13x5cm, 5x7cm and 5x9cm in size. The patient was admitted to our department for emergency treatment. Laboratory findings are given in Table 1. He had necrotizing fasciitis with sepsis. The initial emergency surgical treatment was sharp debridement in combination with topical desiccating agent (TDA) application. A variety of treatment modalities were used; serial surgical debridement, negative pressure wound therapy (NPWT), topical epidermal growth factor (tEGF), interval split thickness skin grafting with NPWT and skin substitute application over the graft.

Results / Discussion: After his initial hospitalization, the patient returned 146 days later for an outpatient follow-up session. He had five toes, all the grafted areas and donor sites were entirely closed, and his gait was normal. The HbA1c level was 5.1%.

Conclusion: The TDA was applied once, which resulted in an uneventful granulation phase and helped suppress initial necrotizing infection.  Amputations resulting from DFU may be prevented with aggressive, tenacious interventions in combination with liberal application of appropriate wound care products.

Reference TDA= Debrichem^®

EP0194 Hyperbaric oxygen therapy in the management of diabetic foot ulcers

Imen Mezoughi^1
1Military Hospital of Tunis,Tunis, Tunisia

Aim: Diabetic foot ulcers are common complication in diabetes that requires multidisciplinary treatment approaches. Adjunction of Hyperbaric Oxygen Therapy (HBOT) is showing promising results. The aim of the study is to assess the clinical, epidemiological and evolutionary characteristics of our population in order to determine the prognostic factors of patients treated with HBOT for diabetic foot injury

Method: This is a retrospective study including 1050 diabetic patients treated from January 2012 to December 2022.

Results / Discussion: The mean age of was 72.9+/-10. Seventy nine percent of them were males. Patients suffered Type 2 Diabetes In 79% of cases with a mean duration of 21 years. Ulcers were mainly classified as stage 4 (44%) according to Wagner classification. Bacteriological sampling was performed in only 58% of patients. E. Coli was the most frequent infesting agent (39%). The average number of HBO sessions was 27. The outcome was favorable in 59% of cases; total healing was obtained in 20% of cases. In 39% of cases significant budding appeared. Minor amputation was performed in 6% of cases and 8% underwent major amputation. The uni-variate analysis showed that peripheral arterial disease, kidney failure, heart disease and depth of the lesion were considered as poor prognostic factors whereas the number of HBOT sessions was a good prognostic factor (P=0.000).

Conclusion: According to our study, HBOT is an effective adjunctive therapy for the treatment of chronic diabetic foot since it increases the cure rate and reduces the rate of amputation.

 

EP0195 Prevention of revision amputation surgery with the use of copper dressings - a paradigm change

Dr. Eyal Melamed¹, Ithamar Cheyne², Jihad Dabahh^1
1Rambam Health Care Center, Haifa,Israel, ²Medical University of Warsaw, Warsaw, Poland

Aim: Major leg amputations have a notoriously high rate of complications and revision surgeries. Wound dehiscence, stump ischemia, skin tension, subcutaneous hematoma, pressure necrosis, and superficial or deep infections often lead to extended or repeat hospitalization and surgery. The copper dressing has a well-known antimicrobial effect, and in addition can promote angiogenesis, granulation tissue formation, autolytic debridement, and epithelization. We prospectively substituted revision surgery with copper dressings in an outpatient setting.

Method: Six patients, three hospitalized, in whom revision amputation surgery was cancelled, and three discharged patients with new necrosis and dehiscence, were recruited. Five diabetic patients had a transtibial amputation and one (vascular patient) transfemoral. The aetiology was pressure necrosis, stump ischemia, dehiscence due to tension of the sutures or from uncertain aetiology.
Bilayer active copper dressing was applied to the wound cavities and an adhesive copper dressing on top served for mechanical compression of the wound edges. Dressings were changed once or twice weekly.

Results / Discussion: All the wounds healed uneventfully except for one patient who needed a short course of oral antibiotic. The average wound size was 19.6 (±10.4) cm². The time to closure was 84.6 (±25.4) days. The observed copper dressings effects were antimicrobial protection, stimulation of autolytic debridement, granulation tissue formation, and epithelization, in line with the ‘continuum of wound care’ concept.

Conclusion: These cases demonstrate the ability to combine the copper dressings multi-mode of action (antimicrobial, autolytic debridement, angiogenesis, granulation tissue formation, and epithelization) with good dressing technique to perform a paradigm shift toward non-surgical treatment in many amputation stump failures. The suggested treatment is convenient for the patient, and costs less than 5% of the hitherto approach.

 

EP0196 The effectiveness of a podiatrist and endocrine nurse-led diabetic foot clinic in a singapore tertiary institution: a retrospective study

Yuen Fun Alexis Lai¹, San San Oh^1
1National University Hospital, Singapore, Singapore

Aim: Singapore has an 81.7% prevalence of diabetes-related complications, especially lower limb amputations, which are increasing globally. To address this, a one-weekly clinic was established to provide specialised wound care for diabetic foot ulcers and metabolic risk management. The clinic monitors wound progress, provides interventions, and manages hospital admissions. Podiatrists and nurses work together to improve patient outcomes and reduce complications.

This study evaluates the effectiveness of a podiatry and nurse-led clinic in managing active diabetic foot ulcers.

Method: This retrospective review analyses data from 2018 to 2023, focusing on patients aged 18 to 95 with diabetes and active foot ulcers under endocrinology care. Patient identities were kept anonymous. Descriptive statistics were used for reporting.

Results / Discussion: 106 patients were treated over five years, with a mean age of 59. Wound sizes varied: 16% were less than 1 cm and 69% were larger than 1 cm. 27% were treated for diabetic skin and nail conditions without wounds. 35 out of 94 patients had healed wounds, 6 are still in treatment and 6 had mortalities unrelated to wounds. Notably, 38% of patients defaulted on appointments. The average healing time was 22.5 weeks. The average HbA1c for healed patients improved from 9.19% to 8.33%. The clinic identified foot complications in 11 patients, leading to orthopaedic and vascular referrals. Two patients were hospitalised for infections and two required antibiotics.

Conclusion: Collaboration between podiatrists and nurse clinicians enhances care for diabetic foot ulcers, improving patient outcomes and emphasizing the importance of interdisciplinary teamwork in complex health management.

 

EP0553 The frequency of anemia and multidrug-resistant bacterial growth in diabetic foot patients and its effect on healing

Fevziye Duygu Avlar¹, Hilal Samur¹, Hakan Uncu²

¹Ankara University Faculty of Medicine, General Surgery Department, Ankara, Turkey, ²Ankara University Faculty of Medicine, General Surgery Department, Ankara, Turkey

Aim: This study examines the association between concurrent hemoglobin levels, the presence of multidrug-resistant (MDR) microorganisms in cultures and ulcer healing rates in diabetic foot patients undergoing treatment.

Method: This study was conducted among 120 diabetic foot patients selected from those treated in wound care center of Ankara University Faculty of Medicine. Patients were categorized into anemic and non-anemic groups. Patients with hemoglobin levels below 13.1 g/dl were defined as anemic. The non-anemic group was classified as Group A, the anemic group as Group B. In Group A, the average age was 65.07(49–94 years) with 18.5% female,81.4% male. In Group B, the mean age was 63.68(42–85 years) with 35.4% female,64.6% male. Follow-ups were evaluated by healing time,if healing was not achieved, total treatment duration.

Results / Discussion: In total, 93 of the 120 patients were anemic. Among Group A, 29.6% showed no microbial growth. MDR bacteria were present in 91% of the anemic patients, whereas only 18% of the non-anemic patients exhibited MDR bacterial growth. The most commonly cultured microorganisms in Group A were Methicillin-Resistant Coagulase-Negative Staphylococci (MRCNS) (21.7%), Corynebacterium striatum (17.3%), Pseudomonas aeruginosa (13%), whereas in Group B, Corynebacterium striatum (14.4%), Pseudomonas aeruginosa (12.3%), MRCNS (10.3%) were most prevalent. Healing was achieved in 78.3% of Group A and 71.2% of Group B, with average healing times of 115 days (3-644 days) for Group A and 169 days (7-1272 days) for Group B.

Conclusion: Diabetic patients frequently face multisystem complications like foot ulcers, retinopathy, nephropathy, neuropathy and also anemia from end-organ dysfunction. Anemia is more frequently observed in diabetic patients compared to the non-diabetic population. MDR growth was more common in the anemic patient group. Considering that MDR infections alone extend the treatment duration, the presence of anemia further affected the healing process. Therefore, during patients’ initial consultations, a complete blood count should be performed and hemoglobin levels should be assessed. If anemia is detected,necessary treatments should be initiated to correct it.

 

EP0197 The use of hyperbaric oxygen therapy in patients with diabetic foot ulcers wagner stage ≥3 – description of five cases

Georgia Papingioti¹, Evangelos Papoutsidakis², Nikolaos Zikos¹, Jorge Carderon Villaroel³, Rodrigo Catalan³, Vasileios Drouvis¹, Spyridon Koulas¹, Filippos Siakas^1
1General Hospital of Ioannina  ‘G. Hatzikosta’, Ioannina, Greece, ²Hospital Moises Broggi, Barcelonα, Spain, ³Hospital Ancud, Ancud, Chile

Aim: This study aims to evaluate the hyperbaric oxygen therapy in patients with diabetic foot ulcer (DFU) with Wagner stage ≥ 3 as an adjuvant to standard therapy and in combination with it.

Method: Five patients aged 60 to 66 years old with type II diabetes mellitus and Wagner stage ≥ 3 ulcers (DFU) are described. These patients were treated with hyperbaric oxygen in combination with standard treatments (surgical cleansing and administration of antibiotics). One of the five patients also suffered from chronic osteomyelitis. The hyperbaric oxygen was applied through 30 treatments at 2.3 ATA, each one of them on a daily basis in a multichambered ward. The patient with osteomyelitis received 40 treatments.

Results / Discussion: All patients achieved complete healing of ulcers and avoided the possibility of major amputation. There was clinical and laboratory remission in the case of the patient with osteomyelitis.

Conclusion: Hyperbaric oxygen accelerates ulcer healing in diabetic foot ulcers (DFU) and helps treat osteomyelitis adjunctively and in combination with other established therapies. Studies with a larger number of patients and control groups are needed to provide stronger evidence for the above conclusion.

 

EP0198 Leveraging 3D technology for sustainable diabetic foot ulcer monitoring and treatment: A paperless approach in healthcare

Haroon Siddique¹, Claire Ling¹, Aisha Rummaan¹, Orighomisan -Pamela Awala¹, claire taylor¹, Helen Horrobin¹, Wendy Walker¹, Annabelle Tomkins^1
1The Dudley Group NHS Foundation Trust, Dudley, United Kingdom

Aim: This project aimed to enhance diabetes foot wound care through 3D camera technology, improving interdisciplinary communication. Objectives included assessing healthcare providers’ awareness of national standards for digital record-keeping (Paperless NHS by UK 2025) and gauging patient satisfaction with the technology.

Method: Our team used 3D imaging to capture foot wounds and developed a standardized communication template for clinicians and community providers. Patient satisfaction (n=38) and provider compliance across the UK (n=34) with national guidelines were surveyed.

Results / Discussion: Overcoming funding challenges through grassroots efforts, we raised £10,000 to acquire the 3D camera, integrating it seamlessly into clinic workflows. This shift reduced paper reliance and saved six hours monthly of healthcare providers’ time on administrative tasks. Nearly 100% of patients were satisfied with digital wound imaging, with 92% reporting improved understanding of their healing process. Among providers, only 12% adhered to image-sharing guidelines, and one-third were unaware of national digital record-keeping goals. Additionally, the technology enabled mini-audits, revealing reduced wound healing times and enhanced monitoring of amputation rates for governance purposes.

Conclusion: 3D imaging technology has significantly improved patient engagement, interdisciplinary communication, and clinical outcomes in wound care. By adopting digital record-keeping, the clinic has reduced its carbon footprint, saved time, and gained valuable insights into patient outcomes, inspiring broader adoption across regional health networks. Early findings highlight the potential of this technology to transform diabetes wound care and emphasize the need for increased awareness of digital integration.

References:

https://www.nice.org.uk/guidance/ng19/chapter/Recommendations#diabetic-foot-ulcer.

Digital transformation in the NHS - Health and Social Care Committee (parliament.uk)

 

EP0199 Co-designing a personalised self-care support programme for primary care patients living with diabetic foot ulcer: the ‘PREPARE’ co-design process for the ‘HEALing’ intervention

Julia Xiaoli Zhu¹, Eng Sing Lee², Frederick H. F.  Chan³, Rachel  Koh³, Phoebe Xin Hui Lim⁴, Yee Chui Chen⁵, Richard  Low⁵, Konstadina  Griva^3
1National Healthcare Group Polyclinics Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore, ²National Healthcare Group Polyclinics Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, ³Lee Kong Chian School of Medicine,  Nanyang Technological University, Singapore, Singapore, ⁴Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore, ⁵National Healthcare Group Polyclinics Singapore, Singapore, Singapore

Aim: Diabetic foot ulcers (DFU) are a devastating complication of diabetes mellitus (DM), imposing significant physical and psychosocial disturbances on patients. We aimed to develop a personalised self-care intervention to support Healing through Empowerment and Active Listening (HEALing).

Method: The co-design process featured the involvement of patients and healthcare providers (HCP). Three phases of ‘PREPARE’ co-design process were inspired by and adapted from the UK Medical Research Council Framework including (i) Planning and Review literature and develop programme logic model, (ii) Engaging key stakeholders for Participating and Actions, and (iii) Refinement through an iterative process and End of development until uncertainties are resolved.

Results / Discussion: Patients with DFU (n=10) and HCPs (n=6) supported co-design activities. Key self-care tasks and their determinants, and psychosocial demands alongside knowledge of DFU care were prioritised as processes to target. A patient- and HCP-endorsed personalised intervention was co-developed guided by Self-Determination Theory and Motivational Interviewing principles. The PREPARE co-design enabled formulation of HEALing pathway and the intervention prototype, which consisted of three face-to-face 30-minute personalised sessions conducted by trained wound care nurses who also performed the patients’ regular wound dressings and foot/wound care education.

Conclusion: The PREPARE co-design placed patients at the centre of the decision-making process. The HEALing intervention used motivational communications to draw patients’ strengths for self-care actions and facilitated patient empowerment through autonomy support for adaptive self-care coping behaviours. The HEALing intervention is currently being tested in a feasibility trial in primary care.

 

EP0200 Maggot therapy and its role in contemporary low resource setting

Sashitharan V Ampalakam^1
1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

Aim: The studies explore accessibility and cost-effectiveness of maggot therapy in low resource setting and highlighting its impact on management, healing rates and potential to reduce the need for surgical intervention in area with limited healthcare infrastructure.

Method: Patients were selected via convenient sampling that fulfill the criteria from low resource healthcare facility where maggot therapy are used and observe treatment practices, cost-effectiveness, availability of resources, and specific wound protocol. Lucilia cuprina applied directly onto the wound at a dose of 10 maggots per 1cm² of wound surface, special dressing was placed over the wound to prepare a place like small cage for the activities of the larvae.

Results / Discussion: The studies found significant improvement after two cycle of maggot application, with reduce approximately 90% slough and necrotic tissue, swelling subside, advancing edge with formation approximately 90% of granulation within 6 days. Maggot plays a crucial role in facilitated debridement as digestion unhealthy tissue as a food and wound healing by secrete healing substances like allantoin and urea, also form granulation through mechanical stimulation caused by larvae crawling and excretion growth stimulating factor, killing microorganisms with antibacterial substances and secrete proteolytic enzymes to liquefy necrotic tissue and maggot tend to change pH from acidic to beneficial alkaline in wound.

Conclusion: It has gained attention as an affordable, effective and cost-effectiveness in low resource setting where can limit the access to advance wound care, surgical debridement, limit antibiotics usage, minimal equipment, compatibility with home care and effectiveness against Resistant Bacteria.

 

EP0201 Impact of a nitric oxide-generating wound dressing in diabetic foot ulcers in patients receiving antibiotics: post-hoc analysis

Chris Manu¹, Daniel Metcalf², Alan Horner³, Michael Edmonds¹

¹King’s College Hospital NHS Foundation Trust, London, United Kingdom, ²Convatec Advanced Wound Care R&D, Deeside, United Kingdom, ³Convatec Advanced Wound Care R&D, Milton Park, Oxford, United Kingdom

Aim: Diabetic foot ulcers (DFUs) are a prevalent and serious complication of diabetes, which place a significant burden on healthcare systems. Nitric oxide (NO) represents a promising therapeutic agent for the management of DFUs, due to its inherent antimicrobial and antibiofilm properties. The purpose of this study was to evaluate the impact of a novel NO-generating wound dressing*, compared with standard of care (SoC), on DFU wound healing in patients that were receiving antibiotics.

Method: A post-hoc analysis of the ProNox 1 randomised controlled trial of a NO-generating wound dressing* compared to SoC was performed to determine the impact of NO-generating wound dressing* on DFU healing outcomes in patients receiving antibiotics. The study was conducted in 10 UK wound care centres, and primary endpoint analysis has been reported (Edmonds et al, 2018)¹. The primary efficacy measure of this post-hoc analysis was percent area reduction (PAR) at 12 weeks.

Results / Discussion: Of the 135 patients in the study, 71 (53%; 34 SoC; 37 NO-generating wound dressing*) were treated with 29 different antibiotics. At final assessment, the mean PAR was 48.7% in NO-generating wound dressing*-treated wounds (Figure 1), compared to 19.8% in the SoC group (Figure 2) (59% greater PAR in NO-generating wound dressing* group). The number of healed (100% PAR) wounds in the NO-generating wound dressing* and SoC groups was 14/37 (38%) and 9/34 (26%), respectively.

Conclusion: This sub-analysis demonstrates the ability of a NO-generating wound dressing* to improve wound healing outcomes in patients treated with antibiotics, compared with SoC.

Reference:

Edmonds ME, et al. Wound Repair Regen. 2018;26:228–237

* EDX 110/ConvaNiox (Convatec Ltd, UK)

 

EP0202 Wound cleansing solutions versus normal saline in the treatmen of diabetic foot ulcers – A systematic review

Anneli Ringblom¹, John Ivory², Ingegerd Adlerberth³, Agnes Wold³, Caroline McIntosh⁴, Axel Wolf^5
1Health and Care Sciences, Gothenburg, Sweden, ²School of Nursing and Midwifery, Galway, Ireland, ³Biomedicin, Gothenburg, Sweden, ⁴Discipline of Podiatric Medicine, Galway, Ireland, ⁵Centre for Person-centred Care, Gothenburg, Sweden

Aim: A common complication of diabetes is Diabetic foot ulceration (DFU). Only 35% of DFUs heal within the year, 48% remains unhealed and 17% lead to amputation. Part of managing wound involves wound cleansing. Our aim was to conduct a systematic review of the literature to investigate the effects of wound cleansing agents commonly used in DFU care, compared to the use of normal saline for DFU management.

Method: This systematic review was conducted according to the guidelines with additional guidance from the Cochrane Handbook. A (PICO) framework was designed for the search strategy, based on the aim of the systematic review. A search was made including MEDLINE, Embase and Central and selected reference lists. Original studies published between the years of 2008-2023 was included.

Results / Discussion: The included studies were of low-quality regarding risk of bias, with low sample sizes and unblinded randomizations and results from each study should not be considered as evidence of succefull treatment methods. However, hypochlorous acid/chloramines suggests reduced bacterial load as well as shorter time to heal than standard treatment.
Conclusion: The level of certainty of the evidence is deemed to be low, and we cannot draw any definitive conclusions regarding the effectiveness levels of these cleansing agents for wound healing outcomes. Further, high-quality, methodologically robust RCTs are warranted to address this evidence gap.

 

EP0203 Rebuild fatty metatarsal pad with lipogems: A diabetic foot case report

Marco Marcianò¹, Sefora La Sala¹, Lucia Smeraldi², Riccardo Salzillo¹, Bianca Vicari¹, Roberto Gullo², Valentina Lombardo², Francesco Maltese², Giovanni Guercio^1
1Università Degli Studi di Palermo, Palermo, Italy, ²A.O.U.P. Paolo Giaccone, Palermo, Italy

Aim: Diabetic foot ulcers (DFU) are a common and highly morbid complication of diabetes. An ulcer is a continuous solution of the mucosal surface with difficult or absent healing; indeed approximately 20% of people who develop a DFU will require lower-extremity amputation and 10% will die within 1 year of their first DFU diagnosis. The standard practices in DFU management include surgical debridement, moist medications, vascular assessment, and infection and glycemic control. Stem cell based therapies, obtained through autologous lipotransfer, have emerged as a very interesting therapeutic strategy to improve the healing process.

Method: We report a case of a 72-years-old male diabetic patient with nonhealing bilateral foot ulcers treated with surgical debridement and lipogems. Liposuction from the abdominal subumbilical region with lipogems kit was performed and about 50cc of fat was obtained.The proceed was injected into the right and left transmetatarsal sites, bilateral metatarsal fat was recreated and ulcerectomy was performed

Results / Discussion: Six-month follow-up showed complete healing of plantar ulcers, new thick adipose tissue in the areas of infiltration with improved metatarsal support. follow-up MRI also showed a reduction in charcot processes and less overall inflammation. in act the patient shows no recurrence at 1 year.

Conclusion: The adipose tissue mesenchymal stem cells are numerous, easy to access and demonstrated regenerative properties when applied in DFU therefore lipogems can be used as a simple useful technique to improve wound healing in DFU where other interventional options to achieve wound healing have failed.

 

EP0204 Characteristics and outcomes of patients admitted for diabetic foot attack

Federico Rolando Bonanni, Martina Salvi^{1 2}, Ermanno Bellizzi, Aikaterini Andreadi^{1 2}, Alfonso Bellia^{1 2}, Davide Lauro^{1 2}, Marco Meloni
¹Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy, ²Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico Tor Vergata, Rome, Italy

Aim: To evaluate characteristics and outcomes of patients admitted for a “diabetic foot attack” (DFA).

Method: The current study is a prospective observational study including a population of patients admitted for diabetic foot ulcers (DFU) managed in a specialized diabetic foot service between April-September 2024. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA (DFA+) and those without DFA (DFA-). DFA was defined as foot infection or ischemic condition leading to high risk of amputation and requiring urgent management. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay (LOS).

Results / Discussion: Overall, 150 patients were included. The mean age was 70.3±12.2 years, most patients were male (76.0%) and had type 2 diabetes (92.7%) with a mean duration of 22.1±13.2 years; 112 patients (74.7%) had neuro-ischemic DFU while 38 patients (25.3%) had neuropathic DFU.

The DFA+ group reported a greater rate of infection (81.8vs50.0%,p=0.002), higher HbA1c values (67.9±22vs56.6±14.3 mmol/mol,p=0.0005) and C-reactive protein (92±81vs26±45 mg/dl,p<0.0001), lower HDL values (30±9vs35±10 mg/dl,p=0.009) and more cases of first assessment in our centre (56.7vs13.5%,p<0.0001) compared with the DFA- group.

Outcomes for DFA+ and DFA- were: minor amputation (36.4vs21%,p=0.04), major amputation (2.3vs1.6%,ns), mortality (1.1vs0%,ns), LOS (17±9.6vs12±6.3 days,p=0.0004) respectively.

Infection (OR 9.4,CI:6.3-14.7,p=0.008) and poor glycometabolic control (HbA1c>63mmol/mol) (OR 6.3,CI:2.9-12.4,p=0.01) were independently related to DFA requiring emergency admission.

Conclusion: DFA increases the risk of minor amputations and longer hospitalization in admitted patients. Poor metabolic control and foot infection are closely related to DFA.

 

EP0205 Thermography-assisted grading in wagner classification system: A new approach for diabetic foot assessment

Víctor Manuel Loza González¹, Mario Aurelio Martínez-Jimenez², Schira Ulmrich³, Mariana Arista-Yampi⁴, Ana-Lorena Novoa-Moreno⁵, Eleazar Samuel  Kolosovas-Machuca^6
1Doctorado Institucional en Ingeniería y Ciencia de Materiales (DICIM-UASLP), Universidad Autónoma de San Luis Potosí, Tissue Bank-wound care center, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ²Burn Unit, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ³Università degli studi di Torino, turin, Italy, ⁴universidad San Martín de Porres, lima, Peru, ⁵Facultad de Medicina UASLP, Burn unit, hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, Mexico, ⁶Coordinación para la Innovación y Aplicación de la ciencia y Tecnología, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico

Aim: This study explores the use of infrared thermography to assist in grading within Wagner classification system. One of the first grading systems developed for diabetic foot was the Wagner Classification. Despite its prolonged use in the medical field, it requires an experienced evaluator to avoid bias in the resultant assessment. This presents an opportunity for infrared thermography, a technology that provides quantitative measurement of temperature changes in areas of interest related to altered vascular flow derived from inflammatory processes.

Method: We evaluated thermographic images of 48 patients diagnosed with diabetic foot. Clinical data and infrared thermographic images were acquired on the first day of evaluation. Temperature differences (ΔT) between the first toe of the affected limb and the contralateral first toe of the unaffected limb were recorded and analyzed with computer software. The ΔT values were then compared with the Wagner classification system grades.

Results / Discussion: A positive ΔT was observed in the first two Wagner grades (Wagner 1:10 patients, ΔT 2.33°C ±3.99), (Wagner 2:18 patients, ΔT 2.06°C ±2.26). From the third grade onward, a negative ΔT was recorded (Wagner 3:6 patients, ΔT -3°C ± 1.34), decreasing further in the final two grades (Wagner 4: 8 patients, ΔT -6.68°C ± 1.49; Wagner 5: 1 patient, initial ΔT -8.9°C). Statistical analysis with Kruskal Wallis test showed a p<0.05 between groups.

Conclusion: These results suggest a potential application for thermography as an accessory tool in wound clinics, allowing students and staff in training to evaluate diabetic foot more objectively.

 

EP0206 Callus Zero campaign: A strategy for preventing foot ulcers and mortality in people with diabetes mellitus

Mariana Bandeira¹, José Luis Lázaro-Martínez², Ana Julia Maibashi¹, Vera Lucia Conceição Gouveia Santos^1
1University of Sao paulo, Sao Paulo, Brazil, ²Complutense of Madrid University, Madrid, Spain

Aim: The mortality rate among individuals with diabetic foot complications is so high that it can be compared to certain types of câncer (1). Local trauma and callus formation preceding diabetic foot ulceration. Therefore, the treatment of pre-ulcerative lesions, such as callus, should be approached with the same rigor as cancerous tumors, aiming to prevent severe complications (2). The aim of the study is to describe the development and validation of an educational infographic for primary care professionals about the importance of managing the callus on the feet of people with DM

Method: The method used to develop the infographic was composed of three stages: a survey of the problem with a systematic review of the diabetic foot disease and adverse outcomes, the development of the content by experts, and the validation of the infographic through an online focal group meeting, to understand the care process for people with DM in primary care, composed by seven nurses to define the core components and content in an easy to understand language and representative images

Results / Discussion: The Callus Zero campaign consists of an infographic with a central message that calls for the attention of health professionals about the risk of death in people with diabetic foot ulcers and the importance of managing the callus and providing preventable strategies before ulcer formation

Conclusion: The campaign is also a dissemination and replication source for other providers looking to educate and sensibilize for a careful look at changes in the feet, focusing on early-stage preventative therapies.

 

EP0207 Selective Planter fascia release in the management of Diabetic foot ulcer over the base of the great toe has a good clinical outcome: An obsevational study in a multidiciplinary diabetic foot center

Mohammad Mahbub Alam¹, Mafruha Nusrat Khan¹, Chowdhury Rashedul Mughni¹, Mahmud Ekram ullah², Jabayer Ahmad^3
1Bangladesh Diabetic Wound And Foot Care Limited, Dhaka, Bangladesh, ²BIRDEM General Hospital, Dhaka, Bangladesh, ³Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh

Aim: Plantar hallux or base of the great toe ulcers are common and challenging to manage, with many available treatments. One of the most common sites of ulceration in a patient with diabetes is the plantar hallux.  In persons with diabetes, this may lead to chronicity and possibly amputation. Selective planter fascia release (SPFR) has been used in the management of plantar forefoot ulcers.

Method: This observational study was conducted in a multidisciplinary diabetic foot care Centre from January 2021 to june2024. Group A (30 patients): Patients with non-ischemic chronic DFUs in great toe were treated with SPFR. Group B (30patients): Patients with non-ischemic planter hallux DFUs in great toe who had treated with standard conventional protocol.

Results: The rate of complete healing for ulcers in group A was achieved in 16 patients (53.33%) at the 3^rd week, 9 patients (30%) were healed completely by the fifth week and 5 patient (16.66%) healed in the 8^th week.  In group B showed complete healing at 10^th week  30% (n = 9 cases), were healed by 14^th week 16.66% (n = 5 cases),12 patients (40%) were not completely healed after 20^th week. 3 patients (10%) had complication and toe amputation and 01 patient (2%) was died. P value was statistically significant <0.001 between the groups.

Conclusion: SPFR is a modern surgical technique modality in management of non-healing diabetic foot ulcer in the base of the great toe which is feasible, safe and effective with high rate of limb salvage and clinical improvement.

 

EP0208 Determinants of wound related outcomes in mild diabetic foot infection

Mart Roosimaa^{1 2}, Helen Ilumets³, Tiiu Kaha³, Anna-Liisa Kubo², Andres Valkna², Mariliis Sihtmäe⁴, Meelis Kadaja², Olesja Bondarenko², Grigory Vasiliev^{2 5
1}Confido Medical Centre, Tallinn, Estonia, ²Nanordica Medical, Tallinn, Estonia, ³North Estonia Medical Centre, Tallinn, Estonia, ⁴National Institute of Chemical Physics and Biophysics, Tallinn, Estonia, ⁵West Tallinn Central Hospital, Tallinn, Estonia

Aim: Diabetic foot infections (DFIs) are a major global health concern due to their potential for serious complications such as amputation, if not properly managed. This post-hoc analysis examines how patient characteristics at the start of the treatment influence wound related outcomes in mild DFIs.

Method: We conducted a retrospective analysis of a randomized controlled trial comparing a novel wound dressing incorporating synergistic copper and silver nanoparticles and commercially available gelling fiber silver ion dressing. The trial enrolled 30 patients diagnosed with grade 2 DFIs according to the International Working Group on Diabetic Foot (IWGDF) guidelines. Baseline data collected included age, sex, initial wound size, bacterial load, pain levels and Diabetic Foot Ulcer Scale (DFS) quality of life questionnaire.

Results / Discussion: The trial demonstrated a reduction in mean wound surface area over time, with smaller initial wounds exhibiting greater improvement. Patients presenting with higher initial bacterial loads consistently maintained higher levels throughout the study. Notably, at baseline, females exhibited statistically significantly higher bacterial counts compared to males, while older patients displayed lower bacterial loads. Pain associated with the wound decreased during the trial but remained correlated with initial pain levels.  The DFS score followed a similar pattern, with baseline scores strongly correlating with subsequent scores. Older patients tended to have higher DFS scores.

Conclusion: This study highlights the significant influence of baseline patient characteristics on wound related outcomes in mild DFIs. Initial wound size, bacterial load, sex, age and pain all appear to be determinants of wound related outcomes.

 

EP0631 Between considering what’s at risk and self-care for your feet

Herlander Rodrigues¹, Maria Sousa², Vanusa Rocha³, Matilde Soares⁴, Rui Pereira^5
1CINTESIS - Center for Health Technology and Services Research, University of Porto Faculty of Medicine, Porto, Portugal, University of Cape Verde Faculty of Science and Technology, Cape Verde, Porto, Portugal, ²Porto Nursing School, CINTESIS - Center for Health Technology and Services Research, University of Porto Faculty of Medicine, Porto, Portugal, Porto, Portugal, ³University of Cape Verde Faculty of Science and Technology, Cape Verde, Praia, Cape Verde, ⁴CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal, Escola Superior de Saúde da Cruz Vermelha Portuguesa – Lisboa, Lisboa, Portugal, Porto, Portugal, ⁵University of Minho - Nursing School, UICISA:E - Research Unity Health Care - Nursing, Coimbra Nursing School, Nucleous UMinho, Braga, Portugal

Aim: To verify the association between the risk of developing a foot wound due to diabetes and foot care.

Method: A cross-sectional study was carried out that included people with diabetes attending primary health care centres on Santiago Island-Cape Verde. It consecutively included 586 people with diabetes between August 2018 and January 2019. After physical examination and according to the degree of risk, they were classified into four risk categories. Self-care behaviours in relation to foot care were classified as adequate or inadequate, and the perception of developing a foot wound due to diabetes was classified as low, medium and high risk.

Results / Discussion: The sample was mostly female, 98% had type 2 diabetes and an average duration of diabetes of 6 years.  According to the IWGDF-2019 risk stratification system, the majority were in the high-risk category (68%). 99% of the participants perceived themselves to be adequately cared for, and regarding the risk of developing a foot wound due to diabetes, 40% considered themselves to be at low risk and 41% at high risk, and only 19% considered themselves to be at medium risk. Fisher’s exact test showed that there was a statistically significant association between the risk of developing a foot wound due to diabetes and foot care with χ²= 30.71; p=<0.001.

Conclusion: The diabetic foot is a growing problem in primary care and changes are needed in nurses’ actions to classify and evaluate the practice of self-care for the feet.

 

EP0479 Non-ionic cream associated with sapucainha butter and alpha bisabolol for heels of patients with diabetes mellitus

Mariana Bandeira¹, Diba Tosta de Souza², Daniela  Morais Sene², Adriana Mendonça², Valter  dos Santos^2
1EEUSP, São Paulo, Brazil, ²Universidade do Vale do Sapucaí, Pouso Alegre, Brazil

Aim: Develop and evaluate a product using as active ingredient components of sapucainha butter and alpha bisabolol 10% associated with a non-ionic cream base for the skin of the heels of patients with Type 2 Diabetes Mellitus (DM).

Method: Randomized, controlled, triple-blind clinical trial. Three basic health units. Inclusion: DM2 patients, both sexes, age ≥ 40 with heel changes. Exclusion: DM1 patients, gestational diabetes and other types of diabetes, sensitivity to the compounds: sapucainha and α-bisabolol, urea cream or non-ionic cream, refusal to sign the TCLE. Exclusion: adverse reactions. Instruments: Device for skin assessment, pH meter, sociodemographic, clinical and heel change questionnaire. Assessments: Days zero (D0), day five (D5) and tenth day (D10).

Results / Discussion: 38 participants. Groups: Silver: sapucainha butter and alpha bisabolol 10% associated with non-ionic cream - 13; Green: Non-ionic cream 12 and Orange: Non-ionic cream associated with 10% urea cream - 13. Female predominance, incomplete elementary education. Diseases: Systemic Arterial Hypertension in the groups. The Silver product: balances pH value and oiliness, improves skin moisture and elasticity.

Conclusion: The cream consisting of sapucainha butter and alpha bisabolol 10% associated with a non-ionic cream base was developed and evaluated in the heels of DM2, with improvement in moisture, elasticity and oiliness and balanced pH level. Applicability for heels with changes in pH, elasticity, oiliness and skin moisture, preventing infections, amputations and mortality. Registration Request: National Institute of Intellectual Property: BR102024008687-2.

 

EP0480 A multicentre retrospective study supporting the benefit of medical grade honey for treating infected diabetic foot ulcers

Daniela Chrysostomou¹, Harikrishna K.R. Nair², Prathap Potula³, Adéla Holubová⁴, Niels Cremers⁵, Andrea Pokorná^6
1Wound Clinic Health@45, Johannesburg, South Africa, ²Wounds Malaysia, Kuala Lumpur, Malaysia, ³Burjeel Hospital, Abu Dhabi, United Arab Emirates, ⁴DiaPodi care, Sezimovo Usti, Czech Republic, ⁵Maastricht University Medical Centre+, Maastricht, Netherlands, ⁶Masaryk University, Brno, Czech Republic

Aim: Diabetic Foot Ulcers (DFU) are hard-to-heal wounds, with long-term impacts on quality of life (QoL) and general health. Wound bed preparation, combined with the golden standard of treating such afflictions (VIP- vascularisation, infection, pressure) and adequate local therapy will have the desired effects in healing. The study aims to verify the impact of Medical Grade Honey (MGH) in treating DFUs, at any stage and grade of the Texas’ classification.

Method: Following a multicentre approach, we included thirty patients (13♀/17♂, mean age: 69 years) with chronic (>6 weeks) infected diabetic ulcers, often colonized with antibiotic-resistant strains. Wound and general patient assessments were recorded at each visit. Vascularisation evaluation by Doppler. Infection/inflammation was assessed by NERDS and STONEES, as well as wound swabs. Neuropathy was identified by Semmens-Weinstein monofilament test. Pressure points, skin colour, and the presence of calluses were recorded. All patients signed an informed consent.

Results/ Discussion: All 30 included patients had multiple co-morbidities and can be considered complex cases. Malodour was generally controlled after the first dressing changes, while the infection was clinically improved after the second dressing. After 3 months, half of the cases (N=15) achieved complete healing while the other patients had good evolution. MGH proved antibacterial, and anti-inflammatory, and wound healing was enhanced by promoting autolytic debridement, granulation tissue formation, angiogenesis, and reepithelialisation.

Conclusion: With a global increase in antibiotic resistance, MGH might be a worthy alternative in treating infected DFUs. MGH appears to be an easy, and cost-effective treatment for treating DFUs with low risk of sensitisation.

 

EP0481 Awareness regarding diabetic foot syndrome in community pharmacy services: Results from a dedicated questionnaire

Irene Fagioli¹, Francesco Gaggia¹, Giuseppe  Murdolo¹, Simone Casucci², Marco Sciorio³, Cristiana Vermigli^1
1Azienda Ospedaliera di Perugia, Perugia, Italy, ²Ministero dell’Istruzione e del Merito, Roma, Italy, ³Studio Medico 4  Strade, Castel Gandolfo (Roma), Italy

Aim: Diabetic foot syndrome (DFS) represents one of the most severe complications of diabetes mellitus, increasing the risk of major amputations. Despite advances in managing the acute setting, primary prevention could make a difference in reducing the number of hospitalizations and amputations. The project “Make a Difference with the Diabetic Foot Syndrome” was developed through a special questionnaire designed for pharmacists to investigate the level of awareness and perception of pharmacists regarding DFS and the role of a multidisciplinary team.

Method: The questionnaire is structured with several items including general information about the pharmacy, knowledge of DFS, approach to diabetic foot care, role of the podiatrist, training and support. The information collected involved various aspects of diabetic foot management.

Results / Discussion: We delivered 90 questionnaires receiving 75 responses. The results of the survey are broken down by geographic area and in urban and metropolitan areas, pharmacists show relatively high knowledge of diabetic foot complications, from the ability to recognize a diabetic ulcer to recommend a podiatrist.

Conclusion: Pharmacies play a crucial role in the management of chronic conditions, such as diabetic foot, and in supporting patients’ therapeutic adherence. The ability of pharmacists to recognize diabetic foot complications, recommend podiatric intervention and actively participate in therapeutic adherence projects is critical to ensuring effective care. Through greater integration of pharmacists into Italian public health projects, it is possible to ensure more equitable and effective management of diabetic foot.

 

EP0482 Biodegradable temporising matrix an alternative way to deal with diabetic foot wounds

Zeki Celik¹, Agit Sulhan¹, Kadir Barış Tiryaki¹, Perçin Karakol^1
1University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Aim: Approximately 33% of diabetic patients develop diabetic foot ulcers. Peripheral artery disease often accompanies patients with diabetic foot ulcers. In patients with peripheral artery disease, our options for flap reconstruction are limited, requiring alternative treatments for these wounds. Biodegradable Temporising Matrix (BTM) is a synthetic polyurethane dermal matrix used to reconstruct complex wounds. BTM enhance soft tissue repair rather than skin replacement in chronic wounds and provide the appropriate microenvironment for the nutrition and attachment of split thickness skin grafts (STSG).

Method: In this study, we retrospectively evaluated the wound site after BTM application in 8 patients with tissue defects secondary to diabetic foot infections who applied to our clinic between January 2023 and August 2024.The most common symptom was a discharging, malodorous wound (91.6%). Serial debridements were performed in all patients to prepare the wound bed, and antibiotic therapy was adjusted according to culture results. Three weeks after the application of BTM, a split thickness skin graft (STSG) was applied to the patients

Results / Discussion: It was observed that after BTM application of the wound grounds, the discharge decreased, the wound tended to close, and the defects tended to heal significantly when combined with STSG application.

Conclusion: In patients in whom reconstruction with free or pedicled flaps is not suitable for bone-exposed tissue defects secondary to diabetic foot ulcers, the use of BTM was observed to be a good alternative for closure of tissue defects with the support of STSG.

 

EP0483 Use of an oxygen-enriched oleic matrix impregnated gauze releasing reactive oxygen species (ROS) in diabetic foot ulcers allows to standardize the handover in a remoted cooperative approach

Sara Sandroni¹, Emanuele Bartolini¹, Rosa Nigro¹, Sofia Butini¹, Teresa Scognamiglio¹, Matteo Apicella¹, Michele Mantuano¹, Elisa Marinelli¹, Stefania Fabrizi¹, Alessia Scatena^1
1Azienda USL Toscana sudest, Arezzo, Italy

Aim: Diabetic foot care requires multiple hospital visits. Tele-cooperation between the hospital and the wound care network could improve management and save resources.
Method: 52 patients with neuroischemic diabetic foot ulcer were managed with visits every 30 days, and the remote cooperation between Foot Clinic and Wound care network was managed using the TC-DFU framework (granulation Tissue, necrosis, exudate, infection, Ulcer dimensions) to report on the weekly evolution of the wound. When the TC-DFU score was < or = 6 for a 2 weeks run-in period, patients were divided into two groups: 26 were treated using the oxygen-enriched oleic matrix dressing (treatment group), and 26 were treated with advanced dressings second TIME caracteristics (SoC)  (control group). After a 6-months follow-up period, the following were assessed: (a) primary outcomes: healing rate, healing time, admissions, referral to emergency department, supplementary visits; (b)secondary outcomes: mortality, amputations, side effects.
Results / Discussion: All patients completed the intended follow-up. Healing rate was significantly higher 84.6% (22) in the treatment group vs 57,7% (15) in the control group (p=.03). Healing time was 61+/- 11 days vs 74 +/- 9 days respectively. Admissions were 2 and 3 respectively. No patient was referred to the emergency department, while only 10 patients in the control group needed supplementary visits to perform debridement. No side effects were reported in both groups.
Conclusion: The use of an oxygen-enriched oleic matrix impregnated gauze releasing reactive oxygen species (ROS), when embedded in a remote cooperation handover protocol between the wound care community nurse network and the Diabetic Foot Unit shown to be safe and effective and allowed improving the outcomes compared to the standard of care.

 

EP0484 Autologous stamp-shaped skin micrografts to enhance healing in severe infected diabetic foot ulcers. A prospective case series

Juan Pedro Sanchez Rios¹, Irene Valero Luján¹, Miguel Ignacio Herrero Marco¹, Ignacio Querol Cisneros¹, Jesús Manuel Alfayate García¹, Sandra Vicente Jiménez¹, Luis de Benito Fernández^1
1University Hospital Fundación Alcorcón, Alcorcón, Spain

Aim: To evaluate the clinical outcomes using autologous stamp-shaped skin micrografts after limb-salvage surgery in diabetic foot ulcers (DFU) with moderate/severe infection.

Method: 12 diabetic patients with neuropathic or neuroischemic ulcer and moderate/severe infection, who required a large debridement an drainage were included from May 2023 to September 2024. After debridement and revascularization if needed, autologous stamp-shaped skin micrografts from anterolateral aspect of tight was used to enhance healing. Wound size, degree of infection, revascularization, mean time for complete healing and possible complications were collected.

Results / Discussion: All patients were male (100%). 11 (91.6%) had type 2 of Diabetes Mellitus. 3 patients (25%) had ulcer history and minor amputations and 2 (16.6%) had undergone previous revascularization. 7 patients (58.3%) had absent distal pulses and 4 (33.3%) had pathological Ankle-Brachial Index (ABI) or Toe-Brachial Index (TBI). 9 patients (75%) were admitted for severe infection according to Infectious disease Society of America (IDSA), and 7 (58.3%) required revascularization: 2 endovascular, 3 distal bypass and 2 venous arterialization. The mean wound size was 25.28+/-16cm² located on transmetatarsal amputation (TMA) in 9 patients (75%), 1 (8.3%) in Achilles Tendon, 1 (8.3%) in Chopart amputation and 1 arthoplasty of 1^st metatarso phalangeal joint (MPJ). Complete healing was achieved in all patients (100%), with a mean time of 2.2+/-0.9 months. All patients had positive cultures previously. No graft-related complications were recorded.

Conclusion: Autologous stamp-shaped skin micrografts have demonstrated to be an ambulatory, effective and safe technique for quickly healing on DFU with severe infections.

 

EP0485 Autologous whole blood clot in hard-to-heal diabetic foot ulcers

Heidi Tirkkonen¹, Antti Jokiniitty¹, Antti Juntunen¹, Jorma Lahtela^1
1Tampere University Hospital, Tampere, Finland

Aim: Diabetic foot ulcers (DFUs) remain a challenge to health care often leading to amputation and disability. Long treatment time and frequently unsatisfactory outcome warrants new therapies. This observational study was aimed at identification of suitable hard-to-heal DFU patients for novel topical autologous blood clot (TABCT). TABCT contains all blood cells and growth factors and is applied topically. TABCT is used on top of standard wound care.

Method: A single center, prospective, and observational case study. Ten adult patients with diabetes and hard-to-heal wound were enrolled. All patients had prior vascular evaluation and standard wound care had been used for more than 3 months. TABCT was applied once a week until full closure or 8 times if not fully closed. Wound size and appearance were evaluated at every visit. End point evaluation was done at 12 weeks. Time for full closure, area change if not fully healed, and side effects were recorded.

Results: All patients suffered from multiple comorbidities. The mean age was 63.4+6.3 yrs and duration of diabetes 20.2+7.7 yrs. All patients had combination therapy including insulin. Wound location was foot sole or toes. Background for the wounds were Charcot (2), neuroischaemic (2), neuropathic (2), and postamputation (3). Average wound size was 6.3+ 1.2 cm². At 12 weeks four patients had full closure and three reduction of the wound size in a timely manner. One patient had surgical debridement at week three due to open bone.

Conclusion: Autologous whole blood clot treatment in hard-to-heal DFUs was found to be a promising approach adding a new tool for ambulatory patients.

 

EP0486 An update on technology-lipido-colloid-nano-oligosaccharide-factor (TLC-NOSF) dressings for limb-threatening surgical wounds following charcot neuroarthropathy (CN) limb preservation surgery in diabetic patients with peripheral vascular disease

Abigail Durston¹, Sarah Davies², Ines Reichert², Raju Ahluwalia^2
1Aneurin Bevan University Health Board, Newport, Wales, United Kingdom, ²Mike Edmond Diabetic Foot Unit, King’s College Hospital, London, United Kingdom

The combination of diabetes, Peripheral-arterial-disease (PAD), infection and deformity are compound risk factors for limb salvage. Post-operatively, rapid wound healing limits the opportunity for bacterial colonisation of any metalwork or tissues.

Aim: A comparative assessment of TLC-NOSF* dressings with off-loading/standard treatment versus off-loading/standard treatment alone for post-surgical incisions/wounds in diabetic CN patients with PAD undergoing limb salvage.

Method: Patients with PAD undergoing limb salvage for CN and diabetic foot complications who presented to our Diabetic Foot Unit with postoperative wound dehiscence/ breakdown/ extensive tissue loss from 2014- 2024 were included. Before August-2021 patients underwent standard clinic-based podiatric debridement, non-adhesive porous dressings or negative-pressure-wound-therapy (NPWT) for large soft tissue defects with total contact casting (TCC). Thereafter, patients were also treated with a TLC-NOSF dressing. Primary outcome measure was time to complete epithelialization of the wound or to infection-free grafting. Secondary outcome measures included frequency of sharp debridement and recurrent wound infection.

Results / Discussion: 29-patients were identified, 14 of whom received TLC-NOSF therapy in addition to standard treatment. All were treated with bacterial culture-specific antibiotics until wound healing. Mean lesion size where surgical dehiscence occurred was 2.3cm². TLC-NOSF improved healing rates from 0.11 to 0.17cm²/week (p>0.05). Two patients had extensive post-surgical tissue loss; application of TLC-NOSF had no inferiority in time to grafting, but reduced frequency of sharp debridement compared to NPWT alone. No patient required revascularisation during treatment/follow-up

Conclusion: Surgical wound healing may be expedited with TLC-NOSF dressings due to their mechanical and antibacterial properties. Further studies are required.

 

EP0459 Management of diabetic foot ulcers using dialkylcarbamoyl chloride coated dressings for infection control: A case series analysis

Priscila Cantú Saucedo¹, Paulina Morelos Guzmán^2
1UANL, Monterrey, Mexico, ²UNAM, Ciudad de México, Mexico

Aim: Diabetic foot ulcers are a significant medical challenge due to impaired healing from poor circulation and neuropathy, a high risk of severe infections, and the need for complex, multidisciplinary treatment. Preventive measures, such as regular foot inspections and proper blood glucose management, are crucial to avoid severe outcomes like amputations. Additionally, the use of dialkylcarbamoyl chloride (DACC) in dressings is vital for managing infections without the risk of generating antimicrobial resistance.

Method: A descriptive retrospective observational case series study, describing the clinical management outcomes of 15 patients in their fifth and sixth decades of life, with clinical characteristics according to the San Elian classification, conducted In 2024, due to complications associated with diabetic foot ulcers.

Results / Discussion: In managing the progression of these patients, we observed that with the treatment of the infection using DACC coated dressings, not only was the bioburden controlled, but there was also significant progress in the growth of granulation tissue.

Conclusion: The wound management of diabetic foot ulcers in the studied patients showed that the use of DACC coated dressings was effective not only in controlling the bioburden of infections but also resulting in diabetic foot ulcers completely healed. These results highlight the importance of a multidisciplinary approach and the use of advanced treatments to improve clinical outcomes in patients with complications associated with diabetic foot infections.

 

EP0487 Hospital management of the “middle-old” and “oldest-old” patient with ulcerated diabetic foot syndrome

Francesco Gaggia¹, Irene Fagioli¹, Giuseppe  Murdolo¹, Antonella Ferrieri¹, Chiara Ingriccini¹, Giuseppe Pietro Pio Basta¹, Cristiana Vermigli^1
1Azienda Ospedaliera di Perugia, Perugia, Italy

Aim: Evaluate the impact of old age in the “diabetic foot syndrome” (DFS).

Method: A retrospective observational study was conducted on the medical records of inpatient clinics (from February to August 2024) diagnosed with DFS. 49 patients were selected and divided into 3 groups according to age range: “Middle-Old” (M-O) patients (75-84 y), n. = 20 pts; “Oldest-Old” (O-O) patients (≥85 y), n. = 9 pts; and  “Early-Old” (E-O) (65-74 y), n = 20 pts. Demographics and clinical characteristics (ie, age, sex, type and duration of DM), as well as pharmacologic treatments, were first analyzed. Moreover, we performed microbiological exam of each lesion (punch biopsy) and the bacterial(s) were classified for GRAM-staining and Multi-Drug-Resistance (MDR). Pedal medial arterial calcification (MAC) score by conventional X-ray radiography was calculated.

Results / Discussion: All patients had at least one micro- or macro-vascular complication (57.1% retinopathy; 71.4% Chronic ischemic heart disease, 63.3% chronic kidney disease). Treatments for glucose control, lipid, blood pressure, and antiplatelet therapy were not optimized, leading to an increased risk of dialysis, and major adverse limb and cardiovascular events, both in “E-O” and “M-O” group.  The microbiological exams revealed a trend towards higher occurrence of GRAM+ in the “E-O” vs the other subgroups, with a progressive trend towards GRAM- infections in the “O-O. Finally, MDR bacteria were found in almost all the samples analyzed, without differences between the groups. The MAC score was lower in E-O (3.23) increasing in M-Os (3.4) and O-Os (4.25).

Conclusion: These data, although hypothesis-generating, suggest that age should be viewed as an important and emerging “risk modifier” in the management and in progression of DFS in hospitalized geriatric patients.

 

EP0488 Education and self-examination of patients with diabetic foot

Dominik Vicković¹, Ana Lamza², Vesna Konjevoda^2
1KB Sveti Duh, Zagreb, Croatia, ²KB Sveti Duh, Zagreb, Croatia

Aim: Diabetes mellitus is a prevalent chronic disorder with severe complications, including diabetic foot, which can lead to ulcers and, in advanced cases, amputation. Importantly, diabetic foot is preventable with proper education and self-care. To address this need, the Department of Vascular Surgery at Clinical Hospital Sveti Duh has developed an educational leaflet to help prevent the onset of diabetic foot complications.

The leaflet is intended for distribution to all patients at their initial diabetic foot clinic visit. Many patients with chronic wounds find it difficult to retain the overwhelming information they receive during the first consultation. This leaflet organizes essential information on diabetes and diabetic foot care, focusing on prevention. It covers topics such as self-examination, foot and nail care, specialized footwear, dietary guidance, and recommended physical activities, as well as alarm symptoms requiring specialist attention.

Method: The leaflet will be distributed at each new patient’s initial visit to the clinic and also given to regular patients. The objective is to monitor the healing of existing chronic wounds and to assess the prevention of new wounds through increased patient awareness and self-care.

Results / Discussion: This program is not yet in practice, as the leaflet is undergoing final graphic editing. While results are currently unavailable, we hope to share initial outcomes and patient feedback at the next congress.

Conclusion: Patients with diabetic foot often lack adequate knowledge about their condition and preventive care. This leaflet aims to fill this gap, empowering patients with practical self-care strategies that can improve their daily lives and overall well-being.

 

EP0209 From a concept of quality through the identification of an indicator of good quality of assistance in ischemic diabetic foot patients: the Ischemia Improvement Group of the Diabetic Foot Valley Tuscany Project

Alessia Scatena¹, Chrisina Lencioni², Margherita Occhipinti³, Monica Lorenzetti⁴, Simone Barbagallo⁵, Alberto Piaggesi^6
1Diabetology & Diabetic Foot Unit Director San Donato Hospital Arezzo - Local Health Authority South East Tuscany, Arezzo, Italy, ²Diabetology Unit Lucca - Local Health Authority North West Tuscany, Lucca, Italy, ³Diabetology Unit Empoli - Local Health Authority Center Tuscany, Empoli, Italy, ⁴Diabetology Unit Prato - Local Health Authority Center Tuscany, Prato, Italy, ⁵Hippocrates Research, Genova, Italy, ⁶Diabetic Foot Unit - University of Pisa, Pisa, Italy

Aim: The only quality indicator (QI) included in benchmarking Italian programme to measure quality in diabetic foot (DF) care is amputation rate. This QI doesn’t describe exhaustively the complexity of high-need diabetic foot (DF) patients, and can’t distinguish between different etiologies and pathways. The Ischemia Improvement Group is a part of the Diabetic Foot Valley Tuscany (DFVT) project, with the aim to explore critical items of the revascularization pathways, analyze data and evaluate improvement strategies.

Method: After explorative and analytic phases, which data were discussed in EWMA 2024, a formal consensus among DF care stakeholders, diabetologists and vascular specialists, was performed to find QI, which must be based on evidence-based standards of care, be associated with a desired outcome and can describe the collaboration of the multidisciplinary team.

Results/Discussion: If favorable outcomes are related to revascularization, timing depends on diagnostic modalities, team collaboration, hub and spoke connections, facilities availability. The expert panel proposed a target of 1 week for inpatients and 2 weeks for outpatients. Assessment of the patient well-being through patient-reported outcome instruments was already proposed. QIs are than submitted to benchmarking institutes to decide if they are feasible for implementation in quality monitoring, data sourcing and time monitoring.

Conclusions: A formal methodology has been useful to find QIs. Next step will be an impact analysis to evaluate if implementation of QIs changes processes of care and improves patient outcomes. Furthermore, a set of indicators could be used to describe multiple etiology and pathways in DF care.

 

EP0210 Comparative study of collagen and synthetic dermal matrices in the treatment of diabetic foot ulcers (DFUS)

Marco Marcianò¹, Sefora La Sala¹, Bianca vicari¹, Roberto Gullo², Valentina Lombardo², Francesco Maltese², Giuseppe Carollo², Giovanni Guercio^1
1Università degli studi di Palermo, Palermo, Italy, ²A.O.U.P. Paolo Giaccone, Palermo, Italy

Aim: The diabetic foot ulcer (DFU) is a complication of diabetes and the main cause of hospitalization among diabetic patients. DFUs often require long healing time. They are characterized by higher infection rates and in the worst cases lower limb amputations. Newly introduced Dermal Substitutes help in the management of complex cases and optimize healing.

Method: We propose a retrospective observational study involving patients with DFUs treated with two different dermal matrices. In the first group  DFUs were treated with the application of Integra®, a collagen dermal matrix and patients. In the second group, DFUs were treated with synthetic Biodegradable Temporising Matrix (BTM). SINBAD SCORE  from 4 to 6 patients were included and complications ratio and healing time were estimated.

Results / Discussion: In the group of patients treated with INTEGRA the mean healing time was 248 days, with 31.25% of patients experiencing graft removal due to complications. In the group treated by BTM the mean healing time was 100 days,  only 5.56% of patients failed the treatment. The early walking with Integra patients interfered with healing time, while early walking in BTM patients against advised off loading, did seems not to affect the epithelialization time, bone and tendons coverage.

Conclusion: According to our clinical experience, patients treated with BTM exhibited better outcomes as compared to Integra, indeed BTM is a more efficacy tool to improve the tissue strength and healing time in complex DFU.

 

EP0542 Delphy consensus to improve the management of diabetic ischemic foot patients. The amelioration project on the Critically Ischemic DF (CIDF) of Diabetic Foot Valley Tuscany

Alessia Scatena¹, Chrisina Lencioni², Margherita Occhipinti³, Monica Lorenzetti⁴, Simone Barbagallo⁵, Alberto Piaggesi^6
1Diabetology & Diabetic Foot Unit Director - San Donato Hospital Arezzo - Local Health Authority South East Tuscany, Arezzo, Italy, ²Diabetology Unit Lucca - Local Health Authority North West Tuscany, Lucca, Italy, ³Diabetology Unit Empoli - Local Health Authority Centre Tuscany, Empoli, Italy, ⁴Diabetology Unit Prato - Local Health Authority Centre Tuscany, Prato, Italy, ⁵Hippocrates Research, Genova, Italy, ⁶Diabetic Foot Unit - University of Pisa, Pisa, Italy

Aim: In the context of the Diabetic Foot Valley Tuscany (DFVT) initiative, the amelioration project on the Critically Ischemic DF (CIDF) aimed to reach a consensus between diabetologists and vascular specialists on the revascularization pathways of CIDF, which a previous survey demonstrated criticity implementing guidelines’ indications

Method: A Delphi consensus meeting between diabetologists and vascular specialists from the Tuscany public centers was asked to express their agreement on 10 statements about dispersion of cases, disparity of access to the procedures, revascularizations delay, differences in the procedural outcomes, inadequacy of the procedures respect to the pathology and inadequacy of medical therapy compared to the best medical practice.

Results/Discussion: The participants agreed in changing the organizational model extending the possibility for the patients to timely access the treatments, the identifications of multidiscilplinary dedicated teams and settings to address the pathology at the increasing level of complexity, to limit the delay of revascularization procedures within 1 week for inpatients and 2 weeks for outpatients, to identify centers able to deliver distal effective procedures and to convey there the most critical patients, to grant to no-option patients the alternative therapies before give indications for major amputations, to take adequately care of comorbidities, to stop considering the number of major amputation per se, not associated to more descriptive parameters, as a marker of quality of care for DF, to introduce as a process indicator the delay between indication to revascularization and its effective actuation.

Conclusion: the Delphi consensus meeting inside the DFVT identified the components of the amelioration program for CIDF management to be realized in the next phases of the project.

 

EP0543 Innovative using of gauze based oxygen oleic matrix combined with negative pressure wound therapy for accelerating diabetic foot ulcer healing

Roberto De Giglio¹, Ilaria Formenti², Vincenzo Curci², Viviana Zoppini², Laura Bonasegla^2
1Diabetic Foot Unit Chief, Abbiategrasso, Italy, ²Diabetic Foot Unit, Abbiategrasso, Italy

Aim: Gauze based oxygen oleic matrix is an advanced dressing for the treatment of skin lesions, now used by numerous specialists and also for Diabetic Foot Ulcers (DFUs).

Negative Pressure Wound Therapy (NPWT) is a commonly used medical procedure for DFUs healing.

Method: From 1 January to 30 October 2024, in our Center for the treatment and prevention of diabetic foot, we subjected six patients to surgery for drainage of an acute phlegmon.

After surgical debridement, large areas of tissue loss remained.

We used gauze based oleic matrix in contact with the ulcer and placed the NPWT polyurethane foam on top, replacing the dressing twice a week.

After only 14-21 days we had a wound bed ready for the dermal graft.

All six patients subsequently underwent a dermal graft, achieving a complete healing.

Results / Discussion: Using this new approach we observed:

• a more cleaned wound bed (no fibrin, no infection)
• greater filling and tissue growth
• reduced times for performing the dermal graft
• no pain
• easy applicability

Conclusion: We believe gauze based oxygen oleic matrix used with NPWT can be considered an innovative procedure very useful for accelerating the healing of diabetic foot lesions. It will be necessary to extend the number of patients involved to better confirm the evidence.

 

EP0544 Bioactive glass application in podiatric surgery

Karol Sutoris¹, Vladimíra Fejfarová¹, Veronika Woskova¹, Michal Dubský¹, Bedrich Sixta¹, Petr Teyssler¹, Libor Janoušek¹, Jiří Froněk^1
1Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Aim: The link between chronic osteomyelitis (OM) and diabetic foot ulcers (DFU) in diabetic foot syndrome (DFS) significantly increases lower limb amputation risk in diabetic patients. Proper timing of bone resection and the use of bioactive, biocompatible bone substitutes are critical. Supporting osteogenesis post-surgery is essential for long-term OM remission. This study presents our initial use of bioactive glass for DFS, making us the first in the Czech Republic and fourth in Europe to do so.

Method: In this single-center case-control study, we assessed our first clinical outcomes in nine patients (n=9) with OM. Surgical treatment involved applying bioactive glass and putty (BonAlive®) to fill anatomical bone cavities in various foot regions, followed by ulceroplasty. The procedures took place between April 2023 and August 2024, averaging 78 minutes per surgery.

Results / Discussion: Clinical and radiological healing was achieved in 89% of cases. Postsurgical complications, including surgical site infections, were slightly lower than in a comparative cohort (33% vs. 46%; p=0.05). Patients exhibited early reduction in edema, no wound secretion, no refistulization, and a negative probe-to-bone test postoperatively. Radiographic evidence of bone remodeling appeared within three weeks, with an average healing time of 8 weeks. No patients required amputation, resulting in a 100% limb salvage rate.

Conclusion: Bioactive glass shows promise as a bone substitute in chronic OM, helping preserve functional limbs in DFS. Further data are needed to evaluate its full potential in complex DFS cases, as bioactive ceramic materials present unique challenges in podiatric surgery.

 

EP0545 The influence of risk factors on the outcome of reconstructive surgical treatment of the diabetic foot

Saša Milićević¹, Milica Milićević^2
1Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia, ²Center for Residence and Day Care for Children and Youth with Disabilities, Belgrade, Serbia

Aim: Ischemic and neuropathic foot ulcers are characteristic of the diabetic foot. Untreated ulcers often lead to foot amputation. The aim of the work is to determine the influence of risk factors on the outcome of reconstructive surgical treatment of the diabetic foot.

Method: In a period of one year, 40 patients with ischemic and neuropathic diabetic foot ulcers were treated surgically and conservatively. The patients were divided into subgroups in relation to the presence of risk factors for the occurrence of foot ulcers, in relation to the method of treatment, and in relation to the outcome of the treatment. During reconstructive surgical treatment, depending on the impact of risk factors on tissue vitality, dressings for the treatment of chronic wounds and vacuum-assisted compression therapy were applied.

Results / Discussion: Ischemic ulcers are more prevalent in the examined group of patients. Analysis of risk factors revealed that untreated diabetes mellitus, combined with the presence of a greater number of risk factors, has the greatest impact on the outcome of treatment in both types of ulcers. In patients with the presence of multiple risk factors, in whom not all risk factors are present, the most unfavorable treatment outcome is in patients with untreated diabetes mellitus, who have high blood pressure, and who are smokers.

Conclusion: The treatment of diabetic foot requires a multidisciplinary approach, and the most favorable outcome of reconstructive surgical treatment is in patients who do not have high blood pressure and who are not smokers.

 

EP0547 Systematic priority setting of the iwgdf recommendations to inform health policymakers: A Q-methodological study

Kathleen Stevens¹, Ahtisham Younas¹, Zulfiqarali Abbas², David G. Armstrong³, Ahmed Kayssi⁴, Hermelinda Pedrosa⁵, Beata Mrozikiewicz-Rakowska⁶, Harikrishna K.R. Nair⁷, Vijay Viswanathan⁸, Roberto Anichini⁹, Alex Warner¹⁰, Vildan Çakar¹¹, James Hill¹², Kristien van Acker¹³, Mariam Botros¹⁴, Georgia Krehbiel¹⁵, Joel Alleyne^16
1Memorial University Faculty of Nursing, St. John’s, Canada, ²D Foot International, Dar es Salaam, Tanzania, ³Keck School of Medicine, Univeristy of Southern California, Los Angeles, United States, ⁴University of Toronto, Sunnybrook Hospital, Toronto, Canada, ⁵D Foot International, Brasilia, Brazil, ⁶Polish Wound Management Association, D-Foot International, Warsaw, Poland, ⁷Asia Pacific Association for Diabetic Limb Problems, D-Foot International, Kuala Lumpur, Malaysia, ⁸D-Foot International, Chennai, India, ⁹D Foot International, Pistoia, Italy, ¹⁰Carribean Wounds Network, Kingston, Jamaica, ¹¹Wound Ostomy Incontinence Nurses Society of Turkey, Instanbul, Turkey, ¹²Past President, Canadian Podiatric Medical Association, Windsor, Canada, ¹³D-Foot International,, Petigny, Belgium, ¹⁴Wounds Canada, D-Foot International, Toronto, Canada, ¹⁵American Limb Preservation Society, Atlanta, United States, ¹⁶University of Toronto, Wounds Canada, D-Foot International, Toronto, Canada

Aim: To identify what diabetic foot experts determine as the priority International Working Group on the Diabetic Foot (IWGDF) recommendations for policy in Canada, the Caribbean, Europe, India, and the United States (US).

Method: Q-methodology and purposive sampling were used. Diabetic foot experts were recruited from professional associations. There were two critical elements: (1) participants ranked order statements of opinion regarding the priority setting of the IWGDF recommendations onto a grid from least important to most important. (2) participants answered open-ended questions that explored their ranking. Data was analyzed using factor analysis, and the results were integrated with the answers to the open-ended questions to generate shared viewpoints (SVPs).

Results / Discussion: Four SVPs were generated for: Canada (n=88) (68% explained variance); India (n=30) (75% explained variance); US (n=36) (71% explained variance); and Europe (n=36) (72% explained variance). Two SVPs were generated for the Caribbean (40% explained variance). Similarities were seen in the viewpoints across countries and region, with some variation. Education was viewed as essential for preventing DFUs and amputation and there was recognition that an upstream approach, access to care, and system changes are needed. Access to advanced specialty care was viewed as a priority for Canada, the US, and Europe.

Conclusion: The findings provide direction regarding prioritizing strategies to prevent DFUs and amputation and suggest that recommendations across countries are consistent; however, each country has unique needs. These findings highlight the importance of implementing recommendations and policies, considering the local context.

 

EP0548 Ort infra-red consumer camera as screaning tool for diabetic foot diagnostics

Roman Liberzon¹, Ektarina Kalchuk², Aharon Leiberson^3
1Diabetic foot unit, orthopedic department Laniado hospital, Netanya, Israel, ²Physician Diabetic foot unit, orthopedic department Laniado hospital, Netanya, Israel, ³Head foot and ankle unit orthopedic department, Laniado hospital, Netanya, Israel

Aim: Evaluation of on shelf available cheap portable smart-phone attached infra-red cameras (IRC) as additional diagnostic and prognostic tool for diabetic foot (DF).

Diabetic foot (DF) is dangerous health condition, the leading reason for non-traumatic amputations. Main complications of DF are infection and ischemia, having single common sign – temperature changes. Cooled expensive high resolution IRC provide fine foot temperature distribution picture, but significant size, high cost and longtime of registration restrict wide method application.

Method: Was applied smart-phone with attached IRC. Thermography was performed on 2 healthy adults and 12 patient’s feet with signs suspicious for ischemia or infection. Follow-up and routine laboratory and visualization tests were performed for comparison with thermography.

Results / Discussion: Thermograms of patients presented foot temperature changes and its distribution, both inflammatory and ischemic. Thermal image changes in the case of ischemia earlier, that visual clinical signs. Increasing of local temperature may be a sign of forming infection focus, which is not registered by soft tissues ultrasound, blood tests and X-ray.

Thermal signs predict clinical manifestation, providing better planning of operation. Cool foot demands vascular investigation predicting signs of critical ischemia.

The software of application is not completely friendly as do not provide registering of patient’s data

Conclusion: Cheap available IRC can provide additional diagnostic information to define treatment program for DF, but its software demands upgrade. Further research would provide data for design of home self-applied foot thermal imaging device

 

EP0549 The possibilities of using ages as a marker of dnoap in type 2 diabetes mellitus

Ekaterina Zaitseva¹, Marika Kalandya¹, Alla Tokmakova¹, Gagik Galstyan^1
1Enocrinology Research Centre, Moscow, Russian Federation

Aim: To study the role of advanced glycation end products in the development and progression of diabetic neuroosteoarthropathy.

Method: The study included 88 patients with type 2 diabetes mellitus and the neuropathic foot ulcers, who were divided into 2 groups. Group 1 (n=43) consisted of patients with diabetes mellitus with the presence of DNOAP, group 2 (n=45) consisted of persons with type 2 diabetes mellitus without this complication. The level of AGEs was studied in peripheral blood by ELISA test systems in accordance with the manufacturer’s instructions. AGE (G-Biosciences, USA), minimum detectable level of 0.188 ng/ml, expected values of 0.313-20 ng/ml.

Results / Discussion: The median age of patients was 57 [49; 65] years in group 1 and 63 [56; 65] years in group 2. The median duration of diabetes mellitus was 15 [11; 20] years in group 1, 15 [9; 18] years in group 2. The median HbA1c in the first group was 8.3% [7.0; 9.6], in the second group 15% [9; 18], p>0.05. All patients underwent a blood test for AGEs. The median AGEs in the group without DNOAP was 218.8 ng/ml [197.4; 270.8], and in the group with DNOAP 209.6 ng/ml [167.8; 264.0]. There were no statistically significant differences in the level of AGEs (p= 0.258) between the two groups.

Conclusion: The present study did not show any statistically significant differences in the level of AGEs in serum in patients with DNOAP and without this complication. As a marker of DNOAP, it is possible to study the expression of AGEs receptors directly in the compact substance of the bone tissue of patients with type 2 diabetes.

EP0550 Management of 2 complex wounds with a sequential treatment of polyabsorbent fibres with technology lipido-colloid and silver (TLC-AG) and technology tlipido-colloid dressing with nano- oligosaccharide factor (TLC-NOSF) treatment range

Dr Anoop Vasudevan¹, Vikas  Kakkar², Emilio Galea^3
1Amrita Institute of Medical Sciences,, Kochi, India, ²Kakkar Clinic,, Amritsar, India, ³Laboratoires Urgo, Chenove, France

Aim: In India, there were 101 million people living with diabetes in 2021¹, with 25% of this population developing diabetes related ulcers (DRU), of which 50% become infected, requiring hospitalisation, while 20% need amputation.

An integral part of wound management and wound bed preparation involves desloughing, as slough contributes to delayed wound healing by prolonging the inflammatory response, which results in high levels of proteases. In this proteolytic environment, DRUs fail to heal due to a reduction in extracellular matrix formation, matrix degradation, delayed cell migration and inhibition of collagen deposition.

Polyabsorbent fibres dressing pad supports the absorption of wound exudate as well as the trapping of sloughy residue and is considered to offer a safe and effective method to remove debris from the wound bed. The TLC-NOSF treatment range has MMP- reducing properties and has been shown in literature to promote healing in various types of chronic wounds.

Method: Explore the efficacy of a sequential management with TLC-Ag and TLC_NOSF in 2 complex diabetes related wounds.

Results / Discussion: The results achieved in both cases were satisfactory, with a rapid reduction of clinical signs of infection, slough, exudate and pain, and a rapid wound closure, with no adverse events reported during the course of treatment.

Conclusion: The sequential treatment may help to reduce morbidity and mortality in patients with infected DRU by resolving these wounds in a shorter period.

 

EP0551 Case series of complete healing with Macrophage-Regulating Drug ON101 cream on treatment on Wagner grade 2 to 3 diabetic foot ulcer

Khor Shih Chieh^1
1Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan

Aim: To assess the efficacy of Macrophage-Regulating Drug ON101 cream on treatment on Wagner grade 2 to 3 diabetic foot ulcer (DFU).

Method: Total 10 patients with Wagner grade 2 to 3 DFU, aged 40-81, who received adequate debridement (including forefoot amputation with large area of open wound), revascularization of vessel if indicated, and adequate offloading. Macrophage-Regulating Drug ON101 cream was applied twice daily and the area and condition of the wound was assess by plastic surgeon regularly.

Results / Discussion: All the patients in this series achieved complete healing, defined as fully shrinkage and epithelized DFU and no recurrence at follow

Conclusion: After proper correcting main risk factors of DFU, including adequate infection control, revascularization of vessel if indicated, adequate offloading and nutrition as well as blood sugar control, Macrophage-Regulating Drug ON101 cream showed ideal treatment result.

 

EP0552 Diagnostic accuracy and surgical utility of MRI in complicated diabetic foot

Mayank Mahendra^1
1King George’s Medical University, Lucknow, India

Aim: To assess the diagnostic accuracy and surgical utility of MRI in complicated diabetic foot.

Method: 34 complicated diabetic patients were evaluated prospectively. Initially x-ray was done and a provisional management plan was formulated. Later T1W, T2W and FSat sequences of the affected foot and ankle was carried out. The soft tissue, tendons and osseous apparatus were evaluated and subsequently compared with histopathological examination. Before and after MRI, change in management plan was marked. Previously operated cases with persistent ulcer of affected foot were excluded from the study.

Results / Discussion: Twenty two males and 12 females with mean age of 52±8.8 years were analysed. The sensitivity of MRI for tenosynovitis and osteomyelitis was 88% and 100% respectively. The specificity for the same was 100% and 90%. Of all 34 cases, MRI reshapes surgical planning in 23.5% cases (8 patients). The difference between MRI and histopathological findings was evaluated statistically using Fisher-Z test and the proportion of difference between these two groups was not significant as values for tenosynovitis was Z=0.50 (p-value >0.05) and for osteomyelitis Z= 0.54 (p-value>0.05).

Conclusion: The result indicates that MRI is a sensitive and accurate imaging modality for evaluation of diabetic foot and for planning proper treatment and the MRI correlates significantly with the surgical finding.

 

 

DRESSINGS

EP0122 Subvacuum dressing: substitution of surgical treatment for refractory wounds after burns

Jian Jin^1
1Fudan University, Shanghai Depeac Biotechnology Co., Ltd, Shanghai, China

Aim: A subvacuum dressing creates a subvacuum environment in the local area of a wound with good biocompatibility, and does not cause cytotoxicity, stimulation during intradermal implantation, or sensitization. Therefore, we explored the therapeutic effects of subvacuum dressings on refractory burn wounds.
Method: We measured water absorption, water lock performance, and biocompatibility testing of subvacuum dressing according to the ISO10993 standard. We extracted data from the digitized medical records systems of five burn centers and included all inpatients with refractory wounds after burns (≤5%, failed to heal within 8 weeks) admitted between January 2016 and August 2016.
Results / Discussion: The absorption rate of purified water can reach 23.17±1.94 times that of self-weight, and the water lock performance was 44.52±3.38 mm. Biocompatibility testing acceptable, include cytotoxicity test, intradermal stimulation, sensitization, and heat source detection. The clinic results revealed that the skin grafting rate and number of dressing changes for the wounds treated with subvacuum dressings were significantly lower than those for the wounds treated with conventional treatment (P<0.05), without a significant increase in wound healing time.
Conclusion: Collectively, these results suggest that a subvacuum dressing is a novel and effective treatment for refractory wounds after burns as well as a possible alternative to surgical treatment.

EP0123 The efficiency of “moist therapy” in wounds of various etiologies

Mihaela Pertea¹, Stefana Luca², Malek Benamor^3
1Grigore T Popa University of Medicine and Pharmacy Iasi, Clinic of Plastic Surgery, Sf Spiridon Emergency County Hospital, Iasi, Romania, ²Grigore T Popa University of Medicine and Pharmacy, Clinic of Plastic Surgery Sf Spiridon Emergency County Hospital, Iasi, Romania, ³Clinic of Plastic Surgery Sf Spiridon emergency County Hospital, Iasi, Romania

Aim: The use of these dressings has a multipurpose effect, in that they can be applied to virtually all areas of the body, have cooling and wound covering functions, come in many sizes, and can remove heat from the wound through convection and evaporation.

Method: We studied a group of 60 patients with hard-to-heal wounds (chronic ulcers, calcaneal or lower leg pressure sores, etc.), as well as deep burns. After surgical debridement and infection management with antibiotic treatment, we utilized moist dressings such as hydrocolloids, hydrogels, or hydrofibers. The use of these dressings was alternated with hyaluronic acid-based creams. For wound cleansing and irrigation, antiseptic solutions were used.

Results / Discussion: Of the studied group, 60% were female, and the age range varied from 35 to 89 years, with a mean age of 68.7 years. The moist dressings were applied at intervals of 3–4 days for a period of 3–4 days, alternating with hyaluronic acid cream. The healing time and hospitalization duration varied depending on the patients’ comorbidities. The average hospitalization duration was 24.5 days, depending on the lesion area and the local and general conditions of the patient. Due to their special properties, this dressings are an ideal for patients’ convalescence and with hard-to-heal wounds.

Conclusion: The use of moist dressings represents significant progress in the care of wounds with various etiologies.

 

EP0124 Microscopic evaluation of biofilm-encased bacteria exposed to cuprous oxide-impregnated wound dressings

Dr. Gadi Borkow^{1 2}, Tohar Roth², Tally Kossovsky³, Einat Zelinger^3
1The Skin Research Institute, The Dead-Sea & Arava Science Center, Masada, Israel, ²MedCu Technologies Ltd., Herzliya, Israel, ³The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel

Aim: To evaluate the impact of cuprous oxide-impregnated wound dressings (COD) on biofilm-forming gram-positive and gram-negative bacterial populations.

Method: MRSA, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis grown for 7 hours at 37±2ºC served as stock bacterial mix (SBM). Duplicate swatches (0.5 cm²) of COD and control dressings were inoculated with SBM and incubated for 0, 1, 2, or 3 hours. Bacterial viability was assessed using AATCC TM 100. Recovered bacteria were analyzed by scanning electron microscopy (SEM).

Results / Discussion: The bacterial mix produced viable biofilm. Immediate exposure to COD showed no significant effect on bacterial viability or biofilm structure. However, after 1 and 2 hours of exposure to the COD, the bacterial viability decreased by over 99% (p<0.001), compared to controls. SEM revealed cytoplasmic leakage in both gram-positive and gram-negative bacteria exposed to COD, which was absent in control dressings. After 3 hours, gram-negative bacteria displayed holes in their membranes, while gram-positive bacteria showed a significant reduction in width (p<0.001).

Bacterial biofilms are prevalent in chronic wounds, hindering healing. This study confirmed that exposure of bacteria to COD for just 1 hour reduced bacterial viability by over 99% even when the bacteria is protected by biofilm. The kill mechanism involved disruption of the bacterial cell membrane, leading to leakage of the bacterial cellular contents.

Conclusion: This study shows that copper oxide dressings effectively kill bacteria even within biofilms. The primary mechanism involves damaging the bacterial cell wall, leading to cytoplasmic leakage.

 

EP0125 National, multicenter, prospective, randomized in parallel groups, non-inferiority, open-label study to compare properties of two contact layer dressings in the management of acute wounds (SLALOM)

Sylvie Meaume¹, Jean-Charles Kérihuel², Andres Malatesta³, Flavien Roux³, Daria Trofimenko⁴, Martin Abel^4
1Sorbonne University Hospital, Paris, France, ²Vertical, Paris, France, ³RCTs, Lyon, France, ⁴Lohmann & Rauscher GmbH & Co. KG., Neuwied, Germany

Aim: This study compared two contact layer dressings in treatment of acute wounds. The primary endpoint was percentage of minimally painful (<30 mm on a 100 mm VAS) first dressing changes (D3±2), secondary endpoints were rate of achieved healing and time to wound closure.

Method: Patients with acute wounds were randomly assigned to treatment with either an investigational product (IP, n=78) or a comparator product (CP, n=81), and received treatment until the wound healing, or for 23 days maximum.

Results / Discussion: By the first dressing change (D3±2), minimal pain was observed by 97.4% of patients in intervention and 97.5% of patients in control group (mITT, modified intention-to-treat population). For both mITT and PP (per protocol) populations, the lower bound of the unilateral 97.5% confidence interval did not overpass the prespecified -10.0% non-inferiority margin; thus, the non-inferiority of the IP to CP was confirmed. By D21+2, 61.5% of patients in the IP group and 67.9% of patients in the CP group achieved wound healing (mITT, p=0.412). Time to wound closure, estimated for 50% of the patients using the Kaplan-Meier model, composed 20±1.9 days for intervention and 19±2.7 days for control group (mITT, p=0.053). The epithelization area doubled from baseline to D3±2 and further to D21+2 in both groups. The number of peri-wound skin abnormalities significantly decreased in both groups. Very good safety profile was demonstrated.

Conclusion: Both dressings were effective in promoting wound healing. The IP is non-inferior to the CP in minimizing of dressing-change associated pain in acute wounds.

 

EP0126 Eugenol-enriched PEO-based electrospun and photo-crosslinked scaffolds for wound healing applications

Alessandro Calogero Scalia¹, Jessica Alexandra Talamo Ruiz², Lucrezia Cianciaruso¹, Ziba Najmi¹, andrea cochis¹, Lia Rimondini¹, Alessandra Vitale^2
1Università Del Piemonte Orientale, Novara, Italy, ²Politecnico di Torino, Torino, Italy

Aim: Acute and chronic wounds represent a clinical and economic burden. Acute wounds are sudden skin injuries, either open or closed, with the primary risk being infection, which can delay healing and turn an acute wound into a chronic one¹. To prevent this, selecting an appropriate wound dressing that protects against bacteria while promoting tissue regeneration is crucial. This study evaluates a crosslinked polyethylene oxide (PEO) scaffold loaded with eugenol for its suitability as a wound dressing, ensuring antibacterial activity and tissue regeneration.

Method: PEO-based membranes loaded with eugenol (EU) or methacrylated eugenol (EEMA) were prepared via electrospinning and photo-induced crosslinking. After physicochemical characterization, the cytocompatibility and antibacterial activity were tested on fibroblasts and Gram-positive and Gram-negative strains using direct and indirect assays. The regenerative potential of the patches was also evaluated in monolayer and using a commercial Reconstructed Human Epidermis 3D model. Additionally, an innovative cell/bacteria co-culture system was employed.

Results / Discussion: Tests demonstrated eugenol-doped patches’ cytocompatibility and antibacterial activity. However, eugenol’s different effect on the Gram-positive and negative strains was noticed, probably due to differences in bacterial membrane structures and permeability. The cells/bacteria co-culture system demonstrated a protective effect of eugenol on the cell culture used. Furthermore, the 2D and 3D wound assays demonstrated a marked pro-regenerative behaviour of eugenol-doped patches, with a wound width reduction of 65% and 85% in 2D, and 68% and 50% in 3D for EU and EEMA, respectively.

Conclusion: Eugenol-doped PEO patches are effective tools for antibacterial and pro-regenerative wound dressings.
Reference:

1.Ather, S. & Harding, Keith. (2009). Wound management and dressings. 10.1533/9781845696306.1.3.

 

EP0127 A survey of European healthcare professionals’ experiences of gelling fibre wound dressings for different wound types

Matthew Malone^{1 2}, Sinead Fahy³, Monique Rennie^4
1Molnlycke Healthcare Ab, Goteborg, Sweden, ²Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia, ³Mölnlycke, Gothenburg, Sweden, ⁴Mölnlycke, Toronto, Canada

Aim: A survey of healthcare professionals (HCP) was conducted to capture feedback on the usability and performance of gelling fibre dressings (GFD) and a silver-containing variant (GFD-Ag).

Method: Between April and July 2024, HCPs across Europe were provided with a QR code to access the survey questionnaire (Qualtrics platform). Only HCPs with a minimum of 3 months’ experience of using the dressings were eligible. Survey translations were provided in several languages. HCPs were asked to answer 12 questions for each dressing; 10 focused on dressing usage in different clinical scenarios, one focused on overall dressing rating and one asked participants if they would recommend the dressings to colleagues. At survey closure, data were extracted by a blinded statistician for analysis.

Results / Discussion: 572 HCPs provided responses relating to GFD and 243 relating to GFD-Ag. The highest numbers of responses came from Spain (315), France (200), Germany (124) and BeNeNord region (70). 82% of HCPs indicated that the dressings are extremely effective in terms of one-piece removal, 70-78% indicated that they are extremely effective at absorbing, retaining, and transferring exudate; 70-75% indicated that they are extremely effective at facilitating patient comfort during wear, and 75% rated GFD-Ag as being extremely effective at contributing to an infection management protocol. 76% of HCPs rated their overall impression of the dressings are as being extremely effective.

Conclusion: The findings demonstrate the clinical utility and performance of GFD and GFD-Ag in the management of chronic wounds.

 

EP0128 Real-world outcomes of acellular fish skin grafts for chronic wounds -
A retrospective analysis of effectiveness and costs

Pavlo Dinter¹, Lina Weiss¹, Alexander Navarini¹, Simon Müller^1
1University Hospital of Basel, Basel, Switzerland

Aim: Chronic wounds (CW) are a major public health problem. Acellular fish skin grafts (AFSG) are increasingly used in advanced wound care, but data on their effectiveness and costs in real-world settings are scarce. We therefore retrospectively analysed the wound surface area (WSA), pain scores and AFSG related costs in patients with CW over a 12-week follow-up period.

Method: In this single-center observational study, we analysed two datasets of 34 (full dataset) and 22 (WSA-dataset) CW patients treated for AFSG in a university hospital.

Results / Discussion: Of 34 AFSG-treated patients (mean age 75.9±11.4 years, 44.0% females) with 50 CW of various aetiologies (median ulcer duration 32 weeks), 66.6% experienced pain improvement at 12 weeks. Of 22 patients, 19 (86.4%) showed a mean reduction in WSA of -60.7±143.8% (p=0.0025); 36.4% of CW were healed. AFSG-related costs were 1232.3 EUR/patient and 130.4 EUR/reduced cm² (n=22), which was 6.5 times more cost-effective compared to previous study results using living cellular skin substitutes.

Conclusion: During 12 weeks of follow-up in a real-world setting, AFSG resulted in reduced WSA in most patients, improved pain in two-thirds and healed CW in one-third. AFSG may be more cost-effective than other products, but prospective head-to head comparisons are needed.

 

EP0129 A retrospective cohort analysis of patients treated with a three-layer acrylic adhesive foam dressing as part of an integrated care bundle for the management of wound exudate in chronic wounds

Catherine McCarthy¹, Julie Murdoch¹, Theresa Hurd^2
1Smith and Nephew, Hull, United Kingdom, ²Nursing Practise Solutions, Buffalo, Canada

Aim: The aim of this retrospective, real world, cohort analysis is to report the clinical and economic outcomes of an Integrated Care Bundle (ICB) that utilized a 3-layer acrylic adhesive foam dressing for exudate management across multiple chronic wound types within a community setting in Canada.

Method: Analysis of the safety and effectiveness of an introduction of wound centered ICB’s which were adopted to improve the management of chronic wounds, from March 2015 to December 2018. Outcomes were compared from patients who received a 3-layer acrylic adhesive foam dressing alongside an ICB against those that did not, as part of their care.

Results / Discussion: Patients who received care with an ICB and the 3-layer acrylic adhesive foam dressing (n=3678) experienced improved clinical outcomes, compared with those who did not (n=2242). Including faster time to healing (11.8 vs 25.4 weeks, respectively). There were reduced number of nursing visits in the ICB cohort which led directly to reduced resource costs, compared to the patients in the non-ICB cohort (CAD$1722 vs $6488, respectively).

Conclusion: This real-world cohort analysis demonstrated the adoption of an ICB that included treatment with a 3-layer acrylic adhesive foam dressing, improved clinical outcomes, reducing chronic wound healing times and the frequency of wound dressing changes.

 

EP0130 Wound product provision for care homes

Donna Richardson, Janice Wallace¹, Linzi Munro¹, Lisa McArthur¹, Eamonn Brankin¹, Claire Osprey^1
1NHS Lanarkshire, Glasgow, United Kingdom

Aim: To improve wound management pathways for care home residents by providing a permanent provision of wound product stock from a distribution service.

Method: See process map below of the system registered nurses (RN’s) in care homes currently follow for new wounds.

Total number of days = 14 days

With the identified current process it was clear this could be improved by the implementation of wound stock cupboards. This was achieved by having an initial core stock delivered via a distribution service to each care home.  Each manager was then asigned onto an ordering sysytem where they would order top up products to maintain the stock for their care home

Results / Discussion: The results have shown quicker application of the wound product which will promote faster healing rates for residents as they are receiving wound treatment initated 13 days earlier. The process map below identfies the new timeline following implementation:

                    1 day                                                          same day                                                       same day

Conclusion: Earlier implementation of wound management pathways in care homes resulted in faster initiation of appropriate treatments. In addition, there was a:

• 35% reduction in Tissue Viability referrals.
• 10 % reduction in hospital visits by immediate use of tissue glue.
• Improved patient experience: “my father did not have to wait for hours in hospital to have the cut on his head dealt with.  This was carried out in his own room where he was content and not upset”

 

EP0131 A prospective, multi-centre, post-market clinical follow-up study to evaluate the safety and effectiveness of a three-layer silicone adhesive foam dressing

Sophie Berry¹, Julie Murdoch², Catherine McCarthy², Uwe Reinhold³, Ulrike Raap⁴, Julie Journet⁵, Jan Heggemann⁶, Jeanette Milne^7
1Smith+Nephew, Watford, United Kingdom, ²Smith and Nephew, Hull, United Kingdom, ³Dermatology Center, Bonn, Germany, ⁴Klinikum Oldenburg AöR, Oldenburg, Germany, ⁵Centre Hospitalier William Morey, Chalon-sur-Saône, France, ⁶Niels-Stensen-Kliniken Christliches Klinikum Melle GmbH, Melle, Germany, ⁷Northumbria Healthcare NHS Foundation Trust, Northumberland, United Kingdom

Aim: The primary objective of this PMCF study is to demonstrate the clinical performance of a three later silicone adhesive foam dressing as measured by reduction in the size of the wound area (cm2) over a 4-week treatment period, in subjects with chronic and acute wounds.  In addition to the reported primary and secondary endpoints, the overall benefits observed for patients, with specific focus on 7 patient case studies reported.

Method: Between March 2019 and November 2021, forty eligible patients across 6 sites with either a chronic or acute wound, were enrolled in a prospective, single-arm, clinical study. Patients received treatment with a foam dressing for up to 4 weeks. Outcomes reported included: the change in wound size, dressing wear time, and patient reported outcomes.

Results / Discussion: Wounds treated in the modified Intention to Treat (mITT) study population demonstrated a significant median area reduction of 2.2 cm² from baseline to 28 days (p=0.002) and a significant percentage median area reduction of 47.0% (p<0.001). Exudate levels were managed effectively, with a reported mean wear time of 4.5 days.  Patients experienced a positive impact on their overall quality of life and wellbeing from baseline study visits to end of treatment.  This PMCF study supports the use of a three-layer silicone adhesive foam dressing and has demonstrated its safe and effective use in the management of chronic and acute wounds.

Conclusion: The use efficacy and safety of a three-layer silicone adhesive foam dressing for the management of both acute and chronic exuding wounds has been demonstrated by the PMCF clinical study.

 

EP0132 Non-inferiority of copper dressings compared to negative pressure wound therapy (NPWT)  in diabetic foot – A randomized control trial

Dr. Eyal Melamed¹, Jihad Dabahh¹, Talia Israel¹, Ilana Kan¹, MIcael Pinzur², Tohar Roth³, Dr. Gadi Borkow^3
1Rambam Health Care Center, Haifa, Israel, ²Loyola University, Chicago, United States, ³MedCu Ltd., Herzliya, Israel

Aim: Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper Oxide Dressings (COD) in the management of diabetic foot wounds (DFW).

Method: A randomized controlled trial was conducted in patients with DFW for whom NPWT was indicated. The primary endpoint was wound size reduction, assessed by a tissue-analytics (TA) program. 23 patients were randomized to each arm.

Results / Discussion: Twenty-two patients completed the study in the COD arm and 16 in the NPWT arm. The initial wound area was 19.9±4.4 cm2 in the COD arm and 14.1±2.3 cm2 in the NPWT arm (p=0.2). NPWT was applied for an average of 46.9±6.03 days.

Wound size reduction was comparable between the groups, with a 20% margin analysis demonstrating the non-inferiority of copper dressings (p<0.01). After adjusting for confounders such as gender, age, and BMI, ANCOVA revealed a significantly greater wound size reduction with COD (91.23%±13.7) compared to NPWT (68.32%± 2.9) (p=0.039). Granulation tissue assessed by TA was similar in both arms.

Wound closure occurred in 11 patients (47.8%) in the COD arm and 8 (34.8%) in the NPWT arm, though the difference was not statistically significant.

Patients and caregivers found COD more convenient (p<0.001 and p<0.003, respectively), with a shorter application time (p<0.001). Additionally, COD treatment cost was only 14% of the NPWT cost.

Conclusion: The similar efficacy of COD as NPWT in reducing diabetic wound size, combined with greater convenience and approximately 85% cost savings, makes COD a preferable first-line treatment for diabetic foot wounds when NPWT is indicated. Applying these findings to other hard-to-heal wounds could further reduce healthcare costs.

 

EP0133 Clinical and laboratory data highlight the effectiveness of a gelling fiber dressing under compression

Jan heggemann¹, Kolja Szymanski², Nora Pällmann², Daniela Gabriele Seidler^2
1Christian Hospital Melle, Niels Stensen Hospitals, Melle, Germany, ²BSN medical GmbH (Essity Group), Hamburg, Germany

Aim: Venous leg ulcer (VLU) patients need low-pain wound dressings that can absorb and retain exudate under compression. To show that a gelling fiber dressing* enables balanced exudate management in VLU, its performance under compression was assessed in vitro and in vivo.

Method: Free swell absorptive capacity and fluid retention under compression of the gelling fiber dressing* and five relevant competitors were measured by the Surgical Material Testing Laboratory (SMTL), UK. Leg ulcer patients treated with compression therapy that were included in an observational study examining the gelling fiber dressing* in clinical routine in 36 patients with wounds of different etiologies, were analysed in regard to exudate management and wound healing during the 4-week study period.

Results / Discussion: In standardized laboratory tests, the gelling fiber dressing* absorbed 23.65 g liquid per 100 cm² and retained approx. 90% of the absorbed liquid when using a pressure equivalent of 40 mmHg, being among the top of the six tested gelling fiber dressings. Clinical study data of leg ulcer patients using the gelling fiber dressing* under compression therapy (N=3) showed successful exudate management and a mean relative wound size reduction of 62% (from 9.0 cm² to 2.6 cm²) after 4 weeks, accompanied by a robust general wound pain reduction.

Conclusion: Clinical data reflecting laboratory results highlight the effectiveness of the gelling fiber dressing* for treating exuding leg ulcers under compression therapy.

*Cutimed® Gelling Fiber, BSN medical GmbH (Essity Group)

Study funded by BSN medical GmbH (Essity Group)

 

EP0134 Silver-impregnated hydrofiber in wound healing: Implications for clinical practice

Camila Moraes¹, Dioney Neves², Juliana Lucinda dos Santos
¹Universidade Federal do Rio de Janeiro, Macae, Brazil, ²Universidade Federal de Santa Catarina (UFSC), Blumenau, Brazil

Aim: To search for and evaluate the scientific evidence on dressings using Hydrofiber associated with silver in wound healing.

Method: This is an integrative review that followed the steps: Formulation of the guiding question (what is the available evidence on the use of dressings composed of Hydrofiber associated with silver in the wound healing process in the last 10 years?); search of the literature for studies (PubMed, Cochrane Library, EMbase, Science Direct, Web of Science); categorization of studies (inclusion criteria: articles that addressed the use of dressings composed of Hydrofiber associated with silver in the wound healing process; published from April 2014 to April 2024 and articles without distinction of the research design used); evaluation of the studies included in the review; discussion and synthesis.

Results / Discussion: 3348 studies were found, and 20 articles were analyzed. 12 (60%) studies pointed out the impact of using hydrofiber impregnated with silver in clinical practice, the most frequent being its use in burns, which is present in 6 (33.3%) of these studies. Notably, the studies also highlighted its effectiveness in various other wound types, including those in children and surgical situations. The methodology of the studies was systematic reviews with meta-analysis, multicenter clinical studies, single-center clinical studies, case series, and experience reports. The articles discussed the impact of using silver-impregnated hydrofiber in wound healing with biofilm, emphasizing the difference in the result in wounds depending on the amount of exudate.

Conclusion: The results showed the potential that silver-impregnated hydrofiber dressings can effectively control exudate and infection levels, manage biofilm, and prepare the wound for surgical coverage.

 

EP0135 Efficacy of CollaHeal^® Plus vs. ProHeal^® dressings in promoting healing of split-thickness skin graft donor sites

Seung-eun Hong¹

¹Department of Plastic and Reconstructive Surgery, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Rep. of South Korea

Aim: Split-thickness skin grafting (STSG) is a widely used surgical technique for wound repair, encompassing trauma, ulcers, and reconstructive surgeries. The procedure necessitates the creation of a donor site, which in turn requires the application of an appropriate dressing.  This study aimed to compare the effectiveness of CollaHeal^® Plus and ProHeal^®, two collagen-based bioactive dressings, in promoting healing of donor sites after split-thickness skin grafts.

Method: A retrospective chart review was conducted on a consecutive series of patients who underwent STSG between 2020 and 2023. Subjects were categorized into one of three treatment groups: CollaHeal^® Plus(collagen+ Hyaluronic Acid), ProHeal^®(collagen) or a standard dressing without bioactive components. Factors such as demographic data, past medical history, and wound characteristics were recorded. The status of the wounds was assessed every three days, starting from postoperative day 3, until complete healing was achieved.

Results / Discussion: This retrospective study included 47 patients with a mean age of 43.8 years, comprising 27.6% women. There was no statistically significant difference in time to complete wound healing, pain intensity, or itching between the two types of bioactive dressings at the 95% confidence level (P > 0.05). However, the control group without bioactive dressings showed significant differences across all evaluated parameters (P-value > 0.05), confirming the efficacy of bioactive dressings.

Conclusion: Bioactive dressings are defined as dressings composed of natural or synthetic materials designed to influence the wound healing process either directly or indirectly. The current research indicates that the use of collagen-based bioactive dressings may help achieve optimal outcomes for donor site management in split-skin grafting procedures.

 

EP0137 Rapid evaluation of a multi-layer foam dressing for management of exuding wounds

Jennifer Gale¹, Tim Styche^1
1Smith + Nephew, Hull, United Kingdom

Aim: Chronic wounds impact the quality of life of nearly 2.5% of the total population of the United States (US). Clinically unnecessary dressing changes are a substantial economic burden and contributor to pain and stress for patients with chronic wounds. The aim of this study was to collect data to evaluate the effectiveness of a uniquely designed five-layer hydrocellular polyurethane foam dressing (HPFD)* with a wear time indicator for management of exuding wounds.

Method: Respondents in the US accessed the product evaluation form using a unique QR code or weblink and input data over a 7-day auditing period. Clinicians were asked to use HPFDs in lieu of dressings currently in use, and to follow their normal protocol for dressing examination and change. The HPFD evaluation included ratings of product usage and performance in several key areas. Each site was provided with a report within 5 working days of the end date.

Results / Discussion: Between July 2022 and April 2024, 122 responses were collected from 13 hospitals (questions were non-mandatory). The results show patient satisfaction levels were 97.1% (102/105 responses) relating to the wear time indicator, and 99.1% (115/116 responses) for exudate retention during removal. 86.5% (96/111 responses) believe the HPFD helped avoid unnecessary dressing changes because it lasted longer.

Conclusion: The rapid evaluation method enabled sites to assess the HPFD and this was demonstrated to be effective for exudate management and increased wear time. These reports could also be used for local training and engagement. 

* ALLEVYN^TM LIFE (Smith and Nephew, Hull, UK) 

 

EP0139 Combination of hyaluronic acid and amino acids in the management of patients with necrotic chronic wounds: A case series and literature review

Levent Demir^1
1Kayseri City Training and Research Hospital, Kayseri, Turkey

Aim: Nutrition is essential for wound healing. During physiological stress, the body’s need for nutrients increases, particularly cell growth and protein synthesis. Insufficient nutrition can delay the healing process. This study aimed to present a case series on the effectiveness of combining hyaluronic acid and amino acids (HA+AA) for treating chronic wounds with necrotic components, while also interpreting the results in light of existing literature.

Method: We evaluated the effectiveness of HA+AA gel in treating chronic wounds with necrotic components in a series of clinic patients. Critical data recorded included demographics, Wagner staging, white blood cell count, hemoglobin concentration, sedimentation rate, wound cultures, and C-reactive protein levels. The progression of the wounds was evaluated.

Results / Discussion: Eight patients treated with HA+AA gel were evaluated. The mean age of the patients was 58.5 (28-75) years. Four patients were classified as Wagner Stage 3, while the other four were classified as Stage 2. All patients exhibited reduced necrotic tissue, increased granulation tissue, and decreased wound size. Recent research from the past 15 years shows that combining HA with AA accelerates healing and improves scar quality more effectively than HA alone. The literature also supports its cost-effectiveness for hard-to-heal wounds.

Conclusion: Effective wound management involves using dressings that support the healing process. A review of the literature and our own experience suggests that HA+AA can cost-effectively enhance chronic wound healing by regulating inflammation and promoting collagen production. The gel form of HA+AA may effectively treat wounds with necrotic tissue.

 

EP0140 Does the use of DACC-coated dressings improve clinical outcomes for hard to heal wounds: A systematic review

Saskia Schwarzer¹, José Luis Lázaro-Martínez², Amanda Killeen³, Paulo Alves⁴, Andrea Gledhill⁵, Erik Nygren⁶, Lawrence Lavery⁷, Matthew Malone^{6 8
1}Liverpool High Risk Foot Service, South Western Sydney Local Health District, New South Wales, Australia, ²Complutense University of Madrid, Diabetic Foot Unit, University Clinic of Podiatry, Madrid, Spain, ³School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, United States, ⁴Wounds Research Laboratory, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Catolica Portuguesa, Lisboa, Portugal, ⁵Great Western Hospital NHS Foundation Trust, Department of Trauma and Orthopaedics, Swindon, United Kingdom, ⁶Wound Care Research and Development, Molnlycke Health Care AB, Gothenburg, Sweden, ⁷Department of Plastic Surgery, University of Texas, Southwestern Medical Centre, Dallas, Texas, United States, ⁸Infectious Diseases and Microbiology, School of Medicine, University of Western Sydney, Sydney, Australia

Aim: Evaluate the in vivo clinical evidence for the effectiveness of DACC-coated dressings in chronic, hard to heal wound-related outcomes.

Method: The GRADE Framework was used as the template for this systematic review with PICO format used to identify key clinical questions in determining patient outcomes under two domains (infection control and wound healing). A systematic search was performed and all abstracts were screened independently by two reviewers, with six further reviewers independently assessing records proceeding to full review. The authors rated the quality of evidence for each of the outcomes critical to decision making.

Results / Discussion: 748 records were screened from the databases, and 13 records were sought for full review. Following full review, a further three records were excluded, leaving ten records for data extraction. Three records were narrative reviews, three systematic reviews, two prospective non-comparative before/after studies, one prospective head-to-head comparator cohort study and one retrospective head-to-head comparator cohort study. No RCTs or case versus control studies were identified. The overall quality of clinical evidence for the use of DACC-coated dressing to improve wound infection and wound healing outcomes was assessed as very low.

Conclusion: There is an urgent unmet need to perform appropriately designed RCTs or case–control studies. The extracted data provide no clarity and has limited to no evidence to support the use of a DACC-coated dressing to improve wound infection or wound healing outcomes. Further, there is no evidence to suggest this therapy is superior to standard of wound care or equivocal to topical antimicrobial agents in the management of infected hard to heal wounds.

 

EP0141 Sequential management of chronic and acute wounds with polyabsorbent tlc-ag fibre dressing and TLC-NOSF treatment range

Agnieszka Wojciechowska¹, Emilio Galea², Piotr Dembinski^3
1URGO Polfa Łódź Sp. z o.o., Warszawa, Poland, ²Laboratoires Urgo, Chenove, France, ³Laboratoires Urgo, Czech Republic

Aim: Several factors have been identified that may impair the healing process, including local and systemic factors - local factors include the presence of devitalised tissue, foreign bodies, and wound infection, while systemic factors include comorbidities, advanced age, malnutrition, and other chronic organ diseases.

Technology lipido-colloid with silver (TLC-Ag) is supported by high quality clinical evidence, and, moreover, the addition of polyabsorbent fibres, has allowed clinicians to apply this technology to higher exuding wounds to provide a cleaning and antimicrobial action². Furthermore, the TLC with nano oligosaccharide factor (TLC-NOSF) treatment range, with matrix metalloprotease reduction properties, has been shown to reduce healing times and overall wound management costs, and improves the patients’ health related quality of life³.

Method: Clinical evaluation of the sequential management with polyabsorbent TLC-AG fibre dressing and TLC-NOSF treatment range in two pressure ulcers and a burn wound.

Results / Discussion: In both chronic and acute wounds, the management with the two evaluated treatment ranges provided very good results with resolution of local wound infection and rapid wound closure.

Conclusion: In all cases, a score of 5 (with 0 being the worst and 5 being the most desirable) was given for all dressing for ease of application, ease of removal, non-adherence to wound, conformability, acceptability by clinician, and acceptability by patient, without any adverse events.

 

EP0142 Biodegradable temporising matrix (BTM) dressing on scalp bone exposed wounds in the outpatient setting

Marcella Yudo¹, Ines Prasidha^{1 2}, Natalie Osborne¹, Shahn Coburn^{2 3}, Emel Fikri¹, David Coker^{1 2 4 5}, Robyn Saw^{1 2 4 5
1}Royal Prince Alfred Hospital, Sydney, Australia, ²Melanoma Institute Australia, Sydney, Australia, ³Melanoma and Skin Cancer Nurses Association, Sydney, Australia, ⁴University of Sydney, Sydney, Australia, ⁵Mater Hospital, Sydney, Australia

Aim: To trial the feasibility of Biodegradable Temporising Matrix (BTM) dressings on bone exposed scalp wounds applied in the outpatient setting.

Method: BTM dressing conventionally requires sharp debridement of the wound bed and suturing/stapling in the operating theatre.
Sharp debridement of the wound edge to bleeding tissue and wound bed down to bare bone was performed. No anaesthetic or analgesia was required. Cut to shape BTM were applied and secured to perfused wound edges using skin closure adhesive strips. Secondary dressings included non-stick interface, gauze padding and non-woven fixation tape.

Patients attended the clinic 1-3 times per week for maintenance, dependent on BTM moisture level and stage of healing. Therapy duration was calculated from the date of BTM application to the date of BTM membrane delamination with formed neodermis.

Results / Discussion: Eleven patients with bone exposed scalp wounds at an outpatient clinic of a major tertiary hospital were treated (2022-2024). Median age was 77 years (range: 39-97 years).

9 were applied by surgeons, 2 by an accredited nurse.

Average duration of therapy was 109 days (median: 78, range: 49-307).

7 were successful with 100% neodermis growth and epithelisation. 2 partially failed (required ongoing wound care, but both were deceased prior to completion of care due to old age). 2 others completely failed (required bone resection and large rotation flap repair).

Complications include infection, hypergranulation, detachment of dressing from wound edge and other comorbidities.

Conclusion: BTM facilitates skin regeneration on bone exposed scalp wounds and promotes healing, providing an alternative to complex skin repair procedures under general anaesthetics in operating theatres. Both doctors and nurses can apply BTM dressings in an outpatient setting.

 

EP0143 Slow enzymatic debridement followed by nanocellulose-based wound dressings  in second degree burns treatment– clinical study

Camelia Tamas¹, Oana Diaconu², Irina Jemnoschi-Hreniuc³, Diana Alecu^{2 2}, Catalina Pintilie², Cristina Stanescu^4
1University of Medicine and Pharmacy “Gr. T. Popa”, Emergency Hospital “Saint John”, Iasi, Romania, ²University of Medicine and Pharmacy “Gr. T. Popa”, Emergency Hospital “Saint Spiridon”, Iasi, Romania, ³University of Medicine and Pharmacy “Gr. T. Popa”, CFR Hospital, Iasi, Romania, ⁴Universitatea “Dunarea de Jos” Galati, Galati, Romania

Aim: To evaluate the clinical results after slow enzymatic debridement in second degree burns, using only collagenase or combining it with other devices able to stimulate the wound healing.

Method: We selected 30 patients with acute second degree burns extended on 20% from the total body skin area (tbsa), with negative bacteriological exam of wound secretions.

To perform slow enzymatic debridement, we used an ointment based on collagenase, extracted from Vibrio Alginoliticum and hyaluronic acid (HA).We applied collagenase on 20%tbsa. For every patient, on 10% tbsa burn, we added nanocellulose-based dressings (NCBD) in 15 cases, or negative pressure wound therapy (NPWT) for other 15 cases . For the rest of wound surface, at the same patient, we applied usual sterile dressing with saline solution.

After wound cleaning, we applied collagenase for a period of 10-15 days. We monitored the healing process each 5 days, while changing the dressing. Every 3-5 days we cleaned the wound and removed the superficial layer of debrided cells using a dry compresse, we evaluated the wound surface and thickness with a Periscan Laser Doppler System, then we applied again collagenase ointment, following the initial protocol.

Results / Discussion: The wound debridement was complete for all the cases. The highest wound healing daily rate (3.59-2.92% wound surface) was recorded for the group with NPWT comparative with 2.86-2.52% for NCBD or 2.12-2.05% for usual dressing.

Conclusion: The use of NPWT or NCBD can increase the efficiency of slow enzymatic debridement, stimulate the healing process and reduce the hospitalization period.

 

EP0144 A clinical application of porcine skin as a biological wound dressing: Case series

Si Eun Lee¹, Min Young Lee¹, Min Ji Kim^1
1Ajou University Hospital, Suwon-si, Rep. of South Korea

Aim: Human cadaveric-derived skin is now a mainstream skin alternative in many eras of reconstruction. But its high cost, limited source of material and complicated processing make it challenging to apply as dressing materials. Thus many demands for heterogenic-derived skin are increasing. Porcine skin is a good candidate as skin alteranative, which contains essential wound healing factors such as collagen, elastin and laminin. We want to share our experiences through case series.

Method: The patients who visited Ajou university hospital for open wounds were recruited for this study. The causes of the wound included diabetes, trauma and skin graft donor site. The inclusion criteria is the wound occurrence day within four weeks. Porcine skin dressing (Mycuber^®, Msbio) was used in the treatment. During the treatment period, surgical debridement or other operation limited but secondary dressing for material fixation and negative pressure vacuum treatment (NPWT) were allowed.

Results / Discussion: Total 8 patients underwent conservative treatment with porcine skin dressing (Mycuber^®). The median wound follow up period is 18.7± 5 days. The median full epithelization date is 7.3 ± 5 days in an acute wound and 21.7± 3 days in a diabetic wound. The complete healing rate is 75% and the unhealing wound is diabetic, but their depth improvement was revealed in all cases.

Conclusion: We demonstrate that porcine skin can act as a biological dressing in a clinical setting. Proved no-immunogenicity, secure structural support makes its wound healing acceleration. There are no meaningful inflammation-related adverse events and sustained material until wound epithelization. Cheap and easy access to the material application anticipated its role expansion in wound dressing material requests.

 

EP0145 Progress in the application of microneedles combined with near-infrared light in wound repair

Hanbin Deng¹, Shaowen Cheng^1
1Department of Wound Repair, Key Laboratory of Emergency and Trauma of Ministry of Education,The First Affiliated Hospital of Hainan Medical University, Haikou, China

Aim: In this paper, the application of near-infrared light responsive microneedle system in wound repair in the past six years is summarized, which provides a new strategy for wound repair and reconstruction.

Method: The literature published from 2018 to 2024 was searched by computer through English databases such as PubMed, Web of Science, Google scholar and Chinese databases such as CNKI and Wanfang Data. The Chinese search words were “痚针ㄛ倛红魤恞ㄛ创惎”; The English search terms were “Microneedle, Near-infrared light, Wounds”, and 40 literatures were included according to inclusion and exclusion criteria.

Results / Discussion: Microneedle drug delivery has the advantages of easy operation, minimally invasive and high efficiency. Appropriate near-infrared light has the advantage of deep penetration and low phototoxicity. In recent years, this combination has been gradually used for transdermal drug delivery, antibacterial treatment of wound, infection healing and detection, especially in the treatment of diabetic foot ulcers. In this paper, we summarize the mechanism of Near-infrared light responsive microneedle system in different wound areas. The role of near infrared light responsive microneedle system in promoting wound repair was verified.

Conclusion: The Near-infrared light-responsive microneedle system integrates multiple benefits, achieving a synergistic effect akin to “1+1>2”: (1) Controlled drug release. (2) On-demand drug delivery. (3) Accelerated drug administration. (4) Enhanced wound healing through PTT, PDT, and other treatments (5) Wound monitoring capabilities. This system provides a promising method for wound repair and the prevention and treatment of wound related diseases.

 

EP0146 Rapid evaluation of a multi-layer foam dressing for pressure injury prevention

Jennifer Gale¹, Tim Styche^1
1Smith + Nephew, Hull, United Kingdom

Aim: Pressure injuries affect 1-3 million people in the United States (US) each year and approximately 95% are preventable. Foam dressings are used in pressure injury prevention (PIP) as they can provide a protective barrier over areas of the skin at risk of developing pressure injuries. The aim of this study was to collect data to evaluate the effectiveness of a uniquely designed five-layer hydrocellular polyurethane foam dressing (HPFD)* for PIP.

Method: Respondents in the US accessed the product evaluation form using a unique QR code or weblink and input data over a 7-day auditing period. Clinicians were asked to use HPFDs in lieu of dressings currently in use, and to follow their normal protocol for dressing examination and change. The HPFD evaluation included ratings of product usage and performance in several key areas. Each site was provided with a report within 5 working days of the end date.

Results / Discussion: Between July 2022 and April 2024, 210 responses were received from 15 hospitals (questions were non-mandatory). Overall expectation of dressing performance was met 94.7% (198/209 responses) of the time with application of the HPFD. Furthermore, 19 respondents applied the HPFD in conjunction with a medical device and 100% would continue to use HPFDs for PIP. Compared to dressings they have used in the past, 87% (180/206 responses) were satisfied with wear time.

Conclusion: The rapid evaluation method enabled sites to assess the HPFD and this was demonstrated to be effective; these reports could also be used for local training and engagement.

* ALLEVYN^TM LIFE (Smith and Nephew, Hull, UK)

 

EP0147 Assessment of the performance characteristics of a new multilayer foam dressing

Jordyn Bunker¹, Shauna Powell¹, Donna Kesteven^1
1Convatec, Deeside, United Kingdom

Aim: Effective wound management is essential for promoting healing, preventing complications, and improving patient outcomes. The development of an advanced dressing tailored to meet these specific needs is imperative to optimize outcomes and enhance patient comfort and quality of life.

Method: The performance characteristics of a new multilayer foam dressing, A*, were compared to those of two competitor dressing, B^† and C°, in vitro. The speed of absorbency, defined as the rate at which 5ml of saline solution is transmitted through the dressing pores, was assessed for all dressings. The adhesive strength of the dressings was assessed by the force required to peel a sample of the adhesive border of each dressing from a polycarbonate substrate by the Zwick Universal Testing Machine. Seven-day fluid handling testing was carried out in line with the principles of BS EN 13726.

Results / Discussion: Dressing A* resulted in superior 7-day fluid handling capacity (85.69 g/10cm²/7 days) when compared with dressing B^† (72.18 g/10 cm²/7 days) and C° (72.43 g/10 cm²/7 days) (p<0.05). Dressing A* exhibited statistically significant, superior adhesive strength compared to dressing B^† and C° (p<0.05). In addition, dressing A* resulted in the fastest fluid uptake rate (9.1 seconds), when compared to dressings B^† (224.3 seconds) and C° (52.8 seconds).

Conclusion: This data shows that the new multi-layered foam dressing is better equipped at managing and handling wound fluid when compared against its competitors.

*ConvaFoam Silicone™, Convatec, Inc.

^†Mepilex^® Border Comfort, Molnlycke, Inc.

°Allevyn™ Gentle Border, Smith & Nephew PLC.

 

EP0148 Evaluating the efficacy of a povidone iodine non-adherent wound dressing in chronic wound management: a case series

Charalambos Agathangelou¹, Sofoulis Achilleos^2
1Ske Dhali, Dhali, Cyprus, ²Ske Dhali, Dhali, Cyprus

Aim: Evaluate the effectiveness of a povidone iodine non-adherent wound dressing in chronic wounds, in terms of wound healing, reduction of exudate, wound size, infection, pain and ease of application.

Method: Ten patients selected with an average age of 86 years old with chronic wounds and duration ranging from six weeks to four months (2 trauma – 6 PU – 2 VLU). Patients with a known hypersensitivity (allergy) to Iodine, under treatment for kidney problems, Thyroid disease and Dermatitis Herpetiformis were excluded.

A thorough medical, nursing, and social assessment of the patient’s history, concerns and a detailed wound assessment based on the TIMERS principle was performed at baseline, mid treatment and end of treatment.

Results / Discussion: All chronic wounds included in the study were previously treated unsuccessfully with other wound care products such as collagen, silver, and silicone-foams. All patients were previously treated with i.v. antibiotics due to recurrent infections.

All patients showed a gradual reduction of wound size with no re-infection, exudate levels decreased from moderate or high to low in all cases. Patient pain reduced from an average of 8 to 2 after 2 weeks. (VAS scale).

The Nursing team reported ease of application and removal, with no dressing residue observed.

Conclusion: Solutions for accelerating wound healing in chronic wounds are highly desired in clinical practice. More research is needed, but very promising findings in our small study indicates that a povidone iodine non-adherent wound dressing plays a key role in reducing wound bioburden and managing chronic wounds.

 

 

EP0149 Use of alginogel enzyme in the local treatment of complex traumatic wounds in the pediatric population: clinical cases

Rita Cabral¹, Carla Santos¹, Paulo Ramos^2
1ULS Trás-os-Montes e Alto Douro, Vila Real, Portugal, ²ULS Póvoa de Varzim Vila do Conde, Póvoa de Varzim, Portugal

Aim: To present a series of cases of complex traumatic wounds, of different aetiologies, in the paediatric population in which Enzyme Alginogel was used as local treatment.

Method: This is a series of cases involving complex traumatic wounds in the pediatric population (ages 5-17), followed up at the pediatric outpatient clinic of the ULS of Trás-os-Montes, Vila Real unit. Photographic records of the wounds were taken after obtaining informed consent from the parents or legal guardians. A total of 4 cases of traumatic wounds of different etiologies will be presented, in which the following local approach was used: Cleaning with an antiseptic solution, autolytic and mechanical debridement as evaluated by the team, application of Enzyme Alginogel as the primary dressing, followed by non-adherent silicone gauze and a secondary dressing suitable for exudate management.

Results / Discussion: In all cases, complete healing of the wounds was achieved within a maximum period of 9 weeks. None of the cases required antibiotic therapy for deep compartment infection. Enzyme Alginogel proved to be a safe dressing material for paediatric use, with no reported sensitivity reactions or interactions. Pain assessment was conducted in all cases, and it was one of the factors that led to the use of Enzyme Alginogel.

Conclusion: Further studies are needed on the effectiveness of dressing materials in the paediatric population. In the cases presented Enzyme Alginogel was very effective for local management of complex wounds in this specific population.

 

EP0150 Confirmation of the antibacterial activity of a superabsorbent wound dressing in vitro

Claudia Feldkamp¹, Martin Abel¹, Cornelia Wiegand^2
1Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany, ²University Hospital Jena, Jena, Germany

Aim: Confirmation of the antibacterial activity of a superabsorbent¹ wound dressing in vitro.

Method: The antibacterial activity against E. coli was investigated in vitro according to JIS L 1902:2015 with polyester material as growth control. Furthermore, an experimental E. coli biofilm was treated with the dressing for 24h. Biomass was then quantified by determination of the bacterial respiratory activity after removal of the dressings and compared to an untreated control without dressing. The release of endotoxins during treatment of planktonic and biofilm E. coli as well as the binding were investigated via absorbance measurements on a plate photometer and compared to a control.

Results / Discussion: The superabsorbent¹ wound dressing reduced the growth of E. coli significantly (2.65 log cfu vs. control: 0.00 log cfu reduction). Treatment of an experimental E. coli biofilm with the dressing significantly reduced biomass (87.8% reduction compared to untreated control). Release of endotoxins was low after treatment with planktonic E. coli (1.40 EU/mL; polyester control: 0.05 EU/mL) and an E. coli biofilm (1.38 EU/mL; untreated control: 1.46 EU/mL). The dressing bound significant amounts of E. coli endotoxin and reduced its concentration in the simulated wound fluid. After 1h the endotoxin reduction was already >90% compared to the control.

Conclusion: Test results indicate that the superabsorbent¹ wound dressing significantly reduces microbial growth and biomass in vitro. The dressing binds endotoxins rapidly and efficiently, with a low release of endotoxins after treatment of planktonic E. coli and an E. coli biofilm.

¹ Vliwazell^® Pro Superabsorbent Wound Dressing

 

EP0152 A wound dressing shows its value: Clinical and economic effects of a dressing regime change for primary and home care chronic wound management

Andrés Roldán Valenzuela^1
1Centro De Salud Mairena Del Aljarafe (Sevilla), Sevilla, Spain

Aim: In a multi-centre clinical trial, a silicone-coated multilayered foam dressing (SCMFD)* was associated with longer intervals between changes, compared to other multilayered foam dressings in the management of chronic wounds.1 This prompted eight primary care centres in Spain to consider introducing the SCMFD into their chronic wound management regimes.

Method: At a baseline assessment, details of dressings used in the preceding week and feedback from clinicians and patients concerning performance were recorded (historical control).  The SCMFD was then used for an expected follow-up of 4 weeks, after which the same data were captured at a final visit.     

Results / Discussion: Data from 37 patients were analysed. The median number of dressings changed within the 7 days preceding the final visit was significantly less than that within the week leading up to the baseline assessment (1 vs 3; p<0.001), equating to a 44% saving on dressing costs.  The performance of the SCMFD (e.g. ease of application/removal, conformability, ability to stay in place and minimise trauma) was rated highly by clinicians; all indicated that they would recommend it to colleagues.  Patients reported less pain and better comfort when using the SCMFD, compared to previously used foam dressings; all stated that they would recommend it to relatives or friends.

Conclusion: SCMFD performs well in the management of chronic wounds and can be expected to prolong the interval between dressing changes and, in doing so, reduce dressing-related costs.      

* Mepilex Border Flex (Mölnlycke Health Care)

1. Alvarez, O.M., et al. J Comp Eff Res 2021;10(6):481-493.

 

EP0212 The impact of a biologically relevant simulated wound fluid (SWF a) on the fluid handling capacity of foam dressings: Promoting the clinical relevance of testing

Erik Nygren¹, Anna Svensby¹, Jenny Perez Holmberg¹, Amit Gefen², Breda Cullen³, Åsa Ronkvist¹, AnnBritt Gergely¹, Marina Craig^1
1Mölnlycke Health Care, Gothenburg, Sweden, ²Tel Aviv University, Ghent University & Hasselt University, Tel Aviv, Israel, ³RedC Consultancy, Bradford, United Kingdom

Aim: To evaluate the impact of using biologically relevant simulated wound fluids (SWFs) in fluid handling capacity (FHC) testing of advanced foam wound dressings for refined standard method protocols, achieving assessments that better reflect clinical reality.

Method: The FHC of eight bordered and non-bordered dressings was tested using three fluids: Solution A (aqueous protein-free salt solution), SCS (benchmark reference serum-containing solution simulating chronic wound exudate), and SWF A (simulated wound fluid developed in this study to represent physiological protein, salt, and buffer concentrations). The key physicochemical parameters of these fluids were compared to assess their relevance to clinical exudates. An independent laboratory subsequently tested the FHC of nineteen dressings using Solution A and SWF A. FHC testing was performed according to EN 13726:2023.

Results / Discussion: The study found significant differences in the FHC of wound dressings when tested with SWF A and SCS compared to Solution A. SWF A closely resembled SCS in its physicochemical properties, providing a more accurate prediction of performance in clinical settings. The results highlight the limitations of using Solution A, which does not adequately mimic the complexity of real-world exudates, producing biased results.

Conclusion: Standard methods, including EN 13726:2023, must be improved to incorporate more biologically relevant SWFs. By adopting complex fluids that better mimic clinical exudates, such as SWF A, laboratory evaluations can provide more accurate predictions of dressing performance in real-world settings. The adoption of such fluids in standards could improve outcomes and inform better decisions, ultimately enhancing patient quality of life.

 

EP0213 The role of nitric oxide in the killing and prevention of biofilm by a new nitric oxide-generating wound dressing

Daniel Metcalf¹, Nicholas Boote², Alan Horner^2
1Convatec Advanced Wound Care R&D, Deeside, United Kingdom, ²Convatec Advanced Wound Care R&D, Milton Park, Oxford, United Kingdom

Aim: To demonstrate the antibiofilm activity of nitric oxide (NO), based on acidified sodium nitrite (NaNO₂), within a novel NO-generating wound dressing technology*.

Method: Initial prototype test dressings comprised absorbent layers plus carrier layers (CL) containing varying concentrations of NaNO₂. Biofilms of methicillin-resistant Staphylococcus aureus (MRSA) were grown on nitrocellulose filters for 24 hours, before prototypes/controls were applied. To assess biofilm prevention, planktonic MRSA-inoculated filters were immediately covered with prototypes/controls for 24 hours. Treatment time was measured regularly over a 24-hour period to evaluate biofilm killing and prevention using the final dressing design* containing a 1M NaNO₂ CL.

Results / Discussion: MRSA biofilm was reduced by 3 log₁₀ in 24 hours by prototypes with CL containing 0.2M NaNO₂, and eradicated by dressings with CL containing 0.5M NaNO₂ (Figure 1). MRSA biofilm formation was not prevented by dressings with CL containing 0.1M NaNO₂, but was completely prevented by dressings with CL containing 0.2M NaNO₂, after 24 hours. When using dressings* with CL containing 1M NaNO₂, MRSA biofilm was reduced by 3 log₁₀ after 2 hours, by >7 log₁₀ after 4 hours, and completely eradicated after 6 hours (Figure 2); biofilm formation was completely prevented after 6 hours.

Conclusion: Biofilm kill and prevention models showed that varying the concentration of NaNO₂ used to generate NO, and varying the duration of treatment with the final dressing*, resulted in a dose-response effect on MRSA biofilm kill and prevention.

* EDX 110/ConvaNiox (Convatec Ltd, UK)

 

EP0214 The evolution of wound dressings: past, present and future approaches to address local barriers to wound healing

Scarlet Milo¹, Daniel Metcalf^1
1Convatec, Deeside, United Kingdom

Aim: To describe a next stage of the evolution of advanced wound dressings.

Method: Narrative review.

Results / Discussion: Developments in dressing technologies have targeted three key local barriers to wound healing: (1) exudate management, (2) infection management, and most recently, (3) biofilm management.

Past approaches have focused on physical and chemical characteristics designed to manage exudate and infection. Material advances in alginates, hydrocolloids and advanced gelling fibres have provided clinically useful material properties for the management of moderately to highly exuding wounds. Moreover, the addition of, for example, ionic silver to such dressings* provided a safe and effective method for infection management.

More recently, biofilm has been inexorably linked to hard-to-heal wounds. The present ‘state of the art’ dressing is the first of its kind designed to manage biofilm**, utilising additional excipients to penetrate biofilm extracellular polymeric substances and facilitate the antimicrobial effects of silver.

Conclusion: Future approaches will require next generation wound dressings to enhance and expand the management of the above local barriers   to wound healing. By addressing factors such as poorly-perfused tissue and hypoxia, dressing technology can facilitate   the power of the host immune and wound healing systems.

A novel nitric oxide-generating dressing*** combines physical and chemical properties to not only manage exudate, infection and biofilm, but also to address tissue perfusion and hypoxia to improve wound healing outcomes. Enhanced physical and chemical dressing characteristics (fluid absorption and donation, continuous moisture vapor transmission rate, pH), also impart an environment that is inhospitable to pathogens and biofilm development.

* Aquacel Ag (Convatec Ltd, UK)

** Aquacel Ag+ Extra (Convatec Ltd, UK)

*** EDX 110/ConvaNiox (Convatec Ltd, UK)

 

EP0215 Laser specle contrast analysis LASCA assessment of the use of an innovative synthetic, biodegradable matrix designed to close hard-to-heal chronic wounds

Magdalena Szatan¹, Anna Hepa-Banasik¹, Anna Słaboń¹, Artur Wielgórecki¹, Wojciech Łabuś^1
1Dr Stanislaw Sakiel Centre for Burn Treatment in Siemianowice Slaskie, Poland, Siemianowice Slaskie, Poland

Aim: The purpose of our study was to present preliminary results of the use of a polylactide acid membrane (polylactic acid membrane) dressing in the treatment of patients with chronic wounds. Patients enrolled in the presented program were heavily burdened, and the placement of this dressing was a desperate attempt to close hard-to-heal chronic wounds. Polylactid acid membrane combines the advantages of the microporous structure of polylactic acid known from the alloplastic skin substitute.

Method: 10 patients suffering from chronic wounds who were not qualified for anesthesia due to comorbidities were included in the study. Patients had outpatient visits, during which wounds were managed. The management included: cleaning the wound, fighting infection, etc. Dressings were applied to clean granulation wounds. During subsequent visits, the wound healing process was observed. Healing progress was monitored using planimetry and LASCA. The overall appearance of the wound was evaluated - wound color, presence of exudate (color and odor), presence of swelling, inflammation, infection, pain level, etc.

Results / Discussion: In all cases analyzed, the wounds healed. A very important part of the healing process was adherence to the doctor/nurse’s recommendations (balanced diet and adequate physical activity, wound hygiene, normalization of sugar levels, use of compression therapy, etc.). Regular visits to the nurse’s office allowed monitoring the healing process of a hard-to-heal wound.

Conclusion: The use of the dressing discussed in this paper may be the optimal treatment strategy for hard-to-heal chronic wounds, especially in patients where anesthesia for surgery is not possible. Nursing care is a key element in the treatment of a patient with a difficult-to-heal wound when using the use of a polylactic acid membrane.

 

EP0216 Advancing the management of hard-to-heal wounds: A prospective, multicenter study of a next-generation multi-layered foam dressing

Cristin Taylor¹, Alisha Oropallo², Christina Del Pin², Marisa Ranire-Maguire², Anne Marie Lanza-Bisciello², Russell Caprioli², Rebecca Rodger³, Cristin Taylor^4
1ConvaTec, Lexington, United States, ²Northwell Health, Lake Success, United States, ³Convatec, Deeside, United Kingdom, ⁴Convatec, Lexington, United States

Aim: The aim of this study was to assess the efficacy and performance of next-generation advanced multi-layered foam dressings* in the management of hard-to-heal wounds. 

Method: A prospective, multicenter, interventional, non-comparator, open-label study of hard-to-heal wounds, managed with either a border, silicone or non-adhesive version of a next-generation advanced multi-layered foam dressing.* The primary endpoint was percentage change in wound size from baseline to 4 weeks post-dressing application. The secondary endpoints were satisfactory clinical progression defined as 40% reduction in study wound area at 4 weeks post-dressing application. 

Results: Ninety-two patients with 111 wounds were enrolled in the study (mean patient age, 66.0 years). Venous (mixed) ulcers were the most common wounds reported in the study (n=64; 57.7%). In addition, the study population included 34 diabetic foot ulcers (30.6%), 10 pressure injuries (9.0%), and 3 arterial ulcers (2.7%). Of the 92 patients enrolled, 73 completed the study (number of wounds, n=109). At week 4, the median percentage wound area of change from baseline was -47.9% (p<0.0001). Satisfactory clinical progression at 4 weeks was reported for 61 wounds (55.96%).

Conclusion: The next-generation advanced multi-layered foam dressings* were shown to be safe and effective in the management of hard-to-heal wounds.

*ConvaFoam™ Silicone, ConvaFoam™ Border and ConvaFoam™ Non-adhesive 

 

EP0217 The use of collagen matrix in chronic wound healing

Anna Hepa-Banasik¹, Magdalena Szatan¹, Anna Słaboń^1
1Dr Stanislaw Sakiel Centre for Burn Treatment in Siemianowice Slaskie, Poland, Siemianowice Slaskie, Poland

Aim: The study aimed to evaluate the effectiveness of collagen dressings in the outpatient treatment of chronic wounds, such as trophic ulcers, diabetic wounds, pressure sores, and traumatic injuries. The goal was to assess how the dressing supports tissue regeneration, accelerates healing, and reduces the risk of complications compared to traditional methods.

Method: The study included 29 patients (11 women and 18 men) with 32 chronic wounds. It began on 21 May 2024 and is ongoing. Collagen dressings were applied 1 to 2 times per week, with secondary dressings selected based on the clinical condition of the wound. Each visit involved wound cleansing, antiseptic application, and planimetric measurement. Microcirculation was also evaluated using the LASCA technique.

Results / Discussion: The use of the collagen dressing significantly improved wound healing, reduced wound size, and accelerated tissue regeneration. Patients experienced reduced exudate and a lower risk of infection. LASCA-based microcirculation results confirmed improved tissue perfusion, directly contributing to the healing process. In many cases, wounds unresponsive to other treatments began to heal after applying the collagen dressing. Treatment-related costs, including outpatient visit frequency, were reduced. To date, six patients achieved 100% wound closure, and the remaining patients are currently continuing treatment in outpatient nursing care.
Conclusion: The collagen dressing proved to be an effective tool in treating chronic wounds, contributing to faster healing and improved tissue microperfusion. The dressing also reduced infection risk and exudate, enhancing patient comfort and accelerating recovery. This dressing may serve as a valuable addition to chronic wound therapy in daily clinical practice. The collagen dressing notably accelerated tissue regeneration and reduced healing time.

 

EP0218 Metal release and antibacterial effectiveness of nine wound dressings against pseudomonas aeruginosa and staphylococcus aureus

Denys Bondar¹, Heiki Vija², Olesja Bondarenko¹, Anna-Liisa Kubo¹, Grigory Vasiliev^1
1Nanordica Medical OÜ, Tallinn, Estonia, ²National Institute of Chemical Physics and Biophysics, Tallinn, Estonia

Aim: This study aimed to compare the effectiveness of 9 antibacterial wound dressings with copper and/or silver against Pseudomonas aeruginosa and Staphylococcus aureus. In addition, we measured Cu and Ag release from these wound dressings, since high Ag concentrations may have adverse effect on skin cells and delay wound healing.

Method: Antibacterial dressings were inoculated with P. aeruginosa and S. aureus (1×10^7 CFU/mL) and incubated for seven days, inoculation has been repeated every day. Afterwards, the dressings were washed in PBS, washing solution was grown on LB agar, and CFUs were determined. For metal release, 2x2 cm dressing samples were incubated in LB at 37°C for 24 hours, followed by dilution and analysis using Atomic Absorption Spectroscopy to quantify Ag and Cu.

Results / Discussion: Three wound dressings completely inactivated (>7 log reduction) both bacteria: Nanordica copper-silver wound dressing, Acticoat Flex 3 and Aquacel Ag+ Extra. The Ag release from wound dressings was 0.17, 4.5 and 2.4 mg/100cm2, respectively. Thus, Nanordica wound dressing with copper and silver had the most potent antibacterial effect at very low Ag concentration. In contrast, copper-based wound dressing had very weak (1.5 log reduction) antibacterial properties.

Conclusion: The Nanordica copper-silver wound dressing provides effective antimicrobial action against common wound pathogens with low Ag and Cu release. This suggests its potential for safe, prolonged wound management with minimal environmental and biological impact, marking it as a promising alternative in wound care.

 

EP0219 Prevention and resurrection of infected skin graft with dialkylcarbomoyl chloride (DACC)-coated dressings

Müge Sert¹, alperen pala¹, Gaye Filinte^1
1University of Health Sciences Hamidiye Medical Faculty Kartal Dr.Lütfi Kırdar City Hospital, Istanbul, Turkey

Aim: DACC coated dressing is a type of dressing that mechanically removes bacteria and fungi with each dressing change by irreversibly adhering them into dressing. Infection is the second most common cause of skin graft failure. Therefore, we wanted to manage infection in skin grafts by intervening with DACC coated dressings.

Method: 14 patients with infection symptoms on grafted wound site after 3 days of skin grafting were divided randomly into two groups. We used DACC coated dressing in the first group (n=7) and chlorhexidine impregnated gauze in the control group (n=7). On the 7th day, graft viability was assessed and categorized as fully viable (70-100%), semi-viable (30-70%), or non-viable (0-30%) in each group. Patients with systemic infection were excluded.

Results / Discussion: In the patient group with DACC coated dressing only 1 graft failure, 1 semi viable graft and 5 total viable graft was observed. In the control group 1 grafted area was semi viable and 6 of them was non viable. The chlorhexidine gauze required daily changes, whereas the DACC-coated dressing was changed twice weekly. Local infection signs was still present in the control group. The cost was similar in both groups however patient comfort was much higher in DACC coated dressing group due to the decreased number dressing changes.

Conclusion: DACC coated dressing is a remarkable option on managing colonized and infected skin grafts by mechanically decreasing bacterial load thus decreasing the chance of graft failure.

Figure 1. Application of DACC coated dressing on grafted areas

 

EP0220 Effectively managing exudate from hard to heal venous leg ulcers using hydroconductive dressing

Harikrishna K.R. Nair¹, M.Vadivelu Muniandi^2
1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, ²Hospital Tuanku Ja’afar, seremban, Malaysia

Aim: To evaluate the efficacy of Hydroconductive Dressings in managing highly exudative chronic venous leg ulcers.

Method: We recruited 8 patients with chronic hard-to-heal venous leg ulcers, that underwent following treatment regimen:

1) Wound cleansing followed by debridement

2) Application of barrier cream around peri-wound skin

3) Application of antimicrobial primary dressing material

4) Hydroconductive dressing as secondary absorbent dressing

5) Application of Gamgee/Compression bandage

The dressing was changed every 3-5 days, depending on the patients’ logistics and wound exudate level.

Results / Discussion: 2 patients had complete wound closure at day 43 and 51 respectively, while 3 patients had more than 50% wound size reduction (58.3%, 79.7%, and 96.2%) in less than 8 weeks. The average wound size reduction in this study was 68.9% in 8 weeks duration. All the patients achieved good exudate control with minimal exudate at the end of the study period.

Conclusion: Effective exudate management is essential in handling hard-to-heal chronic venous leg ulcers and appropriate exudate management will accelerate wound healing. The hydroconductive dressing material has been shown to effectively improve the rate of wound healing due to its ability to transfer excessive wound exudate away from the wound bed while retaining its integrity when moist, thereby assisting to maintain appropriate wound moisture balance and improve healing outcomes.

 

EP0221 Retrospective analysis of wound management and pressure injury prevention performance outcomes from using a non-adhesive foam dressing as part of an integrated care bundle

Catherine McCarthy¹, Sophie Berry¹, Julie Murdoch¹, Theresa Hurd^2
1Smith and Nephew, Hull, United Kingdom, ²Nursing Practise Solutions, Buffalo, Canada

Aim: Integrated care bundles (ICBs) are interventions that used together synergistically improve wound care outcomes. Patients with fragile and/or sensitive skin, may require use of low or non-adherent dressings to help reduce the risk of damage. This study assessed wound management outcomes and impact on pressure injury (PI) prevention protocols using a non-adhesive foam dressing as part of an ICB.

Method: A comprehensive wound care program using ICBs was implemented at two large healthcare organizations in Ontario, Canada in December 2015, and its progress was tracked until March 2018. Anonymized patient data were analyzed retrospectively.

Results / Discussion: 4,421 patients with chronic wounds received an ICB including a non-adhesive foam dressing; 2,242 patients did not receive an ICB. With use of the ICB including a non-adhesive foam dressing versus no ICB: mean time to healing was shorter (12.7 vs 25.5 weeks), mean time between dressing changes was longer (3.1 vs 1.9 days), and mean Bates-Jensen Wound Assessment Tool (BWAT) Score was lower (27.4 vs 33.2) at end of treatment. Mean labour costs were lower with use of the ICB including a non-adhesive foam dressing (CAD 1,766 vs 6,488; p<0.05). 466 patients received the ICB including a non-adhesive foam dressing for PI prevention and 98.4% achieved treatment goal at discharge. No adverse events related to the non-adhesive foam dressing were reported.

Conclusion: Use of an ICB incorporating this non-adhesive foam dressing improved wound management outcomes and reduced mean labour costs compared with not using an ICB.

 

EP0222 The potential of bacterial cellulose dressings in chronic wound care: insights from clinical studies and case series

Paul Zahel^{1 2}, Dana Kralisch^{1 3}, Thomas Eberlein⁴, Uwe Beekmann^1
1JeNaCell - An Evonik Company, D-07745, Jena, Germany, ²Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, University of Jena, D-07743, Jena, Germany, ³Evonik Operations GmbH, D-45128, Essen, Germany, ⁴Akademie-ZWM AG, 8424, Embrach, Switzerland

Aim: This study evaluates the effectiveness of Bacterial Cellulose (BC) dressings in chronic wound management, focusing on their unique properties and clinical outcomes, with a highlight on their application in complex and special cases.

Method: A case series involving 40 patients treated with a bacterial cellulose hydroactive dressing* was conducted to explore BC dressing efficacy and gain insights into various complex clinical situations. Additionally, a comprehensive review of clinical studies was conducted, including seven randomized controlled trials (RCTs) and eight observational studies.

Results / Discussion: The case series highlighted effective wound cleansing, rapid granulation and successful wound closure, even in complex cases such as pressure ulcers stage IV [1], stagnating ulcers [2], sinus pilonidalis [3], or exposed structures [4]. Notably, BC dressings further facilitated healing in non-adherent skin grafts. With regard to the literature, BC dressings demonstrated significant benefits in maintaining a moist wound environment, enhancing autolytic debridement, and reducing healing times [5]. These earlier findings were confirmed by the outcome of the case series.

Conclusion: BC dressings show substantial promise in chronic wound management, offering effective wound cleansing and promoting healing. Notably, they have demonstrated success in managing complex cases by facilitating efficient wound bed preparation, rapid granulation and reducing healing times.

*epicite^® balance

References:

1. Kruschwitz, S., ProVita Wundmanagement, 28 (2) 2024
2. Von Hallern et al., MEDIZIN & PRAXIS, 9 (15), 2024
3. Bertram, C., ProVita Wundmanagement, 29 (4) 2024
4. Eberlein, T., Report: Clinical Application Study of epicite^® within the Measures of PMCF, 2024
5. Zahel et al., Pharmaceuticals, 15 (6) 2022

 

EP0223 Utility of hydrogen sulfide in diabetic and non-diabetic wound healing: a systematic review and evidence synthesis

Costanza Pregnolato^{1 2}, Hana Nasir², Shengyu Zhou^{1 2}, Tony Lockett^{1 2}, Alex Dyson^{1 2 3
1}Centre for Pharmaceutical Medicine Research, Kings College London, London, United Kingdom, ²Institute of Pharmaceutical Science, Kings College London, London, United Kingdom, ³Division of Medicine, University College London, London, United Kingdom

Aim: Diabetes mellitus commonly results in chronic wounds that impose a considerable economic and healthcare burden. Exogenous sulfide administration has demonstrated efficacy in numerous non-clinical wound healing models; however, it is yet to be trialled clinically. To better understand this lack of translation, we performed a systematic review of non-clinical studies of wound healing in diabetic and non-diabetic states.

Method: A literature search was conducted with two concepts; “HYDROGEN SULFIDE” and “WOUND HEALING”. 499 studies identified were triaged to 24 (12 diabetic and 12 non-diabetic), following screening for duplication and eligibility using a Population, Intervention, Comparison, Outcome (PICO) analysis framework. Evidence synthesis constituted extracting data from prospective, binary questions, with significant deviation (p<0.05) from the null hypothesis addressed by Chi-squared (χ2) testing.

Results / Discussion: Sulfide application was unanimously effective in all studies, demonstrated using appropriate functional or biochemical outcome measures. In non-diabetic wound healing, sulfide was applied locally and frequently administered using an advanced delivery system. By contrast, in the diabetic studies, sulfide delivery varied (local or systemic), and advanced delivery systems were under-utilised. Sulfide release testing in vivo was only performed in 8% of studies overall.

Conclusion: Our systematic review highlights the promise of sulfide in wound healing but also reveals key challenges for clinical translation. Effective sulfide delivery remains difficult, with questions around optimal exposure timing, dosage, and patient targeting. Addressing these challenges requires accurate in vitro sulfide release testing, alongside in vivo monitoring of sulfide levels and pharmacodynamic effects, to enable precise dose adjustments and improve the potential for successful clinical outcomes.

 

EP0224 Effectively managing exudate from hard to heal venous leg ulcers using hydroconductive dressing

Harikrishna K.R. Nair^{1 1}, M.Vadivelu Muniandi^2
1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, ²Hospital Tuanku Ja’afar Seremban, Seremban, Malaysia

Aim: To evaluate the efficacy of Hydroconductive Dressings in managing highly exudative chronic venous leg ulcers.

Method: We recruited 8 patients with chronic hard-to-heal venous leg ulcers, that underwent following treatment regimen:

1) Wound cleansing followed by debridement

2) Application of barrier cream around peri-wound skin

3) Application of antimicrobial primary dressing material

4) Hydroconductive dressing as secondary absorbent dressing

5) Application of Gamgee/Compression bandage

The dressing was changed every 3-5 days, depending on the patients’ logistics and wound exudate level.

Results / Discussion: 2 patients had complete wound closure at day 43 and 51 respectively, while 3 patients had more than 50% wound size reduction (58.3%, 79.7%, and 96.2%) in less than 8 weeks. The average wound size reduction in this study was 68.9% in 8 weeks duration. All the patients achieved good exudate control with minimal exudate at the end of the study period.

Conclusion: Effective exudate management is essential in handling hard-to-heal chronic venous leg ulcers and appropriate exudate management will accelerate wound healing. The hydroconductive dressing material has been shown to effectively improve the rate of wound healing due to its ability to transfer excessive wound exudate away from the wound bed while retaining its integrity when moist, thereby assisting to maintain appropriate wound moisture balance and improve healing outcomes.

 

EP0225 Sustainable smart-release wound dressings loaded with green tea extracts for diabetic wound healing: boosting stability and bioavailability

Syeda Attiqa Tajammal¹, Austin Coffey², Shiau Pin Tan Graece^3
1South East Technological University (SETU), Technological University of Shannon (TUS), Waterford, Ireland, ²Technological University of shannon (TUS), Athlone, Ireland, ³South East Technological University (SETU), Waterford, Ireland

Aim: The study aims to incorporate bioactive substances from green tea having antimicrobial potential into nanosystems followed by their incorporation into sustainable smart-release wound dressings to enhance their stability, bioavailability, and permeability to provide better wound care products specifically for chronic wounds such as for diabetic patients.

Method: The Green Tea Extract (GTE) was extracted using the heat reflux extraction technique and encapsulated into phytosomes, using phosphatidylcholine as lipid carrier through the thin film hydration technique. The encapsulation efficiency (EE) was calculated by High performance Liquid Chromatography (HPLC) analysis. The physicochemical characterisation, including size, zeta potential, physical stability, release profile, and Fourier transform infrared (FTIR) analysis, were performed. Antimicrobial potential was evaluated against numerous wound-associated pathogenic and non-pathogenic strains. Phytosome-loaded sodium alginate dressings cross-linked with calcium chloride at different concentrations were prepared.

Results / Discussion: The EE of GTE in phytosomes was 69.9±2.35%. FTIR analysis confirmed the physical interactions between –OH and phospholipid phosphate group of tea-polyphenols and phosphatidylcholine respectively. The average particle size of phytosomes was 198.6±0.35 nm, with a zeta potential of -18.23 mV, and showed stability confirmed by repeated size measurements for 3 months and slow-release for 7 days. Antimicrobial studies showed significant inhibition zones against pathogenic and non-pathogenic strains as compared to free GTE. Sodium alginate dressings at 2.5% calcium chloride maintained shape and texture.

Conclusion: Green tea phytosomes with antimicrobial potential have been successfully integrated into wound dressing, though further optimisation is needed for smart release capabilities. Additionally, cytotoxicity studies are essential to confirm the dressings are non-toxic and would have wound healing properties, potentially advancing wound care innovation.

Key words: Green tea extracts (GTE), Phytosomes, antimicrobial potential, wound dressings

 

EP0226 A unique permanent hydrophilic coating for wound dressings that prevents bacteria forming biofilm

Graeme Brookes¹, Per Wirsen¹, Ana Romero¹, Linda Bergstrom¹, Serhiy Surkov¹, Jan Tejbrant¹, Åsa Wang¹, Narmin Asadli¹, Elena Dhamo¹, Henrik Larsson^2
1CytaCoat AB, Stockholm, Sweden, ²Absorbest AB, Kisa, Sweden

Aim: Wound infections caused by bacterial biofilm impede the healing of 60% of chronic wounds, costing healthcare systems billions each year. Conventional antimicrobial dressings employ a ‘kill’ technique and are not proven to effectively prevent biofilm. They release silver or other anti-microbials, depleting after a short time and promoting antimicrobial resistance (AMR). A unique, “no-kill”, performance-enhancing coating technology for wound dressings will be presented. This coating continually prevents bacteria from being triggered into biofilm-forming mode and reduces their virulence.

Method: A novel, simple and cost-effective UV-activated polymerization process has been invented to covalently bond a permanent hydrophilic coating, featuring a proprietary anti-biofilm ligand. The coating performance characteristics can be optimized and tuned for a wide range of different wound dressing materials.

Results / Discussion: The coating kept the wound dressing surface clean and prevented biofilm formation without releasing any substances. Unlike non-coated surfaces, bacteria were reluctant to enter biofilm mode and remained in a planktonic state on the coated surface (Figure). In addition to preventing biofilm, the hydrophilic properties of the coating also improved fluid transport into the absorbent core of the wound dressing.

Conclusion: The coating effectively prevents biofilm formation by both Gram-negative and Gram-positive bacteria without killing or releasing cytotoxic substances. It is biocompatible and does not promote antimicrobial resistance. This coating technology is now being applied to superabsorbent wound dressings*. This first wound care product will feature additional performance benefits, such as improved fluid transport and atraumatic removal.

*CytaCoat AB and Absorbest AB

 

EP0227 Development of silver nanoparticle-incorporated triple-layered nanofibrous dressing for chronic wounds

Shailesh Dugam¹, Prajakta  Dandekar¹, Ratnesh Jain^1
1Institute of Chemical Technology, Mumbai, Mumbai, India

Aim: This investigation aimed to develop a triple-layered nanofibrous wound healing dressing; as a more economical and safe intervention for more efficient healing of chronic wounds.

Method: Electrospun polymeric nanofibrous bandages were fabricated using the layer-by-layer approach over a hydrophilic polymer. The middle layer of cellulose acetate was loaded with silver nanoparticles as an antibacterial agent while the lowermost layer was formulated using hydrophobic polycaprolactone. Morphological analysis of the electrospun nanofibers was conducted using field emission electron microscopy. The release of silver nanoparticles from the bandages was studied using inductive coupled plasma spectroscopy. The fabricated bandages were also investigated for physicochemical properties like in-vitro degradation, water swelling characteristics, porosity, mechanical strength, etc. Further, the bandages were evaluated for their anti-microbial efficacy and cytotoxicity towards skin cells. The contraction and histological studies of the wounds treated with the triple-layered bandages indicated their healing efficacy in Sprague Dawley rats

Results / Discussion: The fabricated tripe-layered nanofibrous bandages exhibited a smooth, uniform, and bead-free morphology, with the nanofiber diameter ranging between 200-400 nm. The fabricated nanofibers demonstrated excellent wettability, slow in vitro degradation, controlled drug release, and potent antibacterial against Gram-negative and Gram-positive bacteria. The fabricated bandages had excellent mechanical strength upto 12.72 ±0.790 M. Pa, which was suitable for biomedical and tissue engineering applications. The bandages demonstrated excellent in vitro hemocompatibility and biocompatibility. In-vivo, excisional wound contraction and H&E staining confirmed the nanofibrous bandages’ potential in full-thickness wound healing.

Conclusion: The fabricated triple-layered polymeric nanoengineered bandages, loaded with nano-therapeutic silver, exhibited promise as a multi-functional wound-healing intervention and may be further evaluated in clinical settings.

 

EP0228 The role of collagenases from Vibrio Alginolyticus and hyaluronic acid in ischemic pressure injuries

Pierluigi Gallo^1
1Mavi Center, San Sebastiano Al Vesuvio, Italy

Aim: Pressure ischemic lesions pose a significant clinical challenge, characterized by tissue damage due to prolonged pressure. Vibrio Alginolyticus Collagenases and hyaluronic acid (HA) are emerging therapeutic agents that may enhance the healing of these lesions.

Method: A literature review was conducted to analyze the efficacy of Vibrio Alginolyticus collagenases and HA in the treatment of pressure ischemic lesions. Between September 2023 and September 2024, we treated about 60 cases of ischemic skin lesions ointment applications twice daily until ischemic signs persisted, also incorporating active mobilizations, diet management, and use of appropriate devices according to the patient’s risk. We evaluated parameters such as healing rates, wound size reduction, and patients’ quality of life.

Results / Discussion: Collagenases from non-pathogenic Vibrio Alginolyticus facilitate degradation of damaged collagen, contributing to wound bed preparation. HA, with its moisturizing and anti-inflammatory properties, promotes cell proliferation and neoangiogenesis. This promotes tissue regeneration and improves the wound microenvironment. The combined use of these agents demonstrated synergistic effects, accelerating the healing process and improving clinical outcomes. We monitored the patients over the necessary duration to assess the effectiveness of enzymatic debridement during this phase of skin lesions, where treatment options are typically uncertain and no established procedured local therapy exists.

Conclusion: The use of collagenase from Vibrio Alginolyticus and Hyaluronic Acid represents a novel approach in the treatment of ischemic pressure ulcers. While the results are promising, further research is needed to confirm the efficacy of these treatments and establish standardized therapeutic guidelines.

 

EP0229 Pressure injuries and dressings used in intensive care patients

Marilia Valenca¹, Miriane Virlane da Silva¹, Jabiael Carneiro da Silva Filho¹, Isabel Cristina Santos¹, Marcela Klyviann Bezerra de Vasconcelos^1
1University of Pernambuco, Recife, Brazil

Aim: To describe the occurrence of Pressure Injuries in patients admitted to Intensive Care Units and the main dressings used for prevention and treatment.

Method: This is a descriptive, cross-sectional study with a quantitative approach, carried out based on the analysis of 119 patient records and nursing documents, in 3 General Intensive Care Units, which were transcribed into the collection instrument subdivided into three parts, the first with sociodemographic identification questions, the second with clinical data and the last with regard to the dressings used for the prevention and treatment of Pressure Injuries. The data were entered into a Microsoft Excel 2019 spreadsheet and analyzed with the help of the statistical package “Statistical Package for the Social Sciences®”

Results / Discussion: The majority of the sample was male (64.9%), with a mean age of 43 years. The incidence of pressure injuries was 28.8%, most of which were in the sacral region (62.5%) and stage 2 (59.3%). The only dressing applied for prevention was the hydrocolloid plate (36.9%) and the most used therapy by the nursing team for treatment was Essential Fatty Acids (50%).

Conclusion: It was evident that the occurrence of Pressure Injury is still a reality that still affects critical patients. The dressing used for prevention was the hydrocolloid plate, while for treatment the most applied were Essential Fatty Acids and Collagenase.

 

EP0230 Is treatment variability dependent on wound aetiology and severity?

Diana Herrera-Valenzuela¹, Jose Manuel Rosendo Fernandez^2
1Gradiant, Vigo, Spain, ²Complejo Hospitalario Universitario de Pontevedra Área sanitaria Pontevedra-Salnés, Pontevedra, Spain

Aim: To quantify the treatment variability for each etiology and category of the wounds registered in the last year at a set of healthcare facilities.

Method: The wound registry of 2023 of a health area serving approximately 301.664 inhabitants was retrieved. Descriptive statistics for the frequency for each wound aetiology and category, and the number of different products that were used for each of them were computed.

Results / Discussion: In total, 5323 wounds were retrieved. Distribution of wound’s body locations are shown in Figure 1. Most of them were pressure wounds (Figure 2). Figures 3 and 4 summarize the frequency of each wound aetiology by classification level (bubble size) and the number of different products applied to each subgroup, for chronic and acute wounds respectively.

There is a pattern of more treatment variability with respect to higher wound frequency, as could be expected. There is no trend of increased treatment variability related to increased wound severity for any aetiology. Nonetheless, for all aetiologies in the highest category excluding pressure and surgical wounds, the number of different products used is larger than the number of wounds treated; these are as well more complex wounds with characteristics such as infection or abundant exudate, which require more treatment products to properly manage a wound. Interestingly, the same pattern is seen for arterial and diabetic foot wounds of categories 2º and 3º, and 3º moisture associated skin damage (MASD).

Conclusion: Descriptive statistics show higher treatment variability for arterial, diabetic foot wounds and MASD of categories above 1º.

Figure 1

EP0231 Improving the healing process with multifuntional polymeric membrane dressing

Veronica Sierra¹, Laura Baltà Domínguez¹, Sofia Megino Escobar¹, Conchi Lara¹, Yolanda Baños Lazaro², Valentina Osses González^2
1Institut Català de la Salut, Barcelona,Spain, ²Servicio Madrileño de Salud, Madrid, Spain

Aim: The primary goal in wound care is to achieve healing in the shortest possible time and without complications. The treatment chosen depends on the etiology of the injury, its evolution, and the individual needs of each person.

For a year, we have used Multifunctional Polymeric Membrane Dressings (MPMDs) on wounds of various etiologies, caused by different agents, and at different stages of the           healing process.

Method: Descriptive case study of MPMD use in Spain during 2023 and 2024.

Data collection was performed by healthcare professionals in primary care, hospitals, occupational health services, or podiatry centers, and subsequently evaluated by a wound care nurse expert.

We included 36 cases of various etiologies, ranging from venous ulcers to radiation dermatitis wounds. These were treated exclusively with MPMDs without any other concomitant products.

We monitored the size of the lesion until complete healing through photography and pain using the visual analog scale (VAS).

Results / Discussion: MPMDs have demonstrated their effectiveness in wound healing, reducing associated pain, positively impacting tissue mechanisms, and reducing the use of multiple products.

Conclusion: They are a good option for treating wounds of any etiology, by skilled nurses, caregivers, or even patients themselves, reducing the morbidity of lesions and improving patients’ quality of life.

 

EP0232 Results of an evaluation of an ozone lipozoid dressing on hard to heal wounds

Aharon Wanszelbaum¹, Marina Karasik^2
1Meuhedet Health Fund, Jerusalem, Israel, ²Meuhedet Health Fund, Jerusalem, Israel

Aim: to test the efficiency of an ozone lipoid dressing (OLD)on hard to heal wounds (HHW) OLD is due to disrupt slough and biofilm and therefore expecting to help wound healing.

Method: 20 patients with HHW failed to improve with standard of care and with given oral consent recruited

12 women 8 men – Age 54-99 (mean 76.8)

Etiology: venous:10 -diabetic:1 -pressure:1 -arterial:3 -Raynaud:1 -neuropathy:1

Evaluation of improvement scaled: 0(none) 1(mild) 2(moderate) 3(significant) 4(very significant) 5 (closure)

On basis of the wound getting cleaner and/or reducing.

Results / Discussion:

-dropouts: 5 because of unbearable pain all venous

3: poor compliance/understanding

-on 12 remaining:

0:1 (venous)

1:0

2:1(neuropathy)

3: 5 (venous:2-arterial:2 -Raynaud:1)

4: 5 (venous:3- diabetic:1 -arterial:1)

5:0

-10 out of 12: good outcomes (83%)

-5out of 20 could not bear their pain - all venous ulcer known for prone to pain

-no closure: was not the aim of the treatment which is slough/biofilm eradication

Conclusion: OLD has a good efficiency even when other treatments failed.

 

EP0233 Efficacy, tolerance, and acceptability of an innovative TLC dressing in local treatment

Jose Miguel Gallego¹, Mariapaz Beaskoetxea Gomez^2
1Laboratios URGO, Barcelona, Spain, ²Hospotal de Galdakao, Galdakao, Spain

Aim: To evaluate the efficacy, tolerance, and acceptability of a pure Lipido-Colloid Technology (TLC without a mesh of polyester) dressing in the treatment of acute wounds in a multicenter case series in Spain. This study addresses the need for advanced treatment options for acute wounds such as burns, abrasions, and surgical wounds, adapting to complicated anatomical locations and focusing on minimizing pain during dressing removal, optimizing healing time, and improving patient quality of life.

Methods: Forty patients with acute wounds of various etiologies including specifically the complex anatomical locations were included. Efficacy variables such as healing time and wound area reduction were assessed. Additionally, on a regular basis, dressing tolerance and acceptability parameters were studied based on feedback from healthcare professionals and patients, including ease of application and removal, dressing conformability and the documented clinical outcomes.

Results/Discussion: All patients showed very favorable progression of their wounds, with significant reduction in wound area and wound closure leading to wound healing and good dressing tolerance. Ease of removal and adaptability to different body areas were highly rated by both patients and healthcare professionals, minimizing pain and protecting healthy tissues.

Conclusion: The TLC dressing proved to be effective and well-tolerated in the management of acute wounds, showing favorable results in pain reduction and healing optimization. This study supports the use of the new 100% TLC dressing as a relevant option in the treatment of acute wounds, especially with hard to wear locations.

 

EP0235 Superabsorbent with cinnamon dressing in the management of complex surgical wounds

Viviana Gonçalves^1
1Centro Hospitalar e Universitário de São João, Porto, Portugal

Aim: Sternotomy dehiscence caused by a reaction to the sternum wires, are complex wounds that only close when the material is removed in surgery. The time between the appearance of the wound and surgery can be long, with the development of several complications, i.e., purulent exudate with bad odor, hypergranulation tissue and maceration of the periwound skin. The use of a superabsorbent dressing with cinnamon promotes effective odor control with effective exudate management, improving quality of life and the condition of the periwound skin.

Method: Use of a superabsorbent dressing with cinnamon to control odor and manage exudate in sternotomy dehiscence due to rejection of the sternum wires. Used in adult patients awaiting surgery, with effective management of perilesional skin and odor.

Results / Discussion: This treatment was carried out on 15 patients, who had waited more than 6 months for surgery, with total rejection of the sternum wires, with purulent exudate and needing treatment twice a week. They managed to keep the perilesional region intact, which allowed for more effective healing after surgery, in addition to allowing them to maintain their social life and consequently a better quality of life, through odor control.

Conclusion: This dressing material has a significant effect on patients with odorous wounds, as one of the biggest consequences is social isolation, which directly interferes with quality of life and consequently the progress of healing. It is important to promote the quality of life of these patients, so that after surgery, healing is not compromised.

 

EP0236 Pus plus: The positive pus effect of copper dressings

Dr. Eyal Melamed¹, Jihad Dabahh², Ithamar Cheyne^3
1Bnai Zion Medical Center, Haifa, Israel, ²Rambam Health Care Center, Haifa, Israel, ³Medical University of Warsaw, Warsaw, Poland

Aim: The presence of pus in wounds is viewed as a negative indicator suggesting infection, wound deterioration, and a need for surgical intervention and/or antibiotic treatment.

Copper is a potent antimicrobial agent, and can also induce angiogenesis, granulation tissue formation, autolytic debridement, and epithelization. Using copper dressings, we occasionally noticed pus at dressing changes but discovered that it was a positive stage in wound healing. We describe and analyze four such cases.

Method: All patients were diabetics, not hitherto treated with copper dressings: 1. Ischemic necrotic thigh muscles, after transfemoral amputation were replaced within two weeks with granulation tissue, and then thick pus was seen. 2. Necrotic tissues two weeks after knee open fracture treated with debridement and external fixator.  Five days of copper-dressing application resulted in pus formation. It was continued, and rapid filling with granulation tissue succeeded, allowing skin grafting. 3. Dehisced trans-tibial amputation stump with necrotic tissue was treated with deep copper threads. A thick yellowish discharge was seen initially. Healing with granulation tissue ensued. 4. Dehisced venous harvesting wound with mild necrosis. Copper dressing resulted in a yellowish-thick pus-like secretion, with a clean pink granulation tissue underneath.

Results / Discussion: The increased blood supply through angiogenesis and granulation tissue formation resulted in pus and increased wound healing (cases 1+2). Autolysis of necrotic tissue resulted in yellowish pus-like secretion (cases 3+4). These are signs of effective healing with copper dressing.

Conclusion: A debridement and healing response due to copper dressing can manifest with pseudo-pus, which is a result of liquefication of necrotic tissue, or true pus due to improved blood supply. In such “Pus-Plus” instances, the copper dressings should be continued.

 

EP0238 Utilization of an enzyme Alginogel^® in paediatric wound care: Clinical insights after 20+ years of experience

Eric Roovers^1
1Wound Care Clinic, Ziekenhuis Aan de Stroom (ZAS) Middelheim, Antwerp, Belgium

Aim: Paediatric wound care poses unique challenges due to fragile skin, communication barriers, and complex clinical scenarios. This case series reviews over 20 years of experience in managing high-risk paediatric wounds using a consistent treatment strategy, focusing on safety and efficacy.

Method: Six cases spanning neonates to adolescents illustrate the difficulties in high-risk wound management. These included staphylococcal scalded skin syndrome (6-day-old premature infant, 80% TBSA), impetigo bullosa (5-year-old patient), a post-operative abdominal wound (3-year-old patient with giant omphalocele), self-inflicted wounds (16-year-old patient), an extravasation injury (6-day-old premature infant), and a medical device pressure injury (12-year-old patient). Treatment consisted of daily or alternate-day dressing changes with an enzyme alginogel, supplemented by systemic antibiotics when necessary.

Results / Discussion: All cases achieved complete healing. Staphylococcal scalded skin syndrome resolved within 12 days with systemic antibiotics, safely managed in an incubator. Impetigo bullosa healed in 9 days with appropriate local and systemic care. The post-operative abdominal wound required over three months of treatment, demonstrating the safety of extended use. Extravasation (covering the entire foot) and a 9 cm² pressure injury healed within two weeks, with the latter incorporating preventive measures.

Conclusion: This case series highlights the importance of consistent treatment strategies in paediatric wound care, offering reassurance to clinicians, patients and families while promoting optimal outcomes in high-risk scenarios.

 

EP0154 Application of an enzyme alginogel^® in extensive wounds involving large surface areas: Indications, best practices, and clinical recommendations

Kris Bernaerts¹, Maryline  Vandeputte², Iris De Smet^2
1Wound Care Support Team, UZ Leuven, Leuven, Belgium, ²UZ Leuven, Leuven, Belgium

Aim: Large surface area wounds, including partial and full thickness burns, traumatic wounds, and soft tissue injuries may present with specific challenges, such as an increased infection risk, cytotoxicity of dressing material and quick and easy application procedures. Negative pressure wound therapy (NPWT) is a preferred option with extensive wounds, however alternatives may be required. The aim of this study is to present specific and challenging large area wounds and to demonstrate a safe and effective complementary solution in a case series.

Method: In this descriptive study, 6 specific large surface area wounds will be discussed. These wounds include two burn injuries, two deglovements and two soft tissue injuries. The TBSA of these wounds range between 10% and 60% and each presents with its specific challenges. An enzyme alginogel was selected as alternative for or complement to NPWT with the objective to stimulate granulation tissue in preparation for surgical closure or complete healing.

Results / Discussion: All 6 wounds – including TBSA wounds of 11%, 14%, 17%, 20%, 27% and 58% - healed within a time frame of 7 and 21 weeks. Patient-specific challenges, such as exposed bones and tendons, will be part of the detailed description.

Conclusion: Extensive wounds (TBSA > 10%) often present with specific challenges. Within this case descriptive study, 6 large area wounds of different aetiologies healed successfully using a complement to or alternative for NPWT.

 

EP0155 Adressing antimicrobial resistance in wound care: A call for careful stewardship and effective solutions

Sabine Raes¹, Elise Dehaes¹, Jeannine Spinnael¹, Kelly Ruysch^1
1Wound Care Clinic, UZ Brussels, Brussels, Belgium

Aim: Antimicrobial resistance (AMR) is a growing challenge in wound care, undermining treatment efficacy and increasing healthcare costs. Effective antimicrobial stewardship (AMS) is essential to optimize treatment and reduce unnecessary antimicrobial use, particularly for chronic wounds in aging and immunocompromised populations. This quality improvement project (QIP) assessed the implementation of the 7 EWMA AMS principles at the wound care clinic of University Hospital Brussels.

Methods: Over 20 weeks, AMS principles were integrated using baseline adherence assessments and education for the wound care team, patients, and caregivers. Emphasis was placed on hygiene and wound cleaning over disinfection. Interventions addressed challenges like managing infected wounds while minimizing antimicrobial prescriptions. Data were collected through questionnaires and clinical evaluations.

Results: Five of the seven AMS principles, led by nurses, were successfully implemented by the wound care consultant. These included promoting hygiene adherence, wound cleaning over disinfection, and supporting patient education. Challenges remained in reducing unnecessary prescriptions and supporting interdisciplinary collaboration. AMS-compliant care in three cases (burn, decubitus, and leg ulcer; mean age 67 years) achieved excellent outcomes: full granulation of a deep 2nd-degree burn in 13 days, 50% reduction in decubitus size in 7 days, and complete leg ulcer healing in 3 weeks. Results were achieved with an enzyme alginogel and daily wound care.

Conclusion: This QIP highlights the importance of AMS-focused education and patient empowerment in improving wound care outcomes. Enzyme alginogel is a promising adjunctive therapy, and further case analyses will enhance understanding of AMS efficacy in clinical settings.

 

EP0237 Sequential wound management of chronic wounds with polyabsorbent fibres dressing coated with technology lipido- colloid and silver, and then with sucrose octasulfate dressing: a case series

Emilio Galea^1
1Laboratoires Urgo, Chenove, France

Aim: Evaluate a sequential management of chronic wounds with a polyabsorbent dressing with silver, to manage infection and desloughing, followed by a technology lipido colloid dressing with nano-oligosaccharide factor (sucrose octasulfate) dressings, to enhance wound healing.

Method: Six clinicians, with vast experience in managing diabetic foot and other chronic wounds, provide the results achieved in 10 challenging cases.

Cases include:

1. 8-month-old diabetes-related ulcer (DRU) covering the medial and central forefoot plantar area of the right foot with suspected local signs of clinical infection
2. Recurring DRU on the posterior aspect of the right foot
3. Post toe amputation (2) and extensive debridement
4. Pressure injury over the right calcaneum, present for 5 months, which was not healing and increasing in size
5. 3-month-old DRU on the medial plantar area of the right foot
6. 8-month-old left hallux amputation non-healing DRU
7. 4-month-old DRU on the left hallux
8. 4-month-old infected stump wound following a below-knee amputation due to snake bite cellulitis
9. 2-month-old DRU on right foot dorsum and right lateral malleolus
10. 15-day-old DRU on the left second toe, plantar aspect, with suspicion of local infection

Results: All wounds showed rapid improvement after the sequential treatment with the two dressings.

Conclusion: The results achieved were satisfactory, with a rapid reduction of clinical signs of infection, slough, exudate and pain, and a rapid wound closure, with no adverse events reported. The sequential treatment may help to reduce morbidity and mortality in patients with infected DRU by resolving these wounds in a shorter period.

 

EP0240 A survey of European healthcare professionals’ experience on using a new and innovative non-bordered foam dressing in the management of different wound types

Matthew Malone¹, Alison Hedley¹, Ana Martins¹, Arianne Oberendorf¹, Joran Chancrin¹, Monique Rennie^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: A survey of healthcare professionals (HCP) was conducted to capture feedback on the usability and performance of a new and innovative non-bordered foam wound dressing* designed to minimize risk of leakage.

Method: HCPs were provided with a QR code to access a survey questionnaire (Qualtrics platform) over a 2-month period. Translations of the survey were provided in several languages. HCPs who had used the non-bordered foam dressing on at least two patients for a minimum of two weeks were eligible. They were asked 8 questions relating to the clinical performance of the dressing.

Results / Discussion: An interim analysis was undertaken of data from 180 HCPs from across 16 European countries who used the dressings on 785 patients. The dressing was most commonly used on venous leg ulcers (55%) and on wounds with high (47%) to moderate (40%) exudation. The dressing was rated highly in terms of:

• Ease of handling and application (92% extremely effective)
• Facilitating patient comfort during wear (98% effective)
• Managing exudate (96% effective)
• Minimizing leakage (93% effective)
• Minimizing maceration (95% effective)
• Minimizing pain during dressing changes (96% effective)
• Meeting the clinical needs when used under compression therapy (94% effective)
• Wear time (94% effective)

Conclusion: The interim results demonstrate positive trends in the clinical utility and performance of a new and innovative non-bordered foam dressing. These trends are further encouraging given that just under half of the wounds were categorized as having high exudate levels.

*Mepilex Up (Molnlycke Health Care)

 

 

EDUCATION

EP0178 The application of objective structured clinical examination based on immediate verbal feedback in the training and assessment pathway of international wound therapist

Yi Wang^1
1Beijing Jishuitan Hospital Affiliated to Capital Medical University, Beijing, China

Aim: To observe the application effect of objective structured clinical examination based on immediate verbal feedback in the training and assessment pathway of international wound therapist.

Method: Fifty-eight trainees who participated in the training and assessment of EWMA International Wound Therapist School, Beijing Jishuitan Hospital, Capital Medical University in 2022-2023 were selected as the study subjects, and the objective structured clinical examination based on immediate verbal feedback was applied to evaluate their practice level and test their training effect.

Results / Discussion: The average score of the trainees was 289. 80 ± 24. 39, with a pass rate of 100%. The difficulty coefficient of the assessment was 0.37-0.74, the differentiation degree was 0.08-0.43, and the assessment contents of the physical examination and evaluation site and the dressing change operation site needed to be further adjusted and improved. Both trainees and examiners thought that the examination format could reflect the overall effect of the course learning, and were satisfied with the content of the examination.

Conclusion: The objective structured clinical examination based on immediate verbal feedback can objectively reflect the students theoretical level and clinical operation skills, and provide reference for objectively evaluating the practice level of trainee wound therapist and testing the training effect.

 

EP0165 Podiatrists and diabetes footcare education survey Ireland

Ellen Kirwan¹, Tara Molyneaux^{1 2}, Caroline McIntosh^1
1University of Galway, Galway, Ireland, ²National Institute for Prevention and Cardiovascular Health, Galway, Ireland

Aim: This study aimed to investigate how podiatrists in Ireland provide diabetes footcare education to their patients. It aimed to discover what resources they provide patients with and whether they think there is a lack of podiatry specific structured patient education. Finally, it aimed to investigate whether there was an association with the podiatrists’ work setting and type of diabetes education provided. 

Method: The study employed a cross-sectional cohort design whereby Podiatrists in Ireland were invited to complete an online questionnaire using QuestionPro software. The survey was disseminated via email through the Irish governing body for podiatrists, Podiatry Ireland, to all members and was live on social media platforms X, Facebook and Instagram. SPSS version 27 statistical package was used to analyse data. Chi-square test was used to determine an association between the type of education provided and a podiatrist’s work setting. 

Results / Discussion: Findings included verbal education being most frequently used by Podiatrists in Ireland. It found that lifestyle factors such as diet, smoking status and physical activity were least frequently discussed. Many podiatrists thought that group education sessions, a more standardised approach and a National Campaign would aid in providing education. Finally, there was no significant association found between a podiatrists’ work setting and type of education they provided. 

Conclusion: This study discovered a variety of topics covered, a range of resources and methods used, and the qualitative data provided a clear insight into podiatrists in Ireland perceptions of diabetes footcare education. 

 

EP0632 Doctoral theses from Spain on skin integrity impairment

Javier Sánchez-Galvez^{1 2}, Monica Rodriguez Valiente^{2 3}, Francisco Mateo Ramírez⁴, Eva García VIzcaíno^{2 5}, Sergio Liarte Lastra^{2 5}, Daniel Fernández García⁶, Santiago Martínez Isasi^7
1Faculty of Nursing. UCAM Universidad Católica de Murcia., Cartagena, Spain, ²Research Group on Molecular and Cellular Biology Solutions in Regenerative Medicine, UCAM Universidad Católica de Murcia, Murcia, Spain, ³Department of General Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain, ⁴Universidad Internacional de La Rioja (UNIR), Cartagena, Spain, ⁵Faculty of Nursing. UCAM Universidad Católica de Murcia., Murcia, Spain, ⁶Departamento de Enfermería y Fisioterapia. Universidad de León, León, Spain, ⁷Facultad de Enfermería. Universidade de Santiago de Compostela. Santiago de Compostela, Santiago de Compostela, Spain

Aim: This study aims to evaluate the doctoral scientific output in Spain related to skin integrity impairment, focusing on the main research themes and the types of lesions studied.

Method: A descriptive, observational, and retrospective study was conducted. A search was performed in February 2023 in the Spanish Ministry of Universities’ Doctoral Thesis Database using the keywords “Ulcer,” “Wound,” “Diabetic foot,” “Ostomy,” “Burns,” and “Skin integrity impairment” in Spanish, Catalan, Galician, and English. The review covered doctoral theses published between the 1978/1979 and 2021/2022 academic years, with peer review applied for selection and data extraction based on eligibility criteria.

Results / Discussion: Out of 198 identified theses, 162 were included in the analysis. Of these, 79 were authored by physicians, 56 by nurses, and 27 by other disciplines. A significant proportion of the theses (54%) were completed between 2013-2014 and 2021-2022, indicating an increasing trend in recent years. The most frequently studied lesions were pressure ulcers (21.6%), surgical wounds (16.7%), and vascular ulcers (8.6%). Additional topics included biological treatments and in vitro models (12.3%), development of wound care products (9.9%), and studies focusing on management, quality evaluation, and training related to skin integrity impairment (5.5%).

Conclusion: The doctoral scientific production on skin integrity impairment in Spain has grown significantly, especially in recent years. However, there is still a need for more research focusing on management strategies, educational approaches, and quality assessment, as these areas remain underexplored. Expanding knowledge in these domains is essential to improve both clinical outcomes and professional training.

 

EP0166 AI takes the lead: Revolutionising wound care education in aged care and community settings

Frances Henshaw^{1 2 3
1}Smith And Nephew, Sydney, Australia, ²Western Sydney University, Sydney, Australia, ³Queensland University of Technology, Brisbane, Australia

Aim: Artificial Intelligence (AI) is transforming clinical education by providing personalised, adaptive learning methods (1,2). In healthcare, where knowledge retention and adherence to evidence-based guidelines are critical, AI addresses educational gaps by offering real-time, context-specific learning and immediate feedback (3).  AI also enhances cognitive engagement, fostering deeper knowledge capture and improved clinical reasoning (4).

This pilot project explored the use of a well-known AI-powered language model platform that generates human-like text responses, to educate registered nurses from aged care and community settings during a wound education seminar. The goal was to evaluate the platform’s effectiveness in helping nurses identify the characteristics of different wound types and pinpoint evidence-based guidelines.

Method: Working in groups, nurses posed questions about assigned wound types and received instant, evidence-based responses from the AI platform. Two PhD-qualified wound-experts moderated these responses for accuracy. Each group then presented the moderated information in a ‘flipped-classroom’ format. While the AI platform’s responses were generally accurate, some discrepancies were found, particularly in the selection of evidence-based guidelines, as noted by the moderators.

Results / Discussion: A significant increase in nurses’ confidence in wound knowledge was observed, 37% by pre/post survey (n=29). Participants reported that AI-based learning was engaging, accessible, and valuable for their clinical practice. However, it was clear that the immediate feedback provided by AI, sometimes lacked specificity, which could pose a problem for the unsupervised novice-learner.

Conclusion: This project demonstrates AI’s potential to reshape clinical education by offering flexible, personalised, and scalable learning solutions, with the potential to improve patient care outcomes.   

 

EP0167 Improving the quality of referrals utilising an education intervention in a rural foot protection team

Pauline  Wilson¹, Amber Coffey^2
1Health Service Executive, Dublin, Ireland, ²Health Service Executive, Kildare, Ireland

Aim: International guidelines recommend annual foot assessment for all patients with diabetes (Schaper et al 2023). In Ireland, there are clear guidelines for patients following such assessment by their health care professional (HCP) (Health Service Executive, 2021). Schoen et al (2016) highlighted that there is often limited knowledge among HCPs regarding this process (Thepwongsa et al, 2014). This project aimed to increase the quality of referrals to the foot protection team (FPT) by utilising a targeted educational intervention

Method: This mixed method assessment combined a 3-month audit of all referrals to the FPT. An educational intervention was targeted to those HCP’s sending low-quality referrals. Following this intervention, a further 3 month audit of referrals to the FPT was conducted. In addition, qualitative data was collected from those receiving the educational intervention.

Results / Discussion: During the initial audit, 76 referrals were received of which 72% (n=54) were low-quality. In the second stage and subsequent to the education intervention, this figure was 50% (n=27). The number of low quality referrals in those who received the education intervention reduced from 43% (n=32) to 14% (n=7).

The qualitative feedback showed 58% of HCP’s engaging in education had no prior formal training.

Conclusion: While low-quality referrals persist, the second audit revealed that only 14% were received from those who received the education intervention. These results suggest that similar to the work of Schoen et al (2016), HCP’s have a low level of knowledge in of diabetic foot screening and assessment which may be remediated by education.

 

EP0168 Bioengineering 3D wound simulations as tools in wound care training

Jessica Senior¹, Kayley Jaworska¹, Karen Ousey², Leanne Atkin¹, Samantha Holloway³, Alan Smith^1
1University Of Huddersfield, Huddersfield, United Kingdom, ²Omniamed Communications, London, United Kingdom, ³Cardiff University, Cardiff, United Kingdom

Aim: Wound care specialists are faced with limited resources that enable them to safely and effectively develop their debriding and wound management skills. Current training resources include citrus peels and cadavers, either exhibiting poor mechanical resemblance to wounds in live humans or lacking in supply, which subsequently causes a significant risk when translation to patients is inevitably mismatched. Our research aims to establish a multitude of true-to-life wound simulations with various aetiologies, allowing the practice of multiple wound management and debridement techniques, whilst also overcoming the mechanical, ethical and accessibility-related issues of other models.

Method: Collaboration between academic staff, materials scientists and tissue viability nurses has facilitated the creation of our initial prototype – a chronic wound simulation. Models were bioengineered using 3D printing and casting technology, generating multiple wound layers including healthy skin base in a range of skin tones, rough granulation tissue, removable slough, and debridable skin necrosis. The mechanical properties of the models were matched to those found in human wounds using 100% natural and sustainable biomaterials that are readily accessible.

Results / Discussion: From this, we have extended our portfolio, establishing a wound tear simulation, diabetic foot model with multiple ulcers, and incorporated other anatomical features including hair, fat and bone to enhance realism and further educate the user. We continue to successfully supply model units with multinational wound care companies, in addition to partners Accelerate Academy (UK), who deliver Society of Tissue Viability endorsed sharp debridement courses, with excellent feedback being given.

Conclusion: We envisage that our wound models will help contribute to a more skilled and confident wound care workforce in a cost-effective manner, ultimately leading to improved patient outcomes.

 

EP0169 Wound at rest - Why recovery time is impotant

Michaela Kaiser¹, Martin Berli^2
1Spital Limmattal, Schlieren, Switzerland, ²S, Schlieren, Switzerland

Aim: Education, know-how in wound management, theory of healing, case reports and our daily work are our basis for healing wounds and helping people return to daily routines in their lives. This valuable patient time during the healing process should be used, especially to determine recovery time.

Method: Patient contact – 3 Pillars

First Pillar patient: Clarify patient’s interests and their illness

Knowing physical, psychological, social and cognitive frailties.

Second Pillar expert: Provision of subsequent documentation, photos, so the patient follows the healing process, asks questions, gains important confidence for the future, even after setbacks.

Third Pillar patient and expert: Learning, becoming informed about therapy, establishing recovery time for the wound. Patients need to be able to realize what is happening, including good or bad feelings.

Results / Discussion: Using these three easy steps: 1) interest finding, 2) wound documentation, photos, 3) establishing time for wound at rest gives patients better understanding of connections with wound healing, their illness, the comorbidities and self-management after treatment.

Conclusion: Education, know-how by medical staff is insufficient. The patient’s potential needs analyzing and including in therapy. Wound at rest time can now be discussed, showing benefit to the wound. These three levels must be easily understood, and explained and motivate the patient, and also become an established concept for caregivers and experts.

 

EP0170 The exploration on the effectiveness of “thoughts and principles of diagnosis and treatment of chronic refractory wound in china”, a multi-center clinical study

Hong-Wei Liu¹, Wei Dong², Lanjun Nie³, Yaohua Zhao⁴, Yiwen Niu⁵, Duyin Jiang⁶, Yuan Lin⁷, Weiguang Xie⁸, Zhixue Wang⁹, Jinfeng Fu¹⁰, Yuangui Zhang¹¹, Donghai Shen¹², Ningzheng Tai¹³, Bin Wu¹⁴, Huaqiang Ge¹⁵, Yunmin Cai¹⁶, Lu Shuliang^5
1Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China, ²Department of Burns and Wound Healing, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China, Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China, Nanjing, China, ³Department of Burns and Wound Healing, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China, ⁴The Affiliated Jiangyin Hospital, Medical College of Southeast University, Jiangyin, China, ⁵Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China, ⁶Department of Burns and Plastic Surgery, Second Hospital of Shandong University, Jinan, China, ⁷Department of Burns and Plastic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China, ⁸Department of Burns and Plastic Surgery, The Nanjing General Hospital of People’s Liberation Army, Nanjing, China, ⁹Department of Burns and Plastic Surgery, Suzhou Municipal Hospital,, Suzhou, China, ¹⁰Department of Burns, Trauma and Plastic Surgery, Kunming Children’s Hospital, Kunming, Kunming, China, ¹¹Department of Burns and Plastic Surgery, The Affiliated Hospital of Xuzhou Medical University,, Xuzhou, China, ¹²Department of Surgery, Shanghai Yongci Rehabilitation Hospital,, Shanghai, China, ¹³Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China, ¹⁴Department of Burns and Plastic Surgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China, ¹⁵Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, ¹⁶Wound Healing Center, Jinshan Hospital of Fudan University, Shanghai, China

Aim: Patients with chronic refractory wounds has increased in China. Work hasn’t been well advanced. A multi-center study had been conducted to explore effectiveness of “Thoughts and principles of diagnosis and treatment of chronic refractory wound in China” (“T&P”).

Method: We adopted WoundCareLog-APP as research tool. More than 100 wound-care facilities participated. In first-phase, cases were uploaded through WoundCareLog-APP based on participants’ experience without communication with the Assessment Team Members (ATMs). During second-phase, participants can communicate with ATMs as counselling method to adjust strategy accordingly.

Results / Discussion: The wound-healing-treat-time was significantly decreased (1st vs 2nd Phase, 31.64±2.32 vs 23.22±3.27 Trauma; 35.55±3.02 vs 23.39±2.24 Infection; 43.87±4.82 vs 26.73±3.56 PU; 40.87±4.03 vs 29.61±3.78 Diabetes; 29.07±3.64 vs 15.08±2.87 Burns; 36.69±4.10 vs 24.94±2.86 PVD; P<0.05). Results show “good” and “reasonable” cases increased significantly (P<0.001), whereas “unreasonable” cases decreased significantly in second-phase (P<0.001). The sub-item case assessment show “good” and “reasonable” in second-phase were significantly increased (#1 to #11 items, P<0.001χ2 test). Instead, “unreasonable” cases were significantly decreased in second-phase (P<0.001 χ2 test).

Conclusion: By comparing the ET’s application of “T&P” counselling and non-counselling case groups, the study proved effectiveness of “ T&P” in diagnosis and treatment of wounds.

 

EP0171 Results of a educational campaign to improve the knowledge of referring providers related to the benefits of hyperbaric oxygen therapy on late radiation tissue injuries

Wiliam Tettelbach¹, Daniel Christopher^1
1RestorixHealth, Metairie, United States

Aim: The purpose of this analysis is to determine whether a nationwide educational campaign targeting radiation tissue injuries (LRTIs) could favorably impact patients’ access to hyperbaric oxygen (HBO₂) therapy.

Method: A twelve-month LRTI education campaign was initiated on October 1, 2023, and led by over 25 directors targeting local and regional oncology practitioners across North America. From October 2023 through September 2024 the total number of HBO₂ therapy treatment sessions organized by ICD 10 codes specifically correlating with patients treated for LRTIs was collected. The comparator group was collected before the education campaign from October 2022 through September 2023. Statistical significance was calculated using Chi-Square.

Results / Discussion: During the twelve months of the LRTI educational campaign, there was a statistically significant 12.1% increase in the number of HBO₂ therapy treatments targeting LRTIs when compared to the baseline twelve months before the start of the LRTI campaign through the educational intervention period.

Pre - LRTI Campaign (October 2022 – September 2023):

HBO₂ treatments radiation-related indications = 21,982

HBO₂ treatments all other indications = 70,236

Post - LRTI Campaign (October 2023 – September 2024):

HBO₂ treatments radiation-related indications = 23,288

HBO₂ treatments all other indications = 70,236

The chi-square statistic is 197.2904. The p-value is < 0.00001.
The chi-square statistic with Yates correction is 197.1376. The p-value is < 0.00001.

Significant at p < .05.

Conclusion: This real-world retrospective analysis suggests that patients suffering from LRTIs may never be offered HBO₂ therapy as a treatment option to alleviate their pain and suffering due to a lack of familiarity among referring providers with the benefits of hyperbaric medicine.  Further studies are warranted to corroborate these findings.

 

EP0172 From adoption to adaptation: A one-year follow-up on the usability, perception, and adoption of digital interactive clinical pathways among a portuguese national wound care society

Tania Santos¹, Lourdes Hidalgo², Katia Furtado³, Elaine Song⁴, Catherine T. Milne⁴, Tiffany Hamm⁴, Jeffrey Mize^4
1ULS Algarve, Albufeira, Portugal, ²ULS Coimbra, Coimbra, Portugal, ³ELCOS, Portalegre, Portugal, ⁴WoundReference, San Francisco, United States

Aim: Traditional paper-based pocket guides quickly become outdated. Having digital information readily available allows wound clinicians to overcome the challenges of staying current with ever-changing evidence-based practice recommendations.^1,2 A Portuguese national wound care society* transformed their printed pocket guide library into nineteen interactive digital guides featuring interactive clinical pathways, videos, checklists, and documentation templates and disseminated these among 100 Society members. This study evaluates the usability, satisfaction, and adoption one-year post-implementation.

Method: An evaluation form gathered feedback using four Likert scale and two open-end questions. This assessed usability (how easy and often the guides are used), perceived usefulness (how the guides aid in decision-making and promote best practices), and overall perception/satisfaction. Data on the frequency of pathway usage was collected independent of the evaluation form.

Results / Discussion: Of the 22 members who completed the evaluation, the most frequently accessed pathways were “Leg Ulcers,” “Wound Bed Preparation,” and “Infection Management.” Eighty percent of clinicians used the pathways 1-2 times monthly; 86% found them helpful in clinical decision-making; and all would recommend them to peers. Five percent reported difficulties in accessing the guides, prompting the Society to offer members case-based educational webinars illustrating how to use each digital guide at the point-of-care.

Conclusion: The digital pathways demonstrated high usability and satisfaction among members, streamlining information dissemination and updates. They offer the Society enhanced content management and distribution, enable in-depth data analysis, and facilitate the evaluation of interventions linked to improved real-world outcomes to standardize care, reduce healthcare costs, and enhance wound management outcomes.

 

EP0173 Design of a vademecum of products related to skin wound care: a way to improve variability in care

Raquel Valera Lloris^{1 2}, Andrea Peinado Vila³, Ana Belen Gonzalez Cuenca³, María Anastasio Belda³, Gabriel Jiménez Molina^3
1Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain, ²Universidad de Valencia, Valencia, Spain, ³Hospital Clínico Universitario de Valencia, Valencia, Spain

Aim: There is significant variability in care related to pressure injuries, partly due to the large number of materials available for wound management. The CATIC (Commission for Action and Care in the Prevention of Skin Integrity Deterioration) of the Clinico-Malvarrosa Health Department has initiated a working group focused on materials, with the first activity aimed at reaching a consensus on the selection of dressings for wound care, with the following objectives:

• Unify criteria and select the preferred products for pressure injury care.
• Design a vademecum for nurses in both primary and specialized care departments.
• Disseminate the vademecum to professionals in the department.

Method: A working group was created, consisting of 10 nurses from Primary and Specialized Care.

A schedule of bi-monthly meetings was established, starting from September 2023 to the present.

Out of 80 existing products, 43 essential products were selected, categorized by type: hydrocolloids, polymeric foams, antimicrobials, compression dressings, and skin protection.

The information required for each product was defined: maximum duration (expressed in days), exudate management, cutability, need for securing, indications (intact skin, granulation, erythema, moisture lesion, slough, necrotic tissue), description, size, price, and product image, using easily identifiable icons.

Results / Discussion: The design of the vademecum was completed in October 2024, with a poster format, one for the wound care cart, and a pocket-sized consultation edition.

Dissemination will take place in December 2024.

Conclusion:

• It is expected to contribute to the unification of criteria.
• The vademecum is a useful reference document.
• Dissemination is a fundamental aspect for the proper implementation of established criteria.

 

EP0174 Recommendations for chronic wound care in hospital wards

Tea Stiplosek¹, Marija Kohek^1
1General hospital Murska Sobota, Murska Sobota, Slovenia

Aim: Nurses often face challenges in caring for patients with chronic wounds due to a lack of specific knowledge. Additionally, an analysis of the hospital’s annual expenditure on wound dressings revealed that these costs are consistently rising. For this reason, we decided to develop recommendations for chronic wound care in hospital wards. These recommendations aim to simplify daily work by being professionally accurate and user-friendly.

Method: We examined international and national guidelines for chronic wound care and the technical specifications of products available in our hospital. Based on this knowledge, we prepared recommendations for chronic wound care.

Results / Discussion: Our recommendations are divided into three sections:

The first section focuses on wound assessment, as it is essential to evaluate the wound’s condition with each dressing change, given that this assessment determines the appropriate dressing choice. The wound is evaluated based on the condition of the wound bed, the wound depth, and the amount of exudate.

The second section provides recommendations for selecting a dressing, advising users on the most appropriate dressing based on the assessed wound condition. For each wound condition, there are two types of dressings available, allowing for a selection that best suits the individual patient.

The third section includes visual examples of wounds to assist nurses in making more accurate wound assessments.

Conclusion: We hope that the use of these recommendations will improve the selection and application of dressings in our hospital, contribute to more consistent and effective chronic wound care, and simplify the work of healthcare workers.

 

EP0175 Do knowledge levels in skin tear management change following a conference lecture? A pre-post study at the Norwegian orthopaedic nurse congress

Ida Marie Bredesen^{1 2}, Martine Enger^{1 3}, Dimitri Beeckman^{4 5}, Carina Bååth^{6 7}, Vigdis Grondahl⁷, Edda Aslaug Johansen^{8 9
1}Oslo University Hospital, Oslo, Norway, ²University of South-Eastern Norway, Drammen, Norway, ³University of Oslo, Oslo, Norway, ⁴Örebro University, Örebro, Sweden, ⁵Ghent University, Ghent, Belgium, ⁶Karlstad University, Karlstad, Sweden, ⁷Østfold University College, Halden, Norway, ⁸Vestre Viken Hospital Trust, Drammen, Norway, ⁹University of South-Eastern Norway, Borre, Norway

Aim: To assess changes in knowledge regarding skin tear (ST) management before and after a conference lecture.

Method: This pre-post study utilized the Norwegian version of a 20-items multiple-choice assessment tool for ST knowledge, known as OASES, with a scoring range from 0 (lowest) to 20 (highest). Attendees at a Norwegian Orthopaedic Nurse Conference (N = 125) was invited to complete the OASES questionnaire anonymously prior to the conference. The conference featured a lecture that presented the latest evidence on the diagnosis, prevention, and treatment of STs. Immediately following the lecture, participants were invited to complete a post-test to compare pre- and post-intervention results. Descriptive statistics (mean (SD), percentage), chi-square tests, and t-tests were conducted.

Results / Discussion: The pretest sample (N = 30) yielded an average OASES score of 10.50 (SD 2.9). These results are consistent with findings from previous studies. In contrast, the posttest sample (N = 27) achieved a mean score of 16.85 (SD 2.0). This reflects an approximate 60% increase in total knowledge, which was statistically significant (p < 0.01). Few studies have examined pre-post results using the OASES instrument.

Limitations: Due to the anonymous nature of the assessments, it is possible that different participants completed the pretest and posttest, rendering individual-level comparisons unfeasible. Furthermore, the small sample size necessitates caution in the interpretation of the results.

Conclusion: A lecture highlighting the latest evidence on the diagnosis, prevention, and treatment of STs significantly enhanced the knowledge levels of the conference participants.

 

EP0176 The Impact of a standardised, evidence based patient education program on lower limb self care and prevention of recurrence of venous ulceration

Maree Healy¹, Mary Costello^2
1Midland Regional Hospital Tullamore, Tullamore, Ireland, ²Laois Offaly Public Health Nursing Service, Mountmellick, Ireland

Aim: To explore the impact of a standardised and evidence based education program, in a population of patients post healed venous leg ulceration, on self care practices and its resulting effect on venous ulceration recurrence.

Method: A sample size of 60 patients were examined using a quantitative approach to measure the following;

• the level of difficulty experienced in 3 aspects of self care, namely skin care, exercise and compression hosiery, using a likert scale, pre and 6 weeks post the education session
• Venous ulceration recurrence 1 year post education session
• the patients knowledge of lower limb self care using a pre and 6 weeks post questionnaire

Results / Discussion: Results indicated a significant increase in participants’ understanding of the benefits of all aspects of self care including improved confidence in applying and wearing the hosiery. Furthermore, the patients voiced reducing feelings of isolation often associated with chronic disease management.

A 72% incidence of venous ulceration recurrence was indicated by a retrospective review of patient records, prior to the education program. Current results have shown only a 10% recurrence rate of VLU.  The pre/post questionnaire highlights a deficit of knowledge and understanding of the term ‘circulation’ by the patient population. The likert scale of difficulty completing the 3 aspects of lower limb care has improved by 100% in all cases.

Conclusion: Effective patient education is crucial for individuals transitioning from healed leg ulcers to self maintenance in all aspects of care, which plays a vital role in preventing ulcer recurrence.

 

EP0177 Enhancing communication and wound care: A qualitative analysis of specialist nurses experiences with the timers tool at the hospital fair

Camila Safranski¹, Dioney Neves^1
1Missner, Blumenau, Brazil

Aim: The article qualitatively analyzes the experience of specialist nurses with the TIMERS tool during the Hospital Fair, one of the largest health events in Latin America. The goal is to assess the tool’s effectiveness in communication and wound treatment, as well as the impact of the immersive experience promoted during the event.

Method: The methodology included recruiting specialist nurses based on their experience and expertise. Data collection was conducted through interviews and questionnaires, which were qualitatively analyzed to identify common themes and insights regarding the experience with the TIMERS tool. Additionally, the Missner company team provided feedback on the impact of the action on client prospecting and brand promotion.

Results / Discussion: The results showed that the immersive experience was well received by the nurses, who highlighted the opportunity to share knowledge and the effectiveness of the interactive approach. The action was considered a positive differential, contributing to the education of participants and promoting the company’s products. However, challenges such as limited presentation time and available space were identified, along with suggestions for improvements in future editions. The experience proved effective in promoting engagement among health professionals, enhancing understanding and clinical application of the TIMERS tool.

Conclusion: The integration of tools like TIMERS in interactive environments contributes to improved clinical outcomes and patient satisfaction. The immersive experience stands out as an innovative and effective practice in the health sector, reinforcing the importance of combining educational strategies with market practices.

 

EP0429 Enhancing wound care knowledge through a serious game: Development and preliminary evaluation

Sofia Zahia¹, Paul Bobbink², Swann Pichon², Alessio Stefanelli², Guillaume Chanel³, Rania Niri³, Sebastian Probst^2
1imito AG, Zurich, Switzerland, ²Haute École de Santé Genève, Geneva, Switzerland, ³University of Geneva, Geneva, Switzerland

Aim: This study aims to develop and evaluate a serious game designed to improve wound care knowledge, visual expertise in tissue identification, and clinical reasoning.

Method: The game challenges players to build a virtual wound care hospital, with progression tied to success in theoretical knowledge, visual identification, and clinical reasoning. Training is based on evidence-based practices aligned with European Wound Management Association (EWMA) guidelines. Feedback was provided after each question to enhance learning, with a 60% performance threshold required to advance in the game. In August 2024, the game was distributed to 10 healthcare professionals (HCPs) to evaluate its effectiveness. Participants completed the 25-item PUKAT questionnaire before and after playing the game to measure knowledge of pressure ulcers. Usability was assessed using an 11-item Likert scale survey.

Results / Discussion: Preliminary data from 8 HCPs, of whom 5 completed the game and assessments, showed a significant increase in PUKAT scores (t(5)=-2.1, p=0.042), with a strong effect size (d = 0.87) observed among HCPs. Usability feedback indicated positive evaluations regarding the educational content and improvement in tissue recognition skills, though lower scores called for further developments for improving dressing knowledge and tissue surface quantification.

Conclusion: The serious game demonstrated promising results in improving wound care knowledge, especially among HCPs, and is currently being tested by 100 student nurses. While the initial usability results are promising, further improvements are planned to enhance training on dressings and tissue surface quantification. Continued data collection will refine the game’s educational impact

 

EP0430 Transforming skin tears prevention: An innovative approach to engage and empower nursing teams

Amanda C.M.A.G. Brandão¹, Maria Emília Gaspar Ferreira Del Cistia¹, Marcia  Santos¹, Emilly Goncalves¹, Danivea Bongiovanni Poltronieri Munhoz¹, Carolina Oliveira¹, Nuala Hipolito¹, Simone Brandi^1
1Hospital Israelita Albert Einstein, São Paulo, Brazil

Aim: To showcase the impact of an innovative educational strategy designed to raise awareness and actively engage healthcare professionals in preventing skin tears within the hospital setting.

Method: This experience report highlights a dynamic simulation activity carried out in April 2024. Targeting five major hospitals in Brazil—three public and two private—the initiative engaged nursing teams to boost their competence and confidence in skin tears prevention.

Results / Discussion: During Skin Tears Prevention Week, a creative simulation exercise was introduced where participants practiced removing transparent film adhered to a balloon, simulating the gentle care required to prevent skin tears. Of the 682 professionals who participated, including nurses and nursing technicians, an impressive 96% (655 professionals) successfully removed the film without bursting the balloon. This simple yet powerful exercise resulted in overwhelmingly positive feedback, with participants expressing high satisfaction and enthusiasm. More importantly, the activity fostered greater confidence and skills in the early detection and management of skin tears, translating knowledge into practice with memorable impact.

Conclusion: The simulation-based approach not only deepened professionals’ understanding of skin tears prevention but also cultivated a shared commitment to patient safety through hands-on learning. The exceptional engagement observed suggests that expanding this approach could be instrumental in fostering a proactive culture of injury prevention, making this initiative a model for other healthcare settings striving to enhance care quality.

 

EP0431 Enhancing nurses’ knowledge and skills in ostomy care management – A key to improve clinical outcome and patient experience

Nimfa Jeraldine Buizon¹, Browyn Mendoza^1
1Al Zahra Hospital Dubai, Dubai, United Arab Emirates

Aim: Ostomy patients face unique challenges such as skin injuries, dietary concerns, and psychological impacts related to their surgical procedures. However, many nurses lack comprehensive training on ostomy care, leading to potential gaps. Ostomy Care Management requires specialized knowledge and skills, making education a critical component in ensuring high-quality care. This paper explores the pivotal role of Wound, Ostomy Continence (WOC) Nurses in providing a standard program for nurses emphasizing its impact on patient outcomes and experiences.

Method: 2 WOC Nurses conducted 10 ostomy classes composing of lecture and workshop from July to August 2024 during the low season of patient census. 400 nurses from all wards – ICU, HDU, OT, NICU, ER, Surgical, Paediatric, Medical and Oncology, including Outpatient department - attended the class on various dates.

Results / Discussion: Pre evaluation revealed that 90% of the participants lack the confidence to handle patient with an ostomy. Post evaluation showed that after the ostomy class, nurses verbalized “confidence and knowledge” on different ostomies, ostomy appliance and health teachings for an ostomy patient.

Conclusion: Implementing a structured educational program for nurses can bridge this gap, with the guidance of WOC nurses. By providing the necessary tools and knowledge, nurses can deliver personalized care resulting to better clinical outcomes, reduced complications, and enhanced patient satisfaction.  Enhancing nurses’ expertise in ostomy care is instrumental in elevating the quality of care and uplifting the overall patient experience in hospital settings.

 

EP0432 Development of a clinical communication skills training program for tissue viability nurses using artificial intelligence

Nuno Correia¹, Alexandre Rodrigues², Susana Mantas³

¹ULS S.João - UCC Vallis Longus, Universitat Rovira i Virgili - Tarragona, Porto, Portugal, ²Universidade de Aveiro, Aveiro, Portugal, ³Universitat de Girona, Girona, Spain

Aim: To develop and assess the effectiveness of a Clinical Communication Skills Training (CCST) program specifically tailored for Tissue Viability and Wound Treatment (TVWT) nurses. The primary goal is to enhance patient-centered care, reduce healthcare costs, and improve overall patient quality of life, particularly for those with chronic wounds and complex care needs.

Method: The study is structured into three stages to ensure comprehensive evaluation and development. (1) Identifying and validating an assessment tool to determine key barriers and facilitators in CCST among Portuguese nurses, including cultural adaptation for TVWT specialists and rigorous analysis of validity and reliability. (2) Conducting a systematic review to establish the best available evidence on pedagogical structures and evaluation methodologies to build an effective CCST program in wound care. (3) Implementing the CCST program and evaluating its effectiveness through high-fidelity simulations paired with an AI-enhanced assessment tool (using ChatGPT-4). The program incorporates both quantitative and qualitative analysis methods, focusing on empathy, self-efficacy, and essential communication skills among TVWT nurses.

Results / Discussion: Expected results include validated CCST assessment tools, an evidence-based training curriculum tailored to wound care, and empirical data on the effectiveness of AI-supported assessments. Initial findings highlight AI’s potential to augment traditional assessment methods, offering more consistent, objective, and comprehensive evaluations of communication competencies.

Conclusion: This program aims to address a critical training gap in CCST for TVWT nurses, promoting greater patient empowerment and advancing the quality of wound care. Integrating AI in communication skills assessment provides a promising approach for real-time feedback, supporting continuous skill improvement among healthcare professionals and potentially elevating standards of care worldwide.

 

EP0433 Knowledge, skills and training needs of Polish nurses on chronic wound treatment

– current status compared to other European countries

Aleksandra Zdrojewska^1
1Akademia Humanistyczno-Ekonomiczna w Łodzi, Łódź, Poland

Aim: The following study aimed to explore nurses’ knowledge and skills as well as educational needs within the area of chronic wound care. Similar studies were performed in 6 other European countries, which not only provided and interesting insight but allowed a comparison between Poland and other countries.

Method: The study assessed 60 professionally active nurses from Poland from various medical backgrounds and with various experience in chronic wound care. With the use of a study questionnaire, the responders were asked about their knowledge and skills on chronic wound care including modern treatment methods and adjuvant treatment techniques. The training needs and readiness was also explored.   

Results / Discussion: The study found that Polish nurses, in general, declare less skills and confidence in modern wound assessment and care techniques than the European average. At the same time it is evident that they have a wide holistic approach to patient care and present high need and readiness to develop their skills and improve everyday practice within the area of chronic wound treatment. Responders from Poland often pointed to time constraints and lack of equipment as core limitations to education and more often found resources existing the their institution as inadequate. Polish nurses appreciate input from case studies and state areas of improvement more clearly than nurses from other countries.

Conclusion: The study clearly shows that Polish nurses are interested in performing high quality chronic wound care and confirm the need for further training and skill enhancing programs on the subject pointing clear directions for further development.

 

EP0434 The implementation of a professional practice model undefeeted among renal centres: A CPR bundle care guide

Sumita Poopalalingam^1
1Malaysian Society Of Wound Care Professionals, Kuala Lumpur, Malaysia

Aim: The Professional Practice Model (PPM) UndeFEETed was designed to enhance nursing practices and provide person-centered care for dialysis patients through the Check Prevent Refer (CPR) diabetic foot bundle care program. This program guided nursing staff with clear objectives and scientific values, empowering them to perform foot assessments, implement prevention strategies, and make quick referrals to reduce hospitalizations and amputations.

Method: Implemented in 14 dialysis centers, the CPR framework used a questionnaire to assess patients’ feet, identify risks and abnormalities, and refer patients for immediate treatment. Patients were managed according to the D-Foot International guidelines and underwent periodic assessments. Prevention strategies included teaching self-care steps and using hyperoxygenated fatty acids (HOFA) oil to reduce pruritus and repair vulnerable skin.

Results / Discussion: Between January and June 2024, 1033 assessments were completed. Results showed that 8.2% of patients experienced foot pain, 11.5% had no foot sensations, and many had dry or extremely dry feet. Additionally, 2% had fungal infections, 10% had cracked heels, 12% had long toenails, and 4% had ingrown toenails. 15% of patients were identified as having a foot risk and required further care, with 3 to 4 patients undergoing amputations due to advanced foot ulceration.

Conclusion: The findings highlighted the importance of the PPM UndeFEETed foot care bundle in dialysis patient care. The CPR steps, focusing on foot care, nutrition, foot exercises, and HOFA oil, were crucial in preventing amputations and improving patients’ quality of life. The program’s success suggests the need for further research to enhance the role of renal nurses in preventing amputations.

 

EP0435 The patient with substance abuse disorder, which have a skin ulcers: The challenge of nursing care

Beatrice Mosca¹, Maria Castoldi¹, Francesca  Turrini¹, Maria Teresa De Rose¹, Simone Toscano¹, Stefania Chiarenza^1
1Istituti Clinici Zucchi, Monza, Italy

Aim: Drug abuse can cause vascular complications such as vasoconstriction and thrombosis of the vessels. Some methods of intake can lead to the formation of skin ulcers, over-infection or, tissue necrosis. Psycho-social cofactors, living conditions and social isolation are fundamental factors. There are also important psychiatric pathologies, absent family and work context.
Investigate the difficulties in managing patients with skin ulcers and drug abuse.
Method: We subjected the nursing staff to an interview divided into four areas, concerning the management of patients belonging to the Vulnology Center of the Zucchi Monza Clinical Institutes.
Results / Discussion: Various difficulties emerged in managing the relationship with these patients, such as: prejudices, feeling of being manipulated, lack of trust in healthcare personnel, anger. The difficulty is to creating a shared care path and an empathy between healthcare personnel and these patients. The difficulties are: missed appointments, periods of absence, poor hygiene of injuries and personal hygiene in total. Even though there are several professional figures and structures in the area, but there is also a lack of structured paths.
Conclusion: Conclusions: It’s fundamental the education of a healthy lifestyle that can help the healing of the ulcers. The difficulty is to strive for a balance between the right and the effective. It would therefore be useful to create a network of communications and exchange of strategies between the Drug Addiction Services, setting up training courses for healthcare personnel so that they can have the emotional and relational tools to be able to carry out an optimal therapeutic path.

 

EP0436 Health literacy in pressure ulcers treatment: patient co-producer of care

Joana Cachulo^1
1Director of the Department of Health – Fernão Mendes Pinto Association, Associative Research and Wounds Group (GAIF), Centre for Health Research Studies of the University of Coimbra (CEISUC), Figueira da Foz, Portugal

Aim: The upward growth in the prevalence and incidence of pressure ulcers in the Portuguese context has proved to be a public health problem with an impact on both health spending and the quality of life of patients with these pathologies. Health professionals must bear in mind that the effective transmission of information to patients in the management of their disease plays a paradigm shift in the approach to health care delivery as well as in the understanding of the new role of the patient, who no longer has a traditional role, as co-producer in treating pressure ulcers. The aim of the study is evaluate the impact of health literacy on the patient as co-producer of care in terms of effectiveness outcomes in wound care.

Method: Description and evaluation of the impact of health literacy on the patient as a co-producer of care on the results of effectiveness and quality of life obtained in the treatment of pressure ulcers in the Portuguese context.

Results / Discussion: The results obtained show that teaching the patient with pressure ulcers in terms of health promotion care, adherence to treatments and adoption of behaviors that promote good outcomes induces an effective integration of the care provided and the resources used and has direct and faster impact on the effectiveness results and the co-creation of health value obtained.

Conclusion: The impact of literacy in patients with pressure ulcers promotes their role as co-producers of care, promoting cost-effectiveness in their treatment and improving gains in quality of life. Resulting in fewer days lived with disability, higher healing rates over shorter time horizons. This leads to a reduction in hospitalizations and infections.

 

EP0438 Preparation of a booklet for the prevention of complications from surgical wounds

Marilia Valenca¹, Alice Fonseca Pontes¹, Natália Almeida¹, Jabiael  Carneiro da Silva Filho¹, Isabel Cristina Santos¹, Jully Hannay de Souza Santos^1
1University of Pernambuco, Recife, Brazil

Aim: To construct the first version of an educational booklet to be used as a care-educational technology for patients in the postoperative period of cardiovascular surgery, in addition to identifying the care needs and knowledge gaps of individuals in the postoperative period of cardiac surgery with surgical wounds and their companions.

Method: This is a methodological study based on the PICO strategy (P - Post-surgical patients; I - FO care; CO - Health education guidelines), and the guiding question: what are the care and guidelines of health education in relation to the needs of patients with surgical injuries? Data was collected from May to August 2023. The research was approved by the Ethics and Research Committee through the CAAE opinion: 58589922.7.0000.5192.

Results / Discussion: The sample consisted of n=60 patients and n=50 companions. There was a predominance of elderly patients (56.67%) and adult companions (96%). Based on these findings, the first version of the booklet was created.

Conclusion: It is recommended that further studies be carried out with the main objective of standardizing conduct in the assessment of FS care, including the use of educational technologies and the needs of nursing care.

 

EP0440 Advanced wound care management in a rural hospital in a low income country: A pilot course

Alvise Montanari^1
1University of Padua, Padua, Italy

Aim: In developing countries, volunteer surgical missions frequently perform high-complexity reconstructive surgery on patients with chronic ulcers. However, due to rural settings and limited resources, these procedures are often not followed by adequate postoperative patient management or sufficient preoperative preparation. How can proper theoretical and practical preparation be provided to local personnel?

Method: In April 2024, the team from the University of Padua organized an accelerated wound care course for the nursing staff at North Kinangop Catholic Hospital in Kenya. This pilot course is intended to be the first in a series also open to external personnel.

Results / Discussion: The four-day course was structured into a theoretical component and a practical component. The theoretical portion, led by an international faculty team—some in person and others remotely via Zoom—covered topics from the anatomy and pathophysiology of common wounds and chronic ulcers to diagnostic and management protocols, culminating in the use of advanced wound care dressings. In the afternoons, hands-on practical sessions were held in outpatient clinics, wards, and the operating theater, where participants practiced under the guidance of tutors. Pre- and post-course tests were administered to quantify the benefit of the training, with results validated by a follow-up test five months later.

Conclusion: Accelerated wound care courses, such as the one conducted, have proven to be a valuable tool for training local nursing staff in rural areas of developing countries in advanced wound management techniques and the use of modern dressings.

 

 

E-HEALTH

EP0633 A novel automatic segmentation using machine learning and human-in-the-loop approach in photographs from pressure ulcers

Jeong Yeop Ryu^1
1Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Rep. of South Korea

Aim: Accurate segmentation of pressure ulcers (PUs) is useful for effective treatment planning. Traditional methods often lack the necessary efficiency and precision. While recent studies have explored AI-driven techniques for this task, research on their clinical efficacy remains limited.

Method: This study involved 961 patients with PUs located in the sacral or coccygeal regions. Among them, total of 512 features were extracted from the images to build an AI training dataset. Manual segmentation was conducted on 256 patient photographs using 3D Slicer. The remaining 256 images were segmented using a human-in-the-loop approach, resulting in a fully annotated dataset of 512 samples. A comparative analysis was performed to evaluate the Dice coefficients and execution times between manual and semi-automated segmentation methods.

Results / Discussion: In a comparison between AI-assisted semi-automated segmentation and manual segmentation, all six annotators achieved significantly lower average inference times, with no substantial difference in Dice coefficients (90.31% vs. 88.72%). For the 256 manually segmented photographs, a high average Dice coefficient of 89.9% was observed, with an inference time of 38.42 ms. For the entire dataset, the AI model achieved an impressive average Dice coefficient of 94.1%, with a rapid inference time of 32.55 ms per image.

Conclusion: This study highlights the potential of AI for delivering both high accuracy and time efficiency in the segmentation of pressure ulcers. The model shows promise for broad clinical applications, particularly in enhancing the speed and consistency of segmentation in the orbital region.

 

EP0156 First the humans then the technology; A realist evaluation of a wound care telemedicine solution in a cross-sectorial setting

Annette Høgh¹, Susanne Leegaard², Susanne Søndergaard^1
1Department of Vascular Surgery, Viborg, Denmark, ²VIA University College, Nursing, Viborg, Denmark

Aim: The study aimed to evaluate the role of the Danish telemedicine (TM) solution Pleje.net® in the treatment and care of patients with diabetic foot ulcers (DFU) within a cross-sectorial, multidisciplinary setting.

Method: We utilized a realist evaluation methodology combined with ethnographic participant observation to examine the role of the TM solution Pleje.net® in the treatment and care of patients with DFU. Data collection involved observing patients and healthcare professionals for 68 hours in 2023. The analysis followed the process of context, mechanism, and outcome configurations, along with cumulative thematization to highlight key insights.

Results / Discussion: We identified three cumulations relying on 84 context, mechanism, and outcome configurations. 1) Time matters: Challenging time restrictions regarding both organizational and personal matters in TM and person-centered care for patients with DFU. 2) Building bridges: The power of relationships in sustaining telemedicine use is outstanding 3) Tech obstacles: Aligning perceptions and mastering digital telemedicine tools significantly influence the utilization of TM solutions in cross-sectorial settings.

Conclusion: Our study highlights that the TM solution Pleje.net® fosters strong relationships between healthcare professionals cross-sectorially and thereby supporting the existence of trust and engagement along the DFU patient’s pathways. When these robust relationships are present the TM solution facilitates timely and coordinated care across different sectors, ultimately improving patient outcomes in a multidisciplinary setting and creates the efficient and effective care and treatment of patients with DFU.

 

EP0634 Content of a wound care mobile application for newly graduated nurses: An e-Delphi study

Julie Gagnon^{1 2}, Julie Chartrand^{1 3}, Sebastian Probst^{4 5 6 7}, Michelle Lalonde^{1 8
1}University of Ottawa, Ottawa, Canada, ²Université du Québec à Rimouski, Rimouski, Canada, ³Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada, ⁴HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland, ⁵Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia, ⁶College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland, ⁷Geneva University Hospitals, Geneva, Switzerland, ⁸Institut du Savoir Montfort, Montfort Hospital, Ottawa, Canada

Aim: To achieve expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses.

Method: Experts participated in three rounds of online surveys. The first round involved 29 wound care nurses (clinicians, researchers, and educators), who provided qualitative feedback through a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. Twenty-five experts participated in the two subsequent rounds, rating their agreement on the items using a 5-point Likert scale. These iterative rounds allowed experts to reconsider their previous responses and review anonymized results. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds, with a predetermined consensus threshold of 80%.

Results/Discussion: Eighty items were categorized into six categories based on the first round’s results. Of these, 75 items (93.75%) reached consensus, while 5 items (6.25%) did not. High consensus was found for items addressing signs and symptoms of infection, pressure injuries, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus.

Conclusion: The findings will guide the initial content development for the mobile wound care application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. The ongoing discussion around items without consensus highlights areas needing further exploration. This study also clarifies the competencies in wound care expected of newly graduated nurses.

 

EP0157 Elpo App: Innovative, evidence-based tool for assessing the risk of positioning injuries

Camila Moraes^1
1Dra Camila Mendonca - Enfermagem Avancada, Guaxupe, Brazil

Aim: To present the ELPO App, a practical and innovative application for assessing the risk of patient positioning injuries during surgery.

Method: This is a technological development of an educational mobile application through scientific rigor. The construction followed the steps of contextualizing (problem), project, coding (use of programming tools), testing, and evaluating.

Results / Discussion: The ELPO App is available in Portuguese and English and can be downloaded from mobile app stores for free. It consists of a validated tool with seven items that assess intrinsic and extrinsic risk factors for patient positioning injuries. The app features an interactive digital scale for selecting items, simplifying the assessment process. It calculates total scores based on the selected sub-items and provides evidence-based care recommendations. From January 2022 to November 2024, nearly 50000 downloads were recorded, and the app received a five-star rating on mobile app stores. Using ELPO can aid perioperative nurses in identifying patients at higher risk and providing targeted care to ensure surgical patient safety.

Conclusion: The ELPO App is more than just a technological tool; it is a valuable resource for assessing and mitigating the risk of patient positioning injuries. It offers evidence-based care recommendations to guide the care process and enhance patient safety. Healthcare professionals can rely on the ELPO App to deliver excellent care during patient positioning. Download the ELPO App and take a significant step towards improving patient safety.

 

EP0158 What did we learn from pixaire-1trial? Impact on the modalities of wound surface measurement

Guillaume Maxant¹, Madalina Pastrav¹, Ioan  Gogeneata², Carine Bajcz¹, Anne Claire Bertaux^1
1Centre Hospitalier de Haguenau, Haguenau, France, ²Centre Hospitalier de Haguenau, Haguenau, France

Aim: The Pixaire-1 study aimed to validate the machine learning algorithms developed to measure chronic wound area: WT * (semi-automated measurement) and WS ** (automated measurement).

After summarising the results of the trial, we will focus on complementary elements, focusing on the failures of the machine learning models and the way to strengthen the robustness of the tools.

Method: Pixaire 1 is an open-label, monocentric study involving 42 consecutive patients. Acetate tracing and digitised planimetry using Image J was considered the gold standard for area measurement. Each wound was assessed independently by two experts.

Reliability (inter-operator agreement) and precision (agreement of the evaluated methods with acetate tracings) were assessed. A qualitative analysis of errors in automated segmentation (WS) was performed.

Results / Discussion:

- Woundtrack showed very similar results to acetate tracing in terms of reliability and accuracy.

- Woundsize showed good but inferior results.

- Qualitative analysis of Woundsize segmentation showed good to perfect results in 80% (19/79) of cases, but also critical failures in specific situations: low contrast between wound and surrounding tissue (12); complex wound edges (7); surrounding artefacts (2).

Conclusion: Woundtrack is similar to acetate tracing in that it measures the area of the wound.

Woundsize is effective in most cases, but the algorithm lacks robustness in certain conditions. Its use in clinical practice needs to be integrated by involving the operator in a correct-then-validate process.

 

EP0163 Wound care telenursing as support tool in the remote management of patients with chronic wounds to improve the outcomes

Sabrina Rodilossi¹, Claudia Lucia Belloni¹, Rita Baldinu¹, Serena Saccotelli¹, Elena Pedrini¹, Daniela Bianco¹, Giusy Vuono^1
1ASST GOM Niguarda, Milan, Italy

Aim: Telenursing is an innovative approach to remotely manage of fragile patients, such as those with chronic wounds, who often have others comorbidity, which makes difficult for them to reach the clinic to renew the dressings. Wound care specialist nurses (IWS) through telenursing can monitor and assist these patients; moreover, they can give support to caregivers or to home care nurses (ICDom) to improve the whole caring process.

Method: To this purpose in our Hospital was created a nursing ambulatory run by IWS, where patients with chronic wounds are managed both in person and via telenursing. IWC nurses defines the therapeutic program during the first appointment at the ambulatory with the patient, after a holistic assessment. If the patient matches the requirement and is suitable to access the program, he/she is included in telenursing. After this the IWS receives wound’s images via email; IWS will then contacts regularly the patients/caregiver/ICDom through telephone calls to continue monitoring the situation and to provide specialist assistance, even through health education.

Results / Discussion: Since the start of the ambulatory, 37 patients with different chronic wounds have been recruited (16 pressure ulcers, 11 vascular ulcers, 10 others), continuing regularly monitoring and consultancy activities for caregivers, for a total of 82 telenursing accesses.

Conclusion: With telenursing, caregivers/ICDoms and IWS reached a good level of interaction, with the direct consequence of an improvement in patient’s wounds-evaluated in terms of wound healing, extension, exudate control, odor, pain-and patients comfort.

 

EP0635 Improving access to tissue viability services by expanding e-clinics to six community hospitals

Polly Cox¹, Adele Woodyer², Helen Ramsay^3
1Urgo Medical Limited, Loughborough, United Kingdom, ²Urgo Medical, Loughborough, United Kingdom, ³NHS Lothian, Edinburgh, United Kingdom

Aim: An e-clinic has operated for nine years, serving district nurse teams, care homes, and long-term care facilities, providing 60% of referred patients with a treatment plan within three hours. However, community hospitals had no provision and poor access to medical photography and tissue viability services. A project proposal was submitted to widen e-clinic scope to include hospitals.

Method: Supporting community hospitals utilising the e-clinic service is expected to reduce delays for patients with complex wounds requiring specialist care. Comprehensive cost analysis was conducted to confirm the project’s viability. Tissue viability service staff will allocate 16 hours for additional training to ensure the referral process is accurate and effective. This will be further supported with 10 hours administration.

Project aims:

• Reduce wait times for tissue viability advice.
• Improve MDT collaboration.
• Support education for wound assessment and management.
• Improve care provision, minimising the need for patient escalation.

Results / Discussion: Faster access to specialist advice improves healing rates, studies show 73–75% success in specialist clinics ⁽¹⁾ Empowering staff to perform detailed referrals with photographic images enhances triage, prioritisation, and monitoring of healing progressions. Impact on formulary adherence will be measured on implementation of the project.

The extension of the e-clinic will support improved patient outcomes and reduce risk for this vulnerable patient group. Early intervention will contribute to a reduction in emergency care and will reduce the incidence of pressure ulcers with effective risk assessment and preventative management.

Conclusion: Expanding the e-clinic to community hospitals will aim to ensure equitable, timely, and cost-effective wound care. Future efforts will focus on measuring the changes proposed within this project to assure quality for patients and the organisation.

 

EP0159 Analysis of AI-based wound segmentation with public datasets

Johannes Kilian¹, Nils Gessert¹, Michael Perkuhn^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: Wound measurement is crucial for wound documentation, ensuring appropriate treatment choices, and tracking healing progress over time. Manual wound delineation is often time-consuming and subjective, making automated and accurate wound segmentation a valuable tool. Many approaches to wound segmentation have been published, often relying on different public datasets, raising concerns about the comparability of these results. We evaluated how wound segmentation results differ across datasets.

Method: We used four publicly available datasets (DFU challenge, Medetec, SIH, and AZH) for training and evaluating wound segmentation models. We used a cross-validation scheme where three datasets were used for training and the fourth for evaluation. We trained a U-Net segmentation model for each of the four data split definitions. We then evaluated the model’s performance on the held-out dataset.

Results / Discussion: Figure 1 shows the Dice score for all four datasets, shown as box plots. We observe that Dice scores differ significantly (p<0.05, Wilcoxon rank-sum test) across the four datasets. Performance on the SIH dataset is the lowest while performance on AZH is the best. This indicates that insights on performance derived from one dataset may have limited transferability to other datasets.

Conclusion: We find that performance results for wound segmentation can differ substantially across datasets. Evaluations and insights on wound segmentation should thus be considered in the context of the datasets that are being used. Consistent use of the same datasets is likely needed for deriving tangible insights. Future work could investigate how to overcome these dataset limitations.

Fig 1.

 

EP0160 Bioimpedance measurement for monitoring wound healing: a systematic review

Magdalena Antoszewska¹, Katarzyna Połomska², Piotr  Spychalski², Atte Kekonen^{3 4}, Jari Viik, Wioletta Barańska-Rybak^1
1Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland, ²Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland, ³Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, ⁴CutoSense Oy, Kaarina, Finland

Aim: Chronic wounds decrease patients’ quality of life and pose an economic burden on healthcare systems and individuals. Wound assessment tools and monitoring technologies may reduce the costs related to chronic wound management.

Method: A systematic review of literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in three electronic databases (PubMed, Scopus and Web of Science). The search was carried out on the 30th of August 2024 by the first and the second author independently. Only the studies on bioimpedance measurement for monitoring of wound healing were included.

Results / Discussion: Sixteen studies were included. Our review presents different approaches for use of bioimpedance measurement for the purpose of monitoring of wound healing process. Different measurement techniques were analyzed. Outcomes were briefly summarized.

Conclusion: Our review presented many techniques of bioimpedance measurements and indicated that this method can be useful in the monitoring of wound healing process.

 

EP0161 Reimaging wound care – A virtual approach. The outcomes & value of a multi-organisation ‘complex wound’ virtual ward (hospital at home) across an NHS region

Rebecca Housley¹, David Cruttenden-Wood², Caroline French³

¹Hampshire Hospitals Foundation trust, Basingstoke, United Kingdom, ²Hampshire Hospital Foundation trust, Winchester, United Kingdom, ³Hampshire Hospital Foundation Trust, Winchester, United Kingdom

Aim: Patients with complex wounds often receive inequities in community care, resulting in avoidable hospital admissions, morbidity and mortality. Hospital discharges are often delayed due to challenges organising continued complex wound care at home. 

To address these issues a complex wound virtual ward (CwVw) was established in a region in England. It aimed to create a one-team approach across individual care providers to deliver safe and effective complex wound care to patients at home. 

Method: Mixed-methods service evaluation; prospective quantitative data collection from electronic patient records, highlighting patient characteristics, safety, service use and costs. A rapid ethnography further explored the value of the CwVw, collecting qualitative data from staff and analysing data using Translational Mobilisation Theory.  

Results / Discussion: 87 patients were admitted to the CwVw over 15 months, with 56% early supported discharges and 44% admission avoidance. Median length of stay was 9 days. 67% were elderly. 84% had significant comorbidities.  The readmission rate was 13.8%. Mortality was 5.7%. 356 hospital bed days were saved equating to £89,000. 

Figure 1 shows how the CwVw organises care differently for patients with complex wounds:

Staff perceived value included improved wound healing, patient outcomes and experiences, and enhanced professional satisfaction, education and relationships.   

Conclusion: This is the first time a virtual ward/hospital-at-home has delivered care for people with the most complex wounds. Previously, these patients would have mandated hospital admission. 
Our multi organisational ‘one-team’ virtual ward delivered high quality safe care, bringing widespread benefit to patients and society. This demonstrates an evolution in healthcare away from hospital admission. 

 

EP0162 The use of the application as an adjuvant in managing the hard healing wound healing process: wound browser

Elaine Monteiro¹, Natalia Barros², Alessandra Miranda Garcia Storti^3
1European Wound Management Association, SOBENDE - Brazilian Society in Dermatology Nurse, SBQ - Brazilian Society in Burns, São Paulo, Brazil, ²SOBEST - Stomatherapy Brazilian Society, SOBENDE - Brazilian Society in Dermatology Nurse, São Paulo, Brazil, ³SOBEST - Stomatherapy Brazilian Society, São Paulo, Brazil

Wound bed preparation is a paradigm to optimize the treatment of hard healing wounds. This holistic approach examines the treatment of the cause and the proper preparation of the wound bed, traditional wound assessment methods, such as manual measurement, has a challenge to the professional who often does not have appropriate measurement tools, getting camping bias. The use of applications such as Wound Navigator is an innovative solution to assist in the unified monitoring of clinical reports

Aim: Use an educational application with realistic simulation in the preparation of the wound bed

Method: Clinical Study as an Experience Report 81 Years, with base diseases such as heart disease, DM, femur fracture for 1 year with calcification. Required hospitalization after complications of the DM, it has a stage III pressure injury in left calcaneal. After TCE authorization and patient data protection.

Results / Discussion: When conducting the dressing, the bed was cleaned in the appointment of the type of fabric selected in yellow color, type of exudate large exudate, coverage used overbacket with Sorbact technology associated with SAP, being allowed to exchange A A Every 48 hours, after 15 days of treatment improvement of the exudate exchanging every 96 hours. In one month of treatment it obtained a vigilable reduction in the app measurement of 60% of the beginning of treatment in 26.05.23 the last evaluation 05.07.23.

Conclusion: In the assessment of Wound Navigator was effective in precise inspection of measuring the lesion, thus avoiding bias in conventional methods.

 

EP0164 Virtual wound review - an effective evolutionary alternative to face-to-face review for At Home Services

Fritzie Marmita-Vina¹, Aiwei Foster¹, Elizabeth Wallis¹, Hannah Kifoto¹, Janelle Walters¹, Eva Staunton¹, Sarah Sage^2
1The Royal Melbourne Hospital, Parkvile, Australia, ²Melbourne Health, Brunswick, Australia

Aim: The Acute and Subacute At Home Services were created to address increased hospital length of stay and limited bed access.  Both services replicated applicable ward-based care within the patients’ home. Patients with wounds of concern were referred to the Wound Management team for face-to-face review by Wound Clinical Nurse Consultants (Wound CNCs). In 2020, these face-to-face wound reviews were discontinued during the Covid-19 pandemic. To ensure continued provision of staff support to appropriately manage these wounds, a Virtual Wound Review (VWR) was initiated.  

Method: The VWR occurs weekly and is conducted using an online meeting platform approved by the organization. It is led by the Wound CNCs and attended by Podiatry, Nurse Unit Manager/ Coordinator; and Medical Practitioner/ Allied Health occasionally. Patients with complex wounds (e.g. Buruli ulcer, dehisced surgical wounds) not managed by other specialist teams (e.g. Plastics), are referred for VWR via an Electronic Medical Record (EMR) system. Digital wound photographs taken by road nurses during patient home visits and assessments uploaded to patients’ EMR are used for discussion following the ISBAR communication tool. Recommendations are documented using a standardised template.

Results / Discussion: Anecdotally, the VWR facilitated multidisciplinary evaluation of >900 patients since 2020; with an average of 10 patients or five new referrals per week. It enabled timely recognition of wound deterioration, and identified wounds requiring referral/s to appropriate community services as a collaborative approach to discharge planning. Improvements in the quality of referrals, clinical information discussed and wound care outcomes were noted.

Conclusion: Virtual multidisciplinary collaboration is an evolving platform that has positive impact to both patient wound outcomes and ongoing development of At Home Services’ medical and nursing staff’s skills in managing complex wounds. 

 

 

HEALTH ECONOMY AND OUTCOME

EP0621 Impact of high skin pigmentation - Clinical diagnosis of wound infection diagnosis with fluorescence imaging of bacteria

Jonathan Johnson, MD, MBA, CWSP^1
1Comprehensive Wound Care Services, LLC, Washington, DC, United States

Healthcare disparities, particularly in chronic wound management, are influenced by systemic inequities, implicit biases, and a lack of representation of diverse skin tones in medical education. Traditional diagnostic methods often fail to identify signs of infection in patients with darker skin tones, leading to delayed treatment and worse outcomes. This study highlights the limitations of standard clinical assessments in detecting erythema and infections across varying levels of skin pigmentation and evaluates the role of fluorescence imaging as a supplemental diagnostic tool.

Importance: A lack of skin tone representation in medical education disproportionately affects the care provided to patients of color. In wound care, traditional diagnostic markers like erythema and inflammation are often under-recognized in individuals with darker skin tones, contributing to diagnostic disparities.

Objective: To evaluate the impact of skin pigmentation on the detection of clinical signs and symptoms (CSS) of infection and to assess the efficacy of fluorescence imaging (FL) in improving the detection of pathogenic wound bacteria across diverse skin tones.

Design: This study involved a post-hoc analysis of a prospective, single-blind, multicenter clinical trial.

Setting: Data were collected from 14 outpatient wound care centers across the United States.

Participants: A total of 350 adults with chronic wounds, including diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure ulcers (PUs), and surgical wounds, were analyzed.

Exposure: Participants were grouped by skin pigmentation based on the Fitzpatrick Skin Phototype Classification (FSPC): low (I & II), medium (III & IV), and high (V & VI).

Main Outcomes and Measures: The study examined the reporting frequency of CSS, total bacterial load (TBL) quantified as >10⁴ CFU/g, and the improvement in diagnostic sensitivity when FL-imaging was added to standard clinical assessments.

Results: TBL levels were consistent across FSPC groups (P = .38), but the frequency of erythema detection declined significantly with increasing FSPC score—from 13.4% in lowpigmentation patients to 2.3% in high-pigmentation patients (P = .05). CSS sensitivity in high-pigmentation individuals was up to 8.4-fold lower than in other groups (P = .003 to .04). The integration of FL-imaging markedly improved the detection of TBL >10⁴ CFU/g, with the greatest improvement observed in the high-pigmentation group, where diagnostic sensitivity increased 12-fold compared to clinical assessment alone (P < .001).

Conclusions and Relevance: Diagnostic disparities in chronic wound care

disproportionately affect patients with darker skin tones, leading to delayed treatment and poorer outcomes. FL-imaging significantly enhances diagnostic sensitivity and serves as an objective tool for equitable infection assessment. Implementing this technology could help address racial inequities in wound care and improve outcomes for underserved populations.

 

EP0606 Topical oxygen therapy in the management of hard-to-heal wounds in Columbia: A retrospective review

Windy Cole¹, David Fernandez², Thomas Serena^3
1Kent State University College of Podiatric Medicine, Cleveland, United States, ²NATROX Wound Care, Cambridge, United Kingdom, ³Serena Group, Cambridge, United States

Aim: This study examined the use of continuous topical oxygen therapy (cTOT) to treat various types of chronic wounds. This cohort of patients presented with multiple types of chronic wounds including diabetic foot ulcers (DFUs), venous ulcers (VUs), pressure injuries (PIs), traumatic wounds, surgical wounds and burns.
Methods: A retrospective cohort analysis was conducted at clinic locations throughout Columbia, South America. Medical records were used to identify patients receiving cTOT age >18. Sixty-nine patients met the criteria and were divided into two groups: a continuous treatment group (n=47) and a discontinuous treatment group (n=22). The following information was recorded: demographics, wound characteristics, and outcomes.
Results: Significant differences were noted between the Continuous (uninterrupted) and Discontinuous (interrupted) cohorts. The mean treatment duration for Continuous cohorts was 12.2± 7.4 weeks, while the Discontinuous cohort had a longer mean duration of therapy of 27.4 ± 23.0 weeks (p=0.006). Continuous treatment reduced mean wound size from 42.5 cm² to 1.6 cm², with a median decrease from 27.0 cm² to 0.0 cm² (p= 1.0E-07). Discontinuous treatment saw a mean reduction from 67.6 cm² to 4.9 cm², with a median decrease from 40.1 cm² to 0.2 cm². The mean time to complete closure was significantly shorter for Continuous treatment (mean= 10.5±5.7 weeks, median = 9.0 weeks) compared to Discontinuous treatment (mean = 20.7±6.4 weeks, median = 20.3 weeks) (p= 0.0021).
Conclusion: The findings of this study suggest that cTOT could promote accelerated wound healing and reduce treatment duration when used continuously rather than discontinuously.

 

EP0607 The clinical and economic outcomes of an integrated care bundle utilising a three-layer silicone adhesive foam dressing for exudate management of chronic wounds: A retrospective cohort analysis

Catherine McCarthy¹, Theresa Hurd², Julie Murdoch^1
1Smith+Nephew, Hull, United Kingdom, ²Nursing Practise Solutions, Buffalo, Canada

Aim: The aim of this retrospective, real world, cohort analysis is to report the clinical and economic outcomes of an Integrated Care Bundle (ICB) that utilized a 3-layer silicone adhesive foam dressing for exudate management across multiple chronic wound types within a community setting in Canada.

Method: Analysis of the safety and effectiveness of an introduction of wound centered ICB’s which were adopted to improve the management of chronic wounds, from March 2015 to December 2018. Outcomes were compared from patients who received a 3-layer silicone foam adhesive dressing alongside an ICB against those that did not, as part of their care.

Results / Discussion: Patients who received care with an ICB and the dressing (n=6612) experienced improved clinical outcomes, compared with those who did not (n=2242). Including faster time to healing (12.7 vs 25.4 weeks, respectively) and longer time between dressings changes (3.5 vs 1.8 days, respectively). There were reduced number of nursing visits in the ICB cohort which led directly to reduced resource costs, compared to the patients in the non-ICB cohort (CAD$1736 vs $6488, respectively).

Conclusion: This real-world cohort analysis demonstrated the adoption of an ICB that included treatment with a three -layer silicone adhesive foam dressing improved clinical outcomes, reducing chronic wound healing times and the frequency of wound dressing changes.

 

EP0608 Comparative effectiveness of collagen/oxidized regenerated cellulose/silver-orc dressing* with cellular tissue product versus cellular tissue product alone in wound care

Laura Soloway¹, Leah Griffin^1
1Solventum, Maplewood, United States

Aim: This study was designed to examine the difference in outcomes between wounds treated with collagen/oxidized regenerated cellulose/silver-orc dressing (COSO)* and a cellular tissue product (CTP) and wounds treated with a CTP without COSO.

Method: Using U.S. Wound Registry data, 1,674 wounds treated with COSO+CTP were identified. Propensity score matching within each wound type was used to create a cohort of 1,674 control wounds that used CTP alone. Outcomes evaluated included the healing status and change in wound size. Chi-square and t-tests were used to evaluate differences between the two cohorts.

Results / Discussion: After matching, the two cohorts were balanced on most patient and wound demographics.  Those variables that were not fully balanced (wound age, smoking, and vascular disease) indicated that the wounds treated with COSO+CTP were older and on patients who had a higher percentage of risk factors.  Significantly more wounds were healed when treated with COSO+CTP compared to CTP alone (49.0% versus 43.8%; p<0.0001) with an odds ratio of 1.24 (95% Confidence Interval: 1.09, 1.43). When healed wounds were combined with wounds that improved, there continued to be a significant difference in favor of the COSO+CTP cohort (83.3% versus 80.1%; p=0.0158). There were no differences in the change in wound size.

Conclusion: Despite the COSO+CTP treatment group having a higher percentage of risk factors, this group had much better outcomes than the CTP group.  Using COSO+CTP for a wide range of wounds may help to improve patient outcomes.

*3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver; Solventum Corporation

 

EP0609 Wound care miracles on a $10 budget: Innovative approaches in an indonesian government hospital under the jaminan kesehatan nasional program

Bramastha Rosadi¹, Terry Renata Lawanto², Jupri Jupri^2
1Tebet Distric General Hospital, Jakarta Selatan, Indonesia, ²Tebet District General Hospital, Jakarta Selatan, Indonesia

Aim: This retrospective study examines the use of split modern dressings in managing wound cases within financial constraints, focusing on healing outcomes and cost efficiency under Indonesia’s universal healthcare program Jaminan Kesehatan Nasional (JKN).

Method: Data from 6,000 wound care cases (2021-2023) were analyzed. The clinic used split modern dressings, targeting critical wound areas with hydrocolloids, foams, and antimicrobials. Cases were categorized into diabetic foot ulcers (DFU), post-operative wounds, abscesses, surgical site infections (SSI), and pressure injuries.

Results / Discussion: Case distribution included diabetic foot ulcers (84%, 5,040 cases), post-operative wounds (20%, 1,200 cases), abscesses (15%, 900 cases), SSI (1.6%, 95 cases), and pressure injuries (0.75%, 45 cases). The split dressing method kept 90% of cases within the $10 budget. Wound healing within 4-6 weeks was achieved in 70% of patients, while material costs were reduced by 30%. Patient satisfaction remained high, with 85% reporting positive experiences. Indonesia’s universal healthcare program Jaminan Kesehatan Nasional (JKN) allocates only $10 per outpatient visit, including wound care. While many clinics rely on povidone iodine and ethacridine lactate due to cost, our hospital implemented modern wound dressings to improve outcomes in which physicians receive only 0.25 cents per visit.

Conclusion: The use of split modern dressings enabled effective wound care despite financial limitations. This approach optimized resources while maintaining positive clinical outcomes, demonstrating that innovative strategies can enhance care in resource-limited settings. The dedication of physicians, who work with minimal compensation, played a key role in the program’s success.

EP0611 New urgostart data for HTA: French organisational impact & budget impact models

Isabelle Boucley¹, Fabienne Midy^2
1Laboratoires Urgo, Chenove, France, ²Vyoo Agency, Paris, France

Aim: This study aims to assess the organisational and budget impacts of using TLC-NOSF dressings instead of neutral dressings for the treatment of venous leg ulcers (VLU) and diabetic foot ulcers (DFU).

Method: Markov models were developed for both populations, simulating the care process of incident DFU and VLU cohorts. Healing data come from an RCT and the real-world administrative database SNDS. Other data are from the literature or ad-hoc calculations.

Results / Discussion: Over a DFU treatment duration, TLC-NOSF dressings save 8 boxes of dressings (B/16), 127 nursing visits, 8.6 medical consultations, 0.2 hospitalizations and prevent 0.5 infections and 0.03 amputations per patient.

The same way for a VLU patient, TLC-NOSF dressings save 3.4 boxes of dressings (B/16), 55 compression bandages, 55 nursing visits and 5 medical consultations.

Based on the 2024 TLC-NOSF incident population (10,000 DFU and 18,300 VLU patients), the savings are estimated at 143,500 dressing boxes (B/16), more than two million nursing visits and 179,600 consultations. Specific to VLU patients, 1 million compression bandages would be avoided. These benefits allow a more environment friendly management of chronic wounds.

Treating 10,000 DFU patients with TLC-NOSF dressings would avoid 2,200 hospitalizations (excluding infections and amputations), 5,400 infections and 280 amputations.

On the duration of a patient’s care, TLC-NOSF dressings save €5,000 per DFU and €1,300 per VLU compared with using a neutral dressing.

Conclusion: The higher efficacy with TLC-NOSF dressings in DFU and VLU management leads to major healthcare resource savings that benefit patients, payers and the environment.

 

EP0605 Forming and implementing a wound care committee: Insights and suggestions

Seung-Kyu Han^{1 2}, Eunbi Lim^3
1Department of Plastic Surgery, Korea University College of Medicine, Seoul, Rep. of South Korea, ²Diabetic Wound Center, Korea University Guro Hospital, Seoul, Korea., Seoul, Rep. of South Korea, ³Department of Nursing Service, Korea University Guro Hospital, Seoul, Rep. of South Korea

Aim: The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of a wound care committee for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound care committee by reporting our experiences with the establishment of a wound care committee.

Method: The wound care committee was established at Korea University Guro Hospital. Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wound care committee. The data were analyzed to assess the types of wounds and their outcomes. In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members.

Results / Discussion: Regarding the wound type, 81,898 (45.3%) were catheter-related, while 48,976 (27.1%), 26,557 (14.7%), and 21,250 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores for the patient, ward nurse, wound care committee nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively. Additionally, 136 dressing-related complications (0.08%) were reported.

Conclusion: The wound care committee can enhance satisfaction among patients and healthcare providers while maintaining low complication rates. Our findings may provide a potential framework for establishing similar service models.

 

EP0612 Enhancing chronic wound management through collaboration: A case study from Jesenice General Hospital and community nursing teams

Mojca Strgar Ravnik¹, Hubert Terseglav^1
1Jesenice General Hospital, Jesenice, Slovenia

Aim: Chronic wound management poses significant challenges due to complex patient needs and a fragmented care approach. This study explores a collaborative model between Jesenice General Hospital (Slovenia) and local community nurses aimed at improving outcomes for patients with chronic wounds. Initiated in 2021, this cooperative model integrates advanced wound care expertise from our hospital-based wound manager with the day-to-day observations and support of community nurses. The primary objective was to bridge knowledge gaps, standardize wound care practices, and enhance communication between community nurses, general practitioners, and hospital staff to optimize patient-centered care.

Method: Monthly virtual meetings were established, bringing together the wound manager and community nurses to discuss active cases. This forum facilitates real-time case evaluations, adjustments to treatment plans, and assessment of the need for further diagnostics, surgical interventions, or secondary care follow-ups. Community nurses provide critical insights into patients’ home environments, including aspects such as nutrition, family support, and resource availability, which inform a holistic care approach.

Results / Discussion: The initiative has led to improved wound management, a reduction in physical and psychological stress for patients, fewer wound infections, and a decrease in unnecessary hospitalizations. Additionally, this model has fostered greater inter-professional collaboration, resulting in a cohesive, standardized approach to chronic wound care.

Conclusion: The partnership between Jesenice General Hospital and community nursing teams demonstrates a successful model of integrated, patient-centered care. Regular interdisciplinary communication and shared expertise have significantly enhanced chronic wound outcomes, setting a valuable precedent for similar healthcare settings.

 

EP0613 Wound inequity in peripheral arterial disease and amputation

Laura Swoboda¹, Kara Couch², Karen Bauer³, Barbara Bates-Jensen^4
1Association for the Advancement of Wound Care, The Healing Institute, Carthage College, Milwaukee, United States, ²George Washington University, Washington DC, United States, ³University of Toledo, Toledo, United States, ⁴UCLA, Los Angelos, United States

Aim: A collaboration between the Association for the Advancement of Wound Care and the European Wound Management Association aims to identify and address disparities in wound care.

Method: An in-depth literature review was conducted to explore the underlying causes of these disparities. The review highlighted actionable steps to enhance inclusivity and decrease disparities in wound care. Subsequent sections delve into common complex wounds, such as this second report regarding peripheral arterial disease (PAD) and amputations, to identify specific disparities and potential solutions.

Results / Discussion: Our environments, including molecular, cellular, social, and physical factors, significantly influence the development of wound-related conditions and healing outcomes.

In the US, PAD affects millions and contributes to over 150,000 non-traumatic limb amputations annually. Disparities in PAD, ischemic ulcers, and amputations are prevalent among certain populations. For instance, Black individuals have a two-fold higher risk of PAD than White individuals, a ~30% lifetime risk. Additionally, socioeconomic factors like low income, low education levels, and neighborhood deprivation are associated with a higher risk of PAD and amputations. About 56% of areas with the highest rates of amputation were in the Southern region of the US. Other contributing factors include suboptimal risk factor management, delayed PAD recognition, limited health insurance coverage especially for high-risk groups, systemic social injustices, and inadequate access to advanced PAD care.

Conclusion: By acknowledging and addressing existing gaps in wound care, we can improve outcomes for all populations through more equitable care. Multifaceted interventions are necessary to reduce the root causes of PAD and amputation disparities.

 

EP0614 Treating wounds in conflict zone and low resource settings: My experience as a wound specialist in Gaza

Laura Swoboda^{1 2 3
1}Association for the Advancement of Wound Care, Milwaukee, United States, ²Carthage College, Kenosha, United States, ³The Healing Institute, Milwaukee, United States

Aim: Dr. Swoboda served as a wound specialist in the Gaza Strip, Palestine. Their experience in treating wounds in this conflict zone setting highlights the challenges of providing care in low-resource and conflict-ridden environments.

Method: Conflict zones place significant burdens on collapsed health systems, with four primary healthcare needs: weapon-wounded, environmental & sanitation issues, general health problems like uncontrolled chronic diseases, and secondary complications from environmental deterioration.

Results / Discussion: Healthcare personnel and patients face heightened risks due to the scarcity of personal protective equipment, poor hygiene, and sanitation. Even basic items like sharps containers are often unavailable. Supplies cannot be reliably sanitized between patients, and room sanitation practices are virtually non-existent, leading to rampant infections, unintentional myiasis, and amputations.
Wounds often go untreated due to a lack of access to essential sanitation items like soap, potable water, sanitizing wipes, and wound cleansers. Additionally, the absence of narcotic pain medications, including for pediatric patients with multiple new limb amputations, results in repeated exposure to procedures without pain relief. Limited antimicrobial availability hinders the treatment of wound infections, osteomyelitis, and sepsis.
Reported death rates are likely underestimated, as casualties who die in the field due to uncontrolled diseases, poor sanitation, starvation, and infection may not be accounted for.

Conclusion: The overarching goal in conflict settings is to aid victims of armed conflict and preserve their dignity. Standard peacetime healthcare services are already limited in many low-income countries. The influx of weapon-wounded individuals and those affected by adverse environmental conditions further overwhelms hospital systems. Extrapolating long-term needs from current disease patterns in Gaza underscores the urgent need for both immediate intervention and sustained support.

 

EP0615 Potential cost savings with the use of hydration response technology (HRT, a unique superabsorber) – A cost comparison in venous leg ulcers

Åsa Vikingson¹, Stefan Walzer^2
1Essity, Gothenburg, Sweden, ²MArS Market Access & Pricing Strategy GmbH,, Weil am Rhein, Germany

Aim: Venous leg ulcers (VLUs) are serious chronic wounds that can take years to heal and impact patient’s quality of life. Comprehensive care requires compression therapy, wound care, and sometimes surgical interventions. The economic burden is substantial; long-term treatment, frequent medical visits, and potential complications can be very costly. Considering the performance of different absorbent dressings, an estimation of outpatient visits and a cost analysis of each dressing was performed.

Method: Foam-dressings utilized were the mostly used ones in Austria and England. Cost input data (per month and 100 patients) were obtained from country-specific databases and public literature. Studies suggest that the HRT dressing* requires fewer weekly dressing changes than foams (2 vs 2.5). Total direct cost including sensitivity for break-even discount and number of visits were calculated.

Results / Discussion: The HRT dressing* could free up to 200 visits.
Reduced costs for superabsorbent dressing* per country:
Austria: –4,298 € vs. FoamA, –5,322 € vs. FoamB, –4,502 € vs. FoamM
England: –3,202 £ vs. FoamA, –3,072 £ vs. FoamB, –3,332 £ vs. FoamM
Costs are reduced by 37% - 66% compared to foam dressings per cm². Results are consistent across countries and product sizes. The analysis demonstrates that treatment with the HRT dressing* in VLU is cost saving and resource-efficient when compared to broadly used foam dressings in Austria and England. To validate shown outcome comparative clinical data are required.

Conclusion: The usage of the HRT dressing* indicates a relevant economical advantage in comparison to foams.

* Cutimed Sorbion® Sachet® S, BSNmedical GmbH/Essity

 

EP0617 The impact of veous leg ulcer s on ecomonmically disadvantaged individuals who are dual enrolles of medicare and medicaid health plans in the United States

Naz Wahab¹, Wiliam Tettelbach², Vickie Driver^3
1Roseman University College of Medicine, 10530 Discovery Dr, Las Vegas, NV 89135, United States, ²Western University of Health Sciences, Pomona, CA, United States, ³Western University of Health Sciences, 309 E. Second St. Pomona, CA 91766-1854, United States

Aim: To quantify and compare health outcomes for Medicare-only versus Medicare/Medicaid population who develop a venous leg ulcer.

Method: Medicare Hospital Inpatient and Outpatient Files were used to VLU follow episodes of care from October 1, 2015 - October 2, 2019.  Propensity matched cohorts were split into patients enrolled in Medicare-only (73%) and Medicare and Medicaid (dual-enrollees, 27%). Treatment methods were compared with CAMP usage, and dehydrated amnion chorion membrane. Claims documented demographics, comorbidities, treatments for VLUs. Outcomes including ulcer closure time, complications, hospital utilization, Quality of Life metrics, pain were compared.

Results / Discussion: 27% of the 530,220555,284 beneficiaries evaluated were Medicare/Medicaid enrollees. For Medicaid, income was below 133% of the federal poverty level. Dual-enrollees, vs. Medicare-only demonstrated a Charlson Comorbidity Index (CCI) score 1 point greater (p=< 0.0001), a 16% increase in ethnic minorities, lengths of treatment that were 16 days longer with higher rates of infection, hospital utilization, and costs. Dual-enrollees who received early and regularly applied CAMPs, such as DHCAM, saw significant reductions in time to ulcer closure, healthcare utilization, and VLU complications.

Conclusion: Socioeconomic status of dual-enrollees includes poverty status, increased ethnic minorities, and high comorbidity rates compared to Medicare-only counterparts. Dual-enrollee VLUs take longer to close, develop more complications, and use more hospital resources. Outcomes improved when VLU episodes provided a CAMP, like DHACM, while following parameters for use. Socioeconomic variables are associated with poor outcomes for patients with VLUs. This should be tracked to find cost-effective interventions throughout their journey to provide equitable care and ensure they are not left behind. Greater access for dual-enrollees to CAMPs, has potential to improve clinical outcomes while reducing overall healthcare expenditures.

 

EP0620 UFECAP: Establishing a complex wound unit in primary care – A nursing-led project

Cèlia Pintado Jou¹, Núria Vidal Martínez¹, Roser Segura Castell¹, Miguel Ángel Díaz Herrera¹, Susana Casaus Carmona¹, Marta Prats Guardiola¹, Montse Villanueva Villanueva^1
1Complex Wound Unit Primary Care Metropolitan South and Penedès (UFECAP), Catalan Health Institute, L’Hospitalet de Llobregat, Spain

Aim: To describe the experience of establishing and developing a Complex Wound (CW) Care Unit within Primary Care Centers (PCC).
Method: The project began in 2017 across PCCs serving a population of 1,350,000 inhabitants and involving 62 PCC. A team of specialized nurses was recruited to support these health centers, and following a period of specialized training, protocols were established for registration, diagnosis, and wound treatment.
In 2020, the model was enhanced by incorporating the Advanced Practice Nurse role, with gradual implementation of this model which was fully completed by the end of 2021.
Results / Discussion:

• Clinical Outcomes: 30% reduction in CW prevalence compared to other regions in Catalonia. Development of CW care pathways in collaboration with six hospitals, integrating PCC with Diabetic Foot Units and Specialized Vascular Units.
• Training: Continuous specialized training and postgraduate studies provided to the CW Specialized nurses.
• Education:

o Training plan implementation for 1,500 professionals.

o Annual specialized health training for 32 nurse residents.

o Participation in two master’s programs focused on CW.

o Coordination of a CW specialization within an official university master’s program.

• Research: Establishment of an accredited research group.
• Innovation:

o Implementation of minor surgery rooms in PCCs for skin grafts in CW.

o Implementation of vascular ultrasound consultations focusing on “Pedal Acceleration Time.”

• Quality: Received the Avedis Donabedian Award for Best Primary Care Project in 2021.
• Economic Impact: €1,500,000 reduction in specific wound care supplies costs from 2020 to 2023.

Conclusion: Specific evaluation and implementation strategies are essential to the successful development of advanced practice models in CW care. The impact of these models within PCC is cost-effective and enhances equity in healthcare delivery.

 

EP0618 Wound care education and professional development initiatives of the wound, ostomy, and incontinence nurses society in Turkey

Zehra Göçmen Baykara¹, Ayişe Karadağ², Emine Sezgünsay³, Derya Karakaya⁴, Senay Gul⁴, Aysel  Ören Hin⁴, Emel Gülnar^4
1Gazi University, Ankara, Turkey, ²Koç University, İstanbul, Turkey, ³İzmir University of Economics, İzmir, Turkey, ⁴YOIHD (Wound, Ostomy and Incontinence Nurses’ Society, Turkey), Ankara, Turkey

Aim: This abstract aims to highlight the role and activities of the Wound Ostomy and Incontinence Nurses’ Society in advancing wound, ostomy, and incontinence care within Turkey.

Method: The Society’s initiatives encompass a multifaceted approach, including workshops, conferences, guides for patients and healthcare professionals, and partnerships with international wound care organizations. Additionally, it designs certification programs for wound and ostomy care nurses and advocates for their legal rights. This study analyzes the Society’s activities over the past year.

Results / Discussion: Throughout 2024, the Society has implemented 22 initiatives aimed at enhancing the knowledge and skills of healthcare professionals and patients in wound, ostomy, and incontinence care. Fifteen activities consisted of participation in national and international conferences and courses. In addition to organizing annual awareness events for Pressure Injury Prevention Day and Ostomy Day, the Society also attended A World Without Skin Tears Day to promote national awareness.

To collectively plan the development of wound and stoma care nurses in Turkey, regional meetings have been held. The Society has revised guides to support the home care of patients with pressure injuries and stomas after discharge. Additionally, the documents “Basic Wound Care for Non-Medics” and “Patient Algorithm for Pressure Ulcer Self-Assessment” from the European Wound Management Association (EWMA) have been translated into Turkish. The Society continues its scientific activities through its research committee

Conclusion: The Society’s initiatives in 2024 have significantly enhanced the knowledge and skills of healthcare professionals and patients in wound, ostomy, and incontinence care. These efforts underscore the importance of structured education and collaboration in improving patient outcomes and advancing nursing practices in these specialized fields.

 

EP0619 Campaign for professional wound therapy as a starting point for systemic changes in patient wound care in Poland

Beata Mrozikiewicz-Rakowska¹, Tomasz Banasiewicz², Przemysław Lipiński³, Piotr Merks^4
1Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw, Poland, ²Department of Surgery, Poznan Medical University, Poznan, Poland, ³Argo Medical Centre, Łodz, Poland, ⁴University of Cardinal Stefan Wyszynski, Department of Pharmacology, Warsaw, Poland

Aim: This project aims to identify the barriers and needs associated with chronic wound care in Poland, addressing the global challenge of effective antimicrobial stewardship. The goal is to present a comprehensive, state-of-the-art proposal to the Minister of Health to support organizational improvements in wound care across Poland.

Method: Seven-member expert council representing various medical fields (surgery, diabetology, nursing, pharmacology) undertook an analysis of barriers to effective chronic wound care in Poland. During four online meetings, they defined the current “state of the art” regarding patient conditions and systemic obstacles. These findings were then refined through nationwide workshops involving 31 experts from across Poland (microbiologists, epidemiologists, surgeons, nurses, diabetologists, and pharmacists).

Results/discussion: During six months of work, the Expert Council developed the “Agreement for Professional Wound Therapy,” which identifies 12 systemic barriers and challenges in chronic wound care in Poland. The document underwent public consultations with a wide range of professional and medical communities, resulting in 38 co-authors contributing to the final version. The Agreement proposes new systemic solutions, starting from reforms in higher and postgraduate education, standardizing procedures and ICD-10/11 coding, and analyzing available funding methods. The document has been endorsed by over 22 institutions.

Conclusion: The current state of care for patients with chronic wounds presents significant challenges for the healthcare system. Although precise statistics are lacking, it is estimated that up to one million Poles suffer from chronic wounds. The assessment presented in the Agreement highlights the need for decisive actions to improve care for patients with non-healing wounds, including the creation of an integrated and interdisciplinary wound care system.

 

 

HOME CARE

EP0451 Transition of care for chronic wounds in community-based care

Ron Ordona¹, Holly Kirkland-Kyhn^2
1Senior Care Clinic House Calls, Care Home By RNs, University of California, Davis, Sacramento, United States, ²University of California, Davis Betty Irene Moore School of Nursing, Sacramento, United States

Aim:

• Identify transition of care opportunities for developing new approaches.
• Appraise the evidence to determine application to local settings.
• Highlight learning to modify practice in terms of added approaches to transitions of care in chronic wounds.

Method: Literature review of transition of care in relation to chronic wounds and community-based providers and care facilities.

Results / Discussion: Looking into an acute care data showed that majority of patients being admitted with chronic wounds are from home, and not from skilled nursing facilities as previously thought.  This opened insights into what can be done for community-based providers and care facilities so wound management education can be rolled out.

Patients are often transported to the ER without family or significant others to relay information.  This is especially hard for older adult community dwellers.  During this transition, vital information can be lost. The same happens when this same individual is discharged back into the community.

Shared educational for mentoring on wound education with outpatient clinics, primary care providers, and others in the community is in development.

Conclusion: Effective coordination of care, discharge planning, and standardization of the discharge planning process is needed to prevent readmissions during the transition from acute to community-based care.

The role of the case manager, the medical house call provider (MD/NP/PA), the home health nurse, and the community-based facilities cannot be overemphasized. Their interoperability is crucial in managing patients with chronic wounds, particularly older adults with multiple chronic conditions.

An interdisciplinary team approach is key; therefore, it is of the utmost importance to educate community-based healthcare team members in wound care and wound management.

 

EP0452 Setting up a wound management clinic for homeless and undocumented people in Amsterdam the Netherlands

Louk van Doorn^{1 2}, Dorien van der Sluis^{2 3
1}Leiden University Medical Center, Leiden, Netherlands, ²Kruispost Amsterdam, Amsterdam, Netherlands, ³Leiden University Medical Center, Kruispost Amsterdam, Leiden, Netherlands

Aim: Setting up a wound management clinic for homeless and undocumented people in Amsterdam, The Netherlands.

Method: Services Offered: Wound Care Management; Health Education; Referrals to Hospitals: Integrated Social Services.

Results / Discussion: Amsterdam is home to a significant number of homeless and undocumented individuals who are particularly vulnerable to chronic wounds and infections due to poor living conditions. Access to healthcare is often limited for these populations, exacerbating preventable health issues. This project outlines the establishment of a dedicated wound management clinic to improve care for these underserved groups.

Conclusion: The establishment of a wound management clinic for homeless and undocumented individuals in Amsterdam is essential to address the healthcare needs of this marginalized population. By collaborating with local services and focusing on cultural competence, this clinic will offer much-needed healthcare access while reducing the burden on emergency services.

 

EP0453 Challenges and application of holistic care model in home-based wound care by family nurse practitioners in Taiwan

Yuan Chun Lo^1
1Hsiao-Chun Home Care Clinic, Taitung, Taiwan

Aim: To explore the challenges encountered by Family Nurse Practitioners (FNPs) providing home-based wound care in rural Taiwan, and to achieve comprehensive support for patients, caregivers, and families through a holistic care model.

Method: FNPs perform comprehensive wound assessments that include wound type, healing stage, infection control, and pain management. Communication strategies are adapted to the diverse cultural backgrounds of patients, caregivers, and families. In resource-limited rural settings, FNPs assess available support systems and facilitate connections to local healthcare, nursing, and long-term care resources. Economic assistance and nutritional guidance are provided as needed.

Results / Discussion: In culturally diverse, resource-constrained environments, FNPs exhibit high cultural sensitivity, adjusting care approaches based on the specific needs of patients, caregivers, and families. By evaluating and integrating local healthcare resources, they ensure continuity of care. During times of financial hardship, FNPs make flexible use of resources, providing cost-effective alternatives and helping patients access appropriate nutritional support to promote wound healing.

Conclusion: Through the holistic care model, FNPs significantly improve wound care outcomes and overall patient health in home-based settings. This model ensures that rural patients, caregivers, and families receive sustained and comprehensive support across physical, mental, and spiritual aspects, contributing to enhanced quality of life and recovery.

 

EP0454 Use of multilayer multicomponent bandage systems with application indicators to improve outcome in the therapy of nenous ulcers by no-specialised personel

Carlo Rivellini¹, Ordonez Esther^1
1Geneal Surgery Unit of Mondovì Hospital, Cuneo, Italy

Aim: This paper is to present the result of systemic use of a multicomponent pressure-controlled bandage system for the management patients with phlebostatic wounds.

Method: 78 patients (of which 25 with BMI>35) with phlebostatic non-healing ulcers were treated as home-patients. All patients were already undergoing restraint and compression therapy performed differently by non-specifically trained healthcare professionals (HCPs). The bandage system introduced was a multicomponent compression bandage with pressure indicators guiding the application in proper stretching and overlapping of the bandage because of its particular ease of use and good tolerability by patients, as well as the ease of combining it with different dressings, including negative pressure. 60 patients enrolled had phlebostatic wounds (38 with primary reflux of saphenous axes and 22 with post-obstructive reflux of deep circulation) and 18 had mixed wounds but with good arterial flows on Doppler. Wound management didn’t change significantly from the pre-enrollment period.

Results: In all enrolled patients, there was significant clinical improvement in about 30 days with a 90% wound healing rate in six months. At the end of the study period, HCPs confirmed the ease of use of the bandage with good confidence when applying it, while patients reported good tolerability.

Conclusion: The use of multicomponent bandages in this experience has confirmed it is possible to significantly improve the efficacy of compression therapy especially in obese patients and patients with post-obstructive type reflux due to increased confidence of HCPs and less fear in giving the bandages the right tension to achieve adequate pressures.

 

 

INFECTION

EP0592 Methylglyoxal - the key to Manuka honey’s efficacy

David Norrie¹, Chris Mcmahon², Denis Watson³, Stephen Bergquist⁴

¹ManukaMed UK, Oxshott, United Kingdom, ²ManukaMed NZ, Hamilton, New Zealand, ³ManukaMed NZ, Masterton, New Zealand, ⁴Jackson Clinic, Jackson, United States

Aim: To compare MGO levels in a variety of honeys and correlate them with microbial killing ability. Outline the relevance to medical wound case studies using medical grade honey.

Method: ZOI studies measuring bacterial killing and measurement of MGO in honey. Clinical case studies using high MGO honey to illustrate practical clinical results.

Results / Discussion:  MGO levels correlate with killing ability in vitro. If you start with a low MGO honey, once you factor in the drop off post gamma sterilization and dilution with wound fluid you fall below a level of MGO that can kill wound pathogenic bacteria.

Conclusion: It is crucial that a honey with minimum MGO concentration of 600mgs/kg is used to treat wounds. Wounds treated with such honey more likely to heal.

 

EP0594 The impact of cancer diagnosis on SSI incidence

Lenka Veverkova¹, Petr Doležal², Jakub Habr¹, Petr Vlček³, Michal Reška⁴, Jan Žák³, Igor Penka^3
11st Surgical Dept., Masaryk University and the Saint Anne University Hospital,, Consulting s.r.o, Brno, Czech Republic 2, Brno, Czech Republic, ²1st Surgical Dept., Masaryk University and the Saint Anne University Hospital,, Consulting s.r.o, Brno, Czech Republic 2, Masaryk University, Brno, Czech Republic, ³1st Surgical Dept., Masaryk University and the Saint Anne University Hospital,, Brno,, Czech Republic, ⁴1st Surgical Dept., Masaryk University and the Saint Anne University Hospital,, Brno, Czech Republic

Aim: The aim of this study was to analyse the incidence of surgical site infections (SSIs) in patients undergoing surgery over a ten-year period and to compare it with that in patients diagnosed with cancer.

Method: A retrospective analysis was performed using data from the Hospital Information System (HIS), focusing on patients who underwent surgery for a primary diagnosis of cancer. A total of 26,486 patients were included in the analysis, of whom 2,298 had an oncological diagnosis. Statistical significance was assessed at a level of 0.05 using t-tests, examining variables such as age, diagnosis, type of surgery, length of hospital stay and incidence of SSI.

Results / Discussion: The results showed that the incidence of SSI was 2-3 times higher in cancer patients compared to non-cancer patients. The confidence intervals ranged from 2.83% to 6.36%, suggesting that there is a 95% probability that cancer patients have a significantly increased risk of developing an SSI. Age was not identified as a statistically significant factor for the occurrence of infections; however, SSIs led to longer hospital stays in both oncological and non-oncological patients.

Conclusion: These findings confirm that oncological diagnosis is a significant factor influencing SSI incidence and highlight the need for targeted prevention and infection management strategies in this population. We recommend further research into specific factors that may increase the risk of SSI in cancer patients and interventions that may reduce these infections. The results of this study may contribute to improved patient care and reduced morbidity associated with surgical procedures in cancer patients.

 

EP0595 Assessing the antimicrobial effect of novel polylactic-acid wound closure matrices

Jose Ramirez-GarciaLuna, Brock Liden^1
1Cutting Edge Research LLD, Circleville, United States

Aim: Chronic wounds, especially in the elderly and patients with comorbidities, pose a major healthcare challenge due to frequent biofilm presence, which complicates healing, prolongs treatment, and increases costs. Polylactic-acid (PLA) based wound closure matrices have shown promise in treating complex wounds, with preliminary evidence suggesting antimicrobial properties. The objective of this research was to evaluate the antimicrobial efficacy of PLA wound closure matrices in both in-vitro and in-vivo models, focusing on bacterial load reduction and immune modulation.
Method: An in-vitro study used human viable skin with partial-thickness burns infected by either MRSA Staphylococcus aureus or Pseudomonas aeruginosa, treated with PLA matrices, copper (Cu) dressings, or no treatment (control). Bacterial counts and cytokine profiles were analyzed after three days. Additionally, a clinical trial randomized 20 patients with grade 2 Wagner diabetic foot ulcers to weekly treatments with either PLA matrices or collagen dressings. Bacterial DNA from wound swabs at baseline, 2, and 4 weeks quantified CFUs.
Results / Discussion: The in-vitro data showed PLA matrices significantly reduced Pseudomonas counts, comparable to Cu dressings, while Cu dressings were more effective against MRSA. PLA-treated tissues showed elevated angiogenic factors and tissue inhibitors of metalloproteinases (TIMPs), supporting tissue repair. In the clinical trial, PLA-treated wounds demonstrated a significant reduction in bacterial bioload by week 4 compared to collagen dressings.
Conclusion: These findings suggest PLA matrices reduce bacterial load, particularly against Pseudomonas, and support tissue repair through increased TIMPs and angiogenic factors. The in-vivo trial confirmed the potential of PLA matrices to reduce bacterial load and improve wound healing, positioning PLA as a valuable option for managing infected chronic wounds.

 

EP0596 Are our guidelines to assess lower limb infection appropriate and inclusive for all skin tones?

Luxmi Dhoonmoon^1
1London North West University Healthcare NHS Trust, London, United Kingdom

Aim: To explore clinicians’ experiences in assessing lower limb infections, particularly in patients with dark skin tones.

Method: Online survey conducted, shared via social media and peers. Target clinicians: podiatrist, Nurses, Doctors, Student nurses and physician associate. Duration of survey 4 weeks.

Results / Discussion: 106 respondents with experiences varied between 0->20years in clinical practice.

While 23% responded they rarely assess patients with dark skin tones, 77% responded they assess patients with dark skin tones daily/ weekly or monthly.

However, only 23% responded extremely confident in identifying lower limb infections in dark skin tones with 58% responded they have never received any formal education on assessing skin conditions in patients with dark skin tones. 47% responded that current guidelines do not address assessment of infections in patients with different skin tones.

Conclusion: The above survey was conducted as a review to inform a qualitative interview at a later stage. However, the data generated from this survey has indicated we need to review our current guidelines, training, and educational materials to reflect different skin tones. This approach will enhance clinical practice and enable patients receiving appropriate care at the right time. Right action at right time will prevent overuse of antibiotics and reduce delay in receiving appropriate care.

 

EP0597 Polymicrobial bacterial contamination of complex lower extremity wounds successfully healed with chlorhexidine gluconate (CHG) and application of skin substitute: Multiple case series

Rimi (Rimvydas) Statkus¹, Patrick McEneaney¹, Peter Lovato^1
1Northern Illinois Foot & Ankle Specialists, Crystal Lake, United States

Aim: Infected ulcers in the lower extremity can pose many challenges in treatment. After stabilization of infection with antibiotics, treatment is often focused on debridement of devitalized tissue for further reduction in bioburden. Re-infection is an ongoing concern, especially when large surface areas are involved. The multiple case series presented highlights successful wound treatment in patients with complicated past medical history deterrents to healing managed with debridement, application of skin substitute and frequent wound irrigation using Chlorhexidine Gluconate (CHG).
Method: 8 patients with complex lower extremity wounds were included in this case series. Following wound debridement, the patient would undergo wound irrigation utilizing 0.05% CHG in sterile saline via handheld jet lavage followed by application of skin substitute.
Results / Discussion: Advanced adjunct therapies – such as the use of a wound disinfectant – may need to be considered in patients with significant comorbidities and other deterrents to healing. Complete closure of the complex wounds was achieved within 2-3 months from initiation of CHG irrigation with wound debridement and application of skin substitute. The patients remained epithelialized and was carefully monitored in the year following treatment.
Conclusion: A combination of surgical intervention, wound debridement, application of skin substitute, offloading, wound disinfectants and other advanced modalities are often required for patients with complex medical conditions for successful limb salvage. This case report exemplifies that a complete clinical picture needs to be considered with aggressive treatment in the setting of surgical site dehiscence and wound contamination.

 

EP0598 Advanced treatment of complex surgical wounds: Case study with polymeric acid and negative pressure therapy

Cláudia Alexandra Cunha¹, Tânia Manuel², Anabela Moura^3
1ULS Santa António, Porto, Portugal, ²Universidade Católica Portuguesa, Porto, Portugal, ³ULS São João, Porto, Portugal

Aim: To demonstrate the efficacy of polymeric acid in the treatment of complex surgical wounds, highlighting its application in combination with negative pressure therapy (NPT) to promote healing in patients with multiple comorbidities.
Method: This is a case study of a 62-year-old patient with a clinical history of COPD (Chronic Obstructive Pulmonary Disease), thyroidectomy, chronic pancreatitis of probable alcoholic etiology, and a smoker.
The patient was admitted with an interocutaneous intestinal fistula located on the posterior aspect of the stomach, close to the gastrojejunal anastomosis.
After surgical excision of the fistula, a progressive treatment protocol was applied. Initially, the surgical wound was treated with saline solution irrigation and application of hydrofiber with silver, and mechanical removal of the fibrin tissue was performed in each treatment.
However, due to the persistence of purulent drainage and fibrin tissue, polymeric acid was introduced on 5/7, in conjunction with NPT.
Results / Discussion: Wound status was monitored regularly, and additional treatments with mechanical debridement and NPT application were performed after 6th and 10th days of the initial application of polymeric acid.
The patient was discharged on 06/06, with indication for continuation of treatment with NPT at home. Complete wound closure was confirmed 15 days after discharge.
The use of polymeric acid has been shown to be effective in the management of complex wounds, promoting a rapid improvement in the condition of the wound and allowing infection control.
Conclusion: Polymeric acid may be a valuable alternative in the treatment of infected surgical wounds, speeding up recovery and reducing hospitalization time.

 

EP0599 Necrotizng fascitis and scoring systems: a systematic review

Carlotta Scarpa^1
1Plastic and Recontructive Surgery Clinic, Padova, Italy

Aim: Necrotizing fasciitis (NF) is a rare and potentially life-threatening bacterial infection of the soft tissues. Various scoring systems have been developed to assist clinicians in assessing the risk of this infection. This systematic review examines and compares these scoring systems in light of recent literature

Method: This review is based on a comprehensive search of the literature on necrotizing fasciitis (NF) and related soft tissue infections published in PubMed in the period from January 1, 2010, to October 20, 2024. The primary search was conducted using the following key words: Necrotizing fasciitis, LRINEC score, Laboratory Risk Indicator for Necrotizing Fasciitis, SIARI score, Systemic Immune-Inflammation Index, Early diagnosis, Inflammatory markers, Risk factors, Mortality, Prognosis.
Results / Discussion: Necrotizing fasciitis (NF) remains a significant diagnostic challenge in clinical practice. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score marked an important step towards a more standardized diagnosis of NF. However, the sensitivity and specificity of the LRINEC score vary considerably, suggesting that while it is a useful tool, it should not be used as the sole diagnostic criterion. The introduction of the Systemic Inflammatory Response Index (SIARI) represents a significant improvement by integrating both clinical and laboratory parameters. Its higher diagnostic accuracy, with C-statistics above 0.8. ; this score can be more suitable in emergency settings. The Systemic Immune Inflammation Index (SII) emerges as an innovative biomarker, and its correlation with worse outcomes in NF suggests a potential role not only in diagnosis but also in prognosis and risk stratification of patients.

Conclusion: A critical aspect that has emerged from this review is the importance of a multimodal diagnostic approach.

 

EP0600 Efficacy of a topical desiccating agent in chronic wounds and in-patient pathway in real life

Hajnal-Gabriela Illes¹, Olivier Illes², Quentin Guerin³, Lydie Rio³, Emilie Haumont³, Avenier Alexandra³, Justine Rissel³, Emma Turlure³, Françoise Hemon³, Jean-Paul Lembelembe³, Cécile Libois^3
1Clinique des Augustines, Chronic Wound Department, Malestroit, France 56140, Malestroit, France, ²Saint Julien College, Malestroit, France, ³Clinique des Augustines, Malestroit, France

Aim: To evaluate the application of Topical Desiccating Agent (TDA) from January to October 2024, on various chronic wounds, aiming for rapid granulation by the third month post-treatment with a single 60-second application of TDA. 

Method: This single-center prospective study followed patients treated with TDA for chronic hard-to-heal wounds over three months. Data collected included demographics, comorbidities, wound type, bone or tendon exposure, sepsis presence, dermohypodermatitis, antibiotic therapy, length and type of hospitalization, and wound assessements at one, two, and three months. 

Results / Discussion: Over nine months, 20 patients (13 males) received TDA, with an average age of 74 years (15-96 years). Eleven had stage IV obliterating arteriopathy of the lower limbs, six had vascular stents, four were neurological patients, and four had diabetes mellitus. The cohort included eight with pressure ulcers (six on lower limbs), nine with arterial ulcers, two with diabetic foot ulcers, and one with a venous ulcer. Six patients presented with sepsis and five with necrotic dermohypodermatitis; 11 received antibiotic therapy. Two patients died after discharge, and four dropped out, returning to their initial wound centers. 

By the third month, nine out of 10 patients showed wound improvement (four still in follow-up). Two achieved complete healing (one sacrococcygeal cyst, one heel pressure sore), and one arterial ulcer had over 80% healing. None underwent RECOSMA laser or skin grafting; two had negative pressure wound therapy. 

Conclusion: TDA is an effective chemical debridement method for complex wounds in elderly patients with comorbidities, facilitating accelerated healing.

 

EP0602 Hyperbaric oxygen therapy in necrotizing fasciitis treatment: An observational comparison study

Marco Marcianò¹, Sefora La Sala¹, Vincenzo Benenati¹, Marco Graziano², Roberto Gullo², Giuseppe Carollo², Valentina Lombardo², Francesco Maltese², Gianfranco Cocorullo¹, Giovanni Guercio^1
1Università Degli Studi di Palermo, Palermo, Italy, ²A.O.U.P. Paolo Giaccone, Palermo, Italy

Aim: Necrotizing fasciitis is a rare and progressive infection characterized by necrosis of the fascia and subcutaneous tissue, often associated with severe systemic toxicity. Therefore, early recognition and treatment are essential; in untreated patients, mortality approaches 100%. The standard treatment protocol involves aggressive debridement of necrotic tissue combined with broad-spectrum antibiotic therapy and hemodynamic support. The addition of hyperbaric oxygen therapy (HBOT ) to these treatments appears to provide enhanced support and reducing mortality rates.

Method: We propose a retrospective observational study on patients admitted to our department with a diagnosis of necrotizing fasciitis. The first group received standard treatment and hyperbaric oxygen therapy, while the second group was threated with standard therapy alone. For each patient, the LRINEC score was calculated at the time of admission, as well as 1 day and 7 days after first surgical intervention. In the first group, the LRINEC score was also calculated 1 and 7 days after the first hyperbaric treatment session

Results / Discussion: The analysis of the LRINEC score trend enabled us to determine whether the use of HBOT contributes to a more favorable prognosis for patients. The results revealed that in the first group, there was a significant reduction in the LRINEC score compared to the group treated with standard therapy alone.

Conclusion: HBOT, due to the direct bacteriostatic and bactericidal action, represents an essential tool when combined with surgical intervention and antibiotic therapy. This approach is crucial against  the progression of necrotizing infections and it reduces patient mortality.

 

EP0603 Navigating complex wound healing in hidradenitis suppurativa: A post-surgical case report

Gulnaz Tariq^1
1International Inter-professional Wound Care Group (IIWCG), Abu Dhabi, United Arab Emirates

Aim: This case study examines the post-surgical outcomes of a 35-year-old male patient diagnosed with Hidradenitis Suppurativa (HS), a chronic, inflammatory skin condition characterized by recurrent, painful nodules and abscesses, primarily affecting intertriginous areas. The study aims to highlight the complexity of managing advanced HS and the challenges associated with postoperative care and long-term disease control. 

Method: The patient had a long history of recurrent HS in the axillary and inguinal regions, leading to extensive scarring, sinus tracts, and secondary infections. Despite multiple pharmacological treatments, including antibiotics and biologics, the disease remained refractory, necessitating surgical intervention. The patient underwent wide excision of affected areas, followed by dressings to manage the large wound beds. Postoperative care involved wound management, infection control through chemical debridement, and pain management. 

Results / Discussion: Over several weeks of follow-up, the patient showed significant wound healing and improvement in quality of life, although some complications, such as delayed wound healing and social isolation, were noted. This case underscores the importance of a multidisciplinary approach, including dermatologists, surgeons, and wound care specialists, to achieve optimal patient outcomes. 

Conclusion: This abstract provides a concise overview of the patient’s condition, treatment, and outcomes, which would be expanded upon in the full case study, emphasizing the need for comprehensive management strategies in advanced HS cases. 

 

EP0604 Chronic pain reduction in complex hard-to-heal wounds by chemical debridement

Jannie Jongedijk¹, Uulkje Bron¹, Saskia Van der Graaf-Ijsselstein^1
1QualityZorg, Nieuw-Vennep, Netherlands

Aim: Non healing ulcers can be very painful and this can impact significantly the quality of life of the patient. The patients are not able to partake in society or worklife, causing stress that impacts wound healing. The addition of Topical Desiccating Agent (TDA) application to standard wound care in a pilot trial indicates that this chemical debridement has a positive effect on chronic wound pain.

Method: Within a pilot study executed by QualityZorg, the Netherlands, of using TDA in homecare an unexpected outcome was noticed, chronic wound pain reduction. TDA has then been used to increase patient comfort (chronic wound pain reduction) in 8 patients as main target, wound healing was a secondary outcome that was monitored.

Results / Discussion: Average age is 75 (range 45-97); population 8 (6 male); 1 pressure ulcer without Diabetes, 1 pressure ulcer with Diabetes, 2 trauma ulcers, 2 arterial ulcers, 2 venous ulcers. Average chronic wound pain duration: 6 weeks. 50% has no chronic pain within 2 weeks of TDA application. 12,5% has sporadic stinging pain. 37,5% have pain reduction increase happiness. 37,5% have completely healed. 37,5% have had no oral antibiotic treatment to treat bacterial infection. 1 patient healed within 3 weeks of TDA. Both arterial ulcers (notoriously painful ulcers) have reported strong chronic pain reduction.

Conclusion: Concluding this series, patients suffering from chronic ulcers with high chronic wound pain levels that impact the quality of living can benefit of a single TDA application to reduce that pain and promote the quality of life. 

 

 

LEG ULCER

 

EP0329 Risk factors for lower extremity edema in patients with chronic leg ulcers: A multicenter study in Hubei Province, China

Man Luo^1
1Wuhan Third Hospital Affiliated with Wuhan University, Wuhan, China

Aim: This study aimed to examine the frequency and risk factors associated with lower extremity edema in chronic leg ulcer patients.

Method: This cross-sectional multicenter study used convenience sampling to enroll 300 chronic leg ulcer patients from four centers in China between November 2023 and June 2024. Data were obtained from medical records, imaging, and interviews. Edema was assessed through bilateral limb circumference differences, the Pitting Edema Test, and Stemmer’s sign, with severity categorized using the modified Fukazawa method and International Society of Lymphology staging.

Results / Discussion: Lower extremity edema occurred in 71.33% of patients , with only 14.02% receiving compression therapy. Independent risk factors included vascular ulcers (odds ratio (OR)=4.82, 95% confidence interval (CI) 2.22–10.45), being wheelchair-bound (OR=3.52, 95% CI 1.08–11.42), bedbound (OR=5.02, 95% CI 1.03–24.61), overweight (OR=2.48, 95% CI 1.04–5.92), obese (OR=2.95, 95% CI 1.14–7.69), having diabetic peripheral neuropathy (OR=2.76, 95% CI 1.14–7.69), wound size >25 cm² (OR=3.61, 95% CI 1.09–11.95), wounds located on the ankle (OR=4.00, 95% CI 1.26–12.69) or anterior tibia (OR=3.49, 95% CI 1.10–11.13). Larger and longer-duration wounds were correlated with the severity of edema. Stratified analysis showed increased edema risk in patients with vascular ulcers who smoked (OR=9.56), or had diabetes (OR=8.51).

Conclusion: This study identified several risk factors for lower extremity edema in chronic leg ulcer patients. Notably, wound size and duration affect the progression of edema, highlighting the necessity for integrated management of wound care and edema to promote healing.

 

EP0330 Multimodality therapy in venous leg ulcer management

Kien Phan^{1 2
1}Cho Ray Hospital, Ho Chi Minh, Viet Nam, ²Edopi Healthcare, Ho Chi Minh, Viet Nam

Aim: Compression is cornerstone therapy of venous leg ulcer (VLU). However, some complicated VLUs have difficulties in completely healing. The aim of this study was to evaluate the effectiveness of multimodality therapy in venous leg ucer management.
Method: Retrospective study of 21 VLU patients who had failed with alone compression from 2022 to 2024. We combined many modalities: endovenous intervention for saphenous and deep vein incompetence, bridge vaccum-assisted closure (VAC), bordered foam dressing and topical acid hyaluronic. Wound area and reduction were measured by Imito application.
Results / Discussion: Average wound area was 25,9 cm². All patients were applied bordered foam dressing to control exudate. 14 patients with saphenous vein incompetence underwent thermal ablation, 1 patient with May Thurner syndrome underwent iliac stenting. 6 patient with post thrombotic syndrome(PTS) were not suitable for deep vein intervention. The rates of completely healing at week 12 and 36 were 66,7% and 85,7%. 3 PTS patients not healed at week 36 received bridge VAC, topical acid hyaluronic and completely healed at week 51.
Conclusion: Multimodlity therapy should be considered as the first approach in complicated venous leg ulcer management, especially in PTS patients.

 

EP0636 Physiotherapy in the management of venous leg ulcer: An outpatient consultation at the dermatology wound centre

Jessica Otero Gerpe¹, Sandra De Almeida Baptista¹, Laurence Toutous Trellu¹, Damien Pastor¹, Isabelle Empeyta^1
1Hôpitaux Universitaires de Genève, Geneva, Switzerland

Aim: Wounds and chronic oedema are common disorders. Poorly controlled oedema is a risk factor for wound and infectious complications such as cellulitis potentially leading to repeated hospitalizations. To optimize chronic oedema management, we have developed a physiotherapy outpatient consultation at the dermatology wound healing centre. Our goal was to promote ulcer healing and reduce hospitalization related to wound complications through adequate treatment of oedema.

Method: The multidisciplinary approach contains medical, nursing and physiotherapeutic evaluations, limb hygiene skincare, manual lymphatic drainage, complex wound care, adapted compression bandaging, therapeutic education, anticipation of complications followed by long-term compression garments after wound healing. Number of healed ulcers, limb volume reduction (centimetric measurement) and hospitalization rate before and after physiotherapy treatment were evaluated.

Results / Discussion: From April 2021 to August 2023, 38 patients (23 men, 15 women), mean age 69 (± 14.25) received 2-3 times/week treatment during a mean follow-up of 4.4 months (± 5.6). 60 limbs were treated, 38 of whom had ulcers (33 venous etiology, 5 mixed ulcers). Our approach allowed ulcer healing in 20 limbs out of 38 (table 1) and edema reduction in 100% of cases. We observed no hospitalization (for dermatological admission reason) during the physiotherapy follow-up compared to 15 patients out of 38 who had had 1 or more hospitalizations since 2020 (18 in total) without physiotherapy follow-up (table 2).

Conclusion: Outpatient physiotherapy combined with specialized nursing wound care could be beneficial in oedema reduction, ulcer healing and a reduction of hospitalization related to wound complications during follow-up.

 

EP0331 Challenging the status quo to improve lower limb wound management for patients in hospital

Kim Whitlock¹, Polly Cox^2
1North Bristol NHS Trust, Bristol, United Kingdom, ²Urgo Medical, Shepshed, United Kingdom

Aim: Upon hospital admission it has been standard practice in the U.K. to remove compression therapy and not continue until the patient is discharged. A hospital trust tissue viability (TV) team established a collaborative leg ulcer pathway to ensure continuity of care for patients.

Method:

• Collaborative working with stakeholders to create a leg ulcer pathway enabling seamless care for patients in hospital and community services.
• Creation of a virtual leg ulcer clinic for inpatients in which their leg ulcer care is delivered by the TV team.
• A two-layer multi-component bandage system and TLC-NOSF dressing as the first choices for those with complex leg ulcers.
• Separate pathways for admission areas and hospital wards to standardise leg ulcer care prior to attending the clinic.
• Partnership working with industry and community TV team to provide education and clinical skills training to the TV team.

Results / Discussion: In the first four months 77 patients were reviewed by in the leg ulcer virtual clinic; 38% had not had an ankle brachial pressure index completed in the community and 21 patients that could have been in compression were not. Positive responses about the service have been received from both patients and clinicians.

Conclusion: Challenging the status quo of patient care delivery requires drive, determination, and courage. The TV team identified that the lack of consistent leg ulcer care within hospital care was impacting patients, and that there were system wide inconsistencies. By working collaboratively with a range of stakeholders they have commenced a journey to improve leg ulcer care.

Reference:
The two-layer multi-component bandage system is UrgoKTwo. The TLC-NOSF dressing is the UrgoStart Plus Treatment Range.

 

EP0333 Leg ulcers: Improving patients outcomes by following national guidance

Polly Cox¹, Yvonne Manning², Kate Lewis², Elizabeth Merlin-Kwan^3
1Urgo Medical Limited, Loughborough, United Kingdom, ²HCRG Care Group, West Lancashire, United Kingdom, ³Urgo Medical, Loughbrough, United Kingdom

Aim: To monitor healing rates for patients with legs ulcers by ensuring adherence to the local clinical pathway. An evidence-based pathway was introduced locally to standardise care. However due to increasing demands on community nurse’s caseload and unbalanced skill mix, implementation was poor. This resulted in leg ulcer patients not receiving the recommended treatment or ankle brachial pressure index (ABPI) assessments being undertaken.

Method: The pathway was amended to include national guidance and recommendations. A tissue viability nurse supported the team of community clinicians with implementation. This facilitated improved adherence to the leg ulcer pathway for patients on their case load.

Results / Discussion: An audit of patients with leg ulcers was performed and during a 3-month period 27 patients were fully assessed and commenced on the pathway. Wound duration was recorded as >12 months, 6-12 months, 3-6 months and up to 3 months. Fifty percent of wounds greater than 1 year of age healed within 3 months. For wounds that were between 6-12 months, 100% healed in less than 2 months and for wounds between 3-6 months 83% healed within 3 months. Full outcome data will be detailed.

Conclusion: These results validate the importance of consistent implementation of standardised evidence-based pathways in improving outcomes for patients with leg ulcers and reducing the demand on clinical resources.

 

EP0334 Superior healing outcomes with an advanced wound care dressing vs. standard of care in hard-to-heal venous leg ulcers: Results from a multinational randomized controlled trial

Stefania Beraldo¹, Matthias Schneider¹, Frau Drews¹, Cristin Taylor², Beate Paintner-Hanson^2
1DRK-Krankenhaus Mölln-Ratzeburg GmbH, Ratzeburg, Germany, ²Convatec, Deeside, United Kingdom

Aim: To evaluate the performance of a carboxymethylcellulose dressing containing ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride* (‘CISEB’) versus a dialkylcarbamoyl chloride-coated dressing (‘DACC’)† in venous leg ulcers (VLUs).

Method: This study was conducted in 2022–2024 across Germany, the United Kingdom, and Columbia. Subjects were randomized to the CISEB or DACC arm. Therapeutic compression and routine wound care were standardized management in both arms. Subjects returned to clinic for weekly follow-up. The primary endpoint was complete wound closure at 12 weeks. Additional endpoints included time to complete wound closure and incidence of adverse events (AEs).

Results / Discussion: 203 subjects were randomized to CISEB (n=100) or DACC (n=103). Final analysis included 109 wounds in the interventional arm and 110 wounds in the control arm. Wounds treated with CISEB displayed significantly higher healing rates at 12 weeks than those treated with DACC (74.8% and 55.6%, respectively, superiority p-value <0.0031). CISEB-treated wounds were 35% more likely to heal completely by 12 weeks than those treated by DACC [Relative Risk 1.35 (95% CI, 1.10-1.65, non-inferiority p<0.0001)]. Time to complete wound closure was shorter in CISEB-treated wounds compared to DACC (median 56 and 70 days, respectively, p<0.0272). 11 AEs in 5/101 (4.95%) subjects from CISEB arm were recorded with 27 AEs in 18/102 (17.65%) subjects from the DACC arm.

Conclusion: Hard-to-heal VLUs treated with CISEB were found to achieve superior clinical outcomes with significantly higher healing rates, shorter time to wound closure, and fewer AEs compared to those treated with DACC.

*Aquacel® Ag+ Extra™

†Cutimed® Sorbact®

 

EP0335 Venous leg ulcer management with a biofilm-targeted dressing

Honda Hsu^1
1Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan, School of Medicine, Tzu Chi University, Hualien, Taiwan, Dalin, Taiwan

Aim: Venous leg ulcers (VLUs) present considerable treatment challenges due to their chronic nature, which often leads to cycles of ulceration, healing, and recurrence. The presence of biofilms in these wounds further complicates management, as biofilms increase resistance to antimicrobials and slow down healing. This study examines the efficacy and safety of using a biofilm-targeted dressing (AQUACEL™ Ag+ Extra) alongside compression therapy in the management of VLUs.

Method: This retrospective analysis reviewed patients with VLUs treated from January 2019 to January 2023, focusing on those who met specific inclusion criteria such as age, ulcer classification, duration, and confirmed presence of varicose veins. Patients treated with AQUACEL™ Ag+ Extra were included, with data collection covering demographics, comorbidities, surgical interventions, and wound characteristics.

Results / Discussion: The study included 27 cases, consisting of 10 male and 17 female patients, with an average age of 76 years (range: 51–87 years). Complete wound healing occurred in an average of 63 days (range: 21–245 days). By week 24, all but one patient had achieved full ulcer healing. Specifically, 88% (22 patients) healed by 16 weeks, 76% (19 patients) by 12 weeks, 68% (17 patients) by 8 weeks, and 12% (3 patients) by 4 weeks. Wounds showed an average reduction in size of 1.83 cm² every two weeks.

Conclusion: The combination of biofilm-targeting dressings with compression therapy effectively enhanced wound healing in chronic VLUs. However, adherence to compression therapy remains crucial for achieving optimal results. Further studies are needed to assess the long-term efficacy and cost-effectiveness of this treatment strategy.

 

EP0336 An open-label, proof-of-concept study assessing the effects of bromelain-based enzymatic debridement on biofilm and microbial loads in patients with venous leg ulcers and diabetic foot ulcers

Cyaandi Dove¹, Stephen  Heisler², Howard  Petusevsky³, Aya  Ben-Yaakov⁴, Robert Snyder^3
1University of Texas Health Science Center at San Antonio, San Antonio, United States, ²University of North Carolina at Chapel Hill, Chapel Hill, United States, ³Barry University, Miami, United States, ⁴MediWound Ltd., Yavne, Israel

Aim: Most chronic wounds contain biofilm, and debridement remains the centerpiece of treatment. Enzymatic debridement is an effective tool in removing nonviable tissue; however, there is little evidence supporting its effect on planktonic and biofilm bacteria.  This study evaluated the effects of Bromelain-Based Enzymatic Debridement (BBD), a mixture of proteolytic enzymes derived from the pineapple stem, currently in late-stage clinical development, on removal of nonviable tissue, biofilm, and microbial loads in patients with chronic ulcers.

Method: Twelve patients with Diabetic Foot Ulcers (DFU) or Venous Leg Ulcers (VLU) were treated with up to 8 once-daily applications of BBD and then followed up for an additional 2 weeks. Punch biopsy specimens were collected and analyzed for biofilm. Fluorescence imaging was used to measure bacterial load. 

Results / Discussion: Ten patients completed treatment, and 7 achieved complete debridement within a median of 2 applications (range, 2–8). By the end of the follow-up, the mean ± SD reduction in wound area was 35% ± 38. In all 6 patients who were positive for biofilm at baseline, the biofilm was reduced to single individual microorganisms or no detected microorganisms by the end of treatment. Red fluorescence for Staphylococcus aureus decreased from a mean of 1.09 cm² ± 0.58 before treatment to 0.39 cm² ± 0.25 after treatment. BBD was safe and well tolerated.

Conclusion: The results of this clinical study suggest that BBD may be effective in debriding DFU and VLU, reducing biofilm and planktonic bacterial load, and promoting reduction in wound size.

 

EP0337 Effective management of traumatic wounds in elderly patients: A therapeutic holistic approach with tlc-nosf tecnology and a novel monolayer multicomponent compression system

Victoria Hernández^1
1Angiogrup, Barcelona, Spain

Aim: To assess the efficacy of a therapeutic holistic approach combining local wound care and etiological treatment in managing traumatic wounds in elderly patients with multiple comorbidities. Secondary objectives include evaluating the safety and efficacy of a novel monolayer multicomponent compression system for treating non-venous wounds in the lower limb and reducing healing times.

Method: A weekly follow-up was conducted with three patients who had traumatic wounds between 10.5 and 16cm2 of surface area, located in the tibial crest region. All individuals presented positive pulses. Initially, a silver poly-absorbent dressing coated with lipido-colloid technology (TLC-Ag) was applied to regulate bacterial colonies and facilitate debridement. Following this, a dressing with lipido-colloid technology and nano-oligosaccharide factor (TLC-NOSF) was utilized to reduce excessive metalloproteinases and promote rapid wound healing. A monolayer multicomponent compression system was applied throughout the entire course of treatment.

Results / Discussion: All three individuals achieved complete wound healing after 3 weeks. The use of TLC-NOSF dressings facilitated rapid tissue regeneration, while the novel monolayer multicomponent compression system further promoted edema reduction and enhanced wound healing by facilitating patient compliance to compression therapy.

Conclusion: The therapeutic holistic approach, combining innovative local wound care alongside a new monolayer multicomponent compression system, effectively enhanced the healing of traumatic wounds in elderly patients receiving anticoagulant therapy. While compression therapy is not conventionally employed for traumatic wounds, these findings highlight its efficacy in preventing complications such as dissecting hematomas, bacterial infections, and wound chronification, by substantially reducing time for wound healing. Also, the strategic approach to wound management using TLC-NOSF technology reflects the potential to improve clinical outcomes by biochemically regulating proteases in complex patients.

 

EP0338 Use of synthetic poly-lactic acid alloplastic skin substitute in a pyoderma gangrenosum, increase in temperature and oxygenation

Mario Aurelio Martínez-Jimenez¹, Jose Ramirez-GarciaLuna, Brock A Liden², Ana Lorena Novoa-Moreno¹, Víctor Manuel Loza González¹, Samuel  Kolosovas-Machuca^3
1Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ²Surgical Services, Berger Health System, Ohio, United States, ³UASLP, San Luis Potosí, Mexico

Aim: Pyoderma gangrenosum is a rare noninfectious neutrophilic dermatosis, that presents with rapidly developing, painful skin ulcers with peripheral erythema. Topical therapy with modern wound dressings is useful to minimize pain and the risk of secondary infections.

Method: 48 year old female patient presenting a 3 month evolution, full thickness ulcer measuring 11.8 cm2 (4.2cm long, 3.7cm wide), located in the mid-third and anterior part of the right leg, with active exudate, 90% fibrin, 5% nectotic tissue and 5% granulation tissue, with pain 8 of 10. Having a confirmatory diagnosis of pyoderma gangrenosum with negative bacterial culture growth a polylactic acid dressing is applied weekly for 6 weeks until the wound reached 50% of granulation tissue and 50% for re-epithelization, and without pain.

Results / Discussion: Wound closure was performed at week 12 after the start of treatment, with the first thermography recording showing a difference between the wound and healthy skin of -4.4 ºC, at week 6 a difference of -3.3 ºC and at the end of treatment confirmation of wound closure with no difference in temperature. Measuring oxygen with the KENT near-infrared spectroscopy camera, the difference between the oxygen in the wound and healthy skin was 13%, at week 6 it was 8% and at week 12 there were no differences.

Conclusion: The use of synthetic poly-lactic acid alloplastic skin substitute as a local treatment is a simple, practical and effective method for the treatment of difficult-to-heal full-thickness ulcers such as pyoderma gangrenosum lesions. In this case demonstrated by the use of thermography and near-Infrared spectroscopy camera.

 

EP0339 Inflammation-resolving wound dressing improves wound healing in chronic wounds

Lucas Schirmer¹, Passant Atallah², Sebastian Kühn², Carsten Werner^{1 3}, Uwe  Freudenberg^2
1Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Dresden, Germany, ²Leibniz Institute of Polymer Research Dresden, Dresden, Germany, ³Technische Universität Dresden, Center for Regenerative Therapies Dresden, Dresden, Germany

Aim: Excessive, chronic inflammation remains a major cause of delayed wound healing in chronic wound patients. Capturing and neutralizing inflammatory mediators offers a powerful new strategy for improving healing of chronic wounds^,1,2. Here, we evaluate the safety and efficacy of a novel polymer-coated, non-occlusive, drug-free wound dressing that resolves inflammation in the wound bed and therefore promotes complete wound healing.

Method: We enrolled adults with moderate-to-severe venous leg ulcers into a prospective, multi-center, interventional, and randomized investigation. 108 Patients either receive the inflammation-resolving wound dressing or a standard of care wound contact layer together with compression therapy for up to 12 weeks or until complete healing. Progress is assessed based on the objective measurement of the wound area. Secondary outcome measures include the wound condition, the exudate amount and consistency, the dressing change-related pain, and the patient’s quality of life.

Results: The first results of the ongoing trial demonstrate weekly improvements of the wounds treated with the new dressing until full healing, together with wound area reduction and general amelioration. Both clinical and patient feedback reflect an improvement of the wounds from week to week, which also included less pain and much improved mobility.

Conclusion: Our findings demonstrate that inflammation-resolving dressings offer a novel and suitable strategy for managing VLUs. Direct treatment of the underlying inflammation might further improve healing results in other types of chronic wounds.

References:

1: Schirmer, L., Atallah, P., Freudenberg, U. & Werner, C. Chemokine-Capturing Wound Contact Layer Rescues Dermal Healing. Advanced Science 8, 2100293 (2021).

2: Lohmann, N. et al. Glycosaminoglycan-based hydrogels capture inflammatory chemokines and rescue defective wound healing in mice. Science Translational Medicine 9, eaai9044 (2017).

 

EP0340 The treatment of hard-to-heal leg ulcers using autologous whole blood clot: Acase series report

Minna Hellgren¹, Maria Honkala^2
1Helsinki University Hospital, Helsinki, Finland, ²Helsinki University Hospital, Trade name Maria Honkala, Helsinki, Finland

Aim: Managing hard-to-heal leg ulcers can be challenging because of their multiaetiological nature and many other factors influencing the healing process. This report includes wounds with multiple aetiologias and with an age over one year. The wounds had been treated with other surgical procedures prior to the whole blood clot treatment. The focus in this report is to present the results in treating hard-to-heal leg ulcers with whole blood clot treatment to recreate the natural wound healing environment.

Method: Six (6) individuals with leg ulcers were treated with autologous whole blood clot created at point of care by using their own blood. The treatment was optimized by using the TIMERS-model.

Results / Discussion: In all the cases the autologous whole blood clot activated the vitality and the growth of the granulation tissue of the wounds. In one week, the healing percentage of the wound surface was 94% at the highest and 15 % at the lowest. The average healing percentage was 39,9% at week. In two of the cases, the wounds were healed completely in six weeks of using blood clot treatment.

Conclusion: The autologous whole blood clot seems like a promising treatment option for hard-to-heal leg ulcers for which surgery is not an option. Additionally, it can even be a cost-effective alternative for surgery. The autologous whole blood clot treatment can be used to boost the wound healing process. Using the TIMERS-model the whole blood clot is suitable under the letter R: Repair and Regeneration. More research is needed in the future.

 

EP0341 Physiotherapy intervention management to support venous ulcers treatment: delphi panel results

Sabrina Medeiros¹, Alexandre Rodrigues^{1 2}, Rui Costa^1
1School of Health Sciences, University of Aveiro, Aveiro, Portugal, ²Centre for Health Studies and Research of the University of Coimbra (CEISUC), Coimbra, Portugal

Aim: To investigate physiotherapeutic interventions for the management of venous ulcers.

Method: Exploratory and descriptive study using the Delphi method. The interventions were identified through a systematic literature review and subsequently evaluated by a panel of 12 wound care experts over two rounds of analysis. Quantitative analysis measured the level of agreement among the answers, while qualitative analysis was applied to the experts’ comments. Ethical approval was obtained from the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA:E) of the Coimbra Nursing School (Number 705/09-2020).

Results / Discussion: In the first round, consensus among the answers ranged from 80% to 100%, while in the second round it increased to a range of 83.3% to 100%. By the end of the second round, all interventions had achieved a minimum consensus of 80%.

Conclusion: Physiotherapy serves as an adjuvant therapy in the management of venous ulcers. The intervention includes therapeutic exercises such as resistance training, aerobic training, stretching, balance training, and the use of a vibrating platform, alongside compression therapy. All interventions are adjuvant to a specific local wound treatment.

 

EP0342 Use of PRP for chronic wounds in arteriopathic patients

Laura Viviani¹, Raffaella Cordelli², Monia Della Valle^3
1Asst Valtellina ed Alto Lario, Sondalo, Italy, ²Rete di Cure Domiciliari, Sondalo, Italy, ³RSA Baita Serena, Valfurva, Italy

Aim: Ischemic wounds represent a clinical condition that afflict in a chronic and a disabling way the population, due to various factors: physical factor because of pain and handicap, psychological factor because of lack self-sufficiency, and the social factor that require people to receive treatments repeated in time.

The main purpose of this study is to evaluate the effectiveness of Platelet Rich Plasma for chronic wounds in arteriopathic patients, after a limb revascularization. The expectation is that PRP use could speed up wound healing
Method: Systematic review of literature, in database like Pubmed, Embase, Cochrane Library. Use of PICO framework: 
P: chronic arteriopathic patients with chronic wounds that received limb revascularization
I: use of PRP as wound dressings
C: comparison with traditional wound dressings used
O: Speed up wound healing
Results / Discussion: Before PRP application, patients underwent surgical debridment, lifestyle correction: (blood sugar, smoke, dyslipidemia). Wound dressings were carried out twice a week. Results: significant reduction of wound size, improvement of tissue perfusion in skin graft, faster healing of wound in diabetic foot, pain reduction and improvement in quality of life. The systematic review made by Martinez-Zapata ed al are based on low quality evidence due to the small number of studies and patients included.
Conclusion: It is unclear if PRP is involved in wound healing. This is biologically safe, simple to use, non-allergenic, painful less.  However, further studies are required.

 

EP0343 Venous leg ulcer in a patient with Chagas heart disease: a case report

Mariana Bandeira¹, Janaina Silva², José Luis Lázaro-Martínez³, Vera Lucia Conceição Gouveia Santos^1
1University of Sao paulo, Sao Paulo, Brazil, ²Urgo Medical, Sao Paulo, Brazil, ³Complutense University of Madrid, Madrid, Spain

Aim: Chagas Heart Disease (CHD) is an inflammatory cardiomyopathy characterized by chronic fibrosing myocarditis and progressive impairment of myocardial function1. The decreased cardiac capacity affects the venous return and the ulcer healing. However, the literature has not discussed the relationship between venous leg ulcers (VLU) and CHD. This study aims to report the case of a VLU in a female patient with CHD and discuss the relationship between the diseases.

Method: The photographic and patient data were recorded after she signed the consent form for image use. The patient had a venous leg ulcer located on the left malleolus measuring 24 cm2. The peripheral pulses were present, and the ankle-brachial index was 1.3. Topical treatment was performed with appropriate wound care: cleansing and selective instrumental debridement, a multicomponent compression system at 40 mmHg, and dressings for each phase of the healing process. Initially, we applied a hydro-desloughing structure combined with TLC-Ag healing matrix dressing focusing on debridement and managing moisture and infection. Once healthy tissue was observed, the TLC- NOSF sucrose octasulfate lipidocolloid matrix was used to inhibit excess metalloproteinases and promote the action of cells necessary for healing.

Results / Discussion: The patient achieved complete ulcer healing and limb preservation six months later. The relationship between venous insufficiency and heart failure is rarely discussed and may hinder the implementation of compression therapy. However, by employing gold-standard care, the outcome was positive.

Conclusion: This case demonstrates that the multicomponent compression system associated with appropriate wound care is potentially effective in healing, even in individuals with Chagas Heart Disease, a common condition in Latin America.

 

EP0346 Bridging the gap: accessible wound care for homeless community

Ciara Cotter¹, Caitriona Doyle^2
1The Dublin Simon Community, Dublin, Ireland, ²North West HSE, Dublin, Ireland

Aim: Homeless populations face heightened risks for acute and chronic wounds due to complex factors such as unstable living situations, multi-faceted comorbidities and limited healthcare access, all of which complicate wound management. Our aim was to address these barriers by delivering adaptable, effective wound care solutions within the homeless community. 

Method: Homeless clients are often transient and may not attend regular appointments, we established wound care clinics in homeless accommodation aiming to reduce barriers to wound care for homeless clients. Our integrated care plan offered on-site wound care clinics in hostels, offering walk-in access without the need for appointments.  

We chose an Enzyme Alginogel, a dressing that debrides, has antimicrobial properties, and absorbs exudate, making it ideal for clients who may not return for weeks. It allows longer intervals between changes while maintaining wound integrity, enhancing management and overall healing for patients with inconsistent wound care. 

Results / Discussion: We succeeded in overcoming specific wound care challenges for homeless clients, whose transient lifestyle often limits follow-up. For client safety, we found that using a natural Enzyme Alginogel dressing is especially beneficial for homeless clients, reducing the risk of tissue damage from embedded dressings. 

Conclusion: Considerations need to be made when treating homeless clients, the clinician must adapt their choice of dressings to suit the lifestyle of the person. We found that by using a natural Enzyme Alginogel, it acts as the ideal dressing of choice for homeless clients as it reduces the incidence of embedded dressings causing tissue damage. 

Dressing used in clinics: Flaminal  

 

EP0347 High intensity focused ultrasound (HIFU) - SONOVEIN^®: a case report of successful treatment of recurrent heel venous ulcer

Orlanda Castelbranco¹, Ana Matos^2
1CUF Sintra, Hospital Egas Moniz, Lisboa, Portugal, ²Hospital Egas Moniz, Lisboa, Portugal

Aim: To report a clinical case of recurrent heel venous ulcer successfully treated with high intensity focused ultrasound (HIFU) applied to a perforating vein of the foot.

Method: A 70-year-old female patient with post-thrombotic syndrome and recurrent venous ulcer (C6rEsiApPr) on the left heel with a 9-year progression. Already treated with one session of foam sclerotherapy without success. Duplex ultrasound revealed recanalized  femoral vein with compensatory superficial system and, on the inner aspect of the heel, a large (3 mm) infra malleolar perforator with reflux. The patient underwent SONOVEIN® of the perforator vein with 16 pulses of 1 second. Complete ulcer healing was observed within one month, with closing of the perforator. After 10 months there were partial re-opening of the perforator but the ulcer did not recur.

Discussion: SONOVEIN® represents the first fully non-invasive treatment for insufficient perforators promoting exovascular ablation of veins. There has been a previous report of ulcer healing in the ankle with Sonovein®, but to our knowledge, this is the first report of foot ulcer closed with the HIFU technology. Although the vein closure has not been permanent it helped to diminish the venous hypertension without recurrence of ulcer, 10 months after treatment.

Conclusion: HIFU should be considered a valuable option in cases of recurrent ulcers and fragile skins and the future direction should involve improving technology to allow persistent closure of more superficial veins.

 

EP0348 Homologous skin grafts in typical and atypical cutaneous ulcers

Serena Corraro, Agata Janowska¹, Bianca Cei¹, Alessandra Michelucci¹, Marco Romanelli¹, Valentina Dini^2
1University of Pisa, Pisa, Italy, ²University of Pisa, PISA, Italy

Aim: Chronic ulcers pose a significant therapeutic challenge. This study aims to assess the effectiveness of homologous skin grafts in promoting the healing of chronic ulcers, both typical and atipica.
Method: 44 patients with non-healing ulcers, despite receiving adequate treatment, underwent homologous skin grafting. Treatment efficacy was evaluated based on the incidence of surgical site infection, wound bed granulation, pain reduction with improved mobility, and enhancement in quality of life and physical-psychological status. Ulcer dimensions were measured using a 15 cm ruler and a three-dimensional laser camera. Wound bed quality was assessed using the Wound Bed Score (WBS), and patient pain perception was measured using the Numerical Rating Scale (NRS). Assessments were conducted at baseline (T0, graft day) and weekly for 8 weeks. Local graft management was standardized with steri-strips for skin anchoring and a silver-infused polyurethane foam dressing.
Results / Discussion: Patient ages ranged from 28 to 87 years. The baseline ulcer area varied from 0.3 to 125.3 cm². After 8 weeks, 13 patients achieved complete wound healing, while the remaining 31 showed significant reductions in lesion area and improvement in wound bed quality. Pain perception also significantly decreased by week 8, with an NRS reduction of 6 points from baseline.
Conclusion: The ideal dressing for chronic wounds should provide adhesion, breathability, elasticity, bacterial barrier function, lack of toxicity and immunogenicity, ease of application and removal, and cost-effectiveness. Donor skin grafts exhibit most of these characteristics. By adhering closely to the wound bed, they not only act as a physical barrier but also create a microenvironment that stimulates the host’s immune response, controls bacterial proliferation, and promotes tissue formation.

 

EP0349 Multicenter retrospective study on the efficacy of multicomponent compression therapy as first-line treatment for hematomas in elderly patients

Paz Beaskoetxea Gómez¹, Nuria Serra Perucho², Ana  Roig Garcia ^3
1Unidad Multidisciplinar de Heridas Complejas de la Organización Sanitaria Integrada (OSI) Barrualde-Galdakao, Vizcaya, Spain, ²Angiogrup, Barcelona, Spain, ³Clinical Department, Urgo Medical Spain, Barcelona, Spain

Aim: In elderly patients, hematomas can progress into dissecting hematomas, leading to skin ischemia and extensive necrotic areas. Without early intervention, these injuries often require aggressive debridement, resulting in substantial tissue loss and diminished quality of life. This study aims to assess the efficacy of multicomponent compression therapy (monolayer and bilayer) for these injuries through a descriptive and statistical analysis of hematoma evolution in elderly individuals.

Method: A multicenter, national, retrospective, non-controlled study was conducted involving patients with dissecting, subcutaneous, and intramuscular hematomas in the lower limbs. Data collected included demographic information, wound descriptions, hematoma characteristics, and lesion evolution for descriptive analysis. Patients without peripheral arterial disease (PAD) were treated with either a monolayer or bilayer multicomponent compression system. Local treatment was administered based on the healthcare professional’s assessment of wound bed conditions, including cleansing, debridement, and antimicrobial dressings in cases of infection or metalloproteinase-modulating dressings to promote healing.

Results / Discussion: Preliminary findings indicate that early compression therapy significantly accelerates hematoma healing, facilitating reabsorption without complications and reducing the need for aggressive debridement. In superficial hematomas, compression alone allowed for rapid reabsorption, while in deep or dissecting hematomas, it promoted complete epithelialization post-debridement. Across both groups, multicomponent compression therapy minimized complications, demonstrating its effectiveness as a primary treatment strategy for managing hematomas.

Conclusion: Early compression therapy should be a first-line treatment to standardize care for lower extremity hematomas, particularly in elderly patients with anticoagulation, multiple comorbidities, or impaired gait and stability. This approach may prevent complications and improve outcomes in this vulnerable population.

 

EP0350 Literature review: Use of autologous platelet-rich plasma as an adjuvant for the treatment of chronic vascular ulcers

Alicia Herance Blasco¹, Paqui Pavón Rodríguez¹, Enric Mateo Viladomat¹, Sergio Aparicio López¹, Joan Mora García¹, Inmaculada Artero Jiménez¹, Yolanda Rodríguez Hernandez¹, Marta Gibert Arnau^1
1CASAP Can Bou, Castelldefels, Barcelona, Spain

Aim: The general aim is to determine the efficacy, effectiveness and adverse effects of using autologous platelet-rich plasma to treat chronic vascular wounds that do not respond to conventional treatments.

Method: A literature review was carried out using Pubmed, Dialnet and Google Scholar databases, with studies published between 2012 and 2023, written in English or Spanish and freely accessible. The Boolean operators “AND” and “OR” were used. The following keywords were used: “platelet rich plasma”, “ulcer” and “chronic wound”.

Results / Discussion: 11 articles were selected to respond to the aim set. The studies show the quick healing and safety of using PRP in vascular ulcers, as well as reducing allergies associated with certain types of dressings. Most ulcers heal in approximately 10 weeks, using the gel rich in growth factors once a week.

Conclusion: There are no proven adverse effects in the use of PRP. The use of PRP gel reduces the risk of infections, as well as pain, increasing the quality of life. In all of them, a reduction in hospital stay has been shown, in addition to decreasing in morbidity and mortality. The use of prepared kits could entail a higher cost than if the material available in a primary care center is used. However, it is necessary to avoid the variability of methods of obtaining PRP in order to analyse the results more objectively. Likewise, there are not many studies with a sufficient sample size to compare the use of plasma with conventional therapies.

 

EP0351 Assessment of a novel multi-sensor, pressure-monitoring system (MSPMS) for targeted compression application in venous leg ulcer treatment

Liz Hawes¹, Daphne Hazell^1
1Home Wound Care UK, Bognor Regis, United Kingdom

Aim: The cornerstone of venous leg ulcer (VLU) treatment is compression therapy. Unfortunately, there is a 90% failure to achieve targeted pressure in clinical practice and pressure can be rapidly lost due to swelling reduction and non-compliance. The current study assesses the use of a novel multi-sensor, pressure-monitoring system (MSPMS), including a wearable device and associated digital platform, for improving the targeted application and self-management of compression therapy in VLU patients.

Method: VLU patients (n=7) were provided standard compression therapy for 2-4 weeks, prior to applying compression under the guidance of the MSPMS for a further 2-4 weeks. Pressures were measured at the point of application (blinded during the standard compression therapy period) and remotely shared by patients and/or their informal carers. Healing rates were compared between periods of unguided and guided compression application.

Results / Discussion: Average pressures achieved in the unguided application were 44.8±1.8 mmHg, 41.5±3.4 mmHg, and 37.9±3.4 mmHg at C, B1, and B positions, respectively. Average pressures achieved in the guided application were 55.4±3 mmHg, 51.4±2.1 mmHg, and 53.8±2.5 mmHg at C, B1, and B positions, respectively. All patients and/or their carers were able to remotely transmit pressure data on a daily basis. Statistically higher pressures that were achieved using guided application resulted in 2.15% wound area reduction per day (%WAR/day), compared to 1.41 %WAR/day in the paired unguided group (n=5). A positive Pearson correlation coefficient of 0.47 was found between total pressure applied and %WAR, suggesting a moderate relationship between compression pressure and healing at the pressure range assessed.

Conclusion: These results highlight the potential of the MSPMS to impact compression application, promote self-management, and improve healing rates of VLUs.

 

EP0352 Treatment of venous ulcers with multifuncional polymeric membrane dressing under compression

Maria Jose Gil Mosteo¹, Mª Isabel Ballester Zanuy², Belen Vazquez Rodriguez³, Rosa María Bonilla Sánchez³, Joaquín Fidalgo Perniá⁴, Veronica Sierra², Adrian Díaz Bermejo^2
1Servicio Aragones de Salud, Zaragoza, Spain, ²Institut Català de la Salut, Barcelona, Spain, ³Servicio Madrileño de Salud, Madrid, Spain, ⁴Hospital General de Defensa, Zaragoza, Spain

Aim: Most below-knee lower extremity ulcers are venous in origin, resulting from venous hypertension commonly associated with chronic venous insufficiency. The aim is to combine the primary treatment for venous ulcers, compression, with a multifunctional polymeric membrane dressing (MPMD).

Method: Application of MPMD under compression without using any other product on the wound. Assessment of: dressing change duration, pain reduction using the Visual Analog Scale (VAS), healing time, ease of application and removal. Eight individuals with venous wounds treated in primary care over the past year were evaluated. All signed informed consent and data transfer.

Results / Discussion: All participants were women with a mean age of 78.6 years. Ninety percent of the dressings were changed weekly, primarily using the highest absorption MPMD. Complete wound healing was achieved in an average of 7.5 weeks. Pain was reduced by 2 points on the VAS and remained at low levels in subsequent dressings. Ease of application and removal was positively evaluated by professionals.

Conclusion: MPMDs have demonstrated efficacy in healing venous ulcers under compression, reducing associated pain, positively impacting healing, reducing the use of multiple products, and improving patients’ quality of life

 

EP0362 Importance of negative pressure wound therapy in the management of leg ulcers with complex aetiology

Antal Jobbágy¹, Norbert Kiss¹, András Bánvölgyi^1
1Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary

Aim: Management of chronic wounds with complex aetiology is a major challenge for both patients and healthcare systems. Nowadays, negative pressure wound therapy (NPWT) is considered as one of the most advanced and minimally invasive techniques to manage wound healing.

Method: The aspects of NPWT are presented in cases of Wegener-granulomatosis, Warfarin-induced skin necrosis, deep vein thrombosis induced leg ulcer and wound with multidrog-resistant bacteria. Patients were examined by surgeons to rule out the possibility of acute intervention. If it was necessary, imaging examinations were performed. Investigations were carried out to exclude autoimmune background, coagulation disorders and malignancy. In addition, microbiological swabs were taken to start adequate antibiotic treatment and eliminate the pathogens. Regular wound debridement and necrectomy were performed during hospitalization. After clarification of the etiological factors, NPWT of the leg ulcers was used for 14 days.

Results / Discussion: In combination of adequate treatment of the underlying diseases, NPWT reduced the amount of exudate, cleared the wound bed and induced healing. At the same time, it significantly decreased the amount of pain. The vacuum effect also contributed to the elimination of pathogens that colonised the wound. This led to a reduction in the patients’ drug consumption and the number of bandage changes.

Conclusion: In case of leg ulcers with complex aetiology, NPWT improves wound healing in several ways. Generally, it improves quality of life and reduces the burden on healthcare systems in the longer term.

 

EP0353 Effectiveness of self-efficacy enhancement interventions in patients with venous ulcers: a systematic review

Nilgun Sert Bas¹, Hatice Ayhan^2
1Ankara Medipol University, Ankara, Turkey, ²University of Health Sciences Turkey, Ankara, Turkey

Aim: The aim of this systematic review is to examine randomized controlled intervention studies to increase the self-efficacy of patients with venous ulcers, to provide recommendations for clinical practice and to raise awareness.

Method: A literature search was performed in PubMed, Wiley Online Library, Google Scholar databases between 11-18 October 2024. In these searches using the keywords “venous ulcer, self-efficacy” defined in the MeSH Index, randomized controlled trials published in all years in English were examined. Studies that were incompatible with the relevant subject and duplicate studies were excluded.

Results / Discussion: A total of 50 articles were accessed. Randomized controlled trials (n=7) were included in the systematic analysis. It was observed that 4 leg exercises, 1 cryotherapy, 1 education and 1 individual lifestyle counseling intervention were compared with standard care in the studies conducted with a total of 671 patients. In 2 studies where exercise intervention was applied, a statistically significant relationship was found between exercise self-efficacy and adherence to exercise program and wound healing (p<0.05). Cryotherapy did not affect patients’ self-efficacy (p=0.988). It was found that the educational intervention increased (X̄=264.5; SD 22.94) the initial self-efficacy scores of the patients (X̄=247.7; SD 55.90). Individual lifestyle counseling was found to be statistically significantly effective in behavior change in young patients (p=0.009).

Conclusion: The results of this study show that exercise program, education and individual counseling are effective in improving the self-efficacy of patients with venous ulcer and wound healing. Accordingly, it is recommended to include these interventions in venous ulcer treatment in clinical practice.

 

EP0354 Leg ulcers associated with antiphospholipid syndrome, investigation of the mtor pathway

András Kovács L¹, Csaba Gyömörei², Réka Dudley³, Szabina Horvath¹, Zsuzsanna Lengyel¹, Rolland Gyulai^4
1Department of Dermatology, Venereology and Oncodermatology, Medical School, Clinical Centre, University of Pécs, Pécs, Hungary, ²Department of Pathology, Medical School, Clinical Centre, University of Pécs, Hungary, Pécs, Hungary, ³Department of Dermatology, Veszprém County Csolnoky Ferenc Hospital, Veszprém, Hungary, ⁴Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary

Aim: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by persistently elevated levels of circulating autoantibodies against phospholipid/protein cofactors (aPL), hypercoagulability, venous, arterial, and microvascular thrombosis, and obstetric complications. The aPL antibodies, by binding to vascular endothelial cells, activate the mammalian target of rapamycin (mTOR) signaling pathway, which regulates cell growth, proliferation, and survival. Its activation results in intimal hyperplasia and vasculopathy, which occurs despite appropriate anticoagulation.

Method: Between January 2020 and June 2023, the authors retrospectively evaluated the prevalence of aPL antibodies among patients with lower leg ulcers developed as a result of post-thrombotic syndrome (PTS-ulcer). In aPL-positive patients, samples were taken from the edge of the ulcers by punch biopsies (sample amount: 10) and examined for the activation of the 2 mTOR complexes using immunohistochemical reactions: mTORC1 - S6 ribosomal protein (S6RP), mTORC2 - through AKT (Ser473) phosphorylation.

Results / Discussion: Among 104 PTS-ulcers, aPL (lupus anticoagulant, anticardiolipin, antibeta-2-glycoprotein) prevalence was 23%. In the endothelial cells of small vessels, cytoplasmic S6RP positivity was detected in 100% (10/10) of cases, while AKT phosphorylation was always negative, indicating the activation of one branch (mTORC1) of the mTOR pathway.

Conclusion: Currently, thrombosis prevention remains the primary therapeutic focus in APS. Literature highlights mTOR inhibitor (sirolimus) efficacy in preventing vasculopathy recurrence and graft loss in APS patients post-kidney transplantation. Based on the authors’ investigations, the mTOR pathway activation in specimens from aPL-positive lower leg ulcers implies the potential use of mTOR inhibitors for preventing or treating vasculopathy and ulcers.

 

EP0355 Evaluation of compression therapy and hydrophobic antimicrobial dressings as an holistic management for venous leg ulcer: a case series

Priscila Cantú Saucedo¹, Paulina Morelos Guzmán^2
1UANL, Monterrey, Mexico, ²UNAM, Ciudad de México, Mexico

Aim: Chronic venous ulcers (CVUs) present a significant clinical challenge due to their high prevalence and complexity in treatment. This study aims to evaluate the efficacy of a treatment protocol combining multilayer compression therapy and hydrophobic DACC (Dialkyl Carbamoyl Chloride) coated antimicrobial dressings.

Method: A retrospective case series was conducted with 8 patients diagnosed with chronic venous ulcers. The ulcers ranged in size from 6-9 cm², had an average duration of 12 months before treatment, and exhibited moderate to severe exudate. Patients were treated with a multilayer bandage, including an Unna boot and an inelastic compression bandage, in combination with DACC coated dressings. Dressings were changed every 5 days over a 16-week period. Primary outcomes assessed were epithelialization and complete ulcer closure, evaluated through periodic clinical reviews.
Results / Discussion: All patients achieved epithelialization and complete ulcer closure within the study period. The combination of multilayer bandages and DACC dressings proved effective in promoting the healing of chronic venous ulcers. Additionally, there was a significant reduction in ulcer size and exudate levels.

Conclusion: Multilayer compression therapy combined with hydrophobic antimicrobial dressings (DACC) is an effective strategy for the holistic management of chronic venous leg ulcers. This approach can significantly improve clinical outcomes and reduce the economic burden associated with the treatment of these lesions.

 

EP0356 2-year experience with hyperbaric oxygen treatment of hard to heal diabetic and venous ulcers in specialised clinic

Edvin Mahmutović¹, Albin Totić¹, Milisav Galjak¹, Sabina Kurtović Serezlić¹, Meho Mahmutović, MD PhD^2
1Specialised Hospital for Internal and Hyperbaric Medicine “M Medical Clinic”, Novi Pazar, Serbia, ²General Hospital Novi Pazar, Novi Pazar, Serbia

Aim: In this retrospective study, we evaluated the effect of Hyperbaric Oxygen Treatment (HBOT) in treatment of patients with hard to heal diabetic and venous ulcers, performed between January 2022 and December 2023 in our clinic.

Method: Each HBOT cycle lasted for 60 minutes. Wound care prior to every HBO therapy consisted of cleansing, surgical debridement and antiseptic treatment with octenidine.

Results / Discussion: From 184 patients in total, nine were excluded due to incomplete documentation and seven more who stopped treatment due to reasons not related to HBOT. Of remaining 168 patients in this study, 58.93% were male and average age was 66.07 +/- 11.60 years. Wounds persisted prior to HBOT for 166.96 +/- 112.91 days with different clinical manifestations in size and depth, localized in following anatomical regions: crural (14.3%), tarsal (17.9%), pedal (23.2%) and phalangeal (44.6%). Number of treatments per patient was 30.71 +/- 12.60 within 53.02 +/- 21.63 days, pressure averaging 1.69 +/- 0.22 ATA.

Of note, after the last HBO treatment: complete wound healing was achieved in 96/168 (56.36%), in 54/168 (32.73%) granulation with islands of epithelised tissue was present and further wound hygiene was continued at home, and in remaining 18 patients (10.91%) granulation started and wound management was continued in outpatient clinic.

Conclusion: In conclusion, HBOT in combination with octenidine resulted in significant percent of healed and completely granulated wounds in our study (89.09%). In order to minimise the risk of amputation, it is highly recommendable to consider implementation of this protocol in treatment algorithm of hard to heal wounds.

 

EP0357 Identifying risk factors and mitigation strategies for venous ulcer recurrence: A scoping review

Daniela Fonseca¹, Marcia Correia², Paulo Alves^3
1Universidade Católica Portuguesa, Centre for Interdisciplinary Research in Health (CIIS), Porto, Portugal, ²Mater Misericordiae University Hospital, Universidade Católica Portuguesa, Dublin, Ireland, ³Universidade Católica Portuguesa - Centre for Interdisciplinary Research in Health (CIIS), Faculty of Health Sciences and Nursing, Associação Portuguesa Tratamento de Feridas, Porto, Portugal

Aim: Venous leg ulcers (VLU) heal slowly and frequently recur, significantly affecting individual’s physical and psychological well-being and creating financial burden for patients and healthcare systems. Research indicates that more than half of VLU’s are expected to recur within a year of healing. The aim of this study was to identify the most commonly associated risk factors for venous ulcer recurrence and to explore strategies for their mitigation.

Method: This scoping review adhered to the Joanna Briggs Institute methodology. The search was conducted in databases such as PubMed and EBSCOhost, including all studies regardless of publication year. A peer review process was also implemented to ensure the quality and validity of the findings. The descritors used were “venous leg ulcer”; “Risk factors”; “Recurrence”; “Nursing”.

Results / Discussion: This scoping review investigates risk factors for VLU recurrence and prevention strategies analyzing 17 studies. VLU recurrence is influenced by patient-related factors (advanced age, history of deep vein thrombosis, low physical activity, limited social support), disease-related factors (chronic venous insufficiency, comorbidities), and treatment-related factors (adherence to compression therapy). Key prevention strategies include consistent compression therapy, patient education, psychosocial support and routine monitoring.

Conclusion: This review highlights the critical importance of compression therapy in managing VLU and the need for empowering patients through education and using risk assessment tools to enable personalized interventions. Future research should prioritize on strategies that enhance patient adherence to compression therapy and focus on multicenter studies to validate findings across diverse populations of these preventive measures.

 

EP0358 Conservative strategy maintaining scabs to promote epithelialization of acute and chronic wounds

Lorena Sanchez Mantero¹, Elena Conde Montero^2
1Atencion Primaria, Madrid, Spain, ²Hospital Virgen de la Torre, Madrid, Spain

Aim: Scabs are commonly mistaken with dirt, rubbed and washed... However, they can be very useful and the traditional practice of its removal could be a barrier to the physiology of the natural healing process.

When signs of infections are present, scabs should be removed. On the other hand, when scabs are dry, attached to the wound bed and without signs of inflammation in the perilesional skin, they may be considered part of the physiological healing process. As research on scabs is lacking, we present a case series on wounds that are having a good progression and, are not cleansed.

Method: We present a series of cases showing that we do not perform any kind of these scabs in wounds that are progressing well. To promote the maintenance and protection of this new scab, and to avoid its maceration in exudative wounds, barrier products containing zinc oxide at each dressing change could are used. We commonly use alginate as a primary dressing, regardless of wound exudate, considering that it may form a matrix that can simulate the physiological scab, specially spacing out dressing changes.

Results / Discussion: All cases epithelialized with spaced out dressing changes and absence of wound cleansing, with scabs protecting the neoformed epidermis.

Conclusion: In addition to being beneficial for the wound, maintaining protective scabs, avoiding the pain and trauma involved in each dressing change, is also an eco-responsible strategy. But the benefits of this strategy, so far, are only based on observation. Studies are needed to better understand the dynamic structure of scabs and to bust false myths. It is curious that the “so frequent scabs are so unknown”.

 

EP0359 Case study to evaluate clinical benefit of cohesive 2 layer compression in combination with superabsorbent dressings for the treatment of highly exuding venous leg ulcers

Christine Bongards¹, Luxmi Dhoonmoon^2
1Solventum, Kamen, Germany, ²London North West University Healthcare NHS trust, London, United Kingdom

Aim: Determine clinical outcomes and patient and clinician preference of a cohesive two-layer compression system (C2LC)* in combination with Superabsorbent Dressing (KC-SAD)^† for treatment of highly exuding venous leg ulcers (VLUs).
Method: Patients with highly exuding VLUs and history of compression care were recruited from 3 different wound clinic sites by tissue viability nursing specialists. C2LC system in combination with KC-SAD was implemented and assessed over a minimum of 3 weeks. Clinical parameters including wound healing, circumference measures to evaluate oedema, dressing leakage, bandage slippage, and frequency of visits were assessed. Additionally, patient-reported outcomes and clinician satisfaction were evaluated before and after implementation of C2LC.
Results / Discussion: Patients with history of highly exuding VLUs and compression care were included in this case series (n=12).  With C2LC the dressing change frequency was reduced from 2-3 visits per week to once per week. C2LC stayed in place until next scheduled appointment and no strikethrough of exudate through the bandage observed. All patients demonstrated improvements in leg oedema, with reduced mean ankle circumference from 29.4 cm to 25.1 cm within 2 weeks. Within 2-4 weeks, 3 VLUs closed and 9 required continued care, with patients expressing a preferences for the continuation with C2LC. All clinicians reported C2LC as the preferred compression system and highlighted the ease of application.
Conclusion: In these patients, the tissue viability nursing team noted improved clinical outcomes, ease of application, and improved patient acceptance when C2LC and KC-SAD were used as compression care.

 

EP0360 Evaluation of the efficacy and tolerance of the multi-component reduced-compression system for venous leg ulcers

Joy Tickle¹, Hollie Robinson², Lorraine Grothier³, Georgina Ellis^4
1Isle of Wight NHS Trust, Isle of Wight, United Kingdom, ²South Warwickshire University NHS Foundation Trust, Leamington, United Kingdom, ³Laboratoires Urgo, Shepshed, United Kingdom, ⁴Northamptonshire Healthcare, Wellingborough, United Kingdom

Aim: This study assessed the benefits of the multi-component reduced-compression system (20 mmHg) in patients presenting with venous leg ulcers (VLU). The primary focus is on wound healing rates over 4-12 weeks of treatment, while secondary outcomes assess local tolerance, specifically the occurrence of adverse events.
Method: This retrospective, non-comparative, multi-center study collected data on patients treated with the multi-component reduced-compression system across three NHS sites inthe United Kingdom. Medical records of 100 patients with VLU, treated as part of standard care from January to June 2024, were reviewed. Inclusion criteria include patients aged 18 or older, treated in an outpatient setting, with an ankle-brachial pressure index (ABPI) between 0.8 and 1.3. Baseline data captured demographics, comorbidities, venous disease history, and ulcer characteristics.
Results / Discussion: Primary outcomes focus on wound healing (defined as 100% epithelialization) within 4-12 weeks were a high percentage of VLUs were healed. Secondary outcomes involve clinicians’ and patients’ acceptability of the reduced-compression system that was very positive due to due to the benefits of early intervention of care in accordance with the National Wounds Care Strategy recommendations.
Conclusion: This study provide insights into the potential benefits of the multi-component reduced-compression system in managing VLUs in diverse patient populations such as low compliance patients or patients whereby ABPI is yet to be performed, is difficult, or delayed due to local service demands. This evaluation may enhance patient outcomes through optimized wound care strategies adapted for all patients.

 

EP0361 Case studies on the clinical effectiveness of superabsorbent dressings combined with cohesive two-layer compression bandages for treating highly exuding venous leg ulcers

Christine Bongards¹, Laura Paterson^2
1Solventum, Duesseldorf, Germany, ²NHS Ayrshire and Arran, Ayr, United Kingdom

Aim: Compression therapy increases healing and lowers recurrence of venous leg ulcers (VLUs). This study evaluated the clinical performance of two superabsorbent dressings (SAD) used with a cohesive two-layer compression system (C2LC^*) for the management of highly exuding VLUs.

Method: Patients with highly exuding VLUs were treated with C2LC combined with two sequential SAD treatments. Standard of care SAD (SOC-SAD) were used for two weeks followed by four weeks of treatment with SAD that wick and lock-in exudate (KC-SAD^†). Wound size reduction, edge maceration, and surrounding skin condition, as well as dressing leakage, saturation, and slippage, were assessed with patient-reported outcomes.
Results/Discussion: Treatment was discontinued in 1 of 10 patients during the first SAD treatment. Little to no improvement was observed in 50% (5/10) of wounds treated with C2LC and SOC-SAD. Positive healing progression was observed in 100% (9/9) of wounds treated with C2LC and KC-SAD. Wound size reduction led to use of smaller SAD sizes, with no significant difference in dressing saturation (0.45-0.46 g/cm², p-value=0.76418). KC-SAD significantly reduced dressing leakage frequency (p-value<0.001) and improved maceration and surrounding skin conditions in all cases. No slippage was observed during use of C2LC with any SAD. Patients consistently reported enhanced comfort, less strike through and leakage, and a reduction in heat and moisture under the bandage. Dressing and compression-related pain was reduced when using KC-SAD and C2LC.

Conclusion: Use of KC-SAD with C2LC reduced wound edge maceration, promoted wound healing and enhanced patient quality of life. Larger studies are required to confirm these improved outcomes.

* 3M™ Coban™ 2 Two-Layer Compression System, ^†3M™ Kerramax Care™ Super-Absorbent Dressing (Solventum Corporation, Maplewood MN, USA)

 

 

NEGATIVE PRESSURE WOUND THERAPY

EP0363 What is the impact of negative pressure wound therapy on healing in patients post excision of pilonidal sinus? A systematic review and meta-analysis

Liliana Morais¹, Zena Moore^{1 1 2 3 4 5 6 7 8}, Declan Patton^{1 2 3 9}, Tom O’Connor, Hannah Wilson^1
1Royal College of Surgeons Ireland, Dublin, Ireland, ²Fakeeh College of Health Sciences, Jeddah, Saudi Arabia, ³School of Nursing and Midwifery, Griffith University, Queensland, Australia, ⁴Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia, ⁵Department of Public Health, Faculty of Medicine and Health Sciences, Ghent, Belgium, ⁶Lida Institute, Shanghai, China, shanghai, China, ⁷National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia, ⁸University of Wales, Cardiff, UK, Cardiff, United Kingdom, ⁹Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia, Wollongong, Australia

Aim: This systematic review aimed to determine the impact of negative pressure wound therapy on healing in patients with pilonidal sinus following surgical excision.

Method: Using systematic review methodology, we included original research studies written in English. The search was conducted using CINAHL Plus, Ovid, PubMed, EBSCO Host and Cochrane databases. Quality appraisal was undertaken using the evidence-based librarianship (EBL) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were analysed using meta-analysis where appropriate, otherwise the data are presented narratively.

Results / Discussion: Ten studies were included with a mean sample size of 61 (SD: 33). Three studies were randomized control trials, four were retrospective studies, two were prospective cohort studies and one was pre-post study. Studies showed reduction in wound healing time, recurrence rates and postoperative pain, as well as higher patients’ satisfaction with the use negative pressure wound therapy. However, the certainty of the evidence was very low.

Conclusion: The findings underscore the efficacy associated with use of negative pressure wound therapy, highlighting its potential as a treatment option post excision of pilonidal sinus. However, the very low certainty of evidence, demands more rigorous research with larger sample sizes, to consolidate these findings and explore sustained benefits.

 

EP0364 Negative pressure wound therapy (NPWT) after hybrid reconstruction of occipital pressure sore using local flap and skin graft

Jun Ho Park¹, Ji Won Jeong^1
1Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Rep. of South Korea

Aim: Pressure sores are a common medical burden among patients particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment.

Method: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group.

Results / Discussion: The NPWT group (n=24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared to the conventional dressing group (n=22) (98.2% vs. 81.2%, p<0.05). No significant difference in flap survival rate was observed between the two groups.

Conclusion: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

 

EP0365 Negative pressure wound therapy with instillation for peri-prosthetic infection following breast reconstruction: A systematic review

Ashley Collinsworth¹, Leah Griffin¹, Robert Galiano^2
1Solventum, Maplewood, MN, United States, ²Department of Surgery/Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, United States

Aim: Peri-prosthetic infection following breast reconstruction is not uncommon and can result in loss of the implant pocket and negative patient outcomes. Management of these infections typically involves removal of the prosthesis, treatment with antibiotics, and delayed reconstruction upon infection resolution. The impact of adjunctive use of negative pressure wound therapy with instillation and dwell (NPWTi-d) on breast pocket salvage rates, time to implant reinsertion, and related outcomes was examined.

Method: A systematic literature search using PubMed, Cochrane, OVID, Scopus, and Embase was conducted to identify peer-reviewed articles written in English and published between January 2004 and April 2023 that examined NPWTi-d* use in the breast pocket with a history of peri-prosthetic infection following breast reconstruction.

Results / Discussion: Of the 1703 publications, 6 studies met inclusion criteria, representing 115 patients and 122 breasts. Overall breast pocket salvage rate with NPWTi-d across studies was approximately 92%. In the 5 studies that included prosthesis type and radiation history, overall salvage rates were 97.8% (45/46) for pockets containing implants and 93.8% (15/16) for pockets containing tissue expanders. Salvage rates were 85.7% (12/14) and 91.7% (53/58) for irradiated and non-irradiated breasts respectively. Mean time to implant reinsertion ranged from 2.3 to 10.3 days.

Conclusion: In this review, antibiotic therapy along with adjunctive use of NPWTi-d for peri-prosthetic infections following breast reconstructions was associated with high rates of breast pocket salvage and reduced time to implant reinsertion. Larger prospective and randomized trials are needed to better understand and optimize the effectiveness of NPWTi-d in this population.

*3M™ Veraflo™ Therapy, Solventum Corporation, Maplewood, MN

 

EP0366 Application of negative pressure wound therapy after early-stage subungal melanoma functional surgery and delayed skin grafting

Kyoung Ae Nam^1
1Yonsei University Severance Hospital, 50-1 Yonsei-Ro, Seodaemun-Gu, Dermatology Outpatient Clinic, Seoul, Rep. of South Korea

Aim: Early-stage subungal melanoma (SUM) can be treated with functional surgery instead of amputation. Conservative treatment using Mohs Micrographic Surgery of the nail unit bed followed by delayed skin grafting. The objective of this study is to evaluate the efficacy of the negative pressure wound therapy (NPWT) after early stage subungual melanoma functional surgery and delayed skin grafting.

Method: Retrospective review of 92 patients (50 males,42 females) from August 2011 to December 2023 was performed.

Results / Discussion: Mean age of the patients was 56.7 years (18~90 years) with 50 male patients (54.3%) and 42 female patients (45.7%) and all patients were diagnosed with early-stage SUM. The most common anatomical site was thumb in 36 patients(39.1%), followed by great toe 29 patients(31.5% ), Index finger in 9 patients(9.8%), 3rd finger in 5 patients(5.4%), 4th finger in 6 patients(6.5%), 5th finger in 3 patients(3.3%), 2th and 4th toe in each 1 patient(1.1%) and third toe 2 patients(2.2%). After confirming the complete removal of the melanoma through histopathological examination of surgical specimens, NPWT was applied for an average of 34ays (range: 14~ 69 days).

These results show that a combination treatment of NPWT and skin grafting is an excellent therapeutic option for early-stage subungual melanoma functional surgery and delayed skin grafting.

Conclusion: NPWT can be used effectively for early-stage subungual melanoma functional surgery and delayed skin grafting. Since the nail unit is covered with thick and skin graft, functional and aesthetic outcomes are excellent.

 

EP0367 Case study of complicated traumatic hand injury treatment with negative pressure wound therapy

Ernest Zacharevskij¹, Saulius Knystautas¹, Kęstutis Braziulis¹, Loreta Pilipaityte^1
1Lithuanian University Of Health Sciences Kaunas Clinics, Department of Plastic and Reconstructive Surgery, Kaunas, Lithuania

Aim: to share our experience and present case study of negative pressure wound therapy (NPWT) adaptability in treatment of patients with complicated traumatic hand injury.

Method: we report one case with traumatic hand injury treatment. Patient underwent wound revision and debridement surgery followed by installation of (NPWT) on the site of wound.

Results: 64 years male patient was hospitalized in Lithuanian University of Health Sciences Kaunas clinics department of Plastic and reconstructive surgery with traumatic left-hand injury. Wound revision surgery was performed: extensor tendons of first and second finger were sutured, and end-to-end anastomosis of radial artery branch was performed. Three days after surgery postoperative complication occurred: extensor tendons of first and second finger ruptured. Furthermore, wound infection symptoms occured: febrile fever, leukocytosis and increased CRP in blood test. Antibioticotherapy was initiated. Secondary revision surgery was performed. Ruptured extensor tendons were sutured and retinaculotomy was performed. Due to damaged tissue edema and infection, wound in wrist was left to heal in secondary intention healing. The following day NPWT was applied. After two weeks autodermoplasty with Full-thickness skin graft was performed and NPWT was reapplied. One week after the surgery and NPWT application patient was discharged for further out-patient treatment and rehabilitation.

Conclusion: NPWT gives significantly positive results of improvement in the wound, as shown in our case report. Application of the NPWT was a useful method in stimulating wound healing after complicated traumatic hand injury.

 

EP0368 Evidence-informed implementation of cinpt in a Belgian hospital

Marie-Line Himpe¹, Sara Labeeuw¹, Yana Baele^1
1AZ Groeninge, Kortrijk, Belgium

Aim: The aim of this project was to develop a structured implementation process for innovative wound care materials, focusing on evidence-based usage. New products regularly enter clinical practice, making a critical assessment of their relevance essential. This requires understanding the specific needs of the healthcare setting, alongside scientific evidence on the product’s effectiveness and cost-efficiency.

Method: The project originated from a setting specific challenge in wound care following caesarean sections, where risk factors such as obesity and emergency procedures were linked to wound complications. Research indicates that postoperative wound infections can affect up to 50% of high-risk cases, with approximately 60% being preventable. This highlights the need for preventive strategies, such as closed incision negative pressure therapy (ciNPT).

Results / Discussion: The use of ciNPT is recommended for high-risk patients. A literature review was conducted to establish criteria for identifying these patients. Criteria can be divided into intrinsic risk factors (e.g., obesity) and procedure-related risk factors (e.g., emergency procedure).  An assessment defined the surgical procedures and patients most at risk in the hospital, consulting surgeons from various disciplines. A tailored tool was developed to guide ciNPT use, with a specific version for gynaecology. To ensure proper application, the wound care team monitors usage, and training sessions were provided.

Conclusion: Key factors for successful implementation include a thorough understanding of the healthcare setting, scientific evidence, stakeholder consultation, practical tool development, and ongoing training and monitoring.

 

EP0369 A reproducible algorithm of care using intact fish skin grafting and negative pressure wound therapy

Allegra Fierro¹, Mary Bridge², Nour Hijazi¹, John Lantis^{1 2
1}Icahn School of Medicine at Mount Sinai, New York, United States, ²Mount Sinai West, New York, United States

Aim: Negative pressure wound therapy (NPWT) is a good bolster for split-thickness skin grafting (STSG) as well as for cellular and acellular matrix like products (CAMPs).[1]  We performed a prospective nonrandomized case series using a particular CAMP, an intact fish skin graft (IFSG) followed by NPWT to evaluate its safety, application schedule, and efficacy in limb salvage cases.

Method: Patients with wounds greater than 40cm² amenable to admission for at least 96 hours were selected. All patients were adequately revascularized and infection was treated or excised. Operative hydrosurgical debridement and ISFG affixation was performed, a non-stick dressing was placed, and NPWT was initiated at 125mmHg continuously. After 4 days, NPWT was stopped and a second application of IFSG was performed before placing appropriate dressings and compression.

Results: 15 wounds were included in the study. All patients complied with the inpatient protocol and underwent a 2^nd IFSG application on day 4. Most patients underwent a 3rd application of IFSG 1 week later. All wounds 40-100cm² underwent STSG 4 weeks after the initial procedure with a greater than 95% take as documented by digital imaging.

Conclusion: Using a schedule that includes IFSG re-applications with the aid of NPWT appears to provide a reproducible timeframe prior to autologous grafting in lower extremity limb salvage cases. Additionally, this combination and timing allows for a very good if not optimal vascularized dermal bed on which to place a STSG.

References:

1. Gabriel, A., Thimmappa, B., Rubano, C. and Storm-Dickerson, T. (2013), Evaluation of an ultra-lightweight, single-patient-use negative pressure wound therapy system over dermal regeneration template and skin grafts. International Wound Journal,10:418-424
2. IFSG - Kerecis®;Kerecis, Isafjordur, Iceland

 

EP0370 Comparison of NPWT modalities in diabetic foot ulcer management; a prospective randomized trial

İsmail  Sezikli¹, Murat Kendirci¹, Ünsal Savcı^1
1Hitit University School of Medicine, Corum, Turkey

Aim: Diabetic foot ulcers (DFUs) are a leading cause of non-traumatic amputations and pose significant challenges in wound management. Advancements in negative pressure wound therapy (NPWT) have shown promise in enhancing wound healing. However, there is limited comparative data on the efficacy of different NPWT modalities. This study aims to compare the efficacy of four NPWT modalities: standard NPWT, NPWT with hypochlorous acid instillation, NPWT with silver-impregnated dressings, and NPWT with antiseptic solution instillation in promoting wound closure and reducing bacterial load in DFUs.

Method: A randomized controlled trial was conducted with 120 patients diagnosed with Wagner grade 3 DFUs. Patients were randomly assigned to one of the four NPWT modalities. The primary outcomes were time to wound closure and bacterial load reduction. Secondary outcomes included pain levels and hospital length of stay (LOS).

Results / Discussion: NPWT with hypochlorous acid instillation significantly reduced time to wound closure (median 24 days) and bacterial load compared to the other modalities (p < 0.001). Pain levels were also significantly reduced in this group. NPWT with silver-impregnated dressings was effective in bacterial control but showed slower wound healing. NPWT with antiseptic solution instillation demonstrated intermediate efficacy. Patients in the hypochlorous acid group had the shortest LOS.

Conclusion: NPWT with hypochlorous acid instillation is the most effective modality for enhancing wound closure and reducing bacterial load in DFUs, offering a promising alternative in infection control and wound management.

 

EP0637 Impact of a sNPWT* system on mature biofilms

Daniel Fitzgerald, Runi Brownhill, John Vaughan^1
1Smith & Nephew, Hull, United Kingdom

Aim: The presence of bacterial biofilm has long been known as a factor in stalled healing of chronic wounds. This study aims to elucidate the mechanistic effects of a single-use Negative Pressure Wound Therapy* (sNPWT) system in comparison to conventional wound dressings on mature biofilms in-vitro.

Method: In-vitro studies were conducted using a wound surface biofilm model testing a sNPWT system and conventional dressings (a foam dressing with a Dialkylcarbamoyl chloride coated wound contact layer^# (DC) and a foam dressing with superabsorber^‡ (MB). Mature Pseudomonas aeruginosa biofilms (grown on cellulose acetate filters in a colony drip-flow reactor) were transferred to Petri dishes containing growth media and dressings applied for 24-72 hours. Following treatment, viable counts were recovered from filters and analysed, comparing to baseline control. Data presented as average bacterial recoveries (n=3), differences were considered statistically significant at p<0.05.

Results / Discussion: Application of the sNPWT system caused a reduction in mature biofilm, reaching significance (p<0.05) at both 24 and 72 hours. The level of reduction achieved with sNPWT was 1.24 and 1.49 log₁₀ CFU/ml (93/97%) after 24 and 72 hours, respectively. Reductions achieved by sNPWT were also significantly greater than those of conventional dressings, which did not reach significance at either treatment time.

Conclusion: Treatment with the sNPWT system results in a significant reduction of mature biofilm, this was not achieved by tested conventional dressings. This finding, in addition to the previously demonstrated ability of the sNPWT system to lock away bacteria may further support the use of this therapy in hard-to-heal wounds.

*PICO™ single-use Negative Pressure Wound Therapy, Smith & Nephew.

^# Cutimed™ Siltec™ Sorbact™, Essity.

^‡ Mepilex™ Border Comfort, Molnlycke.

 

EP0371 Understanding the biomechanical effects of a sNPWT* system

Daniel Fitzgerald¹, Louise France², Euan Motion¹, Runi Brownhill^1
1Smith + Nephew, Hull, United Kingdom, ²University of Hull, Hull, United Kingdom

Aim: This study aims to map the biomechanical responses of tissue when undergoing therapy delivered by a single-use Negative Pressure Wound Therapy* (sNPWT) system.

Method: To demonstrate the biomechanical tissue effects of the sNPWT system, in vitro studies were conducted using open wound porcine models (n=3) and corresponding computational models over a period of up to 24 hours. Bespoke sensors were used to collect data at various depths and locations surrounding the wound pertaining to tissue moisture movement, pressures experienced by the tissue, and resultant tissue displacement patterns. Finite element analysis was used to verify and validate in vitro experimental data.

Results / Discussion: In vitro data showed the sNPWT system delivers uniform negative pressure across the dressing, with no statistical significance (p>0.05) detected in pressure delta between locations surrounding the wound. The distribution of forces caused identifiable tissue displacement in tissue surrounding the wound extending to wider regions. Time dependant studies showed that the sNPWT system influences the movement of moisture around the wound site and in wider regions under therapy.

Conclusion: The sNPWT* system delivers compressive forces and moisture movement beyond the wound to the surrounding tissue. The delivery of compressive therapy could be responsible for reducing oedema and the inflammatory environment, creating favourable wound healing conditions.

*PICO™ single-use Negative Pressure Wound Therapy, Smith+Nephew.

 

EP0372 Treatment of surgical wound dehiscence in the community

Mike Steele¹, Jane Thinggaard Knudsen^2
1Smith+Nephew, Watford, Zimbabwe, ²Smith+Nephew, Watford, United Kingdom

Aim: To evaluate the early intervention of single use negative pressure wound therapy (sNPWT) in the treatment of surgical wound dehiscence in the community.

Method: Several communities participated in the data collection. The data included knowledge about the wound and risk factors before intervention with sNPWT was initiated. Follow up data (wound size and treatment) was collected weekly until complete healing or up to 8 weeks. No patient identifiers were recorded in this evaluation. A total data set of 81 wounds were captured.

Results / Discussion: There was a reported reduction in dressing changes from an average of 3.53 pre intervention, to an average of 1.38 per week during sNPWT treatment. The mean numbers of weeks sNPWT was used increased the older the wound was when treatment initiated. This was also true in terms of healing rate. Within 8 weeks 56% of the wounds healed, 37% progressed and 7% did not respond to treatment.

Conclusion: This evaluation suggests that the earlier sNPWT is introduced when the wound first deteriorates, the more effective in terms of time to treat in surgical dehisced wound cohorts. This intervention demonstrated an approximate 50% reduction in numbers of dressing changes per week with an associated positive effect on the local health economy.

*Brand names - PICO™ 7 Single Use Negative Pressure Wound Therapy System

™Trademark of Smith+Nephew. All Trademarks acknowledged. © October 2024 Smith+Nephew (45827) UKINOR

 

EP0373 Management of left ventricular assist device (LVAD) driveline infection by negative pressure wound therapy at driveline exit site (DLES): A retrospective review

Wai Sze Ho¹, Kar Kay Chan¹, Wing Yee Shum¹, Lai Shan Wong¹, Pak Ho Wong^1
1Queen Mary Hospital, Hong Kong, Hong Kong

Aim: To retrospectively review the effectiveness of negative pressure wound therapy (NPWT) at driveline exit-site (DLES) in the management of driveline infection (DLI), and explore its alternative role as non-invasive treatment with the preservation of LVAD.

Method: From January 2022 – April 2024, 41 consultations of the patients with implanted LVAD and DLI were reviewed.  Data was collected from Clinical Management System.  13 of them involved NPWT application to DLES for managing DLI were included in the analysis.  Eradication and optimization of DLI was studied by DLES culture results, C-reactive protein (CRP) level and DLES exudate drainage.

Results / Discussion: Among the 13 consultations, 2 and 11 of them were implanted with LVAD HeartMate II and HeartMate III respectively.  Duration of NPWT treatment ranged from 6 to 25 days; all with antibiotics treatment combined. Prior to NPWT, 85% of cases showed positive DLES cultures, with 88% of those tested post-NPWT returning negative results, decreased type and amount of species isolated.  A significant decrease in CRP levels observed in 11 out of 13 cases (52-97% reduction), with one case showing a 28% reduction.  During NPWT, 67% of cases drained purulent exudate over 100 ml, with maximum 400 ml.  Following NPWT, 75% of cases were free of purulent exudate, while three cases retained minimal exudate.

Conclusion: NPWT at DLES effectively decreases bioburden, enhance drainage, and reduces infection in DLI cases.  Combined with antibiotics, this serves as an alternative non-invasive treatment option potentially lowering healthcare costs related to hospitalization and readmissions compared to invasive procedures like debridement or LVAD relocation.

 

EP0374 Effectiveness of negative pressure wound therapy (NPWT) after punch skin grafting for scalp wounds; experience with 6 cases

Kyoung Ae Nam^1
1Yonsei University Severance Hospital, Dermatology, Seoul, Rep. of South Korea

Aim: Complex wounds of the scalp are difficult to reconstruction. Negative pressure wound therapy (NPWT) is playing an increasingly important role in the management of complex wounds and has been reported for the treatment of complex wounds of the head and neck. A challenge for use on the scalp is sealing the hair-bearing scalp surface. Despite these challenges, NPWT has been used to maintain negative pressure immediately after punch skin grafting with successful results.

Method: Retrospective review of 6 patients (2 males, 4 females) from November 2016 to July 2024 was performed.

Results / Discussion:  Mean age of the patients was 60.5 years (42~80 years) with 2 male patients and 4 female patients. The most common anatomical sites were the frontal scalp in three patients, the temporal scalp in one patient, the parietal scalp in one patient, and the vertex in one patient. Patients were diagnosed with angiosarcoma, basal cell carcinoma, nevus sebaceous, squamous cell carcinoma, cellulitis and malignant peripheral nerve sheath tumor. The skin graft donor site was a 3mm punch from the lower abdomen for two patients and a 2mm punch from the occipital containing hair for four patients. NPWT was applied for an average of 11.7days (range: 7~14days). It took 48 days for the wound to heal completely.

These results show that a NPWT after punch skin grafting is an excellent therapeutic option for on scalp wounds.

Conclusion: NPWT can be used effectively after punch skin graft in the scalp wounds. In the 2mm hair transplant group, the scars were very small due to hair survival, proving that it was a good treatment.

 

EP0375 The synergistic effect of hyaluronic acid and amino acids with negative pressure therapy in the treatment of non-healing wounds

Panfilo Di Gregorio^1
1Annunziata General Hospital, Surgery Unit-Regenerative Unit and Diabetic Foot Surgery, Sulmona (AQ), Italy

Aim: The aim of this study is to demonstrate the efficacy of a treatment combining hyaluronic acid (HA) and four amino acids (Glycine, L-Proline, L-Leucine, and L-Lysine) with negative pressure wound therapy (NPWT) in promoting healing in non-healing wounds of various etiologies.
Method: We selected 20 patients with different types of chronic wounds, including diabetic foot ulcers, dehiscent surgical wounds following lower limb amputations, dehiscent orthopedic surgery wounds, and post-traumatic wounds. All patients were treated with a powder formulation of HA and amino acids as the primary medication, in association with NPWT using a silver foam as a filler. NPWT was initially set at -100 mmHg for 5 days, then increased to -125 mmHg for 21 days, with dressing changes every five days.
Results / Discussion: In all 20 patients treated, we observed rapid, progressive, and complete healing, regardless of the wound’s etiology or size.
Conclusion: The combined approach of NPWT and the active formulation of HA and amino acids represents a new, advanced technique for enhancing the healing process. This method improves anti-inflammatory responses and supports tissue regeneration.

 

EP0376 A -80MMHG single-use negative pressure wound therapy (snpwt) device reduces the risk of incisional infections and complications in breast surgery: A systematic literature review and meta-analysis

Lloyd Atkinson¹, Ben Costa^1
1Smith+Nephew, Hull, United Kingdom

Aim: Negative pressure wound therapy has been shown to reduce the incidence of surgical site complications (SSC) among many surgical indications, however, there has been little aggregate analysis of the role of sNPWT within breast surgery. As the underlying need for this surgery is often malignancy-related, swift recovery is critical for the initiation of adjuvant chemotherapy.  In this study, we aimed to investigate the effect of prophylactic sNPWT in the prevention of surgical site infection (SSI) and SSC in breast surgery among currently published literature.

Method: A systematic literature review was performed in August 2023 relating to SSI and SSC prevention in breast surgery with prophylactic use of sNPWT. Searches were undertaken in EMBASE, PubMed, Cochrane library, CINAHL and SCOPUS. Binary meta-analyses were performed and reported using risk ratios (RR) with 95% confidence intervals (CI).

Results / Discussion: Eight studies were identified for analysis, constituting 1161 incisions (572 sNPWT vs 589 conventional dressings). Prophylactic use of sNPWT resulted in a significant reduction in the risk of SSI (RR 0.29 [0.37;0.56]), SSC (RR 0.61 [0.37;0.99], dehiscence (RR 0.53 [0.38;0.75]) and seroma (RR 0.32 [0.15;0.71]). Subanalysis of available data demonstrated a significant reduction in the risk of dehiscence for malignancy-related procedures (RR 0.18 [0.04;0.78]) and studies using within-subject controls (RR 0.58 [0.40;0.82]).

Conclusion: The prophylactic use of sNPWT in breast surgery is associated with a reduction in the risk of developing a variety of SSCs. These findings highlight the important role sNPWT can play in the incisional management of breast surgery patients.

 

EP0377 Negative pressure wound therapy (NWPT) in the treatment of mucocutaneous dehiscence in ostomized patients: a scoping review

Paula Costa¹, Ana Carolina Mendes², Ana  Tedim³, Paulo Alves^4
1ULS Alto Ave, Guimarães, Portugal, ²Mölnlycke, Matosinhos, Portugal, ³ULS Santo António, Porto, Portugal, ⁴Centre for Interdisciplinary Research in Health | CIIS-Wounds Research Lab, Faculdade de Ciências da Saúde e Enfermagem, Universidade Católica Portuguesa, Porto, Portugal

Aim: To identify and map the effects and benefits of negative wound pressure therapy (NWPT) in the treatment of mucocutaneous suture dehiscence in adult ostomized patients.

Method: This scoping review uses the Joanna Briggs Institute (JBI) methodology with PICO criteria:

• Population: Adult ostomized patients with mucocutaneous dehiscence.

• Intervention: NWPT.

• Comparator: No intervention or conventional treatment.

• Outcome: Effects and benefits of NWPT to promote healing without complications.

The search was carried out on PubMed, including complete articles in Portuguese, English or Spanish. Studies that did not use NWPT for dehiscence in ostomized patients were excluded. The research question is: “What are the effects and benefits of NWPT on mucocutaneous dehiscence healing in adult ostomized patients?”.

Results / Discussion: Five of the 15 articles researched on the use of NWPT in cases of mucocutaneous suture dehiscence in ostomized adults were analyzed, with a focus on healing and reducing infections. NWPT was found to be the central strategy in the different studies, even though it was associated with other approaches such as absorbable meshes, autolytic debridement and silver dressings for antimicrobial action. The results suggest that NWPT has significant benefits in managing dehiscences, reducing infections and accelerating healing, but the lack of larger samples and controlled studies limits the generalizability of the results and reinforces the need for standardized protocols for therapeutic combinations.

Conclusion: NWPT shows promise for dehiscence in ostomized patients, though heterogeneity of methods and limited studies restrict definitive conclusions. More controlled studies are needed to establish specific protocols.

 

EP0378 Combined hyperbaric oxygen and negative pressure therapies in the management of a complex abdominal wound: Case report

Antônio Pessoa¹, Caio Lopes¹, Priscilla Alves da Silveira F Pinheiro¹, Lucas Melo¹, Karine Silva¹, Bruno Silva¹, Bianca Oliveira^1
1Cicatriclin, Vitória da Conquista, Brazil

Aim: To describe the use of hyperbaric oxygen therapy (HBOT), negative pressure therapy (NPT), and specialized dressings in treating a patient with extensive abdominal wound dehiscence.

Method: This case report was structured according to the CARE case report guidelines, using data obtained from medical record and photographic documentation. Patient consent was obtained through an Informed Consent Form.

Results / Discussion: A 46-year-old female patient who underwent incisional hernioplasty using polypropylene mesh in the abdominal region developed post-operative wound necrosis, requiring follow-up with polyhexamethylene biguanide (PHMB)-impregnated foam dressings and 90-minute HBOT sessions at a pressure of 2.5 atmospheres absolute in order to increase the dissolution of oxygen in the plasma, improving perfusion in weakened tissues. Due to necrosis progression, the patient required extensive debridement, exposing a large area of subcutaneous tissue. The wound care team initiated NPT for 7 days with primary coverage using non-adherent silver mesh, which promoted significant superficialization and wound edge contraction. Over the following months, primary coverage and HBOT sessions were continued. The lesion showed favorable healing with marked reduction in wound edges. Currently, 3 months post-admission and following 50 HBOT sessions, the wound has reduced dimensions with a granulating surface, indicating progression toward complete healing.

Conclusion: The integration of advanced healing technologies, along with the dedication of the multidisciplinary wound care team, likely played a key role in achieving effective healing of the postoperative wound.

 

EP0379 Accelerating patient transitions from hospital to home with single use NPWT: A discharge pathway

Mark Portou¹, Ashley Collinsworth², Siobhan Lookess^2
1Royal Free Hospital, London, United Kingdom, ²Solventum, Maplewood, Minnesota, United States

Aim: Complexities in wound management step-down strategies can result in extended hospital length of stay (LOS) for patients who require negative pressure wound therapy (NPWT) but could otherwise be discharged. Single use NPWT (sNPWT) can serve as a bridge between hospital and community NPWT, allowing patients to return home once outpatient wound management is achievable. The aim of this study was to implement a discharge pathway utilizing sNPWT* and to examine the feasibility, effectiveness, and potential cost savings of this strategy.   

Method: This case series included 68 patients with open lower limb wounds treated by a vascular surgeon at a National Health Service facility using the sNPWT discharge pathway. Wounds were assessed before and after sNPWT use and differences in average inpatient length of stay (LOS) and costs were calculated for patients discharged on sNPWT compared to patients who remained hospitalized until community NPWT was available.

Results / Discussion: Use of the sNPWT discharge pathway was well tolerated by patients and resulted in good clinical outcomes including complete wound healing. Compared to patients who remained hospitalized on NPWT, patients discharged on sNPWT had an average reduction in LOS of approximately 20 days for a projected cost savings of £12,350 per patient in hospital costs.

Conclusion: Preliminary findings indicate the use of a sNPWT discharge pathway is feasible and may result in reduced hospital LOS and costs while improving patient care. Additional studies are needed to understand the impact of this sNPWT transition strategy on patient outcomes and overall costs of care.

*3M™ Prevena™ Plus 125 Therapy Unit with 3M™ V.A.C.® Dressings, Solventum Corporation, Maplewood, MN.

 

EP0380 Use of two different drapes for negative pressure wound therapy in patients with chronic or traumatic wounds: Evaluation of patient and clinician satisfaction

Leah Griffin¹, Boris Zelle^2
1Solventum, San Antonio, United States, ²UT Health San Antonio, San Antonio, United States

Aim: Use negative pressure wound therapy (NPWT) dressings with two different adhesive drapes (traditional acrylic adhesive drape* and silicone-acrylic adhesive hybrid drape^†) were evaluated.

Method: In this exploratory prospective study, patients with chronic or traumatic wounds treated with NPWT using either traditional or hybrid drape were assessed. Only patients that required a minimum of 2 NPWT dressing changes at the bedside were eligible for inclusion. Patients received at least 1 dressing application with each drape. Pain at dressing removal was graded by the patient on a visual analogue scale ranging from 0 (no pain) to 10 (maximum pain). Clinician ease of use was graded at each dressing change on a five-item Likert scale from 0 (strongly disagree) to 5 (strongly agree).

Results / Discussion: Twenty-nine patients were enrolled. The mean pain score at dressing removal was 3.3 ± 3.5 and 5.2 ± 3.6 for the hybrid and traditional drapes, respectively. Patient reported pain scores at drape removal were significantly lower for the hybrid drape ( -1.8 ± 3.4, p=0.0065). Clinician reported satisfaction was significantly higher with the hybrid drape (76.9% versus 48.3% for rating 5=strongly agree, p=0.0304). Negative pressure leaks were reported in 2 patients (6.9%) with the hybrid drape compared to no patients with the traditional drape, though this was not significant.

Conclusion: In these patients, reduced patient reported pain at drape removal and increased clinician reported ease of use was observed with the hybrid drape.

*3M™ V.A.C.^® Drape; ^†3M™ Dermatac™ Drape (Solventum Corporation, Maplewood, MN, USA)

 

EP0381 The association of advanced technologies in complex post-operative abdominoplasty: Case report

Antônio Pessoa¹, Caio Lopes¹, Priscilla Alves da Silveira F Pinheiro¹, Bruno Silva¹, Lucas Melo¹, Karine Silva¹, Bianca Oliveira^1
1Cicatriclin, Vitória da Conquista, Brazil

Aim: To report the clinical evolution of a patient with a complex post-abdominoplasty wound treated with advanced healing technologies.

Method: This case report was structured according to the CARE case report guidelines, using data obtained from medical record and photographic documentation. Patient consent was obtained through an Informed Consent Form.
Results / Discussion: A 58-year-old female patient who had previously undergone bariatric surgery presented to the specialist wound clinic with an ischemic abdominal lesion following abdominoplasty. The interdisciplinary team initiated treatment using hydrogel and polyurethane dressings in combination with sessions of Hyperbaric Oxygen Therapy (HBOT) at 2.5 atmospheres absolute pressure for 90 minutes per session. On the 21st Day of Treatment (DOT), debridement was required. Treatment continued with specialized dressings and HBOT. On the 81st DOT, the surgeon decided to approximate the wound edges after observing lesion size reduction. However, unfavorable necrosis development necessitated further debridement. On the 109th DOT, a treatment protocol was implemented involving dermal matrix coverage (DMC), silver-impregnated mesh (SIM), and Negative Pressure Wound Therapy (NPWT) for 10 days, followed by 20 additional days of NPWT and DMC, and subsequent SIM dressing. The patient was discharged on the 173rd DOT after complete epithelialization, having undergone a total of 120 HBOT sessions.

Conclusion: The patient demonstrated substantial improvement following advanced multimodal therapy, posing a considerable challenge for the multidisciplinary team throughout this complex physical and psychological recovery process.

 

EP0382 The negative pressure wound thearpy in the treatment of necrotizing fascitis

Carlotta Scarpa¹, Simone Caccetta¹, Franco Bassetto^1
1Plastic and Recontructive Surgery Clinic, Padova, Italy

Aim: Necrotizing fasciitis (NF) is potentially life-threatening bacterial infection of the soft tissues requiring an immediate surgical treatment called fasciotomy. Here we’ll verify if the negative pressure wound therapy with instillation and dwell time can be a useful aid both to fight necrotizing fascitis infection and to obtain a good wound bed preparation.

Method: After informed consent and pictures, we treated 60 patients affected by necrotizing fascitis. In all the patients we performed fasciotomies in emergency, after 3 days we applied negative pressure wound therapy with instillation and dwell time. The dressing has been changed every 3-4 days for a maximum of 3 dressing changes; we used solutions as saline, polyhexanide and betaine solution. We performed swabs before the application and during every dressing change.

Results / Discussion: Necrotizing fasciitis (NF) remains a significant challenge in clinical practice. All the patients reached a very good wound bed preparation in a maximum of 10 days (min 6 max-10). No adverse events have been reported. We verified the negativization of swabs after 1 week of treatment. In our experience, in these patients we can use both the ROCF-V and the ROCF-CC foams depending on the age of the patients and the anesthesiologic risk: we preferred, indeed, The ROCF-CC in very fragile patients and in the old ones.

Conclusion: The negative pressure wound therapy with instillation and dwell time can be a very useful aid in the treatment of fasciotomies after necrotizing fasciitis.

 

EP0383 Single use negative pressure wound therapy system: Prevention and treatment of surgical wound dehiscence

Giulia Vidotto¹, Sara Maria Lupi², lina carmela  ognibene¹, Gaetano De Angelis³, Umberto Cazzaro¹, Bertulli Gianluca^1
1Ospedale San Raffaele, Milano, Italy, ²San Raffaele Hospital, Milano, Italy, ³San Raffaele Ospedale, Milano, Italy

Aim: The goal of a discharged patient wound care unit is to give patients the opportunity to return to everyday life. The aim of this case series is to demonstrate the versatility of single use Negative Pressure Wound Therapy system, to prevent and treat surgical wound dehiscence.

Method:
Prevention:

• 2 patients with popliteal fossa incision after vascular surgery
• 2 patients with groin incision after vascular surgery
• NPWT surface system application once a week in 2 weeks

Treatment:

• 2 patients with the dehiscence of Pfannenstiel incision after cesarean cut
• 2 patients with the dehiscence of thorax incision after cardiac surgery
• NPWT surface system application twice a week in 2 weeks

Detected feature: Wound Bed Score, Numerical Rating Scale for pain, volume, picture

Results / Discussion: Prevention: patients show a reduction of edema and erythema in periwound skin in 2 weeks. Only one patient developed a dehiscence with 1 cm of depth.

Treatment: patients show a general improvement in 2 weeks. 30% reduction in wound volume, 50% improvement in wound bed score, 30% reduction of pain. No adverse events were registered: no accidental removal or leakage of the dressing.

Conclusion: The evaluated technology conforms to anatomical locations such as the groin, lower abdomen and popliteal fossa. Technology is safe and effective; it has allowed the maintenance of a good quality of life and the return to everyday life: walking and managing a newborn. The presence of a place with wound care specialist nurses and technologies allows discharged patients to return home safely.

 

EP0384 Efficacy of vacuum assisted closure (VAC) therapy in the treatment of diabetic foot ulcer

Mafruha Nusrat Khan¹, Mohammad Mahbub Alam², Hasina Alam¹, Ezaharul Haque Ratan^1
1Birdem General Hospital, Dhaka, Bangladesh, ²Bangladesh Diabetic Wound and Foot Care Limited, Dhaka, Bangladesh

Aim: During COVID-19 pandemic (2020-21), managing diabetic foot patients needing daily dressing became a challenge. To reduce the frequency of clinic visits, we applied VAC therapy in them. All collections from the wound were removed with intermittent negative pressure, promoting healing, without frequent dressing change. Our purpose was to evaluate the efficacy of VAC therapy in Wagner’s grade 2 - 4 wounds.

Method: This was an observational study in a diabetic foot centre, for 18 months. VAC was prepared with polyurethane ether foam dressing, Nelaton catheter, adhesive drape and negative pressure of 70 to 125 mm Hg with single chamber suction unit with manometer. Dressing changed every 6-7 days for 2-5 rounds.

Results: Ninety patients, with mean age 54.35 years, M: F = 4:1, showed reduced hospital stay (~60%) and daily visit (~81%). Complications encountered in 4.

Conclusion: VAC therapy is a cost effective technique, with lower hospital visits and stay with enhanced healing.

 

EP0385 Enhancing surgical wound healing with a single-use, canister-based negative pressure wound therapy (NPWT) system: A case report

Joana Costa¹, Eliane Joconiano¹, Ana Carolina Mendes^2
1Cirúrgia Plástica Reconstrutiva e Estética e Unidade de Queimados da ULS S. João, Porto, Portugal, ²Mölnlycke, Matosinhos, Portugal

Aim: Evaluating whether a single-use, canister-based NPWT system improves healing of uncomplicated surgical wounds in patients with multiple surgeries and prior complications

Method: Data were retrospectively collected through medical evaluations and extraction of relevant clinical information for case development. Additionally, clinical outcomes and response to the applied NPWT were documented.

Results / Discussion: A 52-year-old male with a history of valvular pathology and multiple femur and tibia surgeries underwent osteosynthesis removal and debridement in January 2023, followed by another debridement with vancomycin-infused cement eight months later. In March, plastic surgery was performed with excision, ostectomy, and flap reconstruction, using NPWT Single-Use Without Canister, which developed into a hematoma and new wound dehiscence.

Two months later, the patient underwent further plastic and reconstructive surgery to debride and close the wound. The Single-Use, Canister-Based NPWT System was applied intraoperatively to allow effective healing and eliminate the need for more complex reconstructive methods due to the absence of osteomyelitis. The patient was discharged the day after surgery with the NWPT system.

At the 8-day follow-up, multilayer dressing managed drainage effectively, preventing potential hematogenous complications. The patient reported no pain or discomfort, and therapy continued. At 14 days, slight exudate was noted, but healing was favorable; therapy continued for another seven days. By the end, the wound was dry, sutures removed, and healing complete. At 43 days, the wound remained stable without complications.

Conclusion: The single-use, canister-based NPWT system promoted efficient exudate management, faster healing, and reduced complications, supporting early discharge, and illustrating its effectiveness in wound care for complex cases.

*Avance® Solo

 

EP0386 NPWT in community care prescribed by advanced practice nurses in complex chronic wounds in Málaga, a positive experience

David Pérez-Barreno¹, Pilar Camarero-Gómez¹, Antonio Jesús Vazquez-Luque¹, Agustín Bruna-Cerezo¹, María Teresa Ruiz-Castillo¹, Maria del Carmen Serrano-Cepas^2
1Servicio Andaluz de Salud, Málaga, Spain, ²Servicio Andaluz de Salud, Coin, Spain

Aim: Show the effectiveness of NPWT in complex wounds healing in primary care settings under the indication of Advanced Practice Nurses on Complex Chronic Wounds (APNCCW).

Method: During our clinical experience in primary care at Málaga-Guadalhorce Valley Health District in Andalusia (Spain), we begun to apply negative wound pressure therapy (NPWT) in three specific contexts: surgical wound dehiscence, pressure ulcers, and post-surgical closures of pilonidal sinuses. NPWT has been indicated in 100% of cases by APNCCW and the candidate cases have been detected, in most cases, through direct referral by the community nurses of our healthcare district. After the first early “on-site” evaluation appointment of the case by the APNCCW, if the indication criteria were met, the patient was appropriately informed and, after acceptance, the use of NPWT began. Both the patient and the family member were informed of the objective, the operation and risks of using the NPWT and in all cases the APNCCW hotline was provided to the patient.

Results / Discussion: NPWT proved to be effective in all cases. Healing time were significantly lesser compared to other conventional treatments. The reduction in wound size was more than evident and patients reported improved quality of life and greater comfort during the healing process. The noise of some devices or the smell have been the only incidents reported by patients subjected to this therapy.

Conclusion: NPWT is a valuable therapeutic option in the management of complex chronic wounds in primary care. An early application accelerates healing and improves quality of life of patients. It is essential that nursing professionals are trained in its use and monitoring.

 

EP0387 Cost of illness of complex wounds in Italy: A study on real-world data

Angela Ragonese¹, Fabrizio Malan², Patrizio Festa³, Giuseppe Giudice⁴, Giovanni Papa⁵, Marino Ciliberti⁶, Antonio Sciuto⁷, Paolo Sciattella^1
1Economic Evaluation and HTA (EEHTA CEIS) –University of Rome “Tor Vergata”, Rome, Italy, ²Plastic Surgery Department, Città della Salute e della Scienza, C.T.O. Hospital, Turin, Italy, ³Trauma Center Department, Cardarelli Hospital, Naples, Italy, ⁴Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy, ⁵Plastic Surgery Department, Ospedale di Cattinara, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy, ⁶Wound Care Centre (Centro Aziendale di Riparazione Tissutale), Castellammare di Stabia, Italy, ⁷Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy

Aim: To assess the clinical effectiveness and cost benefits of Negative Pressure Wound Therapy with instillation and dwell (NPWTi-d) compared to standard NPWT and other therapies in managing complex wounds.

Method: An observational, retrospective, multicentric study was conducted using data from three hospitals. Eligible patients included all adults discharged in 2021 with specific diagnoses related to difficult wounds. Data on healthcare resource utilization, including length of hospital stay (LOS), number of dressings, and procedures performed, were analyzed. The economic evaluation estimated hospitalization costs based on the average daily rate. The analysis findings were further examined in an expert meeting (EM) focused on assessing the impact of continuity of care pathways on treatment outcomes.

Results / Discussion: A total of 64 patients were enrolled: 38 received NPWT, 16 NPWTi, and 10 other treatments. The NPWTi group demonstrated a significantly shorter average length of stay (13.4 days) compared to NPWT (23.6 days) and other treatments (21.5 days). Patients receiving NPWTi also had fewer dressing changes (2.6) than those treated with NPWT (3.5) and other therapies (6.6). This reduction in resource consumption translates to cost savings of over €6,000 (-35.1%) per hospitalization compared to the overall average and €7,645 (-40.7%) compared to other treatments. The findings were confirmed during the EM.

Conclusion: By improving patient outcomes and reducing the burden on healthcare systems, NPWTi-d should be considered a key component in modern wound care pathways. Its implementation aligns with current healthcare initiatives focused on optimizing resource utilization and improving patient quality of life.

 

EP0388 Effect of closed incision negative pressure therapy in the management of complications and costs following caesarean section in South Africa

Siobhan Lookess¹, Ashley Collinsworth^1
1Solventum, Minnesota, United States

Aim: Caeserean section (CS) rates are growing globally. Current rates of 21.5% are expected to increase to 28.5% by 2030. The global incidence of surgical site infections (SSI) following a CS is 5.6% with the African region highest with a rate of 11.91%.

This study aimed to examine the effect of closed incision negative pressure therapy (ciNPT) in reducing surgical site complications and healthcare utilization in South Africa following CS.

Method: This retrospective study was conducted utilizing a large, South African, private health insurance claims database. A propensity matched cohort of 44 patients receiving ciNPT or standard of care (SOC) for CS from 2018-2022 was created. Differences in multiple clinical and health economic outcomes were compared between ciNPT and SOC using t tests.

Results / Discussion: The overall surgical site complication (SSC) rate in the ciNPT group was lower at 0 cases (0.0%) compared to 4 cases (9.1%) in the SOC group (p=0.041). The average length of hospital stay was lower in the ciNPT group vs. SOC (4.1 vs. 5.5 days, p=0.008) resulting in significantly lower average admission cost ciNPT vs. SOC (R85,392 vs. R119,747, p=0.017). The percentage of total admissions with an intensive care unit (ICU) stay was lower in the ciNPT group vs. SOC (2.3% vs. 18.2%, p=0.014) resulting in a reduction in average ICU admission cost for the ciNPT group vs. SOC (R7,346 vs. R51,584, p=0.02).

Conclusion: The data suggests ciNPT may reduce wound-related healthcare utilization and costs in the management of caesarean sections in South Africa.

*ciNPT - 3M™ Prevena™ Therapy

 

EP0389 Beyond standard care: A multidisciplinary approach to complex ileostomy complications

Anabela Moura¹, Tânia Manuel², Cláudia Alexandra Cunha^3
1ULS São João, Porto, Portugal, ²Universidade Católica Portuguesa, Porto, Portugal, ³ULS Santo António, Porto, Portugal

Aim: To describe the therapeutic approach and the application of a device adapted for stool derivation in patients with ileostomy, in order to avoid the deposit of residues in the abdominal wall through a case study.

Method: A 54-year-old patient with a history of gastric sleeve presented to the emergency department with abdominal pain, vomiting and food intolerance on the sixth postoperative day. The CT scan revealed a strangulated trocar incisional hernia. In the postoperative, the patient presented dehiscence of the jejuno-jejunal anastomosis, requiring a new enterectomy and terminal ileostomy, in addition to jejunostomy and the appearance of a fistula of the terminal ileum. Subsequently, the presence of feces was found in the path between the ileostomy and the abdominal wall, requiring intervention to redirect the feces and protect the surgical wound. TPN was used with adaptation of a bottle teat as a fistula device, connected to a collection bag.
Results / Discussion: The use of TPN associated with the device adapted for stool derivation proved to be effective in preventing residue deposit in the wound, favoring the healing process without additional complications. The improvised device satisfactorily fulfilled the function of directing feces to the collector, avoiding contact with the abdominal wall and reducing the risk of infection.
Conclusion: The multidisciplinary approach and innovation with the use of TPN and adaptation of improvised devices were fundamental for the proper treatment of fistula and wound healing. This case reinforces the importance of creativity and personalization of strategies in the care of complex complications in patients with ileostomy.

 

EP0390 “Shared wound care”: how to involve the patient in single-use NPWT at home for preventing surgical site infection

Domitilla Foghetti¹, Maurizio Carnali^2
1General Surgery Department, San Salvatore Hospital, AST Pesaro-Urbino, Fano (PU), Italy, ²General Surgery Department, Fabriano Hospital, AST Ancona, Fabriano (AN), Italy

Aim: Single-use NPWT may be used to prevent surgical wound complications (SWC) in high risk patients. We investigated two different surgical procedures with a high risk of SWC, as pilonidal cyst removal and ileostomy reversal, in which the incisional-NPWT may reduce the complications rate, to identify a standardized method for enrolling and monitoring patients capable of managing therapy at home.

Method: We enrolled 30 patients (20 pilonidal cyst removal, 10 ileostomy reversal), 23 men-7 women, age 16-72. Before surgery, the eligibility for discharge with NPWT was assessed using a safety checklist regarding the patient’s clinical condition, social situation, and possibility to communicate with a healthcare provider. Before hospital discharge, patient and/or caregiver training on device management, based on a standardized program, was conducted. During the first follow-up, a satisfaction questionnaire was administered.

Results / Discussion: 25/30 patients were enrolled for NPWT: 1 patient refused the treatment, 2 patients were excluded for clinical conditions, and 2 for social conditions. Before the training, 1 patient refused the NPWT dressing application. 24 patients were discharged with NPWT devices (8 ileostomy reversal surgery, 16 pilonidal cyst surgery). 4 patients needed to contact the healthcare provider for further information or reassurance before the follow up. The evaluation of satisfaction questionnaires highlighted in 83% of cases the ease of use of the device, the absence of pain, and the ability to continue daily activities.

Conclusion: Sharing care practices, allows to improve clinical results, and can make patients feel more independent and empowered to be involved in their own care. It is essential to implement an appropriate checklist to select patients, a standardized training program, and a method for monitoring the outcomes.

 

EP0391 Use of negative pressure wound therapy in facial and head trauma

Margrit Wilke¹, Pablo Ferreira¹, Olímpio Augusto da Paz Peçanha^2
1Vide Bula Importação e Exportação de Produtos Hospitalares e Medicamentos Ltda, Rio de Janeiro, Brazil, ²Clinica Cirurgia Plástica Olympio Peçanha, Niteroi, Brazil

Aim: Highlight the effectiveness of Negative Pressure Wound Therapy (NPWT) in facial and head trauma, emphasizing the originality of the technique used.

Method: Qualitative descriptive study, developed through a case study, documenting the conflict of interest. The treatment duration was approximately 1 month and 10 days, with dressing changes every 7 days, utilizing dermal regeneration matrices and skin grafts performed.The patient is an 18-year-old male, a victim of assault, with a mandible fracture and a lesion on the left side of the face, initially presenting with bruises, which progressed to necrosis.

Results / Discussion: After 31 days of treatment, the lesion showed sufficient granulation tissue, approximately 0.5 cm, for grafting. In conjunction with NPWT, the patient was discharged from the hospital with the expected outcome, having formed epithelial tissue over the entire area of the lesion, completing the treatment. NPWT combined with the use of dermal matrix is significant in terms of tissue repair time, providing results more quickly, reducing the patient’s hospital stay, and consequently the time required to achieve results in the progression of the lesion.

Conclusion: This article clearly demonstrates the effectiveness of the combined use of dermal regeneration matrices and negative pressure wound therapy. It emphasizes the rapid healing process, totaling 38 days of treatment, leading to hospital discharge.

 

EP0392 Systematic review of negative pressure wound therapy as a definitive treatment for upper extremity wound defects

Hsu-Tang Cheng^1
1Division of Plastic Surgery, Department of Surgery, Asia University Hospital, Taichung City, Taiwan

Aim: This study aimed to identify the most common indications for using Negative Pressure Wound Therapy (NPWT) for upper extremity wound defects.

Method: A systematic literature review was conducted with keywords like “upper extremity,” “arm,” “forearm,” “wrist,” “hand,” “finger,” and NPWT-related terms, including “VAC therapy” and “vacuum-assisted closure.”

Results / Discussion: The review analyzed 45 studies with 731 cases, finding frequent NPWT use in the forearm (42%), hand (30%), arm (18%), and fingers (10%) for 20 different indications. A meta-analysis of NPWT for radial forearm flap donor sites found no significant reduction in graft loss or complications compared to traditional dressings, though earlier hand function improvement was noted. High device costs remained a drawback. Two randomized trials showed NPWT, combined with rehabilitation or multiple flaps, significantly improved hand function and reduced inflammation in severe trauma cases. A retrospective study comparing NPWT with Integra Meshed Bilayer Wound Matrix (IMBWM) to IMBWM alone found a higher graft success rate (96.8% vs. 85.1%, p=0.03) and fewer complications (3.2% vs. 14.9%, p=0.03) in the NPWT group. Portable NPWT (piNPWT) for post-bariatric brachioplasty demonstrated faster healing and fewer dressing changes, despite some hyperchromic scarring at 90 days.

Conclusion: NPWT is a versatile and effective treatment for upper extremity wound reconstruction. It offers significant benefits, such as improved outcomes and fewer complications, reinforcing its role as a valuable tool in managing complex wound cases, despite some limitations related to cost and scarring.

 

EP0393 Effect of vacuum assisted closure therapy in orthopaedic trauma to reduce post- operative infection in lower limb compound fractures

Deepak Kumar ¹, Dharmendra Kumar^1
1King George’s Medical University, Lucknow, India

Aim: To compare the postoperative infection rates between VAC and conventional dressing methods in lower-limb compound fractures.

Method: This study was conducted in the Department of Orthopaedic Surgery at King George’s Medical University, Lucknow, from January 2023 to January 2024, with sample size of 38 patients. Patients were divided into a VAC dressing group (n = 20) and a Conventional Dressing group (n = 18) based on the treatment. In the VAC dressing group,20 patients were treated with VAC, while in the control group, 18 patients were treated with conventional dressing methods.  The dressing maintenance time was 5–7 days. As the treatment progressed, assessment of wound size and granulation tissue formation done along with serum C-reactive protein and total leukocyte count levels were measured on days 3 and 7, respectively, to study the post-operative infection.

Results / Discussion: In our study, we observed a significant decrease in the duration of wound healing in the treatment group compared to the control group (P value = 0.02). VAC can reduce wound healing time and expedite recovery for patients, leading to a significant reduction in hospital stays. Serum C-reactive protein and total leukocyte count levels in both groups decreased on days 3 and 7, respectively, after treatment. VAC is able to decrease serum inflammatory marker levels, reduce wound inflammation, and facilitate faster wound healing. In the VAC group, the incidence of post-operative infection was lower than in the conventional group (P value = 0.0094).

Conclusion: In conclusion, VAC dressing in the management of compound fractures reduces the frequency of dressing changes, hospital stay, post-operative infections, and enhances wound healing.

 

EP0394 Single-use hydrofiber NPWT system for the treatment of no-healing chronic ulcers of any etiology

Carlo Rivellini¹, Ordonez Esther^1
1Geneal Surgery Unit of Mondovì Hospital, Cuneo, Italy

Aim: The aim was to assess the efficacy of NPWT dressings in the topical treatment of patients with “non-healing” cronic ulcers.

Method: We considered 65 patients treated consecutively between November 2020 and 2024 with only “non-healing” cronic ulcers with  NPWT Hydrofiber (venous, ischaemic and mixed ulcers); these non-healing wounds had fibrinous tissue, eschar and slough removed and were targeted with anti-biotic therapy following positive swab and treated for underlying venous disease (bandaging, phlebotonics, lifestyle improvements, weight loss and surgical treatment of refluxs) or ischemic disease (surgical or interventional revascularization and/or farmacological approach). The patients studied all had one or more comorbidities and several risk factors for venous stasis or ischemic disease and ulceration. The dressing was changed was the presence of enough exudate to wet 50% of the dressing. In the event of minimal or no exudate, the dressing was left in place for seven days.  The dressing was applied under a bandage in 42 cases.

Results / Discussion: In all cases there was a clinical improvement in the wound after 30 days, in particular in the wound bed with greater debridement, greater vascularization and more reduction in the production of slough and exudate, and a marked reduction in periwound inflammation and pain. Application of the dressing under a bandage was well tolerated by all patients and does not alter the functioning of the device.

Conclusion: Single-Use NPWT devices offer a range of benefits and are able to provide sufficient negative pressure to the wound bed, with low weight and low impact on patient quality of life. They are also able to be used in conjunction with compression bandages for venous leg ulcer treatment.

 

 

NUTRITION

EP0524 A survey of nutrition care practices among nurses

Georgina Gethin¹, Marek Lichota², Ben Weise³, Philippe Fauque^4
1University of Galway, Galway Ireland, Geneva School of Health Science, HES-SO University of Applied Science and Arts, Western Switzerland, Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland, ²Appetite for Life, Krakow, Poland, ³B Braun  Avitum AG, Melsungen, Germany, ⁴Private practice, Medicine Nutritionniste, Cannes, France

Aim: Patients with chronic wounds have a high level of comorbidities, many of which affect diet and nutrition. The role of nutrition in wound healing is poorly recognised. We aimed to understand how competent nurses feel in relation to nutrition care.

Method: A survey, using a project specific questionnaire was conducted among nurses attending a major wound care conference in 2024 to evaluate their nutrition care practice patterns and training requirements.

Results / Discussion: 138 nurses from 23 countries responded (n=47 Europe (EU); n=50 United Kingdom (UK); n=21 Australia (AU)). 38% (n=52) reported nursing experience > 20 years. Of these, 94% (49/52;) routinely asked patients about their diet or food intake and 75% (39/52) routinely perform nutrition screening. Overall, 14% (n=20/138) routinely perform nutrition screening and weigh their patients weekly. The highest level of autonomy in nutrition care was perceived among nurses from EU (26%), followed by UK (20%) and AU (5%). Respondents were asked to self-assess their competency in nutrition care on a scale of 0-10. 14% (n=20) ranked themselves as having low level of competency (score 1-4); 55% (n=71) average level (score 5-7) and 25% (n=35) advanced level (score 8-10). The demand for further education in nutrition care was over 92% across all groups.

Conclusion: The likelihood of nutrition screening increases with years of nursing experience.  Nurses who feel more autonomous in nutrition care more frequently conduct nutrition screening. Nurses acknowledge the role of nutrition in wound care and have a high demand for further education on the topic.

 

EP0638 Improving pressure injury management through the development of a multidisciplinary nutrition intervention and nursing program

Yongeun Hong^1
1National Cancer Center, nursing department, Gyeonggi-do, Rep. of South Korea

Aim: The aim of this study was to develop and implement standardized nutritional and nursing interventions for pressure injury management in cancer patients, focusing on improving healing duration and enhancing the quality of life.

Method: A total of 363 pressure injury cases were analysed at the National Cancer Center in 2020. The study targeted patients with stage 2 or higher pressure injuries during their hospitalization. Data were collected through assessments, interviews, dietary surveys, and medical records to evaluate pressure injury characteristics, nutritional status, and quality of life indicators before and after intervention. Nutritional interventions included adjusting meal preferences, providing nutritional supplements, and ensuring adequate intake of essential nutrients like energy, protein, and zinc. Nursing interventions involved regular dressing changes and educational support for repositioning

Results / Discussion: The findings indicated that the risk of pressure ulcers significantly increased during hospitalization, with an 82.1% prevalence of nutritional risk among patients. Following the implementation of standardized guidelines, there was a notable increase in the intake of essential nutrients, with over 90% of patients meeting their nutritional requirements. The healing duration for pressure injuries was reduced by more than 10%, and the overall quality of life scores improved significantly (from 28.8 to 39.6).

Conclusion: The implementation of integrated nutritional and nursing interventions effectively reduced pressure injury healing time and improved patients’ quality of life. Future efforts should focus on identifying high-risk patients for early intervention and expanding standardized guidelines to enhance pressure injury prevention and management.

 

EP0525 Nurse led nutritional screening and nutritional care pathways for hard to heal wounds

Evelyn Walsh¹, Rosemarie Derwin², Linda Nugent³, Chanel Watson^3
1RCSI, Dublin, Ireland, ²RCSI, TCD, Dublin, Ireland, ³RCSI, Dublin, Ireland

Aim: Hard to Heal Wounds (HTHWs) have a significant impact on patients and healthcare resources. One essential aspect to providing evidence-based care for patients with HTHWs is to ensure that their nutritional needs are appropriately assessed and met. In addition, aging demographics have contributed to malnutrition being a major health concern. This study sought to explore current malnutrition screening practices and nutritional care processes carried out by community nurses caring for patients with HTHWs with a view to informing future research and practice.

Method: Within a qualitative research design 10 nurses were interviewed about their practice in treating patients with HTHWs.

Results / Discussion: Findings suggest that screening practices are inconsistent and that nutritional care processes once a need is identified, are varied. The study highlighted several issues facing nurses who care for patients with HTHWs, including lack of confidence in the screening tool available to them, lack of dietetic service for patients, the multifactorial nature of malnutrition and the lack of services for patients presenting to wound care clinics with obesity. The findings also identified the various resources nurses utilise to inform their nutritional care decisions and nurses’ own perceptions on how their practice in relation to nutritional care processes could be improved

Conclusion: The study highlighted the necessity for standardising care pathways for those with HTHW and the potential for other malnutrition tools for use in the community be explored enabling nurses to feel confident that the care they provide is evidence based and appropriate for their patients.

 

EP0526 Impact of nutritional supplementation as an adjuvant strategy in the healing of complex injuries

Ana Claudia  Zanini¹, Gabriela Oliveira¹, Marcelo Mendes², Camila Moraes^3
1Prodiet, Curitiba, Brazil, ²Clínica Cicatripelli, Belem, Brazil, ³Universidade Federal do Rio de Janeiro, Macae, Brazil

Aim: To describe a series of cases after including nutritional supplementation in treating patients with chronic, difficult-to-heal injuries.

Method: Eight elderly patients with complex, difficult-to-heal wounds of various etiologies (chronic venous wounds, pressure injuries, diabetic feet, arterial wounds, bacterial wounds) were included. The patients were monitored by specialized nursing and, in addition to wound care (cleaning, use of appropriate technologies, etc.), which was already performed before the start of the study, the patients were instructed to consume a specialize nutritional supplement for wound healing that contained collagen peptides, arginine, vitamins A, C and E, zinc and selenium. Data were collected for two months or until the wound was completely healed, with records of the progress of each dressing and image.

Results / Discussion: After starting supplementation, we observed a gradual improvement in all patients’ conditions. Even considering the specificities of each patient and each lesion, there was a noticeable growth of granulation tissue and improvement in its coloration. Furthermore, we identified the emergence of neo-epithelialized tissue on the edges and significant contraction of its size in all patients.

Conclusion: Our study highlights the importance of a patient-systemic approach to wound healing. As demonstrated in our study, combining specific nutritional supplements (collagen, arginine, vitamins, and minerals) with specialized care can significantly optimize the healing of chronic and difficult-to-heal wounds. This approach not only provides safety and quality of care but also offers a potential advancement in wound treatment practices.

 

EP0527 Effectiveness of glutamine and arginine in wound healing of pressure ulcers: a systematic review

Tim Torsy^{1 2}, Inge Tency^{1 3}, Dimitri Beeckman^{2 4}, Flore De Vylder^{1 5
1}Department of Nursing and Midwifery, Odisee University of Applied Sciences, Sint-Niklaas, Belgium, ²Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, ³University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, ⁴Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, ⁵Research Group Physical Activity & Health, Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

Aim: To assess the effectiveness of glutamine and arginine supplementation in wound healing of pressure ulcers (PUs), this review focuses on their potential benefits in improving clinical wound-related outcomes.

Method: A systematic search following PRISMA guidelines was conducted across five databases (PubMed, Cochrane Library, EMBASE, CINAHL, and Web of Science), including studies (2004-2024) on adult patients with PUs receiving enteral glutamine and/or arginine supplementation. Outcomes were healing time, wound size reduction, local infection, PU recurrence, and PU-related pain. A narrative synthesis was conducted due to methodological and outcome heterogeneity, with risk of bias assessed using the Cochrane RoB2 and JBI checklists.

Results / Discussion: Fifteen studies including 1,085 participants were analysed. The findings indicated a trend toward improved wound healing with arginine supplements and combined glutamine/arginine supplements, with reported relative wound size reductions ranging from 18.6% to 98.2% over intervention periods of 2 to 20 weeks. However, results were inconsistent; specifically, 7 studies reported non-significant differences or lacked statistics for within-group or between-group differences related to wound size reduction, while 6 studies had similar issues concerning healing time. Glutamine was studied in only four studies as part of a combined supplement with arginine, limiting conclusions about its isolated effect. None of the studies assessed PU recurrence or PU-related pain as outcomes.

Conclusion: Arginine supplementation shows promise for enhancing PU healing, but evidence is inconclusive. Future research should focus on follow-up until complete wound closure. Additionally, the effect of glutamine as an isolated supplement on clinical wound-related outcomes needs further investigation.

 

EP0528 Are dietary interventions effective in prevention and management of chronic wounds in people living with diabetes; a systematic review and meta-analysis

Hailey Donnelly^{1 2}, Clare Collins^{1 2}, Erin Clarke^{1 2}, Natalie Gilbertson Viljevac¹, Prudence Morrissey^{1 2}, Peta Tehan^{1 3
1}University of Newcastle, Newcastle, Australia, ²Hunter Medical Research Institute, Rankin Park, Australia, ³Monash University, Melbourne, Australia

Aim: Determine effectiveness of dietary interventions in prevention and management of chronic wounds in people with diabetes.

Method: A systematic search was conducted of intervention studies in prevention and/or management of chronic wounds in people with diabetes. Risk of bias was assessed with Rob-2 or ROBINS.  A meta-analysis was conducted utilising mean wound size at follow-up and non-adjusted data where available. Sensitivity analyses were performed.

Results / Discussion: Seventeen randomised controlled trials and six non-randomised trials were included. Included studies explored dietary interventions for treatment of diabetes-related foot ulcers (DFU) only, with one evaluating both prevention and treatment of DFU. No studies for any other wound aetiologies were eligible for inclusion. Twenty studies focused on nutrient supplementation alone, one explored nutrient supplementation with nutrition education, one evaluated nurse-led nutrition education, and one utilised a multidisciplinary intervention which included a dietitian. Quality of included studies was variable. The meta-analyses for wound length, width and depth all found statistically significant differences favouring intervention, however there was not a significant difference for proportion of people healed. Sensitivity analyses excluding non-randomised studies and per-protocol papers did not show significant changes for wound length, width and depth, and proportion of people healed.

Conclusion: This meta-analysis demonstrates that nutrition supplementation is effective in reducing wound length, width and depth in people with diabetes and active foot ulceration. Nutrition education may support wound size reduction and proportion of people healed, however more research is required. More research in other wound types, and the role of nutrition in wound prevention would be beneficial.

 

EP0812 Annual prevalence survey of pressure ulcers in an internal medicine hospitalization unit

Andrea Peinado Vila¹, Raquel Valera Lloris², Aitana Prats Lloret³, Ana Belen Gonzalez Cuenca¹, Fatima Sanchis^1
1Hospital Clínico Universitario de Valencia, valencia, Spain, ²Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain, ³Hospital Clínico Universitario de Valencia, València, Spain

Aim: Pressure ulcers are a concerning issue. To understand their prevalence, cross-sectional prevalence surveys are planned.

• Describe the risk factors
• Analyze the preventive measures implemented for hospitalized patients
• Determine the prevalence of pressure ulcers

Method: A descriptive cross-sectional study was designed in a tertiary hospital setting. The sample consisted of 27 participants. A hetero-administered questionnaire was designed, including the following variables: sociodemographic data, risk assessment using the Braden scale, extrinsic/intrinsic risk factors, prescribed preventive measures and their frequency, resting surfaces, and the presence of lesions.

Results / Discussion: The mean age was 69 years. 55.56% were women. The average length of stay was 11 days. The most common diagnosis was respiratory infection, accounting for 22.22%. 33.33% were multi-morbid patients, and 81% were polymedicated. 30% were at high risk of developing pressure ulcers.
The most frequently used preventive measures were the use of barrier creams (51.82%), polyurethane heel protectors (18.52%), and dressings with the same percentage.
Finally, 22.22% presented skin lesions related to dependency, with 100% being pressure ulcers.

Conclusion:

• The primary cause of the lesions was the support surface.
• The most commonly used preventive measures were barrier creams with zinc oxide, heel protectors with polyurethane dressings, and positional changes.
• The prevalence of pressure ulcers was 22.22%.

 

EP0529 The management of patients with complex wounds in the cervicofacial area:
A personalized nutritional approach

Francesco Stivala¹, Antonino Lombardo¹, Enrica Fontana¹, Sandra Iannarino¹, Antonella Mariotto¹, Giuseppe Riva¹, Marta Anrò¹, Michela Miletta¹, Mario Paleologo^1
1A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Turin, Italy

Aim: Develop a nutritional personalized protocol aimed at optimizing the nutritional status of patients with complex wounds in the cervicofacial area, whether fed orally or through a Nasogastric Tube (NG tube) or Percutaneous Endoscopic Gastrostomy (PEG).

Method: A multidisciplinary team was formed consisting of a nurse, a dietitian, a nutritionist, and an otolaryngologist. This team developed a nutritional protocol for patients with extensive skin wound involving the cervical region, oral cavity, and facial area.

Results / Discussion: The protocol, drafted by the multidisciplinary team following scientific literature guidelines, prescribes the following daily nutritional intake:

• 30 / 35 kcal/kg body weight
• 30 / 35 ml water/kg body weight
• 1.5 – 2.0 g protein/kg body weight (protein supplement based on Glutamine and Arginine)

These intakes are adjusted according to the size of the lesion: the more advanced the stage and the size of the wound, the higher the nutritional intake administered.

Conclusion: All the studies agree that optimizing the nutritional status of patients with complex wound in the cervicofacial area is an excellent strategy to accelerate healing. Specifically, Arginine and Glutamine improve the immune response, and promote better tissue regeneration.
Additionally, Arginine promotes collagen synthesis and stimulates lymphocyte activity, acting as a bactericide that reduces the risk of infection and improves wound healing times.

 

EP0530 Patient-reported outcome measures: Validity and reliability of two health-related quality of life instruments in patients with venous ulcers

Miguel Angel Barbas Monjo¹, José Verdú Soriano^2
1Universidad de Alicante, Gneaupp, Hospital de Fuenfría, Madrid, Spain, ²Universidad de Alicante, Gneaupp, Alicante, Spain

Aim: To determine, following cultural adaptation and content validity, whether the SPVU-5D instrument is valid and reliable in the Spanish context, as well as to study its convergent validity with the CCVUQ-e instrument. Both instruments are applied to patients with venous ulcers to assess their health-related quality of life.

Method: Translation-back translation, transcultural adaptation, and face validity of the SPVU-5D-e instrument into Spanish.

• Determination of the content validity of the SPVU-5D-e instrument.
• Evaluation of the psychometric properties of the SPVU-5D-e and CCVUQ-e instruments.
• Sociodemographic and clinical characteristics of patients with venous ulcers at Guadarrama Hospital and their wounds.
• Assessment of health-related quality of life (HRQoL) in patients with venous ulcers at Guadarrama Hospital.

Results / Discussion: All quality-of-life items and the total scores of the CCVUQ-e and SPVU-5D-e questionnaires showed significant improvement from before to after, as did the RESVECH 2.0 healing indicator

Conclusion: This study contributes to knowledge on the validation of HRQoL assessment instruments in patients with venous ulcers, identifying both strengths and areas for improvement in the SPVU-5D-e. Future studies should aim to address the methodological limitations observed and explore the instrument’s applicability in various clinical contexts. Additionally, further validations are needed to confirm the instrument’s sensitivity to change and convergent validity, which are key aspects for its implementation in routine clinical practice.

 

EP0531 Analyzing wound-related factors affecting quality of life in Spanish patients with chronic wounds. Preliminary results of ALBAMAD study

Celia Horcajada Reales¹, Manuel Gerónimo-Pardo², Elena Conde Montero³, Matthias Augustin⁴, Remedios Nieto Carrilero⁵, Lucía Herreros Sáez⁵, Carmen Selva Sevilla^6
1Department of Dermatology. Hospital Universitario de Fuenlabrada, Madrid, Spain, ²Servicio de Anestesiología y Reanimación. Gerencia de Atención Integrada de Albacete, Albacete, Spain, ³Sº Dermatología. Hospital Universitario Infanta Leonor, Madrid, Spain, ⁴University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland, Hamburg, Germany, ⁵Unidad Funcional de Heridas Complejas. Gerencia de Atención Integrada de Albacete, Albacete, Spain, ⁶Facultad de Ciencias Económicas de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain

Aim: Chronic wounds impair the functioning and wellbeing of the affected people as they affect all spheres of health-related quality of life. The aim of this study was to determine the wound-related factors affecting the quality of life of patients with chronic wounds.

Method: This preliminary analytical cross-sectional study was conducted between January and July 2024 in 22 outpatient clinics in Spain. Approval from the ethics committee was obtained. Sociodemographic information and wound characteristics (wound size, number of wounds, duration of injury, etiology, depth (superficial or deep), infection, wound odor, periulcer dermatitis, itching and pain) were collected through individual interviews and clinical characterization. Quality of life was measured with the Spanish version of the Wound-QoL-17. For data analysis, multiple linear regression was performed.

Results / Discussion: The study included 195 patients with chronic wounds. Wound-QoL-17 score was 1.70±1.07, pain was 3.97±3.13, 13.5% had wound odor and 69.8% had deep wounds (beyond dermis). Multiple regression analysis revealed that Wound-QoL-17 was significantly explained by wound odor, wound depth, and pain (R2 0,35); both psique and everyday-life subscales were explained by wound depth and pain (R2 0.24 and 0.21 respectively). Body subscale was not explained by any wound-related variables.

Conclusion: The wound-related factors influencing quality of life for these Spanish patients with chronic wounds included wound odor, wound depth and pain. When evaluating and caring for patients with chronic wounds considering that aspects can be very relevant to obtain the best clinical approach.

 

 

PAIN

EP0455 Pain reduction in ischemic ulcers using erbium yag laser: a promising therapeutic approach

Ram Chilgar^1
1Elrevo Clinic, Chhatrapati Sambhajinagar, India

Aim: The Erbium YAG laser with a 2936 nm wavelength has promising technology to heal the ischemic ulcers. This study aims at introducing the Erbium YAG laser as a therapeutic method to alleviate the pain due to ischemia.

Method: This single-arm study was conducted from May 2022 to April 2024. 11 patients of peripheral vascular disease with painful ulcer on foot were included in the study. The subjective analysis scale was used to evaluate the pain component associated with the ulcer. The pain score was marked before and after the weekly laser sessions. The Erbium YAG laser utilized with two steps protocol, where Step 1 involved Erbium YAG laser ablation with energy of 9.95 J/cm². Step 2 involved spatially modulated Erbium YAG laser with energy of 2.30 J/cm².

Results / Discussion: A total of 11 patients were treated by laser for painful ischemic ulcers on leg and foot. The pain score showed significant reduction in pain. The range of pain score was 4 to 10 before the start of treatment. It reduced to 0 to 6 in follow up laser sessions. The average 4 lesser sessions required to reduce the pain score less than 5.  Patients were followed after the pain relief without aggravation of pain score in minimum follow up of 5 months.

Conclusion: The Erbium YAG laser is an effective treatment modality for alleviating the troublesome pain component of ischemic ulcers. The pain modulation pathway and incremental effect on localized blood circulation plays important role in pain relief. Further multicentre studies needed to authenticate the protocol-based treatment in painful ischemic ulcers.

 

EP0456 Pain management from a multidisciplinary perspective. A case series

Gaetano De Angelis¹, Sara Maria Lupi¹, Lina Carmela  Ognibene¹, Umberto Cazzaro¹, Bertulli Gianluca¹, Giulia Vidotto¹, Anna Aloise^2
1San Raffaele Hospital, Milan, Italy, ²Community nurse Milan, Milan, Italy

Aim: The aim of this paper is to present pain management in discharge patients with ulcers, at the wound care center of a metropolitan hospital. A multifactorial and multidisciplinary approach has been adopted. Several features lead to pain in ulcer: oedema, bacteria load, misguides diagnosis and treatment. Sometimes, the diagnosis is painful itself: pyoderma gangrenosum, vasculitis, scleroderma.

Method: Literature reviews are conducted to discover advanced product and technologies in pain relief.

Poster with case series about treated patients has been accepted during wound care national and international conferences.

Standard protocols provide:

• Pain assessment with Numerical Rating Scale of pain (NRS)
• Pain relief topical agents: absorbent polyurethane foam dressing containing 0.5 mg/^cm2 of ibuprofen; topical anaesthetics containing 5% Lidocaine hydrochloride.
• Bacterial load control topical treatment: Fluorescent light energy, antimicrobial dressing.

Specialist clinician consultation: infectious diseases, pain, rare disease.

Results / Discussion: In the last 2 months 10 patients with local pain NRS >7 have come to our unit.  8 patients reach the 50% decrease of pain in 2 weeks of local treatment. 1 patient has a pain specialist consultation and reaches a 40% decrease of pain in 2 weeks with local and systemic treatment. 1 patient is still waiting for the correct diagnosis after infectious diseases specialist and rare disease specialist consultation.

Conclusion: Pain is very common in patients with acute and chronic wounds. Pain relief and control are fundamental for the improvement of quality of life. For the future we will prove other alternative therapies such as hypnosis

 

EP0457 Hypnosis in pain management in complex cervicofacial wounds

Francesco Stivala¹, Antonino Lombardo¹, Enrica Fontana¹, Anna De Luca¹, Sandra Iannarino¹, Antonella Mariotto¹, Giuseppe Riva¹, Michela Miletta¹, Mario Paleologo^1
1A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Turin, Italy

Aim: Assess the effect of hypnosis in pain management for complex cervicofacial wounds.

Method: From March 2023 to March 2024, 21 patients (15 men and 6 women) with an average age of 61 years and complex wounds in the cervicofacial area were observed.
The current protocol includes the application of 5% Lidocaine cream plus:

• Paracetamol 1000 mg, administered orally or intravenously;
• For debridement: Tramadol 50 mg in 100 ml of 0.9% saline solution;
• Following surgical procedures: Oxycodone 2.5 mg in 100 ml of 0.9% saline solution.

In this study, after applying 5% Lidocaine cream, hypnosis therapy is initially performed. If the patient experiences procedural pain, the prescribed pharmacological pain management therapy is then administered as per the protocol.

Results / Discussion:

– Patients who underwent hypnosis: 21/21

– Average pain for treated patients: Numerical Rating Scale (NRS) 2,5

– Patients treated with hypnosis only: 15/21

– Average pain for patients treated with hypnosis: NRS 1,8

– Average pain for patients with pharmacological treatment: NRS 5

– Patients with no benefit from hypnosis treatment: 6/21

Conclusion: Data analysis reveals that pain control was achieved in approximately 71% of patients treated with hypnosis therapy, with NRS values < 2. The effective pain control observed with hypnotic treatment allowed for a reduction in the need for medication, which lowers the risk of pharmacological complications, results in cost savings, and, most importantly, enables the patient to experience a positive procedure that was previously associated with painful memories.

 

EP0458 Management of split thickness skin graft harvest sites with fish skin xenograft

Richard Bruno^1
1EVMS, Norfolk, United States

Aim: Split thickness skin graft sites have documented healing times of two to three weeks and often have increased pain. Fish skin xenograft was utilized to assist in the management the split thickness skin graft harvest site.

Method: Six patients underwent harvest of split thickness skin grafting to assist in healing their lower extremity wounds. No patients received wound vacuum therapy as a bolster dressing was applied for each case. Each graft donor site was dressed with a non-adherent dressing. Each patient received a single application of the fish skin xenograft to the donor site.

Results / Discussion: All six patients went on to heal their lower extremity wounds with the split thickness skin graft. Patients had an average donor site healing time of eight and a half days. Four patients expressed no pain to the donor site following fish skin xenograft application. There were no healing complications or instances of infection. Two patients graded their pain scores as mild to moderate which was managed with over-the-counter pain medication.

Conclusion: Fish skin xenografts are a viable option to assist with faster healing times and decrease subjective pain scoring to split thickness skin graft donor sites.

 

 

PRESSURE ULCER

EP0396 Changes in skin and tissue following spinal cord injuries - a scoping review

Leander Gaaarde Melin¹, Knaerke Soegaard^1
1Odense University Hospital, Odense C, Denmark

Aim: Spinal cord injury (SCI) leads to severe and complex alterations in skin and tissue due to denervation, increasing the risk of PI and negatively affecting wound healing. No recent comprehensive review of the literature has been conducted. This scoping review aims to identify and describe the available evidence regarding skin and tissue changes following SCI.

Method: A comprehensive literature search was conducted in the Medline, Embase, Cochrane Library, and SCOPUS databases. English-language studies addressing skin and tissue changes after SCI were included, with no restrictions on study type or publication year. Two independent reviewers selected studies and categorized them into the following subgroups: 1) histopathology, 2) ultrasonography, 3) biomechanical properties, 4) skin perfusion, 5) sebum and sweat gland excretion, and 6) microbiota.

Results / Discussion: Twenty-five articles were included from 5,190 reviewed. The epidermis of SCI patients exhibited atrophy and progressive thinning due to denervation. The dermis showed fibrosis and reduced collagen synthesis, with conflicting results on skin thickness but consistent findings of increased tissue stiffness. Skin perfusion studies revealed diminished reactive hyperemia, inhibited vascular autoregulation, and reduced spontaneous skin oxygenation.

Conclusion: Denervation following SCI results in skin and tissue changes characteristic of aging and injury, including compromised structural integrity, reduced collagen synthesis, and impaired vascular responses. These changes heighten vulnerability to PI and negatively affect wound healing. The existing literature varies in quality with a significant risk of bias, underscoring the need for further research to better understand these mechanisms.

 

EP0397 The uptake of the international pressure ulcer/injury prevention and treatment guidelines: A systematic citation analysis

Monira El Genedy-Kalyoncu¹, Jan Kottner^1
1Charité – Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Berlin, Germany

Aim: The European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance (EPUAP/NPIAP/PPPIA) collaboratively developed International Clinical Practice Guidelines for the prevention and treatment of pressure ulcers/injuries in 2009, 2014, and 2019. Dissemination of these guidelines involves extensive efforts to improve recognition, awareness and uptake. The aim was to provide an updated citation analysis of the three published Clinical Practice Guidelines.

Method: Referencing formats, citation counts, and global distribution of citations of the 2009, 2014, and 2019 Clinical Practice Guidelines and all derivative products including short versions and translations were searched in the citation database Scopus from 2009 to 2023.

Results / Discussion: The search revealed more than 330 different referencing formats with nearly 2900 citations until December 2023. Citations displayed wide geographical diversity, with citation peaks observed approximately four years after each edition’s release and sustained interest to the present.

Conclusion: The three Clinical Practice Guidelines and their derivate versions have a substantial uptake in the scientific literature. This supports the assumption that the guideline dissemination strategies were and are successful worldwide.

 

EP0398 Using the LEO (Leading an EMpowered Organization) programme to support an effetive tissue viability datix campaign in Scotland

Ines Alexandra Esteves Sadoc Pereira^1
1NHS Grampian, Aberdeen, United Kingdom

Aim: Describe how using the LEO Programme guided the creation and implementation of a Tissue Viability Datix campaign during the Pressure Ulcer (PU) Awareness Week.

Method: Used the I2 / E2 formula for change, alongside “appreciative questions” to prepare and deliver the campaign during the PU Awareness Week.

Results / Discussion: The data collected since January 2024 has shown generalized underreporting of PU across the Health Board (HB), hence the need to continue to campaign against the thought that Datix is punitive and show how valuable it can be, if utilized appropriately.  It can be paramount when developing quality improvement projects, to provide a cost-effective way of care, as well as promoting skin damage prevention.

The use of a structured approach that encourages clarity of vision and purpose, to engage others in this project, and using the continuous loops to assess and adapt/improve the approaches being utilized to create and disseminate the campaign, allowed for key stakeholders contribute/inspire the campaign design. Posteriorly, utilizing current educational channels, to ensure all involved have the same level of knowledge, permitted networking and collaboration with a multitude of professions. This can lead to positive outcomes such as prompt incident reporting, and shared learnings from those incidents across the HB.

Conclusion: The campaign design is ongoing with multiple initiatives being developed both face to face and online, but the results and real impact of the campaign will only be known at the end of November, post PU Awareness Week. The evaluation will include staff feedback, audits and data collection. This can showcase the improvement in incident reporting and how learnings are shared amongst healthcare professionals, to improve patient care.

 

EP0399 Exploring the benefits of wound referral systems in the clinical care of pressure injuries

Ching-uen Huang¹, Kuei-Ru Chou^2
1School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan, Taipei, Taiwan, ²School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan

Aim: Pressure injuries are a high-cost and complex issue in hospital care, requiring significant effort. This study focuses on a system that automatically triggers wound consultations. Senior wound care specialists, trained in professional wound management, actively assist and guide clinical staff in identifying and caring for pressure injuries. This intervention aims to reduce the severity of pressure injuries and enhance care quality.

Method: This retrospective study collected and analysed three years of wound consultation data from a medical canter in Taiwan, focusing on pressure injuries. The impact of proactive guidance by senior wound care nurses on the accuracy of pressure injury management and wound healing was observed.

Results / Discussion: Between January 2022 and August 31, 2024, there were 9,809 wound consultations, with an average patient age of over 81 years, predominantly male. The top three wound types were pressure injuries (39.4%), incontinence-associated dermatitis (24.4%), and fragile skin (7%). After intervention, there was a significant reduction in unstageable pressure injuries, while Stage II cases increased.

Conclusion: The multidisciplinary wound consultation system, led by wound care experts, significantly supports the challenging care of pressure injuries. Beginning with proper identification, prevention, and care guidance, supplemented by quick educational interventions, this system highlights the value and effectiveness of professional wound care in improving patient outcomes.

 

EP0627 Are there physiological differences in response to injury depending on skin tone?
A scoping review

Pinar Avsar¹, Zena Moore¹, Declan Patton¹, Tom O’Connor, Lone Bertelsen¹, Desmond Tobin², Giulio Brunetti¹, Keryln Carville³, Vignesh Iyer⁴, Hannah Wilson^1
1RCSI University of Medicine and Health Sciences, Dublin, Ireland, ²University College Dublin, Dublin, Ireland, ³Silverchain, Perth, Australia, ⁴Bruin Biometrics, Los Angeles, United States

Aim: To explore existing literature examining physiological differences in pressure ulcer (PU) response among individuals with differing skin tones.

Method: This is a scoping review. Articles were retrieved from electronic databases including PubMed, CINAHL, Scopus, Cochrane, and EMBASE, using the keywords “pressure ulcer,” “skin pigmentation,” “melanin,” and “risk factor.” Data were extracted using a predesigned data extraction tool and analysed using a narrative synthesis.

Results / Discussion: Five papers met the inclusion criteria. There are five potential mechanisms which may influence the skin’s ability to withstand mechanical stress and its inflammatory response to damage among those with different skin tones; the structure of the stratum corneum, collagen density, fibroblast activity, mast cell density, and transepidermal water loss (TEWL) might. The stratum corneum can compromise skin resilience, while collagen density and fibroblast activity may impact skin strength and repair. Mast cells affect inflammation, which can exacerbate PU damage, and increased TEWL in dark skin tones can result in lower water content in the stratum corneum, affecting hydration. On the other hand, factors like melanosome size, hair follicle and hair fiber characteristics, sebaceous gland activity, vitamin D production, UVR protection, and desquamation rate, although relevant to overall skin health, may not directly affect the mechanical processes.

Conclusion: Physiological differences in skin structure may contribute to alterations in the response to PU development among individuals with dark skin. Recognising these differences is important for targeted prevention strategies within diverse populations. However, further research is needed to explore the mechanisms underlying this association.

 

EP0400 Local treatment of pressure ulcers at risk or with clinical signs of local infection with TLC-AG dressings* - evidence from a prospective, multicentre real-life study

Joachim Dissemond, MD^1
1Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Germany

Aim: To assess the performance of TLC-Ag dressings in the local treatment of PUs at risk or with clinical signs of local infection in real-life conditions.

Method: A large, prospective, multicentre observational study in patients with a wound at risk or with clinical signs of local infection treated with two TLC-Ag dressings* was conducted in 39 centres across Germany. This report will focus on the results achieved in patients with PU.

Results / Discussion: Among the 728 patients included in this clinical study, 32 patients had a PU. At the initial visit, risks of wound infection were present in 97%, clinical signs of wound infection in 81% and a wound infection was established in 72%, while antibiotic therapy was prescribed to 25%. Throughout the study period, the parameters of wound infection continuously decreased, the most rapidly diminished being wound deterioration/enlargement, presence of pus and clinical signs related to wound exudate, resulting at the final visit in a reduction by 61% of local wound infections and by 70% of the presence of the different signs on average. Concurrently, in terms of healing process, 91% of the wounds healed or improved, and 6% stabilized. Overall, the two dressings were ‘well tolerated’ and ‘well accepted’ by most patients and were assessed by the physicians.

Conclusion: These results are consistent with previous clinical evidence on TLC-Ag dressings. They support the good efficacy, tolerability and usefulness of these antimicrobial dressings in the management of patients with PUs in association with appropriate standard of care.

*UrgoTul Ag, UrgoTul Ag Lite Border, Laboratoires URGO, France

 

EP0401 Wound healing in patients with pressure ulcers treated with TLC-NOSF dressings* - evidence from a pooled analysis of two prospective, multicentre real-life studies

Joachim Dissemond, MD^1
1Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Germany

Aim: To assess the performance of TLC-NOSF dressings in the local treatment of PUs in an unselected cohort of patients under real-life conditions.

Method: Data were pooled from two large, prospective, multicentric observational studies conducted in Germany. 2101 patients with a chronic wound treated with different TLC-NOSF poly-absorbent dressings* were followed up for 12 weeks. This work will focus on patients with PU.

Results / Discussion: 208 patients with PU were treated with the evaluated dressings. At the initial visit, PUs had a median surface area of 9.4 cm² covered by 43% sloughy tissue, and most often with high or moderate level of exudate. By the final visit, 47.1% of ulcers were healed and 48.6% improved. The median relative wound area reduction was 98.7%. The proportion of wounds with moderate/high level of exudate decreased from 63.9% to 11.5%. Maceration and malodour were reduced by 78.6% and 87.4%, respectively, and perilesional skin condition was improved in 76.4% of patients. Optimal healing results were achieved when the dressings evaluated were used as first-line treatment, i.e. in PUs lasting ≤1 month, with 54.3% of wound healing in 43 days. The dressings were ‘very well’ tolerated and accepted by most patients.

Conclusion: These results show the good performance of these dressings in rapidly improving wound healing in patients with PU treated in real-life settings. They are consistent with previous clinical evidence on TLC-NOSF dressings, supporting their use as a first-line treatment in the local treatment of PUs, in association with appropriate standards of care.

*UrgoStart Plus Pad, UrgoStart Plus Absorb and UrgoStart Plus Border, Laboratoires URGO, France

 

EP0402 Can protective colostomy have a role in pressure injury management? A prospective non-randomized controlled study

Andrea Scotti¹, Franz Baruffaldi Preis¹, Marco Borrini¹, Vito Russo¹, Simona Lavolpicella^1
1ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

Aim: The purpose of this article is to evaluate the potential role of a protective colostomy after reconstructive plastic surgery in individuals with spinal cord injury and neurological bowel, where pressure injuries are a serious complication.

Method: This began as a case-control observational study. From 2019, the therapeutic protocol was modified, and colostomy was proposed to all individuals. 45 people with spinal cord injuries and grade 3 or 4 pressure injuries were recruited. The experimental group underwent colostomy, while the control group received direct lesion reconstruction. Fisher’s exact test and Student’s t-test were utilized for group comparison. Primary outcomes included the number of healed ulcers and post-operative infections.

Results / Discussion: The number of lesions healed within 30 days and the rate of flap infections showed significant differences between the two groups. A crucial statistical difference was found (p< 0.05). The complication rate was 44.44% in the control group and 17.65% in the experimental group (p-value < 0.05). Quality of life also showed encouraging results: 88% declared an improvement of their condition and only one patient asked to reconnect his stoma. As collateral consideration, there were no differences in healing rate between patients treated with fasciocutaneous or musculocutaneous flaps.

Conclusion: Protective colostomy may prevent ischial and sacral complications after surgery in tetra and paraplegic patients with neurological bowel, reducing long-term hospitalization and healthcare costs. It also seems to improve individuals with spinal cord injury quality of life.

 

EP0403 Evaluation of tlc-nosf dressings for the management of pressure ulcers: A case series in geriatric department in France

Marion Delannoy¹, Lolita KADA¹, Hester Colboc^1
1Hopital Rothschild Ap-HP, Paris, France

Aim: To evaluate, through an exploratory clinical assessment in hospitalized patients, the effectiveness of these TLC-NOSF dressings prescribed for the management of pressure ulcers, ranging from stage II to IV.

Method: We propose a prospective case series conducted in a geriatrics department in a French Hospital. The study will include patients with non-infected pressure ulcers (stage II-IV) of any location, without dry necrosis, eligible for local wound care with TLC-NOSF dressings. Eligible patients will be followed for a maximum of 12 weeks. The primary criterion will be the number (and percentage) of patients achieving complete healing (100% re-epithelialization) at the end of the 12-week treatment period (or last treatment visit). Secondary criteria include:

Healing time of pressure ulcers treated with this strategy.

Frequency of dressing changes since the initial visit.

Overall clinical assessment of healing progression.

Dressing acceptability and overall performance evaluation

Evolution of perilesional skin condition.

Nature and number of adverse events.

Results / Discussion: As of the abstract submission, patient recruitment for the study is ongoing (7 patients included), with an anticipated total of approximately twenty cases to be included.

Conclusion: The proposed study aims to provide insights into the clinical effectiveness, tolerability, and acceptability of TLC-NOSF dressings in the management of pressure ulcers (stage II-IV). By evaluating various parameters, we aim to contribute valuable data to support the use of these dressings in real-world clinical settings.

*UrgoStart Plus® Pad, UrgoStart Plus® Border®, UrgoStart Contact

 

EP0404 A prospective, randomized, non-inferiority trial to compare the efficacy of 3% povidone-iodine foam dressing and silver foam dressing in the treatment of pressure injuries

Kyung Hee Park^1
1The University of Suwon, Hwaseong-si, Gyeonggi-do, Rep. of South Korea

Aim: As chronic wounds such as pressure injuries (PIs) are frequently colonized and can easily deteriorate into infection, it is important to reduce their bacterial load, for which antimicrobial dressings can be needed. This study aims to evaluate the efficacy of a 3% povidone-iodine (PVP-I) foam dressing compared to that of a silver foam dressing.

Method: This prospective non-inferiority study was conducted between 2016 and 2019 at three sites in South Korea. A total of 80 PI subjects were randomized to be dressed with either PVP-I foam (experimental group) or silver foam (control group) for up to 8 weeks.

Results / Discussion: Based on the Pressure Ulcer Scale for Healing (PUSH) tool, 25.0% of the experimental groups and 17.5% of the control groups (χ2=0.743, P=0.389) healed by more than 70%. The degree of reduction in wound size was analyzed using Image J, and the experimental and control groups decreased by 41.6%±35.3% and 49.7%±38.2% (t=–0.986, P=0.327), respectively. A Kaplan-Meier survival analysis to confirm the time to heal showed that if more than 30% of the PUSH score was healed, the time to heal was 27.0±9.3 days and 18.0±2.8 days in the two groups (χ2=3.225, P=0.073), respectively. The healing rates at 50 days were 85.8%±8.9% and 93.9%±5.7% in the two groups (P=0.073), respectively. There were no statistically significant differences between the groups in all results.

Conclusion: This study demonstrated the non-inferiority of the 3% PVP-I foam dressing compared to the silver foam dressing for PI treatment.

 

EP0405 Impact of wound hygiene incorporating an antibiofilm gelling fiber dressing on hard-to-heal pressure ulcers/injuries

Rachel Torkington-Stokes¹, Daniel Metcalf^1
1Convatec, Deeside, United Kingdom

Aim: To evaluate the impact of the Wound Hygiene protocol (WHP), a 4-step (cleanse, debride, refashion, and dress) biofilm-based wound management strategy, on hard-to-heal pressure ulcers/injuries

Method: A subgroup analysis of patients with pressure ulcers/injuries in a prospective, real-world study of hard-to-heal wounds managed with the WHP (incorporating an antibiofilm gelling fiber dressing*) for approximately 4 weeks, or as clinically appropriate, was performed. The primary endpoint was change in wound volume from baseline to the final assessment.

Results / Discussion: 110 patients had pressure ulcers/injuries (38% were static, 24% were deteriorating) and were included in this analysis (median treatment duration 32 days). Of 88 patients with baseline and final wound volume assessments, 30 (34%) had complete wound closure (100% volume reduction). Mean wound volume reduced from 143.1 cm³ at baseline to 37.4 cm³ (73% reduction) at final assessment. Exudate levels changed from predominantly moderate (50%) at baseline to predominantly low (36%) at the final assessment. Signs of clinical infection were present in 51% at baseline, which had reduced to 5% at final assessment. Suspected biofilm was 78% at baseline and 15% at final assessment. At final assessment, 20% of pressure ulcers/injuries had healed and 75% had improved.

Conclusion: Management with the WHP resulted in healing or improvement in nearly all hard-to-heal pressure ulcers/injuries (95%), and notable decreases in wound volume, exudate level, suspected biofilm, and local infection. Our findings suggest that the WHP incorporating an antibiofilm dressing is an effective treatment strategy for pressure ulcers/injuries.

*Aquacel® Ag+ Extra™ (Aquacel Ag Advantage in the United States).

 

EP0639 Reported incidence and prevalence rates of pressure ulcers in the paediatric population: a meta-review of systematic reviews

Lauren Vickers¹, Zena Moore¹, Aglécia Budri
¹Royal College of Surgeons in Ireland, Dublin, Ireland

Aim: This meta-review examines the incidence and prevalence rates of pressure ulcers (PUs) in paediatric populations, addressing the gap in the literature compared to adult populations. This review also provides a foundation for research on early factors contributing to paediatric PUs, aiming to improve understanding and prevention.

Method: A comprehensive electronic literature search of seven databases yielded 409 articles for consideration in this review. After applying inclusion/exclusion criteria and critical appraisal with the JBI checklist for systematic reviews, five systematic reviews met the inclusion criteria and were included in this review.

Results / Discussion: Three varieties of pressure ulcers (PUs) were discussed in the included studies: hospital-acquired pressure ulcers (HAPU), medical device-related pressure ulcers (MDRPU), and tracheostomy-related pressure ulcers (TRPU). These were analysed separately due to the significantly higher reported rates of TRPU compared to MDRPU. The pooled incidence rate for HAPU was 8% (95% Confidence Interval [CI] 4% - 13%), and for MDRPU, 9% (95% CI: 2% - 19%). The pooled prevalence rate for HAPU was 8% (95% CI: 5% - 12%), and for MDRPU, 10% (95% CI: 1% - 26%). Interventional studies on TRPU showed a pooled risk ratio of 0.35 (95% CI 0.26 – 0.49).

Conclusion: PUs are a concern in paediatric populations, with comparable incidence and prevalence rates between HAPU and MDRPU. Children with tracheostomies face a significantly higher risk of developing PUs, highlighting the need for tailored preventive interventions. PU represent a significant challenge in paediatric healthcare, requiring vigilant preventive measures and tailored interventions to safeguard the well-being of young patients.

 

EP0640 Impact of pressure injuries on health-related quality of life: A systematic review

Shiwen Liu¹, Helen Rawson¹, Rakibul M. Islam², Victoria Team^1
1Nursing and Midwifery, Monash University, Melbourne, Australia, ²School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Aim: To synthesise the evidence of the impact of pressure injuries (PIs) on the health-related quality of life (HRQoL) of adults aged 18 years and older.

Method: Electronic databases (Ovid Medline, Ovid Embase, CINAHL EBSCO, Scopus and Central Register of Controlled Trials) were systematically searched for eligible studies published between January 2019 and April 2024. Risk of bias was assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Institute critical appraisal tool. Data were narratively synthesised due to methodological heterogeneity.

Results: Twenty-two studies (n= 12 quantitative; n= 9 qualitative; n= 1 mixed methods) met the inclusion criteria. The qualitative studies were grouped into four main impact areas: symptoms, physical function, psychological well-being and social functioning. Five instruments were used to assess HRQoL and identified low scores in people with PIs, with the lowest scores mostly reported in physical functioning, role physical and emotional concepts. A complexity of factors influenced the HRQoL of people with PIs, including age, gender, number of PIs, PI interventions, duration of care, comorbidities, PI stages and locations, and care settings.

Conclusion: This review indicated that PIs were associated with low HRQoL scores, negatively affected all aspects of HRQoL. The findings highlight the significance of maintaining psychological well-being and implementing effective pain management, while also emphasising the need for preventative strategies to improve HRQoL. This review further underscores the complexity of factors impacting HRQoL in people with PIs, suggesting that future research should explore these factors in greater detail.

 

EP0406 Analysis of five cut-offs of prevalence of dependence-related skin lesions in the neonatal population admitted to institutions of the national health system. 2023-2024

Anna Gros¹, Evelin Balaguer-López², Pablo Buck³, Pablo García-Molina⁴, Julia de Frutos Pecharromán⁵, Isabel  Mora Morillo⁶, Laura Pla Marzo⁷

¹Hospital Universitari Vall D‘hebrón, Vall D‘hebrón Institut De Recerca, Barcelona, Spain, ²Servicio Pediatría. Hospital Clínico de Valencia, Universitat de València. Departamento de Enfermería, Grupo de Investigación en Cuidados, Valencia, Spain, ³Hospital Universitari Vall D‘hebrón, Vall Hebrón Institut De Recerca, Barcelona, Spain, ⁴Unidad Enfermera de Úlceras y Heridas Complejas. Hospital Clínico de Valencia, Universitat de València. Departamento de Enfermería, Grupo de Investigación en Cuidados, Valencia, Spain, ⁵hospital Universitari Vall D‘hebrón, Barcelona, Spain, ⁶Hospital Regional Universitario de Málaga, Malaga, Spain, ⁷Universitat de València. Departamento de Enfermería, Valencia, Spain

Aim: To obtain updated epidemiological indicators on the prevalence of dependence-related skin lesions (DRSL) in Spain in a hospitalized neonatal population.

Method: A cross-sectional, multicenter, analytical, observational, descriptive study was conducted. Analysis of a series of 5 prevalence cut-offs in two years (March 2023 – June 2023 – October 2023 – March 2024 – June 2024). Data collection and analysis of all neonates admitted during cuts in neonatal units of the National Health System integrated in the project (19 hospitals).

Results / Discussion: Data were obtained from a total of 789 patients who signed the informed consent. 58% were women. The mean age was 26.04 (± 33.8) days, with a mode of 3, minimum age 1, and the maximum age 559. The mean weight of the patients was 1915.7 ± 994.16. 29.5% of the patients had DRSL, 9.3% had pressure injuries, 20.2% had moisture injuries, 4.4% had friction injuries, and 2.1% had skin tears. Regarding risk factors, the mean admission was 23.88 (± 27.49) days, with a mode of 1. 96% of patients had clinical devices such as nasogastric tubes (41%), peripheral vascular catheters (20%), or pulse oximeters (93%). Data were also taken on preventive measures such as postural changes (98.23%), change of saturation sensor (96.45%), use of essential fatty acids (27.5%), and use of barrier products (28.01%).

Conclusion: Three of the ten neonates had DRSL. It is necessary to monitor their appearance together with risk factors and preventive measures to develop effective prevention and management strategies.

 

EP0427 Management protocol for mucosal pressure ulcers in the intensive care unit: Clinical successes with hypochlorous acid 330ppm and pH 5.5

Camilo Valle^1
1Hospital de la Serena, La Serena, Chile

Aim: To describe a protocol for managing mucosal pressure ulcers (PU) associated with medical devices (MD) in critically ill patients using hypochlorous acid (HOCl) at 330 ppm and pH 5.5.

Method: Descriptive observational study. Case report including 5 adult patients hospitalized in the Intensive Care Unit presenting with MD-associated PU in mucosal membranes. Patients selected had lesions in moist membranes lining the oral cavity and/or genitourinary tract, secondary to the use of orotracheal tubes and/or indwelling urinary catheters, respectively. A local management protocol was implemented, consisting of oral and/or genital hygiene every 6 hours, pressure relief through MD mobilization every 4 hours, and the application of gauze soaked in HOCl 330 ppm and pH 5.5 over the affected area for 5 minutes every 6 hours.

Results / Discussion: All patients showed improvement in lesions, with progressive reduction in lesion size, absence of bleeding, and reduction in tissue damage.

Conclusion: Maintaining a standard of care that addresses both the etiology and local management of the lesion promotes effective tissue recovery, with visible results achieved in a short time. The use of HOCl 330 ppm and pH 5.5 in mucosal lesions proved to be a straightforward technique with favorable clinical outcomes and high adherence by healthcare staff. These results suggest that this practice could be replicated in the management of similar lesions.

 

EP0407 Sacral skin discoloration phenomena in adult patients at end of life

Barbara Bates-Jensen¹, Sharon Sonenblum², Victoria Nalls³, Vicky Nguyen⁴, Taylor Krause-Leemon⁴, Lisa Seidl⁴, John Calonia⁴, Antonia Osuna-Garcia⁵, Heather McCreath^6
1University of California, Los Angeles School of Nursig and Division of Geriatrics David Geffen School of Medicine, Los Angeles, California, United States, ²Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, Georgia, United States, ³CareBridge, Nashville, Tennessee, United States, ⁴University of California, Los Angeles School of Nursing, Los Angeles, California, United States, ⁵University of California, Los Angeles, Los Angeles, California, United States, ⁶University of California, Los Angeles Division of Geriatrics David Geffen School of Medicine, Los Angeles, California, United States

Aim: Conduct scoping review and delineate findings to guide research on the phenomena as it is poorly recognized across skin tones, variously labeled “Kennedy terminal ulcer” and “skin failure”, and no consensus exists on terminology, characteristics, and outcomes which impacts care.

Method: A Scoping Review conducted using PubMed, CINAHL, Embase, and grey literature through June 2023. Twenty search terms related to pressure ulcer/injury, skin failure, end-of-life care, and adults addressed: 1) What are characteristics of sacral skin discoloration? 2) What are antecedent conditions? 3) What are consequences or outcomes?  Four reviewers selected citations based on apriori inclusion criteria, graded full-text literature, and extracted data using a pre-defined form.

Results / Discussion: Searches yielded 15,613 sources with 128 multiple types included: opinion/editorials (n=35), clinical/reviews (n=38), case series (n=14); quantitative (n=40) and qualitative (n=1) studies. Critical care, long term care, end-of-life, and acute care settings were comparably noted. Shape (butterfly, pear) and color (red, black, purple) were described in opinion/editorials but unsupported with primary data. Antecedents included organ failure and vasopressors but were rarely discussed (n=27/128). Rapid skin worsening was reported in 25% (n=32/128) of papers. Death was noted with a range of units (hours, days, weeks, months). Minimal papers reported race/ethnicity or skin tone (n=7), pain (n=8), or provided biophysical data (n=1).

Conclusion: Significant gaps exist in knowledge of sacral skin discoloration at end-of-life. Many opinion/editorial reports exist, but quantitative studies need inclusion of more data to better elucidate this phenomenon. Development of common dataset elements could facilitate identification.

 

EP0408 The usefulness of gracilis musculocutaneous pedicled flap as a surgical option in ischial pressure injury

Jung Yeol Seo^1
1Department of Plastic and Reconstructive Surgery, School of Medicine, Pusan National University, Yangsan, Rep. of South Korea

Aim: Ischial pressure injuries are common in patients with paraplegia. Even if surgical reconstruction is performed, ischial pressure injury often recur. The gracilis musculocutaneous pedicled flap in ischial pressure injury reconstruction is more useful as a surgical treatment option for recurrence after the first reconstructive surgery than the other ones.
Method: This study was performed on patients with ischial pressure injury who had paraplegia. 11 patients who underwent more than one ischial pressure injury reconstruction on the same site, excluding gracilis musculocutaneous pedicled flap, underwent ischial pressure injury reconstruction with gracilis musculocutaneous pedicled flap.

Results / Discussion:  The patients were 8 males and 3 female, all had paraplegia. In all 11 patients, the ischial pressure injury reconstructions were performed with gracilis musculocutaneous pedicled flap on the ipsilateral side. Three of them had no complications over at least 6 months after surgery at the surgical site. One patient had some skin disruption due to mild flap congestion immediately after surgery, but it recovered soon after only dressing treatment. The other one patient had full dermis necrosis due to flap congestion, and recovered by negative pressure wound treatment and skin graft.

Conclusion: The gracilis musculocutaneous pedicled flap with a large surgical range and possible complications such as flap congestion is not useful as a primary surgical option. However, Recurrent ischial pressure injury reconstruction, the gracilis musculocutaneous pedicled flap can be a good surgical option to reduce tension when seated while providing sufficient soft tissue volume in the ischial pressure injury.

 

EP0409 Device-related pressure injuries in intensive care unit

Kyuwon Baek^1
1Korean Wound Management Society, Seoul, Rep. of South Korea

Aim: Intensive care unit (ICU) patients frequently use various devices that cause Pressure injuries. The use of these devices increases the risk of developing pressure injuries due to devices. Therefore, this study analyzed device-related pressure injuries currently occurring in ICUs.

Method: This study collected and analyzed data on pressure injuries occurring in the ICU of one hospital in Korea from January 1, 2024 to June 30, 2024. This study retrospectively analyzed the DRPI.

Results / Discussion: As a result DRPI accounted for 28.6% of all Pressure injuries occurring in the ICU. The site of occurrence were 16 anatomical locations in total. DRPI mainly occurred in the nose (54.5%). DRPI caused by L-tube (27.3%) was highest. Followed by HFNC(15.2%), Nasal cannula (9.1%), T-cannula (9.1%), AES (6.1%), Foley (6.1%), Restraints (6.1%).

Conclusion: The incidence of DRPI remained high in this study. The most common devices linked with DRPI were L-tube and mask, making assessment and prevention efforts critical for patients who require those devices. We should take appropriate preventive intervention to reduce the incidence of DRPI.

 

EP0411 The treatment of a pressure injury, a need! The application of EHO-85 an opportunity?: A case report

María Dolores Rubio González¹, María Elena Fernández Díaz¹, María Salud Nieto González¹, Manuela Urbano Priego¹, Silvia Luna-Morales², Caridad Dios-Guerra², Antonio Casado-Diaz³, José Verdú Soriano, Miriam Berenguer Pérez^{4 5
1}Distrito Sanitario Córdoba Guadalquivir, Córdoba, Spain, ²UGC Occidente-Azahara, Córdoba, Distrito Sanitario Córdoba y Guadalquivir e IMIBIC, Córdoba, Spain, ³UGC Endocrinología y Nutrición, CIBERFES, IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain, ⁴WINTER-Heridas., Universidad de Alicante, Alicante, Spain, ⁵Dpt. Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia., Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, Spain

Aim: EHO-85 hydrogel containing olive leaf extract is a treatment that, in addition to its inherent moisturizing and barrier functions, balances the ulcer microenvironment by modulating reactive oxygen species and lowering pH. Then, the objective is to report on the use of EHO-85 to aid towards healing of a patient with pressure injuries (PI).

Method: Case report: 87-year-old woman, with insulin-dependent diabetes mellitus, COPD, femur fracture with hip prosthesis. Admitted to hospital for pneumonia where she developed a grade III pressure ulcer in the sacrum (2.4 x 5.3 cm). Basal glycaemia: 147mg/dl; glycosylated hemoglobin 7.9%, ankle brachial index (ABI): 1.14, visual analog scale (VAS): 4.

Results / Discussion: Treatment was started according to guidelines and included EHO-85. Wound evolution: 2 weeks: -19.1%, 4 weeks: -46.3%; 6 weeks: -87.9%; completing 100% healing in 8 weeks. Exudate has been kept under control, wound edges delimited, perilesional skin intact, without any episode of infection. VAS assessment was = 0 at all visits.

Conclusion: The application of EHO-85 in the treatment of pressure injuries may constitute an effective, inexpensive, and fast-acting therapeutic opportunity as indicated by a pivotal Randomized Controlled Trial recently published.

 

EP0412 Prevalence and risk factors of pressure ulcers in Jordanian hospitalized patients

Maen Aljezawi^1
1Al al Bayt University, Mafraq, Jordan

Aim: This study aims to explore the prevalence, risk factors, and preventive measures for pressure ulcers (PUs) in hospitalized patients in Jordan.

Method: A prospective matched case-control design was utilized, following the European Pressure Ulcers Advisory Panel methodology and minimum data set for comprehensive data collection.

Results / Discussion: The overall prevalence rate of pressure ulcers across all grades was 11.5% (7.93% when excluding grade I). Grade I ulcers were the most common, accounting for 27.45% of cases, with the sacrum identified as the most affected site (39.12%). Multivariate analysis revealed several significant risk factors associated with PU development, including low albumin levels (< 32 mg/dl), previous hospitalizations, elevated urea levels, and being overweight (BMI).

Conclusion: The prevalence of pressure ulcers in Jordan is lower than that reported in other countries, which may be attributed to the country’s younger population. Additionally, the current study found a decline in PU prevalence compared to a 2013 study, likely due to the implementation of more effective preventive measures in participating hospitals. Despite this decline, pressure ulcers remain a significant concern, underscoring the necessity for ongoing preventive strategies and a deeper understanding of risk factors to mitigate patient suffering.

 

EP0413 Stimuli-responsive nanofibers for the treatment of pressure ulcers

Marta Pollini¹, Eleonora Bianchi¹, Marco Ruggeri¹, Barbara Vigani¹, Giuseppina Sandri¹, Silvia Rossi^1
1University of Pavia, Pavia, Italy

Aim: The aim of the present study was the design and the manufacturing of 4D scaffolds based on polycaprolactone (PCL) and zein (Z) nanofibers, coated with polypyrrole (PPy), for the treatment of pressure ulcers upon electrical stimulation.

Method: PCL pellets and Z were dissolved in acetic acid 96% and subjected to electrospinning. Afterwards, the fibrous scaffolds were coated with different loadings of PPy, which resulted by the in-situ polymerization of pyrrole in presence of an oxidant agent.

Fibers morphology, diameter and topography were evaluated by means of SEM and AFM. Mechanical properties were assessed by performing DMA analysis. Fibers conductivity was studies using the Four Probe Method. Scaffolds cytotoxicity was evaluated. In-vitro cell adhesion and proliferation on scaffolds was investigated overtime with and without the application of exogenous electrical stimulation.

Results / Discussion: PPy particles adhering to the surface of PPy coated PCLZ fibers were confirmed by both SEM and AFM analysis. The mechanical properties proved that the hydration process did not affect the scaffolds resistance. In terms of scaffolds conductivity, it was found that the most promising formulation is the one obtained by the polymerization of pyrrole 0.03M with FeCl₃ 0.09M. The in-vitro characterization allowed to confirm the biocompatibility of the scaffolds and cell adhesion and proliferation up to 21 days.

Conclusion: This study allows to successfully develop PPy coated PCLZ nanofibers which should be an innovative scaffold enhancing wound healing of pressure ulcers. Further investigations are on-going to prove scaffolds antibacterial properties and in-vivo efficacy.

 

EP0414 Protecting the fragile: A scoping review of medical device-related pressure injury prevention in NICU and pediatric patients

Ana Pinho¹, Ana  Monteiro², Paulo Alves^3
1CHUC, Associação Portuguesa Tratamento de Feridas (APTFeridas), Coimbra, Portugal, ²Universidade Católica Portuguesa, Faculty of Health Sciences and Nursing, Nursing School (Porto), Porto, Portugal, ³Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Associação Portuguesa Tratamento de Feridas, Porto, Portugal

Introduction: Newborns in Neonatal Intensive Care Units (NICUs), especially those requiring continuous respiratory and nutritional support, face elevated risks of medical device-related pressure injuries (MDRPIs) due to prolonged device contact on delicate skin. This scoping review aimed to identify devices most associated with MDRPIs in pediatric and neonatal populations and assess effective interventions for prevention.

Methodology: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Databases including PubMed, CINAHL, and EBSCO were searched, with MeSH terms like “neonatal intensive care,” “pressure ulcer,” and “medical device-related injuries” applied for standardized results. Study selection adhered to JBI guidelines, incorporating studies on MDRPIs in neonatal and pediatric populations. Two reviewers independently screened titles, abstracts, and full texts for eligibility. Data were extracted on device types, injury risks, and preventive interventions, then charted and analyzed to identify patterns and gaps in the current research.

Results / Discussion: Eleven studies highlighted common high-risk devices such as nasal prongs, CPAP masks, and cervical collars, which frequently contribute to MDRPIs due to prolonged use. Effective interventions identified include structured training for NICU staff, care bundles, and interdisciplinary quality improvement initiatives, which significantly reduced MDRPI incidence by improving device monitoring and protective practices. Risk assessment tools, including the Braden QD Scale, were noted as promising in predicting high-risk cases.

Conclusion: This review identifies respiratory devices and cervical collars as primary contributors to MDRPIs in NICU and PICU settings. Preventive strategies, such as staff education, quality improvement protocols, and regular risk assessments, can significantly reduce MDRPI rates. Multicenter studies are recommended to further validate these findings and promote widespread adoption of MDRPI prevention practices.

 

EP0415 Prevalence of surgical pressure ulcer measured by the subepidermal moisture and visual skin assessment: A cross-sectional study

Rhavenna Oliveira¹, Fabiana Ramos¹, Karime Oliveira¹, Graziela Almeida¹, Tamara Bicudo¹, Rúbia Alencar¹, Aglécia Budri, Marla Avila^1
1Sao Paulo State University (UNESP), Botucatu, Brazil

Aim: To investigate the prevalence of surgical pressure ulcers (PU) measured by subepidermal moisture (SEM) and visual skin assessment (VSA).

Method: This is a cross-sectional study conducted with 110 adult and older patients undergoing surgical procedures from different specialties, lasting 120 minutes or more. Patients who presented visually detectable PU before surgery were excluded. VSA was performed following the recommendations of the EPUAP. SEM was assessed using the SEM Scanner device on the sacrum and the right and left heels, with a SEM-delta value of 0.6 or higher on two consecutive days being considered as SEM PU. Following ethical approval, assessments were conducted in the immediate preoperative period, within 24/48/72 hours postoperatively. The STROBE checklist was followed.

Results / Discussion: The prevalence PU identified by VSA was 6.4%(n=7), while the prevalence of SEM PU was 48.6%(n=53). We observed that male population had double the risk of developing SEM PU(p=0.008), being obese increased the risk by 81%(p=0.046) and participants classified as ASA 4 had four times the risk of developing SEM PU(p=0.021). Additionally, each extra day of hospitalization within the first 24 postoperative hours increased the risk by 4%(p=0.004), and the use of a standard hospital mattress as a support surface during the first 72 postoperative hours tripled the risk of SEM PUs(p=0.009).

Conclusion: The prevalence of SEM PU was higher than that of visually identified PU. Incorporating SEM assessment in surgical populations emerges as a robust adjunct to traditional methods, significantly enhancing the early detection of PUs.

 

EP0416 The single-center experience of the modified “Reader” flap technique combined with NWPT in the repair of severe pressure sores

Yue Yang¹, Xiaoye Tuo¹, Guang Feng^1
1Peking University Shougang Hospital, Beijing, China

Aim: To explore the effect of modified “reader” skin flap combined with NWPT in the repair of severe pressure ulcer.

Method: The results of repair treatment in 36 patients with pressure sore from October 2022 to December 2023 were retrospectively studied. All of them were treated with the modified “reader” flap technique combined with NWPT at the Department of Prosthetics and Reconstructive Surgery of Shougang Hospital, Peking University. In this group, 22 cases were male and 14 were female. The patients ranged in age from 41 to 85 years old, with an average age of 61.5 years old. The locations of pressure sores include: sacrococcygeal, hip, ischial tubercle, heel and so on. The average size of pressure sores was 10.0cm×9.0cm, and the defect area was 8.0cmx6.0cm-21.0cmx15.0cm.

Results / Discussion: 36 cases of skin flap survived completely. Tip necrosis occurred in 2 cases and seroma in 2 cases, which were healed by dressing change.  Postoperative hematoma occurred in 1 patient, which was improved after bedside cleaning of the hematoma. The texture and color of the flap were good in all patients, and only 1 patient had hematoma blockage with negative pressure closed drainage. After 6-12 months of follow-up, there were 2 cases of recurrence of pressure ulcers, all patients with mild scar degree, 36 patients and their families were very satisfied with the results of surgery.

Conclusion: The modified “Reader” skin flap combined with NWPT is effective and the blood supply of the skin flap is reliable. It can fully drain and protect the flap, and the method is simple and easy to operate. It is worth further expanding the sample size.

 

EP0417 AI-enabled staging of pressure injuries

Ayşe Sılanur Demir¹, Ahmet Emin Battal², Cevat Güleç², Eren Ergün², Ahmet Bakcacı², Ayişe Karadağ¹, Çiğdem Gündüz Demir^2
1School of Nursing, Koç University, İstanbul, Turkey, ²Department of Computer Engineering, Koç University, Istanbul, Turkey

Aim: This study aims to design an artificial intelligence tool that can more accurately and objectively identify different stages of pressure injuries (PIs).

Method: In this study, we propose using AI and computer vision to classify PI images by stage. To this end, in our approach, we implemented a classification network and trained it on a set of PIs images labeled with their stages. This dataset includes images from two different sources, namely the publicly available PIID dataset (1091 images), and a private dataset from Koç University Hospital (572 images). All images were resized to 224x224 and normalized according to the ImageNet-1K dataset before model input. Various deep learning architectures, including ResNet18, ResNet18-Transformer Encoder Hybrid Model, and DenseNet-121 were used for training and testing. Three-fold cross-validation was used to ensure more robust training and testing. Multiple configurations were tested for each model and the best-performing configuration was identified. Grad-CAM was applied to visualize attention areas for further evaluation of the model results.

Results / Discussion: Following three-fold cross-validation, ResNet18 outperformed all tested models, achieving an average accuracy of 76.92 ± 0.92 percent on the four-class classification task. The model demonstrated the highest precision of 87.35 ± 5.54 percent for Stage 1 and the lowest precision of 64.72 ± 2.66 percent for Stage-3. Grad-CAM visualizations, interpreted by expert nurses, showed that the model was able to generally focus on the appropriate regions of the images during classifying.

Conclusion: The results of using the proposed computational approach for PIs staging are promising. Our AI model can automate PI stage classification, making it a valuable tool for clinic experts.

 

EP0418 Equity in care: Skin tone diversity education in pressure damage prevention

Sarah Everett^1
1Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, United Kingdom

Aim: Bring awareness of Skin Tone Diversity Education in Pressure damage prevention.

Method: Quality Improvement project.

Results / Discussion: When the Best Practice Statement regarding Skin Tone bias in wound care was released in 2021, the Tissue Viability (TV) team acknowledged this. In May 2022, data collection of patients with acquired pressure ulcers and dark skin tone was gathered by TV team. By October 2022, there was a significant increase in acquired pressure damage overall, and underscoring of the skin damage, significantly increased in patients with a darker skin tone. The Patient Safety Nurse and Quality Matron were commissioned to conduct a retrospective deep dive and root cause analysis to investigate the factors contributing to this. As a result of this deep dive, it was identified the lack of awareness of “Skin colour bias” amongst the workforces.  Through this it was then identified the importance of bringing equity to the current pressure ulcer (PU) and skin damage PU prevention assessments and management strategies. Using quality improvement methodologies QI project was started the nurse led team using the PDSA cycles, thematic reviews, deep dive reports and research methods. The team review the existing assessment tools and protocols and all current teaching materials. The revised and reworked Educational Strategies on Skin Tone Bias started in November 2022.

Conclusion: After years of “React to Red”, we have broken down the barrier to dark skin tone assessments and demonstrate undergoing inequalities and systemic skin tone bias. Over 350 staffs were trained,all new RNs, RNA’s and HCA’s now receive skin tone assessment training and how to avoid skin tone bias as part of their clinical induction program.   

 

EP0419 Establishing a diverse patient and public involvement panel for pressure ulcer research: A methodological approach

Hannah Wilson¹, Declan Naughton¹, Wendy Chaboyer^{1 2}, Declan Patton¹, Zena Moore^1
1Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Ireland, Ireland, ²Griffith University, South East Queensland, Australia

Aim: To establish a diverse patient and public involvement (PPI) panel to identify future research priorities and address the gap in patient and caregiver involvement in pressure ulcer (PU) research in Ireland.

Method: A methodological framework was developed to form a PPI panel of patients and caregivers with lived experience of PUs. Seed funding from the European Pressure Ulcer Advisory Panel supported PPI reimbursement. Engagement was initiated through Ireland’s national PPI Ignite Network opportunity noticeboard (July 2024), inviting patients and caregivers to collaborate with the research team. Accessible outreach materials, written at a 7^th-grade reading level using a Flesch-Kincaid calculator, were distributed through communication channels with local communities, charities, and wound care organisations to broaden outreach.

Results / Discussion: A patient advisory partner with PU experience co-developed lay summaries, a graphic illustration, and a voice message to engage potential panel members. This collaboration successfully established a diverse PPI panel of ten members. Early involvement of an advisory partner strengthened connections with local charities and highlighted the project’s importance, enhancing its relevance for PU research.

Conclusion: Utilising varied communication strategies, including multimedia, broadened outreach and inclusivity within the PPI panel. Early advisory partner involvement mitigated challenges in building local connections, fostering meaningful patient and caregiver representation. This approach supports equitable inclusion of those affected by PUs, ensuring research outcomes that align with their needs, experiences, and preferences.

 

EP0420 Pressure ulcer prevalence, risk, clinical features and outcomes among patients in a general university hospital in Athens, Greece

Georgios Nikolaou¹, Eirini Karampekiou¹, Aikaterini Panagiotopoulou¹, Panagiotis Besikos¹, Panagiota Andreadaki¹, Maria Nystazaki², Eleni Pisimisi^1
1”Attikon” General University Hospital of Athens, Athens, Greece, ²Attikon General University Hospital, Athens, Greece

Aim: The purpose of this study was to quantify Pressure Ulcers (PU) prevalence and to identify clinical characteristics, nursing care measurements and patient variables among inpatients admitted to 24 internal medicine departments at a General University Hospital in Athens, Greece. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation.

Method: A cross-sectional study research design was used. Patients demographics, clinical characteristics, Norton scale score and PU information were collected in September 2024 by the research team.

Results / Discussion: From a population of 573 inpatients a total of 81 patients presented PU. The total PU prevalence was 14,4%. PUs were most often stage 2 (41, 50,61%) located at the sacrum (71, 54%) and hospital-acquired (54, 66%). Most of the patients 22,27% were admitted due to an infectious disease. Moreover, Dementia/Alzheimers patients accounted for 22% of all patients presenting PU. A significant relationship between Norton scale score and hospital-acquired PU was found (P<0,01).

Conclusion: PU incidence was highest in patients suffering from infectious diseases and patients >65 years old, patients with a diagnosis of Dementia/Alzheimer’s disease were at highest risk. Risk assessment should be conducted and appropriate preventive measures should be implemented at high risk patients during facility admission. Longitudinal studies focusing on preventing PU development during hospitalization are warranted.

 

EP0421 Association of pressure ulcers and contractures in hospitalized individuals

Nils Lahmann^1
1Charité Universitätsmedizin Berlin, Medical School Berlin, Berlin, Germany

Aim: Contractures restrict the mobility of hospitalized individuals. The risk of developing pressure ulcers is increased in these people. The aim of the study is to show the strength of the association of pressure ulcers and contractures.

Method: Data from two nationwide cross-sectional studies from 2017 and 2018 of 10 nursing homes and 12 hospitals were analyzed. A total of 3125 hospitalized individuals were included in the study. Patient or their next of kin had to give informed consent to participate in the study. Prevalence rates of pressure ulcers of those with and without contractures were compared. In a logistic regression analysis, the findings were controlled for kind of institution, sex, age and mobility status (bedridden yes / no).

Results / Discussion: The sample comprised 2395 hospital patients and 730 nursing home residents. Of the whole sample 45% were male, the mean age was 68.8 The prevalence of pressure ulcer in hospitalized individuals without a contracture was 2.7%, whilst in those with at least one contracture it was 9.9%, corresponding to an OR of 3.9. Controlled for the confounders the OR for contractures was 2.0. The strongest predictor was the mobility status. If a patient was bedridden the OR was 6.9. sex and kind of institution were not statistically significant.

Conclusion: Limited mobility remains the biggest risk factor for hospitalized individuals. However, contractures are an important risk factor for pressure ulcers. Hospitalized individuals with contractures should be given increased attention with regard to the risk of pressure ulcers.

 

EP0422 Analysis of length of stay and reimbursement of pressure ulcers in German hospitals

Nils Lahmann^1
1Charité Universitätsmedizin Berlin, Medical School Berlin, Berlin, Germany

Aim: Hospital-acquired pressure ulcers are an important indicator of the quality of care. Our aim was to raise awareness of the value of pressure ulcer prevention by estimating the excess length of inpatient stay associated with hospital-acquired pressure ulcers, and by assessing whether additional costs are covered by increased DRG reimbursement

Method: Data were extracted covering discharges from German hospitals between January 1st and December 31st, 2021. Cases were selected according to the presence of a pressure ulcer diagnosis using ICD-10-GM codes L89.0-L89.3. Information was extracted for the ten most common DRG codes in patients with a secondary pressure ulcer diagnosis on mean length of stay and average DRG reimbursement. Ulcer-associated excess length of stay was estimated by comparing cases within the same DRG with and without a pressure ulcer diagnosis.

Results / Discussion: Mean length of stay was higher in patients with a pressure ulcer than in patients with no ulcer by between 1.9 (all-ages) and 2.4 days (patients aged ≥65) per case. In patients aged ≥65 years, 22.1% of cases with a pressure ulcer had a length of stay above the norm for the DRG. In the German system length of stay above the norm is not normally reimbursed. Excess length of stay between 1.9 and 2.4 days leads to a potential cost to a hospital of between 1,633€ and 2,074€ per case.

Conclusion: Hospital-acquired pressure ulcers represent an important source of cost for a hospital which highlights the potential value of effective prevention.

 

EP0423 Skin tone diversity education in pressure damage prevention

Sarah Everett^1
1Whipps Cross Hospital, Barts Health NHS Trust, Leytonstone, United Kingdom

Aim: The purpose of this abstract is to bring awareness about skin tone diversity in pressure damage prevention.

Method: Quality Improvement project.

Results / Discussion: The last few years we have seen a growing emphasis on increasing equity in the skin and wound care field. Assessment of the patient’s skin can be crucial to many diagnoses, however, some concerning skin changes can be less obvious in patients with dark skin tones. With the publishing of the Best Practice statement about skin tone bias in 2021 , the Tissue Viability team realized potential bias in skin assessments was impacting our patients with dark skin tone.

Conclusion: After years of “React to Red”, we have broken down the barrier to dark skin tone assessments and demonstrate undergoing inequalities and systemic skin tone bias. Over 350 staffs were trained, all new RNs, RNA’s and HCA’s now receive skin tone assessment training and how to avoid skin tone bias as part of their clinical induction program.   

 

 

EP0424 Pressure ulcer prediction in intensive care units using artificial intelligence: A scoping review

José Alves^{1 2}, Rita Azevedo^{1 2}, Ana Marques^{1 3}, Paulo Alves^{1 4
1}Faculty of Health Sciences and Nursing – Catholic University of Portugal, Porto, Portugal, ²Local Health Unit of Braga - Intensive Care Unit, Braga, Portugal, ³Local Health Unit of Gaia and Espinho - Intensive Care Unit, Gaia, Portugal, ⁴Center for Interdisciplinary Research in Health (CIIS), Porto, Portugal

Aim: Pressure ulcers significantly challenge healthcare, affecting quality of life and straining systems. Despite most being preventable, these injuries remain common in Intensive Care Units (ICUs). Effective risk identification is crucial, but traditional scales have limitations, prompting the development of new tools. Artificial intelligence (AI) offers a promising approach to dynamically identify and prevent pressure ulcers in critical contexts. This review assesses the literature on AI technologies for predicting pressure ulcers in critically ill patients in ICUs, identifying knowledge gaps and guiding future research.

Method: Using the Joanna Briggs Institute’s scoping review methodology, this study focuses on AI technologies for pressure ulcer prediction (C) in critically ill patients (P) admitted to ICUs (C). The protocol was previously registered on the Open Science Framework. Search was conducted across relevant electronic databases yielding 137 publications.

Results / Discussion: Fourteen studies were included. Most used cohort designs with electronic health records to train machine learning algorithms. AI models were trained using 6 to 86 variables, with the best models showing Area Under the Receiver Operating Characteristic Curve (AUROC) values ranging from 0,73 to 0,99, reflecting high predictive accuracy. One publication studied the impact of an AI model in clinical practice, achieving a reduction in pressure ulcer prevalence from 21,26% to 4,04% and a decrease in ICU length of stay from 7,63 to 5,17 days, demonstrating high adherence and significant clinical impact.

Conclusion: AI technologies offer a dynamic solution to improve the timely prediction of pressure ulcers, addressing limitations of traditional tools. This review synthesizes current findings and directs future research toward enhancing ICU care.

 

EP0565 A challenging disease to treat: Pressure ulcer and reconstruction options

Zeki Celik¹, Agit Sulhan¹, Kadir Barış Tiryaki¹, Perçin Karakol^1
1University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Aim: Decubitus ulcers, also known as pressure ulcers, develop in areas where tissues are subjected to prolonged pressure, typically over bony prominences. These ulcers are almost always accompanied by ischemic tissue loss. Pressure ulcers most commonly affect the sacrum, heels, ischium, and trochanters. Treatment strategies depend on the ulcer’s stage and severity, often requiring complex wound care and surgical interventions.

Method: This study included 26 patients treated between February 2023 and August 2024 for pressure ulcers at stage 4, with defect sizes ranging from 2x3 cm to 12x18 cm. In defect repair, 12 patients underwent reconstruction with a superior gluteal artery perforator (SGAP) flap, 3 with a lateral sacral artery perforator (LSAP) flap, 2 with an inferior gluteal artery perforator (IGAP) flap, 2 with a gluteus maximus muscle flap, 2 with a tensor fascia lata flap, and 5 with a rotational flap.

Results / Discussion: Wound detachment due to infection occurred in 8 patients. These infections were managed with antibiotics and debridement, followed by secondary suturing to close the defects. Partial flap loss due to venous insufficiency was observed in 4 patients who underwent SGAP flap reconstruction. Two of these patients were managed with debridement and dressings, allowing the defects to heal secondarily.

Conclusion: The treatment of decubitus ulcers is often challenging due to the patients’ comorbidities and the characteristics of the wounds. In advanced-stage pressure ulcers, primary closure is rarely feasible, and various reconstructive options must be considered. Optimal wound care, control of infections and comorbidities, and the selection of an appropriate reconstruction technique are essential for successful treatment. Thus, a multidisciplinary approach is crucial to achieve durable outcomes in these patients.

 

EP0566 Nursing home and home care – comparison of the prevalence of pressure ulcers – results from two cross sectional multicentre studies

Nils Lahmann¹, Sandra Strube-Lahmann^1
1Charité Universitätsmedizin Berlin, Berlin, Germany

Aim: Most care dependent individuals try to stay in their home as long as possible and do not like to be transferred into a nursing home. So far, it is not clear if the quality of care is different in these settings. Pressure ulcers are common in care dependent individuals and can be considered as indicators for the quality of care. The aim of the study is to compare the prevalence of pressure ulcers of nursing home residents and home care clients in Germany.

Method: Multicentre cross-sectional studies were performed in 2012 and 2015. In total, data 205 home care service stations and from 63 nursing homes could be analysed. The EPUAP System was used to rate the severity of wounds. The prevalence rates were calculated with and without Category (cat) 1 pressure ulcers

Results / Discussion: Data from 1.801 clients from home care service stations and 4.546 residents from nursing homes could be analysed. The prevalence rate of pressure ulcers in nursing homes residents with (without PU Cat) was 3.6 (2.6) in 2012 and 3.6 (2.0) in 2015. The prevalence rate of pressure ulcers in home care client with (without PU Cat) was 4.0 (2.0) in 2012 and 3.5 (2.1) in 2015.

Conclusion: There is no clinical relevant difference in pressure ulcer prevalence between nursing home residents and home care clients.  Data can be used for national and international comparison and are important markers of the quality of care in these institutions.

 

EP0567 DRPU and ROS, a different bioactive dressing to improve care outcomes in postacute setting

Sara Sandroni¹, Roberto Bindi^1
1Azienda USL Toscana sudest, Arezzo, Italy

Aim: Device-related pressure ulcers are a variation of pressure ulcers and have a significant prevalence and incidence in intensive and post-intensive care settings, often not related to a level of care. It is necessary to choose and evaluate new medical device technologies to allow tissue repair and contain the phenomenon of complications.

Method: We evaluated a new type of dressing for DRPUs occurring following respiratory devices (nose, mouth, exit-site of percutaneous/surgical tracheostomy). The lesions were evaluated (BWAT-WBS, TIME, ease of use and pain). Monitoring was performed on 20 patients with DRPUs treated with standard dressings and a control group of 20 patients treated with ROS-releasing oil matrix dressings in the lesion areas.

Results / Discussion: Patients treated with the innovative dressing recorded 100% (n.20) a reduction of over 50% of the lesion area after the first two applications (performed at 3-day intervals). In all lesions with crusted/necrotic areas (n.12), the dressing allowed cleansing of the base with a reduction in exudate and edema present in the perilesional skin. Operators reported ease of use and the pain reported by patients was reportedly reduced by 50% from the first dressing change in the surveys of the group treated with the innovative dressing. No adverse events were reported.

Conclusion: Prevention is the fundamental aspect of this type of ulcers, but it is often necessary to manage the outcome. The possibility of using new types of medical devices represents an added value in the management.

 

EP0568 Support surfaces for pressure injury prevention available in brazil: An exploratory-descriptive analysis

Aline Ramalho¹, Cynthia Andrade², Paula Freitas³, Aryanne Santos³, Heloísa Rédua³, Luanna Dias³, Rayanne Kuster³, Paula Nogueira^4
1Hospital Sírio Libanês, São Paulo, Brazil, ²Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, ³Universidade Federal do Espírito Santo, Vitória, Brazil, ⁴Universidade de São Paulo, São Paulo, Brazil

Aim: To identify the characteristics of support surfaces (SS) available in Brazil, aligned with the National Pressure Injury Advisory Panel (NPIAP) Clinical Practice Guidelines for Prevention and Treatment of Pressure Injuries in order to provide scientific support for health professionals in selecting appropriate SS.
Method: This exploratory-descriptive research correlates the features of SS registered with Brazil’s National Health Surveillance Agency (ANVISA) against minimum criteria established by the NPIAP and other relevant scientific evidence for effective pressure injury prevention.
Results / Discussion: The literature lacks specific criteria to distinguish superior SS characteristics. Consequently, selecting the most suitable SS must consider the unique needs of each patient, supported by performance tests in pressure redistribution, shear, and microclimate management, as defined by the Support Surface Standards Initiative (S3I). While such testing occurs in other countries, the absence of similar data in Brazil limits selection options, often resulting in the procurement of low-quality products, such as low-density pyramid mattresses and pneumatic mattresses. Additional challenges include limited access to technical product information, language barriers in data translation, and reliance on outdated sources.
Conclusion: The selection of optimal support surfaces remains ambiguous due to information accessibility issues and the lack of standardized testing in Brazilian healthcare institutions, highlighting the need for improved resources and research in this area.

 

EP0569 Can a pressure ulcer be stitched up?

Marcin Malka^1
1PODOS Wound Care Clinic, Warsaw, Poland

Aim: Promotion of a simple method of closing pressure ulcers stage III and IV EPUAP scale to shorten the time and reduce the costs of treatment.

Method: Few patients with pressure ulcers qualify for reconstructive surgery. Most patients are treated conservatively, which is associated with a long healing period and significant costs. We are still looking for cheap, simple surgical methods aimed at accelerating treatment. Encouraged by positive observations from wounds of other etiologies, we have attempted to close pressure ulcers in an analogous manner, i.e. by excision of the edges and layered closure with an antibiotic implant.

Results / Discussion: Patients with effectively implemented pressure ulcer prophylaxis, properly nourished, without significant burdens, with a wound in the proliferative phase should be analyzed for reconstructive procedures. Some of these patients can avoid complicated, costly and high-risk procedures by using simple wound suturing performed in an outpatient clinic.

Conclusion: By using appropriate methods, we can qualify selected patients with pressure ulcers for simple wound suturing with an antibiotic implant. Such actions will allow us to reduce the costs and risks of treatment.

 

EP0570 Potential of the wound care team in reducing hospital-acquired pressure injuries: An experience report

Aline Ramalho¹, Claudia Rentes², Eliane Mazocoli², Danielle Barreto², Paula Freitas³, Renata Gonçalves², Alessandra Marin^2
1Sirio Libanes Hospital, Universidade de São Paulo, São Paulo, Brazil, ²Sirio Libanes Hospital, Sao Paulo, Brazil, ³Universidade Federal do Espirito Santo, Espirito Santo, Brazil

Aim: To report the experience of restructuring a wound care team to reduce hospital-acquired pressure injuries (PIs).

Method: This experience report was conducted in a Brazilian general hospital. At the onset of the COVID-19 pandemic, there was a significant increase in PIs, the prevalence reaching over 13%, compared to the previous 5%. In response to the surge and need for effective management, the healthcare administration expanded the wound care team to three dedicated nurses, including one specialist focused on prevention. A quality improvement project was initiated, implementing real-time monitoring of the prevention bundle and acquiring specific devices for proper positioning. Preventive recommendations for unstable patients were developed, along with support surface selection guidelines, and a multidisciplinary team was engaged to discuss preventive interventions. Training sessions, workshops, and capacity-building activities were conducted.

Results / Discussion: At the end of 2022, PI prevalence had returned to the pre-pandemic level of 4%. During 2023 and 2024 the team was expanded to four specialists, with one nurse focused on prevention. New initiatives included training programs for reference nurses, expanded use of low-level laser therapy for wound treatment, prevention bundles specific to surgical centers and emergency departments, and automated PI incidence reporting. As a result, the median PI rate fell to 2.5% in early 2024.

Conclusion: A specialized wound care team impacted PI reduction, enhancing patient safety, optimizing resources, and achieving continuous improvement in patient care. This experience highlights the critical role of a dedicated team in preventing and managing adverse events, especially in reducing PIs.

 

EP0571 Implementing a pressure ulcer prevention bundle in adult icus: Insights from implementation science

Paula Freitas¹, Cândida Primo¹, Eliane Lima¹, Rayanne Kuster¹, Heloísa Rédua¹, Aline Ramalho², Andressa Borghardt³, Mayana Fraga³, Roberta Passamani³, Ramon Araujo Dos Santos^3
1Universidade Federal do Espírito Santo, Vitória, Brazil, ²Hospital Sírio Libanês, Vitória, Brazil, ³Hospital Universitário Cassiano Antonio Moraes, Vitória, Brazil

Aim: To describe the process of creating a bundle to prevent pressure ulcers in adult intensive care units.
Method: This participatory research, grounded in implementation science and using the PDCA (Plan-Do-Check-Act) cycle, was conducted in a university hospital setting. A multidisciplinary team validated the product through a structured four-stage process: (1) developing a pilot bundle informed by best practices from guidelines and summaries, (2) adapting it collaboratively to the local context, (3) presenting the content to the care team, and (4) identifying barriers and facilitators for implementation.
Results / Discussion: This was the first pressure ulcer prevention bundle specifically developed for the intensive care unit of this hospital and named ACERT, representing five categories: A: Assessment of the skin and pressure ulcer risk, C: Care of the skin and moisture management, E: Engagement of patients and companions, R: Repositioning and support surfaces, T: Therapy through nutrition. Sixteen participants assessed the bundle, with 95-100% agreement on objectivity, clarity, and applicability, and 100% on relevance. Key implementation facilitators included training and material availability, with the primary barrier being limited team engagement.
Conclusion: Using bundles for pressure ulcer prevention can improve care delivery outcomes. Successful bundle development requires collective healthcare team involvement, local context adaptation, low complexity, and strong evidence. This research outlines a systematic, step-by-step process for implementing best practices based on implementation science, with potential applicability in various internal hospital sectors and across national and international contexts.

 

EP0572 Cachterization of wounds and dressings of patients with pressure ulcers in a Brazilian hospital

Rhayssa Araujo¹, Mariana Freire Fernandes¹, Gabriela  Costa Câmara¹, Monise de Melo Bispo¹, Julianny Barreto Ferraz², Isabelle Fernandes Costa^1
1Universidade Federal do Rio Grande do Norte, Natal, Brazil, ²Hospital Universitário Onofre Lopes, Natal, Brazil

Aim: To characterize patients with pressure ulcers followed by a skin team in a Brazilian university hospital.
Method: This is a documentary, retrospective, exploratory and quantitative study carried out based on a documentary research in medical records of patients admitted to a university hospital in the city of Natal/RN. Patients who had pressure injuries were considered. Data collection was carried out between October 2022 and December 2023. The data were collected using an instrument produced by the researchers, with sociodemographic, clinical and care information. The data found were tabulated in a Microsoft Excel spreadsheet and later analyzed using the Statistical Package for Social Sciences (SPSS) 20.0 software. This research was approved by the UFRN Research Ethics Committee.
Results / Discussion: There were considered two different moments, which were the moment of admission (T1) and the moment of discharge (T2), different aspects related to the wound and the dressings were considered. Aspects related to the characterization of the wounds tissues presented significant statistical differences (p-value <0,05), therefore it was noticed a significant improvement of granulation tissue and reduction of necrotic tissue and edema. With regards to the wound dressing it was noticed the use of non-adherent dressings to most of the wounds. This result can be explained by the possibility of allowing atraumatic removal and pain-free dressing changes.
Conclusion: There were found statistical significance in aspects related to the wound tissue, this research could also provide a profile of the most used wound dressings to patients with pressure ulcers.

 

EP0573 Early signs of terminal ulcer development in patients at the end of life:
Scoping review

Vanessa Gonçalves¹, Ânia Ramalho da Silva², Patricia Correia³, Paulo Alves^4
1Réseau Santé Sarine, Fribourg, Switzerland, ²ULS Leiria, Leiria, Portugal, ³ULS Leiria, Universidade Católica Portuguesa, Leiria, Portugal, ⁴Universidade Católica Portuguesa, Porto, Portugal

Aim: Organ failure at the end of life often includes skin failure, which can manifest as terminal ulcers. Recognizing specific skin changes during the final days or hours of life is crucial for providing effective nursing care. Failure to identify these changes may hinder appropriate therapeutic measures and delay family preparations for grieving, impacting patient dignity and family emotional readiness. This review identifies early signs of terminal ulcer development in end-of-life patients across various healthcare settings, assisting caregivers in offering timely interventions.

Method: A scoping review was conducted following Joanna Briggs Institute methodology, analyzing research from PubMed and EBSCO databases. Studies published between 2014 and 2024 were included, focusing on descriptors like “Palliative care,” “End of life,” “Kennedy ulcer,” and “Skin failure.”

Results / Discussion: Thirteen articles were identified, with ten meeting the inclusion criteria. Findings emphasize the distinction between terminal ulcers, particularly Kennedy Terminal Ulcers (KTUs), and standard pressure injuries. KTUs typically present distinct shapes—pear, butterfly, or horseshoe—and appear suddenly, indicating a rapid decline in condition. Notable changes in skin temperature are valuable indicators for early detection of these ulcers. Terminal ulcers are primarily linked to systemic skin failure, contrasting with gradual development in standard pressure injuries.

Conclusion: Early recognition of terminal ulcers enhances palliative care and prioritizes comfort. This review underscores the urgent need for healthcare provider training on KTUs and the development of clinical guidelines for timely diagnosis and intervention, ensuring compassionate care aligns with end-of-life protocols, supporting both patients and families during this sensitive time.

 

EP0574 Choosing the optimal flap in the reconstruction of pressure ulcer: a comparison of perforator-based propeller flap and conventional local flap

Jong-Ho Kim^1
1Seoul National University Bundang Hospital, Seongnam, Rep. of South Korea

Aim: Pressure ulcers are a prevalent and debilitating condition, often necessitating surgical reconstruction. Various flap techniques, such as Advancement Flaps (AF) and Perforator-based Propeller Flaps (PBPF), are commonly used for pressure sore reconstruction. This study aims to compare the outcomes of PBPF and AF in patients undergoing pressure ulcer reconstruction.

Method: A retrospective analysis was performed on patients who underwent pressure sore reconstruction utilizing either AF or PBPF techniques between January 2020 and December 2023. Data on demographics, pressure ulcer details, operative time, hospital stay, recurrence rate, and complications were collected and analyzed.

Results / Discussion: In this study of 56 patients, 30 underwent AF, and 26 underwent PBPF. Demographic and clinical characteristics showed no significant differences. PBPF resulted in a smaller flap size (93.7 ± 29.5 cm² for AF vs. 70.5 ± 19.7 cm² for PBPF, p < 0.001), a longer operation time compared to AF (94.6 ± 39.1 minutes for AF vs. 161.0 ± 38.9 minutes for PBPF, p < 0.001) and lower recurrence rate in long-term follow-up (p = 0.036).

Conclusion: PBPF may have the drawback of prolonged surgical time due to the complexity of the surgical procedure. However, when applied appropriately, it can be a meaningful surgical approach for reducing the recurrence rate of pressure ulcers.

 

EP0642 Pressure ulcers in residential facilities for the older adult: a comparison of the Braden and the PURPOSE-T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) risk assessment scales

Breda Wall¹, Angele Sciberras^1
1St Vincent’s Hospital, Athy, Co Kildare, Co Kildare, Ireland

Aim: The purpose of this study is to evaluate the effectiveness of the PURPOSE-T tool in identifying the presence of pressure ulcer risk in comparison to the Braden Scale in residents in long-term care.

The Braden Scale, a commonly utilised instrument for evaluating the risk of pressure-ulcer development, has limitations in its sensitivity, occasionally failing to identify subtle alterations in the skin. When Braden misses these risks, clinical judgement and visual assessments typically induce preventative interventions. The PURPOSE-T was introduced on a 15-bedded Long-Term/Respite Care Unit to complement and validate clinical judgment, thus offering a more comprehensive framework for assessing residents’ risk of pressure ulcers.

Method: The PURPOSE-T instrument was implemented following clinician training. Baseline data was gathered using the Braden Scale to predict residents at risk for developing pressure-ulcers. Notably, nursing staff frequently supplemented the tool with their clinical judgment owing to its limitations. Post-implementation audits of the Purpose T tool examined risk identification accuracy, instrument adherence, and staff feedback on aligning the tool with clinical judgement.

Results / Discussion: PURPOSE-T validated the clinical assessments of clinicians by identifying residents receiving preventative treatments, hence confirming the necessity of these measures
This demonstrated that while the Braden Scale missed certain residents at risk, clinical judgment had successfully identified them. PURPOSE-T offered a systematic confirmation process, minimising the chances of missed risks and promoting team consistency.

Conclusion: This study demonstrated that the Purpose T Tool with clinician’s clinical judgement was more reliable in identifying residents at risk of pressure-ulcer development that the Braden scale.

EP0575 Psychometric characteristics of the Croatian version of the Pieper-Zulkowski test of knowledge of pressure injuries

Ana Žepina Puzić¹, Mirna Žulec², Vesna Bušac^1
1Šibenik University of Applied Sciences, Šibenik, Croatia, ²Universitas Studiorum Catholica Croatica Zagreb, The Polytechnic of Ivanić Grad, Zagreb, Croatia

Aim: To evaluate the psychometric properties, perform a cultural adaptation and analyze the internal consistency of the translated instrument of the Pieper-Zulkowski knowledge test on pressure injuries (PZ-PUKT revised 2021) among nurses from the clinical environment in Croatia.

Method: The translation and adaptation of the questionnaire was carried out from October 2023 to February 2024. A cross-sectional study was conducted from February to April 2024 on a sample of 207 nurses from a clinical setting. PZ-PUKT (revised in 2021) was used. Descriptive statistics were used to analyze the data, the validity and reliability of the questionnaire for Croatian society was assessed by assessing language validity, content validity index, Cronbach’s α and Spearman’s correlation coefficient.

Results / Discussion: PZ-PUKT (revised in 2021) proved to be a valid and reliable tool for assessing knowledge about pressure ulcers, Cronbach’s Alpha is 0.801. Validation was additionally examined by Spearman’s correlation coefficient between the 3 wound subscales (rho=0.77, p<0.001), classification (rho=0.82, p<0.001), prevention (rho=0.89, p<0.001) and on overall measurement scale (rho= 0.90, p<0.001). Median knowledge was 59.72 for the total scale, 55 for the wounds subscale, 57.14 on the classification subscale and the highest of 64.52 on the prevention subscale.

Conclusion: This study showed that the Croatian version of the PZ-PUKT (revised 2021) is valid and reliable for use. It can be used in education and research to assess the knowledge of nurses, as well as to evaluate the effectiveness of education programs on the prevention and treatment of pressure injuries. Results also identified gaps in knowledge about pressure injuries where nurses would benefit from focused educational strategies.

 

EP0576 The “DIP” classification. an improved pressure ulcer classification

José Contreras-Ruiz¹, Carolina Manzotti-Rodríguez², Ruth Bryant³, Thomas Serena⁴, Adriana Lozano Platonoff^5
1CDP Los Cabos, San José del Cabo, Mexico, ²Centro Médico San José, Monterrey, Mexico, ³Abbott Norhtwestern Hospital, Minneapolis, United States, ⁴Serena Group, Utah, United States, ⁵Advanced Wound and Stoma Management Clinic (CAMHE), Mexico City, Mexico

Aim: To present the rationale for a new classification of pressure ulcers (PU) that takes into consideration their pathophysiology, the available evidence-base, and classifies PU according to depth, infection, and perfusion (DIP).

Method: A thorough review of the available literature on PU made evident the current weaknesses of the most used PU classifications. Consensus was reached by a group of experts on improvements to the current classification, and a new classification of pressure ulcers with stronger scientific basis and clinical usefulness was designed and hereby presented.

Results / Discussion: In terms of depth of affected tissue, the DIP classification includes the differentiation between ulcers that involve the bone and/or joint, a factor commonly associated with poor outcomes, that is presently neglected and therefore leaving a gap in proper care and research in the field of PU care. Two other important factors that should be taken into consideration when classifying PU, is the presence or absence of infection, including osteomyelitis and the risk of sepsis. Their absence in the current classifications poses a risk for the patient and the health care facilities caring for them. In terms of PU located on the extremities, one of the most relevant prognostic factors, and a common cause of malpractice, is the absence of perfusion. By correcting these aspects of care, the DIP system of classification of PU, may be an improvement to the present systems available.

Conclusion: The “DIP” classification has theoretical advantages over the existing PU classifications in terms of better diagnosis, better assessment of clinically-relevant variables, aiding in devising treatment plans, and improving the quality of PU classification.

 

EP0425 Clinical evaluation of polyabsorbent fibres dressing with technology lipido colloid and silver in patients with pressure ulcers

Emilio Galea^1
1Laboratoires Urgo, Chenove, France

Introduction: Treating Pressure Ulcers (PU) is challenging, and the inclusion of evidence-based dressings as part of a standard of care is imperative to achieve improvement and healing. Polyabsorbent fibres dressing with technology lipido colloid and silver dressing (TLC-Ag) are supported by both in vitro and in vivo studies.

Aim: Evaluate the TLC-Ag dressing in the management of challenging PIs real-life setting.

Methods: Case series discussing the management of PU:

• A 93-year-old, bedridden for 7 years, with a Stage 4 PU that had been regressing for 3 months
• A 78-year-old, bedridden for 3 years referred with two 2-month-old Stage 4 PIs, one over the sacral region and one on the left trochanteric region
• A 75-year-old referred for management of a 20-day-old, 5 x 4cm sacral unstageable pressure injury with high levels of exudate, previously untreated
• A 74-year-old referred for a seven-day old Stage 3 untreated pressure injury in the sacral region, measuring 12 x 8cm, almost completely covered with slough and producing high levels of exudate
• A 98-year-old referred for a 3-week-old, highly exudative Stage 4 PI in the sacral region, which had previously been managed with gauze soaked in povidone iodine
• A 79-year-old refereed for the management of a 3-month old unstageable PI in the sacral region, measuring 20 x 20cm.

Results: Results showed effective and rapid improvement in all cases with elimination of non-viable tissue and wound area reduction.

Conclusions: These results are also in line with previously clinical studies conducted, supporting that TLC-Ag is an effective dressing in the management of chronic wounds, including PU.

 

EP0426 Correlation between toe spread and toe hold pressure: Influence of flip-flop strap design on diabetic foot ulcers

Shreya Rao¹, William Edwards¹, Julian Cochran^1
1Durham Academy, Durham, United States

Aim: The aim of this study is to evaluate the relationship between toe spread and toehold pressure in diabetic patients wearing flip-flops and to compare the toehold pressure between rolled inner seam (RIS) and standard straight edge (SSE) strap designs. This study also seeks to validate findings from previous smaller sample studies suggesting the RIS design results in lesser pressure at the toehold.

Method: This cross-over study involved sixteen diabetic patients who were asked to perform a 5-step walking trial while wearing flip-flops with two different strap designs. A total of 64 measures of toehold pressure were recorded. Toe spread was quantified using images analyzed by a convolutional neural network algorithm that identified keypoints on the toes. Pearson correlation and linear regression models assessed the relationship between toe spread and toehold pressure. A t-test compared the toehold pressures between the RIS and SSE designs.

Results/Discussion: The correlation between toe spread and toehold pressure was very weak (r=-0.322), with toe spread accounting for only 10.4% of the variance in toehold pressure overall. When analyzed by strap design, the SSE design showed a slightly stronger correlation (R² = 0.121) than the RIS design (R² = 0.022). The comparative analysis via t-test confirmed previous findings, showing statistically significant lower toehold pressures for RIS design compared to SSE design, validating the potential benefits of the RIS strap in reducing the risk of ulcers.

Conclusion: Toe spread appears to have minimal influence on toehold pressure in diabetic patients wearing flip-flops. The RIS strap design significantly reduces toehold pressure compared to the SSE design, suggesting that the RIS design could be beneficial for diabetic patients at risk of foot ulcers.

 

 

PREVENTION

EP0274 Enhancing skin health and safety in aged care (skincare trial): A cluster-randomised pragmatic trial

Monira El Genedy-Kalyoncu¹, Bettina Völzer¹, Jan Kottner^1
1Charité – Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Berlin, Germany

Aim: Adequate, person-centered skin care is essential in daily nursing practice in order to prevent adverse skin conditions. Nursing home residents are at high risk of developing multiple skin conditions simultaneously. Current guidelines typically address these conditions separately. The overall aim of this study was to measure the effects of the implementation of an evidence-based skincare program to prevent and treat common adverse skin conditions in residential long-term care.

Method: A two-arm cluster-randomized controlled trial in n=314 residents ≥65 years in n=17 long-term nursing homes in Berlin, Germany was conducted. The intervention group implemented a structured, evidence-based skincare prevention program for six months, while the control group received standard care. Skin assessments and skin physiology measurements were conducted at baseline, and three months and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo.

Results / Discussion: Cumulative incidences of skin tears (19.2%, 95% CI 12.8–27.8), pressure ulcers (13.6%, 95% CI 8.1–21.9), and intertrigo (27.0%, 95% CI 18.4–37.7) were lower in the intervention group compared to the control group (27.2%, 16.9%, and 37.8%, respectively). However, the incidence of incontinence-associated dermatitis was higher in the intervention group (26.3%, 95% CI 17.9–36.8) compared to the control group (23.1%, 95% CI 14.6–34.5). Mean skin dryness was lower in the intervention group and no changes in skin barrier function were observed.

Conclusion: Results indicate that implementation of a tailored, evidence-based skincare program improves skin health and safety in residential long-term care.

 

EP0275 Treatment effects of two pharmaceutical skin care creams for xerotic feet among persons with diabetes: Rationale and design of a two-armed double-blind randomized controlled trial

Karin Borgström¹, Anna Ericsson², Stefan Acosta³, Tautgirdas Ruzgas⁴, Christine Kumlien⁵, Magdalena Annersten Gershater⁶, Johan Engblom⁴, Sebastian  Björklund⁴, Victoria Lazer², Eva Lavant⁴, Petri Gudmundsson^4
1Department of Biomedical Science, Faculty of Health and Society, Malmö University, Biofilms – Research Center for Biointerfaces, Malmö University, Malmö, Sweden, Malmö, Sweden, ²Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden, ³Department of Clinical Sciences, Lund University, Malmö, Sweden, ⁴Department of Biomedical Science, Faculty of Health and Society, Malmö University, Biofilms – Research Center for Biointerfaces, Malmö University, Malmö, Sweden, ⁵Department of Care Science, Faculty of Health and Society, Malmö University, Biofilms – Research Center for Biointerfaces, Malmö University, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden, ⁶Department of Care Science, Faculty of Health and Society, Malmö University, Biofilms – Research Center for Biointerfaces, Malmö University, Malmö, Sweden

Aim: To minimize the risk of developing foot-ulcers, persons with diabetes are given the advice to daily inspect their feet and to apply skincare formulations. However, commercially available skincare products have rarely been developed and evaluated for diabetes foot care specifically. The primary aim of this randomized controlled trial (RCT) is to evaluate the effects in reducing foot xerosis in persons with diabetes without foot-ulcers by comparing two skincare creams containing different humectants (interventions) against a non-humectant cream (comparator). Secondary outcomes include evaluating skin barrier integrity, biomarkers, skin microbiota, microcirculation, neuropathy, and HbA1c levels.

Method: This double-blind RCT, registered as NCT06427889, requires 78 participants (98 including dropouts) to achieve 80% power and 2.5% significance in each arm. Each participant will treat one foot with an intervention cream (Oviderm® or Canoderm®) and the other foot with a comparator cream (Decubal® lipid cream®) twice daily. Participants are required to undergo a two-week wash-out period before starting. Examinations will occur at baseline, day 14, and day 28.

Results/Discussion: The RCT will assess the effectiveness of humectants in skincare creams for reducing foot xerosis in persons with diabetes.

Conclusion: Improved foot hydration may lead to healthier feet and better vigilance in foot care among persons with diabetes. Demonstrating differences in skin xerosis when using humectant-containing creams versus non-humectant creams could lead to specific product recommendations for preventing diabetic foot ulcers (DFU). This study aims to fill the gap in documented effects of different creams for diabetic foot care.

 

EP0276 Occipital pressure mapping in the operating room

Lisa Peterson^1
1University of California, Davis Health, Sacramento, United States

Aim: Hospital acquired pressure injuries are often preventable with knowledge of the latest evidence and offloading devices. The purpose of this quality improvement project is to find the best pressure offloading device for the occiput by using a pressure mat to measure peak pressures and surface areas.

Method: Three individuals volunteered to pressure map using pressure mapping technology (X-sensor Pro-V3 mattress) in the supine position. Five different pressure offloading devices were tested including: a pillow with a pillowcase, a non-powered fluidized positioner, a medium (17”x17”x1.5”) sized static air seat cushion, a pediatric sized (13”13”x2”) static air seat cushion and a foam donut. Each device was placed directly under the occipital area of the head, except for the medium sized static air seat cushion which was under both the occiput and shoulder area.

Results / Discussion: The non-powered fluidized positioner had the highest peak pressures while the medium sized static air seat cushion had the lowest pressures. The five tested devices did not have a significant difference in surface area for pressure redistribution.

Conclusion: The non-powered fluidized positioner had the highest peak pressures while the medium sized static air seat cushion had the lowest pressures. The five tested devices did not have a significant difference in surface area for pressure redistribution.

 

EP0277 Efficacy of Nd:YAG laser and intralesional triamcinolone injection combination therapy in the postoperative management of keloids

Jun Ho Park¹, Ji Won Jeong^1
1Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Rep. of South Korea

Aim: Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used.

Method: This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections, and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation.

Results / Discussion: The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12 months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups.

Conclusion: Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12 months after operation, along with significant improvements in patient-reported outcomes.

 

EP0278 Transforming incontinence care: achieving a 31% reduction in IAD and boosting efficiency with  3-in-1 cleansing cloths in a UK healthcare system

Abigail Knight¹, Kate Gloess², Iesha Hines^2
1Esneft, Ipswich, United Kingdom, ²Esneft, Ipswich, United Kingdom

Aim: The project aimed to reduce both the average number of hospital-acquired episodes of Incontinence Associated Dermatitis (IAD) and the time taken for healthcare staff to assist incontinent patients with personal care within a large trust.

Method: Five wards with the highest incidence of IAD were identified for the intervention. 3-in-1 cream cloths were selected due to their combined cleansing, barrier protection, and moisturising properties. It was anticipated that these cloths could help reduce IAD episodes and the time spent on patient care. Comprehensive training was provided to healthcare professionals on the use of the cloths. A three-month baseline period was used to collect data on IAD cases and the time required to assist patients following an episode of incontinence. This was followed by a one-month post-intervention period where data on IAD and care times were reassessed.

Results / Discussion: Following the introduction of the cloths, IAD incidents fell from 26 during the baseline period to 6 during the intervention, representing a 31% reduction in average monthly cases (from 8.7 to 6.0). The time taken to assist patients also decreased significantly, from an average of 17.76 minutes pre-intervention to 6.4 minutes post-intervention, a reduction of 63.96%. Staff praised the cloths’ ease of use and noted improvements in patient skin health.

Conclusion: These results demonstrate the product’s effectiveness in reducing IAD, leading to a 31% reduction in episodes, a substantial decrease in care time, enhanced workflow efficiency, improved clinical outcomes, cost savings, and more time for healthcare staff to focus on patient care.

 

EP0279 Global intertrigo prevalence and incidence: A systematic review and meta-analysis

Ahmed Tafesh¹, Sabrina Blomeier-Schaffran¹, Jan Kottner^1
1Charité – Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany, Berlin, Germany

Aim: Intertrigo, a common inflammatory skin condition, affects populations worldwide, yet its global prevalence and incidence are unknown. This systematic review aims to evaluate and to synthesize available epidemiological data.

Method: A systematic review was conducted across the databases Medline, Embase, Cochrane, CINAHL, and Web of Science. Studies reporting intertrigo prevalence or incidence across regions and age groups were included. Duplicates were removed, and two reviewers independently screened titles and abstracts. Studies published from January 1945 in any language were considered. Data extraction will focus on prevalence and incidence rates, study characteristics, and participant demographics. Internal and external validity will be assessed. Prevalence and incidence estimates will be combined using a random-effects model.

Results / Discussion: Preliminary screening shows wide variability in intertrigo prevalence and incidence, with higher rates observed in specific age groups, obese populations, and certain settings. Final results will synthesize regional and demographic trends, with a focus on age, gender, and comorbidities. Data will be presented in tables and figures with standard errors and 95% confidence intervals (CI), including forest plots to illustrate geographic disparities.

Conclusion: This review will be the first to comprehensively map the global epidemiology of intertrigo. The findings will offer critical insights into its burden across populations and inform targeted public health interventions, while identifying gaps for further research on risk factors and outcomes.

 

EP0281 Registered nurses’ experiences and perception of patient education and information in preventive diabetic foot-care

Anna Ericsson¹, Magdalena Annersten Gershater², Victoria Lazer², Christine Kumlien^2
1Health and Social Sciences, Malmo, Sweden, ²Faculty of Health and Society, Malmo University, Malmo, Sweden

Aim: Diabetes mellitus with peripheral neuropathy, dry skin, cracks, calluses increase the risk of diabetic foot-ulcers. This is a devasting complication and a burden for both patients and health-care system. Guidelines state that persons with diabetes are recommended daily inspections of their feet and to use emollients. However, how these recommendations are communicated and followed up by registered nurses is unknown and therefore the aim of this study was to explore the clinical decision-making process and how nurses inform and educate patients with diabetes in preventive foot-care.

Method: Five digital focus-group interviews were conducted with 23 female diabetic nurses in primary and municipal healthcare in southern Sweden. The data was analyzed with thematic content analysis.

Results: A standardized assessment of risk for ulceration was performed prior to information of preventive foot-care. The used information materials came from various sources mainly without critical reflection from the nurses. Clinical decision making was based primarily on their professional experience rather than on evidence-based knowledge. Patient related challenges were cognitive impairment, attitudes to foot care and empowerment. Organizational challenges were lack of allocated time, of diabetes foot competence in the multi-professional team, and lack of access to chiropody. Follow up was performed according to standardized structure and with individual support. The nurses reported frustration when care chain was not in function.

Conclusion: Evidence based guidelines need to be implemented so that nurses can follow them in everyday clinical practice. Furthermore, preventive foot-care need higher priority in the health care system.

 

EP0282 Persons with diabetes experiences of self-management to prevent foot ulcers

Anna Ericsson¹, Christine Kumlien¹, Victoria Lazer¹, Magdalena Annersten Gershater^1
1Faculty of Health and Society, Malmo University, Malmo, Sweden

Aim: Diabetic foot-ulcers cause a burden for patients. Self-management and prevention are important cornerstones to minimize the development of diabetic foot ulcers. The aim was to describe the experiences of self-management to prevent foot ulcers among persons with diabetes mellitus.

Method: Qualitative interview study with conventional content analysis according to Hsieh  and Shannon (2005). Twenty-four individual semi-structured interviews were conducted between 2023- 2024 with 11 women and 13 men with diabetes, living in the south of Sweden, having a mean age of 74.5 and diabetes duration of 12 years. Two categories emerged: Knowledge and Access to health care.

Results: Knowledge: There was an awareness that self-management was important. However, there was an uncertainty about the reasons for this and what should be included in appropriate self-management of the feet. No participants had been offered a structured patient education. Instead, they rely on external information from Diabetes Associations and internet. Access to health care: The experience was that health care professionals had more focus on metabolic control rather than feet and not all of the participants had had their feet inspected. They wished to have more continuous communication and a closer follow-up frequency to reassure them about their foot-status. Those participants who had access to chiropody expressed thankfulness as they provided foot care and feedback regarding self-management efforts.

Conclusion: A more structured patient education regarding diabetes foot care is needed. People that are conducting self-management to prevent diabetes foot ulcers need further communication and support from health care professionals.

 

EP0284 A comparative study on the effect of water vs. air mattresses on pressure injury incidence in intensive care units (ICUs)

Juman Shin^1
1Catholic Kwandong University International St. Mary’s Hospital, Incheon, Rep. of South Korea

Aim: To compare the incidence of hospital-acquired pressure injuries among patients in Intensive Care Units (ICUs) using water mattresses versus air mattresses and to evaluate the cost-effectiveness of these mattresses in resource-limited settings.

Method: A retrospective cohort study was conducted in three ICUs over two periods: Q3 and Q4 of 2023 (water mattress usage) and Q1 and Q2 of 2024 (air mattress usage). Patient data, including total bed days and newly developed pressure injuries during hospitalization, were collected. Pressure injury incidence rates were calculated per 1,000 bed days and statistically compared between the two periods using chi-square tests for significance

Results / Discussion: During the water mattress period, 5 pressure injuries occurred over 2,208 bed days, resulting in an incidence rate of 2.26 per 1,000 bed days. In contrast, the air mattress period showed a significant reduction to 2 injuries over 5,758 bed days, an incidence rate of 0.35 per 1,000 bed days (p < 0.01). By Q2 of 2024, two ICUs reported zero pressure injuries, and the third ICU demonstrated a 75% reduction in incidence. The shift to air mattresses led to a substantial decrease in pressure injury rates without a proportional increase in costs, highlighting improved cost-effectiveness.

Conclusion: Air mattresses significantly reduced the incidence of hospital-acquired pressure injuries compared to water mattresses in ICU patients. For healthcare facilities with limited budgets, air mattresses offer a viable and cost-effective alternative. The best option, however, would be the use of proven polyurethane mattresses if cost is not a concern. Future studies should explore long-term patient outcomes and the integration of air mattresses in diverse clinical settings to reinforce these findings.

 

EP0285 Utilization of grant funds to reduce intraoperative pressure injuries

Lisa Peterson¹, Julie Chou^1
1UC Davis Health, Sacramento, United States

Aim: After eight intraoperatively acquired pressure injuries (IAPI) spanning from 2021-2023, a grant was applied to comprehensively explore how to reduce intraoperative pressure injury occurrence.

Method: This IAPI initiative started with a literature review to find evidence-based recommendations, followed by engaging administrative and clinical nurses in focused projects. A survey on staff’s baseline knowledge on pressure injury prevention and barriers to prevention was completed. Next, educational in-services on pressure offloading devices were conducted and hospital policy on pressure injury prevention was further evaluated. Additionally, there was an exploration of new products, and the publication of patient profiles of past pressure injuries in a staff newsletter. Collaboration with the electronic medical record analysts for risk assessment scale integration was initiated and is still in process. A grant of $94,000 from Be Safe About Safety (BSAS) from the University of California President’s Office was awarded to support these efforts.

Results / Discussion: Since this grant was awarded and the initiatives implemented, there have been zero pressure injuries attributed to the operating room. Many of the projects are still in process with a goal to make sustainable change that is practiced by all members of the operating room team.

Conclusion: Using grant funds to fuel this clinically driven project is leading to change. Ultimately, awareness is increasing, which is creating an environment where pressure injury prevention is a priority.

 

EP0286 Mitigating radiation dermatitis in breast cancer patients through early skin preparation: A clinical trial of an atelocollagen complex-based intervention

Despoina Kokkinidou¹, Constantina Cloconi², Antria Savva², Christina Georgiou², Maria Kyprianidou³, Eleftheria Sidira¹, Anna Christofini¹, Konstantinos Ferentinos², Angelos Kassianos³, Constantinos Zamboglou², Marianna Prokopi-Demetriades^1
1RSL Revolutionary Labs Ltd, Limassol, Cyprus, ²German Medical Institute, Limassol, Cyprus, ³Cyprus University of Technology, Limassol, Cyprus

Aim: Radiation therapy in breast cancer patients frequently leads to radiation dermatitis, negatively impacting patient comfort and skin health. This study aimed to evaluate the protective effects and tolerability of a novel atelocollagen complex-based dermaceutical. The goal was to introduce early preventive treatment for radiation-induced skin damage, emphasizing the importance of skin preparation from the initiation of radiotherapy to prevent severe side effects.

Method: A randomized, double-blind, controlled clinical trial was conducted at the German Oncology Center in Cyprus, involving 80 breast cancer patients undergoing radiotherapy. Participants were randomized into two groups: an intervention group using the atelocollagen complex-based formulation and a control group receiving standard care. The product was administered beginning one day prior to the initiation of radiation therapy and continued throughout the treatment period, and radiation dermatitis severity was evaluated weekly during radiotherapy and at two post-treatment follow-ups (1 week and 1 month) using CTCAE guidelines.

Results / Discussion: At one-month post-therapy, over 93% of patients in the intervention group achieved full recovery, compared to less than 50% in the control group. Grade 2 radiodermatitis was effectively prevented in the intervention group and reductions in skin or nipple-areolar hyperpigmentation were observed, with the intervention group reporting less severe side effects at all timepoints. Skin preparation and early intervention with the atelocollagen complex-based product significantly improved patient comfort.

Conclusion: Early application of the atelocollagen complex-based dermaceutical demonstrated superior protective effects, reducing radiation dermatitis severity and improving recovery compared to standard care. These promising results warrant further investigation in larger-scale trials.

 

EP0287 Barriers and facilitators to home-based Staphylococcus aureus decolonization treatment in patients undergoing orthopaedic surgery

Giangranco Barra¹, Greta Ghizzardi², Giulia Marzagalli¹, Luca Guardamagna¹, Marco Provenzano¹, Davide Di Napoli¹, Arianna Magon³, Cristina Arrigoni^4
1Istituti Clinici di Pavia e Vigevano spa, Pavia, Italy, ²Azienda Socio Sanitaria Territoriale di Lodi, Lodi, Italy, ³IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy, ⁴Università degli Studi di Pavia, Pavia, Italy

Aim: Surgical site infections (SSIs) are a frequent and critical complication in orthopaedic surgery, adversely impacting clinical outcomes and increasing healthcare costs. International guidelines recommend preoperative identification and decolonization of Staphylococcus aureus carriers to minimize postoperative infection risk. This study investigates barriers and facilitators to adherence to home-based Staphylococcus aureus decolonization in arthroplasty patients.

Method: Ethical approval was granted by the Territorial Ethical Committee “Lombardia 1” (Prot. n. 0035970/2). A phenomenological qualitative study was conducted using semi-structured interviews with preoperatively Staphylococcus aureus-positive patients. An experienced qualitative researcher conducted the interviews and analyzed them inductively to identify recurring codes and themes related to patient experiences.

Results / Discussion: Twelve participants (mean age = 63.7 ± 8 years, 58% male) were interviewed. Seven codes were grouped into three main themes:

• Psychological barriers: codes “Initial unawareness” and “Surprise and fear”
• Facilitators to adherence: codes “Need for support,” “Clarity of instructions,” and “Need for monitoring”
• Organizational barriers: codes “Difficulty accessing treatment” and “Communication deficit”

Conclusion: This study emphasizes the importance of effective communication among patients, healthcare facilities, and general practitioners, as well as the need to streamline access to decolonization medications. Preventing SSIs is a shared responsibility among healthcare professionals to optimize clinical outcomes; however, organizational and psychological barriers may compromise patients’ adherence to decolonization treatment. Strengthening educational and organizational strategies could enhance protocol adherence and reduce SSI incidence.

 

EP0296 Save limb: Experience diabetic foot ulcer patient with diabetes mellitus in community base setting

Khairul Bahri¹, Widasari Sri Gitarja², Pipit Lestari³, eviyanti  numalasari⁴, Kana Fajar⁵, Munasirah Munasirah^6
1WOCARE Indonesia, Manager WOCARE Clinic Wound, Ostomy and Continence Care Departement, West Java, Indonesia, ²WOCARE Indonesia, Lincoln University, Malaysia, University of Pelita Harapan, West Java, Indonesia, ³WOCARE Center Indonesia, Manager of Education and Training Corporate University of WOCARE Indonesia, West Java, Indonesia, ⁴WOCARE Center Indonesia, Director of Product and Development WOCARE Indonesia, West Java, Indonesia, ⁵WOCARE Indonesia, Bogor City, Indonesia, ⁶WOCARE Indonesia, Solusi Luka Indonesia, West Java, Indonesia

Aim: Diabetic foot ulcers (DFU) a severe complication of DM that frequently results in amputation if not managed promptly. The aim of this study emphasizes the importance of community-based interventions for early detection and treatment to prevent limb loss and enhance patient outcomes.

Method: A qualitative method was used, involving semi-structured interviews with DFU patients in community settings. Participants were selected through purposive sampling. The study comprised a total of 12 patients aged 30-70 years old, and data were collected on their experiences regarding diagnosis, treatment, and the impact on their daily lives.

Results / Discussion: The study findings four key themes related to the participants’ experience with DFU: delay diagnosis, challenges in treatment, impact on quality of life, the role of community-based intervention. 1)Delayed Diagnosis: Many participants experienced diagnostic delays due to limited awareness, inadequate foot care, and restricted access to healthcare facilities. 2)Challenges in Treatment: Participants faced numerous barriers in accessing timely and appropriate treatment, such as financial constraints, geographical limitations, and a shortage of specialized care facilities. 3) Impact on Quality of Life: DFU significantly impaired participants’ quality of life, causing physical limitations, emotional distress, and social isolation. 4)Role of Community-Based Interventions: Participants highlighted the importance of community interventions in fostering early detection, offering foot care education, and ensuring timely treatment access.

Conclusion: The study concludes that effective community-based interventions are essential to address these challenges, with early diagnosis, prompt treatment, and patient education playing key roles in preventing limb loss and enhancing the quality of life among diabetes patients with DFU.

 

EP0288 A non-randomized study to evaluate the sensitivity of TEWL vs impedance spectroscopy following tape stripping and application of skin emollients to prevent moisture associated skin damage

Leah Conway¹, Natalie Maguire², Toby Jenkins³, Krystal Le Doare³, James Clarke², Karen Wares^{4 5
1}GAMA Healthcare, Halifax, United Kingdom, ²GAMA Healthcare, halifax, United Kingdom, ³University of Bath, Bath, United Kingdom, ⁴GAMA Healthcare, Hemel Hempstead, United Kingdom, ⁵University of Avondale, Avondale, Australia

Aim: To evaluate performance of impedance spectroscopy (IS) vs Trans-epidermal Water Loss (TEWL) in quantifying skin barrier function, as well as a barrier cream cloths* ability to restore skin barrier function after tape stripping.

Method: The baseline skin impedance and TEWL measurement of four sites on the ventral forearm (two/arm) were measured. Tape stripping was performed to induce skin damage with IS and TEWL measured after 10, 20, and 30 strips. Following tape stripping, the liquid expressed from a barrier cream cloth was applied and left to dry. IS and TEWL then measured any recovery in skin barrier function.

Results / Discussion: When assessing effectiveness of IS vs TEWL, it was found that the former is significantly more sensitive than TEWL at measuring changes in skin barrier function: the participant with the greatest skin damage after tape stripping had a >2000-fold decrease in normal skin resistance measured by IS but only a 4-fold increase with TEWL after 30 strips. The increased sensitivity of IS against TEWL was seen for all but one of the participants.

Following application of liquid expressed from a barrier cream cloth, three of seven participants showed a statistically significant recovery (p ≤ 0.05) in skin impedance, whilst three showed no significant effect and one had a marginal effect. TEWL measurement showed only two of seven participants showed any significant reduction in TEWL after product application.

Conclusion: IS was demonstrated to be a more sensitive technique in comparison to TEWL for evaluating skin barrier function. The barrier function of damaged skin was also shown to be restored following only one application of a barrier cream cloth.

*Clinell Contiplan 3-in1 Barrier Cream Cloths

 

EP0643 Management of pressure wound in polytrauma and prone patients in intensive care (2020-2024)

Stefania Lagana’¹, Sarah Schiena¹, Paola Curto¹, Brizilda Fiannaca¹, Carmen Gentile¹, Valentina Aimar¹, Susanna De Filippis¹, Laura Turina¹, Barbara Forino¹, Francesco Stivala², Chiara  Gammarota^3
1A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero CTO, Turin, Italy, ²A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Turin, Italy

Aim: Identify the most appropriate strategies to reduce the risk of pressure injuries in polytrauma patients with thoracic trauma in the prone position.

Method: In 2021, five working groups were formed in our ward, each consisting of two nurses. All members completed a training program in Wound Care. The working group developed a prevention and treatment wound protocol to be applied when positioning patients in the prone position. Five-layer silicone foam interfaces are used on high-risk areas, along with a surface that simulates fluidization effects through full body immersion. Additionally, a pronation kit is provided, consisting of high-breathability open-cell polyurethane foam positioning pillows, and the pronation cycles have been increased from two to four.

Results / Discussion:

2020/2021

• Patients treated in the prone position: 6
• Total wound identified: 12
• Average wound per patient: 2
• Staging (NPUAP/EPUAP Scale): Stage II/IV
• Pronation cycles: min 1 , max 3 pronation per day (pronation cycle time 14 - 16 hours)

2022/2024

• Patients treated in the prone position: 18
• Total wound identified: 15
• Average wound per patient: 0.8
• Staging (NPUAP/EPUAP Scale): Stage I/II
• Pronation cycles: min 2, max 4 pronation per day (pronation cycle time 14 - 16 hours).

Conclusion: Analysis of the 2020–2021 results (pre-training) and 2022–2024 results (post-training) shows that pressure injuries have significantly decreased both quantitatively, with an average per patient of <1, and qualitatively, with a reduction in severity from Stage II/IV to Stage I/II.

 

EP0293 Musculus tibialis posterior and its relevance for podiatric therapy

Christine Kuberka-Wiese^1
1Verband Deutscher Podologen VDP e.V. / German podiatric association VDP e.V., Roßleben-Wiehe, Germany

Aim: The aim is to find out if Musculus tibialis posterior as a deep-seated calf muscle has relevance for German podiatrists, who do foot treatment. Falsifiable hypothesis: ‘The posterior tibialis muscle is relevant for podiatric therapy’.

Method: Screening of randomly selected, consecutive patients in a podiatric practice in a midtown with about 30.000 inhabitants. There were no inclusion or exclusion criteria.

Calcaneus deviation and single heel rise test were screened in 50 patients of a whole of 800 in practice, which makes up a percentage of 6,25 screened persons of the practice.

Results / Discussion: The screening showed that 66 per cent of those examined had hyperpronation of the foot with eversion of the calcaneus in a relaxed foot position. This hyperpronation is an indication of a predisposition to pes planus. The insole coverage was 50 per cent. Statistically, 16 per cent of people at risk of pes planus are without orthotic treatment. With 58 per cent of the people studied suffering from the metabolic disease diabetes mellitus, there is a high risk that the 8 per cent who statistically walk without insoles will suffer serious foot lesions due to incorrect loading.

Conclusion: Prevention of foot problems is one of the tasks of podiatrists. In a podiatric practice a clinical examination could easily find a predisposition of flat foot if the calcaneus is pathologically everted. Preventative treatment by podiatrists like gymnastics to strengthen muscles or take away load from the Musculus tibialis posterior tendon with functional plantar orthotics can help to prevent feet from lesions.

 

EP0294 Protecting peristomal skin: A scoping review on MASD prevention in ostomy care

André Silva¹, Eva Alexandra Capitão², Vanessa Silva³, Paulo Alves^4
1Unidade de Saúde da Ilha de São Miguel, São Miguel, Portugal, ²Unidade Local de Saúde do Alto Minho, Hospital Santa Luzia, Viana do Castelo, Portugal, ³Hospital da Horta, FAIAL, Portugal, ⁴Universidade Católica Portuguesa, Porto, Portugal

Aim: Moisture-associated skin damage (MASD) is a frequent complication in patients with digestive ostomies, affecting comfort, quality of life, and clinical outcomes. This review aims to map and synthesise evidence on risk factors and nursing interventions for MASD prevention in these patients.

Method: Guided by Joanna Briggs Institute guidelines for scoping reviews, a comprehensive search was conducted in PubMed, CINAHL, and Scopus using terms like “nursing,” “prevention,” “risk factors,” “ostomy,” “ileostomy,” “colostomy,” “peristomal skin,” and “moisture-associated skin damage.” Sixty-four studies were initially identified, with 28 meeting inclusion criteria after removing duplicates and non-relevant studies.

Results / Discussion: Peristomal MASD is influenced by multiple factors, including ostomy type (particularly ileostomies with caustic, high-volume effluent), anatomical challenges like stoma retraction and hernias, and comorbidities such as obesity and diabetes. These conditions increase moisture exposure, heightening skin damage risk. Nursing interventions are essential for MASD prevention, emphasizing appropriate devices like moisture-managing silicone adhesives, patient education on self-care, and continuous skin monitoring. Challenges in rural and resource-limited settings necessitate alternative approaches, including silver nitrate for hypergranulation and device adaptations to patient-specific needs.

Conclusion: This review underscores gaps in current knowledge and supports the development of best practices for MASD prevention in patients with digestive ostomies, aiding clinical nursing practice by enhancing preventive care strategies.

 

 

QUALITY OF LIFE

EP0441 Intralesional polydeoxyribonucleotide (PDRN) injection for the management of postoperative scars

Jun Ho Park¹, Ji Won Jeong^1
1Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Rep. of South Korea

Aim: Polydeoxyribonucleotide (PDRN) is known to promote wound healing, but no clinical trials have investigated its effect on scar prevention in surgical wounds. This study aims to evaluate the efficacy of PDRN administration in preventing postoperative scars.

Method: This retrospective study involved East Asian patients who underwent surgery between March 2021 and March 2024. Patients were divided into two groups: one group using only scar gel and the other receiving a combination of scar gel and PDRN injections. The efficacy of these treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months post-operation.

Results / Discussion: The study included 42 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores; however, the combination therapy group demonstrated a statistically significant improvement in mVSS and POSAS scores at 12 months compared to the scar gel-only group. Additionally, there was a significant difference in patient satisfaction between the two groups. No specific side effects related to PDRN injections were observed.

Conclusion: Dual therapy with scar gel and PDRN injections was more effective than scar gel alone in managing postoperative scars. This combination therapy resulted in better scar outcomes at 12 months post-surgery, along with significant improvements in patient-reported satisfaction.

 

EP0644 The experience of living with an ostomy. A phenomenological approach for the reduction of dependency times

David Fernández Díaz¹, Almudena Rivas Raña¹, Fátima María Dios Quiroga¹, Daniel Domínguez Alonso^1
1SERGAS, Vigo, Spain

Aim: To understand how the experience of living with an ostomy is, identifying the elements that constitute the essence of their experience in order to implement them in the individualized support provided by nurses.

Method: Qualitative study of phenomenological approach. The sample were ostomate patients from the health-care district. The sample was intentionally selected until it was complete. A questionnaire was used for the collection of data and, as a basic technique, full interviews were recorded. The analysis was sequentially performed once that all the inter view process (interview-transcription-open coding) had finished.

Results/Discussion: The ostomy has a negative impact on a physical, emotional and social level. People who has undergone an ostomy abandon the medical care after discharge. They do not ask nurses for help to solve their problems as an alternative to their surrounding family, which is not always be a satisfactory support. Therefore, their recovering and social inclusion are slowed down.

Conclusion: Nursing has a fundamental role, through an integral approach and individualized care plans, in improving the autonomy and quality of life of these patients.

 

EP0442 Unlocking the potential of family medicine: establishing a hard-to-heal wound care clinic in primary healthcare

Andrea Bilić^1
1Dom Zdravlja Mostar, Mostar, Bosnia and Herzegovina

Aim: To improve the management of hard-to-heal wounds by integrating a specialized clinic at the primary healthcare level, led by family physicians. We aim to show that greater involvement of family medicine physicians results in better patient outcomes.

Method: The clinic is run by a family medicine physician and a nurse, both trained in advanced wound care. Over 600 wound dressings have been performed for venous ulcers, diabetic foot ulcers (DFU), and pressure ulcers. Treatments include custom off-loading casting for DFU, negative pressure wound therapy, and High-Intensity Laser Therapy (HILT). A “Hard-to-Heal Wound Care Guide for Primary Healthcare” was developed in the local language to support education of healthcare providers.

Results / Discussion: The clinic has achieved positive outcomes, with many patients experiencing wound closure and improvement. Continuous care and close collaboration with surgeons and angiologists have led to enhanced results. Managing wounds at the primary care level reduces pressure on secondary care services and improves patients’ quality of life. Early intervention by family physicians has proven essential in preventing complications.

Conclusion: Establishing a Hard-to-Heal Wound Care Clinic in primary healthcare leads to better patient outcomes, fewer complications, and lower healthcare costs. Family physicians play a pivotal role by offering continuous care and creating individualized treatment plans, which helps reduce the burden on secondary care. This approach allows patients to recover faster, return to normal activities sooner, and saves healthcare resources in the long term.

 

EP0443 Patient involvement in a post c-section wound care pathway and education package

Ines Alexandra Esteves Sadoc Pereira^1
1NHS Grampian, Aberdeen, United Kingdom

Aim: How to involve patients that underwent cesarean section in a post op wound care pathway and patient education package?

Method: Used structured phone call interviews with open questions to understand the impact wound complications had in patient’s lives, focusing on physical, emotional and socio economic aspects. Additionally, I used the Wound - QoL - 17 questionnaire on quality of life with scars, for patients with current scar. The staff involved in this project represent tissue viability, theatre, maternity ward, community midwifery, infection control teams: key teams involved in the patient’s pathway pre and post c- section.

Results/Discussion: The 5 interviews allowed the working group to comprehend the key aspects of care from a patient’s perspective as well as the importance of aligning the care pathway and education to staff and patients with the patients’ needs. As different teams were involved, the project is still ongoing, but we will have final results prior to the EWMA conference.  Once the resources have been agreed amongst the healthcare professionals, patients will be contacted for their views as they all agreed they would like to be involved in the future.

Conclusion: Having patients involved in the review of current post op wound pathway as well as improving staff and patient education will allow the patients’ needs to be at the centre of care, which can improve staff confidence in patient education as well as patient outcomes such as reduced wound complications, and positive experiences in the maternity services and at home.

 

EP0444 Quality of life and health literacy of people with diabetes and lower limb injuries

Larissa Barroso¹, Nathalia   Romeira², Evelyn  Consorti², Jessica Aquino¹, Eliana P Araújo³, Maria Helena Lima^3
1University of Vale do Sapucai, Pouso Alegre, Brazil, ²School of Nursing  of University of Campinas, Campinas, Brazil, ³School of Nursing of University of Campinas, Campinas, Brazil

Aim: To assess the quality of life and health literacy of patients with diabetes mellitus and lower limb injuries.
Method: This is an observational, cross-sectional study carried out in two teaching hospitals. For data collection, a questionnaire was used for sociodemographic and clinical characterization; the Diabetic Foot Ulcer-Short-Form (DFU-SF) instrument, and the Assessment Of Short Assessment of Health Literacy in Adults (SAHLSA - 18). Lesions on the lower limbs were assessed based on the Wound, Ischemia, Foot infection (WIFi) classification, and the data was evaluated using the Statistical Package for Social Sciences (SPSS) 20.0 program for statistical analysis.
Results / Discussion: Of 45 participants (mean age 64.71 years), 66.67% were male, 66.67% were white. The Duration of diabetes was 16.9 (12.02) years. Mean HbA1c was 8,5% (2,1). The mean scores were 32.22 (34.98) for leisure, 55.67 (30.31) for physical health, 46.00 (30.89) for dependency/daily life, 58.15 (27.79) for negative emotions, 42.92 (33.11) for worried about ulcer and 58.47 (29.41) for bothered by ulcer care. On the SAHLSA score 73.33% had low health literacy.
Conclusion: Diabetic patients with DFU face poor QoL, especially in leisure, dependency/daily life and worried about ulcer worries about ulcer in DSF-SF domains. The Health literacy skills are inadequate for most participants.  Identifying patients with low HL and simple data visualizations are the best practice to help patients and clinicians in dealing with limited health literacy and help in their perception about quality of life.

 

EP0445 The burden of DFUs – patients’ perspective

Isabelle Boucley¹, Arnaud Bubeck^2
1Laboratoires Urgo, Chenove, France, ²Fédération Française des Diabétiques, Paris, France

Aim: This study aims to assess the burden of diabetic foot ulcers (DFU) and the impact of TLC-NOSF dressings on patients’ quality of life.

Method: In order to better understand the impact of the DFU, we conducted 9 interviews with DFU patients from different socio-economic profiles, including 6 who had used TLC-NOSF dressings.

Results / Discussion: The complications of diabetic foot have multiple implications: the entry into a new temporality marked by waiting, care pathways are destabilized, everyday life is disrupted, activities must be abandoned or reinvented. Patients suffer from a loss of spontaneity, taste for life. In the most serious cases, life becomes impossible. The results show that the impact of DFU on patients’ quality of life varies according to several factors, including the severity of complications (induced disabilities, pain), the resources to face them and opportunities to adapt. A real contribution of TLC-NOSF dressings is felt by the patients, they are considered as a valuable help for a majority of users. However, there is still a lack of healthcare professional’s education. The challenge is to find the right person, who can guide the patients’ during the healing process.

Conclusion: This study confirms the burden of DFUs in real-life and the impact on patients’ quality of life of these chronic wounds, previously studied in the Explorer study. Using a dressing with a good efficacy and acceptability for patients and healthcare professionals, like TLC-NOSF dressings, can take part in reducing this burden.

 

EP0446 Enhancing patient compliance to therapeutic compression through motivational interviewing: a case study on quality of life in a 15-year venous leg ulcer

José Antonio García García¹, Irene Chivite Marín², Miriam Eslava Suárez³, Montse Pérez Baena⁴, Anna Roig Panisello⁵, Estrella Mesa^6
1Xarxa Sanitària, Social i Docent de Santa Tecla, Tarragona, Spain, ²CAR Vila-seca. Xarxa Sanitària, Social i Docent de Santa Tecla, Vila-seca. Tarragona, Spain, ³Hospital del Vendrell. Xarxa Sanitària, Social i Docent de Santa Tecla., El Vendrell. Tarragona, Spain, ⁴Hospital de Sant Pau i Santa Tecla. Xarxa Sanitària, Social i Docent de Santa Tecla., Tarragona, Spain, ⁵Institut Català de la Salut. Terres de l‘Ebre, Tortosa. Tarragona, Spain, ⁶Pius Hospital de Valls, Valls. Tarragona, Spain

Aim: To assess the effect of motivational interviewing (MI) on enhancing compliance to recommended therapeutic compression (40mmHg) in an 83-year-old woman with a 15-year history of a venous leg ulcer. Secondary objectives include identifying factors that influence treatment adherence and their impact on quality of life.

Method: MI was employed to promote patient compliance by exploring perceptions, beliefs, barriers, and facilitators regarding the use of therapeutic compression. Sessions were structured around principles of empathy, positive reinforcement, and a focus on change. Quality of life was objectively assessed using the Wound-QoL questionnaire.

Results / Discussion: MI revealed key emotional factors, including fear of discomfort caused by the bandage and distrust towards treatment due to previous failures. As such, the importance of compression as the principal etiological treatment was reinforced. With an empathetic and personalized approach, the individual progressively demonstrated an increased willingness to accept multicomponent compression therapy as the primary treatment. Furthermore, the patient reported reduced pain and healing of the lesion within nearly four months, after 15 years of suffering. Lastly, a significant difference greater than 0.5 minimal important difference (MID) was observed in perceived quality of life (Wound-QoL).

Conclusion: MI is an effective tool for enhancing adherence to compression therapy. Personalizing the intervention and addressing the emotional and physical aspects related to treatment facilitate adherence. This case highlights the importance of person-centered communication in optimizing therapeutic interventions and improving perceived quality of life.

EP0645 The 2023 EB insights study; a large comprehensive patient-centric research study to qualify and quantify the impact of epidermolysis bullosa, in the UK

Claire Mather¹, Sagair Hussain^1
1DEBRA, Bracknell, United Kingdom

Aim: Epidermolysis bullosa (EB) describes a complex group of rare, inherited skin fragility disorders characterised by frequent skin blistering/erosions and altered wound healing. Data generation in rare diseases can be challenging and has resulted in a lack of data on EB natural history, healthcare resource-use (HCRU), and the health-related quality of life (HRQoL) impacts on patients and their carers/families. The 2023 EB Insights Study is the most comprehensive, patient-centric research in EB to-date. The study aimed to evaluate the impact of EB on daily life, HCRU, and the HRQoL experienced by patients and their carers/families.

Method: Part 1 involved in-depth interviews with EB patients, carers, and healthcare professionals (HCPs). Part 2 consisted of an online survey with EB patients and carers, while an online survey for HCPs comprised Part 3. 

Results / Discussion: In the context of a rare disease, each study component recruited high participant numbers (24 EB patients/carers and 9 HCPs in Part 1; 215 patients and 103 carers in Part 2; and 50 dermatologists and 100 GPs in Part 3. Responses to the patient/carer online survey came from across the UK, encompassing different EB subtypes (61% EBS, 31% DEB, 4% JEB, 2% KEB), genders (64% female, 35% male), ethnicities (92% white), severities, and ages (25% children, 75% adult).

Conclusion: The Insights Study provides a body of quantitative and qualitative data across a broad demographic of participants, serving as a foundation for patient advocacy and to support pharmaceutical companies in their evidence generation activities for new EB therapies.

 

EP0447 Improving hygiene in critically ill patients: an analysis of disposable bathing

Camila Safranski¹, Juliana Orzechowski¹, Dioney Neves^1
1Missner, Blumenau, Brazil

Aim: Analyze research that evaluates disposable bathing compared to traditional bathing in the care of critically ill patients.

Method: The study compared traditional bathing, which uses compresses, towels, soap, and water, to dry bathing, which employs moist wipes with emollient and moisturizing solution, without soap and alcohol. The effects of both methods on microbial load, hemodynamics, and the workload of the nursing team were analyzed.

Results/Discussion: Traditional bathing may lead to a reduction in arterial oxygen saturation (SpO2) and an increase in heart rate. In contrast, dry bathing showed superiority in reducing the time patients spend in the lateral position, which is crucial for the safety of critically ill patients. Hygiene procedures take between 59 and 288 minutes of assistance, and dry bathing may enhance professional preference. Additionally, the use of disposable bathing resulted in a significant reduction of S. aureus and better maintenance of skin moisture. This combination of benefits—reducing nursing time and microbial load—enhances both patient quality of life and nursing efficiency, ultimately leading to cost reductions for institutions.

Conclusion: It is suggested that disposable bathing is an effective and comfortable alternative for daily skin cleaning of critically ill patients, justifying its incorporation into nursing care routines. This can lead to improved quality of care, cost reduction, and better management.

 

EP0448 Emergency department presentations and hospital admissions in patients attending a chronic wound clinic

Rebecca Iseli^{1 2}, Nicole Liddicut¹, Adeline Chan², Sarah Sage
¹Royal Melbourne Hospital, Parkville, Australia, ²University of Melbourne, Parkville, Australia

Aim: People with chronic wounds are at high risk of Emergency Department (ED) presentation and hospital admission with studies reporting up to 53% of patients with chronic wounds having an ED presentation and 7-25% being admitted to hospital. Wound infection in particular has been associated with higher rates of hospitalisation. The aims of this study are to (i) determine the incidence of ED presentations and hospitalisations in patients attending a chronic wound clinic, (ii) describe the reasons for ED presentation and hospitalisation, (iii) examine factors associated with ED presentation and hospitalisation.

Method: Retrospective review of patients admitted to a chronic wound clinic in 2023. Data will be collected using Research Electronic Data Capture (REDCap), including: demographics; referral information; wound history and assessment; details of wound clinic attendance (including wound outcome during clinic admission and health care disciplines involved in care); patient healthcare burden (other providers involved in patient care); medical conditions; Charlson Comorbidity Index; medications; Clinical Frailty Scale and hospital presentation details (type of presentation, reason for presenting, treatment). Descriptive statistics will describe ED presentations and hospital admissions; factors associated with ED presentation and hospitalization will be analysed using non-parametric tests to compare groups.

Results / Discussion: This study will present findings for the 200 patients that attended a tertiary hospital chronic wound clinic in 2023.

Conclusion: Understanding the reasons for ED presentation and hospital admission in patients with chronic wounds can guide further research to reduce the burden of chronic wounds for patients and improve health care provision.

 

EP0449 Clinical leadership competency in palliative wound care: enhancing quality of life and patient safety

Widasari Sri Gitarja¹, Kana Fajar², Khairul Bahri², Pipit Lestari², eviyanti  numalasari², Munasirah Ismail^2
1WOCARE Indonesia, Lincoln University, Malaysia, University of Pelita Harapan, Indonesia, West Java, Indonesia, ²Wocare Indonesia, West Java, Indonesia

Aim: Effective palliative wound care management relies heavily on nursing care services, where clinical leadership competencies are crucial. Clinical leadership is a critical professional attribute for optimising clinician performance in primary healthcare settings dedicated to palliative care. Clinical leaders demonstrate confidence and competence in team-based care, directing and enhancing service pathways to improve the quality of care. This study aims to analyse five core characteristics of clinical leadership essential for palliative wound care nurses. By establishing a model of clinical leadership competencies, this study seeks to enhance the quality of care and patient safety, thereby supporting palliative wound care nursing as a competitive advantage in clinical performance.

Method: A quantitative, cross-sectional survey was conducted with 200 Indonesian-certified wound care nurses in primary healthcare settings. Data were collected via an online questionnaire from SurveyMonkey, and statistical analyses were performed using PLS-SEM through Smart PLS 3.0.

Results / Discussion: Findings indicated that “improvement in the quality of care and patient safety” received the highest respondent ratings as a priority in clinical leadership, while “collaborating within a multidisciplinary team” was rated as less critical. These results underscore the need for a leadership focus on quality and safety in palliative care settings.

Conclusion: Developing a palliative care unit and fostering an organisational culture focused on excellence pose significant challenges for healthcare organisations. This study highlights the essential role of clinical leadership competencies in palliative wound care management, emphasising the impact on quality, patient safety, and overall clinical performance.

 

EP0450 The impact of a cinnamon odour control dressing in managing malodour in a malignant fungating breast wound

Susy Pramod^1
1The Christie NHS Foundation Trust, Manchester, United Kingdom

Aim: Although relatively rare, with an estimated prevalence rate of 3.6%, malignant fungating wounds (MFW) can be devastating for patients and their family and challenging for clinicians. This case study aims to assess the impact of a cinnamon-based dressing on a patient with a malodorous MFW.

Method: A 40-year-old woman with metastatic breast cancer, presented with a malodorous MFW on the breast, persisting for 8 months. Previous treatments include palliative radiotherapy (20 Gy in 5 fractions), and two cycles of chemotherapy. A carbon dressing had been used in an attempt to control wound odour, however the patient still rated the odour as ‘strong’ with the dressing in situ.

To address her primary concern, malodour, 0.75% topical metronidazole gel was applied in combination with a cinnamon-based dressing for a period of 14 days.

Odour level was assessed at baseline (day 0), day 7 and day 14 using a wound odour scoring system (“none,” “slight,” “moderate,” “strong”). Qualitative feedback was collected on the psychological impact of odour reduction on the patient and her family.

Results/Discussion: Within 7 days, the patient rated the wound odour as ‘none’ with the cinnamon-dressing in situ and this score was maintained at day 14. Patient requested continued use of cinnamon dressing beyond the evaluation period.

In controlling the odour, the patient found relief, felt confident enough to socialize which positively impacted her overall well-being. Importantly, her children and family were able to visit without distress.

Conclusion: This case study suggests that a cinnamon-based dressing effectively controls MFW malodour, significantly enhancing patients’ well-being during this challenging time.

 

 

SURGICAL APPROACHES

EP0460 Fish skin grafts combined with octenidine after cancer ablation in the head and face - overcoming borders in reconstructive surgery

Lukas Fiedler^{1 2
1}SLK Kliniken Heilbronn, Heilbronn, Germany, ²University of Heidelberg, Heidelberg, Germany

Aim: Decellularized intact fish skin is combined with an antiseptic in patients who underwent ablative surgery for malignant and erosive ulcerative lesions in the head and facial region aiming to assess its efficacy in promoting wound healing and granulation.

Method: Seven consecutive treated patients (58-92; M=77,4 years), with squamous cell carcinoma (SCC, n=3), post radiogenic chronic dermatitis (n=3) and basal cell carcinoma (BCC, n=1), were treated post-ablation with described fish skin grafts. The standard algorithm included antiseptic wound bed preparation with octenidine, meshing of the fish skin grafts, and continued hydrogel application. The patients were monitored weekly to evaluate granulation and epithelisation, with follow-ups extending 90 days post-application.

Results / Discussion: Granulation was achieved in all cases, with five wounds reaching full granulation and two achieving 90%. Duration until complete granulation varied, with the shortest period being 5 days and the longest extending to 63 days in a pre-radiated field. Two patients achieved epithelisation without further intervention and five received additionally a full-thickness skin graft. The protocol demonstrated high effectiveness, particularly in the 3 patients with SCC, where the reconstruction was completed within an average of 38 days.

Conclusion: Decellularized intact fish skin presents a viable, effective option in complex wound management following cancer ablation in sensitive head and face areas. The consistent granulation and relatively short timeframes to defect coverage highlight the potential of this biological material to overcome conventional surgical reconstruction limitations. Octenidine did not affect fish skin and prevented local infections in all patients, which supports an optimized healing process.

 

EP0461 Surgical approach to necrotizing fasciitis in the buccal fat pad

Jongweon Shin^1
1Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Rep. of South Korea

Aim: Cervicofacial necrotizing fasciitis (CNF) of the face is a rare and potentially life-threatening bacterial infection that requires immediate intervention. CNF involving the buccal fat pad particularly demands surgical drainage, with attention to the surrounding anatomical structures to prevent vascular or nerve damage. In this study, we reviewed the anatomy of buccal fat pads to suggest appropriate surgical approaches.

Method: A retrospective chart review was conducted on seven patients with CNF who had a buccal fat pad abscess requiring surgical incision and drainage between January 2022 and August 2023. Abscesses within the central buccal fat pad and its pterygoid extensions were drained via intraoral incisions. Abscesses in the temporal extension were addressed by the Dingman approach.

Results / Discussion: All patients underwent our surgical drainage regimen combined with proper intravenous antibiotics, leading to successful treatment of CNF without significant functional sequelae, with an average stay of 18.71 days.

Conclusion: The buccal fat pad, which corresponds to the deep space of the face, is surrounded by vital structures such as the facial artery, vein, nerve, and parotid duct. When treating abscesses in the buccal fat pad, it is important to understand the relationship of the fat pad to other vital structures for optimal outcomes.

 

EP0462 Continuous topical oxygen therapy in the treatment of surgical wound dehiscence: a case series

Windy Cole^1
1Kent State University College of Podiatric Medicine, Cleveland, United States

Aim: Continuous Topical Oxygen Therapy (cTOT) delivers low-pressure oxygen to the wound, 24 hours a day, 7 days a week. A growing body of high-level evidence advocates the use of cTOT as beneficial adjunct to healing in complex wounds. This report examines the feasibility of using a cTOT device as part of a treatment algorithm to treat surgical wound dehiscence (SWD) of the lower extremity.

Method: This is a single-center, retrospective analysis of lower extremity surgical wound dehiscence treated with continuous topical oxygen. All patients were >18 years of age with a history of a SWD of >1.0 cm diameter. Demographics, surgical intervention and clinical course details were recorded. All patient past medical history, smoking status, date of surgery, date of wound dehiscence, date of initial application of cTOT and time to wound closure were documented, as was the grade of dehiscence.

Results / Discussion: Nine patients had mean patient age of 52.6 years. 44.4% of patients were smokers, and 33% had Type II DM, sleep apnea, and high cholesterol respectively. All patients’ SWD grade was either 3 or 4. The mean number of days from starting TOT to the SWD healing was 52.6. The average days to wound healing was 70 days.

Conclusion: The outcomes suggest that cTOT is an effective treatment in the management of SWD. Furthermore, all the SWD treated with cTOT went on to wound closure without need for surgery, hospitalization or other costly procedures.

 

EP0463 Risk of congestive heart failure and mortality following lymphovenous anastomosis: a nationwide population-based retrospective cohort study

Jeong Yeop Ryu^1
1Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Rep. of South Korea

Aim: Lymphovenous anastomosis (LVA) enables lymphatic fluid to drain into the venous system. However, no study has investigated the association between LVA and heart failure (HF) caused by fluid overload in blood circulating system. Aim of our study was to determine whether LVA increases the risk of HF and mortality.

Method: This nationwide study evaluated total of 1,400 lymphedema patients who underwent LVA and two control cohorts with 28,000 lymphedema who did not undergo LVA and 70,000 age- and sex-matched participants from the Korean National Health Insurance database were included. Other cardiovascular risk profiles and comorbidities were obtained during National Health Insurance Service – Health Screening. The incidence, adjusted risk for HF, and mortality were evaluated.

Results / Discussion: Adjusted HRs for HF were 1.20 (confidence interval [CI], 1.03–1.40) and 1.30 (CI, 1.12–1.50) referenced by the general population control cohort and patients with lymphedema without LVA, respectively. In stratified analyses, the risk was notably greater in males compared to females, higher in younger individuals as opposed to older ones, and further elevated within the BMI range of 18.5 to 25. Among patients with lymphedema, LVA did not significantly affect mortality.

Conclusion: LVA is associated with an increased HF risk, independent of cardiovascular risk factors and of associated comorbidities. This association is prominent in subjects aged <50 years, in males, and in the normal-to-obese (BMI ≥18.5 kg/m2) group. Careful management strategies for HF are warranted lymphedema patients who underwent LVA, and indiscriminate LVA in lymphedema patients should be avoided.

 

EP0646 Wound management after ileostomy closure: A literature review

Ismini Kountouri¹, Christina Sevva¹, Eleni Paschou¹, Panagiota Roulia¹, Marios Dagher¹, Vasilis Stergios¹, Amyntas Giotas², Ioannis Katsarelas³, Dimitrios Chatzinas³, Panagiotis Nachopoulos³, Afroditi Faseki³, Konstantinos Papadopoulos¹, Vasileios Alexandros Karakousis¹, Athanasios Polychronidis³, Alexandra  Panagiotou³, Mohammad Husamieh³, Georgia Maria Ntoulia², Stylianos Mantalovas¹, Periklis Dimasis³, Militiadis Chandolias^3
1Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ²Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ³Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece

Aim: This study aims to review the international literature regarding the postoperative wound management after ileostomy closure.

Method: The postoperative management of the wound site after ileostomy closure is still debated in the existing literature. For this study, three databases, Cochrane, PubMed, and Scopus, were methodically searched using specific keywords. Various methods for prevention of postoperative wound site infection following ileostomy closure were found and their results are presented in this study. 

Results / Discussion: Ileostomy closure is a simple but contaminated surgery with significant incidence (up to 41%) of surgical site infection (SSI) and its sequelae, such as prolonged wound discharge, wound herniation and scarring. Several reports in the literature compare the primary closure of the skin with other techniques, such as negative pressure wound therapy (NPWT) to the open wound and purse-string wound-closure (PSSC). Our review of the literature revealed that both PC and PSSC are considered safe approaches for the management of the wound site after ileostomy closure, with the majority of the writers favoring the PSSC method. 

Conclusion: PSSC is a good alternative to primary closure of the wound after ileostomy closure favouring reduced hospital stay, need for wound care, healing time and size of the resultant scar.

 

EP0647 Perineal wound complications after abdominoperineal resection

Christina Sevva¹, Konstantinos Papadopoulos¹, Vasileios Alexandros Karakousis¹, Vasilis Stergios¹, Amyntas Giotas², Ioannis Katsarelas³, Dimitrios Chatzinas³, Eleni Paschou¹, Panagiota Roulia¹, Marios Dagher¹, Panagiotis Nachopoulos³, Afroditi Faseki³, Athanasios Polychronidis³, Alexandra  Panagiotou³, Mohammad Husamieh³, Georgia Maria Ntoulia², Stylianos Mantalovas¹, Periklis Dimasis³, Militiadis Chandolias³, Ismini Kountouri^1
1Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ²Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ³Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece

Aim: To review the global literature regarding wound complications from the perineum

following abdominoperineal resection (APR) and to present methods for preventing and

handling these complications.

Method: For this study, three scientific databases (Pubmed, Scopus, Cochrane) were

methodically searched using specific keywords. Only complications and adverse outcomes from the perineal wound were included. Management options for these complications are presented in this study.

Results / Discussion: APR is a common, yet extensive, surgical procedure performed in patients with rectal cancer, involving removal of the anus, rectum and surrounding tissues.

Complications from the perineal wound (14-80%) are more common and severe than those

from the abdominal wound. These include higher risk of infection (27%), dehiscence and

evisceration, formation of hematomas and seromas, skin irritation or necrosis, delayed healing, fistula formation, perineal hernia formation and chronic pain or discomfort. Intraoperative technique can prevent perineal wound complications by careful vessel dissection and nerve preservation. Methods for managing these complications postoperatively include intravenous administration of antibiotics based on culture results, daily proper wound care and dressing, wound packing and even vacuum-assisted closure (VAC) and tissue transfer using flaps, as well as identifying and addressing contributing factors, either topical (e.g. tension on the wound) or systematic (e.g. diabetes).

Conclusion: Perineal wound complications following APR still pose a challenge to surgeons,

especially when large defects are present or primary closure cannot be an option, mainly due to previous radiation therapy. Surgeons must be aware of the ongoing clinical research regarding new tissue transfer and wound closure techniques and their efficacy and be alert for early identification of such complications.

 

EP0464 Modern post-operative dressing vs traditional dressing

José Araujo^1
1Jupiter Médico - Hospitalar, Barueri, Brazil

Aim: To describe the experience of using a modern postoperative dressing made of soft silicone and polyurethane foam with high absorption and flexibility versus traditional dressings with gauze and adhesive in patients undergoing neurosurgery; observe performance for up to seven days; acceptance by the patient; reduction of frequent changes.

Method: Patients at a São Paulo State Hospital undergoing neurosurgery were randomly divided into two groups with 20 patients (A and B). The first using modern dressing. The second group used traditional dressings. The patients were followed for seven days and answered a questionnaire with closed questions regarding their perception of the dressings: Very Good, Good, Bad and/or Uncomfortable. The number of exchanges within the seven-day interval was considered.

Results / Discussion: Group A: Exchanges = 24; 18 patients considered the dressing Very Good; 1 patient considered the dressing Good; 1 patient considered the dressing Uncomfortable.

Group B: Exchanges = 147; 6 patients considered the dressing Good; 12 patients consider the dressing Bad; 2 patients considered the dressing Uncomfortable.

Conclusion: Dressing costs impact on hospital budgets. It is important to consider that in the process of changing dressings, the costs are not just limited to the materials that will be used, but there are also costs with human resources. Modern dressings may initially present higher costs, however, when we take into account all ancillary costs, it is assumed that they may be more economically viable. The authors observed greater patient and professional satisfaction with modern dressings.

 

EP0465 What is the best way to debride an infected chronic wound: a prospective randomised clinical trial

Murat Kendirci, Ünsal Savcı¹, İsmail  Sezikli^2
1Hitit University School of Medicine, Corum, Türkiye, ²Hitit University School of Medicine, corum, Turkey

Aim: Debridement is the initial step for chronic wound management which reveals removement of all unwanted issues such as infected,necrotic tissues, bacterias, foreign bodies. This study aims to compare debridment techniques which used commonly in order to determine which one is more effective in wound infection management.

Method: Totally seventyfive patients was included, randomized in three groups such as sharp debridement, ultrasound debridement and hydrosurgery. All patients underwent debridement in operation room and recieved tissue culture before and after procedure. All the specimen examined by same specialist and microbiological results are given quantitatively. Bacretia load before and after surgery is noted.

Results / Discussion: Seventyfive patients with Wagner 3 DFU who were randomly seperated in three groups underwent debridement, and debrided via scalpel or ultrasound or hydrosurgery. Wound sizes, demographics of patients, ulcer durations were similar. After surgery bacteria loads decreased in all groups, but rates in decrease was more in hydrosurgery, ultrasound and sharp debridement, respectively. Hospital stay, duration time till reconstruction surgery, infection rates, need for antibiotics, graft loss were less in group 3,2 and 1 respectively. No matter how procedure itself is more expensive hydrosurgery is found to be more cost effective than others.

Conclusion: Debridement is a way of infection management in chronic wounds such as DFU. Any kind of debridement should be performed initially but if the conditions of the center is available, hydrosurgery is recommended as the most effective approach for debridement where it has no harm for vital tissues and decresases bacteria load.

 

EP0466 Minimizing surgical wounds in melanoma through preoperative assessment using novel imaging techniques

Mehdi Boostani¹, Andras Banvolgyi¹, Kende Lőrincz¹, Péter Holló¹, Norbert Wikonkál¹, Szabolcs Bozsányi², Gyorgy Paragh², Norbert Kiss^1
1Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary, ²Roswell Park, Department of Dermatology, Buffalo, United States

Aim: This study aims to explore the potential of non-invasive optically guided high-frequency ultrasound (OG-HFUS) and multispectral imaging (MSI) in preoperatively estimating Breslow thickness in melanoma, with the goal of reducing unnecessary wide excisions and minimizing surgical wounds during tumor staging and treatment.

Method: A prospective cohort of 101 patients with histologically confirmed melanoma was included in the study. Each tumor was categorized by thickness using OG-HFUS at 33 MHz and MSI. An MSI-based algorithm was developed to classify tumors, and its performance in terms of sensitivity, specificity, and agreement with histopathology was compared with that of OG-HFUS. The focus was on how these imaging techniques could inform preoperative decisions to avoid extensive surgeries.

Results / Discussion: The MSI-based algorithm showed a sensitivity of 62.6%, specificity of 81.3%, and fair agreement (κ = 0.440, CI: 0.298–0.583) with histopathological findings. OG-HFUS performed significantly better, with a sensitivity of 91.8%, specificity of 96.0%, and near-perfect agreement (κ = 0.858, CI: 0.763–0.952). These results indicate that OG-HFUS provides a more accurate estimation of Breslow thickness, reducing the need for large excisions and invasive biopsies.

Conclusion: By accurately estimating Breslow thickness non-invasively, OG-HFUS has the potential to significantly reduce the need for extensive surgical excisions in melanoma patients. This approach could lead to better patient outcomes by minimizing surgical wounds and promoting more targeted, less invasive treatment strategies.

 

EP0590 Reducing surgical wounds in basal cell carcinoma through non-invasive optically guided high-frequency ultrasound

Mehdi Boostani¹, Andras Banvolgyi¹, Kende Lőrincz¹, Péter Holló¹, Norbert Wikonkál¹, Szabolcs Bozsányi², Gyorgy Paragh², Norbert Kiss^1
1Semmelweis University, Department of Dermatology, Venereology and Dermatooncology, Budapest, Hungary, ²Roswell Park, Department of Dermatology, Buffalo, United States

Aim: The aim of this study is to evaluate the potential of non-invasive optically guided high-frequency ultrasound (OG-HFUS) imaging to differentiate between aggressive and low-risk basal cell carcinoma (BCC) histological subtypes (HSTs), reducing the need for invasive surgical biopsies and excisions.

Method: A prospective study was conducted, involving clinical and dermoscopic evaluations followed by OG-HFUS imaging at 33 MHz. After imaging, all lesions were surgically excised and histologically analyzed. Seventy-five patients with 78 BCC lesions were recruited. Based on histopathological analysis, 16 lesions were classified as aggressive HST (infiltrative or micronodular) and 47 as low-risk HST (superficial or nodular). A novel risk-classification algorithm was developed using OG-HFUS imaging features such as shape, margins, and internal echoes. Validation of the algorithm was performed on an independent set of 15 lesions.

Results / Discussion: OG-HFUS successfully identified aggressive BCC HSTs based on irregular lesion shape (p < 0.0001), ill-defined margins (p < 0.0001), and non-homogeneous internal echoes (p = 0.004). The algorithm demonstrated superior sensitivity (82.4%) and specificity (91.3%) compared to conventional macroscopic and dermoscopic assessments. Positive predictive value (PPV) was 94.7%, and negative predictive value (NPV) was 78.6%. Validation confirmed a sensitivity of 83.33% and a specificity of 91.66%.

Conclusion: OG-HFUS offers a non-invasive alternative for distinguishing aggressive BCC subtypes, significantly reducing the need for surgical excisions, thereby minimizing patient morbidity and wound complications. This approach may enhance early, targeted therapeutic decisions while reducing unnecessary surgical interventions.

 

EP0467 Treatment with free flap in cases of longstanding non-healing exposured tennon and bone

Sae Hwi Ki^1
1School of Medicine, Inha University, Incheon, Rep. of South Korea

Aim: In cases of long-standing non-healing of tendon and bone exposure, we tried to evaluate the result and complications of the free flap reconstruction.

Method: The retrospective study was from 2012 to 2023. 12 patients who had flap reconstruction due to chronic tendon exposure in upper and lower extremity. Data were collected with patient information, causes, flap success, healing time, complications, and additional procedure.

Results / Discussion: There were 12 patients of mean age 56.15 years. The causes were 8 cases with trauma, 3 cases with complication of repetive surgery, and 1 case with tumor resection. There were 8 tendons exposure and 4 bones exposure.  All case had history of infection after traum and initial surgery. The chronic wound were treated with negative pressure wound therapy and traditional foam dressing for 8 weeks at least. The period of wound dressing was 14.7 weeks. The mean size of wound was 24 cm ². The type of the reconstruction flap were 8 fasciocutaneous flaps and 4 musculocutaneous flaps. The mean size of flaps was 36 cm ². All flaps were survived. The mean healing time with flaps were 9.5 weeks. There was no active infection after flap. The additional procedure was 1.7 times.

Conclusion: In cases of chronic wound treated with flap, the period was relatively long. This is thought to be because subclinical infection remains in exposed tendon. We had good result using free flap without complication in cases of chronic wound that is not treated with consertive treatment.

 

EP0468 Traumatic scalp avulsion: experiences and challenges in surgical management

Mantas Fomkinas¹, Karolina Baltrušaitytė¹, Simas Gindriunas¹, Ernest Zacharevskij¹, Kęstutis Braziulis^1
1Department of Plastic and Reconstructive Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania

Aim: Total scalp avulsion is the detachment of scalp tissues from the periosteum, affecting areas like the hairline, eyebrows, ears, and nose. This study aims to present clinical cases of scalp avulsion, and the treatment strategies employed at our hospital over a 5-year period.

Method: Over the past five years, our hospital has managed three cases of scalp avulsion within its service area. Initial management involved attempts at scalp replantation as the primary treatment modality, however, subsequent complications, including infection and tissue necrosis, necessitated the use of both full-thickness and split-thickness skin grafts for the management of craniofacial wounds. In cases where the periosteum sustained damage, multiple cranial perforations and the application of negative pressure wound therapy (NPWT) were utilized. Following adequate granulation tissue development and favorable outcomes in wound healing, autologous skin grafting (autodermoplasty) was performed. These cases present significant complexity, with associated risks such as sepsis and long-term physical, aesthetic, and psychological consequences.

Results / Discussion: In cases of complex scalp avulsion injuries, replantation remains the primary therapeutic approach, though its success rate can be variable. In instances where the periosteum is absent, osteoperforation techniques should be considered as a viable method to promote granulation tissue formation. Additionally, the use of advanced wound management strategies can facilitate more rapid healing and improve overall treatment outcomes.

Conclusion: In our clinical experience, when scalp replantation was not feasible, skin grafting was the most frequently employed technique. In cases involving periosteal damage, a combination of osteoperforation, autodermoplasty, and negative pressure wound therapy was utilized. The integration of advanced wound management, psychological support, and rehabilitation facilitates a more rapid return to normal daily activities for the patient.

 

EP0469 Fragmented dermo-epidermal units in chronic wound treatment

Aneta Erbenova^{1 2}, Jitka Böhmova¹, Marie Kroneisl^1
1University Hospital Bulovka, Prague, Czech Republic, ²1st Faculty of Medicine, Charles University, Prague, Czech Republic

Aim: We would like to present our experience with the use of fragmented dermo-epidermal units in chronic wound treatment. Autologus micrografting is a method with promising results. Further investigation is needed to implement this procedure as a standard treatment option.

Method: We selected 10 patients with a chronic wound to undergo this procedure. All patients had previously undergone months or years of moist wound treatment, in some cases we had applied NPWT and some patients had been treated with an amniotic membrane derived material repeatedly.

We excised a portion of the patient’s healthy skin under local anaesthesia with a dermal punch set and used a special device – a minidrill – to harvest fragmented dermo-epidermal units from this sample into a saline solution. The suspension obtained from this process was then applied to the wound bed. We used both the method of intra-wound injection and micrograft application onto a collagen scaffold.

Results / Discussion: In all cases we performed a one-time application of the micrograft solution with changes of overlying dressings every three days. Once a week we documented the progress including photographic records. The healing process was accelerated in several cases. We are awaiting further results in the months to come.

Conclusion: This method is indeed very promising and could be the solution to wound healing in indicated cases. We expect further results and conclusions in the upcoming months as we continue our follow-up and would like to present our work.

 

EP0577 Surgical approach and outcomes for lymphangioma

Seong Jun Kim¹, Youngwoong Choi^1
1Ilsan Paik Hospital, Inje University, Gyeonggi-do, Rep. of South Korea

Aim: Lymphangiomas are uncommon benign malformations of the lymphatic system, primarily in the head. While surgical removal is the known treatment, the 23% recurrence rate within 81 weeks post-excision is high. This report describes a case where surgical resection was performed after evaluating a mass in the temple with CT, without tissue examination due to hematoma suspicion. Surgery was conducted due to recurrence, confirming lymphangioma.

Method: In 2015, a 15-year-old male presented with a 3cm well-marginated mass in the right temple, without trauma history. Physical examination revealed deep-seated features, with intact facial nerve integrity. CT diagnosed a benign soft tissue mass (Fig. 1). Surgery revealed a hematoma-like appearance (Fig. 2). Eight years later, the patient presented with the same symptoms.

Results: A 4x1cm cystic mass in the same area was diagnosed as lymphangioma with hemorrhage on MRI (Fig. 3). Following the previous incision line, surgery was performed under general anesthesia. The exposed brownish serous fluid flowing from a thin pocket deeper than the superficial fascia was excised, confirming lymphangioma upon pathological examination (Fig. 4).

Conclusion: This case indicates that MRI and pathological tests are necessary for deep-seated facial masses without apparent trauma. Additionally, removing the mass along with the pocket is essential to reduce recurrence risk.

EP0578 Skin redraping technique for correction of involutional congenital entropion

Youngwoong Choi¹, Seong Jun Kim^1
1Ilsan Paik Hospital, Inje University, Gyeonggi-do, Rep. of South Korea

Aim: Congenital entropion is an ocular condition involving malpositioning of the eyelid, which can result in ocular pain, conjunctival epiphora, or photophobia. Yet, there is no consensus regarding the most appropriate surgical technique. The aim of the study is to introduce skin redraping technique for correction of involutional congenital entropion and report the surgical outcome.

Method: Eight lower eyelids of four patients were retrospectively reviewed from January of 2017 to December of 2021. They underwent correction of involutional lower lid entropion using medial epicanthoplasty with skin redraping technique. The medical records of the patients with at least 6 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics. Main outcome measures were success of surgery and complications.

Results / Discussion: Eversion of the cilia and the creation of cosmetically natural appearance were accomplished in all cases (Fig.1). There has been no case of recurrence yet (Table 1).

Conclusion: This surgical technique enables not only the successful treatment of congenital entropion but also the creation of cosmetically acceptable result with increased patient satisfaction.

 

Fig.1. (Above) Pre-operative photo of 18 years old girl. Both eyes with involutional lower lid entropion presented (Below) Post-operative photo after 2 weeks.

 

Table 1. Complication data

 

EP0579 Long-term outcomes of secondary nasal tip plasty after degradation of a polycaprolactone (PCL) mesh

Seong Jun Kim¹, Youngwoong Choi¹¹Ilsan Paik Hospital, Inje University, Gyeonggi-do, Rep. of South Korea

Aim: Secondary nasal tip plasty often struggles to harvest suitable septal extension grafts for adequate tip projection. This study evaluates nasal tip changes over time after tip plasty using PCL mesh.

Method: We conducted a retrospective study of 86 Asian patients who underwent secondary tip plasty. We examined demographics and outcomes, measuring the nasolabial angle, nasofrontal angle, and Goode ratio (Fig. 2) at short-term (4-6 months) and long-term (over 24 months) follow-ups, assessing aesthetic outcomes with the Global Aesthetic Improvement Scale.

Results / Discussion: Among 86 patients, 56 had long-term follow-up. The average age was 33.33 years, with a male-to-female ratio of 1:5. The nasolabial and nasofrontal angles showed no significant changes. The Goode ratio decreased by 5.00% (Fig. 1), but 96.4% of patients reported improved long-term satisfaction. There were two complications (2.33%), including one infection and one case of PCL-mesh protrusion.

Conclusion: This study supports the safety and effectiveness of PCL meshes in septal extension grafts, highlighting their utility despite biodegradation effects on nasal projection.

 

Fig.1. Intraoperative photograph of septal extension graft (black) and PCL mesh (blue) sutured to L-strut.

 

Fig.2. (Left) The nasofrontal angle (NFA) is defined as the angle between two lines from the radix to the nasal tip and the projecting point of the forehead. The nasolabial angle (NLA) is formed by the line from the subnasale to the labrale superioris and the line from the columellar point to the subnasale. (Right) The Goode ratio is calculated by dividing the distance from the alar crease to the most prominent nasal tip point (b) by nasal length (a).

Table 1. Comparison data between short and long term follow-ups.

 

EP0580 Allogeneic fibroblasts and keratinocytes in the treatment of chronic leg ulcers (CLLU): an Italian preliminary restrospective monocentric study

Stefania Chiarenza^1
1Istituti Clinici Zucchi, Istituto Clinico Villa Aprica, Monza, Italy

Aim: CLLU represent one of the most difficult challenges. Traditional therapies can achieve positive results but sometimes a faster complete healing is necessary.

Aim of the study to evaluate the efficacy and safety of allogeneic Fibroblasts and Keratinocytes as cellular dermal substitutes in treatment of CLLU.

Method: It has been demonstrated that alarmins, multifunctional endogenous molecules, are able to mediate repair when transient and self-limited expressed. Based on this, allogeneic substitutes were developed through the cultivation of keratinocytes and fibroblasts from cadaveric or living donors on a hyaluronic acid matrix, followed by cryopreservation.

The choice of product type was made based on the characteristics of the ulcer.

The efficacy was evaluated in terms of % reduction in size of the skin lesion (score in 6 categories) and by evaluating the wound bed.

Adults of both sexes affected by skin ulcerations for more than 3 months, with an extension between 0.5 cmq and 500 cmq and WI>0.7 were included

Each patient was subjected to hospitalization, surgical debridement, coverage with dermal substitute, non-adherent dressing and bandage. Then medical follow-up in outpatient for 3 weeks.

Results / Discussion: Data were collected about 730 application of fibroblasts and 500 of keratinocytes.

Improvement in reduction of size and wound bed score was observed in 67%.

No cases of rejection, fever or local reactions were observed.

Conclusion: The study in question supports the efficacy, safety and manageability of allogeneic dermal substitutes in treatment of CLLU and reopens new interesting future perspectives. Further investigations remain in progress.

 

EP0581 The “magic touch” in hand wound care, a prospective observational study: interactive versus traditional dressings and the plastic surgeon’s point of view

Giuseppe Guarro¹, Romano Maffia¹, Nicolò Luraschi¹, Marino Cordellini^1
1Usl Umbria 1, Perugia, Italy

Aim: This study aims to explore the efficacy of an oxygenated oleic matrix-based device in promoting rapid recovery of hand-specific lesions. By comparing its performance with traditional wound dressings, the study provides focused insights into the potential for innovative dressing technology to transform hand injury management.

Method: In this observational, prospective study, 70 patients with isolated hand lesions were divided into two groups of 35: one group received standard traditional dressings, while the other was treated with the oleic matrix device. Over a 6-month period, healing progress, tissue quality, and patient-reported comfort were documented at 1, 3, and 6-month intervals, with the validated PROM SCAR-Q capturing key metrics for patient-centered evaluation.

Results / Discussion: The oleic matrix device group demonstrated a marked 35% reduction in healing time, with 87% of patients showing advanced tissue quality and more pliable scar formation. Moreover, in the oleic matrix group, patients reported higher satisfaction scores, particularly in terms of comfort and appearance. By contrast, the traditional dressing cohort exhibited a prolonged healing trajectory and firmer scar textures, underscoring the clinical advantages of the oleic matrix in enhancing hand lesion recovery.

Conclusion: This study reinforces the potential of the oxygenated oleic matrix-based device as a “magic touch” in hand wound care, promoting faster recovery, improved scar outcomes, and heightened patient comfort. These findings suggest a promising role for this technology in advancing standards of care for hand injuries, warranting further exploration and integration into clinical practice.

 

EP0582 The use of a novel polylactic acid copolymer dermal substitute: experience in an Italian Wound Care Center

Stefania Chiarenza¹, Francesca  Turrini¹, Cecilia Muscarà^1
1Gruppo San Donato, Istituti Clinici Zucchi, Istituto Clinico Villa Aprica, Monza, Italy

Aim: This preliminary study investigates the efficacy of a polylactide/trimethylene carbonate/caprolactone- copolymer in a porous foam structure as a novel dermal substitute (DS) for the treatment of chronic ulcers (CU)

Method: 115 patients aged between 57 and 87 years with lower limb CU of variable extension (4 to 400 cm²) and diverse etiology - traumatic (10%), vascular (58%), pressure (3%), and autoimmune (15%)- were observed.

In all patients, the wound bed was necrotic or with biofilm.

Surgical debridement was conducted in the operating room and the DS was applied in 123 cases (multiple treatments in 7 patients). Dressing comprising fatty gauze or microperforated silicone and bandaging was applied.

Medical check-ups and dressing changes occurred twice a week for 6-8 weeks following implantation.

Results / Discussion: In 60.9% of cases, we observed a stable permanence of the DS for 2-4 weeks.

In 39.1% the DS was early removed (about 1 week) due to early degradation or appearance of perilesional maceration.

4 patients had completely healed upon removal of the DS after three weeks.

In all cases, improvement of the lesion base was observed. Re-epithelialization at the edges, granulation tissue and dimensional reduction has been detected in approximately 80% of cases.

Conclusion: The polylactic acid copolymer DS has been demonstrated to be highly efficacious (in combination with surgical debridement) in promoting the healing of CU exhibiting favorable characteristics: good formability, convenient handling and excellent long-term results with sustained benefits, even in the days following the removal

A significant reduction in pain was also observed.

 

EP0583 Porcine atelocollagen dermal substitute in the treatment of chronic leg ulcers: experience in a vulnology center

Stefania Chiarenza^1
1Gruppo San Donato, Istituti Clinici Zucchi, Istituto Clinico Villa Aprica, Monza, Italy

Aim: Although they have been known since ancient times, chronic leg ulcers today represent a real challenge for medicine, affecting approximately 2 million subjects in Italy alone

In recent years, dermal substitutes have been developed with the aim of temporarily replacing the normal extracellular matrix. In particular, collagen-based dermal substitutes provide a regeneration support very similar to the native dermis and can be used in various surgical procedures and specialties.

We conducted a retrospective observational study on 1131 patients (2016-2024 ; average age 47.8 yo) with lower limbs chronic ulcers of different etiology (venous, arterial, vasculitic, traumatic) and variable diameter (from 2 to over 25 centimeters) in order to investigate the efficacy, manageability, safety of use and regenerative capacity of the product.

Method: Surgical debridement was performed in operating room and the dermal substitute was applied, dressing comprising with fatty gauze and leg bandaging.

Medical check-up and dressing change occurred twice a week in outpatient clinic  for 6-8 weeks following implantation.  Removal of the layer was performed in a variable time between the sixth and 21st postoperative day

Results / Discussion: The atelocollagen dermal substitute in question has proven capable of integrating into the host’s dermal tissue with good cellular “homing” capacity and stimulation of neoangiogenesis with activity similar to other dermal substitutes already in consolidated use.

Conclusion: All this implies the formation of a solid granulation tissue with the achievement of the adequate “dermal quota” capable of accommodating a possible thin autologous graft or even starting the final process of re-epithelialization.

 

EP0584 Unique combination of injectable hyaluronic acid and 6 amino acids in 15 pediatric hard-to-heal wounds: an interventional cohort study

Guido Ciprandi¹, Giancarlo Antonielli², Mauro Pace³, Valentina Vanzi³, Marianna  Retattino³, Serena Crucianelli^4
1Consultant Bambino Gesu’ Children’s Hospital, University of Rome, “La Sapienza”, Rome, Italy, ²Bambino Gesu’ Children’s Hospital, Rome, Italt, Rome, Italy, ³Bambino Gesu’ Children’s Hospital, Rome, Italy, Rome, Italy, ⁴University “La Sapienza” of Rome, Rome, Italy

Aim: Hyaluronic Acid enhances fibroblast migration and shows beneficial effects on complex wound healing, resulting in a decrease in inflammation, increasing regeneration, tissue remodeling and neoangiogenesis. Assessing if a unique combination of HA+6 amino acids (6AA) could be effective on care hard to heal pediatric wounds.

Method: Fifteen wounded children aged from 6 to 15 years presenting with pressure ulcers (n.8), traumatic wounds (n.4) and autoimmune related wounds (n.3) were enrolled in this study. All patients presented a delayed wound healing (>12 weeks) and signs of previous infection. An injectable formulation of HA+6AA was used to pierce the gaps of the chronic wound bed.

Results / Discussion: All children recovered, no relapse was observed at 6 months follow-up. The unique combination of HA+6AA acts as a well tolerated, extracellular dynamic matrix: 1.No adverse reaction and/or allergies; 2.No surgical removal; 3.Bridging for other treatment.

Conclusion: In this preliminary experience, HA+6AA injectable formulation led pediatric complex wounds to complete healing in 4 to 6 weeks, with no adverse events and no relapses at 6 months of follow-up.

Figure: Chron disease and skin manifestations on right lower leg. After a deep biopsy a surgical dehiscence occurred. A) Ten weeks later we started treating the recalcitrant wound with HA+6AA by injecting into gaps B) The improvement after two weeks and 4 injections is visible. C) The wound at 4 weeks. D) 6 months follow up with a stable healing.

References:

Romanelli M. Unique combination of hyaluronic acid and amino acids in the management of patients with a range of moderate-to-severe chronic wound. Int Wound J. 2024 Feb;21 Suppl 1:4-8.

 

EP0585 Early skin expansion in closure of soft tissue defects of the cranium

Vasyl Savchyn¹, Nataliia Tuziuk², Yarema Vares¹, Yuliia Medvid¹, Andrii Vilenskyi^1
1Medical Center of the charitable organization “Charitable Fund “Superhumans”, Lviv, Ukraine, ²Lviv Regional Hospital for War Veterans and Repressed named after Yurii Lypa, Lviv, Ukraine

Aim: This study evaluated early tissue expander placement (dermotension) for reconstructing complex scalp wounds that could not be closed primarily. Immediate expansion during initial wound treatment aims to accelerate recovery, especially when standard reconstructive options are limited.

Method: A retrospective review was conducted on 17 patients treated at two medical institutions. The patients, with injuries from combat (35.3%), electrical burns (23.5%), tumor resection (11.8%), and thermal injuries (17.6%), received expanders placed subaponeurotically, with remote filling ports and active drainage for 3-4 days. Patients received a 5- to 7-day antibiotic course, and expansion began two weeks post-surgery with weekly injections of 10% expander volume.

Results / Discussion: Of the 23 expanders, complications were minimal, with only 2 cases (11.8%)—1 implant exposure and 1 infection, both in the final expansion stages. Early expander placement facilitated faster wound reconstruction compared to delayed grafting methods. Expansion progress was monitored for skin tension, capillary refill, and localized pain, ensuring optimal tissue preparation for eventual closure.

Conclusion: Early expander placement significantly accelerates scalp wound reconstruction, minimizing healing time and enhancing outcomes, particularly when primary closure or free flaps are not feasible. This approach proves to be effective for managing complex trauma, enabling timely wound readiness for closure in challenging cases.

 

EP0586 A still effective option for heel defects: Sural flap

Ömer Büyükkaya¹, Kurtulus Oz¹, Perçin Karakol^1
1University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Aim: The reverse flow sural flap is widely used in heel defects due to developed modifications. It stands out as a neurovascular island flap that can be applied quickly in one or two sessions, allowing adequate rotation to reach heel defects. This study aims to share our experiences with the reverse flow sural flap applied in our clinic.

Method: The study included 10 cases that presented to the our clinic with complaints of wounds in the heel region and underwent reverse flow sural flap surgery between February 2023 and August 2024. The defects were composed of 50% trauma, 30% diabetic ulcers and 20% secondary defects due to infections. The average defect diameter was found to be 6x4 cm, while the average flap diameter was 8x5 cm. A two-stage delay was applied to 9 patients, and direct adaptation was achieved in 1 patient.

Results / Discussion: Venous congestion developed in 80% of the cases and continued partially. Medical leech therapy and removal of tension sutures were applied to areas of venous insufficiency. In 4 patients, only epidermolysis occurred, while 4 patients had partial necrosis, and 1 patient experienced total flap necrosis. In our study, the age group and rates of partial/full-thickness necrosis with accompanying comorbidities were similar to those in the literature.

Conclusion: Lower extremity reconstruction is one of the challenging areas of reconstructive surgery. The current situation encourages the use of perforator flaps and free flap options. Free flap options today require microsurgical expertise, such as perforator-to-perforator or end-to-side anastomoses. Despite complications associated with the sural flap, it maintains relevance with a low rate of total flap loss and increasing modifications.

 

EP0587 Retroperitoneal abscess treatment with mini invasive surgery approach and vacuum assisted aspiration/irrigation tecnic

Gian Maria Rossi¹, Stefano Auriemma¹, Matteo Baseggio¹, Silvia Laiti¹, Andrea Geron², Elena  Goldin^2
1AULSS 8. Vicenza, Vicenza, Italy, ²AULSS 8 Berica, Vicenza, Italy

Aim: The introduction of vacuum-assisted therapy in the treatment of wounds has demonstrated excellent results in terms of removal of infected material and formation of granulation tissue. The integration between development of new materials and the improved familiarity with minimally invasive surgical techniques has made it possible to expand what were considered the previous standards of negative pressure therapy. We report the clinical case of a treated by extensive purulent collection of retroperitoneum treated with laparoscopic approach and vacuum-assisted closure aspiration/irrigation system.

Method: Male 42 years old, obese (BMI 34). Hospitalization in general surgical department with a septic status in patient with large retroperitoneal abscess. A MRI performed for acute low back pain, previously treated with corticosteroid, revealed massive purulent collection of left retroperitoneum, psoas muscle and left gluteus muscle. After a first attempt of drainage the retroperitoneal and gluteus abscess, through a double radiological drainage associated with empirical antibiotic therapy and exclusion of intestinal fistula by endoscopy, we decide to perform a retroperitoneoscopic approach to cleaning peri-lumbar abscess and a gluteus incision. We adopt vacuum-assisted closure aspiration/irrigation system with specific less bloody dressing to prevent peritoneal and bowel damage.

Results / Discussion: After 2 surgeries and 14 days, clinical condition of the patient improved and the vacuum assisted closure system was removed. It was necessary to place another radiological drain at the gluteal level to completely resolve septic status. The patient was discharged after 30 days of hospitalization without complications.

Conclusion: The possibility of using specific dressings in vacuum assisted closure aspiration/irrigation system has made possible the minimally invasive treatment of a large abscess. Optimizing the patient’s recovery and limiting the days of hospitalization.

 

EP0588 A novel application of fish skin graft for reinforcement of transtibial amputations

Marcus Duda^1
1Cone Health OrthoCare Greensboro, Greensboro, United States

Aim: To evaluate the efficacy of a novel tissue reinforcement using fish skin graft (FSG) to improve the healing of transtibial amputations, decrease the rate of amputation revision, decrease the time to prosthetic fitting, and improve limb durability.

Method: A retrospective review was performed on 156 consecutive patients who underwent primary transtibial amputation (TTA) that utilized FSG tissue reinforcement. The study included all TTA during 2023 and 2024. FSG micro was applied to the residual limb soft tissue and a FSG sheet was applied to the residual tibia and fibula. A circumferential negative pressure wound vacuum dressing was used for the postoperative dressing.

Results / Discussion: The study cohort data showed an incisional dehiscence rate of 12.0% (20/156) 90 days postoperative. The 1996 Centers for Medicare and Medicaid Services reports the 90 day incisional dehiscence rate from 26% to 34.5%.

The study cohort mortality was 7% (11/156) within the first 90 days. Mortality rate within the first 90 days averaged 18% nationally.

Prosthetic fitting occurred approximately 3 months after surgery. This compares favorably to the Veterans Administration prosthetic fitting of 4 months.

Conclusion: Discussion: The use of FSG for reinforcement of TTA demonstrates a decreased revision rate, decreased time to prosthetic fitting, and decreased mortality. The FSG also created a synostosis between the tibia and fibula. The synostosis between the tibia and fibula is encouraging for potential improved long term viability of the residual limb..

 

EP0589 Clinical experience in a teaching hospital with topical desiccating agent as part of multidisciplinary wound care in vascular compromised patients

Giel Koning¹, Ahmed Algharib^1
1Euregio Hospital Nordhorn, Nordhorn, Germany

Aim: Treating advanced peripheral arterial occlusive disease (PAOD) poses a significant challenge, as conventional treatment quite often fails at this stage. However, a range of interventions can be considered to postpone amputation. This study presents a consecutive cohort of advanced stage PAOD (stage IV) patients with pronounced wound healing disorders.

Method: The baseline characteristics were anonymously gathered in line with recommendations of the Medical Ethical Committee of Hannover, using only codes from our electronic hospital system.

The kind of revascularization was assessed for PAOD IV. Topical Desiccating agent (TDA) was used to treat and/or ‘reset’ the wounds. TDA is a dehydrating agent with potent desiccating characteristics upon application to organic substances. This description results in an illustrated follow-up of the wound beds of all patients by whom we used TDA and is presented in line with the consensus-based surgical case reporting guideline recommendations.

Results / Discussion: Since TDA was introduced in our teaching hospital in 2023, twelve patients were treated for one or more chronic wounds, with or without endovascular - or hybrid - vascular surgery. Male gender in 80% of the cases. All patients suffered from diabetes mellitus. Wound surface and pain reduction occurred in 90%.

Conclusion: After the introduction of TDA and the minimally invasive concept as an adjustment to our multidisciplinary approach for treating patients we have observed a declining trend in both minor and major amputation rates. The implementation of minimal invasive surgery and the use of TDA may significantly contribute to an improved health status for patients.

 

EP0591 Is it possible to surgically treat patients with varicose veins and ulcers on the lower limbs?

Carlo Rivellini^1
1Geneal Surgery Unit of Mondovì Hospital, Cuneo, Italy

Aim: We retrospectively analyzed patients with primary varicous veins and lipodermatosclerosis and active ulceration (CEAP stage C5 and C6) treated with 1470 nm endovenous laser with dual ring technology fiber (ELVeS).  The aim was to evaluate the safety of the method in a high-risk patient population and the efficacy in terms of ulcer healing.

Method: Over a period of 4 years, 157 patients at high surgical risk with varicose veins and lipodermatosclerosis and ulceration were treated consecutively (118 were hypertensive, 48 diabetic, 92 were obese with mean BMI>35, 28 were heart patients). The surgical procedure was performed with tumescent local anesthesia in the operating room but with an outpatient pathway. All patients were treated with a diode laser with a wavelength of 1470 nm using a dual ring fiber according to the standardized ELVeS protocol. In all patients, a synchronous treatment of the varicose tributaries was performed with traditional, sclerotherapy and combined surgical techniques. In 27 patients, a simultaneous treatment of both limbs was performed, while in 47 patients, a simultaneous treatment of multiple saphenous trunks in the same limb was performed.

Results: The success rate of the ELVeS procedure was 100%; the ulcer healing rate was 100% over a period of 1 to 5 months with a recurrence rate of 5.7% over 12 months of follow-up.

Conclusion: The ELVeS protocol has been shown to be safe and effective in the treatment of venous reflux even in patients at high surgical risk and with lipohermatosclerosis and ulceration with a reduction in healing time and recurrence rate of the lesions with a significant improvement pf the quality of life.

 

 

TRANSLATIONAL SCIENCE

EP0501 Daily cleaning with antiseptics does not delay the healing of burns in Wistar rats

Helio Galdino Junior¹, Suelen Malaquias, Ana Caroliny Da Silva¹, Ruy Lino Júnior²

¹Nursing School of Federal University of Goiás, Goiânia, Brazil, ²Institute of Tropical Medicine and Public Health of Federal University of Goiás, GOIÂNIA, Brazil

Aim: To evaluate the effect of daily cleaning with antiseptics on the healing of partial-thickness burn wounds.

Method: Experimental study with 60 Wistar rats. After anesthesia, a partial-thickness burn measuring 2x2 cm was performed. The animals were randomized into 4 groups: Control: cleaning with 0.9% saline solution; Group treated with polyhexamethylene biguanide (PHMB); Group treated with chlorhexidine degerming agent; and Group treated with aqueous povidone-iodine (PVP-I). Dressings were applied daily according to the experimental group and the animals were euthanized at 7, 14 and 21 days after burn induction. The wounds were photographed using a 12-megapixel camera. The images were analyzed in Image J. The percentage of wound closure was calculated by the difference between the area on the day evaluated and the initial area, divided by the initial area and multiplied by 100.

Results / Discussion: At 7 days, the average wound closure rate in the control group was 6.2%, and in the group treated with PHMB, 13.8%, but without significant differences. There were also no significant differences in the wound closure rate at 7 days between the control and other groups. At 14 days, the wound closure rate in the control group was 88.5%, and no significant differences were observed between the control and antiseptics. At 21 days, no significant differences were observed between the groups, and the average closure rate was 100%.

Conclusion: Daily cleaning with antiseptics did not delay the healing of burn wounds in the model studied.

 

EP0502 Hyaluronic acid based adipose derived extracellular matrix scaffold in wound healing

Jun Young Joon^1
1The Catholic University of Korea Seoul St Mary Hospital, Seoul, Rep. of South Korea

Aim: Adipose tissue is considered the most accessible and optimal source of extracellular matrix (ECM) products in clinical settings. We evaluated the effectiveness of human adipose tissue-derived ECM (adECM) sheets as a wound dressing material. To enhance healing potential and cost-effectiveness, we modified adECM sheets by adjusting ECM concentration and incorporating crosslinked hyaluronic acid (HA) Adipose tissue was obtained from healthy donors, processed, and casted into ECM sheets.

Method: Crosslinked HA was added to create ECM-HA sheets (Scaffiller, Medikan, Korea). In vitro analysis involved seeding adipose-derived stem cells (ASCs) onto porous ECM-HA sheets and evaluating cell survival rate and cytokine array after 3 days. In vivo efficacy, applying ECM-HA sheets to full-thickness wounds in a rat model, with HA-based dressing and adECM sheets as control groups. Re-epithelialization and collagen deposition were examined through histopathological examinations, while immunohistochemistry was used to wound healing.

Results / Discussion: The extracted ECM components accounted for approximately 5% of the original tissue volume, with ECM-HA sheet production efficiency being six times higher than adECM sheet. In vitro analysis revealed favorable ASC survival rates and increased angiogenetic and bioactive cytokine levels in ECM-HA sheet. Macroscopic evaluation showed enhanced healing rates, while histological analysis demonstrated improved epithelialization, thicker dermis, increased collagen deposition, and enhanced vascularity in the ECM-HA group.

Conclusion: Our study successfully fabricated ECM-HA sheets incorporating adECM and HA, hold promise as scaffolds for adipose-derived stem cells, showcasing significant therapeutic potential for wound healing applications.

 

EP0503 Exploring the impact of Octenidine in managing candida auris colonization on ex-vivo wounded human skin

Diana Cerbu¹, Saskia Seiser¹, Trinh Phan-Canh², Doris Moser³, Christian Freystätter⁴, Johannes Matiasek⁵, Karl Kuchler², Adelheid Elbe-Buerger^1
1Medical University of Vienna, Department of Dermatology, Vienna, Austria, ²Medical University of Vienna, Max Perutz Labs Vienna, Campus Vienna Biocenter, Vienna, Austria, ³Medical University of Vienna, Department of Cranio-Maxillofacial and Oral Surgery, Vienna, Austria, ⁴Medical University of Vienna, Department of Plastic and Reconstructive Surgery, Vienna, Austria, ⁵Plastic, Reconstructive and Aesthetic Surgery, Medizin am Kärtner Ring, Vienna, Austria

Aim: Candida auris (C. auris) has emerged as a global health threat, displaying an alarming resistance to multiple antifungal therapies and causing severe invasive infections as well as nosocomial outbreaks. Due to its high affinity to patient’s skin, the implementation of effective infection prevention and control measures is strongly recommended within healthcare facilities to limit its systemic spread and rapid transmissibility. In that regard, the present study aimed to evaluate the efficacy of commercial octenidine-based antiseptics in reducing C. auris colonization on ex-vivo wounded human skin.

Method: An established ex-vivo human skin wound model was used to mirror conditions favorable for C. auris colonization in clinical settings. Skin samples from healthy donors (age range: 29-62 years) were left untreated (intact skin) or micro-needled (wounded skin) and topically infected with 1x10⁵ C. auris cells. Six hours post-infection, two ready-to-use octenidine-based products were applied onto skin biopsies and after additionally 18 hours of incubation, fungal presence was assessed through Periodic-Schiff staining, bright field and scanning electron microscopy. Candida colony forming units (CFUs) were quantified following skin digestion and plating on YPD plates.

Results / Discussion: Microscopic analysis as well as CFU quantification revealed that both octenidine-based formulations significantly reduced C. auris on intact as well as within wounded human skin.

Conclusion: These findings indicate that commercial products based on octenidine effectively reduce C. auris on intact and wounded human skin, highlighting their importance in infection prevention and control measures, thereby not only supporting antifungal stewardship but above all, improving patient safety.

 

EP0504 Adipose-derived mesenchymal stem cells are ideal for cell-based treatment of refractory wounds

Hong-Wei Liu^1
1Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Guangzhou, China

Aim: Although Mesenchymal Stem Cells (MSCs)-based therapy has been proposed as a promising strategy for the treatment of chronic lower-extremity ulcers, their optimal sources, amounts, and delivery methods need to be determined. Here we compared the heterogeneity of the human MSCs derived from bone marrow (BMSCs), umbilical cord (UCMSCs), and adipose tissue (ADSCs) in accelerating wound healing and promoting angiogenesis and explored the underlying mechanism.

Method: We developed a diabetic rat model with full-thickness cutaneous wounds on the dorsal foot and topically administered the three kinds of MSCs on the wound. Additionally, we carried out in vitro and in vivo analysis of the angiogenic properties of the MSCs. Moreover, the molecular mechanism of the heterogeneity of the MSCs derived from the three tissues was explored by transcriptome sequencing.

Results / Discussion: When compared with the BMSCs- and UCMSCs-treated groups, the ADSCs-treated group exhibited markedly accelerated healing efficiency, characterized by increased wound closure rates, enhanced angiogenesis, and collagen deposition at the wound site. The three types of MSCs formed three-dimensional capillary-like structures and promoted angiogenesis in vitro and in vivo, with ADSCs exhibiting the highest capacity for tube formation and pro-angiogenesis. Furthermore, transcriptome sequencing revealed that ADSCs had higher expression levels of angiogenesis-related genes.

Conclusion: Our findings indicate that MSCs-based therapy accelerates the healing of ischemia- and diabetes-induced lower-extremity ulcers and that adipose tissue-derived MSCs might be the most suitable for therapeutic angiogenesis and treatment of chronic ischemic wounds.

 

EP0813 Three dimensional adipose-derived stem cell spheroids enhance adipogenesis and angiogenesis in fat graft

Sang-Oh Lee¹, Il-Kug Kim¹, Jun Ho Lee^1
1Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Rep. of South Korea

Aim: Cell-assisted lipotransfer (CAL) is an innovative approach in regenerative medicine aimed at enhancing fat graft retention by using adipose-derived stem cells (ASCs). Despite the advantages of CAL, there is limited understanding of how ASCs, particularly when cultured in three-dimensional spheroids, impact fat graft retention and tissue integration in CAL. This study investigates the comparative effects of three-dimensional (3D)-cultured ASC spheroids (3D-ASCs) and two-dimensional (2D)-cultured ASCs (2D-ASCs) on fat graft retention in CAL focusing on the underlying cellular and molecular mechanisms.

Method: ASCs were isolated from liposuction specimens and cultured to form spheroids or single-cell setups, and their adipogenic and angiogenic potentials and resistance to oxidative stress and inflammation were examined. In murine models, ASCs were combined with fat and observed for 8 weeks to evaluate graft retention and integration. Micro-computed tomography, immunofluorescence, and transcriptomic analysis were used to assess outcomes and explore the molecular pathways influenced by ASC spheroid formation.

Results / Discussion: The 3D-ASC group showed significant increases in growth factors, anti-inflammatory cytokines, and hypoxic resistance, whereas reduced levels of inflammatory cytokines and reactive oxygen species. Immunofluorescence highlighted a greater density of viable adipocytes and vascular structures, with more ASCs following CAL and enhanced differentiation of ASCs into endothelial cells and adipocytes. Transcriptomic analysis indicated a high activation of adipogenesis and angiogenesis pathways, which are considered to involve mitochondria and peroxisomes within cells, along with a suppressed activation of inflammation, hypoxia, and fibrosis pathways.

Conclusion: 3D-ASCs were more effective than 2D-ASCs in enhancing fat graft retention by improving adipogenesis, angiogenesis, and anti-inflammatory reactions. 3D-ASC spheroids are a promising clinical option for CAL applications.

 

EP0505 Pilot investigations into the impact of microcurrent electrical stimulation therapy (EST) and negative pressure wound therapy - alone and in combination, in a porcine full-thickness excision wound model

Robin Martin¹, Emma Woodmansey^2
1Independent consultant, York, United Kingdom, ²Principal consultant Clinical & Scientific Solutions, Honorary Senior Lecturer Cardiff University, York, United Kingdom

Aim: Microcurrent electrical stimulation therapy (EST) both relieves pain and expedites healing across a range of wounds,1 and may be used in combination with other devices to optimise wound healing.  This in vivo study compared a 12-day EST deviceǂ with single-use negative pressure wound therapy (NPWT$) on wound healing and possible synergistic effects when both therapies were combined.

Method: Two full-thickness excisional wounds were created on dorsal flanks of 6 pigs (4 wounds/animal). 2 animals received EST^ǂ alone, NPWT^$ alone, or EST+NPWT together. Wound area reduction and component contraction/re-epithelialisation using image analysis were recorded (d3,6,9&12). Animals were euthanised on day 12 and tissues taken for histology (granulation tissue deposition, re-epithelialisation, collagen deposition, cellular proliferation, angiogenesis and a-smooth muscle actin expression).

Results / Discussion: Wound closure proceeded similarly in each group, with a mean of ³86.5% wound area reduction by day 12: (EST 89.1%; NPWT 85.25%; EST+NPWT 85.17%).  EST favoured closure through tissue contraction, whereas NPWT favoured closure by re-epithelialisation with the combined devices balancing both apsects (80:20, 65:35 and 74.26 contraction:re-epithlialisation repsectively). Increased % tissue expressing a-smooth muscle actin with EST or in combinaton with NPWT (EST 14.5%, NPWT 11.5%, EST/NPWT 17.97%), further supports EST closure through enhanced contraction and concurs with previous studies.³

Conclusion: This preclinical data suggests combined treatment with EST and NPWT, may optimise contraction and re-epithelialisation and be an effective clinical protocol by which to promote the healing of chronic wounds. Further studies are recommended to explore combination EST/NPWT therapy in patients with hard-to-heal wounds.

Significant difference in *contraction and ^¥re-epithelialisation

^ǂ Accel Heal Solo, Accel-Heal Technologies Ltd, Kent UK

^$ PICO, Smith+Nephew Ltd, Hull, UK

 

EP0506 The multimodal action of a five-layer hydrocellular polyurethane foam dressings and its relation to clinical wear-times

Lloyd Atkinson¹, Ben Costa¹, Devon Allen¹, Daniel Fitzgerald¹, Runi Brownhill^1
1Smith+Nephew, Hull, United Kingdom

Aim: This study aims to understand the multimodal action of a unique five-layer hydrocellular polyurethane foam dressing (HPFD)¹ and how it links to improvements in clinical outcomes for various wounds.

Method: Several benchtop tests including bacterial retention and ingress prevention, odour removal and protease sequestration were conducted to understand the efficacy of HPFDs in managing these common barriers to wound healing. Comparators included cotton gauze and treated/untreated controls. A systematic literature review was also performed using PubMed, Embase and the Cochrane Library to identify published articles to determine the effectiveness of HPFD in improving clinical wear-times. The primary outcome was mean weekly dressing changes (MD).

Results / Discussion: Benchtop testing demonstrated HPFDs significantly reduced the number of bacteria and matrix metalloprotease-9 at the wound surface compared to gauze dressings (p<0.05) and locked these molecules away, even under compression. Odour molecules were similarly reduced compared to control. Clinically, HPFD resulted in a significant 38% (MD: 1.21; 95% CI: -1.96, -0.46) and 29% (MD: -0.85; 95% CI: -1.62, -0.09) relative reduction in weekly dressing changes when compared to all previous dressings and previous foam dressings, respectively.

Conclusion: HPFDs have unique multimodal properties such as bacterial and inflammatory molecule sequestration, in addition to odour control. These properties enable the dressing to offer prolonged wear-times compared to standard and other foam dressings. The improved wear-time associated with the use of HPFDs helps support the conditions for optimal wound healing in addition to reducing overall cost of clinically unnecessary dressing changes.
¹ALLEVYN^TM LIFE Foam Dressing

 

EP0507 Identifying strategies for healthcare professionals to implement evidence-based diabetic foot care in a primary care setting: a scoping review

Enda Naughten¹, Martina Giltenane², Timothy O’Brien¹, Mary Costello³, Nicola Gill-Meeley¹, John Ivory, Georgina Gethin
¹University of Galway, Galway, Ireland, ²University of Limerick, Limerick, Ireland, ³Health Service Executive, Dublin/Mid-Lenister, Ireland

Aim: To identify strategies for healthcare professionals to implement evidence-based Diabetic foot care in a primary care setting.

Method: A Scoping review was carried out using a published peer reviewed protocol developed using the Joanne Briggs guidelines.  The scoping review was conducted following the PRISMA-ScR guidelines.

Results / Discussion: Eleven studies identified met the protocol inclusion criteria. The studies were carried out between 1993 and 2019.  The studies could be broadly categorised as looking at strategies that were focused on knowledge acquisition for staff, providing human resources and administrative supports or a combination of all. The interventions ranged from three to twelve months in duration. The majority of the studies had a knowledge acquisition component with only one focusing on the provision of human resources and three focusing only on systems supports.  One study contained a cost assessment component to the study. One study looked at the barriers and facilitators to the implementation of their strategy. The studies did show an improvement in Diabetic foot care, with only one study showing no difference between their implementation and control group. However most of the studies only assessed the effects of their implementation in a twelve month period and there is no evidence of follow-up in the longer term.

Conclusion: The review highlighted effective strategies for implementing Diabetic foot care in primary care. There was limited evidence on the resource implications or barriers and facilitators of the strategies. There is no evidence that the strategies are effective over a longer term.

 

EP0508 Ex vivo human skin models for the pre-clinical assessment of wound healing and antimicrobial efficacy of topical treatments

Fiorenza Rancan¹, Xiao Guo¹, Marco Contardi², Annika Vogt¹, Ulrike Blume-Peytavi^1
1Charité - Universitätsmedizin Berlin, Berlin, Germany, ²Istituto Italiano di Tecnologia, Genova, Italy

Aim: Various tests have been developed to test the efficacy and potential toxicity of topically applied drugs. In vitro cell assays are used to screen drug efficacy on selected cell types, while reconstructed human skin is used as alternative to animal tests for acute skin toxicity. Ex vivo skin models allow the direct topical application of medical devices, contain immunologically active skin cells and appendages like hair follicles. Thus, we aimed at establishing chronic wound models using ex vivo human skin.

Method: Skin is cultured in trans-well set-up at the air-liquid interface. Standardized wounds are created by abrasion, heating or punching. Wounds can be inoculated with bacteria to reproduce specific features of infection or be cultured for up to 12 days to follow the wound healing process. Such models have been used to test new therapeutic approaches such as antimicrobial wound dressings and exosomes derived from adult stem cells.

Results / Discussion: Ex vivo human wound models have been developed in which bacteria such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus can grow as a biofilm. These models have been used to test the efficacy of antimicrobial-loaded dressings as well as local toxicity. To assess the wound healing properties of exosomes and conditioned medium from adipose tissue derived stem cells, ex vivo skin was cultured for 12 days and re-epithelialization, revascularization and inflammatory processes were monitored over time.

Conclusion: Ex vivo wound models are valuable alternatives to animal testing for the preclinical evaluation of topical wound treatments.

 

EP0097 The Wound healing effect of repetitive magnetic stimulation in mouse model

Jiye Kim¹, Ji Yong Lee^2
1Yonsei University Wonju College of Medicine, Wonju, Korea, Rep. of South, ²Institude of Hyperbaric Medicine, Yonsei University Wonju College of Medicine, Wonju, Rep. of South Korea

Aim: This study aims to objectively analyze the effects of wound healing in the case of repeated magnetic stimulation (RMS) treatment by setting the wound model of mice through laser speckle contrast imaging which can visually evaluate microcirculation around the tissue, as well as visually and histologically

Method: A wound model was set up for 15 8-week-old hairless mice (wild genomic type) to conduct animal studies. The test subjects were divided into three categories: control (n=5), Sham group (n=5), and RMS (repetitive magnetic stimulation) group (n=5). For 4 mm punch wound, RMS was performed 20 min/day (230mT intensity, circular coil, 10 Hz,). RMS treatment was performed on the 1st, 3rd, 5th and 7th days from the experiment day and wound was analysed with gross photo for size evaluation, laser speckle image for peripheral circulation evaluation. Histological analysis was performed on the 3rd and 7th days.

Results / Discussion: As a result of gross photo analysis, wound size was significantly reduced on the 5th and 7th days after the experiment in the RMS group compared to the other two groups. In addition, there was no significant difference between the control group and the Sham group. In the histological analysis results, it was observed that the RMS group had a faster epithelialization than the other group, and that the neo- epithelium was formed thicker than the other groups. In the laser speckle image, it was also observed that the peripheral circulation was enhanced on each follow-up day, which was prominent on the 5th and 7th days after the experiment.

Conclusion: This study shows that RMS in the mouse model promotes the wound healing through the enhancement of peripheral circulation.

 

EP0509 The chemical and antimicrobial activity within a new nitric oxide-generating wound dressing

Tilly Coleborn¹, Emma Griffiths¹, Lucy Forbes¹, Nicholas Boote², Daniel Metcalf^1
1Convatec, Deeside, United Kingdom, ²Convatec, Oxford, United Kingdom
Aim: To demonstrate the novel chemical properties (defined water activity and pH), and antimicrobial activity from the supplemental generation of nitric oxide (NO), within a novel nitric oxide-generating wound dressing*.

Method: Water activity (relative humidity) of the entire dressing, and for each of the two dressing layers, was measured using a water activity meter. The pH of the dressing was measured using a pH surface probe by challenging dressings with a pH 7.4 buffered solution at 0.4 mL/hour over 48 hours. The antimicrobial activity of the dressing over 48 hours was measured using a direct inoculation method with 6 bacteria, a yeast, and a mould.

Results / Discussion: The NO-generating dressing* has a water activity of 0.71 ± 0.014, with 90% of the water activity attributable to the absorbent layer. The dressing buffered the alkaline challenge solution immediately and then consistently to pH 5-6 over 48 hours. All challenge microorganisms were rapidly killed by >4 log10 within the dressing.

Conclusion: The water activity of the NO-generating dressing* provides high fluid absorption and is inhospitable to absorbed challenge microorganisms. The dressing immediately buffered the alkaline solution back to acidic pH, creating a state inhibitory towards microorganisms and conducive to healing. This acidic pH also activates the production of NO within the dressing. NO provides additional antimicrobial activity over a minimum of 48 hours, as shown by eradication of 8 challenge microorganisms. The chemical and antimicrobial activity of the NO-generating dressing* provides a potent antimicrobial environment to support wound healing.    

* EDX 110/ConvaNiox (Convatec Ltd, UK)

 

EP0510 Changes in the proteome of dermal fibroblasts exposed to exudates from chronic wounds indicate a specific role of STAT-4 in mediating the fibroblast inflammatory response

Gabriela Cabral¹, Nicole Schöfmann¹, Barbara Wolff-Winiski^1
1Akribes Biomedical GmbH, Vienna, Austria

Aim: Wound exudates (WEs) can transfer the clinical phenotype of non-healing (NH) wounds onto primary human dermal fibroblasts in cell culture with increased transcription of genes involved in inflammation. To understand the impact of NH-WEs at the proteomic level, we performed mass-spectrometry analysis on fibroblasts exposed to two different NH-WEs.

Method: Human fibroblasts were incubated with WEs for 24 hours. Subsequently, cells were exposed to a temperature gradient from 37 to 59 oC before lysis, protein extraction, and mass-spectrometry analysis. Samples exposed to 37oC were analyzed for changes in protein abundance; while samples exposed to 42-59 oC were subjected Proteome Integral Solubility Alteration (PISA) to assess changes in thermal stability of proteins.

Results / Discussion: Mass-spectrometry analysis of the global proteome revealed an enrichment of inflammatory proteins in fibroblasts exposed to NH-WEs compared to controls. The abundance of JAK-1 and -3 proteins increased, while the abundance of STAT proteins was unchanged (STAT-4) or reduced (STAT-2, -3). However, thermal stability of STAT4 was significantly higher in cells exposed to NH-WEs.

Conclusion: Exposure to NH-WEs led to proteomic changes in fibroblasts marked by increased abundance of inflammatory proteins, which is in line with the up-regulation of inflammatory genes described in chronic wound fibroblasts and keratinocytes. Exposure to NH-WE converts normal fibroblasts into chronic wound fibroblasts, thus recapitulating the patient’s condition ex vivo. The specific increase in thermal stability of STAT-4, concomitant with increased abundance of JAK-1 and -3, indicates that the JAK-STAT4 pathway may play a key role in modulating the fibroblast inflammatory response in chronic wounds.

 

EP0511 Safety and usability of a contactless application, resorbable wound dressing in a pre-clinical porcine model

Sarah Bradbury¹, Luke Burke², Fabio Zomer Volpato^2
1Wound Healing Solutions Ltd, Cardiff, United Kingdom, ²Corryn Biotechnologies Ltd, Swansea, United Kingdom

Aim: A novel handheld system has been developed to fabricate resorbable, biomimetic dressing materials directly onto wounds at the point of care, promoting cell infiltration and wound closure. Contactless application and resorbability preclude direct wound contact during dressing, reducing pain during the dressing process and ensuring wound bed conformity. A pre-clinical study was undertaken to determine local tissue effects and performance of the device using a porcine model.

Method: Three dressing material variations were tested against a negative control of non-woven gauze. Test articles and controls were applied to five full-thickness 2.5x2.5cm wounds, across four pigs. Secondary dressings were changed three times weekly and macroscopic observations documented healing progression and local tissue effects to the wound and peri-wound skin. Animals were terminated and samples taken for histopathological analysis at 7 days and 42 days. Device usability feedback during dressing application was recorded.

Results / Discussion: Contactless fabrication and application were achieved across all test articles, with user feedback indicating no major difficulties in application. Local tissue effects after 7 days were moderate/marked and morphologically similar for all test dressings. A slightly higher number of phagocytes with associated suppurative reaction were elicited by the test articles and breakdown products as compared to controls. Macroscopic observations demonstrated material resorption within expected timeframes. All groups displayed evidence of moderately abundant, mature granulation tissue with marked neovascularization and comparable wound healing performance.

Conclusion: Results indicate the safety and usability of a contactless wound dressing system for directly fabricating advanced dressings at point of care.

 

EP0512 Implementation of mesenchymal stromal cell therapy in wound healing

Katarína Szabómihályová¹, Arpád Panyko¹, Martin Dubovský¹, Marián Vidiščák^1
1University Hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia

Aim: The aim is to summarize the currently available information about mesenchymal stromal cells (MSC) regarding their properties, current possibilities of application in clinical practice, and outline MSC therapy in wound healing.

Methods: A literature search was performed on PubMed with a focus on mesenchymal stromal cells (stem) in surgery. The search yielded a total of 10,323 results (dismissing case studies) that were carefully reviewed and 78 were studied and used.

Discussion: MSCs are currently defined as a heterogeneous group of cells or as an in vitro cell culture phenomenon, initially described by Friedenstein in 1970. They have immunomodulatory, proangiogenic and cytoprotective effects. In addition, MSCs secrete extracellular vesicles with biological function. Thej et al. repeatedly demonstrated an improvement in limb necrosis and in limb function after MSC treatment. Markel et al. had shown that intraperitoneal MSC therapy reduced the mortality of ischemia-reperfusion injury in mice by 60%. MSCs have long been tested for their immunomodulatory effects in Crohn’s disease (ADMIRE-CD), complex perianal fistulizing Crohn´s disease and transplant rejection treatment. They are also used in bioprinting to cellularize printed scaffolds. MSC therapy should also provide clinically provable results in wound healing, but there is still a lack of generally recognized guidelines for clinical use and cost effectiveness, as well as the reproducibility and comparability of current studies is a major concern.

Conclusions: Current clinical studies show that MSC administration is effective and safe. However, substantial challenges remain to be overcome before MSCs can be widely used in clinical practice.

 

EP0513 Optimising disaster wound care in indonesia: a multidisciplinary approach to strengthening resilience through modern practices and cultural integration

Widasari Sri Gitarja¹, Kana Fajar², Munasirah Ismail³, Pipit Lestari⁴, Khairul Bahri⁵, Eviyanti  Numalasari^6
1WOCARE Indonesia, Lincoln University, Malaysia, University of Pelita Harapan, Indonesia, West Java, Indonesia, ²Wocare Center Indonesia, Home Care service Wound, Ostomy and Continansia, West Java, Indonesia, ³Wocare Center Indonesia, Solusi Luka Indonesia, West Java, Indonesia, ⁴The University of Glasgow, Wocare Center Indonesia, West Java, Indonesia, ⁵Wocare Center Indonesia, Manager Clinic Wocare Center Bogor, West Java, Indonesia, ⁶Wocare Center Indonesia, West Java, Indonesia

Aim: Disaster-related injuries, particularly those requiring wound care, present formidable challenges in large-scale earthquake scenarios. This study aims to enhance resilience and improve wound care outcomes in disaster settings by developing and applying a seven-step Disaster Wound Management Protocol.

Method: Fieldwork conducted during nine major earthquakes across Indonesia from 2016 to 2021 documented a variety of injuries, including open wounds, fractures, crush injuries, burns, diabetic foot ulcers, and stoma-related wounds. These injuries are often compounded by unsanitary post-disaster conditions, infrastructural damage, and limited healthcare access, further complicating effective wound management. The study analysed 765 wound cases encountered during disaster relief efforts, with traumatic wounds accounting for 66%, open fractures for 19%, and burns for 8%, among other wound types.

Results / Discussion: The findings underscore the need for a coordinated approach involving healthcare providers, local communities, and governmental support. The protocol emphasises essential steps, including rapid wound assessment, cleaning, debridement, dressing, and infection monitoring every 48 hours to optimise patient outcomes and minimise the risks of life-threatening illnesses.

This research underscores the critical roles of preparedness, education, and teamwork in disaster wound care. Lessons learned from managing wounds during high-impact events, such as the earthquakes in Aceh, Lombok, and Palu, highlight the importance of early intervention and structured protocols.

Conclusion: This study offers valuable insights for strengthening wound management in Indonesia by providing a practical framework for disaster wound care. It serves as a potential model for global disaster response frameworks, contributing to improved disaster healthcare resilience worldwide.

 

EP0515 Reducing bacterial burden and improving healing outcomes with herbal-based cleansing soap: findings from an RCT

Widasari Sri Gitarja¹, Kana Fajar², Pipit Lestari³, Eviyanti Numalasari⁴, Munasirah Ismail⁵, Khairul Bahri^6
1WOCARE Indonesia, Lincoln University, Malaysia, University of Pelita Harapan, Indonesia, West Java,, Indonesia, ²Wocare Center Indonesia, Home Care Service Wound, Ostomy and Continansia, West Java, Indonesia, ³The University of Glasgow, Wocare Center Indonesia, West Java, Indonesia, ⁴Wocare Center Indonesia, West Java, Indonesia, ⁵Wocare Center Indonesia, Solusi Luka Indonesia, West Java, Indonesia, ⁶Wocare Center Indonesia, Manager Wocare Clinic  Indonesia, West Java, Indonesia

Aim: Effective wound cleansing is crucial for infection prevention and optimised healing, particularly in chronic, hard-to-heal wounds. Conventional antiseptics, however, often contain synthetic chemicals that may cause irritation and delay healing. This study compares the clinical efficacy and safety of a novel herbal-based cleansing soap designed to minimise irritation and support tissue regeneration with standard antiseptic solutions.

Method: A randomised controlled trial (RCT) was conducted with 100 patients at a tertiary wound care facility, presenting acute and chronic wounds such as diabetic foot ulcers, pressure injuries, and post-surgical wounds. Participants were divided into an experimental group (n=50), receiving the herbal-based cleansing soap, and a control group (n=50) treated with conventional antiseptics. Primary endpoints assessed wound healing rates and infection control, while secondary endpoints evaluated patient-reported outcomes, including skin irritation, comfort, and ease of use. Additionally, microbiological swabs and a cost-effectiveness analysis were carried out.

Results / Discussion: Findings demonstrate that the herbal-based cleansing soap achieves comparable, and in some cases, superior bacterial reduction and wound healing outcomes compared to traditional antiseptics. Patients in the herbal soap group report significantly reduced skin irritation (p<0.05) and higher satisfaction (p<0.01) with the cleansing process. Microbial analysis confirms the potent antimicrobial activity of the herbal extracts, which provide anti-inflammatory and bactericidal benefits. The cost-effectiveness assessment suggests that the herbal-based product offers a sustainable option for long-term wound care.

Conclusion: This study supports herbal-based cleansing soap as a viable, cost-effective alternative to conventional antiseptics. It has significant potential to enhance patient comfort, promote wound healing, and reduce infection risks. These findings highlight the soap’s potential as an innovative solution in clinical wound management, warranting further exploration for broader clinical application.

 

EP0516 Glucocorticoid delivery in wound care: Innovative use of bacterial cellulose dressings and microemulsion technologies

Paul Zahel^{1 2}, Dana Kralisch^{1 3}, Vera Bruggink², Juliana Huelsmann⁴, Robert Hofstetter², Uwe Beekmann¹, Thorsten  Heinzel⁴, Oliver Werz^2
1JeNaCell - An Evonik Company, D-07745, Jena, Germany, ²Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, University of Jena, D-07743, Jena, Germany, ³Evonik Operations GmbH, D-45128, Essen, Germany, ⁴Institute of Biochemistry and Biophysics, University of Jena, Jena, Germany

Aim: Treating inflammatory wounds such as pyoderma gangrenosum requires innovative therapeutic strategies to overcome the adverse effects of systemic anti-inflammatory drugs and the limitations of conventional topical formulations [1,2].

Method: This study explores a novel approach combining hydroactive bacterial cellulose (BC) wound dressings well-known from burns and chronic wound care [3] with microemulsion technology for the topical delivery of glucocorticoids. Five microemulsions were developed, loaded with hydrocortisone (HC) or dexamethasone (DEX), and thoroughly characterized for microstructure, biocompatibility, sterilization-, and shelf-life stability. The drug-loaded formulations were incorporated into bacterial cellulose using an absorption loading technique, as confirmed by freeze-fracture transmission electron microscopy. Drug permeation and anti-inflammatory activity were evaluated in vitro using Strat-M® membranes to assess key aspects of the active wound dressings.

Results / Discussion: The microemulsions displayed stable oil-in-water (o/w), water-in-oil (w/o), or bicontinuous microstructures, while successfully incorporating therapeutic concentrations of HC and DEX. The integration into BC resulted in a uniform distribution within the cellulose network. Strat-M® permeation testing confirmed significant and controllable drug permeation, with glucocorticoids retaining their anti-inflammatory potency in vitro. This innovative approach addresses the challenges of systemic side effects and the limitations of traditional topical treatments.

Conclusion: The combination of BC with microemulsion technology offers a promising solution for developing active wound dressings. This method could significantly improve the management of inflammatory wounds and skin conditions, such as pyoderma gangrenosum by providing a targeted and efficient delivery system for anti-inflammatory drugs.

References:

1. Alavi et al., Am J Clin Dermatol, 2017
2. Moghadam-Kia et al., Int J Dermatol, 2010
3. Zahel et al., Pharmaceuticals, 2022

 

EP0517 Comparative absorbency evaluation of superabsorbent dressings and foam dressings

Sarah Jackson¹, Simone Jurjevic², Christine Bongards², Christoph Schuell^2
1Solventum, Loughborough, United Kingdom, ²Solventum, Kamen, Germany

Aim: This in vitro study evaluated absorbency characteristics of a superabsorbent dressing compared to foam dressings. The goal of this study was to help health care professionals select the most effective dressing for the management of chronic, highly exudating wounds.

Method: Absorbency properties of a Superabsorbent Dressing SAD* and nine commercially available foam dressings were evaluated using recently updated standard test methods for wound dressings.¹ Absorbency was evaluated by testing free swell absorbency (EN13726:2023, Annex B), fluid retention (EN13726:2023, Annex C), and absorbency under compression at 40mmHg and 80mmHg (EN13726:2023, Annex D).

Results / Discussion: SAD showed superior absorbency in free swell and under compression. Compared to the average of nine foam dressings, SAD achieved 266% relative free swell absorbency, 110% relative fluid retention, 226% absorbency under compression at 40mmHg, and 231% absorbency under compression at 80mmHg.

Conclusion: Multiple absorbency test categories demonstrated SAD’s superior performance compared to foam dressings. This suggests that compared to the foam dressings tested in this study, SAD may be more suitable for use in the management of highly exudating wounds. Moreover, the superior absorbency and fluid retention demonstrated by SAD could provide more flexibility for health care professionals in managing frequency of care, and reducing unscheduled dressing changes, which is a great benefit for patients too.

*3M™ Kerramax Care™ Super-Absorbent Dressing (Solventum)

References:

1. EN 13726. Test methods for wound dressings—Aspects of absorption, moisture vapour transmission, waterproofness, and extensibility. European Committee for Standardization; 2023.

 

EP0518 Investigation in biological effect of cold atmospheric plasma on adipose stem cell stemness and potential effect on wound healing

Chih-Hsun Lin¹, Ying-Hao Liao², Ta-Jung  Chiu³, Chih-Hao Yu^4
1Department of Plastic and Reconstructive Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ²Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ³SG Biomedical Co., Ltd, Taipei, Taiwan, ⁴Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

Aim: We try to study the biological changes induced by CAP in rat ASCs (rASCs), offering insights into potential applications for wound healing. We also explored CAP clinical utility in wound healing by focusing on its efficacy in reducing wound size and bacterial load on chronic wounds.

Method: In experiment, CAPs from a dielectric barrier discharge (diameter =34.8mm, and the ground end is a concentric circle with a line width =1.3mm, voltage =1kV, frequency=20kHz) are used to treat rASCs cultured in the medium directly. The cell proliferation, migration, differentiation and surface antigen expression are evaluated. Clinically, we retrospectively collected the data of 26 patients who received CAPs (Adtec SteriPlas) for various types of wounds from December 2023 to July 2024. The wound size reduction and infection control are assessed.

Results / Discussion: After short-duration CAP treatment, rASCs showed increase in proliferation but the migration didn’t increase significantly. CD90 expression is positively correlated with cell viability and ASCs were able to maintain their stemness and could be differentiated to adipocyte after CAP treatment. Clinically, the wounds had an average of 34% in reduction of wound area after 4-month CAP treatment (twice a week). 15% of complete wound healing within an average of 100 days was observed. Pseudomonas aeruginosa was the most common microbe detected (16%) and infection control was significantly enhanced after just 1 to 2 CAP sessions.

Conclusion: CAP has potential positive effect on biological behavior of ASCs. The proliferation increased and stemness maintained after optimal CAP treatment. CAP could assist in wound healing of chronic wounds and decreased bacterial load, especially the wounds that had been stagnant or deteriorating prior to intervention.

 

EP0519 Silk protein-based spray-on dressing for acute burn wound management

Kristo Nuutila¹, Yushu Wang², Anders Carlsson³, Sean Christy¹, David  Larson⁴, Rodney Chan³, David Kaplan^2
1US Army Institute of Surgical Research, San Antonio, United States, ²TUFTS University, Boston, United States, ³The Metis Foundation, San Antonio, United States, ⁴University of Texas Health, San Antonio, TX, San Antonio, United States

Aim: To develop a silk protein-based spray-on dressing for the management of burns. The spray contains antibiotics to prevent infection and coats the injured area with a robust matrix mat to provide

Method: The characteristics of the spray containing silk fibroin, polyethylene glycol (PEG) and gentamicin were optimized in vitro. Subsequently, the spray was used in a porcine deep partial-thickness (DPT) burn model. Standardized DPT burns were created on the dorsum of anesthetized pigs. Analgesia was provided prior to all surgical procedures. Burns on each animal were randomized into four experimental groups: 1) silk - PEG; 2) silk - PEG + gentamicin; 3) silver sulfadiazine cream (SSD); 4) no treatment. The animals were followed for 3, 7, 14 or 21 days. After euthanasia, the burns were excised for histologic analyses. Non-invasive imaging was utilized to assess burns macroscopically.

Results: The spray containing 6% silk, 20% PEG and 1 mg/ml gentamicin was chosen for the animal studies. Antibacterial testing showed the mixture to be effective against E. coli and S. aureus. The porcine study indicated that the silk - PEG + gentamicin treatment decreased inflammation on day 3 (IL1b and IL8), mitigated burn wound progression on days 3 and 7, and promoted both wound healing (re-epithelialization) and quality of healing in terms of contraction and epidermal maturation in comparison to controls.

Conclusion: A portable spray-on dressing was developed using a silk formulation, designed to provide instant and durable protection to wounds of various geometries and sizes.

 

EP0520 Quatsomes containing recombinant human epidermal growth factor: A promising topical delivery system for the treatment of complex wounds

Elisabet González Mira¹, Lidia  Ferrer Tasies², Hector  Santana³, Ingrid Cabrera-Puig¹, Lidia Ballell Hosa⁴, Carla Castellar Álvarez^{2 5}, Alba Córdoba², Josep Merlo Mas², Haydee Gerónimo³, Glay Chinea⁶, Viviana  Falcón³, Jan Skov Pedersen⁷, Jessica  Romero⁸, Claudia  Navarro Requena⁸, Calixto Valdés⁹, Miladys Limonta³, Jorge Berlanga Acosta³, Santiago Sala², Eduardo Martínez³, Nora  Ventosa^10
1Institut de Ciència de Materials de Barcelona (ICMAB)-CSIC, CIBER-BBN, Bellaterra, Spain, ²Nanomol Technologies S.L., Bellaterra, Spain, ³Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba, ⁴Institut de Ciència de Materials de Barcelona (ICMAB)-CSIC, CIBER-BBN, Nanomol Technologies S.L., Bellaterra, Spain, ⁵Institut de Ciència de Materials de Barcelona ICMAB-CSIC, CIBER-BBN, Nanomol Technologies SL, Bellaterra, Spain, ⁶Center for Genetic Engineering and Biotechnology (CIGB), Bellaterra, Cuba, ⁷Aarhus University, Aarhus, Denmark, ⁸LEITAT Technological Center, Barcelona, Spain, ⁹National Institute for Angiology and Vascular Surgery, Havana, Cuba, ¹⁰Institut de Ciència de Materials de Barcelona ICMAB-CSIC, CIBER-BBN, Bellaterra, Spain

Aim: Advances in drug reformulation have revolutionized drug delivery, offering new possibilities for treating complex wounds like diabetic foot ulcers (DFUs). Biologics, such as epidermal growth factors (EGFs), have gained interest for enhancing wound healing. However, evidence shows that exogenous EGF is rapidly cleared from topical application sites due to the protease-rich environment in these wounds, limiting the bioavailability and effectiveness of conventional EGF-based treatments. We present an innovative nanotherapy with recombinant human EGF (rhEGF)-loaded quatsomes, which shows exceptional colloidal stability and dual functionality: i) inherent antimicrobial activity to prevent infection and ii) promotion of re-epithelialization, leading to complete wound healing (Adv.Therap.2021,4,2000260).

Method: rhEGF-Quatsomes, composed of cholesterol and quaternary ammonium surfactant CTAB, were prepared using the robust and eco-friendly DELOS technology. Physicochemical properties were characterized by dynamic and electrophoretic light scattering, cryo-TEM, and small-angle X-ray scattering. Entrapment efficiency and protein loading were assessed by ELISA, while bioactivity, protease resistance, and in vivo efficacy were also evaluated.

Results/Discussion: The re(nano)formulation showed significant improvements in physicochemical and biological properties. rhEGF-Quatsomes achieved over 90% encapsulation efficiency and a threefold increase in bioactivity compared to free protein. The formulation also demonstrated increased protease resistance and effective wound healing, validated in both a diabetic mouse model and in compassionate treatment of chronic DFU patients, leading to exceptional wound closure.

Conclusion: rhEGF-Quatsomes show strong potential as a feasible treatment for complex wounds. These nanoconjugates meet essential production, stability, efficacy, and safety requirements, supporting their future consideration in clinical trials for complex wound treatment.

 

EP0521 Antibacterial and immunomodulatory foam scaffolds for the treatment of burns

Kristo Nuutila¹, Anders Carlsson², Sean Christy¹, David  Larson³, Mohamadmahdi  Samandari⁴, Ali Tamayol⁴, Tannin Schmidt^4
1US Army Institute of Surgical Research, San Antonio, United States, ²The Metis Foundation, San Antonio, United States, ³University of Texas Health, San Antonio, TX, San Antonio, United States, ⁴UCONN, Farmington, United States

Aim: To introduce a simple and effective method for in situ fabrication and delivery of microporous gelatin methacryloyl (GelMA) foam that release minocycline, a broad-spectrum antibiotic, and proteoglycan 4 (PRG4), an immunomodulatory protein for the management of burns.

Method: The foam was created using LAP photoinitiator and foamed with a double-syringe. It was then crosslinked with blue light. In vitro optimization included mechanical testing, stability evaluation, degradation assessment, release kinetics, biocompatibility, antimicrobial activity against MRSA, and anti-inflammatory effects on macrophages. Subsequently, the GelMA foam was tested in a porcine burn model, where 20 standardized burns were made on four anesthetized pigs. Analgesia was administered with buprenorphine. Burns were randomized into five groups: 1) GelMA; 2) GelMA + minocycline; 3) GelMA + PRG4; 4) GelMA + minocycline + PRG4; 5) Silvadene. The animals were monitored for 3, 7, 14, or 21 days. After euthanasia, burns were excised for histologic analysis, and non-invasive imaging assessed them macroscopically.

Results / Discussion: An optimized foam containing 15% GelMA, 0.4 mg/ml minocycline, 1mg/ml PRG4, and 0.67% LAP was identified with ~100 µm pore size, 67% porosity, ~5 kPa compression modulus, biodegradability, a sustained release of PRG4, and a rapid release of minocycline. The foam was biocompatible with fibroblasts and myoblast, and significantly reduced inflammatory marker (TNF-α) secretion from macrophages, and MRSA load by 5X. Porcine studies confirmed that the foam prevented infection, mitigated burn wound progression and improved quality of healing.   

Conclusion: A highly translational robust strategy for the immediate treatment of burn wounds was developed.

 

EP0522 Mentoring teams as a strategy for evidence-based implementation in the prevention of adhesive-related skin injuries in brazilian healthcare institutions

Aline Ramalho¹, Paula Freitas², Natalia Barros³, Elaine Monteiro³, Bianca  Gomiero^3
1Sirio Libanes Hospital, Sao Paulo, Brazil, ²Universidade Federal do Espirito Santo, Espirito Santo, Brazil, ³Essity, Sao Paulo, Brazil

Aim: To report the experience of training professionals to implement a quality improvement project focused on managing Medical Adhesive-Related Skin Injuries (MARSI) in hospitals.

Method: This experience report follows a structured training based on the Joanna Briggs Institute (JBI) methodology. Ten medium- to large-sized hospitals participated in a 40-hour training completed over eight months in four phases: a) topic contextualization and immersion; b) baseline audit; c) implementation planning; and d) follow-up audits.

Results: The mentorship emphasized high performance in MARSI prevention and management. Four synchronous online sessions were conducted with approximately 25 nurses in Phase A. For Phase B, nurses performed baseline audits within their institutions, observing practices according to a JBI evidence-based checklist and identifying local improvement opportunities. Phase C focused on selecting and testing interventions, conducting improvement workshops, and implementing actions and protocols for best practices. In Phase D, data were collected post-implementation. Throughout each phase, project specialists and mentors provided support through scheduled meetings, supplying various materials to assist in organization and awareness.

Conclusions: Mentorship programs for continuous improvement projects can help healthcare managers advance skin management practices in healthcare settings.

 

EP0523 Enhanced wound healing through blood vessel-derived decellularized extracellular matrix (VdECM): A study on elastin-rich scaffold for tissue regeneration

Suk-Ho Moon^1
1Seoul St. Mary’s Hospital, The Catholic Univ of Korea, Seoul, Rep. of South Korea

Aim: This study investigates the wound-healing potential of blood vessel-derived decellularized extracellular matrix (VdECM), an elastin-rich scaffold prepared from porcine blood vessels. Elastin, known for its role in tissue elasticity and scarless healing, is abundant in vascular tissues and may enhance the regenerative properties of dECM.

Method: VdECM was analyzed for elastin content and compared to atelocollagen. Its impact on fibroblast migration was tested through a scratch assay, while fibroblast proliferation and cell viability were assessed in hydrogel form using Live/Dead staining. Growth factor expression in adipocyte-derived mesenchymal stem cell (ASC) media with VdECM was examined via cytokine array. An animal wound model evaluated VdECM hydrogel’s wound-healing efficacy compared to other topical agents.

Results / Discussion: VdECM contained 6.7 times more elastin than atelocollagen by weight. Microscopic examination showed that a 0.35% VdECM hydrogel had consistent distribution and significantly enhanced fibroblast migration compared to 3% atelocollagen. The Live/Dead assay revealed a higher cell survival rate in 1% VdECM, while growth factor expression was notably amplified in ASC media with VdECM. In the animal model, VdECM hydrogel promoted faster epithelialization than the control, oxytetracycline, and epidermal growth factor ointments.

Conclusion: VdECM, with a high elastin-to-collagen ratio, enhances growth factor expression and promotes fibroblast migration, proliferation, survival, and epithelialization, demonstrating wound-healing effects comparable to or superior to other treatments.

 

 

WOUND ASSESSMENT

EP0470 The impact of the circadian rhythm on wound healing

Helen Strapp¹, Bridget Murray¹, Saoirse Tolan^1
1Royal College of Surgeons in Ireland, Dublin, Ireland

Aim: The aim of this study was to identify if wounds that occur in darkness hours heal at a slower rate to wounds that occur during daylight hours. 

Method: A quantitative research methodology was used. The circadian rhythm’s influence on wound healing is a key focus, particularly comparing healing rates during night time and daytime. A cohort of patients from a wound management clinic participated in this study. Over eight months, data was collected through an observational approach, documenting wounds that occurred during both night and day. Wounds were photographed and measured weekly.

Results / Discussion: The findings suggest that wounds sustained during night time hours healed more slowly than those sustained during daylight. This study confirms that the circadian rhythm does have an impact on wound healing rates, demonstrating that wounds sustained during darkness hours healed at a slower rate compared to those sustained during daylight hours.

Conclusion: There are many factors that have an impact on the wound healing. This study looked at the effects of the circadian rhythm on wound healing. The study found that wounds that are sustained in darkness hour wounds did take longer to heal in most cases despite age, comorbidities, and wound aetiology. Understanding the implication of a normal and disturbed circadian rhythm on the human body is essential in the understanding of the impact of the circadian rhythm on wound healing. Educating patients and healthcare professionals on these disruptions and exploring the link between the circadian rhythm and wound healing can lead to innovations in this field.

 

EP0648 Transmetatarsal amputation and risk of plantar flap necrosis: Is there a way to avoid it?

Ismini Kountouri¹, Vasilis Stergios¹, Amyntas Giotas², Ioannis Katsarelas³, Dimitrios Chatzinas³, Christina Sevva¹, Eleni Paschou¹, Panagiota Roulia¹, Marios Dagher¹, Panagiotis Nachopoulos³, Afroditi Faseki³, Konstantinos Papadopoulos¹, Vasileios Alexandros Karakousis¹, Alexandra  Panagiotou³, Athanasios Polychronidis³, Mohammad Husamieh³, Georgia Maria Ntoulia², Stylianos Mantalovas¹, Militiadis Chandolias³, Periklis Dimasis^3
1Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ²Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ³Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece

Aim: To review the international literature regarding the risk factors for postoperative plantar flap necrosis after transmetatarsal amputation (TMA) and to present the available methods for preventing this complication. 

Method: We reviewed the international literature regarding cases of patients who underwent TMA and developed postoperative plantar flap necrosis. For this study, three databases, Cochrane, Pubmed, and Scopus, were methodically searched using specific keywords. Various methods for prevention of postoperative plantar flap necrosis following TMAs were found and their results are presented in this study.

Results / Discussion: TMA is a common surgical procedure for managing severe necrotic foot pathologies, such as peripheral vascular disease and diabetic foot infections. Plantar flap necrosis is a relatively common postoperative complication for these patients. Methods for preventing this severe complication, that can lead to higher amputations and loss of the foot’s function and independence regard preoperative, intraoperative, and postoperative measures. These measures include careful dissection and vessel preservation during the operation, preoperative revascularization, infection resolution, nonviable tissue debridement, use of Indocyanine Green Angiography (ICGA) to help predict TMA viability through real-time visual assessment of distal skin perfusion, negative pressure wound therapy (NPWT) to the open wound and application of a split-thickness skin graft (STSG).

Conclusion: Plantar flap necrosis following TMA can be a severe postoperative complication. Since TMA is a valuable option for diabetic foot gangrene that can prevent major limb loss and minimize loss of function, thus improving the quality of life for diabetic patients, surgeons must remain vigilant regarding this complication and properly assess their patients in order to avoid it. 

 

EP0472 The benefits of using TLC-NOSF dressings as first-line treatment in chronic wounds: a systematic review

Leanne Atkin^1
1Mid Yorkshire Hospitals Nhs Trust, Wakefield, United Kingdom

Aim: TLC-NOSF dressings* are recommended for treating patients with chronic wounds, but still often reported as second-line options, potentially leading to lost opportunity for patients and additional costs for payers. This review aimed to explore the performances of these dressings when used as first-line treatments.

Method: A systematic review was conducted following PRISMA guidelines. Four databases were searched up to February 1, 2024. Studies were eligible if dressings had been used as an integral part of the standard of care (SoC) at first patient presentation and/or in recent wounds. Quality of evidence was appraised using well-recognized risk-of-bias tools.

Results / Discussion: Seventeen studies at relatively low risk-of-bias were included: nine compared TLC-NOSF and standard dressings, both used as first-line; eight reported both first- and subsequent-line uses, and five reported systematic first-line use without control group. Data from the 10,203 wounds analyzed showed that using TLC-NOSF dressings as first-line treatment consistently resulted in significantly higher healing rates, shorter healing-times, and cost savings compared with standard dressings used under similar conditions. Real-life evidence confirmed the results obtained in clinical trials and economic models, within similar ranges, regardless of the characteristics of patients, wounds and settings. The dressings improved patients’ QoL and were well tolerated and accepted.

Conclusion: These findings are aligned with current guidelines recommending using TLC-NOSF dressings in the treatment of chronic wounds and support their wider implementation as first-line treatment and integral part of SoC in daily practice.

* TLC-NOSF lipidocolloid technology with nano-oligosaccharide factor, UrgoStart dressing range, Laboratoires Urgo

 

EP0473 Development and validation of a wound registry form for use in a tertiary hospital in the Philippines

Isabel Luisa Acosta¹, Gene Gerald Tiongco¹, Glenn Angelo Salegumba Genuino¹, Eric Perpetuo Arcilla¹, Marie Carmela Lapitan¹, Mar Aristeo Poncio^1
1Philippine General Hospital, Manila, Philippines

Aim: Wound care greatly impacts a patient’s quality of life and overall health, making effective wound management crucial for enhancing individual well-being, and mitigating societal health burdens. This pilot study aims to create a wound registry in a tertiary hospital in the Philippines, with the goal of creating a valid and reliable tool for use by multiple end users. This tool may serve to improve local wound care practices and data collection, and provide insight into wound management tailored to the Philippine context.

Method: An initial survey and focus group discussion with wound care practitioners were done to develop the form, which underwent content validation with a panel of experts. Pilot data collection was conducted with 75 patients to assess interrater reliability between General Surgery (GS) and Plastic Surgery (PS) residents.

Results / Discussion: A Wound Registry Form containing 36 variables was developed, demonstrating high content validity and good interrater reliability. The residents generally agreed on wound descriptions and treatment choices. However, significant differences were found in assessing wound exudate consistency (p<0.01), and the rationale for dressing selection—GS residents prioritized price and availability, while PS residents focused on clinical indications (p<0.01).

Conclusion: The Wound Registry Form is a reliable instrument for monitoring wound status and treatment response, evaluating wound care efficacy –ultimately contributing to research and public health. Data from this tool may be used by clinicians to provide evidence-based care, by researchers investigating the burden of wounds and varying perspectives on wound care practices, by administrators aiming to integrate standardized documentation of wound data in health records, and by the public, including patients and their families, seeking proactive involvement in their healing.

 

EP0474 Canadian moisture-associated skin damage (CAN-MASD) tool: an instrument to measure severity and healing of moisture-related skin lesions

Joshua Moralejo¹, Kevin Woo^2
1University Health Network - Toronto Rehabilitation Institute E. W. Bickle Centre, Toronto, Canada, ²Queen’s University, Kingston, Canada

Aim: Moisture-associated skin damage (MASD) is a common clinical problem associated with patients’ discomfort, increased risk of pressure injuries and secondary infections. There are several standardized instruments designed to categorize skin damages particularly related to incontinence but they are not intended to describe and track healing. The aim of this abstract is to propose a new Canadian-MASD (CAN-MASD) clinical tool that incorporated key assessment parameters and clinical characteristics based on a structured review of the literature to support its face validity.

Method: The CAN-MASD Tool was developed following the Joanna Brigg Institute methodology for scoping review. We aimed to identify instruments for the assessment of cutaneous signs and symptoms from irritant exposure to moisture including stool, urine, wound exudate, and perspiration. Data extraction and synthesis was done independently by two reviewers.

Results / Discussion: We identified 169 studies and 9 articles were eligible for review.  We examined key characteristics related to moisture lesions and summarized them into four broad assessment parameters: Skin changes (size, maceration, erythema, rash, edema, induration, and weeping), Symptoms (pain and pruritus), Lesion (erosion), and Infection (fungal and/or bacterial). Each indicator was described in terms of severity on a 4-point scale.

Conclusion: The proposed tool can aid assessment and monitoring of moisture breakdown with objective quantifiable skin changes. The CAN-MASD tool has the potential to facilitate ongoing monitoring and evaluation of care provided for patients with MASD.

 

EP0475 Canadian moisture-associated skin damage (CAN-MASD) tool: An instrument to measure severity and healing of moisture-related skin lesions

Joshua Moralejo¹, Kevin Woo^2
1University Health Network - Toronto Rehabilitation Institute E. W. Bickle Centre, Toronto, Canada, ²Queen’s University, Kingston, Canada

Aim: Moisture-associated skin damage (MASD) is a common clinical problem associated with patients’ discomfort, increased risk of pressure injuries and secondary infections. There are several standardized instruments designed to categorize skin damages particularly related to incontinence but they are not intended to describe and track healing. The aim of this abstract is to propose a new Canadian-MASD (CAN-MASD) clinical tool that incorporated key assessment parameters and clinical characteristics based on a structured review of the literature to support its face validity.

Method: The CAN-MASD Tool was developed following the Joanna Brigg Institute methodology for scoping review. We aimed to identify instruments for the assessment of cutaneous signs and symptoms from irritant exposure to moisture including stool, urine, wound exudate, and perspiration. Data extraction and synthesis was done independently by two reviewers.

Results / Discussion: We identified 169 studies and 9 articles were eligible for review.  We examined key characteristics related to moisture lesions and summarized them into four broad assessment parameters: Skin changes (size, maceration, erythema, rash, edema, induration, and weeping), Symptoms (pain and pruritus), Lesion (erosion), and Infection (fungal and/or bacterial). Each indicator was described in terms of severity on a 4-point scale.

Conclusion: The proposed tool can aid assessment and monitoring of moisture breakdown with objective quantifiable skin changes. The CAN-MASD tool has the potential to facilitate ongoing monitoring and evaluation of care provided for patients with MASD.

 

EP0476 Wound documentation and management powered by 3D models and 5G based connectivity and communciation software system

Andreea Ancuta Corici¹, Nils Lahmann², Simone Kuntz², Martin Hocquel-Hans², Mareike Tabea Jansen², Anne Deter^2
1Fraunhofer FOKUS Institut, Berlin, Germany, ²Charite Universitätsmedizin, Berlin, Germany

Aim: Developing a solution for chronic wound management using image processing designed to enable nursing services for remote areas during an eHealth R&D project.

Method: The Nurse Care App running on the mobile phone uses 2D pictures and 3D models of the wound for computing automatically the wound size, depth, surface and volume.  The communication towards the clinical headquarters is enabled by a private network powered by 5G software core network. This ensures secure and high throughput communication for remote areas using satellite connection or the public mobile operator connection when available. The server running in the clinical headquarters is processing the wound 3D model and generating a printable model of the hydrogel patch. The nurse can then request the printing of the hydrogel patch and applies the patch. A video call between the nurse and the wound expert allows for care plan alignment.

Results / Discussion: The validation takes place using plastic wound models. The 3D models obtained via a mobile phone using photogrammetry are considered by the medical team as a real improvement on assessing and tracking the wound development. The bioprinters currently available on the market are expensive, heavy and few consider interfacing via internet connection. Connectivity, sterilization of the patch and easy-to-carry are key requirements. For the moment the medical and technical teams are extending a plastic 3D printer with 5G connectivity module, data communication components and a syringe for bioink.

Conclusion: The usecase of handling chronic wound in remote areas has the potential to decrease the transportation costs, improve the quality of life for the patients, as well as increase the attractivity for becoming a wound nurse in remote areas.

 

EP0477 Dermatoscopic assessment of typical and atypical chronic wounds

Gyozo Szolnoky¹, Doniz Degovics¹, Robert Kui¹, Rolland Gyulai^1
1University of Szeged, Szeged, Hungary

Aim: Dermatoscopy, also known as dermoscopy, was basically invented for the precise inspection of pigmented skin lesions highlighting the exclusion or confirmation of malignant melanoma. This technique has become also useful in the detailed exploration of ectoparasitic infestations, cutaneous/mucosal infections, vascular leasions, hair and nail abnormalities, psoriasis, lichen planus and other dermatologic conditions however the dermatoscopic assessment of chronic wounds is scarce.

We aimed to analyse a large domain of chronic wounds with dermatoscopy in view of slough, vascular and fibrin structures, color of wound bed, epithelization mostly in different stages of healing.

Method: Patients aged ≥18 years having chronic wounds with a duration > 6 month and size < 25 cm² and without bone, muscle or ligament involvement were included.

Typical (venous, venous-arterial, arterial, diabetic and pressure) and atypical (pyoderma gangraenosum, ecthyma, hidradenitis suppurativa, malignancies) chronic wounds were studied.

Dermatoscopic examinations of the ulcers were performed using Illuco IDS 1100 (Illuco USA, Brea, CA, USA) dermoscope and image record was done with the 8 MP, f/2.2, 13mm (ultrawide) camera of the compatible Xiaomi Redmi Note 8T (Xiaomi Corporation, Beijing, China) mobile phone with an attachment using a Universal Smartphone Adapter for Illuco Dermatoscope.

Results / Discussion: This novel application of dermatoscope was able to visualize fine structures of chronic wounds and also demonstrate their changes along wound healing.

Conclusion: Dermatoscope is a reliable auxiliary tool for structural assessment of chronic wounds and may predict wound healing perspective and therapeutic outcome.

 

EP0532 Which signs and symptoms point to biofilm in chronic wounds? Clinical consensus through an electronic Delphi survey

John Ivory¹, Duygu Sezgin¹, Patricia Coutts², Davood Roshan¹, Chloe Hobbs¹, José Verdú Soriano³, James O’ Gara¹, David Gallagher⁴, Georgina Gethin^1
1University of Galway, Galway, Ireland, ²Wounds Canada, North York, Canada, ³Universidad de Alicante, Alicante, Spain, ⁴University Hospital Galway, Galway, Ireland

Aim: To gain wound care clinician consensus on which signs, symptoms and biomarkers reported to be indicative of biofilm in chronic wounds are likely to be so.

Method: A global, two-round electronic Delphi process including participants with ≥ 3 years’ clinical experience (≥ 50% of which must be wound care-related) was run between December 2023 and February 2024. Participants rated 26 signs and symptoms, reported to be indicative of biofilm in chronic wounds identified from a scoping review of the literature on a 9-point Likert scale.

Results / Discussion: Fifty-six & 23 participants completed rounds 1 & 2 respectively. Eleven items (Visual indicators [a shiny, slimy, persistent layer, easily removed, returns quickly without frequent intervention], failure to respond to antimicrobials, infection >30 days duration, poor quality granulation tissue, stalled wound despite optimal management, persistent/prolonged inflammation, wound >6 weeks duration, soft tissue deterioration despite antimicrobials/debridement, signs of local infection, tunnelling/undermining, presence of slough) achieved consensus to include status, the remainder left with a no consensus status. When examined in terms of other similar work, our findings showed inconsistencies in clinical opinion especially regarding visual indicators.

Conclusion: Experienced clinicians are likely aware of wound biofilm; of the risks it can pose and of available treatment strategies, but we ask if we are yet in complete agreement in terms of identifying biofilm in wounds at the bedside. This work supports a need for research that would quantify the predictive abilities of signs and symptoms reported to be indicative of biofilm in chronic wounds.   

 

EP0533 Reliability and usability of evaluation method of wounds through tissue percentage

Isabel Cristina Santos¹, Marilia Valenca¹, Jabiael  Carneiro da Silva Filho¹, Simone Maria  Bezerra¹, Samara Cecília Silva^1
1University of Pernambuco, Recife, Brazil

Aim: To evaluate the reliability and usability of the wound assessment method using tissue percentage.

Method: Methodological study, conducted with four generalist nurses and three wound care specialists. These professionals independently evaluated 200 photographs of wounds using the wound assessment method through tissue percentage. The same evaluation was repeated after a period of twenty days. The consistency of the evaluation was verified through the Spearman correlation coefficient, considering a coefficient <0.1 as an insignificant relationship and ≥0.7 as a very strong relationship. The usability assessment was performed through the agreement rate. The development of the study met the national and international standards of ethics in research involving human beings (approval no. 448.342).

Results / Discussion: In phase one, the correlation results ranged from 0.65 to 0.98. There was significant convergence between the evaluations. In the second evaluation, all correlations were considered significant with a range of 0.79 to 1.00. All nurses (100%) who evaluated wounds using the wound assessment method based on tissue percentage considered the method easy to learn and use, and that it could help in prescribing wound dressings, with a median satisfaction score of nine.

Conclusion: The method showed reliability and excellent usability and level of satisfaction, which can contribute to the quality of wound assessment and treatment.

 

EP0534 Cure rate of chronic wound with sinus tract based on morphologic and pathologic features of the endoscopic evaluated China-LU classification

Xian MA^1
1Shanghai Ruijin Hospital, Shanghai, China

Aim: This study aimed to analyze the cure rate of chronic wounds with sinus tracts (CWST) using an endoscopic classification system, the China-Lu classification, which is based on morphological and pathological characteristics.

Method: A prospective case series was conducted at *** Hospital from November 2017 to October 2021, involving 89 CWST patients. Each wound was classified into four types (simple, morphologically complex, pathologically complex, and refractory) based on CT and endoscopic examination. Endoscopic treatment techniques included debridement, drainage, and removal of foreign bodies as required.

Results / Discussion: The overall cure rate was 86.52%. Cure rates by type were 97.83% for simple, 84.62% for morphologically complex, 86.96% for pathologically complex, and 14.29% for refractory wounds.

Conclusion: The China-Lu classification provides valuable stratification for CWST, with implications for treatment and prognosis. While simple and complex wounds generally responded well to endoscopic intervention, refractory wounds showed lower cure rates, highlighting the need for tailored treatment approaches. Further multicenter research is needed to confirm these findings.

 

EP0535 The effectiveness of acellular dermal matrix in chronic wound reconstruction

Mert Noyan  Dabak¹, Agit Sulhan¹, Kadir Barış Tiryaki¹, Perçin Karakol^1
1University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Aim: In reconstructive microsurgery, surgeons face large and difficult-to-close tissue defects. Due to immunogenic factors, closing these defects is challenging. Particularly in chronic wounds, inflammatory and proteolytic events disrupt the structural components of the extracellular matrix. Rather than replacing the skin, ADMs support soft tissue repair and provide a favorable microenvironment for the nourishment and integration of split-thickness skin grafts (STSG).

Method: This study retrospectively evaluated wound outcomes following ADM application in 18 patients with tissue defects secondary to diabetes and trauma, treated between February 2023 and September 2024. All patients underwent serial debridement, negative-pressure wound therapy (NPWT), and antibiotic therapy based on culture results. ADM was applied concurrently with STSG in patients with negative culture results. Follow-ups were scheduled for postoperative day 5, and at 1 and 3 months.

Results / Discussion: Total graft failure was observed in one patient, and partial failure occurred in two others. In the majority of cases, wounds treated with ADM and STSG were successfully closed. However, the study’s limitations include the small sample size and the lack of objective metrics to assess wound healing.

Conclusion: In cases where free or pedicled flap reconstruction is not feasible for tissue defects with exposed bone due to trauma, the combination of ADM with STSG proved to be a viable alternative. This study demonstrates that ADM, used in combination with other techniques such as grafts, can play an effective role in chronic wound treatment strategies. However, larger case series are needed to achieve more robust outcomes.

 

EP0536 Wound treatment with temporary synthetic skin substitute: Our clinical experience

Ömer Büyükkaya¹, Kurtulus Oz¹, Perçin Karakol^{1 1
1}University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

Aim: Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various etiologies. Skin substitutes are a two-layer, non-medicated wound dressing which approximates the function of human skin.

Method: In this study, we retrospectively evaluated the wound site after Epigard application in 13 patients with tissue defects secondary to diabetes, trauma and burns who applied to our clinic between April 2023 and July 2024. 5 cases were diabetic ulcers in the lower extremities, 4 cases were tissue defects after trauma and 4 cases were tissue defects after burns. A dressing change is performed every 48 hour. In this stud we looked for a granulation and wound sizes in all patients.

Results / Discussion: All of our patients with different etiologies showed a significant increase in granulation tissue on the wound bed following the application of skin substitutes. In patients who underwent consecutive applications, a reduction in wound size was observed.

Conclusion: Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various etiologies. Further research should be carried out evaluate the effectiveness of synthetic skin substitutes.

 

EP0537 The new age of wound care: Leveraging the synergy of multi-modal fluorescence and thermal imaging

Charles Andersen¹, Katherine Mcleod^2
1Madigan Army Medical Center, TACOMA, United States, ²Madigan army Medical Center, TACOMA, United States

Aim: Chronic non-healing wounds are influenced by several factors, including bacteria, impaired blood flow, and poor oxygenation. Thermal imaging offers insights into skin temperature and blood flow, while fluorescence imaging accurately locates bacteria at levels (>104 CFu/gr), that impede healing and set the stage for an infection. Multi-site case series exploring the practical application of a combined device that integrates both imaging technologies, highlighting its potential to enhance bacterial diagnosis and wound treatment.

Method: Patients at advanced wound care centres were evaluated using a handheld multi-modal platform that provides real-time fluorescence imaging to assess bacterial load and thermal imaging to monitor skin temperature and blood flow. Data was collected on the impact of this combined imaging approach on clinical workflow, diagnosis, and treatment strategies.

Results / Discussion: A total of 25 patients were imaged across two centers. Findings revealed that 32% had isolated positive fluorescence results, 16% had abnormal thermal results, and 8% exhibited abnormal findings in both modalities. Case examples illustrate how multi-modal imaging informed clinical decision-making, with thermal imaging revealing critical features like tunneling and increased pressure areas, while fluorescence imaging facilitated targeted bacterial management. The integration of these technologies enhances diagnostic accuracy, streamlines clinical workflows, and enables proactive wound management.

Conclusion: The combination of fluorescence and thermal imaging in a single device significantly improves diagnostic insights and treatment approaches for chronic wounds. This innovative platform not only aids in identifying infection and pressure areas but also supports effective interventions, highlighting its potential to transform wound care practices.

 

EP0538 Healing chronic wounds with topical oxygen therapy: A systematic review and framework analysis

Fatin Fauzi¹, Shams Al-Ani¹, Tony Lockett¹, Alex Dyson^1
1King’s College London, Centre for Pharmaceutical Medicine Research, London, United Kingdom

Aim: Chronic wounds are a major public health concern with high global prevalence. Topical oxygen therapy (TOT) is a promising intervention but has only been tested in relatively small cohorts. We aimed to assess the utility of TOT in chronic diabetic and non-diabetic wounds through a systematic review and framework analysis.

Method: A systematic search for TOT and chronic wounds (all types) was conducted using PubMed, Web of Science, Embase via Ovid, and the ClinicalTrials.gov to include RCTs, cohort studies, case series, and case reports, published in English from 2014-2024. Qualitative coding using a framework analysis was used to predefine themes. Quality assessment was performed using CASP.

Results / Discussion: Twenty-eight articles were included and coded with framework analysis, resulting in five predefined themes: (1) patient characteristics, (2) TOT type, (3) chronic wounds type, (4) TOT administration method, and (5) outcomes (wound and patient-reported). TOT showed significantly improved wound healing compared to standard care although most studies were reported as ‘fair’ quality. Five key parameters for effective TOT administration (flow rate, frequency, duration, pressure, and oxygen concentration) were identified.

Conclusion: Our systematic search has demonstrated the utility of TOT in enhancing wound healing across different chronic wound types. High patient satisfaction was noted due to ease of use. Owing to the lack of high-quality data, more studies are required to confirm the utility of TOT in healing chronic wounds.

 

EP0539 Possibilities and challenges in implementing a wound complexity assessment tool

Michele Rocha¹, Saskia Fleury¹, Maria Ângela Boccara de Paula², Juan Monroy, Magali Thum^1
1Convacare clinics, São Paulo, Brazil, ²Sociedade Brasileira de Estomaterapia, São Paulo, Brazil

Aim: To evaluate the time performance of a wound complexity classification instrument.

Method: A retrospective study conducted from December 2022 to August 2024, including adults with acute and chronic wounds treated at a private stoma therapy clinic. A wound complexity classification instrument, developed through a systematic review, was utilized. This tool measures, through a numerical score, variables that analyze intrinsic and extrinsic factors affecting healing time, such as comorbidities, nutrition, infection, size, area, duration, etiology, and type of tissue of the wound. The selection of variables results in a score that classifies the wound into: special complexity, high, moderate, and low. By understanding the complexity, it is possible to predict healing; the time assigned to each complexity was determined based on a historical series from a clinic in the same network in Colombia.

Results / Discussion: Ten patients were included. In the initial assessment, complexities were classified as follows: 20% special, 50% high, and 30% moderate. At discharge, 10% were in high complexity, 50% in moderate, and 40% in low complexity. The projected treatment time was 117 months, but healing occurred in 30 months, resulting in an average treatment time of three months per patient.

Conclusion: The actual healing time was significantly shorter than predicted, suggesting adjustments to the prediction model, possibly due to the expertise of specialized nurses and advances in wound treatment technologies. Future work is suggested to gather evidence of validity and reliability in predicting treatment time and costs.

 

EP0540 Validation of a digital automatic depth measurement feature within a multi-model wound imaging device

Danielle Dunham¹, Rose Raizman², Claudio Irrgang¹, Ben Gidalevich¹, Nikola Andric¹, Desmond Hirson¹, Laura Jones-Donaldson¹, Micaela Gray¹, Carolina Wuesthoff^1
1MolecuLight, Inc., Toronto, Canada, ²Department of Professional Practice, Scarborough Health Network, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

Aim: There is significant inaccuracy and inconsistency associated with manual wound depth measurements, typically achieved with a probe and ruler. This can inaccurately reflect a wound’s healing progress, significantly impacting treatment planning decisions. We sought to validate the accuracy and reproducibility of a novel automatic-depth feature on a hand-held multi-modal wound imaging device* that also detects pathogenic bacteria in wounds.

Method: A statistically powered validation study using 17 three-dimensional wound models and 34 real clinical wounds. True depths were measured using a calibrated, highly accurate 3D scanner. Triplicate depth measurements of the wound models were captured by three users, and duplicate measurements of real clinical wounds were captured by two users. Testers were blinded to the true depths. Intraclass correlation coefficients (ICC) for intra- and inter-user variability were calculated using a 2-way random effects ANOVA model.

Results / Discussion: The automatic-depth feature was validated to accurately assess the wound depth with an error of ±0.87 mm for wound models and ±0.97 mm for real clinical wounds. Intra-user and inter-user ICCs were 0.999 (95% CI 0.997, 1) and 0.992 (95% CI 0.984, 0.996) respectively for wound models.  Intra-user and inter-user ICCs were 0.998 (95% CI 0.996, 0.999) and 0.997 (95% CI 0.994, 0.998) respectively for real wounds assessed in the clinic.

Conclusion: AutoDepth measurements were highly accurate with excellent reproducibility in both benchtop and clinical testing. This novel feature within a multi-modal wound imaging platform* speeds up the clinical workflow, providing contactless, comprehensive digital wound measurements alongside co-registered bacterial fluorescence images.

*MolecuLightDX

 

EP0541 TCPO2 values in ischemic limb management: An overview and case series

Po-Chun Huang¹, Yun-Nan Lin^2
1Kaohsiung Medical University, Kaohsiung, Taiwan, ²Kaoshiung Medical University Hospital, Kaohsiung, Taiwan

Aim: Predicting ischemic limb prognosis often relies on clinical judgment. Recent studies suggest transcutaneous oxygen perfusion (TcPO2) as a more objective tool for determining amputation levels. However, standardized TcPO2 thresholds for amputation and wound healing are yet to be widely accepted. This study examines the correlation between TcPO2 values and healing outcomes through a case series and literature review.

Method: A retrospective review of 19 ischemic limb patients from 2018-2023 was conducted. Patients underwent various amputation levels, with TcPO2 values collected and a minimum 30-day follow-up.

Results / Discussion: Among 10 amputations, successful toe amputations had a mean TcPO2 of 41.1 mmHg; successful below-knee amputations (BKA) had 20.5 mmHg, while an above-knee amputation (AK) had 48-50 mmHg. A single unsuccessful case had preoperative TcPO2 at 34-36 mmHg, necessitating re-amputation. A TcPO2 below 20 mmHg is predictive of healing failure.

Conclusion: TcPO2 <20 mmHg has predictive value for failure; however, an optimal TcPO2 cutoff for reliable healing remains undefined. This study highlights the need for standardized TcPO2 measurements and further data to refine TcPO2 thresholds for improved amputation outcomes.

 

 

CASE STUDIES

EP0682 Preventing amputation with minimally invasive surgery in a diabetic patient with osteomyelitis and peripheral vascular disease

Orlexia Thomas¹, Francois Lokenye¹, Lady Paula DeJesus²

¹Yale New Haven Health Bridgeport Hospital, Bridgeport, United States, ²Yale New Haven Health Greenwich Hospital, Greenwich, United States

Aim: This study aims to demonstrate the efficacy of minimally invasive surgical interventions in preventing foot amputation and promoting wound healing in a diabetic patient with osteomyelitis and peripheral vascular disease, compounded by a history of ray resection. Effective management of these conditions is crucial to preserve limb integrity, improve outcomes, and achieve wound closure.

Method: The focus was a chronic wound on the right foot, complicated by osteomyelitis. Initial intervention involved resection of the first metatarsophalangeal joint (MTPJ) with vancomycin antibiotic beads to control the infection. This was followed by further surgical management to prevent transfer lesions which would lead to further ulcerations, possible infections. Surgical management of painful right foot bunion, metatarsalgia, and hammertoes, including minimally invasive surgical offloading via floating metatarsal osteotomies of the 2nd, 4th, and 5th metatarsals, hammertoe correction of the 2nd and 4th toes, an Akin osteotomy, and flexor and extensor tenotomies. These techniques were chosen to prevent transfer ulcerations and infections, promote healing, and minimize complications ultimately preventing transmetatarsal amputation.

Results / Discussion: The patient’s wound is with complete closure and no longer experiences pain. The interventions successfully prevented foot amputation and facilitated complete wound healing. Post-operative follow-ups show improved foot function and mobility, with no recurrent infections or complications.

Conclusion: Minimally invasive surgical approaches are effective in managing complex diabetic foot conditions. In this case, they prevented amputation, ensured wound healing, and resolved pain. These findings suggest minimally invasive surgery as a viable option in similar high-risk patients to enhance outcomes and preserve limb integrity.

 

EP0683 Prevention of transmetatarsal amputation in a diabetic patient with chronic foot ulcer including osteomyelitis by minimally invasive surgery floating lesser metatarsal osteotomies in conjunction with adipose injectable filler

Francois Lokenye¹, Orlexia Thomas¹, Lady Paula DeJesus²

¹Yale New Haven health, Bridgeport, United States, ²Yale New Haven health, Greenwich, United States

Aim: This study evaluates the clinical efficacy of combining floating lesser metatarsal osteotomies with adipose tissue injectable filler to prevent transmetatarsal amputation in diabetic patients with chronic foot ulcers and osteomyelitis. The objective is to assess the impact of this minimally invasive technique on ulcer resolution, osteomyelitis management, and biomechanical stabilization, ultimately aiming to enhance limb preservation. Secondary objectives include reducing wound recurrence, promoting wound closure, and improving foot function.

Method: The patient, with a chronic fourth metatarsal head wound probing to bone (0.6 cm x 0.2 cm x 1.5 cm), underwent resection of the infected fourth metatarsal head and proximal phalanx base, confirmed flouroscopicaly. Minimally invasive floating head osteotomies were performed on the second and third metatarsal necks. Due to fat pad atrophy, an injection of adipose allograft matrix filler was injected into the foot for soft tissue padding.

Results / Discussion: Significant improvements in foot function, reduced plantar pressure, and enhanced soft tissue padding, minimizing the risk of future ulcerations. The patient had no complications and could walk three miles without wound recurrence. Postoperative gait analysis confirmed biomechanical stabilization and improved function. The procedure also demonstrated effectiveness in wound healing, osteomyelitis management, and reducing the need for transmetatarsal amputation.

Conclusion: This combined surgical approach offers a promising therapeutic option for managing chronic foot ulcers in diabetic patients, promoting ulcer resolution, enhancing foot stability, and improving overall outcomes. The absence of complications supports its safety and potential as a limb-preserving strategy in diabetic foot care.

 

EP0684 Surgical dehiscence in a patient with systemic lupus erythematosus and rheumatoid arthritis, treated with magnetotherapy and extracellular matrix. A study case

Pere Coca-Alves¹, Cristina Jimenez-de-la-Rosa¹, Sonia Carmona-Fortes¹

¹Parc Sanitari Sant Joan de Deu, Barcelona, Spain

Aim: To demonstrate underused therapeutic options in the treatment of hard-to-heal wounds, such as magnetotherapy and local treatment with extracellular matrices of animal origin.

Method: Clinical case of a 49-year-old female patient with a history of systemic lupus erythematosus, rheumatoid arthritis and associated patergia, who presented with a right lower extremity injury with exposure of the Achilles tendon requiring several surgical interventions: rotation flap, tenotomy, grafts and two debridements. The process was very painful, especially the local management with negative pressure therapy, which is why it was withdrawn and local treatment with intact extracellular matrix (ECM) derived from ovine (sheep) forestomach tissue was started. In parallel, the patient received three sessions per week of magnetotherapy in the area. The size of the wound at the beginning of the treatment was 21 x 7 cm.

Results / Discussion: With the above treatment, the lesion completely epithelialized in 69 days being well tolerated and without any associated complications.

Conclusion: Based on the results obtained in this case, ECM treatment should be considered as an alternative to be taken into account in hard-to-heal wounds. On the other hand, the use of electromagnetic fields on the lesion could have contributed to its rapid healing. We believe that magnetotherapy should be considered as an adjuvant treatment in hard-to-heal wounds.

 

EP0685 Surgical wound management in a necrotizing cutaneous ANCA vasculitis treated with propylthiouracil : a case report

Virginie Van Boeckel¹, Jean-Luc Nizet¹, François Martin¹

¹CHU de Liège, Liège, Belgium

Aim: Necrotizing vasculitis is a complex phenomenon because of an inflammation of small and larger vessels with polymorph infiltration within the vessel’s walls, occurring in several autoimmune diseases. In this report, we present a rare case of a propylthiouracil (PTU)-induced necrotizing cutaneous vasculitis in the setting of autoimmune thyroiditis that was admitted in our burn unit.

Method: A 45-year-old woman with Graves’ disease and antiphospholipid syndrome developed necrotic lesions predominantly on the lower limbs and both arms as cutaneous vasculitis associated with antineutrophil cytoplasmic antibody (ANCA) to myeloperoxidase (MPO-ANCA) and proteinase-3 (PR3-ANCA) during treatment with PTU. 8% TBSA was involved with violaceous non-blanching lesions progressing to full thickness necrosis. Local wound cares were continued until necrotic areas were completely demarcated and progressive necrosis stabilised. We performed serial debridement followed by negative pressure wound therapy and split-thickness skin grafting. The skin lesions were progressively resolved after withdrawal of PTU and treatment with oral steroids. The patient recovered well, both systemically and locally in 4 weeks.

Results / Discussion: PTU is a common antithyroid drug, which has been known to induce ANCA-positive vasculitis. ANCA-associated vasculitis can all display a broad variety of cutaneous manifestation. Positive screening with MPO-ANCA should prompt a thorough clinical investigation. Early diagnosis and prompt cessation of PTU therapy are essential to improve the outcome.

Conclusion: This case demonstrates the complexity of management in extensive necrosis secondary to PTU-induced vasculitis condition. If the vasculitis wounds progress to full thickness necrosis, surgical intervention is required.

 

EP0677 Case report: treatment of a war-injured burn patient with cold plasma

Moritz Milewski¹, Frederik Schlottmann¹, Vincent März¹, Peter M. Vogt^1
1Department of Plastic and Reconstructive Surgery, Hannover, Germany

Aim: The treatment of severe burn injuries, particularly in conflict zones, demands a multimodal approach. This case report aims to evaluate the efficacy of atmospheric cold plasma therapy (ACPT) as a novel treatment for burn wounds colonized by multidrug-resistant pathogens, focusing on both antiseptic effects and wound healing.

Methods: A 40-year-old Ukrainian soldier with 23% burns and a traumatic amputation was treated after being injured in the Ukraine-Russia conflict. Upon admission, colonization with multidrug-resistant Acinetobacter baumannii was detected. Treatment included hydrotherapeutic debridement, antibiotics, and daily ACPT to reduce microbial load. Surgical procedures involved a dermal skin substitute matrix and autologous skin grafts using the MEEK technique.

Results/Discussion: ACPT, applied daily, effectively controlled the spread of multidrug-resistant pathogens. After 70 days, 90% of the burn areas had healed. The combination of ACPT with standard surgical treatments showed promise in improving wound healing outcomes while managing infection risks. This case led to the certification of the department as the first German center for cold plasma treatment of burn wounds.

Conclusion: ACPT is a valuable addition to burn surgery, offering strong antimicrobial effects and enhanced wound healing. This case demonstrates the potential of ACPT for treating complex burn wounds with multidrug-resistant colonization. Future studies are needed to establish standardized protocols, and specialized centers will play a crucial role in advancing its clinical use.

 

EP0791 Effective strategies for enterocutaneous fistula wound care: NPWT and stoma bag education

Chin Wen Shiao^1
1National Taiwan University Hospital, Taipei, Taiwan

Aim: This study explores a patient with liver tumor recurrence post-multiple surgeries and Trans Arterial Chemo Embolization (TACE), compounded by intestinal adhesion and wound dehiscence leading to an enterocutaneous fistula. The aim is to illustrate the effective application of Negative Pressure Wound Therapy (NPWT) and appropriate dressing selection to manage continuous fecal and intestinal fluid leakage, alleviate skin inflammation, facilitate wound healing, and offer systematic stoma bag education for a successful transition to home care.

Method: During the care intervention, the patient’s persistent fecal and intestinal fluid leakage causing skin issues due to the enterocutaneous fistula were observed. Comprehensive wound assessment with triangle method; select NPWT to manage leakage and use PROMOGRAN Ag to promote granulation and wound healing, reducing dressing frequency. NPWT was employed for wound management alongside systematic stoma bag education for the patient and family members.

Results / Discussion: Utilizing NPWT and tailored dressing selection effectively reduced skin inflammation, fostering wound healing. Systematic stoma bag education empowered the patient and family to manage stoma care successfully at home.

Conclusion: This case study demonstrates the efficacy of NPWT and appropriate dressing selection in managing post-operative wound dehiscence complicated by an enterocutaneous fistula. Additionally, systematic stoma bag education enhances patient and family autonomy in care, providing an alternative approach for similar cases, thus improving care quality and outcomes.

 

EP0686 Prevention and topical treatment of type 2 skin tears: case report

Rafael Colodetti¹, Sonia Gouvea^1
1Federal University of Espírito Santo (UFES), Vitória, Brazil

Aim: To report preventive measures and topical treatment of skin tears type 2.

Method: A 93-year-old female, controlled diabetes and hypertension with traumatic injury in the right lower limb. identified skin tears type 2, partial flap loss which cannot be repositioned to cover the wound bed. presence of a bubble with blood content near the wound, inflamed, fragile and hyperemic perilesional skin. presence of ocher dermatitis on the extremities of the lower limbs. Dry cleaning of the injuries was with sterile viscose compresses containing allantoin, Aloe vera, surfactants and benzalkonium chloride. Application of post-trauma dressing composed of a lipidocolloid (TLC), polyabsorbent fibers with silver and with hemostatic action. Porous biocellulose (PB) dressing in combination with a thin layer of gel containing polyhexanide. Olive oil (OO), composed of oleic acid and OO phenolic compounds as primary dressings, were also used. Moisture management was performed by secondary silicone dressing. Ethical appreciation nº 6.248.849.

Results / Discussion: TLC dressing was changed after 24hours. The gel was applied up to the PB only once and remained for three days. The routine was to clean and apply the OO twice a day, without the need to change the silicone dressing for up to seven days. Over the following thirty-two days continued with the aforementioned routine.

Conclusion: After 36 days, the wound was healed with recovery of the non-repositionable skin flap. The bubble has been reabsorbed. Perilesional skin kept hydrated with improved perilesional skin tone. The proposed skin tear topical treatment was effective, showing its potential.

 

EP0687 Topical treatment of atypical skin manifestations in acute chikungunya infection: case report

Rafael Colodetti¹, Sonia Gouvea^2
1Federal University of Espírito Santo (UFES), Foundation Coordination for the Improvement of Higher Education Personnel (CAPES), Federal Government, Vitória, Brazil, ²Federal University of Espírito Santo (UFES), Vitória, Brazil

Aim: To report the evolution of topical treatment in cutaneous manifestations in the lower limbs in severe acute chikungunya infection.

Method: A 64-year-old female with a history of venous insufficiency in the lower limbs (LL) and controlled hypertension was diagnosed with chikungunya disease. Evolution with bullous dermatosis (BD) with translucent content, in the right lower limb. The blisters and inflamed skin were cleaned with sterile viscose compresses containing allantoin, Aloe vera, surfactants and benzalkonium chloride, followed by application of olive oil (OO), composed of oleic acid and OO phenolic compounds (OOPCs), using a touchless aerosol spray.  The biotechnology derived from OO with a high content of antioxidants, such as Oleocanthal, Hydroxytyrosol, St. John’s Wort, Peppermint, Rosemary Oil and vitamins A, D, E, F and K. Ethical appreciation nº 4.316.934.

Results / Discussion: BD remained stable for six days after starting topical treatment. There was spontaneous absorption and/or drainage of the blisters, leaving the skin intact, clean and hydrated. On the seventh day, the remaining blisters burst, exposing a superficial wound. A multilayer silicone was used as the secondary dressing. Wound healing was achieved after one application (48 hours). The aforementioned routine was resumed. No additional wound changes were noted at the thirty-three days follow-up after the first bubble appeared.

Conclusion: Dry cleaning and OO seem to be an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties in similar or different injuries and in others populations.

 

EP0783 Lower limb salvage using surgical debridements and V.A.C. VERAFLO instalation/ negative pressure therapy

Usha  Sharma ^1
1Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom

Aim: A 42year old patient, 6ft 6inches tall and a previous basketball player for his national Zimbabwe team was admitted with right groin pain and diagnosis was necrotising fasciitis. The necrotising fasciitis was spreading rapidly from his right groin down his thigh and leg.  This was deemed a surgical emergency to salvage his right limb.

Debridement of extensive Necrotizing fasciitis of right groin and top of leg carried out by a Consultant Surgeon, and Vac veraflo application by Tissue Viability Team in theatre.

Results / Discussion: 6 weeks of Vac veraflo application we reached up to surface granulation tissue with all underlying structures of muscle and tendons covered.

Method: 9 months Post skin graft Photos.

Conclusion: V.A.C. VERAFLO™ Dressings have been designed to cleanse contaminated wounds, by helping to soften, solubilise, and remove viscous exudate, wet slough, fibrin, and other infectious materials by instilling a saline into the dressing, allowing it to soak and then gentle vacuum to remove the exudate.

It is the clinician’s impression that due to V.A.C. VERAFLO™ Therapy, the patient avoided a possible amputation. No further debridement was required in theatre after V.A.C. VERAFLO™ Therapy application. Factors affecting patients healing were elevated blood glucose levels and low Albumin levels.

TVNs recognised the importance of a holistic approach and supported the patient’s anxieties well during dressing changes, which we feel contributed the management of his pain. A collaborative approach with the multidisciplinary team including the Plastic team and ward staff to administer PRN pain medication prior to TVN visit ensured optimum patient comfort and increased compliancy to treatment plan.

 

EP0786 Malignant transformation in arteriosclerosis ulcer of Martorell - case reports and review of the literature

Cheng Biao^1
1General Hospital of Southern Theater Command of PLA, Guangzhou, China

Aim: Martorell ulcer is often misdiagnosed clinically as an ulcer caused by leucocyte rupture vasculitis, pyoderma gangrenosa and calcific hypersensitivity, etc., and high-dose immunosuppression therapy leads to fatal complications.

Method: This article reports a case of malignant transformation in Martorell’s ulcer, and discusses the common pathological features and controversies of Martorell’s ulcer.

Results / Discussion: Clinical features and histopathology of the patient in this case conform to the diagnosis of Martorell ulcer, meanwhile ruling out leucocyte rupture vasculitis or pyoderma gangrenosa by immunological indicators, diabetes and calcific hypersensitivity by blood glucose and renal function tests. Current etiology suggests a history of hypertension and other cardiovascular disease is not necessary for this diagnosis. Study focused on quantitative histommorphologic information of changes in the vascular arteriole wall of Martorell ulcer, suggesting calcification and hyaluronization of subcutaneous arteriole is the main differential parameter for the differential diagnosis of the microstructure of Martorell ulcer and other leg ulcers. At present, there have been no reported cases of malignant transformation in Martorell’s arteriolar ulcer. In this case, the pathological results showed that the squamous epithelium invaded the basal layer and the epithelial dysplasia was observed.

Conclusion: 1. Considering that hypertension is not the only necessary cause and the common pathological feature of this ulcer is subcutaneous arteriolar sclerosis, it is more reasonable to name it “Arteriolosclerotic ulcer of Martorell”. 2. It is necessary to actively debride, control blood pressure, and manage pain to promote wound healing of these ulcers, instead of conservative treatment; 3. Martorell’s ulcer had the possibility of malignant transformation, and expanded resection combined with NPWT can achieve good clinical treatment effect.

 

EP0664 Huge fibrin accumulation after augmentation mammoplasty with similar clinical features breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Jun Ho Park¹, Ji Won Jeong^1
1Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Rep. of South Korea

Aim: Late seroma and mass formation, which occur after breast augmentation with silicone implants, are important findings that generally suggest breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). In the past 10 years, BIA-ALCL has been attracting attention as the biggest complication of patients who underwent aesthetic and reconstructive breast surgery using silicone implant. Herein, we introduce a breast implant associated late complicative case that can clinically confusing with BIA-ALCL.

Method: A 30-year-old Korean woman presented with contour deformity with palpable mass on left breast. 8 years ago, she underwent augmentation mammoplasty and no side effect was observed since then. However, she visited the outpatient clinic with localized swelling and color change on left breast for 3 weeks. The patient denied history of trauma. Fluid collection was observed in the MRI performed after visiting hospital and the implant rupture was not identified.

Results / Discussion: Bilateral implant removal and reconstruction with local flap was performed. Intraoperatively, excision was done on multiple brownish specimen, huge seroma collection and the capsule. The immunohistochemical and flow cytometry findings of biopsy specimen revealed of fibrin accumulation with fibrous tissue and no infection was found [ CD30(-), Anaplastic lymphoma kinase (-)]. 6 months after surgery, no recurrence was identified and the breast contour was also satisfactory.

Conclusion: Although this clinical case shows the typical clinical pattern of BIA-ALCL, the pathologic finding suggested accumulation of fibrin materials accompanied by seroma without implant rupture. It can be regarded as rare and abrupt complication more than 8 years after augmentation mammoplasty without trauma.

 

EP0688 Strategies and interventions for reducing odor and infection in malignant fungating wounds: Case report

Ching-uen Huang¹, Chia-Yu  Hsieh², Jing-Jing  Chiou^2
1Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan, New Taipei City, Taiwan, ²Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan

Aim: Malignant Fungating Wounds (MFWs) are wound lesions that occur in patients with metastatic or recurrent cancer, representing one of the most severe complications. The incidence ranges from 5 to 14.5%, with the breast being the most common site (39-62%), followed by the head and neck (24-33.8%). These wounds are characterized by exudates, a strong unpleasant odor, bleeding, and infection, often causing severe pain. Patients typically experience fear of wound care, social isolation, and poor prognosis due to limited treatment options. This report aims to provide effective care strategies to reduce odor, exudate, and infection risk, alleviating patient suffering and improving quality of life.

Method:

• Pre-medicate patients with analgesics or topical agents before dressing changes and carefully remove dressings to avoid trauma.
• Use appropriate wound cleansers to gently clean the wound, preventing pain and bleeding from improper handling.
• Apply antibacterial gels and metronidazole.
• Protect the surrounding skin with barrier creams and non-adhesive dressings.
• Regularly assess the wound and adjust care accordingly.
• Incorporate supportive and psychological care to reduce social isolation.

Results / Discussion: In three cases, using super oxidized solution (SOS) and hydrogel for daily wound cleansing resulted in significantly reduced odor and decreased necrotic tissue after five days. Bleeding improved, and pain scores dropped from 8 to 3 without the need for analgesics.

Conclusion: The use of SOS and hydrogel effectively reduces odor, infection, and exudate. Proper removal of dressings minimizes bleeding and pain. These strategies improve wound care for MFWs, reducing discomfort and enhancing patient comfort.

 

EP0795 Nursing care of an aged patient with a massive sacrococcygeal pressure injury guided by the TIME-CDST

Jie Zeng¹, Yang Ya^1
1Dahua Hospital, Xuhui District, Shanghai, China, Shanghai, China

Aim: Case report on the care of an elderly patient with a massive sacrococcygeal pressure injury.

Method: Wound management based on TIME-CDST in an elderly patient with a massive sacrococcygeal pressure injury was performed with the following measures:

A: Assessment of the patient both holistically and locally. The overall assessment includes focusing on the patient’s current and past history, pain, nutritional status, family support system, and so on; the local assessment applies the wound assessment triangle method .

B: Initiate the joint outpatient clinic of the multidisciplinary team in the hospital consisting of wound specialist, surgery, neurology, nutrition, pain, and psychology to realize comprehensive medical care.

C: Control of risk factors affecting healing. Wound specialist nurses play a leading role and participate in the whole management of the patient’s skin, coordinating with multidisciplinary experts to carry out specialized interventions such as pain control, nutritional support, psychological condition, and so on.

D: Selection of appropriate treatment. In this case, wound disposal measures such as sharp instrument debridement, autolytic debridement, negative pressure therapy, and nutritional support were successively selected. The use of wrist and ankle needles for pain relief at the time of dressing change was effective, and the NRS score dropped from 6 to 2.

E: Evaluate effectiveness and set appropriate milestones. Different goals for different stages of the wound. For example, in the early stage, local infection was obvious, and the goal of wound management was to control the infection

Results / Discussion: The wound healed successfully in 3.5 months.

Conclusion: Good healing is facilitated by professional assessment and multidisciplinary collaboration in the development of a wound care program guided by the principles of TIME-CDST.

 

EP0665 Tuberculous cold abscess in the thoracic wall: A diagnostic challenge in atypical wounds

Isabel Gracia Marco¹, Albert Fernandez Borreguero¹, Rebeca Rodriguez Corbaton^2
1Institut Catalá de la Salut, Lleida, Spain, ²Institut Catalá de la Salut, lleida, Spain

Aim: To present the case and the prolonged diagnostic process of a tuberculous cold abscess in the thoracic wall, highlighting the challenges in diagnosing and managing atypical wounds.

Method: A young male patient presented to the emergency department with recurrent right-sided chest pain, initially diagnosed as musculoskeletal. Over the course of eight months, a nodular mass developed in the posterior right thoracic region. Imaging suggested a benign neoplasm, and surgical drainage was performed. Intraoperatively, a large purulent collection was evacuated, and vacuum-assisted closure (VAC) therapy was initiated. After multiple consultations with different medical services due to wound dehiscence and fistulation, biopsy and microbiological cultures confirmed Mycobacterium tuberculosis. Anti-tuberculous treatment was initiated, and the patient was followed by a multidisciplinary team including thoracic surgery, internal medicine, primary care, and wound care specialists.

Results / Discussion: The delayed diagnosis was attributed to the absence of typical inflammatory signs and the slow progression of the wound. The patient’s wound healing was complicated by bacterial superinfection and delayed tissue recovery, necessitating prolonged VAC therapy and multidisciplinary management. Anti-tuberculous therapy led to gradual wound improvement, with ongoing care required for complete resolution.

Conclusion: Tuberculous cold abscesses, though rare, should be considered in the differential diagnosis of chronic atypical wounds, especially when the initial presentations are subtle. Multidisciplinary collaboration is essential for timely diagnosis and effective management. This case also underscores the critical role of wound healing units in managing complex and atypical wounds, ensuring comprehensive care that addresses both the infectious and structural components of the disease.

 

EP0689 Complex cases of cutaneous leishmaniasis under immunosuppression: Diagnostic challenges and future considerations

Ferhat Yenilmez, Sabrina Fehrmann¹, Aleksandr Sumenko¹, Marcel Roswora¹, Marcellus Fischer¹, Andrea Vanegas Ramirez^1
1Department of Dermatology and Venereology, Military Hospital Hamburg, Hamburg, Germany

Aim: Cutaneous leishmaniasis is caused by infection with Leishmania spp. and causes ulcerations. Due to the diverse manifestations of leishmaniasis in immunosuppressed patients, it can mimic other diseases causing chronic wounds at different sites.

This abstract presents two complex cases of cutaneous leishmaniasis in immunosuppressed patients, highlighting both diagnostic and therapeutic challenges and possible future trends.

Method: The first case involves a 42-year-old man with immunosuppressive treatment who developed a progressive sacral ulcer that was initially misdiagnosed as chronic pilonidal disease. Histology and PCR later confirmed Leishmania infantum infection. Despite initial systemic treatment with liposomal amphotericin B, the lesion worsened, requiring a multimodal approach combining systemic miltefosine, intralesional meglumine antimonate and advanced wound care, which resulted in healing after almost one year. In the second case, a 67-year-old man with insulin-dependent diabetes and psoriasis treated with methotrexate presented with a chronic ulcer on his thigh, initially thought to be a pressure ulcer due to polyneuropathy. Biopsy testing provided a crucial clue to a protozoan infection. Diagnostic tests, including Leishmania IST-PCR and tissue culture, confirmed Leishmania infantum infection. Treatment with liposomal amphotericin B and local paromomycin therapy resulted in significant improvement, although cure was delayed.

Results / Discussion: Both cases highlight the need to consider cutaneous leishmaniasis in patients with a history of travel to endemic regions, particularly those receiving immunosuppressive therapies. Furthermore, with the increasing use of immunosuppressive biological agents for conditions such as autoimmune diseases and skin diseases, the number of cases of cutaneous leishmaniasis in immunosuppressed patients is expected to increase.

 

EP0690 Management of recurrent eumycetoma of the foot: a case of surgical excision and antifungal treatment

Marcel Roswora¹, Ferhat Yenilmez¹, Aleksandr Sumenko¹, Sabrina Fehrmann¹, Andrea Vanegas Ramirez¹, Marcellus Fischer^1
1Department of Dermatology and Venereology, Military Hospital Hamburg, Hamburg, Germany

Aim: Eumycetoma is a chronic, progressive infection characterized by granulomatous inflammation, commonly affecting the skin, subcutaneous tissues, and bones. This case study presents the complex management of a 27-year-old male patient with a recurrent eumycetoma caused by Madurella mycetomatis in both feet. Initially diagnosed in 2019, the patient underwent multiple surgical excisions and antifungal treatments, including itraconazole, terbinafine, and posaconazole. The patient’s condition remained refractory, with recurrent nodules and ulcerations developing on both feet, despite intensive medical and surgical management.

Method: In 2024, the patient was admitted to the Bernhard Nocht Institute of Tropical Medicine in Hamburg for further treatment. MRI imaging revealed a persistent granulomatous lesion (right foot) with involvement of the m. adductor hallucis. Despite treatment with posaconazole, the patient experienced significant clinical deterioration, including the development of a new eumycetoma lesion on the left foot. Surgical excisions were performed on both feet, and histopathology confirmed eumycetoma in both cases. Following the excisions, Madurella mycetomatis was identified as the causative organism through culture and PCR analysis. Due to the lack of response to posaconazole, a switch back to itraconazole was made. Post-surgical management included wound care with VAC therapy and biomatrix grafting, resulting in notable improvement in wound healing.

Results / Discussion: The patient’s treatment course has now extended for more than five years, highlighting the prolonged duration of the disease.

Conclusion: This case emphasizes the challenges of managing eumycetoma and the importance of integrating both surgical and systemic antimycotic approaches for managing persistent mycetomas.

 

EP0691 Evaluation of short-stretch compression safety in patients with ABI < 0.6 or TBI < 0.5

Annette Høgh¹, Emil Cronfelt Vasegaard², Christian Høyer^3
1Dep. of Vascular Surgery, Viborg, Denmark, ²Dep. of Vascular Surgery, Viborg, Denmark, ³Department of Clinical Physiology, Viborg, Denmark

Aim: Compression therapy is commonly used for edema management, but its safety in patients with moderate to severe peripheral arterial disease (PAD) remains uncertain. Guidelines do not recommend compression for patients with an ankle-brachial index (ABI) < 0.6. 

Method: We included 18 limbs from patients undergoing reconstructive surgery or treatment of ischemic wounds, at the Vascular Surgery Department at Regional Hospital Viborg (November 2023-March 2024). Inclusion criteria: ABI < 0.6 or toe-brachial index (TBI) < 0.5. 

Toe pressures (TP), ABI, and TBI were measured before and after short-stretch compression (high working pressure and low resting pressure). Comorbidities, including diabetes, cardiovascular disease, peripheral neuropathy, and kidney insufficiency, were collected from medical records. 

Results / Discussion: The range of the index for the 18 included limbs were: ABI 0.22–0.84, TBI 0.1–0.53. No significant differences were found between compression and no compression for TP (37 vs. 36.8 mmHg, 95% CI: 20.0–44.9 vs. 28.2–45.4, p = 0.95), ABI (0.49 vs. 0.55, 95% CI: 0.38–0.61 vs. 0.46–0.63, p = 0.10), or TBI (0.28 vs. 0.27, 95% CI: 0.22–0.33 vs. 0.21–0.33, p = 0.70). TP changes after compression exceeding 10 mmHg occurred in six limbs (2 increases, 4 decreases). No limbs had TP below 10 mmHg post-compression application. 

Conclusion: Short-stretch compression does not compromise TP, TBI, or ABI in patients with ABI < 0.6 or TBI < 0.5, suggesting it is a safe option for edema management in moderate to severe PAD, potentially enhancing wound healing, reducing hospitalization and improving quality of life. 

 

EP0692 Young Chinese male acquired hybrid advanced wound closure methodology on post necrotizing fasciitis upper dominant limb: Local hospital limb salvage experience from Hong Kong

Lee Hoi Shun ¹, Ka Wai Billy Liu^2
1North District Hospital, Hong Kong, Hong Kong, ²North District Hospital, Hospital Authority, Hong Kong, China

Aim: To illustrate successful hybrid healing journey of post Necrotizing Fasciitis (NF) upper dominant functional limb salvage with medial sural artery perforator (MSAP) flap reconstruction while donor site necrosis healing by biodegradable temporizing matrix (BTM).

Method: Young Chinese male was suffering from dominant hand NF. Uncontrolled infection was identified in dorsum metacarpal region and nearly breached to thenar compartment. Extensive fasciotomy and debridement were performed while all extensor tendons were exposed with intact paratendon. After infection was controlled with targeted antibiotics. MSAP flap was done to seal up defects. Unfortunately, it was complicated with partial dehiscence. Simultaneously, donor site necrosis was managed by BTM application. Negative Pressure Wound Therapy (NPWT) was applied to cope with flap salvage and matrix integration.  Significant clinical outcomes were elucidated by successful flap completely anchorage and granulating tissue prompt proliferation.

Results / Discussion: Wounds were completely healed after two months in patient stay and four months outpatient nurse wound care service follow up. Patient could regain all fingers full range of motion and full grip power after vigorous physiotherapy. There were no readmission and major amputation needed. Application of BTM offers a safe and reliable reconstructive option in patients with complex wounds who are unfit for more complex surgery.

Conclusion: In conclusion, this case study demonstrated the success application of NPWT in flap dehiscence salvage and dermal matrix integration. We have shown that hybrid advanced wound care methodology indeed can be successful in salvaging limbs and reducing risk of major amputation. Besides, utilization of BTM appears robust and is showing promise as a useful reconstructive tool.

 

EP0693 Amputation Following Burn Injury. A case report

Ioannis Katsarelas¹, Alexandra  Panagiotou¹, Panagiotis Nachopoulos¹, Afroditi Faseki¹, Dimitrios Chatzinas¹, Christina Sevva², Eleni Paschou², Panagiota Roulia², Marios Dagher², Vasilis Stergios², Amyntas Giotas³, Konstantinos Papadopoulos², Vasileios Alexandros Karakousis², Athanasios Polychronidis¹, Mohammad Husamieh¹, Georgia Maria Ntoulia¹, Stylianos Mantalovas², Militiadis Chandolias¹, Periklis Dimasis¹, Ismini Kountouri^2
1Department of General Surgery, General Hospital of Katerini, Pieria, Greece, Katerini, Greece, ²Department of General Surgery, 3rd Surgical Department, AHEPA University Hospital, AUTH, Greece, Thessaloniki, Greece, ³Gynecology and Obstetrics Department, General Hospital of Katerini, Pieria, Greece, Katerini, Greece

Aim: The aim of this report is to present the case of a patient that underwent amputation of two toes due to a bilateral 3rd degree burn injury of the foot.

Method: A 48-year-old construction worker presented at the Emergency Department of General Hospital of Katerini in Greece, complaining of foot bilateral 2nd degree burns as a result of contact with pitch. The patient had no previous health issues and received no medication. Upon clinical examination both soles of his feet presented with 2nd degree burns. Initial management included excessive debridement, wash out using 2 liters of saline sterile solution and application of hydrogel burn dressings. The patient was then administered in the Surgical Department for further management. On the 2nd day, the burns had progressed to 3rd degree. Surgical debridement of the necrotic tissue was performed. A Computer tomography scan revealed no narrowed or blocked areas in his leg vessels. On the 4th day of hospitalization, a necrosis of the soft tissues on the 1st and 2nd toe of his left foot was observed and the decision for a surgical intervention was made. During the operation the metatarsals of the 1st and 2nd toe of his left foot were found with necrotic points and were considered non-viable. Both toes were amputated on the surgical table.

Results / Discussion: Amputation following burn injury is a rare complication. Our case report showcases that even 2nd degree burns can result in need of an amputation even in patients with no previous vascular disease.
Conclusion: With our case report we intend to raise vigilance to both surgeons and plastic surgeons regarding this rare complication of 2nd degree burns.

 

EP0780 Successful management of ulcerated hemangioma in a 6-months old female child using combination laser therapy: a case report

Ram Chilgar^1
1Elrevo Clinic, Aurangabad, India

Aim: Ulcerated infantile hemangiomas present a significant therapeutic challenge due to their potential complications. This case report highlights a novel, non-invasive approach utilizing combination laser therapy for the management of a persistent ulcerated hemangioma in a six-month-old female patient.

Methods: The 25 cm² ulcerated hemangioma (5 cm x 5 cm), resistant to surgical debridement, was treated with a combination of RecoSMA and KTP lasers. RecoSMA laser (2.30 J/cm²) was administered weekly to treat the ulcer initially. As improvement plateaued, KTP laser (20.7 J/cm²) was introduced for hemangioma management. A total of 13 RecoSMA and 8 KTP sessions were performed, all on an outpatient basis without anesthesia.

Results: The combination laser therapy led to progressive reduction in ulcer size and depth, with complete healing achieved after 13 weeks of treatment. The therapy was well-tolerated, with no complications or recurrence observed at one-month follow-up.

Conclusion: This case demonstrates that combination laser therapy using RecoSMA and KTP lasers offers an effective and safe treatment for ulcerated hemangiomas. This non-invasive approach provides an alternative to traditional surgical methods, and further studies are recommended to refine treatment protocols for broader clinical application.

 

EP0694 Pressure sores as a complication of intermittent pneumatic compression: A hidden risk in therapy

Esther Barak¹, Irina Babis^1
1Assuta Hospital, Tel Aviv, Israel

Aim: In-depth examination and issuance of intrahospital guidelines to prevent action.  Pressure sores, also known as pressure ulcers, are a significant complication among hospitalized patients, particularly those who are immobile or require prolonged care. Intermittent pneumatic compression (IPC) devices are routinely used to prevent deep vein thrombosis (DVT); however, they have been associated with pressure injuries, especially over bony prominences such as the ankles. Furthermore, IPC devices may lead to less commonly recognized complications, including compartment syndrome and bullous lesions. This study aims to assess the incidence and characteristics of pressure sores related to IPC device use, focusing on ankle lesions.

Method: This retrospective study analysed 13 patients admitted to the intensive care unit.

Results / Discussion: Thirteen patients (6.47%) developed pressure sores on their ankles due to IPC device use. Most patients (46.16%) were classified as ASA 2, indicating moderate systemic disease, and were more vulnerable to pressure injuries in areas of continuous mechanical compression.

Conclusion: Although, IPC devices are effective in preventing DVT, they may lead to pressure sores, particularly in vulnerable areas such as the ankles in critically ill patients. at risk in critical patients. Clinicians should be vigilant about monitoring skin integrity in patients undergoing IPC therapy to prevent this complication and others.

 

EP0782 Real-world experience in the treatment of ulcers with pseudomonas aeruginosa biofilm using medical-grade honey: a case series

Yun-Nan Lin^1
1Wesing Hospital, Kaohsiung City, Taiwan

Aim: Chronic ulcers colonized by Pseudomonas aeruginosa biofilms present significant challenges to wound healing. Medical-grade honey is well-known for its antimicrobial properties, its ability to disrupt biofilms, and its role in promoting wound healing. This case series explores the use of medical-grade honey as a primary treatment for such ulcers.

Method: In this study, six patients with hard-to-heal ulcers, where wound cultures tested positive for Pseudomonas aeruginosa after multiple wound treatments, were treated topically with medical-grade honey. Treatment outcomes were evaluated based on biofilm reduction, wound size, and healing time.

Results / Discussion: Across the cases, medical-grade honey led to a noticeable decrease in exudate, signs of inflammation, and significant wound area reduction, along with enhanced tissue regeneration.

Conclusion: These findings suggest that medical-grade honey may be an effective adjunct therapy for managing Pseudomonas aeruginosa biofilm-associated ulcers, offering a natural antimicrobial alternative to conventional treatments. Further studies with larger patient cohorts are recommended to confirm these observations.

 

EP0695 Management of a complex radio-necrosis injury to the mastoid following treatment of mandibular carcinoma

Inês Mota¹, Roslyn McGinty², David  Ross^2
1University Aveiro, Aveiro, Portugal, ²Plastic Surgery W1, London, United Kingdom

Aim: To describe the surgical and nursing management of an area of radiation-induced ulceration in a complex anatomical region.

Method: This case describes the development and subsequent clinical history of a 79yr old male who developed an area of deep ulceration over the right mastoid, exposing the lateral vertebral column and vertebral artery.  The wound was made more complex due to a middle ear fistula communicating with the wound. 

Results / Discussion:  This patient developed a deep, life-threatening area of soft tissue loss, exposing deep structures.  This led to an arterial “blow out”, and risk of further full thickness soft tissue loss. The wound required a combination of complex therapies including surgery, interventional radiology and topical negative pressure wound therapy.  Intensive wound care was also required.  The clinical course of this patient and their wound is described, along with management strategies for radiation induced injuries.  

Conclusion: Radiation necrosis produces deep, unpredictable wounds that can prove life threatening in the head and neck region. Surgical intervention, along with sustained, intensive nursing care achieved a stable wound that progressed to healing, and a return to activities of daily living.

 

EP0666 Effect of hyperbaric oxygen therapy on burn wound developing after hifem and radiofrequency application

Gülşen Yetiş Buluklu¹, Şule Ülker Küçük^1
1Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey

Aim: We aimed to demonstrate the effect of hyperbaric oxygen treatment (HBOT) on a patient who underwent high-intensity focused electromagnetic field (HIFEM) and radiofrequency (RF) procedure in the gluteal area for fat reducing and shaping purposes and developed deep partial thickness burn due to a malfunction in the device.

Method: The burn wound treated with local wound care and HBOT was followed at regular intervals with lesion size, photographs and epicrisis notes.

Results / Discussion:  At her first visit to our clinic, the 50-year-old female patient had difficulty with daily tasks and basic routines including sitting and lying down due to the lesion being located in the gluteal region and causing pain. The patient stated that there was no improvement in the wound or reduction in the size of the wound despite local care for 2 weeks before applying to our clinic. Following the patient received 6 sessions of HBOT and simultaneous wound care with the debridement creams and foam dressing she had used before, the wound was healed in 20 days. The patient’s pain has completely disappeared.

Conclusion: HBOT is considered as a reliable treatment method that accelerates wound healing in the resistant wounds due to radiofrequency burns. It is recommended to apply with local wound care simultaneously, as it shortens the wound healing time and allows patients to return to their daily tasks.

 

EP0696 Open non-angiosome targeted revascularization and nanotechnology for limb salvage and healing

Jhon Berrio Caicedo¹, Mariana Berrio Quintero^2
1Vascular Surgeon  at Fundacion Hospital San José de Buga, Universidad del Valle,  General Surgery Department Professor, UCEVA, Medicine programe Professor, Buga, Colombia, ²Student Social Services at Fundación Hospital San José de Buga, Buga, Colombia

Aim: To stablish the importance of non-angiosome targeted open revascularization and concomitant nanotechnology ulcer treatment as part of interdisciplinary management in a case with high WIfI score

Method: Descriptive analysis of the evolution of a 55-year-old woman admitted for a wide plantar ulceration, nine points on WIfI score; caused by puncture wound one week before.

Sequestrectomy and tenosynovectomies in metatarsus, placement of subatmospheric pressure system as well as adjustment of medications until both, metabolic and infection control, were achieved.

Arterial peripheral endovascular treatment was ruled out due to failure accessing superficial-femoral because of  chronicity, neither retrograde access was achieved through tibial arteries.

Open non-angiosome targeted revascularization, specifically proximal superficial femoral to popliteal P1 bypass with contralateral inverted great saphenous was performed as the only option for limb salvage since the perfusion to the only patent vessel in the leg, the peroneal artery, could be improved.

Once both, infection and pain at rest, were ruled out; she was discharged to continue outpatient management with application of a polysaccharide nano-membrane on plantar ulcer surface with weekly replacement.

Results / Discussion: Complete closure of the lesion was attained ten weeks later leaving a scar in the center of the sole that does not significantly affect the functionality.

The patient remains free of amputation during six years of follow-up, frequent ultrasonographic studies confirms patency of the autologous graft. Likewise, concomitant coronary and carotid disease remain under control.

Conclusion: The favorable result in this case, suggests that in patients with complicated diabetic foot complementing interdisciplinary treatment with salvage surgery not yet aimed at the compromised angiosoma along with advanced local treatment of ulceration may increase the possibility of limb salvage.

 

EP0662 Wound hygiene strategy to avoid surgery in recurrent mastitis: case report

Montserrat Estévez Atienza^1
1Hospital Sant Pau, Barcelona, Spain

Aim: To evaluate the wound hygiene strategy for recurrent mastitis healing through a case study.
Method: A 33-year-old woman without prior medical history presented five episodes of recurrent mastitis between October 2021 and April 2022, following her breastfeeding cessation. She was treated with various antibiotics and underwent surgery for a breast abscess. A month later, inflammatory signs persisted, with a positive culture for B. fragilis, and a new fistula and wound reopening with purulent drainage occurred. She consulted a wound care specialist nurse, who, suspecting biofilm, implemented the wound hygiene strategy. Treatment included mechanical debridement to remove nonviable tissue and biofilm, application of polyhexamethylene biguanide (PHMB) in soaks, and an antimicrobial alginate dressing.

Results / Discussion: The Wound Hygiene Strategy, through maintenance debridement and antimicrobial dressings, promoted rapid healing. Complete wound closure was achieved in 10 days, thus avoiding further surgery.

Conclusion: The Wound Hygiene Strategy proved to be a key tool in managing a complex wound due to recurrent mastitis. Avoiding re-surgery through this strategy can improve patient quality of life and satisfaction, and future studies are needed to further assess its efficacy. Multidisciplinary care is essential for comprehensive patient-centered wound management.

 

EP0697 Management of a post-surgical retroauricular wound: a multidisciplinary approach

Andrea Di Cesare^1
1A.D.I. Basso Molise - C.S.S. / Home Care Molise, Termoli, Italy

Aim: This case report illustrates the multidisciplinary management of a complex post-surgical wound in an 87-year-old male patient, following excision of a basalioma of the left helix, complicated by fistula formation and squamous cell carcinoma (SCC) infiltration.

Method: After the basalioma excision involving cartilage, no initial recurrence was observed. However, a purulent retroauricular fistula later developed, revealing poorly differentiated SCC infiltrating cervical myofascial structures, including the sternocleidomastoid muscle and carotid space. The patient underwent surgical re-intervention with a skin graft, followed by a home-based wound care protocol. For the first four weeks, specialist-prescribed dressings were applied, followed by the use of an interactive dressing based on sodium hyaluronate and collagen-forming amino acids. This dressing promoted granulation tissue formation and tissue regeneration by modulating the inflammatory process and activating fibroblasts for collagen production.

Results / Discussion: Over a 19-week period, regular wound assessments indicated a progressive reduction in lesion size and significant improvement in tissue quality. The interactive dressing maintained an optimal environment conducive to re-epithelialization, supporting recovery and enhancing the patient’s quality of life. No further neoplastic spread was observed during follow-up.

Conclusion: This case demonstrates the success of a targeted, home-based wound care approach in elderly patients with post-surgical lesions. The interactive dressing played a key role in stimulating tissue regeneration, emphasizing the importance of maintaining an ideal healing environment in managing complex neoplastic wounds.

 

EP0698 Atypical leg ulcers and their requirement for a multidisciplinary team approach

Dennis de Bie^1
1University Medical Center Utrecht, Utrecht, Netherlands

Aim: To describe the treatment of atypical leg ulcers with an enzyme alginogel alginate as part of a multidisciplinary medical approach.

Method: Case reports of 1) a 65-year-old patient with IgM-related cryoglobulinemia ulcers and 2) a 77-year-old woman with a painful leg ulcer due to limited cutaneous systemic sclerosis (lcSSc). Wound photography and the TIME-S model (Tissue, Infection/inflammation, Moisture balance, Edge of wound, and Surrounding skin) were used to evaluate wound healing, with patients’ consent.

Results/ Discussion: The enzyme alginogel treatment was painless, facilitated debridement, and supported self-management, enabling the patients to manage their own wound care. A home nurse monitored wound progress weekly, and the patients visited the outpatient wound clinic every two to three weeks. Despite persisting disease, the ulcers healed within six months.

Conclusion: Extensive diagnostics and a multidisciplinary approach, involving a hematologist, dermatologist, rheumatologist, pathologist, vascular surgeon, and nurse specialists, are crucial for the treatment of atypical leg ulcers. Systemic treatment alongside local treatment with an enzyme alginogel led to successful wound healing. The enzyme alginogel supported the patients’ self-management, was applicable in the use of an ibuprofen-containing secondary dressing, and no local infections occurred.

*Enzyme alginogel known as Flaminal®.

 

EP0787 Therapeutic holistic approach to venous leg ulcers combinig a new monolayer multicomponent compression system and tlc nosf technology

Maria Ângela Gonçalves Rocha de Aragão¹, Nadia Rodríguez Sánchez¹, Iria Suarez Reboreda¹, Manuel Abreu Amor¹, Iria López García¹, Ana Roig Garcia^2
1sergas, Vigo, Spain, ²Urgo Medical, Barcelona, Spain

Aim: To assess the efficacy and healing times of two venous leg ulcers (VLUs) through a therapeutic holistic approach incorporating innovative technologies in a patient with multiple comorbidities. Secondary objectives included achieving patient compliance and comfort towards compression therapy by using a new monolayer multicomponent compression system (CS) and ensuring precise follow-up of both wounds with a novel digital tool.

Method: Patient presenting two VLUs (C6 on the CEAP scale) on the anterior and posterior tibial regions of the right lower limb, with surface areas of 15.41 cm² and 29.05 cm², respectively. Signs of chronic venous insufficiency (CVI) included lipodermatosclerosis and stasis dermatitis. Treatment commenced with a silver poly-absorbent dressing coated with lipido-colloid technology (TLC-Ag) to facilitate debridement and manage infection. With an ITB of 1.18 and positive pulses, a bilayer multicomponent CS was initiated. On day 7, this was switched to a new monolayer multicomponent CS to enhance patient adherence and comfort until wound closure. Following infection resolution, a dressing with TLC and nano-oligosaccharide factor (TLC-NOSF) was used to reduce excess metalloproteinases and promote healing. Lastly, the digital tool enabled systematic documentation of wound characteristics.

Results / Discussion: The combination of TLC-Ag, TLC-NOSF, and monolayer multicomponent CS facilitated wound resolution within 4 weeks, significantly improving the patient’s quality of life. Specifically, the edema reduced 6cm at the calf area and 8.8cm at the tibial region. Additionally, the new monolayer multicomponent CS facilitated compliance to etiological treatment. The digital tool allowed timely adjustments to the treatment protocol based on real-time data.

Conclusion: Recommended and tailored treatments led to rapid healing of challenging wounds, while the digital tool enhanced clinical decision-making and patient management.

 

EP0764 A Danish database on people with diabetes and their foot status ensures quality in transitions and research

Lea Stentoft  Berling ¹, Christina Ystrøm Bjerge¹, Birgitte Silkjær^1
1The Association of Danish Podiatrists, Danish Regions, Copenhagen, Denmark

Aim: The Diabetic Foot-Status Database (DFSD) aims to enhance the quality of care for people with diabetes by facilitating the exchange of clinical foot health information between healthcare professionals. It also supports research into diabetic foot complications, leading to improved outcomes and quality of life for patients.

Method: The DFSD collects annual clinical data from over 130,000 patients with diabetes in Denmark. Primary podiatrists in the patients’ local environment perform comprehensive foot examinations in accordance with international guidelines, assessing neuropathy (biothesiometer, monofilament, heat/cold sense, position sense), vascular health, foot deformities, adipose tissue atrophy, joint mobility, wounds, amputations, and footwear. Since 2011, the database has compiled over 850,000 examinations.

Results / Discussion: The DFSD facilitates continuous transitions of care by enabling healthcare professionals to share foot health information. General practitioners automatically receive examination summaries, and both podiatrists and hospitals can access and download relevant data. The database also serves as a valuable resource for research, supporting studies on diabetic foot complications, which can reduce the incidence of serious conditions such as foot ulcers and amputations, ultimately enhancing patient care.

Conclusion: The DFSD improves both clinical care and research concerning diabetic foot health in Denmark. By ensuring continuity of care and enabling evidence-based research, the database helps reduce foot complications in people with diabetes, thereby enhancing their quality of life.

 

EP0699 A daily cleansing-moisturising routine for maintaining skin integrity in aged care residents: a case study

Sharon Meere¹, Dalibor Mijaljica¹, Joshua Townley¹, Maria Nguyen², Yenny Cheung², Wendy Chow², Sandra Brown¹, Fabrizio Spada¹, Mikayla Lai^1
1Ego Pharmaceuticals Pty Ltd, Braeside, Australia, ²OLC Care, Rocky Point Residence, Beverly Park, Australia

Aim: To evaluate the effect of a daily cleansing-moisturising routine on the presence of five underlying skin integrity parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries among aged care residents.

Method: This small, 6-week evaluation study included four aged care residents over 80 years of age. Skin assessment for the presence of five underlying clinical parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries was conducted at baseline and during the evaluation period. Furthermore, clinical notes and photographs were taken at baseline and after 2–3 weeks of the cleansing-moisturising routine comprised of soap-free pH-balanced cleansers and skin-friendly moisturisers.

Results / Discussion: Of the four individuals who participated in this evaluation study, all four showed overall improvement in appearance of skin with a reduction in severity of five underlying skin integrity parameters, where present. Age-related skin changes affect skin’s structural and functional integrity, and reduce the ability of the skin to perform its key barrier functions. Skin breakdown and damage associated with dryness and itch becomes a very common and increasing risk. Thus keeping skin healthy involves a regimen of cleansing and the application of moisturisers to ensure consistency in the prevention and management of skin dryness, itchiness and skin injuries.

Conclusion: This case study has produced basic evidence to support a daily cleansing-moisturising routine as it provides cleansing, moisturising and protective benefits to the delicate and fragile skin of aged care residents where the aim is to reduce skin integrity associated issues.

 

EP0700 Bolstering skin integrity in older adults

Dalibor Mijaljica¹, Sharon Meere¹, Emily Archer², Joshua Townley¹, Fabrizio Spada¹, Mikayla Lai^1
1Ego Pharmaceuticals Pty Ltd, Braeside, Australia, ²Barossa Hills Fleurieu Local Health Network (BHFLHN), South Australia Health, Strathalbyn, Australia

Aim: To implement and evaluate the Skin Integrity Improvement Program (SIIP) involving daily skin cleansing and a twice-daily moisturising routine in residential aged care facilities to help improve skin integrity issues.

Method: Over a period of 12 weeks, the SIIP was implemented across 5 residential aged care facilities. 46 residents met the inclusion criteria and were prone to, or presented with one or more of the following skin integrity issues – pressure injuries, skin tears, cellulitis, lower leg ulcers, dry/fragile skin, itchy skin, excoriation and incontinence-associated dermatitis (IAD). A specific skin-friendly and soap-free cleanser was used once daily when the residents showered. To moisturise, a specific moisturiser characterised by gentle skin properties was applied to affected skin areas twice a day.

Results / Discussion: At baseline, the 46 residents were prone to, or presented with a total of 58 skin integrity issues. After the 12 week program the presence of skin integrity issues was reduced to a total of 15. While the presence of pressure injuries remained static (6 residents had a pressure injury), only 1 resident had a skin tear or cellulitis, respectively; 4 residents had dry/fragile skin; and 3 residents had excoriation. No residents had lower leg ulcers, itchy skin or IAD.

Conclusion: Implementation of the SIIP involving daily skin cleansing and twice-daily moisturising in residential aged care facilities was shown to substantially improve skin integrity in older people over 12 weeks. As skin ages it is more susceptible to damage, breakdown and injury, thus maintaining skin integrity is essential in maintaining skin health.

 

EP0802 Application of local oxygen therapy in a patient with a non-healing wound. Case report

Nina Debelić¹, Karlo Novačić¹, Tamara Sinožić^2
1Poliklinika VeNeS, zagreb, Croatia, ²Specijalistička Ordinacija Obiteljske Medicine, Department of Fammily Medicine, Faculty of Medicine University of Rijeka, Moščenička Draga, Croatia

Aim: To present the outcome of local oxygen therapy in a patient with a recurrent lower leg wound.

Method: A 47-year-old patient presented with a chronic wound along the lateral malleolus of the left lower leg, persisting for 4 months. Initial treatment involved wound dressings and compression stockings, but no signs of healing were observed. The patient has post-thrombotic syndrome. Duplex ultrasound revealed a patent stent, along with reflux in the great saphenous vein (GSV) and varicose branches. The wound measured 2.5 x 4.0 cm, with fibrin in the wound bed, irregular edges, heavy exudate, maceration, and severe pain Visual analog score (VAS): 10. Endovenous laser ablation of the GSV and varicose branches was performed. A wound dressing and multi-layer short stretch bandages were applied. However, after 4 weeks without significant improvement, local oxygen therapy was initiated.

Results / Discussion: Local oxygen therapy was administered by delivering pure humidified oxygen directly to the wound using a single-stage oxygen delivery system under aseptic conditions. After 10 days, the wound bed exhibited granulation tissue, moderate exudate, reduced sensitivity in the surrounding skin, and pain decreased (VAS score: 6). After 9 weeks, the wound had completely healed, and there was no recurrence within a 6-month follow-up period.

Conclusion: The combination of local oxygen therapy, appropriate wound care, compression therapy, and endovenous procedures facilitated wound healing by accelerating the process, reducing pain, enhancing patient adherence, and improving overall quality of life

 

EP0774 The use of advanced wound healing support therapies in the management of wounds following breast augmentation. Case study

Bartosz Ziemiecki¹, Anna Daudzward¹, Karolina Kruszewska^2
1Podos Wound Care Clinic, Warsaw, Poland, ²Medical University of Warsaw, Warsaw, Poland

Aim: The objective of this evaluation is to discuss the case study of a patient with a wound on the right breast in the infra-mammary fold after a breast augmentation procedure with a round implant. The wound has been treated using modern therapies supporting wound healing such as: medications containing hyaluronic acid and amino acids in form of powder and injection, an absorbable calcium sulfate antibiotic carrier, fibrin fractions from the patient’s blood: Injectable Platelet Rich Fibrin (I-PRF), Split-thickness Skin Graft (STSG) and Negative Pressure Wound Therapy (NPWT).

Method: The case was conducted using the TIME method from the beginning on a 70 year old woman. Various approaches were employed such as systematic debridement and cleaning of the wound bed, targeted antibiotic therapy, negative pressure wound therapy and skin grafting. Before skin grafting the wound bed was prepared with hyaluronic acid and amino acid powder and epithelialization was supported with hyaluronic acid and amino acids in the form of an injectable solution and I-PRF. Subcutaneous fistulas were closed with a calcium sulfate-based antibiotic implant.

Results / Discussion: Local application of medications containing hyaluronic acid and amino acids and the use of advaced therapeutic methods supporting the process of wound healing, achieved almost complete healing of the wound. Our results have shown that the various modern approaches of the localised treatment result in a beneficial effect on wound cleansing, granulation and epitalialization, additionally reducing wound healing time.

Conclusion: The use of advanced wound healing support therapies in the management of wounds following breast augmentation can shorten process of healing wounds. Consequently reducing treatment costs, achieve the most aesthetic effect and improving the quality of life.

 

EP0701 Easy to use and economic benefits of an enzyme alginogel; A case series

Sandra Janssen¹, Jennifer Reijntjens^1
1Elkerliek Hospital, Helmond, Netherlands

Aim: To explore the ease of use of an enzyme alginogel with patients of different ages. To report experiences of the patients who performed the dressing changes by themselves. Lastly,  also cost savings are  considered.

Method: A case series of four patients using an enzyme alginogel for wounds with different etiologies, at home, was collected. Patients did get instructions for use from the health care professional and performed the dressing changes themselves at home. Wound healing time was noted. Easiness of use of the enzyme alginogel and the level of comfort with doing the dressing changes themselves  were discussed with the patients at every outpatient clinic visit. Differences in costs were calculated.

Results / Discussion: Four patients, two young and two elderly patients, were included and shared their experiences. All four patients experienced the enzyme alginogel as very easy to apply and to remove. None of the patients reported pain during and in between dressing changes. All four patients indicated that they could perform the dressing changes by themselves and that they did not require home care assistance.

Conclusion: An enzyme alginogel is a valuable treatment option for patients with wounds of different etiologies. Our patients were able to perform the dressing changes by themselves at the home of the patient. This resulted in reduced healthcare costs and a higher sense of self.

 

EP0702 Chemical scalp burn after hair coloring - case report with literature review

Natalia Welc¹, Sandra Wazniewicz¹, Aleksandra Aniola¹, Paulina Sobkowiak², Malgorzata Wilawer², Magdalena Jalowska¹, Ryszard Żaba^1
1Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland, ²Poznan University of Medical Sciences, Poznan, Poland

Aim: Hair dyeing is performed widely around the world. Substances in brightening and coloring products may contribute to chemical burns. The study aimed to describe the case of a chemical burn resulting from hair dyeing, to present an overview of the literature on similar cases, and the composition of hair dyes, their mechanism of action and the process of burn formation.

Method: A 17-year-old female presented with a deep ulceration on the parieto-occipital part of the scalp. A 13x10 cm ulcer had a bottom covered with necrotic masses and purulent contents. General and local treatment was applied, with emphasis on specialized dressings. Subsequent care was continued for 11 months on an outpatient basis. Currently, the patient awaits surgical treatment with an expander followed by an excision of the scarred area.

Results / Discussion: H2O2 concentrations higher than 10% create a particularly high risk of chemical burn. Direct contact of oxidizing substances with the skin causes coagulative necrosis. Treatment includes local glucocorticosteroids and disinfectants, and antibiotherapy in the case of bacterial superinfection of the wound. Skin grafts and hair follicle transplantation are also used. Only several cases of hair dye burns have been described.

Conclusion: Our patient suffered from the most extensive ulceration after a chemical burn with hair dye described in the literature. Maximal caution is needed while performing hair coloring as severe complications might follow. The diagnostics and treatment demand a multidisciplinary effort, with ongoing patient-doctor cooperation, which may complicate and span several months.

 

EP0703 Thinking outside of the box: Advanced Venous disease in the IV drug user and the use of therapeutic levels of compression

Maree Healy¹, Mary Costello^2
1HSE Midlands Regional Hospital Tullamore, Tullamore, Offaly, Ireland, ²HSE Laois/ Offaly PHN Service, Laois/ Offaly, Ireland

Aim: To explore the relationship between appropriate levels of compression therapy in an Intravenous drug user (IVDU) presenting with venous insufficiency and associated wound complications

Method: A case study was conducted on a 42year old female who presented with bilateral lower limb ulcerations ongoing since 2016 (7 years). Compression therapy was applied using a combination of Unna boot with compression hosiery over a 14 week period until complete healing was achieved. Outcomes were measured through clinical assessment, patient reported pain and ulcer healing.

Results / Discussion: The result indicated that while compression therapy is the cornerstone for management of venous hypertension and oedema, strong compression is shown to reduce the presence of pro-inflammatory cytokines and create an increase in anti-inflammatory cytokines. Oftentimes advanced wound care products are advocated particularly when optimal levels of compression fail to heal a wound. Higher levels of compression need to be considered for this cohort of patient, with this patient transitioning to Class III compression hosiery for maintenance.

Conclusion: Treating venous leg ulcers in the IVDU population is complex and multifactorial. This case study highlights the importance of tailoring compression therapy to the specific needs of the IVDU person while considering factors such as the severity of the venous insufficiency and the potential for complications. This case study highlights how higher levels of compression maybe beneficial in improving outcomes for this vulnerable group, although further research would be beneficial on a greater cohort of patients exploring long term outcomes including adherence to compression therapy to fully inform best practice.

 

EP0765 Development of clinical practice guideline by adaptation: Diabetic foot care

Kyung Hee Park^1
1The University of Suwon, Hwaseong-si, Gyeonggi-do, Dem. People’s Rep. of Korea

Aim: This study was done to use a guideline adaptation process to develop a Korean evidence-based diabetic foot care clinical practice guideline for diabetic foot prevention and management.

Method: The guideline adaptation process was conducted according to the guideline adaptation manual developed by the National Evidence-Based Healthcare Collaborating Agency. The process consists of three main phases, with 9 modules including a total of 23 steps.

Results / Discussion: The newly developed diabetic foot care clinical practice guideline consisted of an introduction, description of diabetic foot, summary of recommendations, recommendations, references, appendices, and glossary. There were 165 recommendations in 4 sections (risk assessment for diabetic foot ulcers, prevention of diabetic foot ulcers, wound assessment of diabetic foot ulcers, and management of the diabetic foot). In grading by recommendations, for A there were 30 (18.2%), B, 8 (4.8%), C, 30 (18.2%) D, 97 (58.8%).

Conclusion: This guideline can be used as educational material for healthcare workers and diabetic patients. It can also be utilized as a practice guideline for healthcare workers in the hospital and community setting.

 

EP0775 Using biocellulose to treat suspected pemphigus in a pediatric patient

Camila Safranski¹, Dioney Neves^1
1Missner, Blumenau, Brazil

Aim: This study explores the potential of biocellulose as a supportive treatment option for managing suspected pemphigus in pediatric patients.

Method: A 7-year-old child presenting with clinical symptoms indicative of pemphigus was selected for treatment with biocellulose dressings. These dressings were applied to the affected areas to provide a protective barrier and facilitate healing. The treatment protocol included regular dressing changes and monitoring of the child’s skin condition to assess symptom relief and healing rates.

Results / Discussion: The application of biocellulose led to significant improvements in wound healing, with a marked reduction in blister formation and reported pain relief. Additionally, the use of biocellulose decreased the child’s length of hospital stay, thus reducing the risk of hospital-acquired infections. Biocellulose’s properties—maintaining an ideal microclimate for healing, reducing pain, and ensuring comfort—along with its high biocompatibility and adaptability to mucosal surfaces, created an optimal healing environment. Throughout treatment, no adverse reactions were observed, emphasizing the safety of biocellulose for pediatric use. This highlights its potential as a viable option for managing pemphigus lesions, particularly in children.

Conclusion: This study suggests that biocellulose is an effective and safe treatment for pemphigus in a pediatric patient. The findings warrant further research into biocellulose’s applications in dermatological conditions for vulnerable populations, aiming to quantify long-term benefits and establish standardized protocols for similar cases.

 

EP0788 Utilizing transforming powder dressing on chronic venous leg ulcers refractory to standard of care management: outcomes of three patients

Christina Megal^1
1Medical College of Wisconsin, Milwaukee, United States

Aim: This case series describes the outcomes of 3 patients with chronic VLUs and multiple comorbidities who were transitioned to a novel transforming powder dressing (TPD) after no significant improvements with commonly used standard of care (SOC) wound dressings for several months.

Method: Three patients with wounds refractory to SOC treatments (various modalities including hydrogels and other dressings with broad spectrum antimicrobial properties in conjunction with compression therapy) were transitioned to TPD. TPD was applied to the wound and “topped off” (additional powder sprinkled on existing TPD matrix) or reapplied weekly, followed by compression, in an outpatient wound clinic. The type of compression utilized for each patient before and after implementing TPD was not changed.

Results / Discussion: Three patients [mean age 68.3 years (range 60-74), 33% female] with chronic VLUs refractory to SOC were followed. Duration of VLU ranged from 4 to 9 months prior to initiation of TPD. Average wound area was 2.6 cm2 (range: 1 -4.6 cm2) when TPD was first applied. All wounds epithelialized within 6 weeks of first TPD application [Patient 1: 6 weeks (3 TPD applications, 1 top off); Patient 2: 5 weeks (4 applications, 1 top off); Patient 3: 6 weeks (3 applications, 3 top offs).

Conclusion: Despite quality SOC for VLU for several months, there was no significant improvement for these 3 patients. Once converted to TPD, all wounds epithelialized within 6 weeks with reduced frequency of dressing changes versus SOC. TPD was well tolerated under compression, and no complications were observed. TPD should be considered for treatment of VLUs in addition to standard compression.

 

EP0650 Case report: successful treatment of wound healing after composite graft for fingertip amputation with hyperbaric oxygen therapy (HBOT)

Na Young-cheon¹, Hyemi Lee¹, Choonsoo KIM¹, Seoul Lee^2
1Wonkwang University Hospital, Iksan, Rep. of South Korea, ²Wonkwang University, Iksan, Rep. of South Korea

Aim: Hyperbaric Oxygen Therapy (HBOT) is the system used 100% inspired oxygen at optimal high pressure, providing the amount of oxygen to plasma. There are still many controversies about the effectiveness of HBOT for composite grafts or replantation of complex tissues such as fingertips. We would like to report on the successful results of fingertip replantation using HBOT after the composite graft this year.

Method: A 48-year-old male patient visited the emergency room an hour after injuring the left fourth fingertip with pruning scissors. The fingertip was completely amputation state and the stump was volar cross-section, about 1.5cm x 1cm size including nail (Figure 1). A 6-0 nylon sutures were performed as a composite graft. HBOT was started at 2nd postoperative day and 100% oxygen was applied for 128 minutes at a pressure of 2.4 ATA in a multi-person chamber twice a day for 14 days.

Results: On 7th and 14th postoperative day, we found revascularization through puncture using needle and the digit changed slightly to pink, the sign of healing. On 28th postoperative day, the fingertip was completely healed with pink color, and capillary refill time was fine within 2 seconds (Figure 2). During HBOT, there was no sign of complications like aggravation of sinusitis or barotrauma of the ear.

Conclusion: We found the possibility of effectiveness when HBOT was applied to completely amputation of the finger belonging to acute trauma through this case. Therefore, HBOT can be one of the helpful treatment to acute trauma patient after composite graft or replantation.

Figure 1.

 

Figure 2.

 

EP0704 Experience in Caring for a lung cancer patients with skin ulcer after targeted therapy

Yi-Ching  Chen ^1
1Cathay General Hospital, Taipei, Taiwan

Aim: Targeted therapy is a common cancer treatment but often leads to skin toxicity, which, when severe, may require the discontinuation of treatment, thus affecting disease control. A 57-year-old female patient with lung adenocarcinoma developed skin ulcers on the right buttock (25x15 cm²) and left buttock (22x15 cm²), which was diagnosed by the physician as a side effect of the targeted therapy. According to the NCI-CTCAE v5.0 grading system, this was classified as Grade 4 toxicity, leading to a temporary cessation of the targeted therapy.

Method: Using the TIME framework for wound assessment, the patient’s pain was rated at 10/10, and the wound bed exhibited yellow-green exudate. Intravenous antibiotics and analgesics were administered based on bacterial culture results, and Sulfadiazine Silver cream was applied for wound dressing. Once the infection stabilized, the dressing was changed to Hydrofiber Ag, with weekly assessments over a 5-week period.

Results / Discussion: The wound beds were clean and free of infection, with the right buttock wound fully epithelialized and the left wounds measuring 1.5x5 cm² and 3x3 cm². Overall, wound healing reached 97%, and pain levels decreased from 10 to 0. The patient also resumed treatment for lung adenocarcinoma.

Conclusion: Although targeted therapy is highly specific, it cannot completely eliminate the risk of side effects. Through careful observation, assessment, and effective wound care techniques, the impact and discomfort associated with skin toxicities can be significantly reduced, thus maintaining the patient’s quality of life.

 

EP0705 Nursing experience for a middle-aged woman with intellectual disabilities, hearing impairment, and breast cancer complicated by fungating wound

Yi-Ching  Chen ^1
1Cathay General Hospital, Taipei, Taiwan

Aim: This article discusses the nursing experience of a middle-aged woman with multiple health challenges, including intellectual disabilities, hearing impairment, breast cancer metastasis, and a fungating wound on her right breast. The complexity of her condition required daily assistance from her caregiver, leading to anxiety and uncertainty about managing symptoms such as wound bleeding, foul odor, excessive exudate, and skin infiltration.

Method: Hospitalization was initiated to address these challenges, and considering the preference for home care, the choice of L-Mesitran Ointment was driven by its antibacterial, debridement, and malodour-reduce properties. The nurse implemented a comprehensive wound care procedure involving saline cleansing, L-Mesitran Ointment application, gauze packing, and adhesive tape fixation. Patient education played a pivotal role, with a focus on the correct wound dressing procedure.

Results / Discussion: The primary caregiver demonstratied understanding through return demonstration. Before discharge, the patient complied with chemotherapy, effectively controlling the right breast wound with no bleeding, odor, and reduced exudate. Subsequent outpatient follow-ups showed a reduction in wound size from 4x4x6cm to 3.5x3.5x4cm, a decrease in gauze packing from 2 to 1 piece, and alleviation of symptoms related to the fungating wound.

Conclusion: The family experienced a decreased burden in wound care responsibilities, contributing to an overall improvement in their quality of life. This case underscores the importance of tailored nursing interventions, patient education, and family support in managing complex health issues and enhancing the well-being of individuals with intellectual disabilities and severe medical conditions.

 

EP0706 The role of medical-grade honey as a debriding agent in preparing post-debridement necrotizing fasciitis wound closure – a case report

Nadiya Hamzah¹, Kimberly Anne Mei Ho^1
1Miri General Hospital, Miri, Malaysia

Aim: To demonstrate the efficacy of medical-grade honey as a debriding agent in optimizing the wound bed for optimal wound closure.

Method: A diabetic patient presented with necrotizing fasciitis involving the cervical, thorax and abdominal regions, underwent extensive wound debridement in our hospital. Post-operatively, medical-grade honey was used as a primary dressing, followed by non-adherent absorbent dressing as the secondary dressing. The wound was reassessed every 3 days using TIME framework and exudate was managed by outer layer dressing changes twice daily for the first week, then subsequently daily.

Results / Discussion: When dealing with a wound that consists of large amount of non-viable tissue, it is crucial to select appropriate dressing that can address this problem effectively. The use of medical-grade honey supports the goal of wound bed preparation by managing necrotic tissues, exudate and bacterial bioburden as well as provide a moist healing environment that fosters granulation and epithelization. In this case, we are able to achieve approximately >90% granulation tissue within 4 weeks. No further surgical wound debridement in the operating theatre was required before proceeding with secondary suturing and split skin grafting at day-29 post-extensive wound debridement, which reduces operative- and anaesthesia-related morbidity besides being cost-effective.

Conclusion: Medical-grade honey is a safe and effective debriding agent which possesses a multifactorial antimicrobial property. Its use hastens the process of wound healing by optimizing the wound bed preparation and should be considered as an alternative option for wound management in patients who have contraindications or not suitable for surgical debridement.

 

EP0776 Use of polylactic acid (pla) dressings compared to cadaveric skin grafts in the treatment of full-thickness burns. Histological analysis

Ana Lorena Novoa-Moreno¹, Jose Ramirez-Garcialuna², Mario Aurelio Martínez-Jimenez³, Olga Jhonson-Ponce³, Víctor Manuel Loza González^3
1Facultad de Medicina - Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ²McGill University, Montreal, Canada, ³Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, Mexico

Aim: To compare the macroscopic and histological effects on the healing process in a patient with a full-thickness burn treated with cadaveric skin grafts, or allografts, and polylactic acid (PLA) dressings, using a split-plot approach.

Method: A patient with a full-thickness burn covering 54.6 cm², with no evidence of infection or systemic inflammatory response syndrome, was selected for the study. Surgical debridement of the burn area was performed, followed by the application of allograft on one side and PLA dressings on the other. Biopsies were taken at three time points: day 0, day 7, and day 21 post-treatment. Samples were collected from the areas treated with both cadaveric skin grafts and PLA dressings, as well as from a control area treated conservatively, without any advanced interventions.

Results / Discussion: By day 7, a significant improvement in healing was observed in the proximal area of the leg, with continuous progress up to day 21, reaching the foot. As a result of this progress, the patient was deemed no longer a candidate for autologous grafting. Histological analysis of the PLA-treated area showed reduced inflammation, an increased number of fibroblasts, and a more organized progression of keratinocytes. In contrast, the allograft-treated side exhibited more blood vessels and a thicker, although disorganized, layer of keratinocytes. In all three areas, myxoid edema in the dermis and collagen degradation were noted.

Conclusion: PLA dressings seem to promote greater fibroblast proliferation by day 7 and more organized re-epithelialization by day 21. Further studies involving a larger patient population are needed to confirm whether PLA dressings offer significant advantages over other interventions.

 

EP0777 Process description of the application of polylactic acid (PLA) membranes in children with facial burns

Ana Lorena Novoa-Moreno¹, Jose Ramirez-Garcialuna², Mario Aurelio Martínez-Jimenez³, Víctor Manuel Loza González⁴, Natalia Sanchez-Olivo^1
1Facultad de Medicina - Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ²McGill University, Montreal, Canada, ³Hospital Central “Dr Ignacio Morones Prieto”, San Luis Potosí, Mexico, ⁴Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí, Mexico

Aim: To describe the process to achieve effectiveness between adherence and degradation of polylactic acid (PLA) membranes in pediatric patients with facial burns, for safe outpatient management with minimal wound manipulation.

Method: A descriptive study was conducted using PLA membranes in pediatric patients under 15 years old presenting with facial burns due to scalding or direct fire exposure admitted through the emergency department. The care process was as follows: 1) Debridement of the burn was performed using gauze and saline solution, with prior pain management using analgesics; 2) The PLA membrane was trimmed to fit the wound size; 3) The membrane was applied directly, stretching its edges; 4) Gentle pressure was applied until adherence was achieved, leaving the membrane without any external dressing nor bandages; 5) The patient was discharged after 72 hours, once pain relief was observed; 6) Follow-up was conducted weekly in outpatient clinics until complete wound closure, evaluating the progressive degradation of the PLA membrane.

Results / Discussion: Applying PLA membranes in this manner has demonstrated several benefits, including reduced manipulation, promotion of proper wound healing, decreased infection risk, and improved pain management. As the membrane becomes translucent over time, it allows real-time monitoring of the healing process without the need to remove it, and no external dressings or bandages are required, making it more comfortable for the patient.

Conclusion: The use of PLA membranes in pediatric patients with facial burns has proven to be a comfortable and beneficial treatment when applied appropriately.

 

EP0651 Use of biodegradable temporising matrix (BTM) in complex foot ulcers

Saskia Schwarzer^{1 2}, Prashanth Gunanayagam³, Vanessa Irvine³, Tabby Ahmad^{2 3
1}Liverpool High Risk Foot Service, South Western Sydney Local Health District, Sydney, Australia, ²South West Sydney Limb Preservation and Wound Research, Sydney, Australia, ³Department of Vascular Surgery, Liverpool Hospital, Sydney, Australia

Aim: Diabetes related foot ulcers often result in infections which may necessitate debridement and amputation. These can often result in large tissue deficits that are challenging to heal, and represent opportunity for new infections.

Method: Biodegradable Temporising Matrix (BTM) is a synthetic biocompatible device for facilitating the dermis to grow within a polyurethane matrix. Its use within diabetic foot is a novel and developing. Presented a case series of complex foot and leg debridement and amputation sites, that were at risk of major limb amputation.

Results / Discussion: Presented are case studies on the use of BTM in complex foot and leg debridement’s, which otherwise would have progressed to major limb amputation. Case 1 is a man with DM, significant PAD, end stage renal failure on hemodialysis with necrosis, exposed metatarsal bone shaft and amputation of 1-3 digits. Demonstrated is progression to complete wound healing. Case 2 is a wound over the dorsal ankle with exposed tendon, present for 8 months. Medical history includes DM, severe PVD, Stage 4 ESRD. Demonstrated progression to wound healing. Case 3 is extensive necrosis and debridement of entire medial ankle and lower limb including exposure of deep structures such as tendon, bone and fascia. Demonstrated progression to wound healing.

Conclusion: This case series reflects the use of BTM in ‘last resort’ cases of complex diabetes related foot disease. This demonstrates the use of BTM in complex DFI and surgical site wounds to facilitate wound healing. This can be safely used as an adjunct therapy for managing complex wounds within both the inpatient and outpatient setting.

 

EP0707 Using a silicone based dressing as a primary contact layer in an unstageable facial pressure injury - a case report

Kimberly Anne Mei Ho¹, Nadiya Hamzah^1
1Miri Hospital, Miri, Malaysia

Aim: To demonstrate the cost efficiency and efficacy of silicone contact layer in not only accelerating the healing of an unstageable facial pressure injury, but also providing an optimal environment for healing.

Method: An obese patient who sustained a facial pressure injury (unstageable) during a 7-hour long operation in prone position was referred to us. Wound cleansing done, silicone contact layer applied, followed by a secondary dressing (gauze). Patient was instructed to change the gauze daily. For the first 3 weeks, wound was meticulously assessed and dressings were changed maximally twice a week.

Results / Discussion: This dressing is relatively biologically inert. Besides being gentle and soothing to the wound, it doesn’t disrupt the integrity of the surrounding healthy tissue thus helps protect periwound skin from maceration. It moulds itself to the wound bed but doesn’t adhere tightly on it, which helps preserve new granulation tissue when the dressing is removed. The open mesh allows exudate from wound to transfer vertically to the absorbent secondary dressing (gauze). Due to its transparency, assessment can be done without disturbing the dressing, thus avoiding the interruption of the healing process. Patient was able to change the secondary dressing independently with ease without disturbing the primary dressing. It’s cost saving as well – the same dressing can be kept for as long as 7 days. Our goal for full epithelization was achieved within 8 weeks with no other complications noted.

Conclusion: By using this dressing, it not only quickens the process of wound healing but is cost savvy as well.

 

EP0708 New strategy in the treatment of long-standing non-healing wounds of the feet

Mike Steele¹, Roksana Zdanek², Jane Thinggaard Knudsen^3
1Smith Nephew, Watford, Zimbabwe, ²Olso Kommune, Oslo, Norway, ³Smith+Nephew, Watford, United Kingdom

Aim: To improve the life of a 71-year-old man with non-healing foot and toe wounds through infection management and a reduction in wound care visits. A variety of treatments (including compression therapy) have been used previously over a total 13 years with variable dressing changes up to seven times per week. Previous medical history includes cerebral palsy, BMI of 32, venous insufficiency and wheelchair dependency.

Method: Wound assessment prior to treatment reported inflammation, high exudate level, oedema, and yellow/green slough. A cadexomer dressing was applied for two weeks followed by single use negative pressure wound therapy (sNPWT) in total 8 weeks with intermittent use of an antimicrobial barrier dressing.

Results / Discussion: Dressing changes reduced from daily to three times a week. Visually the wound bed was clean with a reduction in signs of infection during the first two weeks of the new treatment. Subsequent sNPWT saw further markers of healing with dressing changes reducing to two times per week.

Conclusion: Full healing was not expected but was achieved after a total 12 weeks of the new treatment strategy. During the treatment the patient had improved psychological well-being as the wounds had caused considerable uncertainty with resulting depression.

*Brand names - IODOFLEX™ Cadexomer Iodine dressing - Acticoat™ FLEX 3 Antimicrobial Barrier Dressing - PICO™ 7 Single Use Negative Pressure Wound Therapy System

™Trademark of Smith+Nephew. All Trademarks acknowledged. © October 2024 Smith+Nephew (45826) UKINOR

 

EP0709 Hidradenitis suppurativa, Hurley stage 3, Case study

Slađana Đokić¹, Elvis Begić^1
1University Medical Centre Ljubljana, Ljubljana, Slovenia

Aim: To investigate the challenges in post operative wound care and management of Hidradenitis Suppurativa (HS) and its impact on patients quality of life.

Method: A case study was conducted involving ten patients with Hurley stage 3 HS after the operation of painful lumps and abscesses. Post-surgical care included key steps such as changing the alginate dressing for a hydro fiber dressing with silver on the first or second day after surgery. Patients were encouraged to engage in gentle exercises while avoiding heavy exertion. By the fourth or fifth day, they showered with lukewarm water at least once per day, applying hydro fibre with silver dressing after for the first week after the operating procedure. If fibrin or biofilm was present, an activated charcoal and silver dressing was applied.

Results / Discussion: In all ten patients with Hurley stage 3 HS, we observed a gradual start of reduction in wound size area after a period of 14 days. Absence of odour was also immediately noticed in every patient in the first days after the procedure. Low to moderate pain intensity was reported during daily dressing changes. Use of hydro fibre with silver dressings was prolonged for several days on patients with wounds in the anogenital area.

Conclusion: Use of our internal protocol has proven as adequately effective at managing post operative wounds and preventing complications during the wound healing period. Furthermore, the patients quality of life was also positively impacted with simplicity of care and with beneficial effects in dressing change pain moderation.

 

EP0766 Carboxytherapy as a supportive therapy in healing and reduction of diabetic foot ulcers recurrence - A case report

Jadranka Kovačević¹, Juraj Sinožić², Fran Peršić², Tamara Sinožić^3
1Family Medicine Specialists Office Tamara Sinožić, Mošćenička Draga, Croatia, ²Faculty of Medicine, University of Rijeka, Rijeka, Croatia, ³Department of Family Medicine, University of Rijeka, Rijeka, Croatia

Aim: Nearly half of the patients with diabetic foot ulcers (DFU) have peripheral artery disease (PAD) which is significantly associated with the increased risk of adverse limb events and amputation. The treatment period is challenging, and the recurrence rate of DFUs is high. Carboxytherapy is a supportive therapy in wound management.  It is conducted by cutaneous and subcutaneous injection of medical carbon dioxide (CO₂) of 99% purity. The primary effect is vasodilatation and correction of tissue hypoxia due to the Bohr effect. With its effects on vascular endothelial growth factor (VEGF) it stimulates neo-angiogenesis and fibroblast collagen synthesis consequently leading to better wound healing. Aim is to present a case of an effective  carboxytherapy  healing and reduction of recurrence of DFU.

Method: 85 year old male patient, suffers from diabetes, arterial hypertension and PAD. Due to circulatory complications left lower leg was amputated 4 years ago. Patient wears a lower leg prosthesis and walks with the help of crutch. Recurrent wounds on the right foot have been appearing for the last 4 years. Findings showed ABI right < 0.5 and TBI 0.46. Topical therapy with wound dressings was performed twice a week, simultaneously with carboxytherapy.

Results / Discussion: Healing time was extended, to maximum 5 months, sometimes complicated with local signs of infection. There were no signs of systemic infection and no side effects of carboxytherapy, and amputation of right foot was avoided.

Conclusion: Carboxytherapy can be a good supportive therapy in the treatment of DFU to avoid amputation of diabetic foot.

Key words: carboxytherapy, diabetic foot ulcer, supportive therapy, wound management

 

EP0710 Photobiomodulation with bluelight therapy: a case series of successful outcomes in hard-to-heal wounds

Alison Vallejo^1
1University of the Sunshine Coast, Sippy Downs, Australia

Aim: The aim of this research was to investigate a novel, non-invasive, painless wound management modality of Photobiomodulation therapy (PBMt) with blue light. The therapy was aimed at hard-to-heal wounds with notoriously difficult to manage wound aetiologies, despite receiving a high standard of care.

Method: Where healing progression had stalled for an average of 3-4 years, PBMt was delivered (400-430nm,120mW/cm²) on a range of wound aetiologies, including radiation induced ulcers, autoimmune, vasculitis and venous leg ulcers (n=8). Wounds were treated for 60-120s per 20cm² weekly for 10 -12 weeks. Participants were seen within an outpatient specialised wound clinic following referrals from vascular specialists and radiation oncologists.

Results / Discussion: Reactivation of healing was observed in all wounds treated, evidenced by a significant size reduction and in some, wound closure. Exemplary cases of radiation induced ulcers, and one vasculitis wound showed remarkable improvement, demonstrated by less pain, reduced exudate levels and reduced inflammation.

Conclusion: Standard care for hard-to-heal wounds is not always enough to reach wound closure. Wound management can be prolonged, is expensive, and remains a constant risk of infection. The addition of an advanced adjunct therapy such as PBMt can kick-start the wound healing cascade via photobiomodulation to reduce debilitating symptoms and shorten healing rates.

EmoLed

 

EP0653 Effects of hyperbaric oxygen therapy on limb replantation: case report

Imen Mezoughi^1
1Military hospital of Tunis, Tunis, Tunisia

Aim: Traumatic hand amputation is a dramatic injury that may affect the social and psychological quality of life of a patient who is often young and productive. We aim to demonstrate that Hyperbaric oxygen (HBO) is an adjunctive therapy in replantation surgery after prolonged warm ischemia especially if it’s associated to crushed skin and soft tissue damage.

Method: We report the case of a 28 years old construction worker with no medical history who’s right arm was ripped out by a cement mixer.

Results / Discussion: The patient underwent re-implantation surgery within 8 hours of warm ischemia. In the postoperative period, he developed a compartment syndrome treated by aponevrotomy and deep muscular infection treated by large spectrum antibiotics. HBO was started on the 5^Th day of replantation (one daily session at 2,5ATA for 90min). After 10 HBO sessions seepage and muscular swelling decreased as well as biological inflammation markers.

At 20 sessions we obtained a satisfactory budding of the wound with normal CRP levels. Transcutaneous oxygen pressure measurement (TcpO2) showed high values (300mmHg) which was predictor of successful wound healing.

The patient received in total 40 HBO sessions. The global outcome was favorable and he was transferred to plastic surgery for skin graft.

Conclusion: HBO therapy is a very useful adjunctive therapy for major limb replantations.

 

EP0668 A case of eyelid and conjunctival melanoma treated with wide resection and mustardé flap reconstruction, preserving the globe and vision

Kyung Ah Lee^1
1Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Rep. of South Korea

Aim: Eyelid and conjunctival melanoma, though rare, is a potentially sight-threatening malignancy. Traditionally, enucleation has been the mainstay of treatment. However, recent advances in surgical techniques have allowed for globe preservation and improved cosmetic outcomes.

Method: An 81-year-old female patient presented with a two-month history of progressively enlarging, poorly delineated, pigmented lesions on the right lower eyelid, conjunctiva, and caruncle (Fig. 1). Histopathological examination confirmed malignant melanoma. PET/CT imaging and orbital MRI demonstrated no evidence of metastases (Fig.2). The patient initially deferred definitive surgical management.  However, six months later, she presented with rapid progression of the lesion (Fig. 3).  Given the patient’s advanced age and strong desire for globe-sparing therapy, a decision was made to proceed with wide local excision and reconstruction.

Intraoperatively, frozen section analysis of the margins confirmed complete tumor resection (Fig.4). Reconstruction was performed with an auricular cartilage graft and a free oral mucosa graft to recreate the posterior lamella, and a Mustardé rotation flap to reconstruct the anterior lamella.

Results / Discussion: At one-year follow-up, the patient exhibited no clinical or radiographic evidence of recurrent disease and reported high satisfaction with the functional and cosmetic outcome (Fig.5).

Conclusion: This case illustrates that in patients with localized conjunctival and eyelid melanoma, complete tumor resection with eyelid reconstruction can provide excellent oncologic and functional outcomes while preserving the globe. This surgical approach can significantly improve the patient’s quality of life while achieving complete tumor removal.

 

EP0783 Successful management of necrotizing fasciitis in a complex case with diabetes and multiple comorbidities

Oliver Jurić¹, Jelena Kevric², Marija Kolega¹, Tamara Alvir^1
1General Hospital Zadar, Zadar, Croatia, ²Secondary Medical School Ante Kuzmanic, Zadar, Croatia

Aim: This case report describes a complex, critical instance of necrotizing fasciitis in a diabetic patient with multiple comorbidities, highlighting the challenges and approach taken for optimal recovery.

Method: Data were analyzed from the patient’s medical history, including observations of his initial treatment and subsequent medical interventions

Results / Discussion: The patient, a long-term smoker and alcoholic, presented with uncontrolled diabetes, hypothyroidism, chronic kidney failure, and significant visual impairment. Following an elbow injury initially managed with conservative local care, infection developed and progressed despite oral antibiotics. Upon worsening symptoms, including a foul-smelling discharge, he sought further medical evaluation. Upon arrival at the emergency department, necrotizing fasciitis was identified in the left forearm and upper arm. Urgent surgical intervention was undertaken, including necrectomy, fasciectomy, and skin grafting, complemented by negative pressure wound therapy. A multidisciplinary approach, integrating modern surgical techniques and nutritional support, was crucial in managing his complex health needs, ultimately saving his life, preserving limb function, and facilitating recovery.

Conclusion: This case underscores the critical role of a holistic, integrated treatment strategy in managing complex cases of necrotizing fasciitis. Effective multidisciplinary collaboration was instrumental in achieving an optimal outcome, even in the face of significant health challenges.

 

EP0654 The effects of autologous plasminogen on angiostatin levels and matrix metalloproteinase activity in the healing of a chronic venous skin ulcer (clinical case)

Petrenko O.M.¹, Badziukh S.V.¹, Tykhomyrov A.O^1
1Bogomolets  National Medical University, Kyiv, Ukraine

Aim: To investigate the effects of autologous plasminogen (Pg) on wound healing in a non-diabetic patient with a 6-year history of chronic venous ulcer, and to determine the impact of Pg-based treatment on tissue levels of angiostatins (AS) and matrix metalloproteinase (MMP) activity.

Method: Autologous Pg was isolated from the patient’s blood plasma by affinity chromatography on lysine-sepharose. The wound surface was treated with electrophoretically pure Pg dissolved in sterile saline (1 mg/ml) every 2 days for 20 days. Wound area was monitored by planimetric analysis. AS levels in dermal biopsies were determined by western blot analysis, and MMP activity was assessed by gelatin zymography.

Results / Discussion: Local application of Pg significantly reduced the chronic venous ulcer area from 32.4 cm² before treatment to 12.7 cm² on the 24th day. The treatment with Pg did not cause any side effects, and no recurrence of the wound was observed subsequently. Wound closure was accompanied by a 2.3-fold decrease in endogenous angiogenesis inhibitors (AS) and a 2.7-fold reduction in MMP activity compared to pre-treatment levels. Permanent MMP activation in the wound indicates a chronic inflammatory process and is a key factor for unsuccessful healing of trophic ulcers.

Conclusion: This study (a clinical case) reports the first-time effectiveness of autologous Pg local application for treating a non-healing lower limb skin wound with chronic venous insufficiency. Pg promotes the restoration of reparative processes in chronic trophic ulcers by activating pro-angiogenic signaling and normalizing proteolytic activity in the damaged tissue.

 

EP0711 An IAD patient with holistic health care case study

Chia Chi Lin^1
1Cathay General Hospital, Taipei, Taiwan

Aim: Incontinence dermatitis (IAD) is common in hospitalized patients due to skin injuries around the perineum and anus caused by incontinence and risk factors. Patients may experience pain, itching, or even secondary skin infections, which requires more skin cleaning times and time. This time, an 87- year-old woman was admitted due to pneumonia. During the hospitalization, she wore a diaper and became incontinent.06/28 IAD classification: Level 2 (moderate, severe) redness combined with multiple skin lesions.

Method: 1. The medical team discusses the causes of incontinence and provides appropriate treatment, such as albumin supplementation (physiological). 2. Handover the shift correctly and perform wound dressing changes gently to prevent infection and reduce pain (psychological). 3. Evaluate the financial ability and obtain timely care products to provide enhanced protection (social). 4. Discuss current care direction and wound recovery status with family every day to reduce family anxiety (spirituality).

Results / Discussion: 08/02 IAD classification: Level 0, the damaged skin has recovered. According to the patient’s needs, we use team communication (nutritionists, doctors, wound experts) to provide comprehensive care. Nursing staff provide appropriate skin care to restore healthy skin to patients, reduce discomfort and prevent the occurrence of related complications.

Conclusion: The medical team should regularly assess and identify high-risk patients and provide timely IAD preventive measures. Also, we suggest establishing a “skin care product package” that can be provided in a timely manner. The instructions included can also help patients understand the product efficacy, so that preventive measures can be implemented immediately.

 

EP0712 Nursing experience in caring for a patient with a malignant tumor on the left scalp accompanied by a fungating wound

Li-Ching  Huang^1
1Cathay General Hospital, Taipei, Taiwan

Aim: This study describes a 79-year-old male patient with a malignant tumor on the left scalp, presenting with a fungating wound that was bleeding profusely and exuding a large amount of yellow fluid. The patient’s family felt anxious about the situation, prompting hospitalization for treatment. Upon assessment, the wound appeared irregularly elevated, measuring approximately 8 cm in height and 12x12 cm² in size, with noticeable vascularity and significant yellow exudate. A 10x10 cm² gauze covering required changing 3 to 4 times a day, with no odor or pain.

Method: For the bleeding situation, a plastic surgeon was consulted to perform local electrocautery. Due to continuous tumor growth, steroids and hemostatic agents were administered as per physician orders, along with radiation therapy to help shrink the tumor. Nurses implemented a wound care plan to minimize ongoing bleeding and enhance comfort, cleaning the wound with saline and covering it with a non-adherent dressing (SI-AID, 10x20 cm²), secured with gauze. Dressing changes were performed twice daily. Additionally, radiation treatment caused surrounding skin redness, which was treated with aloe vera foam for cleansing and aloe vera gel for application. Family education on proper dressing change techniques was provided, with video recordings for repeated learning.

Results / Discussion: At discharge, the wound exhibited no bleeding, and the exudate volume decreased, requiring only daily dressing changes. The tumor reduced to 12x9 cm², with no skin damage in the radiation area.

Conclusion: The patient’s symptoms improved, reducing family anxiety and enhancing overall quality of life.

 

EP0669 Individualized strategies for complex thoracic wall reconstruction

Xiaoye Tuo¹, Hao Daifeng¹, Guang Feng^1
1Department of Repair and Reconstruction, Peking University Shougang Hospital, Beijing, China

Aim: Non-healing wounds post-thoracotomy has been a challenge to successful thoracic wall reconstruction. Here we aim to find personalized strategies for complex thoracic wall reconstruction.

Method: Patient A is a 73-year-old woman post-mastectomy radiotherapy suffered from chest wall ulceration combined with osteonecrosis and osteomyelitis. We used skin flap transplantation transferred from the other breast. Patient B is a 66-year-old woman with pleurisy and osteomyelitis after 3 years of postoperative radiotherapy for breast cancer. We removed necrotic tissue and three ribs with osteomyelitis. Bone cement was used to bridge the rib defects and latissimus dorsi musculocutaneous flap to cover the wound. Patient C is a 21-year-old boy with congenital heart defect received right ventricle and pulmonary artery conduit replacement + modified Konno Operation + AVR + subaortic diaphragm resection + TVP, the chest incision healed poorly with mediastinitis, the wound deteriorated although negative pressure and transplantation of bilateral pectoralis major myocutaneous flap were performed. We used autologous platelet-rich plasma gel to fill the exposure of chest and skin flap transplantation to cover the defect.

Results / Discussion: All patients healed well. Age, psychological factors, defect and wound conditions were all taken into design of treatment and the patients were satisfied.

Conclusion: For complex thoracic wall reconstruction, treatment plan should be personalized to meet both physical and psychological needs of the patient.

 

 

EP0670 Massive defects involving mouth floor, chin, anterior neck, and mandible, after wide excision of extensively invaded oral cancer

Seong Hwan Kim¹, In Suck  Suh^1
1Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Rep. of South Korea

Aim: Although regional metastasis to the lymph nodes is common in advanced oral cancer, extensive local invasion into surrounding structures including the mandible is relatively rare. After radical surgical resection, massive, composite defects of mouth floor, chin, mandible and anterior neck are left and it is challenging for surgeons to reconstruct.

Method: Two patients who had similar extensive local invasion of squamous cell carcinoma on the floor of mouth visited our clinic. Both patients underwent radical resection followed by a single staged double free flap reconstruction. A fibular osteocutaneous flap with titanium plate and screw fixation was used to reconstruct the mandible and intraoral lining of the mouth floor and an anterolateral thigh fasciocutaneous flap was used for resurfacing the chin and anterior neck.

Results / Discussion: Fibula osteocutaneous free flap was composed of 16cm length fibula with a skin paddle in the distal one-third of the leg centered on strong peroneal artery perforators. Fibula was divided into three osseous segments and molded with a customized titanium plate framework using preoperatively manufactured 3D-printed bone models. The flap was revascularized via anastomosis in one side of the neck, and anterolateral thigh fasciocutaneous flap on the other side. Donor site of the thigh was closed primarily and split-thickness skin graft was used to cover the peroneal area.

Conclusion: Mandible reconstruction can be performed simultaneously as a single-staged operation with good functional and aesthetic outcomes both, in case of extensive invasion of mouth floor cancer through mandible and neck.

 

EP0713 Negative pressure wound therapy combined with a Penrose drain for refractory seroma after ischial flap coverage: 2 cases

Hongbae Jeon¹, Kyung Wook Kim^2
1Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea, Cheonan-Si, Rep. of South Korea, ²1Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Korea, Cheonan-Si, Rep. of South Korea

Aim: Ischial sores are especially common in paraplegic patients and often result in complications like seroma and infection, requiring repeated surgeries and increasing procedural challenges. This study presents a novel approach combining negative pressure wound therapy (NPWT) with a Penrose drain to effectively manage complex cases with a history of multiple flap surgeries.

Method:

Case 1

A 63-year-old paraplegic woman was treated for wound dehiscence with refractory seroma at the left ischium and a right trochanter pressure ulcer. She had undergone several flap surgeries for left ischial sore. Debridement and NPWT were applied, and an inferior gluteal artery perforator (IGAP) flap was conducted. We inserted Penrose drain through the flap margin to the previous seroma formation area and applied NPWT. Penrose drain with was placed inside the sponge of the NPWT to remove the fluid collection and press the dead space.

Case 2

A 54-year-old paraplegic male, who had undergone elliptical excision for treatment of left ischial sore, suffered from wound dehiscence with refractory seroma on left ischium. IGAP flap reconstruction was conducted, and NPWT at 75 mmHg with a Penrose drain was initiated immediately post-surgery.

Results / Discussion: Negative pressure wound therapy (NPWT) was applied twice weekly. All Jackson-Pratt (JP) and Penrose drains were successfully removed without any occurrence of postoperative seroma. No additional complications were observed in patients during the two-month postoperative follow-up.

Conclusion: Managing complicated wounds after previous reconstruction surgery is challenging. In this study, we achieved satisfactory results without postoperative seroma using NPWT combined with a Penrose drain on flap coverage site. This treatment can be useful for management of refractory seroma after flap coverage for ischial sores.

 

EP0714 Wound bed preperation supporting wound healing and reducing patient anxiety in leg ulceration

Ann-Marie Birchall^1
1Countess Of Chester Foundation Trust, Chester, United Kingdom

Aim: Biofilm-based wound care (BBWC) and wound bed preparation (WBP) are crucial for healing. This report focuses on the impact on patient anxiety on ulcerations.

Method: Wound bed preparation was initiated in a patient who’s anxiety had caused picking of a bite to progress to an ulcer.  PHMB & Betaine Solution (PS) was applied for 10 minutes, followed by PHMB and Betaine Gel (PGX). A microfibre debridement pad (PDP) was used every 7–14 days to reduce slough and minimise bioburden. Patient continued WBP as an outpatient as he wanted to be proactive with his care. Dressing changes were daily for 3 weeks, then every other day.

Results / Discussion: Ulcerations reduced by 60% within 4 weeks, with healthy granulation and visible epithelium tissue. Pain and slough decreased quickly. Patient-X reported reduced anxiety when performing WBP, feeling the steps prevented infection and he reported an immediate reduction in pain with cleansing soaks. Anxiety continued to ease as ulcerations reduced and the regime proved manageable.

Conclusion: Fear and anxiety are often not openly discussed by patients, Patient’s openness highlights the impact of wound care on clinical outcomes and quality-of-life. Patient had tried to manage his wounds at home using simple dressings which were causing further harm. Through proper WBP and appropriate pathways of care we achieved effective desloughing, pain reduction, and a 60% wound volume reduction over 4 weeks; reducing anxiety and demonstrating the importance of structured care plans in leg ulcer care while improving patient’s mental wellbeing.

 

EP0671 Calf ulcer-diagnostic and therapeutic challange-case report

Cristina Neagu¹, Ana Maria Gheorghiu², Adrian Zaharia³, David Chirulescu³, Nicoleta Rogozea^3
1I Cantacuzino Clinical Hospital Bucharest, Bucuresti, Romania, ²Carol Davila University of Medicine and Farmacy, Bucharest, Romania, ³CC Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

Aim: Therapeutic management of calf ulcer depends on ethiology. A venous ulcer diagnosed with good evolution does not outrule the existence of multiple causes in the same time.

Method: We present the case of a 68 years old female, heavy smoker, known with a femuro-popliteal vein thrombosis. Doppler ultrasound findings are GSV reflux, without popliteal vein thrombosis or postthrombotic aspect. With compressive therapy the ulcer is healed in about a month. Shortly after this episode, she came back with purpura and ulcer, bigger in size, with superficial necrosis, painfull. This rose the suspicion of vasculitis. The pacient was addressed to the reumathology department, where the ethiology was confirmed. Supressive therapy was initiated with ulcer remission. The patient was periodically evaluated for PAD, and in about one year lost distal pulses.A CIA (common iliac artery) and SFA(superficial femoral artery) stenosis were found at angiography, which were stented. After several episodes of purpura, engraved by the bad aspect of the ulcer, we made a new vascular assesment and we found intrastent thrombosis with popliteal artery occlusion. The patient underwent PTA with good results.

Results / Discussion: The most important task in this case was to find the balance between immunosuppression, antiplatelet, anticoagulant therapies and the risk of infection. The use of multiple kinds of dressings, negative pressure wound therapy and the most suitable moment for each one was also a big challenge.

Conclusion: Not every ulcer is a venous ulcer. We need special attention to all the clinical aspects and laboratory investigations.

 

EP0715 Managing suspected chronic inhibitory bacterial load in diabetic foot ulcerations within the community setting utilising biofilm-based wound care - case series

Beth Lillico^1
1Manchester Local Care Organisation, Manchester, United Kingdom

Aim: Chronic inhibitory bacterial load (CIBL) was suggested as new terminology by Armstrong et al (2023) to describe high levels of bacteria including biofilm that may inhibit wound healing and increase the risk of infection.

This case study explores if adoption of biofilm-based wound care could be utilised to address suspected high levels of bioburden in static, hard-to-heal diabetic foot ulcerations (DFU’s).

Method: Four patients identified as suitable for biofilm-based wound care over a 2-month period. Differing complexities including a history of severe DFI’s and static ulcerations, Patient D is unlikely to heal due to inoperable chronic limb threatening ischaemia alongside a palliative cancer diagnosis – aim, reduce risk of life-threatening infection. Patient C selected as podiatry input limited due to aggressive behaviour – aim, to support care team to use biofilm-based wound care when receptive to care.

Wound healing %, soft tissue infections and tolerability over 12-months as outcome measures

Results / Discussion:

Conclusion: Biofilm-based wound care proved successful. Patients tolerated products with ease of use reported. Aims fully met as no infections during case series with wound reduction achieved in achievable cases.

 

EP0767 A case report: Treatment of a complex diabetic foot ulcer

Ivana Grgic^1
1Polyclinic Podologija, Split, Croatia

Aim: The main objective of this study is to evaluate the technique for managing diabetic foot ulcer and prevent amputation.

Method: This case report presents 84-year-old man with diabetic foot ulcer located on his right heel. On his right leg he has transmetatarsal amputation and also left low leg amputation. Patient´s foot ulcer was classified following the assesment of the six items of the SINBAD system. These six items of this acronym are: site, ishemia, neuropathy, bacterial infection, area, depth. Patient had six points. For managing diabetic foot we used IWGDF guidelines and EWMA documents and our personal experience in wound care. We debrided wound with Maltodextrin and 1% ascorbic acid and we applied rapid capillary action dressing which created a negative pressure of 68mmHg. We protected bone with gentle two-sided wound contact layer. On top we put superabsorbent wound dressing. After debridment we applied dressing with copper on the wound. When the wound bed was clean, without fibrin, we applied natural extracellular matrix. The patient’s diet was also corrected, physical therapy was introduced and normoglycemia was achieved

Results / Discussion: We started managing wound on 22 April, 2023.

17 June, 2024. the patient’s diabetic foot ulcer had fully healed. We used what the wound dictated.

Conclusion: This study showed that in addition to the application of appropriate dressings, normoglycemia, physical therapy and proper nutrition are also necessary for ulcer healing.

 

EP0799 Use of fillet flaps in lower limb trauma: literature review and our experience

María García¹, Mar Merino Romero¹, Marcos Bayo Montoliu¹, Alberto Pérez García¹, Maria Dolores Pérez del Caz¹, Belén Andresen Lorca^1
1Hospital Universitari i Politècnic La Fe, Valencia, Spain

Aim: Traumatic amputations of the lower limb can be a considerable challenge for plastic surgeons. Their sequelae are potentially devastating, meriting every effort to preserve the longest and most stable stump possible. Using a fillet flap from the amputated limb is a common reconstructive technique to improve the quality of life of affected individuals.

Method: We reviewed the recent literature on lower limb trauma and free fillet flaps. We included articles in English and Spanish that were fully accessible and available in indexed journals about traumatic amputations and free fillet flaps, excluding those on oncological cases or upper limb. Additionally, we revised our case series, and we present three examples of patients who suffered from high-energy traumatic limb amputations. After having discarded the possibility of replantation, we performed free plantar fillet flaps based on the posterior tibialis artery.

Results / Discussion: Traumatic below-the-knee amputations are complex injuries that may occur in high-energy events. If limb replantation is not feasible, a fillet flap from the amputated limb provides proper and more stable coverage of the stump, facilitating effective prosthetic fitting and subsequent premature rehabilitation. Our patients underwent successful surgeries. They have already been prosthetized and are continuing their rehabilitation journey.

Conclusion: Fillet flaps offer effective coverage for below-the-knee stumps, enhancing the quality of life for patients who experience life-altering traumatic events.

 

EP0716 The role of education and self - care in patient with venous leg ulcer in homelessness crisis

Monika  Aleksy-Polipowska^{1 2
1}Camillian Center for Palliative Care, Cavalry Captain Witold Pilecki State University of Małopolska in Oświęcim, Tarnowskie Góry, Poland, ²Cavalry Captain Witold Pilecki State University of Małopolska in Oświęcim, Oswiecim, Poland

Aim: The aim is to highlights the significance of education and self-care in managing venous leg ulcers, especially for individuals in a homelessness crisis with limited access to healthcare.

Method: Case report

A 61-year-old patient in a homelessness crisis, sought emergency care. The patient had chronic conditions and frequent hospitalizations due to a long-standing venous ulcer on the right leg. The ulcer was shallow, infected, covered by biofilm and fibrin, and presented with poor hygiene, heavy purulent discharge, and maceration around the wound, which limited mobility and life quality. P.aeruginosa presents. (Fig 1) Wound treatment (TIMERS), along with psychological support, was provided. The patient received intensive self-care education, including wound hygiene with highly effective octenidine-based solutions and edema management.

Results / Discussion: Education and psychological support helped stabilize the wound microbiologically, control infection under difficult conditions, and prevent microbial imbalance. Pain symptoms have decreased (from 9/10 to 3/10), and the skin around the ulcer has improved. The wound area has reduced by 20%. (Fig 2)Contact with the patient is being maintained

Conclusion: Patient education plays a crucial role in self-care, especially in chronic wound management and prevention. Education for marginalized patients should cover wound hygiene, lifestyle habits, diet, alcohol avoidance, and limb offloading with psychological support for improved outcomes.

 

EP0768 Effectiveness of moisturizing cream in preventing skin complications in diabetic patients

Margrit Wilke¹, Leticia Giaconia^2
1Residencial Qualy Life, Sao Paulo, Brazil, ²Imparmed Comercial Impor e Exp, Sao Paulo, Brazil

Aim: Diabetic foot is the result of a combination of factors such as dry skin, hyperkeratosis, chronic hyperglycemia, infections and diabetic neuropathy of the lower limbs, which can progress to severe conditions and infections, leading to amputation, and prevention is ideal through cutaneous hydration of the feet of diabetic patients. The aim is to evaluate the efficacy of moisturizing cream in the prevention and treatment of skin complications in diabetic patients; investigate how continuous use can contribute to injury prevention.

Method: This is a descriptive study, such as a case report carried out under home monitoring. Male patient, 78 years old, diagnosed with type II diabetes, hypertensive, diabetic neuropathy, awaiting amputation of the right toes. He had previously used AGE without evolution. Start of treatment 08/21/2024.

Results / Discussion: Significant improvement of peripheral perfusion within 24 hours of cream use. Follow-up for 30 days, with progressive improvement of the perfusion. Hydration of the lower limbs in diabetic patients with low peripheral perfusion is a crucial measure to prevent severe skin complications. Impaired circulation hinders healing, aggravates skin dryness, making hydration necessary. Diabetic moisturizing creams containing calendula, pomegranate, birch oil, arnica oil, and Aloe vera glycolic extract can improve skin elasticity and integrity, preventing cracks and small lesions that quickly develop into ulcers. The formulation with nano vectors allows hydration at all levels of the skin, with gradual release of its components, maintaining hydration.

Conclusion: The use of a specific moisturizing cream for diabetics proved to be effective as a skin barrier and prevention of lesions. The need for future research on improving peripheral microcirculation with creams with nanovectorized bioactives for the high-risk population is highlighted.

 

EP0778 Wound ointment containing β-sitosterol as dressing for chronic wounds: a case series

Affandi Wiramur^1
1Sebelas Maret University, Surakarta, Indonesia

Aim: This study aimed to assess the effectiveness and safety of Wound Ointment Containing β-Sitosterol for patients with chronic wounds, which often impact quality of life.

Method: Six patients with various types of ulcers received daily dressings with Wound Ointment Containing β-Sitosterol, with weekly assessments to monitor healing over a period of up to six months.

Results / Discussion: Chronic wounds, particularly common among aging populations, typically take over three months to heal. Wound Ointment Containing β-Sitosterol has shown promise in expediting healing by reducing pain, preventing infection, and promoting cell and blood vessel growth. Clinical studies indicate it accelerates wound closure (around 30 days) and lowers treatment costs compared to standard care. Wound Ointment Containing β-Sitosterol also proves more beneficial than surgery, costing around $500 compared to approximately $9,000 for surgical intervention. Further benefits over surgery include its non-invasive application, affordability, and reduced scarring, though additional research is needed on its long-term effects for chronic wounds.

Conclusion: Wound Ointment Containing β-Sitosterol proves effective and well-tolerated for enhancing wound healing in chronic wound patients.

Figures

 

EP0717 Polyhexamethylene biguanide-betaine dressing combined with silver sulfadiazine for biofilm control in an advanced cancer wound: A case report

Kyung Wook Kim¹, Hongbae Jeon^2
1Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Korea, cheonan-si, Rep. of South Korea, ²Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea, Cheonan-si, Rep. of South Korea

Aim: Biofilm in a wound base can cause chronic infection and a persistent immune response in the host, inhibiting wound healing. Antibiotics and antiseptics may not be effective because the protective layers of biofilms are difficult to penetrate. Here, we present a case of chronic wound biofilm management using PHMB-B combined with silver sulfadiazine in a patient with advanced breast cancer, which enabled successful flap coverage without infection

Method: A 46-year-old female had left breast cancer with chronic wounds that had not been treated for 2 years. Cancer was diagnosed in 2019 and had metastasized to bones, lungs, and brains. Cancer with open wound (20x20cm) was present and more than three multiple species have been identified in wound culture. After palliative chemotherapy and radiotherapy, the chronic wounds were aggravated with biofilms. After palliative total mastectomy, the wound size was 30cm x 30cm, and Acinetobacter baumannii and corynebacterium species with biofilm were identified. Due to lymph vascular invasion on histology, betadine wet gauze dressing was performed, not NPWT.  However, the wound did not display significant improvement and caused severe pain. Furthermore, pseudomonas aeruginosa was identified in following culture The povidone-iodine dressings were changed to silver sulfadiazine ointment; however, this was also ineffective for controlling the biofilm. Eventually, we additionally applied PHMB-B before silver sulfadiazine which led to wound improvement with no identifiable microorganisms

Results / Discussion: After 2 weeks of dressing, biofilm was no longer visible, and no bacteria was identified in wound culture. We performed pedicled transverse rectus abdominis myocutaneous (TRAM) flap successfully

Conclusion: PHMB-B combined with silver sulfadiazine could effectively eradicate biofilms in a patient with advanced breast cancer.

 

EP0800 Reconstruction using silicone implant of depressed deformity after craniectomy – 3 Cases

Jung Yeol Seo^1
1Department of Plastic and Reconstructive Surgery, School of Medicine, Pusan National University, Yangsan, Rep. of South Korea

Aim: Among the patients who operated craniectomy after intracranial hemorrhage, some suffer from severe depressed deformity. There are various methods for correcting the depressed deformity, but the authors present three cases that were able to perform simple and fast surgery using silicone implants and obtain good satisfaction.

Method: A total of 3 patients (2 men and 1 woman) underwent craniectomy, all were operated in the same surgical method. Before surgery, a model was created to make a silicone implant using clay in the depressed deformity, and a silicone implant was prepared based on this. At the time of surgery, an incision was made in the scalp for silicone implant insertion, and a pocket that fits the size of the implant under the scalp was made and the silicone implant was inserted. Afterwards, the authors confirmed the patient’s satisfaction with the surgical results.

Results / Discussion: During surgery, the scalp incision was made smaller than the size of the silicone implant and inserted. The operation time was very short within 1 hour, and the drainage tube was removed within 3 days after the operation, and the stitches were removed in 7-10 days. In all three cases, the patients showed great satisfaction with the postoperative results.

Conclusion: Cosmetic reconstruction surgery using silicone implants in patients with depressed deformity after craniectomy has the advantage of simple operation, less operation time, and shorter recovery time, resulting in lower overall treatment costs. And above all, it can provide a great satisfaction to patients in the results of surgery

 

EP0718 Scleroderma skin ulcers: Ovine extracellular matrix with hyaluronic acid xenograft, a promising approach to an orphan disease

Wiliam Tettelbach¹, Michelle Moore², Nya Akoteu³, Katrina-Anne  Palu^3
1, RestorixHealth, Metairie, United States, ²Kaleidoscope Clinical Consulting, Las Vegas, United States, ³Vaiola Hospital, Nukalofa, Tonga

Aim: Observe the response of a hard-to-heal scleroderma skin ulcer on the right fourth finger of a 54-year-old diabetic female after initiating the routine application of a xenograft composed of a layer of glycosaminoglycans (hyaluronic acid) between sheets of ovine forestomach-derived extracellular matrix (ECM).

Method: The setting of this case report was a hospital-based outpatient diabetic wound care clinic at Vaiola Hospital in the Kingdom of Tonga. The patient was provided standard wound care for a right fourth finger wound with a combination of topical therapies and selective debridement. In Tonga, there is limited availability of chemotherapy or immunotherapy for treating systemic sclerosis. After three months of standard wound care, a cellular, acellular, matrix-like product (CAMP) was added to the treatment regimen. The standard of care techniques was continued while incorporating a xenograft composed of a layer of glycosaminoglycans (hyaluronic acid) between sheets of ovine forestomach-derived ECM.

Results / Discussion: Fifty-eight days after adding the CAMP, the right 4th finger wound healed. After recurrence, this wound persisted for 115 days before initiating the ovine ECM with hyaluronic acid. A total of six applications of the ovine ECM graft containing a layer of hyaluronic acid were applied until the closure of the scleroderma skin ulcer was achieved. On average, the xenografts were placed every 5.3 days.

Conclusion: Routine applications of an ovine ECM with hyaluronic acid were observed to reinitiate the trajectory towards closure with reductions in wound size and observed an increase in granulation tissue despite the underlying commodities of poorly controlled diabetes and systemic sclerosis. The results suggest a potential novel treatment option for hard-to-heal wounds in patients with scleroderma. Further research is warranted.

 

EP0781 Understanding home care patients with leg ulcers towards various compression therapies

Karen Koh^1
1Student at Curtin University, Singapore, Singapore

Aim: A case study to gain an understanding of homecare patients with leg ulcers regarding their experiences with different compression therapies and healing outcomes.

Method: A mixed method design was used on two homecare patients that had venous or mixed ulcers and were on four layered bandaging at an outpatient clinic and subsequently, modified compression (e.g. tubigrip, compression socks). A homecare nurse visits twice a week for a dressing change and measures the wound fortnightly or when necessary, with a ruler or AI measurement product. Interviews were conducted for the perception of the wound interventions.

Results / Discussion: Higher quality of life was reported when using modified compression as the patients found that 4 layered bandaging restricted their movement and had caused them pain, which added to their difficulties in daily activities. However, the difficulties could have been exacerbated by a lack of carer as both patients are elderly living alone. With good control of moisture level, the wound would heal at about 0.5cm per month. The recurrence rate of the VLU was one year for one homecare patient and ten days for the other.

Conclusion: Although patients with low grade compression did show higher levels of quality of life, it also improved their wound at a much slower rate and increased recurrence incidence. A United Kingdom study had found that exercising along with compression therapy did further improve the wound healing time, hence adjuvant therapies could be considered. A multidisciplinary team approach would also enable a more comprehensive care for patient in a community.

 

EP0769 Wound follow-up with enzyme-alginogenic pomade in neuroischemic diabetic foot wounds

Nesrin Tan Baser¹, Miray Kalınbaçoğlu¹, İlteriş Türkyılmaz^1
1Health Sciences University Gulhane Research and Training Hospital, Ankara, Turkey

Aim: Diabetic foot wounds are chronic wounds that significantly affect the quality of life of patients. Patients with diabetic neuropathy are prone to wound dehiscence and recurrence even when treated surgically. When ischaemia caused by peripheral arterial disease is added to this, flap closure is no longer an option.

Method: We report an 84-year-old patient with type 2 diabetes mellitus and a 20-year history of coronary and peripheral artery disease. The patient presented with an enlarged wound on the plantar surface of the first metatarsal head of the right foot. There was a 2 cm open wound on the plantar surface and cellulitis affecting the dorsum of the foot. Limited surgical debridement was performed because he was on blood thinners.  The wound area was closed with enzyme-alginogel pomade to reduce bacterial load and sloughing. Daily dressings were applied for the first 2 weeks. Then enzyme-alginogel pomade was applied every 3 days.

Results / Discussion: Wound surface area and volume, exudate levels and wound tissue were regularly evaluated. Klebsiella pneumoniae was grown in the first tissue culture. No growth was detected in the 3rd week cultures. Cellulitis regressed in the 1st week. In the 2nd week, granulation started to form in the wound. Complete wound healing was achieved in the 10th week.

Conclusion: Repeated debridement, careful and moisture-balanced dressing to control bacteria and prevent maceration is essential in diabetic foot ulcers. However, radical and repeated debridement is not appropriate in the neuro-ischemic foot. We believe that close wound management with a product with antimicrobial activity that provides both continuous wound debridement and a balanced moist environment is the most appropriate approach in neuro-ischemic patients.

 

EP0719 Fetal iatrogenic skin injuries: new challenges in neonatal wound care

Valentina Vanzi^1
1IRCCS Bambino Gesù Children’s Hospital, Rome, Italy

Aim: Nowadays, different intrauterine procedures are performed to obtain prenatal diagnosis of embryonal and fetal chromosomal abnormalities and to surgically correct few fetal anomalies. This project aim to analyze the phenomenon of fetal iatrogenic skin injuries and to discuss the appropriate wound care treatment.

Method: A scoping review was performed according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) methodology and a case report was presented.

Results / Discussion: The case report showed a skin injury which occurred in a twin due to a fetal reduction in a monochorionic pregnancy (laser ablation and interruption of blood flow in the umbilical cord of the other fetus). As the scoping review showed, skin injuries derived from intrauterine interventions are rare but complex. Even if the sterile uterine environment provides excellent conditions to wound healing, at birth, a neonate exposed to a previous diagnostic investigation or surgical treatment may show a residual lesion as harmful effect. The goal of the management must include an extremely attention to the scar treatment, which does not refer only to the wound healing but also to the emotional and psychological meaning that represents.

Conclusion: Skin injuries related to intrauterine procedures are emerging as a new concept and they represent a challenge in neonatal wound care. Being able to recognize their etiopathogenesis represents the first step in planning the appropriate wound care treatment to optimize the clinical outcome in such vulnerable patients.

 

EP0720 Efficacy of plasma care in treating chronic wound and fistulas in irradiated areas: a case study

Melissa Kiopekzis^1
1Qualityzorg, Nieuw-Vennep, Netherlands

Aim: Chronic wounds and fistulas, particularly in irradiated areas following breast surgery, are often resistant to conventional treatments, presenting challenges in wound care. Plasma Care®, a novel mobile cold plasma device, was exclusively tested on patients with chronic wounds persisting for over two years, targeting improved healing in these complex cases.

Method: Ten patients participated in a three-week Plasma Care® treatment. In week one, each patient received three 3-minute sessions, followed by two sessions per week for two weeks. Two patients required an additional three-week cycle after five months due to recurring wound issues. The cohort included five patients with venous ulcers, three with post-mastectomy and radiation fistulas, one with an exposed skull wound post-tumor removal, and one with a foot fistula complicated by osteomyelitis.

Results / Discussion: Plasma Care® treatment led to significant improvements in most cases. One patient with a chronic leg wound saw a 50% reduction in size within three weeks and complete closure after five weeks, with no recurrence for a year. Another post-radiation fistula patient saw reduced exudate, enabling fewer dressing changes, and full closure after three weeks. A third patient with exposed bone and pus production reported no pus during and up to a month after treatment.

Conclusion: Although two patients showed no improvement, most experienced enhanced healing and fewer required care moments, improving quality of life and reducing healthcare costs. Plasma Care® shows promise in chronic wound care, particularly in irradiated cases. Future research will explore its potential to reduce bacterial loads and replace antiseptics, minimizing care needs further.

 

EP0721 HOFA in the prevention of hyperkeratosis: a cost saving to the NHS

Andrea Herrington^1
1Wiltshire Health & Care, Chippenham, United Kingdom

Aim: The aim of this study is to evaluate patient experience when using HOFA emollients in the prevention of hyperkeratosis.

Hyperkeratosis can often cause a build-up of plaques and inhibit the absorption of emollients causing dry / cracked skin to break or trap bacteria under the plaques which can reinfect vulnerable legs. These patients are often in the health care system for extended periods of time and can re infect if management is not continued. Anti-microbial resistance (AMR) are one of the top global public health and development threats, skin care has an essential role in the management of chronic oedema to prevent skin break down and infection. Due to the nature of the condition, the management is often handed back to the patient and if an effect skin care regime is not upheld then skin is at risk of breaking down and re entering the treatment cycle.

Method: 10 patients evaluated in Wiltshire Health and care for a minimum of 6 weeks comparing HOFA against usage of the top prescribed emollient. Measuring long term management including quality of life indicators such as itching, dryness and pain; gathering data on elimination and prevention of hyperkeratosis and re infection / new wounds.

Results / Discussion: Patients had reduced or resolved hyperkeratosis, reinfection was avoided and patient QoL scores were improved at end of study, reducing the amount of healthcare resource required.

Conclusion: HOFA is a cost saving alternative emollient.

 

EP0722 Comparing vaseline gauze strip dressing and multipurpose dressing with non-adherent interface layer based on supercore technology for donor sites in split-thickness skin grafts

Karolina Pocivavsek¹, Minja Gregoric^1
1Department of Plastic and Reconstructive Surgery and Burns, University Medical Centre Maribor, Maribor, Slovenia

Aim: This study aims to compare the effectiveness of vaseline gauze strip dressing (VD) versus multipurpose dressing with non-adherent interface layer based on SuperCore technology (MPD) in managing donor sites following split-thickness skin grafts. Through this assessment, we seek to provide evidence-based recommendations to aid in selecting the most effective dressing for donor site management, ultimately enhancing patient outcome and care practices.

Method: We recruited three patients for this study. Both VD and MPD were applied to donor site wounds in each patient, respectively.

The evaluation examined several critical parameters, including ease of application and removal, frequency of dressing changes, patient comfort and pain both during and between dressing changes, absorbency and exudate management, healing time, and risk of infection.

Results / Discussion: In terms of ease of application and removal, healthcare providers reported that MPD were easier to handle compared to VD. For the frequency of wound care and recorded pain levels, MPD demonstrated superior results. MPD provided effective exudate absorption, eliminating the need for daily dressing changes and extensive medical supervision, and therefore reducing hospital stays. However, we had a hypertrophic scar formation in one patient when applying MPD, but it is impossible to deduct that it was caused by the dressings. Healing times were comparable between the two groups, with no infections reported.

Conclusion: MPD yielded more satisfactory outcomes than VD for managing exudative donor site wounds.

 

EP0672 Enhancing postoperative recovery in folliculitis decalvans: the role of hyperbaric oxygen and specialized therapies – case report

Antônio Pessoa¹, Caio Lopes¹, Priscilla Alves da Silveira F Pinheiro¹, Lucas Melo¹, Karine Silva¹, Bruno Silva¹, Bianca Oliveira^1
1Cicatriclin, Vitória da Conquista, Brazil

Aim: To report the use of Hyperbaric Oxygen Therapy (HBOT) in the postoperative care of a patient with folliculitis decalvans.

Method: This case report was structured according to the CARE case report guidelines, using data obtained from medical record and photographic documentation. Patient consent was obtained through an Informed Consent Form.

Results / Discussion: This case involves a 40-year-old male with a six-year history of folliculitis decalvans. Following surgical debridement, the patient presented with a significant wound that required specialized dressings and antibiotic therapy to manage infection. Initial treatment included silver alginate dressings, later transitioned to gauze impregnated with Polyhexamethylene Biguanide (PHMB). Hyperbaric Oxygen Therapy (HBOT) was introduced on day 39 of treatment, showing marked improvement in wound healing, and the patient was discharged on day 107 with complete epithelialization of the wound. Multidisciplinary intervention played a critical role, with special attention to wound hygiene and appropriate dressings, underscoring the value of advanced wound care strategies to reduce patient morbidity and accelerate healing. Beyond physical recovery, the approach significantly improved the patient’s quality of life, highlighting the value of integrated therapeutic strategies in managing complex folliculitis decalvans cases.

Conclusion: Adjuvant HBOT shows a positive impact on healing outcomes in folliculitis decalvans, emphasizing the importance of specialized dressings and advanced clinical monitoring to minimize tissue distress and expedite recovery.

 

EP0759 Efficacy of using mesenchymal stem cells derived from adipose tissue in healing lesions in charcot foot - comparative case report in a patient with bilateral charcot foot

Lys Santos¹, Paulo Eduardo Reis², Danielle Brito³, Juliana Lucinda dos Santos, Simone Ferreira⁴, Hanna Dodde⁵, Patrícia Pereira^1
1Aliança Médica Vascular, Rio de Janeiro, Brazil, ²Universidade Federal Fluminense, Niterói, Brazil, ³KM Materiais Medicos, Rio de Janeiro, Brazil, ⁴Vide Bula, Rio de Janeiro, Brazil, ⁵Tratderm, Rio de Janeiro, Brazil

Aim: To demonstrate the effectiveness in healing time and tissue regeneration when using mesenchymal stem cells in complex lesions, such as Charcot foot.

Method: We selected a patient with Charcot foot on both feet, with many dermal fistulas due to osteomyelitis and severe previous surgical approaches. The surgical treatment in both feet was exactly the same, resection of all infected and devitalized tissues superficially and deeply, as well as analysis of the resected bone and tendon fragments for bacterial research and antibiogram. However, on the right foot, we collected mesenchymal cells from adipose tissue and injected them into the edges of the lesions and into the bed as well. On the left foot, we only performed conventional treatment. We monitored both feet on an outpatient basis, with the same dressings, and antibiotics were administered guided by culture.

Results / Discussion: The comparative analysis of the healing evolution of the feet was performed following the same dressing protocol. The healing time and the immunomodulatory response on the right foot , which received the stem cell implant, were significantly demonstrated with the regenerative evolution of the lesions.

Conclusion: The fact that it was the same patient and he had the same lesion on both feet helped us demonstrate reliability in the results. The healing time was more effective on the right foot that received regenerative therapy. Therefore,we can conclude that the use of mesenchymal cells in complex lesions is extremely effective and should be considered as the first option in diabetic patients.

 

EP0723 Application monitoring: Wound cleansing and mechanical debridement with a coarse-pored PU foam dressing

Manuela Korner^1
1LIGAMED Medical Produkte GmbH, Cadolzburg, Germany

Aim: This application monitoring was conducted to evaluate and assess the efficacy of initial and continuous mechanical debridement and wound cleansing with a coarse-pored PU foam dressing. The primary aim was to prove the effectiveness of mechanical debridement, i.e. a significant reduction in wound coatings.

Method: The products tested are available in three different intensities. The effectiveness of wound cleansing can be increased depending on the pressure applied. The wound cleansing pads can be applied using both wiping and twisting techniques.
The observational study was conducted and completed in 39 patients. The patients were between 40 and 93 years old, with an average age of 71.7 years. We treated one decubital ulcer, 19 leg ulcers, 16 diabetic foot ulcers, two post-operative wounds (amputation wounds of diabetic feet) and one skin ligation.

Results / Discussion: The wound coverings were reduced by an average of 60.2% over the eight-week treatment period. The wound size was reduced by 47.7% in length, 47.1% in width and 66.7% in depth within the eight weeks. After four weeks of treatment, the wounds of six patients were free of coatings (=15.4% of the patients). After eight weeks, 41% of the wounds were without coatings or had already healed.

Conclusion: The available data show that mechanical debridement with wound cleansing pads made of coarse-pored PU foam is very effective, quick and therefore also cost-effective. Mechanical debridement with wound cleansing pads may be used by nursing staff and is very simple and safe to use.

 

EP0724 Innovative wound healing: a case report on the impact of TLC-NOSF technology in a traumatic injury in an elderly patient

Navor Pereira^1
1Servizo Galego de Saúde, Ourense, Spain

Aim: To evaluate the effectiveness of lipido-colloid technology with a nano-oligosaccharide factor (TLC-NOSF) in the treatment of a traumatic hand injury in an elderly patient. Secondary objectives include assessing the importance of applying TLC-NOSF technology as a first-line treatment to prevent the stagnation of wounds in prolonged inflammatory phases.

Method: An 82-year-old patient with a medical history of prostate adenocarcinoma and hematological cancer presented with a traumatic hand injury caused by a falling scaffolding board. Initial treatment involved debridement to remove necrotic tissue, followed by the application of a silver poly-absorbent dressing coated with lipido-colloid technology (TLC-Ag) to manage infection and facilitate debridement. Two weeks later, a dressing incorporating poly-absorbent fibers, lipido-colloid technology, and a nano-oligosaccharide factor (TLC-NOSF) was applied for the remainder of the treatment, aimed at reducing excessive metalloproteinase activity to promote wound healing.

Results / Discussion: The application of TLC-NOSF resulted in a significant reduction in wound size and an overall improvement in healing within a three-month period. The effect of TLC-NOSF technology in reducing metalloproteinases, combined with the debridement properties of the poly-absorbent dressing, promoted a clean and rapid wound evolution while preventing wound chronification. Patient-reported outcomes indicated enhanced comfort and satisfaction with the treatment regimen.

Conclusion: The use of TLC-NOSF technology demonstrated a marked improvement in the healing of a complex traumatic wound in an elderly patient. This case highlights the potential of innovative wound care solutions to optimize healing outcomes, particularly in patients with multiple comorbidities, and emphasizes the importance of targeted therapies in clinical practice.

 

EP0725 The use of a silver foam dressing with 3DFit technology in the treatment of a complex leg ulcer: A case study

Charley Ley¹, Nicola Adams^2
1Coloplast Ltd, Peterborough, United Kingdom, ²Likewise Sheffield, Sheffield, United Kingdom

Aim: This case study aims to illustrate the effectiveness of a silver foam dressing with 3DFit Technology in the management of a complex leg ulcer. The patient, a 52-year-old male with a history of intravenous drug use (IVDU), smoking, recurrent cellulitis and osteomyelitis requiring hospital admission. The patient presented with significant mobility issues and declining overall health. The goal was to:

• reduce infection risk,
• promote wound healing
• enhance mobility and
• improve quality of life

Method: The patient presented with a chronic ulcer on the right leg of duration over five years, worsened by IVDU. He ceased injecting into leg ulcer October 2023. The patient regularly attended clinic, 3 times a week after declining an amputation. Following the initiation of a silver foam dressing with 3DFit Technology in October 2023, used alongside one layer short-stretch compression. Due to a high infection risk a silver dressing with 3DFit Technology was selected for its antimicrobial properties, ability to conform to the wound bed and manage exudate

Results / Discussion: During treatment, the patient experienced significant wound improvement, with enhanced mobility, transitioning from the use of walking sticks to becoming fully mobile.

Conclusion: A structured care plan that included the use of silver foam dressings with 3DFit Technology were effective in treating a chronic, complex leg ulcer in a patient with multiple risk factors. The intervention reduced further complications and led to improved mobility and wound healing. This case underscores the importance of targeted, individualised wound care in managing complex patients, demonstrating the value of silver dressings with 3DFit Technology in bioburden management and wound healing.

 

EP0760 Skin sparing surgery with mechanical retention suture and npwt in Fournier’s gangrene: our first experience

Marco Marcianò¹, Bianca Vicari¹, Sefora La Sala¹, Giuseppe Carollo², Roberto Gullo², Gianfranco Cocorullo¹, Giovanni Guercio^1
1Università Degli Studi di Palermo, Palermo, Italy, ²A.O.U.P. Paolo Giaccone, Palermo, Italy

Aim: Fournier’s gangrene is a necrotizing soft tissue infection that requires early diagnosis, prompt surgical excision, and targeted antibiotic therapy. Traditionally, surgical management for sepsis control consists in radical excision of wide areas of skin and the underlying soft tissue. However this approach often results in large wounds that require complex coverage, long hospital stays, and/or delayed healing. This case series aims to report outcomes of FG using a more conservative approach: skin-sparing surgery combined with negative pressure wound therapy (NPWT) and Dermaclose as mechanical retention suture.

Method: We report three cases of FG admitted to our unit in emergency setting. All patients underwent skin-sparing surgery followed by NPWT, set at -125mmhg, and the placement of Dermaclose. In every following medication the tension of the Dermaclose was increased by 5 steps; additionally the viability and retraction of the skin margins, along with the overall condition of the wound were assessed.

Results / Discussion: The application of Dermaclose facilitates a more rapid juxtaposition of the wound margins and simplified the placement and maintenance of NPWT.Upon wound assessment, optimal viability and retraction of the skin margins was observed and the overall condition of the wound showed improvement.

Conclusion: Skin-sparing surgery in combination with NPWT and Dermaclose can contributes in source control, reduce wound healing time, maintain the wound moisture and ensure a better placement of NPWT, thereby potentially preventing complications and reducing hospitalization time of patients with FG.

 

 

EP0726 The utility of indocyanine green in a paediatric complex crush injury

Mei Ling Loh¹, Brenton  Sio¹, Shuxian Ho¹, Joanne Jovina Siow Huey Cheng¹, Tze Yean Kong¹, Yong Chen  Por^1
1KK Women’s and Children’s Hospital, Singapore, Singapore

Aim: Indocyanine green (ICG) has a myriad of applications in plastic surgery. We present a paediatric case in which indocyanine green was used to assess tissue viability in an acute wound with exposed bone, avoiding the need for complex wound coverage such as flap surgery.

Method: An 8-year-old boy sustained a deep abrasion over his big toe with tissue loss and exposed bone after his foot was caught in the tire while riding an electronic scooter. ICG was used intra-operatively to guide the debridement of devitalized tissue and assess the viability of skin edges after undermining and wound closure. The wound subsequently healed well without complications.

Results / Discussion: The use of ICG in this complex wound allowed maximum conservation of viable tissue during the debridement, hence minimizing exposure of underlying bone and obviating the need for flap surgery. When ICG is administered after wound closure, it also provides an accurate assessment of perfusion to predict wound healing, thus permitting confident closure of wounds with tissue loss under tension.

Conclusion: ICG is a useful adjunct in facilitating tissue conservation during the debridement of acute traumatic wounds in which the assessment of tissue viability may be challenging due to a wide zone of injury, such as in crush or shear injuries. It also aids in the assessment of skin perfusion after closure of tenuous wounds under tension.

 

EP0794 Advanced technological approaches in the treatment of complex hand trauma: case report

Antônio Pessoa¹, Caio Lopes¹, Priscilla Alves da Silveira F Pinheiro¹, Bruno Silva¹, Lucas Melo¹, Karine Silva¹, Bianca Oliveira^1
1Cicatriclin, Vitória da Conquista, Brazil

Aim: To describe the application of hyperbaric oxygen therapy (HBOT), negative pressure therapy (NPT), and specialized dressings in the management of a patient with a crush injury to the right hand.

Method: This case report was structured according to the CARE case report guidelines, using data obtained from medical record and photographic documentation. Patient consent was obtained through an Informed Consent Form.

Results / Discussion: A 31-year-old male patient sustained a crush injury to the right hand and wrist, resulting in extensive palmar dislocation. He required suturing of the wound in the surgical suite Postoperatively, the wound developed necrosis, needing the prescription of HBOT 90 minutes at a pressure of 2.5 atmospheres absolute. The patient required extensive debridement 11 days after the accident. During the post-operative assessment, he presented a large lesion with a large amount of bloody exudate. The multidisciplinary wound team started NPT with primary coverage of non-adherent mesh with silver for 5 days, creating a system of continuous suction. After this period, the primary dressing was maintained as the definitive dressing. The lesion exhibited favorable healing, with substantial reduction in size and exudate after 1 month and 5 days of new therapy, culminating in 20 HBOT sessions throughout the entire treatment period.

Conclusion: The combination of TPN, HBOT, and specialized dressings likely contributed to the positive outcome of the case, working synergistically to optimize the patient’s healing.

 

EP0727 Successful treatment for martorell hypertensive ischemic leg ulcer with multiprofessional approach

Réka Sayeda¹, Katariina Noronen², Kirsi Isoherranen^3
1Helsinki University Hospital, Helsinki Wound Healing Centre, Helsinki, Finland, ²Helsinki University Hospital, Vascular Surgery Department, Helsinki, Finland, ³Helsinki University Hospital, Inflammatory Center and Helsinki Wound Healing Centre, Helsinki, Finland

Aim: To demonstrate the importance of multiprofessional teamwork in the treatment of Martorell HYTILU ulcer. 

Method: Case Study. A 69 -year- old woman was brought to ER after laying on the floor for 2 days. She had chronically infected ulcers in the left ankle, which were proven to be both ischaemic- and Martorell HYTILU ulcers. The multiprofessional team included: vascular surgeons, dermatologists, plastic surgeons, geriatrician, infectious disease specialist, tissue viability nurses and physiotherapist. 

Results / Discussion: In the ER evaluation ADP ja ATP were palpable, Cefuroxime was started, and surgical revision was assigned. After second revision, the ulcers necrotized again and became extremely painful. On second evaluation, peripheral pulses were not palpable, and the patient was referred to university hospital, where received interprofessional treatment.  In MRA, multilevel atherosclerotic stenoses were seen on the left limb. After revascularization and starting of intravenous sodium thiosulfate treatment, the reappearance of necrotic tissue declined. Negative pressure wound therapy was started, and even though the importance of compression therapy was emphasized, this did not happen at first due technical challenges. The swelling of the left limb was threatening the success of the skin grafting procedure. After skin grafting, negative pressure wound therapy was changed to compression therapy additionally to SoftCast. After 3 months of multidisciplinary treatment the ulcer was healed. 

Conclusion: Interprofessional teamwork is the key for successful treatment of Martorell HYTILU ulcers. It is also important to repeat clinical evaluation, and healthcare professionals should be educated about the importance of leg oedema treatment.  

 

EP0728 Understanding haematomas: Unravelling the body’s complex reaction

Sharryn Cook^1
1Te Whara Ora Health New Zealand Nelson/Marlboroguh, Blenheim, New Zealand

Aim: The primary aim of this case study was to assess the clinical presentation, diagnostic challenges, and management strategies for a head haematoma. By understanding these factors, this can enhance our approach to the treatment and improve the patient outcome

Method: Introducing Mrs. P, who sustained a head haematoma when she fell backwards. She attended the Emergency Department, where the area was sutured but unfortunately underneath this area was a large haematoma. Within days this area started to swell and become malodourous.

To achieve our aim, we conducted a comprehensive analysis of Mrs. P. The methods included a thorough medical history review, physical examination and imaging studies such as an ultrasound and a CT scan and wound care. We also monitored the patient’s progress over several weeks, documenting any changes in symptoms and the effectiveness of various wound treatment protocols.

Results / Discussion: Our findings revealed that the head haematoma was caused by minor traumatic injury, leading to localised swelling, tenderness and a large head wound. Imaging studies confirmed the presence of a fluid collection, which guided the decision-making process. A conservative management approach was implemented initially, with close monitoring and follow-up appointments for wound care. Over the course of 8 weeks, the wound healed, and the patient experienced a complete recovery without any complications.

Conclusion: In conclusion this case study highlighted the importance of a systematic approach to diagnosing and managing a head haematoma.

EP0655 Conservative management of aplasia cutis congenita (5x7.5cm) of the scalp with associated bone defect (9x11cm)

Bettina Hafner^1
1University Childrens Hospital Zurich, Zurich, Switzerland

Aim: The goal was to achieve complete wound closure with conventional treatment without infection and with well-managed pain.

Method: This case report presents a newborn with a large acute ACC of the scalp and bone, treated conservatively. The wound was cleaned weekly with sodium chloride, hydrogel was applied to maintain moisture and it was covered with a perforated silicone plaster. A silver-infused polymer foam was used to prevent infection, while oral glucose was administered for pain management.

Results / Discussion: After 2 months a 50% reduction in wound size was observed, with complete closure achieved by 4 months, without complications and with well-managed pain. Scalp lesions can lead to complications such as infection, hemorrhage, thrombosis, and seizures. Current literature presents varied opinions on management, advocating both conservative and surgical approaches. The use of systemic antibiotics in conservative treatment remains a topic for discussion.

Conclusion: The management of ACC of the scalp remains controversial. This case demonstrates that even large ACC involving both skin and skull bone can be effectively treated with conventional wound care. Continuous monitoring is essential to identify potential complications early and to facilitate timely surgical intervention if necessary.

 

EP0729 Negative pressure wound therapy and photobiomodulation with blue LED light for pressure ulcer healing - case study

Urska Vernik^1
1University Medical Centre Maribor, Maribor, Slovenia

Aim: We present a case of the patient with sacral pressure ulcer, which was treated with negative pressure wound therapy and blue LED light.

Method: A 74-year-old patient with many comorbidities (Diabetes type 2, cardiac insufficiency, ischemic heart disease, ulcerative colitis, arterial hypertension, hypothyreosis) was operated for revascularization of the myocardium. In the post operative course, he experienced cardiac arrest, pulmonary embolism and bowel embolism which resulted in an emergency bowel resection and anastomosis. During the prolonged hospitalisation he developed sacral pressure ulcer with necrosis of an area of 10 times 10 centimetres. Necrotomy was performed and the treatment with negative wound pressure therapy was introduced. The negative pressure was set between 75 mmHg and 125 mmHg respectively according to the strength of pain. The system was changed every 3 days until discharge to the rehabilitation centre where healing was continued with blue LED light photobiomodulation.

Results / Discussion: The patient was hospitalized for almost 200 days due to many comorbidities and complications. After necrotomy the negative wound pressure therapy was applied for 74 days with intermittent periods. In all that time the wound healed up to the stage for free flap, but the plastic surgeon could not decide for it.  The patient was transferred to the Rehabilitation centre where they started photobiomodulation with blue LED light treatment till pressure ulcer was healed.

Conclusion: A negative wound pressure treatment stimulates the reduction of infective tissue and with combination of blue LED light contributes and promotes the wound healing.

 

EP0730 Effective treatment of a large wound in a patient on antiplatelet drugs

Jerzy Skucinski¹, Weronika Janiec^1
1LUXMED Surgery Clinic, Krakow, Poland

Aim: Presentation the treatment of a wound in a patient on antiplatelet drugs.

Method: A 74-year-old woman with a road traffic injury to the left elbow and adjacent forearm. A week earlier she underwent percutaneous coronary interventions and was using an antiplatelet drug. The patient had numerous bruises and blisters of up to 8 cm in diameter. Blisters were removed, a dressing based on sufathiazole, paraffin and chlorohexidine was applied, and treatment with amoxicillin and circulation-supporting drugs was started. Over the next few days, swelling of the entire upper limb with superficial necrosis of approx. 15 cm in diameter and bloody ecchymoses was observed. An ultrasound exam showed a hematoma in the subcutaneous tissue, measuring 20 cm in diameter. Necrosis was removed, clots were evacuated. Negative pressure dressing was applied for the 4 days. On the fifth day, the wound was abundantly soaked with blood, so the vacuum dressing was removed, as were the clots. Hemostasis was achieved using hemostatic sponge. No recurrence of bleeding was observed. Later, a vacuum dressing was reapplied, this time with positive results. Over the following weeks, progressive granulation and epithelialization were observed, leading to a reduction of the wound. Necrosis and biofilm were surgically removed. The primary dressings were containing absorbent, disinfectant and granulation tissue stimulating agent.

Results / Discussion: After 3 months of treatment, the wound was completely healed, and the patient was fully mobile

Conclusion: The use of multifactorial treatment of an extensive wound despite the use of antiplatelet drugs, allows for full recovery

 

EP0731 Clinical and patient experience and perspective on the use of hyper-oxgenated fatty acids (hofa) for skin care emollients

Kelly Phillips¹, Michaela Delahunty², Gemma Long^3
1Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, Nurse Consultant, Skin Integrity Team, Doncaster, United Kingdom, ²Rotherham, Doncaster & South Humber NHS Foundation Trust, Clinical Lead, Tissue Viability & Lymphoedema Service, Doncaster, United Kingdom, ³Doncaster & Bassetlaw Hospital NHS Foundation Trust, Specialist Support Worker, Skin Integrity Team, Doncaster, United Kingdom

Aim: Collate the effectiveness of Hyper-oxygenated fatty acids (HOFA) for skin care emollients, from a clinical and patient experience and perspective.

Method: 2 audits (Study 1 n=36, Study 2 n=9) and 3 case studies with testimonials were conducted on HOFA Oil or HOFA Emulsion used as emollients. The clinicians visually assessed the patient’s skin after each treatment and gained patient feedback.

Results / Discussion: 98% of patients met their treatment objectives using the emulsion 97% with oil. 92% of clinicians perceived the treatment as positive, 100% rated emulsion and oil better than previous products at improving skin texture, preventing breakdown, retaining moisture, and repairing skin barrier. Absorbency time was reduced on average by 10 to 15 minutes, due to the average absorbency time of the HOFA products being 1-5 minutes. For 45 patients just one application saved between 7.5 hours and 11.25 hours nursing time. Testimonial statements included: “You could feel the improvement”, “Smells divine!”, “My garments and work wear did not rub my skin as my legs remained hydrated for longer”, ‘’My leg remained hydrated all day, as did my hands”, “Aided Simple Lymphatic Drainage”.

Conclusion: The case studies and wider evaluations show that HOFA products are suitable alternatives to standard practice whilst reducing nursing time and fitting patient lifestyle more appropriately, with a level of assurance around improving their quality of life.

 

EP0732 Application of cream and fluid compounded with neem oil, team oil, aloe vera, fermented glycolic extract of papaya and sugar cane, rosemary and hydroxy acids in the treatment of arterial ulcers

Andrea Dultra

Aim: To evaluate the effectiveness of applying cream and fluid composed of Neem oil, Melaleuca, Aloe Vera, fermented glycolic extract of papaya and sugar cane, Rosemary and hydroxy acids in the treatment of arterial ulcers as debridements and antiseptics in an arterial ulcer.

Method: Consisted of a case study accompanied by photographs. Carried out at home between December 27, 2023 and May 23, 2024, respecting the ethical principles of research involving human beings, resolutions nº 466/2012 and 510/2016 of the National Health Council.

Results / Discussion: Patient J.S.S., 58 years old, diagnosed with an arterial ulcer in the right lower limb, had used other treatments for six months without success. The protocol consisted of irrigation with the compound fluid followed by application of the cream every 48 hours. The evolution of the lesion was documented: Initially (Figure A, 12/27/23), the lesion presented ischemia, necrosis and an intense odor. In the next stage (Figure B, 01/21/24), liquefaction necrosis and areas with granulated tissue were observed. On 03/29/24 (Figure C), contraction of the lesion and absence of odor was noted. On 04/24/24 (Figure D), there was contraction of the edges with the presence of granulated tissue, and in the last phase (Figure E, 05/23/24), remodeled tissue was found.

Conclusion: Treatment with cream and fluid composed of Neem oil, Melaleuca, Aloe Vera, fermented glycolic extract of papaya and sugar cane, Rosemary and hydroxy acids demonstrated to be effective as a debridement and antiseptic, promoting tissue regeneration, suggesting a promising alternative for arterial injuries.

 

EP0733 Treatment of a sporotrichosis wound with dialkyl carbamoyl chloride: case report

Paula Freitas¹, Heloísa Rédua¹, Rayanne Kuster¹, Rafael Nogueira¹, Natália Correia¹, Aline Ramalho², Alicia Pacheco³, Thays Gatti⁴, Ramon Araujo Dos Santos^4
1Universidade Federal do Espírito Santo, Vitória, Brazil, ²Hospital Sírio Libanês, São Paulo, Brazil, ³Universidade de São Paulo, São Paulo, Brazil, ⁴Hospital Universitário Cassiano Antonio Moraes, Vitória, Brazil

Aim: To evaluate the evolution of a sporotrichosis wound using Dialkyl Carbamoyl Chloride (DACC).

Method: Case report on the use of DACC to treat a cutaneous sporotrichosis wound in a Brazilian city. Follow-up took place between October and December 2022, totaling seven appointments. Study approved by the Ethics Committee (nº 6.111.709).

Results / Discussion: Patient, 60 years old, diabetes mellitus and hypertension, wound on the right lower limb from scratches and a cat bite. She reported starting treatment for sporotrichosis in September 2022. At the first appointment, the wound bed had a spongy appearance, slough, necrotic tissue and serous exudate, a darkened perilesional area, punctate lesions with irregular borders and hyperkeratosis. Cleaning with aqueous antiseptic solution of polyhexanide (PHMB) and emollient was applied. Followed by mechanical and instrumental debridement of the bed and edges, and Photodynamic Therapy (PDT), 9J, red, DACC as the primary dressing. This approach was maintained in the following appointments, changing the use of photodynamic therapy to photobiomodulation, red light (3J), controlling exudation and signs of biofilm. After seven appointments, the patient was discharged with total epithelialization and a hypertrophic scar. PHMB was used because of its antimicrobial action with a low risk of resistance. The PDT technique was used to induce the death of unwanted cells and was replaced by photobiomodulation to stimulate healing. DACC was chosen to control the fungal load and eliminate the biofilm from the bed.

Conclusion: It was established that the treatment carried out with DACC on a lesion resulting from sporotrichosis was effective, given the complete epithelialization of the lesion.

 

EP0656 Repair of severe avulsion injury of penis and scrotum with superficial iliac artery circumflex flap

Ming Yao^1
1General Hospital of Ningxia Medical University, Ningxia, China

Aim: Patient admitted for “6h after perineal avulsion injury”. Skin defect of scrotum was greater than 50%. The testis and epididymis were completely exposed, and left pedicled superficial iliac artery flap was used for repair.

Method: Pedicled axial flap incision transplantation and transfer coverage: left pedicled superficial iliac artery flap (13*11*7cm) was designed in left lower abdomen, and after the electric knife was free and retrograde transferred in the deep fascia layer, the defect exposed testicle, epididymis and penile root could be completely covered. The tissue scissors were able to fully free the bilateral wound margin of left lower abdominal donor area, and the defect of donor area could be reduced to form 2 arbitrary flaps after parallel moving, but the donor area could not be completely closed. After the tissue scissors were fully free, 2 arbitrary flaps were formed, and the defect area of the pubis was completely closed after parallel movement.

Results / Discussion: After 6 months of follow-up, the sexual life quality of the patients was not significantly different from that before injury, and his wife was pregnant for more than 4 months.

After 2 years of follow-up, the scar at the root of the penis was loosened and the penis was lengthened by local flap covering.

Conclusion: This treatment method is very effective in treating such a patient and the outcome is quite satisfactory.

Figures:

 

EP0734 Multi-modal management of necrotizing fasciitis including open fat grafting

Nimfa Jeraldine Buizon¹, Mohan Rangaswamy¹, Ali Al Dameh¹, Rency Raju², Emadeldin Kotb^1
1Al Zahra Hospital Dubai, Dubai, United Arab Emirates, ²AL Zahra Hospital Dubai, Dubai, United Arab Emirates

Aim: Necrotizing Fasciitis (NF) is a rare, yet critical bacterial infection that, if misdiagnosed—often as cellulitis—can lead to severe complications including limb loss, organ failure, and death. This report presents the innovative technique using open fat grafting on a difficult case of severe NF in the left arm, with necrosis of brachialis muscle, exposure of nerves, vessels, bone, and tendons where conventional skin graft is not applicable.

Method: Clinical assessment by a plastic surgeon was pivotal in the timely diagnosis of NF.  A comprehensive treatment regimen was instituted from December 2023 to August 2024, encompassing 20+ surgical debridement with negative pressure wound therapy (NPWT), 20+ hyperbaric oxygen therapy sessions, several ICU and continuous renal replacement therapy (CRRT) interventions, and multiple graft surgeries, including latissimus dorsi functional myocutaneous transfer. An innovative use of regenerative medicine by open grafting of a composite mixture of liposuctioned fat, platelet-rich gel, and diced extracellular matrix (ECM) was used successfully to cover critical structures exposed by NF.

Results / Discussion: Despite 80% circumferential skin-fat and fascia loss, along with significant muscle necrosis, aggressive multidisciplinary management resulted in effective limb preservation and functional recovery.

Conclusion: This case highlights the importance of early diagnosis and intervention in NF, underscoring the need for heightened awareness among emergency responders and surgical teams. The innovative grafting technique deployed here may offer a viable solution to cover critical structures in challenging cases where traditional interventions are not feasible. Open grafting of fat and matrix is a new concept in wound coverage.

 

EP0673 Calciphylaxis, a rare wound management approach with patient centred care at home

Susan Redmayne^1
1Family Medical Practice @ 2325, Nulkaba NSW 2325, Australia

Aim: To heal lower leg wounds caused by Calciphylaxis in an 84yr old Chronic End-Stage Renal Patient using a multifactorial wound management plan which would enable her to stay at home and be the co-author of her health outcomes.

Method: In the absence of many international publications to provide guidance, wet dressings were chosen to debride the necrotic tissue from the wounds caused by Calciphylaxis. A method of using three types of hydro-responsive wet wound dressings was developed in a sequence as the wound moved through the healing processes.  Dressings were changed three times a week with the timing acknowledging haemodialysis treatment routines of this patient and her need to have “days off” any treatments.  A nutrition plan, oxygen monitoring and supply, pain management and mobilisation plans were all negotiated with the patient.

Results / Discussion: The necrotic tissue was quickly debrided from the wounds and full healing was achieved in three to six months. The patient engaged with all aspects of the wound management plan and was able to fully enjoy her life with minimal pain and healing/healed wounds within 15 months, with all wound care being in her home.

Conclusion: In an international context of doom and gloom for Chronic End-Stage Renal Patients who develop “Hard to Heal” wounds caused by the calciphylaxis condition; this simple therapeutic approach offers optimism.  Educationally engaging with Renal Patients directly through their Renal Associations may lead them to proactively identify such wounds for themselves and know the options of care.   

 

EP0784 A case-cohort study of the outcomes of probiotics on wound healing in a private hospital in abu dhabi

Najat Amharar¹, Wayne Kleintjes², Julius Ray Inso^1
1Reem Hospital, Abu Dhabi, United Arab Emirates, ²Tygerberg Hospital, Cape Town, South Africa

Aim: Our hospital has facilitated the emergence of a long term intensive care unit (LTVU), where patients with multiple organ failure can be managed with ventilation, dialysis, and personalized wound care for an extended stay. This has led to the growth of particularly pathogenic bacteria strains in the unit, resistant to the most advanced antibiotic therapies available. In the wake of the re-discovery of the therapeutic impact of probiotics on wound healing, this study was designed assess the outcomes of concerning patients with infected and/or unhealing wounds treated with topical application of probiotics.

Method: Patients were selected prospectively, the principal criteria for selection were the failure of all conventional wound care therapies. The wounds were dressed daily, with conventional cleansing before applying a paraffin gauze containing one or two probiotics. Pictures were taken regularly, and whenever possible a culture swab was collected before and during the treatment.

Results / Discussion: Six patients were selected, with either infected or stalled wounds despite all conventional wound care treatments. We observed a general improvement of all wounds within the first two weeks of treatment, and a systemic resolution of septic symptoms. This was observed despite stool contamination, or skin damages due to severe malnutrition or advanced vascular disease.Culture swabs showed a switch from a multidrug resistant bacteria to a “no growth” result, either at the second swab or the third, regardless of the presence of any systemic antibiotic therapy.

Conclusion: the topical use of probiotics for wound healing support, whether infected or only colonized, is a potential safe and effective option to consider in the presence of multi-drug resistant bacteria strains

 

EP0735 Use of negative pressue wound therapy in Fournier’s gangrenene: Case study

Yongeun Hong^1
1National Cancer Center, Goyang-sio, Rep. of South Korea

Aim: Fournier gangrene is a rapidly progressing necrotizing soft tissue infection affecting the perineum and genital area, it requires urgent surgical debridement and meticulous wound care. This study aims to evaluate the effectiveness of NPWT in treating two patients with Fournier gangrene.

Method: The case study involves two patients: a 64-year-old female with rectal cancer who was hospitalized for a peri-anal abscess, and a 57-year-old male with lung cancer who was admitted to the ER with severe pain and swelling in the genital and perineal area. First, the patients underwent colostomy revision and surgical debridement of necrotic tissue. And then modified NPWT with instillation was applied every three days, and the condition of the wound was continuously monitored.

Results / Discussion: Both patients exhibited significant improvement in wound healing with NPWT. The NPWT effectively controlled exudate, reduced wound size and notable granulation tissue formation. After 3weeks, NPWT was no longer applied and foam dressing was applied instead of NPWT.  Patients were discharged and their wounds were monitored at an outpatient clinic.

Conclusion: This cases successfully showed wound recovery with NPWT, which was able to prevent further spread of the infection and accelerate the healing process. NPWT proved to be an effective wound management option for patients with Fournier gangrene, contributing to exudate control and granulation tissue regeneration. Additionally, this case demonstrates not only the effectiveness of NPWT in the treatment of Fournier’s gangrene but also the important role of specialized wound management by WOCN nurses in facilitating the recovery of complex wound.

 

EP0736 Hyperbaric oxygen therapy application in problem wound with spider bite: Case report

Büşra Güleçer¹, Kübra Özgök Kangal², Taylan Zaman², Serkan Ergözen³, Abdullah Arslan⁴, Fatma Didem Kesler^4
1Health Sciences University, Gulhane Faculty of Medicine, Aerospace Medicine Department, Ankara, Turkey, ²Health Sciences University, Gulhane Faculty of Medicine, Underwater Medicine and Hyperbaric Medicine Department, Ankara, Turkey, ³Muğla Sıtkı Koçman University, Faculty of Medicine, Underwater Medicine and Hyperbaric Medicine Department, Muğla, Turkey, ⁴Konya City Hospital, Underwater Medicine and Hyperbaric Medicine Department, Konya, Turkey

Aim: We share the results of hyperbaric oxygen therapy (HBOT) in two problem wounds after spider bite.

Method: Case A is 45-year-old male who had gradually growing wound in anteromedial area of his left leg caused by a brown recluse spider bite. The wound healed with wound care. After 2 months, he underwent surgery for venous insufficiency in his same leg. Three days after, a necrotic wound began to develop from incision side in groin and the area where his former wound was located. The patient underwent debridement. Wound worsened. Diagnosis was determined as pyoderma gangrenosum. Treatments were arranged accordingly. He underwent 60 sessions of HBOT. Initially, the wound was 18.7 x 8.7 cm in size with a black-yellow necrotic base. After HBOT, it was 15 x 5.6 cm in size with a completely granulated base.

Case B is 63 years old male. Massive edema developed on his hand after spider bite. Fasciatomy was applied on his hand dorsum and medial part of his wrist. After fasciatomy, HBOT was initiated. His infection markers were elevated and intravenous antibiotherapy was started. Seventeen HBOT session, 3 sessions of negative pressure wound therapy and graft operation were performed. His wound healed without complication.

Results / Discussion: HBOT support wound healing by reducing the hypoxia in the wound, relieving edema, increasing angiogenesis, fibroblast proliferation and collagen synthesis, and its anti-inflammatory and immunosuppressive properties.

Conclusion: In these cases, which turned into a complicated wound with related to spider bite, the treatment success increased with HBOT.

 

EP0737 Elephantiasis nostras verrucosa of unknown etiology with a hard to heal wound: a case report

M. Vadivelu Muniandi^1
1Hospital Tuanku Ja’afar, Seremban ; Wound Care Unit , Orthopedic Department, Seremban, Malaysia

Aim: The purpose of this case study on Elephantiasis Nostras Verrucosa (ENV) is to highlight the importance of identifying the underlying cause in the initial presentation and management of chronic venous stasis and lymphedema.

Method: The patient is a 71-year-old female who started having nodules in the left big toe  15 years ago. Excision biopsy was done and no malignancy was noted. She noted an increase in small nodules 10 years ago on the bilateral foot associated with leg swelling below the knee.

3 years ago she started having a wound over her left ankle with multiple episodes of relapse.

A biopsy was done in 2022 confirmed ENV.

On initial presentation, the patient had a left ankle wound size 5cm x 7cm with good granulation.

The patient started using activated carbon cloth and hydroconductive dressing material to manage inflammation and exudate. The patient also started on a 2-layer compression bandage to manage stasis dermatitis and lymphedema.

Results / Discussion: Generally, the limb will present as Mossy papules, plaques, and cobblestone-like nodules. In this case, patient presented with a non-healing wound due to venous stasis and lymphedema.

Conclusion: ENV with ulcer is uncommon. The principle of treatment is  still inflammation and exudate management. A compression bandage is impartial in managing the lymphedema and Venus statis to heal the wound and prevent relapse.

 

EP0738 Wound bed preparation in scalp lesions with squamous cell carcinoma

Laura Braithwaite¹, Daniel Lee^2
1South Warwickshire University NHS Foundation Trust, Warwickshire, United Kingdom, ²South Warwickshire Foundation Trust NHS, Warwickshire, United Kingdom

Aim: To evaluate the use of surfactant containing cleanser and gel with a microfibre debridement pad for wound bed preparation in a post-surgery and radiotherapy scalp wound in preventing infection and improving wound condition.

Method: A 83 year old female with scalp lesions associated with squamous cell carcinoma present for 13 years were treated with surfactant containing wound bed preparation products and debrided with a microfibre debridement pad.  The lesions were post-surgical and had previously received radiotherapy and were numerous on the scalp.  A soak of 10-15 minutes was applied followed by debridement and a surfactant gel to continue cleansing the difficult to dress wounds for 7 weeks.

Results / Discussion: Previous regime was washing with baby shampoo and saline, many anti-infective dressings had been used. No infection related to the wounds was recorded throughout the evaluation, scabs covering the lesions lifted to reveal slough and granulation tissue, exudate levels decreased by week 2 dressing changes reduced from twice weekly to once weekly by week 6.

Conclusion: Use of a wound bed preparation routine supported healing in these lesions which have been present for some time. Despite dressing with a silicone foam dressing scabs were still present which impeded the healing process.  In 7 weeks the introduction of the new routine has softened and lifted scabs revealing granulation tissue and the lesions are now looking more vascular.

 

EP0801 The use of extracellular matrix in complex reconstruction of the lower leg after massive avulsion

Davor Jurisic^1
1Department of plastic and reconstructive surgery in the Department of Surgery Clinical Hospital Center Rijeka, Rijeka, Croatia

Aim: To show that non-invasive and less invasive surgical techniques can achieve equally good or better results compared to microsurgical reconstruction techniques of such large and complex defects with less morbidity of the donor region and the same or better aesthetic and functional results.

Method: The use of Extracellular matrix in complex reconstruction of the lower leg after massive avulsion

Results / Discussion:  A 30-year-old male, a motorcyclist, with a previous history of type I Diabetes Mellitus, sustained multiple traumatic injuries including  a compound fracture of the tibia and fibula with extensive soft tissue damage, an avulsion fracture of the medial malleolus, and a traumatic open wound on the forearm with arterial involvement. After being treated by the traumatologist, the patient was transferred to the Plastic and reconstructive surgery department for further reconstructive treatment of residual defect. Five days after admission, a necrectomy was preformed resulting in exposure of anterior border of the tibia. In purpose to close the defect, this procedure was followed by a reconstruction using an acellular dermal matrix.  To complement the functional structure, a skin graft harvested from the left thigh, ensuring a comprehensive approach to wound closure. Postoperatively, the wounds were treated with a vacuum-assisted closure to encourage granulation tissue formation and to promote graft acceptance and wound healing. Successful limb salvage was achieved with no postoperative complications, such as infection or rejection of grafts.  The patient’s wounds exhibited healthy granulation tissue, and there were no signs of chronic non-healing ulcers at the time of discharge.

Conclusion: ECM played a crucial role in promoting wound healing by providing a biocompatible scaffold, tissue regeneration and ultimately, wound closure.

 

EP0678 Single-stage achilles tendon reconstruction using flexor hallucis tendon augmentation and peroneal artery perforator propeller flap in a patient with full-thickness contact burn

Claudine Lukban¹, Gerald Abesamis¹, Ralf Santamaria¹, Fernando Acance^1
1Philippine General Hospital, Manila, Philippines

Aim: Reconstructing an Achilles tendon defect after a full-thickness burn is a complex challenge, requiring both durable functional recovery and lasting wound coverage. Scar tissue, necrosis, and tendon loss complicate the process further. This report highlights the successful use of flexor hallucis longus (FHL) tendon transfer paired with a peroneal artery perforator propeller (PAPP) flap in an innovative approach tailored for a resource-limited setting.

Method: A 42-year-old male suffered a full-thickness burn on his right ankle from a motorcycle exhaust, leading to a defect with a desiccated Achilles tendon and infected wound bed. The patient was referred to multiple specialties, including Burns, Orthopedics, Infectious Diseases, Pain, Rehabilitation Medicine, and Social Services, for comprehensive care. Following thorough wound preparation, the Achilles tendon was reconstructed using the FHL tendon, while a PAPP flap provided essential coverage.

Results / Discussion: Postoperatively, the patient was monitored closely for flap viability and graft integration. His multidisciplinary follow-up included outpatient rehabilitation to enhance range of motion and functional recovery. At one month, he demonstrated increased dorsiflexion and ambulation without assistance. By six months, the patient achieved excellent functional outcomes, reporting a return to work and leisure activities. This approach proved economically valuable, requiring fewer resources and a shorter hospital stay. Minimal wound care needs further reduced costs, while outcomes prevented disability, allowing faster workforce reintegration.

Conclusion: This combined FHL-PAPP approach offers an effective, resource-efficient solution for Achilles reconstruction in burn patients, delivering functional and aesthetic success. Further research could extend its potential, especially for care in resource-constrained settings.

 

EP0770 Experience in the treatment of a case of diabetic foot gangrene of the left foot

Gang Kan^1
1Wuhan University of Science and Technology, Hubei, China

Aim: To discuss the experience and considerations in the treatment of diabetic foot gangrene, and related treatments and latest surgical procedures, as well as postoperative and prognostic considerations

Method: Treatment method:

1.Excision and drainage of an abscess

2. Dressing of wounds   

3. Incision and drainage of abscess and closed negative pressure drainage of the wound

4. Bi-layer artificial dermal grafting

Results / Discussion: The gangrenous wound healed well and little toe was preserved. Amputation was avoided. Patient regained walking function and normal daily activity.

Conclusion: The treatment of wet gangrene of diabetic foot must stick to the guidelines as for the following points: debridement, anti-infection and blood circulation.1. Early incision and drainage of abscess. Early debridement should be done as thoroughly as possible. 2. There are usually multi-resistant bacteria presented in the wound, so the bacteria should be clearly identified, and bacterial-sensitive antibiotics should be given. 3. The blood supply of the patient must be clearly and thoroughly evaluated, and the lower limb arteries must be unblocked if the arterial stenosis of the lower limbs is too serious.

Figures:

 

EP0739 A new technique of regenerative medicine on hard-to-heal wounds: Stromal vascular matrix case series

Alper Erkin¹, Hande Cengiz Açil², Havva Sert^{2 2}, Thomas Eberlein^3
1Sakarya University, Training and Research Hospital, Sakarya, Turkey, Sakarya, Turkey, ²Sakarya University, Faculty of Health Sciences, Sakarya, Turkey, Sakarya, Turkey, ³IHM International Institute for technology-based Education in Health, Management and Social Services, Österreich, Germany

Aim: Although wound healing rates have increased worldwide, chronic wounds may lead to serious complications. Regenerative medicine is a new research and application area in the treatment of hard-to-heal chronic wounds

Method: The wound healing status of five cases after Stromal Vascular Matrix (SVM) application was examined.

Results / Discussion: In this case series, all of five patients had hard-to-heal diabetic foot wounds that could not be healed by conventional methods and NPWT. Two of them were hemodialysis patients and one had additional diagnose of thromboangiitis obliterans. All of the cases get satisfactory reduction in wound dimensions after application of Stromal Vascular Matrix (SVM).

Conclusion: As occlusion, SVM cells play an important role on treatment of hard-to-heal wounds of any etiology.

 

EP0740 Should surgery be the first option in an interesting case of aplasia cutis treated by wound care

Alperen Pala¹, Müge Sert¹, Gaye Filinte^1
1University of Health Sciences Hamidiye Medical Faculty Kartal Dr.Lutfi Kırdar City Hospital, Istanbul, Turkey

Aim: Aplasia cutis congenita is a heterogeneous group of disorders in which localized or widespread areas of the skin are absent at birth. At birth, ulcerated lesions may show complete absence of all layers of skin, occasionally extending to the bone or dura. In this study, we aimed to demonstrate that healing outcome of the newborns may delay acute surgery in aplasia cutis defects.

Method: The patient presented with a 10x5 cm full thickness defect on the parietooccipital scalp exposing arachnoid tissue underneath and 8x5 cm full thickness defect on both sides of flank region. (figure 1) We planned ‘shoelace traction’ in the first place but the patient was not suitable for anesthesia so, we had to postpone the surgery. 5% chlorhexidine acetate gauze and silver-containing hyaluronic acid spray applied to both defects. The wound size reduced by 50% by the end of the first week. Within three weeks, the %80 of the wound was healed.

Results / Discussion: Management of full thickness defects of aplasia cutis includes dressing applications, skin grafting, local flaps, epithelial autografts, and cranioplasty (1). Surgery was initially planned due to the potential for excellent wound healing in the first weeks of newborn, however due to inevitable postponement of surgery we observed the healing capacity was quite preferable and the defects closed without a need for acute surgery.

Conclusion: This case highlights that effective wound care in aplasia cutis wounds may delay the need for surgery.

1-Aplasia Cutis Congenita: Clinical Management of a Rare Congenital Anomaly
DOI: 10.1097/SCS.0b013e3181f73937

Figure 1. newborn with aplasia cutis presented with tissue defect in scalp and both sides of flank

 

EP0741 Closure of diabetic foot ulcer with polylactic acid membrane guided by thermographic imaging

Víctor Manuel Loza González¹, Mario Aurelio Martínez-Jimenez², Natalia Sánchez-Olivo³, José Luis  Ramírez GarcíaLuna⁴, Eleazar Samuel  Kolosovas-Machuca⁵

¹Doctorado Institucional en Ingeniería y Ciencia de Materiales (DICIM-UASLP), Universidad Autónoma de San Luis Potosí ́, Tissue Bank-wound care center, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ²Burn Unit, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ³Facultad de Medicina UASLP, Burn unit, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, Mexico, ⁴Division of Experimental Surgery, Faculty of Medicine, McGill University, Faculty of Science, Universidad Autónoma de San Luis Potosí, Quebec, Canada, ⁵Coordinación para la Innovación y Aplicación de la ciencia y Tecnología, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico

Aim: The use of thermography in diabetic foot has reached significant attention in the medical community. We report the clinical progression of a patient with diabetic foot monitored by infrared thermography and treated with a polylactic acid membrane.

Method: A 67-year-old-female patient with Diabetes Mellitus type 2 developed a diabetic foot ulcer following minor trauma. She was treated over two months until her condition progressed to Grade 4 on Wagner Classification. After a recommendation for amputation the patient sought a second medical opinion. Guided by infrared thermography, a treatment plan including antibiotics, silver wound dressings and a polylactic acid membrane was used until wound closure.

Results / Discussion: Thermographic imaging showed a reduction of the temperature differences (ΔT) between the affected and healthy foot and reduction of temperature from the knee area down to the foot area as healing advanced. An initial negative ΔT was observed between the first left toe and the first right toe (Initial ΔT -5.2°C ±1.1) changing to ΔT: -1.7°C ±1.9 at twelve weeks of treatment. The most distal inflammation was initially detected at the knee area (ΔT: -1.7°C ±0.6) at 40 cm from the wound with change to ΔT 0.8 °C ±0.4 at twelve weeks near the metatarsal bones, 8 cm from the wound

Conclusion: By detecting the changes in temperature of affected areas, thermography provided the physician with feedback on wound healing progression phases and treatment effectiveness.

 

EP0797 Advanced wound care in a complex pressure injurie in a critically ill newborn

María Carolina Medel Sánchez^1
1Hospital Dr. Exequiel González Cortés, Santiago, Chile

Aim: To describe the Advanced Wound Care (AWC) approach in a critically ill newborn with a Pressure Ulcer (PU) in the occipital area.

Method: Descriptive study. Clinical case of a 9-day-old newborn hospitalized in the Critical Care Unit, under invasive mechanical ventilation, with acute respiratory dysfunction, renal replacement therapy, and multiorgan failure. After removal of a medical device, a deep tissue pressure injury was observed in the occipital region, which subsequently progressed to complete exposure of the underlying tissue injury. An AWC protocol was implemented using a pure hypochlorous acid cleansing solution (330 ppm, pH 5.5). In case of signs of infection, antimicrobial dressings with debridement capacity were applied. Once the infection was controlled, dressings were used to maintain moisture balance and for atraumatic, painless removal. Dressings were changed twice weekly, and pressure relief measures were implemented.

Results / Discussion: AWC facilitated progressive healing of the pressure ulcer, with reduced tissue damage and positive evolution. One month after starting treatment, the patient experienced clinical complications (systemic infection and lack of weight gain), which

affected the wound. Infected wound management was resumed for two weeks before transitioning back to standard wound care, achieving complete healing within 8 weeks.

Conclusion: Clinical stabilization of the patient is crucial for successful wound management, as systemic complications can compromise wound healing. A comprehensive approach that considers the patient’s clinical status and healing barriers, along with the use of advanced, safe materials for this population, is essential for achieving good clinical outcomes.

 

EP0742 A unique way to destroy the infection of non-healing wounds in 1 minute. Case series

Ingrida Asakienė^1
1Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

Aim: A faster healing of chronic wounds by using a single application method for biofilm disruption and destruction of pathogenic microorganisms.

Method: The treatment: a single application with a topical dehydrating agent (TDA). Biofilm consists of 98% water. After binding water molecules, TDA denatures proteins and disrupts the membranes of microorganisms. Only damaged tissue affected.

According to previous clinical trials 100% of pathogenic microorganisms were destroyed in 30 sec and >90% of wounds formed healthy granulation tissue after 21 days following single application. Clinical case No.1. Venus ulcer developed following trauma and remained unhealed for 2 years, after which the patient underwent VSM phlebectomy. Initial treatment: topical treatment with dressings, antibiotic therapy – no signs of recovery and healing. Wound culture: antibiotic-susceptible S.aureus.

Clinical case No.2 Venus ulcer developed following trauma and remained unhealed for 6 months. Hospitalization. No abnormal findings: Duplex us, CT Angiography, Ankle – brachial index. Wound culture: antibiotic-susceptible S.aureus.

Results / Discussion: After treatment with TDA non-healing wounds recovered. Due to the elimination of the infection, wounds reached granulation phase faster (within 3 weeks (case No.1) and 1 month (case No. 2)) and prompted natural healing.

Conclusion: Topical dehydrating agent (TDA) is an innovative wound care solution for all patients, suffering from chronic wounds, including those facing antibiotic – resistance. TDA offers a lasting solution where conventional infection management methods fall short. A single application versus multiple debridement interventions.

 

EP0657 The holistic approach in the treatment of a patient with extensive radiodermatitis in the cervicofacial area

Antonino Lombardo¹, Francesco Stivala¹, Sandra Iannarino¹, Enrica Fontana¹, Monica Urso¹, Antonella Mariotto¹, Giuseppe Riva¹, Michela Miletta¹, Mario Paleologo¹

¹A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Turin, Italy

Aim: Treatment of the wound using a combined methodological approach: Wound Bed Preparation (WBP) and Wound Hygiene (WH).

Method:

Case Formulation
Male patient, 50 years old, body weight 55 kg, height 168 cm, BMI 18.42, diagnosed with nasopharyngeal carcinoma. The patient underwent 35 radiotherapy sessions totaling 70 Gy. HGB 11.2 g/dl, WBC 1,400. The patient presents an extensive bilateral radiodermatitis on the neck: 12 x 8 cm on the left and 10 x 6 cm on the right.

Treatment

• Reassurance and emotional support for the patient, with active involvement in the care process.
• Nutrition: oral intake with a hypercaloric diet of 2200 Kcal + supplement containing Glutamine and Arginine, totaling 150 g of protein/day.
• Cleansing: solution based on hypochlorous acid.
• Debridement: autolytic and chemical.
• Infection management: systemic antibiotic and topical antimicrobial based on silver + EDTA and Benzethonium Chloride.
• Exudate management: dressing with Hydrofiber technology and silicone foam reinforced at the edges with polyurethane film.
• Pain management: Hypnosis + 5% Lidocaine cream and/or 50 mg endovenous Tramadol if pain NRS (Numerical Rating Scale) > 3.

Results / Discussion:

• Infection resolution: 1 week
• Average dressing change interval: 72 hours
• Healing time: 6 weeks
• Average pain: NRS = 2

Conclusion: The synergistic management between WBP and WH enabled the patient to achieve complete healing quickly. The timelines for dressing changes and infection resolution were satisfactory, and pain management were positive. All of this had a positive impact on healing time, which was not guaranteed, and on the patient’s quality of life.

 

EP0743 Multimodal management strategies of calcium chloride extravasation leading to a complex paediatric wound

Alison Quah¹, Michael Hsieh¹, Savitha Ramachandran^1
1KK Womens and Childrens Hospital, Singapore, Singapore

Aim: Calcium chloride extravasation is a rare but serious complication that can lead to extensive tissue damage. We present the case of a pediatric patient who sustained extravasation of 10% calcium chloride through a cannula placed over the left ankle. Initial treatment included irrigation with normal saline and hyaluronidase injection into subcutaneous tissues. Despite this, the skin over the distal shin became dusky, progressing to an eschar that required surgical intervention.

Method: The patient underwent multiple debridements and negative pressure wound therapy. Initial application of acellular dermal matrix (ADM) was unsuccessful due to poor integration, likely caused by multiple calcium deposits embedded within the wound bed, leading to further tissue necrosis and superimposed infection. Ultrasonic (Misonix SonicOne®) and hydrosurgical (VASERjet®) debridement devices were subsequently used for precise removal of necrotic tissue and calcium deposits while preserving healthy tissue. Negative pressure wound therapy with irrigation was also employed to allow continuous irrigation. Following this, a second ADM application successfully integrated, and the wound was covered with a split-thickness skin graft, which healed uneventfully.

Results/Discussion: Calcium chloride extravasation presents limited treatment options. High concentrations of calcium salts can precipitate protein and cause direct cytotoxicity, leading to tissue necrosis that may extend past the borders of initial injury. Timing of surgical intervention remains controversial, with varying opinions on early versus delayed debridement.

Conclusion: This case highlights the importance of a multimodal approach, utilizing advanced techniques like ultrasonic and hydrosurgical debridement, negative pressure therapy, and ADM to facilitate optimal wound healing and improve patient outcomes.

 

EP0663 Innovative integration of activated carbon cloth dressings and negative pressure wound therapy in managing complex infected abscess in a diabetic patient

Mohd Zurairie Mohd Zubir^1
1Adjunct Senior Lecturer, Monash University Malaysia, Bandar Sunway, Malaysia

Aim: To evaluate the efficacy of combining activated carbon cloth dressings with negative pressure wound therapy (NPWT) for the management of a deep, infected axillary and pectoralis major abscess in a patient with diabetes mellitus.

Method: A 58-year-old male with diabetes presented with a deep axillary and pectoralis major wound abscess, complicated by heavy exudation and purulent discharge. Surgical debridement and abscess drainage were followed by an innovative wound care regimen involving activated carbon cloth dressings combined with NPWT. The treatment strategy focused on reducing exudate, preventing infection recurrence, and promoting wound closure. Clinical outcomes were measured by wound area, depth reduction, and exudate levels over the course of treatment.

Results / Discussion: The combination therapy significantly reduced wound exudation, supported rapid healing, and led to complete wound closure without secondary infection or the need for delayed primary closure. The patient’s tolerance of the treatment was excellent, and the wound healed fully within the expected time frame. Importantly, the activated carbon cloth primarily provided antimicrobial action, effectively controlling the bacterial load in the wound, while also aiding in exudate management.

Conclusion: The combination therapy significantly reduced wound exudation, supported rapid healing, and led to complete wound closure without secondary infection or the need for delayed primary closure. The patient’s tolerance of the treatment was excellent, and the wound healed fully within the expected time frame. Importantly, the activated carbon cloth primarily provided antimicrobial action, effectively controlling the bacterial load in the wound, while also aiding in exudate management.

 

EP0744 Using fluorescent imagery to evaluate debridement – a 49 patient review

Wendy Finch¹, Eileen Rytel^1
1Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom

Aim: To evaluate mechanical debridement products available in the UK NHS in lower limb, trauma and surgical wounds; using clinical and patient outcomes to assess suitability for use in the Tissue Viability Clinic.

Method: 5 mechanical debridement products were chosen to evaluate 9 – 10 patients each.  Patients with hard-to-heal wounds were included. A fluorescent imaging device (FID) was utilised to assess bacterial burden pre and post debridement.  A total of 5 debridement sessions per patient were performed. Slough and granulation tissue % were recorded at the start of the study period and the end, pain, wound size, bacterial load and whether the wound had improved or healed were tracked.

Results / Discussion: 
Table 1:

Series 1: Bacterial load reduction
Series 2: Granulation improvement
Series 3: Best mean pain score 1-10

Conclusion: The FID provided a useful tool to assess bacterial load on a subjective scale.  All debridement products showed an improvement in bacterial load, granulation tissue and pain reduction.  Some products performed better than others and this will help to inform product choice during patient care.

 

EP0679 Basal cell carcinoma as a long-term complication of a steam burn

Cèlia Pintado Jou¹, Francisco Javier Rodríguez Martínez¹, Nuria Tuset Mateu¹, Monica Gonzalez Duran¹, Lydia Sanchez Fernandez¹, Elena Chivite Roman², Susana Casaus Carmona¹

¹Complex Wound Unit Primary Care Metropolitan South and Penedès (UFECAP), Catalan Health Institute., L’Hospitalet de Llobregat, Spain, ²Complex Wound Unit Primary Care Metropolitan South and Penedès (UFECAP), Catalan Health Institute., L’Hopsitalet de Llobregat, Spain

Aim: To describe a case of basal cell carcinoma (BCC) as a long-term complication of a steam burn, emphasizing the role of the Wound Nurse Specialist (WNS) in identifying relevant history in patients with complex chronic wounds.

Method: A thorough history and examination were conducted on a 90-year-old man with no significant medical history or prior pathology; recent blood tests were within normal limits. Physical examination revealed a large erythematous lesion in the left lumbar region (15.5 x 16 cm) with an ulcerated area in the center (5.5 x 3.4 cm), showing hypergranulated tissue, no pain, but intense pruritus. The patient reported a steam burn in the same area 20 years prior.

Initial wound care was managed at the primary health center with no clinical improvement. After 6 months, the patient was referred to the WNS, who performed a biopsy as a complementary test. Results confirmed an infiltrating ulcerated BCC. Treatment involved wide excision with graft coverage (unsuccessful), followed by secondary intention healing.

Results / Discussion: Late-presenting atypical wound was identified by the WNS in a Primary Care Centre.

Conclusion: Detailed anamnesis and examination are essential in patients with complex wounds. BCC arising from burn scars can be challenging to detect initially, as scars may obscure early signs of malignancy. This carcinoma type may present as an ulcerated lesion with irregular borders, underscoring the need for early diagnosis to prevent deep tissue invasion. Additionally, this case highlights the important role of the WNS for the early diagnosis and management of Complex Wounds.

 

EP0789 Intermittent pneumatic compression of the thigh for the treatment of difficult-to-heal venous leg ulcers (UCV) – 2 case reports

Anne Deter¹, Nils Lahmann¹, Kathrin Raeder¹, Michele Haink¹, Sandra Strube-Lahmann^1
1Charité Universitätsmedizin Berlin, Berlin, Germany

Aim: A considerable number of chronic venous ulcerations fail to heal. New therapeutic approaches that support compression as a causal therapy are required. Intermittent pneumatic compression (IPC) represents an additional possibility for improving blood flow. The objective of this study is to determine whether a new developed device that allows IPC is able to support healing in conjunction with standard compression therapy.

Method: Patients with venous leg ulcers were included. Enrolled patients used the IPC device for two hours a day, alongside standard wound care for a 16-week period. The wounds were documented and analysed at two-week intervals using a special camera and 3D wound imaging software. This study describes the course of treatment of two patients who participated in the intervention programme.

Results / Discussion:

Case 1 – male, age: 72

At the beginning, the ulcer had an extension of 16.3 cm² and showed good granulation. After 6 weeks the wound size had halved and after 13 weeks there was still a minimal lesion of 0.9 cm².

Case 2 – female, age: 82

The ulcer had an initial size of 13.2 cm². The wound bed consisted of approx. 85% granulation tissue and 15% fibrin coating. Participation in the study ended prematurely after 12 weeks with complete wound closure.

Conclusion: The case reports suggest that IPC may be able to overcome treatment resistance and reduce relapse rates. The IPC device is characterised by a user-friendly application that could improve treatment adherence.

EP0674 Closure of a diabetic foot ulcer with a fish skin graft in a patient with multiple co-morbidities and vascular compromise

Wendy Stephens^1
1Southwest Health System, Cortez, United States

Aim: This is a 66-yr-old female who is a noncompliant diabetic and smoker with PAOD, PVD, HTN, and history of MI x 2 with PTCA and stent placements.  This patient presented to the ER in October with cellulitis of her right foot due to a gangrenous right great toe.  She had an open wound to her right lateral foot from walking to avoid ambulating on her black toe.  CTA showed bilateral SFA occlusions.

Method: FSG applications were started in December after SOC with serial debridement, dressings, compression, glucose management, and offloading.  The FSG was applied once weekly in the Wound Clinic and secured with a veil, then backed with an absorbent silver hydrofiber (Aquacel), foam borderless dressing, kerlex, and ACE wrap.  She required weekly debridement to prep the wound bed for FSG application with each clinic visit.  A total of 7 applications of decellularized fish skin graft was applied to her right lateral foot ulcer over 3 months.  She required close monitoring of the right foot due to recent amputation of her right great toe as well.

Results / Discussion: Within 1 month of 3 applications of FSG to her right lateral foot wound, her ulcer size reduced in width by 50% as she developed granulation tissue that filled in the defect quickly.  Drainage decreased as well.   6 applications and 2 months later, her foot ulcer was 90% healed.  She closed after 7 applications of FSG by end of March.

Conclusion: Diabetic Foot Ulcers (DFUs) complicated by osteomyelitis are profound and challenging wounds.  Several factors play into non-healing DFUs such as tobacco use, neuropathies, PVD, PAOD, edema, diabetes, prior amputations, foot deformities, ambulatory status, etc.

 

EP0746 Recalcitrant diabetic foot osteomyelitis treated with antibiotics, debridement, tendon balancing and external fixation

Ferdinand Slisuric¹, Kristijan Matkovic¹, Antun Previsic^1
1Pozega General Hospital, Pozega, Croatia

Aim: Diabetic foot osteomyelitis is a complex complication of diabetes mellitus and frequently leads to amputation. The treatment consists of surgical resection of infected and necrotic bone and targeted antibiotic therapy. Additional steps are required to achieve satisfactory healing and to prevent reulceration.

Method: We present a case of a 66-year old diabetic patient with chronic ulcer and cuboid bone osteomyelitis on the stump of his left foot after previous transmetatarsal amputation.

Results / Discussion: Targeted antibiotic therapy and surgical débridement of all necrotic tissue was followed by local application of antibiotic-impregnated cement spacer and negative pressure wound therapy. A week later, the tissue defect was closed by rotation plantar flap. Equinovarus deformity realignment was obtained by tibialis anterior tendon and tendo-achilles lengthening. To maintain bone and joint alignment an external Ilizarov fixator was applied. Postoperatively, a partial wound disruption appeared with local infection. Two months later an autologous bone grafting of the cuboid bone was performed. The external fixator was removed and local wound management was continued. In the following six months there was no improvement. Therefore, the Chopart amputation was performed, but new ulceration followed. Complete healing occurred within twelve months from index surgery with the advent of frequent wound dressing changes and offloading. After three years of follow up the patient is still ulcer-free and ambulatory in custom shoes.

Conclusion: Although recalcitrant pedal wounds in diabetic patients prove to be challenging and costly to treat, every effort should be made to prevent limb loss and regain mobility.

 

EP0747 Improved protocol for antibiotic-free treatment of a 2nd degree burn in a primary care center in serbia

Maja Karadzic

Aim: Application of systemic antibiotics is still common for the treatment of burn wounds within our primary care center, especially in patients at high risk for infection and impaired healing. In the spotlight of the increasing global threat of drug resistance, I evaluated the effectivity of an antibiotic-free topical management of 2^nd degree burn wounds using common octenidine-based antiseptics only.

Method: As a case report, I present a 75-year-old patient, diagnosed with diabetes mellitus, whose dorsal side of index and middle finger were burned by boiling water. Daily algorithm consisted of wound assessment (e.g. possible signs and/or symptoms of infection, detritus, granulation, epithelization), standard surgical wound care (mechanical debridement and cleansing using octenidine-based wound irrigation solution) as well as antiseptic wound bed preparation using octenidine-based antiseptic followed by octenidine-based hydrogel application in order to moisture the wound, prevent itching and friction and reduce the malodor. Secondary wound dressings were applied in initial phase to protect granulation tissue. Moreover, the patient was educated on how to re-apply the antiseptic-based hydrogel several times per day during the follow-up treatment. Neither local nor systemic antibiotics were used.

Results / Discussion: Complete healing was achieved within a short time frame with no signs of wound infection throughout the process. All commercial octenidine-based products were well tolerated.

Conclusion: The antiseptic octenidine represents a suitable alternative to be used in a primary care center, even in high-risk patients to improve wound healing and to avoid infection. The protocol is easy to implement and follows international antimicrobial stewardship recommendations.

 

EP0658 Nursing care of external fixation at periprothetic fractured total knee prothesis and with dermolisis: a case report

Hilda Rezar^1
1Univesity Clinical Centre Maribor, Slovenia, Maribor, Slovenia

Aim: This case report disscused the challenges and nursing care strategies involved in managing a periprosthetic fracture in a patient who has total knee replacemet, lower back fracture and dermathitis.

Method: An 58 year old male patient susteined a multifragmentaly fracture following a fall. The two stage operation had been indicated and less invasive surgical strategies using external fixation. There were a tissue complications - dermolisis. The poor condition of the skin on the right leg made it difficult to care out rehabilitation and ensure optimal healing. Postoperative management included vital sings, bleading from operating area, pain assesment. Very important for nurses is to keep the pin – tract and surroundings skin clean and aseptic ussualy once a day or more. Frequent assesments of blood circulations, sensations and movement of the affected limb and toes were also important.

Results / Discussion: We performed demanding nursing procedures on the patient in the direction of the earliest possible healing of the skin of the lower extremity with an inserted external fixator. The external fixations were removed after 4 weeks and osteosinthesis with two plate was done. He left the hospital on his own foot with sticker. After 4 months he was able to walk without crutcses and he is full of life energy.

Conclusion: This case highlights the significance of interdisciplinary collaboration in nursing care and surgical management of patient with unique complication, reinforcing  the need for diligent monitoring and adaptive nursing care strategies.

 

EP0748 Coexistence of two rare etiologies of lower limb ulcerations in a 49-year-old male

Natalia Welc¹, Honorata Kubisiak-Rzepczyk¹, Adriana Polańska¹, Monika Bowszyc-Dmochowska¹, Ryszard Żaba¹, Aleksandra Dańczak-Pazdrowska¹

¹Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland

Aim: Lower limb ulcers have a wide differential diagnosis. A rare cause of ulceration is sporotrichosis, as well as syphilis, which sometimes presents with non-specific skin lesions. We describe a 49-year-old man with diffuse ulcerations of these origins.

Method: The patient reported painful lesions resistant to topical and systemic treatment. The first developed on the right lower leg four weeks after an unknown cat scratch. Four lesions appeared near left ankle and one each on the left thigh and left buttock. A tissue biopsy was taken from the right lower leg ulceration with a swab from the biopsy wound for direct mycological examination and culture. A biopsy for histopathological examination was taken from the left thigh lesion, and for DIF - from the left buttock. Laboratory tests were ordered.

Results / Discussion: TPHA titer was 1:320, RPR was negative, which was confirmed twice. Screening for antibodies to T. pallidum was positive. The patient was never treated for syphilis. The histopathological result revealed a syphilitic skin lesion with coexisting eczema. On direct examination, mycelial hyphae were observed. Sporothrix spp. were cultured. Sporotrichosis and syphilis of unknown duration were diagnosed. Benzathine penicillin and itraconazole were administered. After two months, the ulcerations had almost completely healed.

Conclusion: Lower limb ulcerations lead to diagnostic and therapeutic challenges. Sporotrichosis and syphilis should be included in the differential diagnosis, especially in patients not responding to the standard treatment. Appropriate tests, like here tissue biopsy with mycological tests and cultures, allow to reach the correct diagnosis and suitable treatment.

 

EP0749 Rapid fill of granulation tissue using ovine forestomach graft in surgical reconstruction of complex soft tissue defects in under-served population in India

Sandeep Naphade^1
1Pushp Superspeciality Cosmetic Clinic, Pimpri-Chinchwad, India

Aim: The purpose of this study is to evaluate a method to facilitate rapid development of granulation tissue in volumetric and complex soft tissue defects of varying etiologies (such as diabetic foot ulcers, pilonidal sinus disease, neoplasm excision, and surgical dehiscence) reflective of a medically challenging and under-served patient population in India.

Method: This retrospective, single-arm, observational cohort includes 28 patients with complex soft tissue defects requiring-operative intervention. Primary endpoint was time to 100% depth fill of defect with granulation tissue. Secondary endpoints included time to full epithelialization, proportion of patients reporting post-operative infections and recurrences.

Results / Discussion: 53.5% of patients had at least two significant co-morbidities which would traditionally complicate healing. Average depth of defect was 1.5 cm (SD=1.03, range: 0.2-4.0) and 82.1% of defects had exposed bone or tendon. Four defects utilized OFM as an implant and so depth was not recorded. Meantime to 100% depth fill in applicable defects was 17.1 days (median,14 days). Mean time to 100% epithelialization was 6.9±8.46 weeks (median,3 weeks). No infections or recurrences were reported. 1 patient (3.5%) had a minor dehiscence which healed with conservative outpatient treatment. All 28 patients achieved full epithelialization of the index defect.

Conclusion: OFM is a clinically effective part of the modern reconstructive ladder and facilitates rapid depth-fill of volumetric soft tissue defects with viable granulation tissue to potentially decrease healing times in an under-served patient population.

 

EP0750 Approach to atypical wound: importance of holistic assessment for the comprehensive approach of a patient with complex wound. A case report

Rosa Torrens Martínez¹, Paula Manzano Chico¹, Ana Carretero Piza^1
1Centro de Salud Son Serra- La Vileta, Palma de Mallorca, Spain

Aim: To demonstrate the importance of holistic and systematized assessment in the etiological identification and approach of an atypical wound in the primary care nursing consultation.

Method: Systematic review and presentation of a clinical case of a patient who presented an atypical wound, approached in a multidisciplinary and biopsychosocial manner. Assessment of the wound was done using the TIMERS scale and complementary tests.

Results / Discussion: Atypical wounds comprise approximately 20% of all chronic wounds. An atypical wound may be suspected if the wound has abnormal presentation or location, disproportionate pain, and heals within 4 to 12 weeks with a good treatment plan. A 63-year-old man came to the primary care emergency service with a wound located in the medial area of the plantar arch of the left foot, lasting 2 days, without associated trauma. He reports VAS 8. He has a history of poorly controlled type II diabetes mellitus since 2013 and stage 4 chronic kidney disease being treated with dialysis. He was referred to his primary care nurse to address the wound. The TIMERS instrument for assessment and complementary tests ABI, blood analysis, soft tissue ultrasound was used to identify etiological origin and diagnostic orientation of an atypical lesion that suggested a differential diagnosis of vasculitis vs hyaline arteriolosclerosis and the local treatment adapted to the detected needs was chosen to wound healing.

Conclusion: The systematic multidisciplinary approach made it possible to heal the atypical lesion in 5 weeks, improving the patient’s quality of life and reducing costs and comorbidities.

 

EP0762 Use of stabilized hypochlorous acid solution at ph 5.5 for the treatment of incontinence-associate dermatitis: An effective and simple alternative for healthcare teams

Jessica Astudillo^1
1Hospital Dr. Ernesto Torres G., Iquique, Chile

Aim: To describe the therapeutic management of type 1 and 2 incontinence-associated dermatitis (IAD) using a hypochlorous acid solution at pH 5.5 (HClO-pH5.5) in adults in an Intensive Care Unit (ICU).

Method: This descriptive observational case series included adults (n=6) in an ICU. Data recorded included age, sex, comorbidities, admission diagnosis, data for IAD categorisation (Ghent-Global-IAD Categorisation Tool 2017), anatomical area affected, time since lesion onset and days of treatment. The treatment involved a solution of 330 ppm HClO pH 5.5, applied after each diaper change. The procedure included cleansing the area with neutral pH soap, applying gauze soaked in HClO-pH5.5 for 3-5 minutes every 6-8 hours, and using a dimethicone-based barrier as needed. Photographic records were obtained with authorization from patients and the hospital and data were systematized following CARE guidelines.

Results / Discussion: All cases showed favorable progression, with a visible reduction in inflammatory signs within 24 hours and complete re-epithelialization within 4-14 days. Targeted therapeutic interventions were supported by understanding the pathogenesis of IAD. Including a HClO-pH5.5 in the treatment regimen helped restore acidic pH, cohesion and synthesis of the stratum corneum, reduce microbial load without cytotoxicity or irritation, and provide anti-inflammatory effects. The technique was easy to use and replicate by clinical teams, reducing nursing time dedicated to managing complex IAD cases. Given the high frequency of IAD in incontinent patients, timely preventive and therapeutic actions proved relevant for our unit.

Conclusion: The inclusion of HClO-pH5.5 in IAD management protocol for adults is safe, reduces inflammation, and promotes re-epithelialization. A prospective study with a larger sample size is recommended.

 

EP0751 Extravasation injuries a clinical experience through the narration of a micropreemies: a nursing role

Eleonora Sasso¹, Valentina Vanzi², Mauro Pace¹, Marianna  Retattino¹, Giancarlo Antonielli¹, Guido Ciprandi^1
1Bambino Gesù Children’s Hospital, Rome, Italy, ²Bambino Gesù Children’s Hospital, Roma, Italy

Aim: Nursing role in the treatment of extravasation injuries in a preterm patient.

Method: Case report.

Results / Discussion: Omar born at 24th gestational week and weighing 600g (a micropreemies) is hospitalized at the Bambino Gesu’ Children’s Hospital and immediately admitted in NICU because of an extreme prematurity, classified as an ELBW. The newborn experienced in few days a NEC, intestinal perforation implicating a stoma creation, a large pneumocele, requiring chest drains, necessitating a long duration mechanical ventilation, lasting for about two months. At two months of age after birth, when he was 1,500 g of weight, he underwent an extravasation of Kchloride infused through avp in the left arm. The consequences can be of different magnitudes: from local redness to tissue necrosis, which can involve tendons and ligaments, causing severe tissue damage, a residual functional impairment and a possible dysmetria. Considering the age and the type of damage, infiltration occurs in 57-70% of newborns while extravasation occurs in 11-23% of these. Extravasation has the potential to cause peripheral tissue injury depending on the type of blister, location, amount, and duration of exposure to the blistering/vescicating drug.

Conclusion: In this case we report the importance for a crucial ES prevention, a strict observation for at risk cases, the immediate actions well reported in a nursing bundle for ES approved and validated. In this study-case the attentive care of a lesion resulting from an ES of a Kchloride infusion in a peripheral venous access in preterm patients, initially treated with surgical debridment, subsequently dressed with an hydrophobic technology, then followed with a gel, DACC, and tulle dressing with medical honey until completely healed in one month.

 

EP0773 A novel approach to treating DFUs utilizing a combination of a topical dehydrating chemical agent & ovine ECM grafts containing a layer of hyaluronic acid

Wiliam Tettelbach¹, Nya Akoteu², Katrina-Anne  Palu³, Michelle Moore^4
1RestorixHealth, Metairie, United States, ²Vaiola Hospital, Nukalofa, Tonga, ³Vaiola Hsopital, Nukalofa, Tonga, ⁴Kaleidoscope Clinical Consulting, Las Vegas, United States

Aim: Observe the response of a hard-to-heal diabetic foot ulcer (DFU) on the medial aspect of the left foot in a 57-year-old female with poorly-controlled diabetes after initiating wound bed preparation via chemical debridement with an active gel containing methane sulfonic acid, which has rapid desiccating (hygroscopic) properties followed by the routine application of a xenograft composed of a layer of glycosaminoglycans (hyaluronic acid) between sheets of ovine forestomach-derived extracellular matrix (ECM).

Method: The setting of this case report was a hospital-based outpatient diabetic wound care clinic at Vaiola Hospital in the Kingdom of Tonga. The patient’s left diabetic foot ulcer (DFU) was treated with standard dressings, including alginate dressings and hypochlorous acid gel, along with selective sharp debridement for 38 days. However, there was no significant improvement. On 07/19/2024, a topical dehydrating agent was applied to prepare the wound bed. On 07/21/2024, the patient developed a deep tissue injury after wearing tight-fitting shoes to church. An offloading boot was provided on 7/24/2024. On 7/25/2024, an ovine ECM graft containing a layer of hyaluronic acid was added to her treatment regimen.

Results / Discussion: Between 07/25/2024 to 09/21/2024, a total of five applications of the ovine ECM graft containing a layer of hyaluronic acid were applied. On average, the xenografts were placed every 12 days.

Conclusion: This report introduces the use of chemical debridement with a topical dehydrating agent, which effectively reduces bioburden and is subsequently followed by routine applications of an ovine extracellular matrix (ECM) combined with hyaluronic acid to facilitate a trajectory toward closure. This approach resulted in a significant reduction in wound size, even in a patient with poorly controlled diabetes.

 

EP0659 Punch graft, a winning technique in the treatment of a three-year non-healing wound: a case study

Reza Ghorbani¹, Negin Hosseini^1
1Karaj Wound Clinic, Karaj, Iran

Aim: Punch graft, a winning technique in the treatment of a three-year non-healing wound

Method: The present study shows treating a three-year non-healing wound with the punch graft technique. A 73-year-old male patient suffered a neuropathy wound following trauma. He was hospitalized for about 20 days, and the necrotic tissue on the foot was debrided from the head of the metatarsal joint. The patient is discharged from the hospital after 20 days of osteomyelitis and infection control. He started treatment for 3 years with a variety of auxiliary treatment methods, including light therapy, advanced dressings, ozone therapy, etc. because of not paying attention to the wound treatment, only an inconclusive examination of the wound was done.

Results / Discussion: After starting treatment necessary trainings were given to the patient about lifestyle. Then, in the local examination of wound treatment, the control of bacterial load of the wound site was started, after systemic antibiotic therapy and control of chronic osteomyelitis, for two weeks, the patient’s wound was the preparation of the wound bed for graft was subjected to NPWT and plasma therapy, finally the graft was punched. Fortunately, the patient’s wound was completely healed in 40 days. Finally, the results showed the effectiveness of the punch graft technique on non-healing wounds.

Conclusion: Punch grafting is a skin graft technique that is placed on the surface of the wound under optimal conditions and reaches Epithelialization, it can be pointed out that it is a simple and painless alternative treatment. Finally, by treating with a multi-specialty team, necessary training, along with the effective punch graft technique, a very important role was played, treatment management of the patient’s limb.

 

EP0752 Importance of evidence-based practice in the treatment of hard-to-heal venous ulcers: case report

Aline Ramalho¹, Paula Freitas², Flávia Portugal², Aryanne Santos², Heloísa Rédua², Rayanne Kuster², Lucas Rezende^3
1Hospital Sírio Libanês, São Paulo, Brazil, ²Universidade Federal do Espírito Santo, Vitória, Brazil, ³Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Aim: To describe the progression of hard-to-heal wounds associated with complications of chronic venous insufficiency in the lower limbs, emphasizing the significance of an up-to-date evidence-based care plan.

Method: This article describes a case report on the treatment of hard-to-heal venous ulcers in a Public Health Unit in Brazil from March to September 2023, highlighting the implementation of a care plan informed by the most recent evidence in the field.

Results / Discussion: A 51-year-old black male patient was monitored, presenting with type 2 diabetes mellitus and chronic venous insufficiency, along with five ulcers on the right lower limb. These ulcers exhibited the following characteristics: unhealthy and friable granulation tissue with diffuse slough, clinical signs indicative of biofilm, large amounts of serous exudate, perilesional moisture and well-defined, elevated, macerated edges, covering an area exceeding 60 cm2. After six months of treatment, employing techniques focused on wound hygiene, antimicrobial dressings containing Dialkyl Carbamoyl Chloride¹, and compressive therapies, all wounds achieved complete healing.

Conclusion: It was determined that the care plan, founded on reproducible and contextually relevant scientific evidence – aligned with principles established in scientific consensus – was both effective and safe, given the complete epithelialization of all lesions.

¹Essity Cutimed Sorbact Dressing

 

EP0753 Evaluation of wound healing time predictability through a complexity instrument

Michele Rocha¹, Saskia Fleury¹, Magali Thum¹, Maria Ângela Boccara de Paula^2
1Convacare Clinics, São Paulo, Brazil, ²Sociedade Brasileira de Estomaterapia, São Paulo, Brazil

Aim: To report the experience of using an instrument to determine the complexity and predictability of time and cost in wound treatment.

Method: This report comes from the experience of stoma therapists in a private clinic, from May 2021 to August 2024. During this period, 38 patients over 18 years old with acute and chronic wounds were treated.

Results / Discussion: The tool was developed from a systematic review of studies related to wound assessment in a wound clinic. In 2021, the first stoma therapy clinic began using the instrument to determine wound complexity and predict time and cost through its numerical score. The instrument evaluates clinical data, wound location, and characteristics, classifying complexity as special, high, medium, or low. Among the 38 patients assessed, 15 were classified with special complexity, 14 with high, 7 with medium, and 2 with low during the initial consultation. Of these, ten patients were discharged due to wound healing, four were hospitalized, three had administrative discharge, and two died. The tool was positively evaluated by professionals for planning treatment time and estimating costs. Challenges included unmanageable factors such as patients’ psychosocial issues and untreated comorbidities. Another challenge was the variability in wound characteristics within the same complexity classification.

Conclusion: The use of this tool in clinical practice highlighted important aspects for initial assessment. Updates based on scientific literature are needed to ensure evidence-based practice, reduce risks of readmissions and complications, and verify the validity and reliability of the instrument.

 

EP0754 Monolayer multicomponent compression system in primary care: a case study

Mónica Costumero-García¹, Ana de la Fuente^2
1Monterrozas Primary Health Care Center, Madrid, Spain, ²Urgo Medical, Barcelona, Spain

Aim: To evaluate the healing outcomes of a new monolayer multicomponent compression bandage in patients with leg ulcers managed in primary care settings.

Method: A case series study was conducted involving seven patients with leg ulcers treated with a 40-mmHg monolayer multicomponent compression bandage in December 2022. Patients attending the nursing practice with a lower limb wound and no contraindication for compression therapy were included. There were four women and three men aged 57-87 years, with different comorbidities. All wounds were of traumatic origin. Four patients had a history of chronic venous insufficiency (CVI), three exhibited clinical signs of CVI without a prior diagnosis, one of them treated as Martorell ulcer.

Local treatment involved poly-absorbent dressings coated with lipido-colloid technology, either with silver (TLC-Ag) for debridement and infection control or a nano-oligosaccharide factor (TLC-NOSF) for debridement, metalloproteinase reduction, and healing promotion. The Martorell ulcer was treated with punch skin grafting and extracellular matrix.

Results / Discussion: Complete wound healing was achieved within a mean of 23 days for lesions with diagnosis or signs of CVI. The Martorell ulcer healed in 58 days. A mean reduction of 2.5cm in ankle circumference was observed, indicating reduced edema. Additionally, all patient tolerated the compression system well, achieving an average patient satisfaction score of 9.14.

Conclusion: Given the average healing time for venous ulcers is 7.8 months, the significantly reduced healing times observed in this study confirm the efficacy of this monolayer multicomponent compression system, highlighting its potential for use in primary care settings.

 

EP0790 Acceleration of neuroischemic wound healing with risk of re-infection with NPWT and punch graft technique

Reza Ghorbani¹, Negin Hosseini^2
1Karaj Wound Clinic, Karaj, Iran, ²Karaj Wound Clinic, Karaj, Iraq

Aim: Acceleration of neuroischemic wound healing with risk of re-infection with NPWT and punch graft technique.

Method: A 70-year-old male patient with a history of kidney disease, diabetes and neuroischemic ulcer comes to the hospital due to otrauma to thumb. Angioplasty was performed and according to the cardiologist report, it was successful. Due to the lack of adequate tissue perfusion immediately after angioplasty, autolytic debridement had expedited, and appropriate antibiotics were started, and after two weeks and ensuring tissue perfusion, sharp debridement was started in the thumb and completely cleared. And in the left and right lateral parts of the bone that was punctured, a hole was created where we saw the growth of granulation in the middle of the bone. The second finger was amputated due to ischemia caused by infection. After that, 5 sessions of vacuum therapy with contact layer were performed, the punch skin graft was started. After two weeks from the start of the punch graft, the size of the wound was reduced to half, and then collagen-based dressing and DBD plasma therapy were used and the wound was completely closed

Results / Discussion: Negative pressure wound therapy aims to help reduce inflammatory exudate and promote granulation tissue especially in neuroischemic wound. Also punch skin graft is a simple procedure to stimulate epidermalization and allow the wound to heal

Conclusion: One of the challenges of treating neuroischemic wounds with bone exposure is the risk of re-infection during treatment, which causes a delay in treatment and prolongs the healing process, as well as high cost. One of the ways to accelerate treatment is NPWT, which has proven effectiveness.

 

EP0798 Management of DTI pressure ulcer in an elderly patient

Monika  Aleksy-Polipowska^1
1Camillian Center for Palliative Care, Cavalry Captain Witold Pilecki State University of Małopolska in Oświęcim, Tarnowskie Góry, Poland

Aim: This poster presents an optimized treatment algorithm for managing Deep Tissue Pressure Injuries (DTPI) in elderly, multimorbid patients.

Method: Case Report
A 76-year-old male patient was admitted to the palliative care unit from long-term care with a diagnosis of “left shoulder joint abscess.” The patient, post-stroke, exhibited left-sided hemiparesis, dementia syndrome, and degenerative spinal changes, resulting in limited mobility. Initial symptoms included fever (38.5°C), pain (NRS 7/10), moderate general condition, Norton score 14, oxygen saturation 95%, blood pressure 125/80 mmHg, pulse 90 bpm, and Karnofsky score 30. Despite previous treatment over several weeks, there was no improvement. Examination revealed a partially open wound with soft, partially liquefied necrotic tissue, abundant purulent exudate, and fluctuance subcutaneously. Treatment was guided by the HR strategy and TIMERS approach, with a topical antimicrobial strategy based on octenidine, alongside a protein-rich diet and rehabilitation.

Results / Discussion: After 20 days, the infection was controlled, pain levels reduced to NRS 2/10, and the patient’s condition stabilized. Full wound healing was achieved after 60 days of therapy.

Conclusion: Initially misdiagnosed, the patient’s DTPI pressure ulcer had resembled an abscess, a common misperception in DTPI cases. The wound’s location aligned with typical patterns in neurologically impaired, wheelchair-bound patients. Treatment adjustments following the TIMERS approach proved effective. This case underscores the need for continuous education among long-term care nurses in accurately identifying and managing pressure ulcers, particularly DTPI.

 

EP0680 Hipertrophic scar in a child after burning by ecological detergent: Case report

Tânia Manuel ¹, Sara Filipa Brandão  Pereira², Cláudia Nunes², Adriana Gonçalves², Beatriz Manuela Azevedo  Costa², Vânia  Marinho², Mariana Monteiro², Nuno Miguel  Mendes Pinto^2
1PROVE.PT Grupo Saúde Nuno Mendes, Porto, Portugal, ²Clínica Nuno Mendes, Porto, Portugal

Aim: To describe the therapeutic approach used in the treatment of hypertrophic scarring in a pediatric patient.

Method: A 2-year-old male patient was consulted for a hypertrophic scar on his left leg, resulting from a burn caused by an ecological detergent, which occurred on February, 2023. Two scars were observed: one at the burn site, after an excerpt of the skin graft, and another at the skin donor site. The initial treatment consisted of the application of protective repair cream and povidone-iodine in the morning and in the afternoon. In the initial evaluation using the Vancouver Scale, the condition was classified as: relief 2, vascularization 3, pigmentation 0 and flexibility 3. During the first treatment, skin asepsis and PDT LED laser therapy (633 nm) were performed. For subsequent treatments, mechanical exfoliation, myofascial massage, and laser therapy were prescribed, with monthly sessions and adaptations according to the skin’s response.

Results / Discussion: After 12 sessions, the treatment provided a visible improvement in the characteristics of the scar, with a reduction in relief and vascularization, in addition to gains in flexibility. The current protocol includes mechanical exfoliation, microneedling with dermapen, and PDT LED (633 nm), which has been shown to be effective in tissue regeneration and aesthetic improvement of the scar. The use of combined these therapies were appropriate and safe for the patient’s age, providing progressive results and with reduced pain.

Conclusion: This treatment proved to be effective for the treatment of hypertrophic scars in pediatric patients, promoting tissue remodeling and improving scar characteristics.

 

EP0675 Management of parastomal ulcers using a combination of dressings: a case of translational wound care?

Michele Blasina¹, Lara Camassa², Luca Spazzapan³, Evelin Makuc³, Giovanni Papa^3
1- ASUGI - SC UCO Chirurgia Plastica, Trieste, Italy, ²ASUGI, Trieste, Italy, ³ASUGI - SC UCO Chirurgia Plastica, Trieste, Italy

Aim: The aim of this paper is to share knowledge in the management of peristomal ulcers, a rare complication that occurs in the presence of an ostomy and is typically related to the location and consequently the characteristics of the output. In the case of an ileostomy, it may be more fluid than a colostomy, continuous and characterised by a high level of digestive enzymes, implying more maceration and a higher risk of skin failure.

Method: The case studied was a 73-year-old man with an ileostomy who had developed several surrounding ulcers caused by the output, which were too difficult for the patient to manage alone, causing him pain and great discomfort.  An approach was explored in collaboration with the ET nurse, combining knowledge and materials.  

Results / Discussion: Prevention of skin breakdown was the primary aim, to protect the peristomal skin from further ulceration. Secondary goals were fluid management and complete re-epithelialisation.  The combined use of hydrocolloid paste and hydrocolloid dressing provided adequate isolation from digestive enzymes from the ileostomy. Wound management and TLC-NOSF enriched dressings resulted in complete healing.

Conclusion: Cross-pollination of materials and approaches from different clinical scenarios is often a forgotten way of making treatment decisions. Instead, the interweaving of different expertise led to the solution in this case.

 

EP0681 Advances in healing: a case study of burn treatment with photobiomodulation

Anabela Moura¹, Cláudia Alexandra Cunha², Tânia Manuel^3
1ULS São João, Porto, Portugal, ²ULS Santa António, Porto, Portugal, ³Universidade Católica Portuguesa, Porto, Portugal

Aim: To present a case study on the treatment and evolution of a burn using photobiomodeling.

Method: A 46-year-old female patient, with no relevant clinical history and no nutritional deficit, presented to the emergency department due to a superficial 2nd degree burn on the forearm and right hand, caused by hot oil, one week after the accident. The patient had burns with lesions in the dorsal region of the distal 1/3 of the right forearm, right hand, and back of the thumb. She was referred to the operating room, where she underwent debridement of the area with a curette and coverage with a partial skin graft. The region was immobilized with a volar plaster splint and a dressing with fat gas with povidone-iodine. After four days, due to the presence of bloody areas and intense pain, the medical team requested an evaluation of complex wounds from the team. Based on this evaluation, treatment with antiseptic, photobiomodulation twice a week and secondary dressing with seliconized transfer foam was instituted.

Results / Discussion: After four weeks of treatment with the specialized approach, the wound showed good evolution, with no signs of infection or pain and with epithelialization throughout the affected area. The patient then started using a cream with growth factors to optimize skin regeneration.

Conclusion: The multidisciplinary intervention and the personalized approach with advanced wound care techniques contributed to a satisfactory evolution of healing and pain control, favoring the functional and aesthetic recovery of the affected region.

 

EP0755 Integration of advanced wound care and pet therapy for children: a case report

Miriam Lambusta^1
1Azienda Ospedaliera Universitaria Meyer IRCSS, Firenze, Italy

Aim: Show how the integration of wound care and complementary therapies, such as pet therapy, can give quick results in terms of healing in acute wounds in children.

Method: Case report of the wound treatment in multiple laceration dog bite wounds with loss of substance on the right arm of a 6-year- old patient. The patient was surgically treated by washing the wounds and positioning a topic negative pressure for 5 days. After the topic negative pressure removal the primary wound dressing was a bacteria and fungi binding dressing with hydrogel;  the secondary dressing was a wound contact layer in soft silicone and polyurethane net. The arm was immobilized by a splint.  The dressings have been changed every 2 days for 22 days. Pet therapy with dogs was included in the wound care process.

Results / Discussion: The integration of both wound care and pet therapy with dogs brought positive results in terms of wound healing and in terms of psychological effects such as overcoming the fear of dogs that the patient was facing. Moreover the pet therapy gave the child a distraction effect and demonstrated to be effective in managing pain and fear. The wounds healed completely within 22 days. It was possible to remove stitches without sedation.

Conclusion: Combining  wound care and pet therapy in children hospitals brings to quicker healing results, not only in terms of wound healing but also in terms of psychological healing. 

 

EP0676 A shot in the dark or how to solve  complicated digital ulcers in systemic sclerosis

Teodora Toc¹, Elena Alina Gogulescu^1
1Spitalul Clinic Municipal de Urgenta, Timisoara, Romania

Aim: Discussing a highly challenging case of a patient with systemic sclerosis and digital gangrene that regained its functionality. Digital ulcers (DUs) occuring on the fingers with systemic sclerosis (SSc) are associated with considerable pain and may lead to infection, gangrene, thus contributing to functional disability, as well as reduced quality of life. Gangrene is present in around 15- 30% of the patients with SSc and can lead to autoamputation. Effective therapy in these situations remains elusive despite the various treatment alternatives.

Method: A 50-year-old female with a 10-year-old history of systemic sclerosis, including Raynaud phenomenon, interstitial lung disease, pulmonary hypertension, pericarditis, dysphagia and arthralgia presented with a 2-month-old dry gangrene at the tip of her right thumb accompanied by severe pain . The digital manifestations debuted two years before, but any systemic treatment was refused by the patient at the time.

Results / Discussion: The patient was started on methotrexate 15 mg/week, colchicine 1 mg/day, amlodipine 5 mg/d, pentoxyfilline 1,2 g/d, aspirine 75 mg/d, tramadol 37.5 mg/d, and vitamin E 100 mg/d with local debridement. A creme with nitroglicerine 2% was applied topically. Significant improval of the thumb was noticeable at a six-month follow-up.

Conclusion: DUs in SSc are linked to microvascular impairment and are very frequently a challenge for the clinician. Vasoactive and vasodilatatory approach should always be taken into consideration and initiated as soon as possible. The presented case is particular due to positive outcome of the gangrene despite the long period between the debut of the manifestations and the initiation of therapy.

 

EP0660 Wound bed preparation in hospital-associated colonization by carbapenem-resistant acinetobacter baumannii after fasciotomy: Two case reports

Po-Chun Huang¹, Yun-Nan Lin^1
1Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Aim: The global rise of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) has become a critical concern, especially in ICUs. Designated by the WHO as a priority for antibiotic research, current CRAB treatments face limitations due to low plasma levels and high toxicity. This report presents two cases where wound bed preparation (WBP) was applied to treat CRAB-colonized limb wounds post-fasciotomy.

Method:

Case 1: A 46-year-old male, post-fasciotomy for compartment syndrome, tested CRAB-positive. After anti-biofilm dressing and IV antibiotics, Hydroclean was used, achieving wound healing within 5 months.
Case 2: A 71-year-old male with necrotizing fasciitis, also CRAB-positive post-fasciotomy, continued with debridement, negative pressure dressing, and Hydroclean, achieving CRAB-negative results in 2 weeks.

Results / Discussion: Local infections impair grafting due to bacterial biofilms and toxins. Hydroclean’s Ringer’s solution and polyacrylate particles facilitate autolysis, absorb MMPs, and disrupt biofilms, fostering granulation tissue development.

Conclusion: Hydroclean effectively supports WBP by reducing bacterial load, MMPs, and biofilms, proving beneficial for complex wound management.

 

EP0756 Perception of specialist nurses regarding the cultural imapct between brazill and china on the care protocols for the treatment of venous ulcers:case report

Juliana Lucinda dos Santos¹, Alfred Chun Kit Ho², Lys Santos^3
1Prime Care cuidados integrados a feridas, Santo André, Brazil, ²Hospital Autority, Hong Kong, China, ³Alianca Vascular, Rio de Janeiro, Brazil

Aim: To describe the work of specialists in the face of the cultural impact between Brazilian and Chinese nursing on care protocols for the treatment of venous ulcers.

Method: Descriptive, narrative, case report study. About work among nurses specialized in care protocols in the treatment of venous ulcers, cities São Paulo (Brazil) and Hong Kong (China). Developed in the perception of care and cultural direction.

Results / Discussion: Brazilian protocols vary according to private public care. Venous ulcers require interdisciplinary treatment, however, most public services lack resources. Treatment in primary care involves a nurse trained to put on a boot, a suggested change 1 time a week, coverage with technology support no matter how much the consensus guides is not a reality in daily practice due to the lack of resources. However, in private outpatient clinics, some have technologies such as hyperbaric chamber, laser therapy and ozone therapy to assist in high-cost treatment. Chinese protocols for treating vasculogenic ulcers often involve a combination of traditional Chinese medicine and modern approaches. Acupuncture, use of herbal medicine (ginseng and astragalus), Chinese massage techniques, exercises such as Qigong and Tai Chi. These methods are often integrated with conventional treatments to provide a holistic approach to patient care.

Conclusion: In this sense, nurses are professionals who can work in carrying out economic analysis studies for the management of care and planning of health services, highlighting their importance as a member of the multiprofessional team. Economic evaluation studies can help health professionals in the construction of care protocols and managers in decision-making when new technologies are incorporated.

 

EP0757 Complications after craniofacial reconstruction with peek psi insertion: pathological comparison of peek and titanium

Hyeju Han^1
1Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Rep. of South Korea

Aim: This case report aims to explore the complications associated with Polyetheretherketone (PEEK) implants in craniofacial reconstruction, focusing on the pathological differences between PEEK and titanium implants during infection.

Method: Two cases were analyzed: a 61-year-old male with postoperative infection after maxilla reconstruction and a 57-year-old female with peri-implant fluid collection following orbit reconstruction using PEEK implants. Histological examinations and bacterial colonization assessments were conducted to evaluate the tissue response around the implants.

Results / Discussion: In Case 1, the patient developed erythema and infection, with histological findings showing necrotic tissue around titanium plates and dense fibrosis around the PEEK implant. Bacterial colonization was detected near the PEEK implant, suggesting a link to maxillary sinus communication. In Case 2, a fibrous capsule with mucinous fluid was found around the PEEK implant during surgical exploration; however, bacterial colonization was absent, indicating different pathological responses.

Conclusion: This report highlights the complications related to PEEK implants, including infection and fluid collection, emphasizing the distinct pathological reactions when compared to titanium implants. PEEK’s low integration potential may lead to capsule formation, facilitating infection spread, while titanium’s high integration potential results in granulation tissue formation. These findings underscore the need for further research to optimize PEEK applications in craniofacial surgery and improve clinical management strategies.

 

EP0661 The innovative use of piscine graft in managing atypical wounds in critical preterm neonates

Roxana Reyna^1
1Driscoll Children’s Hospital, Corpus Christi, United States

Aim: This study evaluated the use of fish skin grafts (FSG) on two critically ill preterm neonates who were unable to undergo surgical treatment for atypical wounds. One infant had a large abdominal wound from a fungal infection, and the other had a significant neck wound due to necrotizing fasciitis. Autologous skin grafts were not feasible for these patients.

Method: A novel approach was employed where medical-grade honey served as a debriding agent for most of the wound bed preparation. Minor sharps debridement was done. Piscine skin graft particles were mixed with honey and applied to the wounds. The wounds were covered with white silicone foam as a bolster, secured with a silicone border dressing. Dressing changes were performed every 5 to 7 days until the wounds healed.

Results/Discussion: The FSG was applied without a fully clean wound bed and incorporated during a period of suboptimal oxygenation, perfusion, and nutrition. Despite this, the wounds, which covered large areas, healed with minimal scarring.

Conclusion: The successful use of FSG in these cases demonstrates its potential for non-surgical management of atypical wounds, even in preterm neonates. There were no adverse reactions, and additional surgical interventions were unnecessary. The FSG application was performed at the bedside without pain medication, leading to healing with minimal scarring. Future studies are crucial to further investigate the efficacy and limitations of FSG in this vulnerable population.

 

EP0771 Soft tissue tension as a measure for tissue defect closure in diabetic foot

Roman Liberzon^1
1Diabetic Foot Unit, Orthopedic Department Laniado Hospital, Netanya, Israel

Aim: Evaluation of soft tissue tension with local wound washing as a method for home treatment of post-debridement wounds in diabetic foot.

Excisional debridement of infected diabetic foot commonly leads to significant tissue defect demanding prolonged treatment. Several methods are applied for complicated wounds treatment, including VAC therapy and soft tissue tension, limited in home conditions.

Method: We present diabetic foot patient with ischemia and 3^rd toe gangrene. After re-vascularization reperfusion started, turning dry gangrene to wet one with spreading of infection and wet necrosis in the plantar foot surface, damaging flexor tendon and plantar fascia. Was performed excisional debridement with toe amputation, removal of tendon and plantar fascia, forming of the significant tissue defect, treated by negative pressure and antibiotics with reduction of suppuration. 

For wound cavity closure was applied soft tissue tension. The concept was developed by prof. Morris Topaz and performed by application of plastic device attached to wound edges like Zip Tie connector, providing gradually approximation of wound edges. Originally device application is combined with negative pressure and wound irrigation with oxygen supply, rather expensive and usually demanding hospital conditions. In outpatient conditions, we combined device with once-daily wound cavity washing by antimicrobial solution. After skin edges contact wound was secondary sutured, resulted in complete wound closure

Results / Discussion: Applied treatment provided complete wound healing with forming of clean eschar and ambulation in regular shoes with orthopedic insoles.  

Conclusion: This case illustrates the ability to close significant foot tissue defects by tissue gradual tension and wound washing, providing more choices in diabetic foot treatment, especially when soft tissues are severely destroyed. 

Antimicrobial solution – PRONTOSAN

Plastic device – TOP CLOSURE

 

EP0772 Soft tissue tension as a measure for closure of toes tissue defect in diabetic foot

Roman Liberzon^1
1Diabetic Foot Unit, Orthopedic Department Laniado Hospital, Netanya, Israel

Aim: Preserving of distal phalanx and reduction of treatment period for the patients with diabetic foot after resection of infected toe joints

Bone defects formed after resection of toe joints in the diabetic foot because of septic arthritis demand a long period for treatment by conventional methods. External fixation is problematic partially due to the low compliance of a significant part of patients.

Method: Under our supervision was a patient with infected diabetic foot and septic arthritis of inter-phalangeal joint (IPJ-1) who was operated with excisional debridement of infected joint with base of distal and partially head of proximal phalanges of a greater toe. Infected bones resection lead to the cavity formation. Continuing wound treatment provided the reduction of suppuration. Bone fixation and bone plastics were avoided due to small bones and risk of residual infection. For wound cavity closure was applied soft tissue tension. The concept was developed by prof. Morris Topaz and performed usually by application of special plastic device providing gradual tissue tension, which can’t be used in the toe due to the small region size. Tension was performed using zip ties sutured to the skin. The residual cavity was daily washed by antimicrobial solution

Results / Discussion: Performed treatment provided complete healing of the wound during two weeks with forming of clean eschar, preserving distal phalanx of greater toe and ability for ambulation in orthopedic shoes  

Conclusion: This case may illustrate the ability of supporting strength of soft tissue scar in the foot, providing more choices in diabetic foot treatment, especially when bone structures are severely destroyed. 

Plastic device for tissue tension - Top Closure

Antimicrobial solution - Prontosan

 

EP0785 Eradication of wound bed and periwound bacterial fluorescence after a single application of a topical desiccating agent

Thomas Serena¹, Alberto Cogo², Johannes P.  Snels^2
1The SerenaGroup®, Cambridge, United States, ²DEBx Medical B.V, Amsterdam, Netherlands

Aim: Fluorescence imaging identifies bacteria at levels greater than the chronic inhibitory bacterial load (CIBL, 10⁴ CFU/g).  Wounds with bacterial levels at or above CIBL heal poorly. Recent studies have shown that sharp debridement in combination with antiseptics require 2 to 3 weeks to eliminate wound bed fluorescence and have no effect on periwound fluorescence. Topcial Desiccating Agent (TDA, Debrichem, Amsterdam, NL) is a novel chemical debriding agent that functions by removing water from the wound. In addition, it kills bacteria and disrupts biofilm. MSA has no adverse effects on intact skin due to its relatively low water content. The significance of periwound fluorescence is unknown; although, clinical experience suggests that it is associated with delayed wound healing.  

Method: A 55-year-old diabetic presented to the wound clinic after undergoing amputation of his right second toe. On examination, the wound bed was covered with nonviable tissue. There was no cellulitis.  Fluorescence imaging revealed intense red bacterial fluorescence in the wound bed and on the periwound skin. TDA was applied to the wound bed and periwound skin for 60 seconds after which it was mechanically removed.  

Results / Discussion: The single application of TDA completely removed the nonviable tissue revealing a wound bed with 100% granulation. Post application fluorescence imaging demonstrated elimination of bacterial fluorescence in the wound bed and periwound skin. This is the first observation of eradication of periwound fluorescence. 

Conclusion: TDA debrides and reduces bacterial burden in nonhealing wounds. It may also have an antibacterial effect on periwound skin.  

 

EP0779 A succesful treatment of radiodermatitis due to the external radiotherapy during vaginal cuff brachytherapy treatment for a mixed leiomyosarcoma patient with a bleeding bulky tumor

Nur Kodaloglu¹, Yeter Soylu¹, gulyasar ketenci incel², Fadime Mentes¹, Gokce Kaan Olcay¹, Fatih Goksel¹, Ebru Karakaya^1
1Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey, ²Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey

Aim: The role of the wound care nurse in the treatment of acute radiotherapy-induced stage4 radiodermatitis in a patient with a bleeding, bulky vaginal mixed leiomyosarcoma tumor.

Method: A 69-year-old patient, after total abdominal hysterectomy and bilateral salpingo-oophorectomy, was diagnosed as myxoid leiomyosarcoma with stage pT1b in March 2022. While she was under drug-free follow-up, in April 2022 reapplied to the hospital with vaginal bleeding. After vaginal cuff biopsy, recurrence of the primary tumour with pathologically confirmed myxoid leiomyosarcoma was occured and 6 cycles of chemotherapy(ctx)(gemcitabine+docetaxdel) was started. Then, the patient was planned to undergo radiotherapy after six cycles of ctx.

After 6 cycles of ctx, a cauliflower-like tumor of about 10-13cm in diameter was observed, extending out of the vagina and extending to the urethra and she had vaginal bleeding from vagina. External beam radiotherapy (EBRT)+Internal Cuff Brachytherapy (ICRT) was planned. After a total of 54Gy external RT (1.8 Gy per fraction in 30fractions), totally 24Gy vaginal cuff brachythearpy application in 4 fractions were applied.

Since stage4 radiodermatitis was observed in the anterior and posterior pelvic region of the patient during the sixth week of the external RT process, wound dressing team applied dressing care for the pelvic wounds on every other days during ICRT. For wound care process, both gel and solution, containing 0.1% polyhexanide and 0.1% poloxamer were applied.

Results: 54Gy EBRT and 24Gy ICRT, made the fragile, bleeding, massive, bulky tumor disappeared. Besides, cure was achieved with these 2 steps solution and gel for the stage4 radiodermatitis, hence deteriorated quality of life of the patient improved.

Conclusion: EBRT+ICRT, regressed successfully bleeding, bulky myxoid leiomyosarcoma. Wound dressing treaments cured stage4 radiodermatitis in 9 days. After this treatment, the patient was capable of sitting.

 

EP0803 Healing of a chronic wound on the lower leg in a diabetic patient after a revascularisation of the extremity with application of the negativ pressure wound therapy

Davor Primc¹, Sanja  Pećanić², Marin Marinovic², Vedran Ivković³, Goran Slivšek⁴, Melita Kukuljan², Miljenko  Kovačević^2
1Clinical Hospital Center Rijeka, Osijek, Croatia, ²Clinical Hospital Center Rijeka, Rijeka, Croatia, ³Clinical Hospital Center Osijek, Osijek, Croatia, ⁴Centre for Applied Bioanthropology, Zagreb, Croatia

Aim: The aim of this presentation is to show the course of treatment of a patient with a chronic wound on his lower leg.

Method: A patient was admitted to the Department of Vascular surgery because of a wound around lateral malleolus that wasn’t healing for ten weeks. Patient had diabetes mellitus and the wound opened after the extraction of the osteosynthetic material. CT peripheral angiography was performed and based on the findings percutaneous transluminal angioplasty was attempted. Since the endovascular intervention was unsuccessful the patient underwent surgical revascularization of the leg. The further course of treatment continued with regular dressings of postoperative wounds. A chronic wound after revascularization was treated with negative pressure wound therapy (NPWT) with a small portable system in combination with a hydrofiber dressing.

Results / Discussion: Postoperative wounds healed properly in normal time and the chronic wound healed with the help of NPWT 10 weeks after revascularization and regular dressings on every fourth day.

Conclusion: The patient’s chronic wound certainly healed faster after revascularization of the extremity and with more comfortable dressings for the patient in combination with a portable system for NPWT with hydrofiber dressing.

 

EP0758 Evaluation of a novel, canister-based, portable negative pressure wound therapy system in the management of pressure injuries

John Timmons^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: To investigate the performance and safety of a portable, single-use negative pressure wound therapy (suNPWT) system* in the management of pressure injuries (PIs).

Method: A non-comparative, multi-centre study involving subjects with low-to-moderately exuding PIs  was undertaken. The suNPWT system was used for up to 28 days, with patients assessed at weekly follow-up visits. The primary endpoint was wound progress based on clinical assessment (deteriorated, unchanged, improved), compared to previous assessment. Additionally, wound specific parameters (area, volume, tissue type, exudate amount), peri-wound skin condition, device-specific performance and safety were investigated.

Results/Discussion: In total, 35 patients were recruited. Wound progress was considered to have improved significantly in 80.6% (95% CI: 72.7% to 87.0%) of visits. Continuous reductions in wound area/volume, compared with baseline, were observed.  There was a general decrease in the proportion of devitalised tissue throughout the study, while the proportion of granulation and epithelial tissue increased. Pain levels were mostly low. The suNPWT system was observed to be easy to use, effective at absorbing and transferring exudate, and associated with a high level of satisfaction (clinicians and patients). None of the reported adverse events raised unknown or unexpected safety issues or concerns relating to the device.

Conclusion: Results showed that the suNPWT system supports wound progress towards healing when used in the management of PIs.

 

 

PROFESSIONAL COMMUNICATION

EP0805 Specialist palliative care nurses’ knowledge and confidence in assessing and managing malignant fungating wounds

Eimer Noone¹, Michael Connolly^2
1Our Lady’s Hospice & Care Services, Dublin, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland, ²Our Lady’s Hospice & Care Services, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland

Aim: The study intended to investigate the knowledge and confidence levels of specialist palliative care nurses in assessing and managing malignant fungating wounds (MFW’s) in an Irish setting. MFW’s are distressing complex wounds frequently encountered in palliative care, and understanding the nurses’ proficiency in addressing them is crucial for enhancing patient care.

Method: A cross-sectional survey was administered to specialist palliative care nurses across inpatient and community-based settings. The survey included questions assessing their knowledge about MFW assessment, management and associated symptom control. Additionally, respondents were asked to rate their confidence in addressing these wounds on a Likert scale. Data was collected, collated, and analysed using descriptive statistics and inferential methods.

Results / Discussion: The results of the study indicated deficiencies in specialist palliative care nurses’ knowledge and confidence in assessing and managing various aspects of MFW’s. Specifically, the findings have revealed nurses lack comprehensive knowledge in areas such as wound assessment techniques, odour, and exudate management. Confidence levels were also shown to be lower than desirable in some cases, indicating a need for improvements regarding education and training in this specialised area.

Conclusion: This study highlights a critical gap in specialist palliative care nurses’ knowledge and confidence relating to MFW’s. The results emphasise the importance of tailored educational programs and professional development initiatives to enhance competence in MFW management. Addressing these deficits can ultimately lead to improved patient outcomes, reduced symptom burden, and enhanced overall quality of life for those facing this challenging aspect of palliative care.

 

EP0806 Challenges in care of patient with prader willi syndrome

Tamara Sinožić¹, Jadranka Kovačević^2
1Private family praxis, Tamara Sinožić, dr. med., Mošćenička Draga, Croatia, Department of Family Medicine, Faculty of Medicine, University of Rijeka, Croatia, Mošćenička Draga, Croatia, ²Private family praxis, Tamara Sinožić, dr. med., Mošćenička Draga, Croatia, Mošćenička Draga, Croatia

Aim: To present a case of long-term comprehensive care for leg wounds and lymphedema in patient with PWS. Prader-Willi (PWS) syndrome is a genetic multisystem disorder characterized in adults by severe obesity with increased risk of cardiac insufficiency, sleep apnea, diabetes, respiratory problems and leg problems, such as wounds, lymphedema and infections and cognitive impairment.

Method: 41-year-old patient came for the first visit 5 years ago due to recurrent wounds on legs. His BMI is 68, he suffers from diabetes, sleep apnea and arterial hypertension. Patient repeatedly had cellulitis of the left lower leg with lymphedema, venous insufficiency on the right. Topical wound therapy was performed with dressings, simultaneously with compression therapy, initially with a short stretch bandage system, and maintaining with individual stockings and intermittent pneumatic compression. The body weight was regularly measured, the patient was advised about the importance of a healthy diet, regular intake of prescribed medications and the use of a continuous positive airway pressure device.

Results / Discussion: Adherence to therapy was high, the patient was motivated. The BMI was stabile for 5 years, but there was no improvement in physical activity, walking or exercise. Occasionally shallow wounds were present that healed within 6 weeks, without recurrence of cellulitis.  Communication during counseling was scarce (alexithymia), at the level of information exchange. The patient was employed, without major absences from work.

Conclusion: quality care for patients with PWS includes care for leg wounds and lymphedema and other comorbidities. The treatment of PDW is a big professional challenge for a family doctor as it requires an individualized biopsychosocial approach.

 

EP0652 Modalities for management of skin necrosis following liposuction procedure: case report

Afriyanti Sandhi^1
1Pertamina Central Hospital, Jakarta, Indonesia

Aim: As the popularity of liposuction continues to soar in the realm of cosmetic surgery, understanding the potential complications associated with this procedure becomes increasingly important for both patients and practitioners. One of the more serious complications that can arise is skin necrosis, a condition that involves the death of skin tissue due to insufficient blood supply or infection.

Method: Here we present a case of a 23-year-old female patient who underwent cosmetic surgery and developed a necrotizing skin infection and sepsis. We will discuss the importance of early diagnosis, risk factors and preventive measures, treatment options and our management of this case.

Results / Discussion: Antibiotic prophylaxis is recommended before multiple debridement procedures, preferably with a second-generation cephalosporin, one hour prior to surgery and should be continued for 5 to 6 days afterwards. Negative Pressure Wound Therapy (NPWT) was installed to treat excessive exudate. Then a definitive operation is performed to repair the skin using full thickness skin grafting techniques. Lastly is the scar management to produce good cosmetics results.

Conclusion: Rapid recognition of skin necrosis and sepsis following liposuction is life-saving and urgent, extensive debridement and prophylactic antibiotics are the mainstay treatment for this condition. Multiple debridement procedures may be necessary for successful treatment. Post-operative scar care to produce a good scar is the key to aesthetic patient satisfaction.

 

EP0807 Implementation of an “error room” to enhance healthcare attitudes towards pressure ulcer prevention

Gilles Burdet, Céline Josserand¹, Sebastien Di Tommaso¹, Sandra Choutko^1
1Geneva University Hospital, Geneva, Switzerland

Aim: The rising prevalence of pressure ulcers in Switzerland has driven healthcare institutions to adopt innovative prevention strategies. One such initiative, introduced by our hospitals, is the “Error Room”—a playful, simulation-based workshop designed to refine clinical practices related to pressure ulcer prevention. The primary goal of this initiative is to enhance healthcare professionals’ attitudes and competencies, ultimately reducing the incidence of pressure ulcers.
Method: The Error Room provides an interactive platform where healthcare professionals can develop critical observation skills, improve communication, and strengthen interdisciplinary collaboration. The workshop involves a simulated patient scenario deliberately embedded with errors in pressure ulcer prevention, offering participants a hands-on opportunity to identify and rectify mistakes. This immersive experience fosters practical learning and reinforces best practices.
Results: This presentation outlines the conceptualization and implementation of the Error Room as an educational tool. Preliminary results will be shared, highlighting shifts in caregivers’ attitudes towards pressure ulcer prevention, assessed through the Attitude towards Pressure ulcer Prevention (APuP) instrument.
Conclusion: Pressure ulcer prevention continues to be a significant challenge in healthcare. Innovative educational approaches, like the Error Room, show promise in improving healthcare professionals’ attitudes and practices, which could lead to better prevention outcomes.

 

EP0808 Complex wounds treatment unit in the portuguese national health service: from the hospital to the community

Fabio Jesus¹, Luis Claro², Liliana Gonçalves³, Susana Sousa^3
1ULS Coimbra, Hospital Arcebispo João Crióstomo, Coimbra, Portugal, ²ULS Coimbra, Coimbra, Portugal, ³ULS Coimbra, Hospital Arcebispo João Crisóstomo, Cantanhede, Portugal

Aim: Standardize clinical practices in the care of people with complex wounds; improve the quality of life of people with complex wounds; promote coordination between primary health care and hospital care; optimize primary prevention in ​​treatment for people with complex wounds.

Method: Patients are referred to by Primary Health Care and third sector institutions in the coverage area. They are screened for the presence of a difficult-to-heal injury that has been present for at least 10 weeks.

Results / Discussion: In 2023, approximately 1,600 treatments were carried out. The discharge rate was 65%.

76% of the patients referred came from Primary Health Care. The treatment of each patient from admission to discharge cost, on average, € 807.83. There was a median of 7 weeks of treatment until discharge. This was the organic unit with the highest number of compliments recorded in the Hospital.

Conclusion: This health response has made it possible to closely monitor the population with chronic stagnant wounds. At the same time, interdisciplinarity allows for the assessment and treatment of other comorbidities.

As a team with specific knowledge, it is possible to reduce healing times and make appropriate referrals to other differentiated services.

This is an opportunity for a clear improvement in the healthcare provided in the context of Local Health Units.

 

EP0809 Chronic wound management in hospital and territorial setting: an observational study

PhD Dario Monaco¹, Leonardo D‘Andrea¹, Serenella Savini^2
1Asl Roma 4, Rome, Italy, ²ASL ROMA 4, Roma, Italy

Aim: The creation of a corporate network of nurses with advanced skills can offer the patient and the family effective and safe solutions, where professionals are links in a single network. The aim of the study is to promote the integration of the wound care network between the different hospital and district structures for the proactive governance of patients suffering from chronic ulcers with different aetiologies and related outcomes

Method: The wound care network employs telemonitoring and teleconsultation strategies. Specifically, to the assessment of quality of life the EuroQol-5D-3L scale, for pain the Numerical Rating Scale (NRS) and tissue repair through the Pressure Ulcer Scale for Healing Tool 3.0. The wound care process is monitored through an observational-longitudinal design.

Results / Discussion: The patients taken care of by the network of wound care nurse specialists are 479. The care settings involved are: home care, health care facilities, district outpatient clinics and hospital settings of the Local Health Unit in Italy. There was a decrease in pain during treatment, achieving a reduction in the average numeric rating scale (NRS) from 7.81 at baseline to 5.34 (p <0.005) and there was a clear increase in assessment of quality of life with a mean score of EuroQol-5D-3L scale from 45.41 at baseline to 62.37  (p<0.005).  Tissue repair showed decreased Push Toll 3.0 values.

Conclusion: The proactive management of the wound care nursing network, guarantees the patient’s stay at home avoiding hospital admissions and emergency room admissions, improves adherence to the treatment plan, promotes the proximity of health care to the citizen and, through family health literacy, promotes healthy interventions and prevents the onset of complications.

 

EP0810 Enhancing wound care skills through the implementation of a rotational nurse position

Sandra Choutko¹, Sebastien Di Tommaso¹, Céline Josserand¹, Gilles Burdet^1
1Geneva University Hospital, Geneva, Switzerland

Aim: The aging population is leading to an increase in complex wounds, presenting considerable diversity. Recent data indicate a significant rise in the prevalence of pressure ulcers in Switzerland. This situation has created a higher demand for specialized consultations and underscores the need for continuous training for healthcare professionals. To address this challenge, a multifactorial approach is essential. This poster presents the implementation of a rotational nurse position within a specialized wound care team at wound care program at a university hospital in Western Switzerland.

Method: A rotational nurse position was created within the wound care program for a duration of one year.

Results / Discussion: This initiative aims to enhance practitioners’ knowledge and clinical skills in wound care through a holistic approach. It also includes the implementation of a project within the candidate’s assigned department. This initiative promotes the application of evidence-based medicine principles, the use of project management tools, and adult learning methodologies.
Conclusion: Three healthcare professionals participated in this training program, with positive feedback indicating a marked development in their wound care competencies and knowledge. The services and departments involved benefited from these improvements throughout and beyond the year-long rotation. Additionally, both individual and group training sessions were established to reinforce the integration of new practices in the field. These initiatives demonstrate a significant impact on the quality of care provided across various units.

 

EP0811 Update and promotion of common guideline for nursing care of burn patients in a university hospital in Switzerland

Vesselina Avramova¹, Matteo Scampa¹, Vladimir Megevand¹, Sandra Choutko¹, Sébastien Di Tommaso¹, Sandrine Le Godais^1
1Geneva University Hospital, Geneva, Switzerland

Aim: The aim of the work was to create and promote an institutional guideline in a large hospital in Switzerland to provide the best care of patients with burns. A burn is a thermal attack on the body, usually on the skin. In most cases, these are superficial burns that heal without sequelae with simple care provided locally. The challenge of managing burns is to limit secondary progression, avoid infectious complications, and accelerate the healing process to avoid scarring as much as possible. After the acute phase, treatment of any scarring and functional after-effects may be necessary.

Method: Implementation of a specialised wound nurse, in the plastic surgery ambulatory unit and surgery department, since May 2023 is helping for a review of the literature as well as the highlight of good nursing practice. With this work, the management of burn patients have been developed within the institution and the health service.

Results / Discussion: Based on institutional data, during the year 2024 in the surgery department, twenty-tree people were hospitalized with burns. Thanks to the transmission of good nursing practice and the implementation of this work, we try to improve the care of patients with burns by using the same guideline in the institution.

Conclusion: Institutional care procedures related to burns were updated and interprofessionnal networking was an essential element for this work. The guideline will be published in the institution 2024, and a brochure for patients and caregivers is currently being created.

 

 

POST-MARKET SURVEILLANCE

EP0804 Performance and safety of a three-in-one emulsifying ointment in the management of dry skin conditions: a survey of clinicians

Matthew Malone¹, Maia Ferré¹, Fia Navntoft^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: A clinicians’ survey was conducted to capture feedback on the performance and safety of a three-in-one emulsifying ointment* in the management of eczema, psoriasis and other dry skin conditions.

Method: Between May and July 2024, dermatologists in the United Kingdom were invited to participate in a digital survey. Inclusion in the survey was restricted to dermatologists who had prescribed/recommended the ointment for patients who had used the ointment for at least four weeks. Participants were asked to record patients’ skin condition before and after treatment with the ointment and report adverse events. Data were analysed by a blinded statistician.

Results/Discussion: 11 dermatologists completed the survey and provided data relating to 30 patients aged <1 (24%), 1-17 (33%), >18 (43%) years. The ointment was mostly used for eczema (67%) and psoriasis (16%). Participants described using the ointment as an emollient (100%), skin cleanser (27%) and bath additive (17%) The ointment was commonly applied once (30%) or twice (50%) daily. The use of the ointment coincided with improved skin condition in 95% of eczema cases, 100% of psoriasis cases and 100% of patients with other dry skin conditions. One adverse event (medical intervention not required) was reported.

Conclusion: The findings support the use of the ointment in the management of a variety of skin conditions in infants, children and adults. These findings are also applicable to wound care practitioners as dry skin conditions are often associated with chronic wounds.

*Epaderm® Ointment / Epaderm® Junior Ointment (Molnlycke)

 

 

 

English Oral presentations

ACUTE WOUNDS

OP060 Assessing the efficacy and safety of an innovative mesh-free, highly conformable contact layer in acute, chronic wounds and epidermolysis bullosa lesions: the heal study

Sylvie Meaume¹, Florent Sala², Beatrix Olivier³, Sophie Blaise⁴, Bourrat Emmanuelle^5
1Hopital Rothschild - APHP, Paris, France, ²Montréal Polyclinic, Department of Vascular Surgery, Carcassonne, France, ³Lyon Sud Hospital -HCL, Pierre-Bénite, France, ⁴Albert Michalon Hospital, Grenoble, France, ⁵Saint-Louis Hospital, Paris, France

Aim: To assess the efficacy and safety of an innovative mesh free, highly conformable wound contact layer in the local management of acute wounds, chronic wounds, and epidermolysis bullosa (EB) skin lesions.

Method: Prospective, multicenter non comparative clinical study, conducted in France in 30 hospital wards and private physicians (dermatologist, vascular and surgical): patients with a non-infected, acute, chronic wound or EB skin lesion were treated with the tested dressing for 4 weeks, with a weekly assessment (clinical, planimetric and photographic). All wounds included had to be at granulation phase. The primary outcome was the relative wound area reduction (RWAR) at Week 4.

Results / Discussion: Eighty-one patients have been included (56 acute wounds, 19 chronic wounds and 6 EB skin lesions). At baseline, the mean wound surface area was 12.6cm² ± 17.9 (acute wounds), 5.5cm² ± 3.7 (chronic wounds), and 21.8cm² ± 30 (EB skin lesions). At week 4, RWAR of -81%, -47% and -90% (mean values) was observed for respectively acute, chronic wounds and EB skin lesions.

Concerning dressing acceptability, removals have been qualified as “very easy”/ “easy” in 99% of cares, while protecting newly formed tissue in 98% of cares and more than 90% of the removals did not cause any pain. The conformability to the wound was rated by investigators as “Very Good/Good” in more than 90% of cases.

A good safety profile was reported.

Conclusion: These clinical results establish the innovative contact layer as a good therapeutic alternative in the local management of wounds, from the granulation phase to complete healing.

 

OP061 Secondary healing for fingertip amputation with bone exposed

Hoang Phat¹, Nguyen Toan¹, Lam Yen², Phan Nguyen^3
1Hospital for Traumatology and Orthopaedics, Ho Chi Minh,Viet Nam, ²Eye hospital of Ho Chi Minh City, Ho Chi Minh, Viet Nam, ³University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh, Viet Nam

Aim: Fingertip amputation is a popular injury. There are a variety of treatment methods from simple to complex, including skin graft, local flaps, regional flaps, microsurgery anastomosis or bone shortening. Fingertip wounds with exposed bone are suggested to be covered with flaps, but conservative treatment with compression bandages for secondary healing is increasingly used for these types of injuries.

Method: From August 2022 to March 2024, Secondary wound healing was applied for 40 cases of fingertip amputation with bone exposed. Those were followed up.

Results / Discussion: The exposed bone was covered by granulation tissue and epithelized after treatment. The average healing time was 3.95 ± 0.75 weeks. Regarding the mean FIOS (Fingertip Injuries Outcome Score), the Allen type 4 group had the highest score (20.17 ± 1.17), then gradually decreased in the type 3 group (16.14 ± 2.31) and the lowest in the type 2 group (12.8 ± 1.11). The majority achieved good (62.50%) and fair (25%) treatment results, mainly concentrated in the Allen type 2 (50%) and type 3 (35%) groups. The group with excellent results accounted for a lower proportion (12.5%) and all belonged to Allen type 2. In addition, infectious complications account for 2.5%.

Conclusion: Secondary wound healing is a safe and effective method that can be applied to suitable fingertip amputation with bone exposed.

 

OP063 Promoting regular foot screening in diabetes: a reliable smartphone-based thermal imaging tool for ulcer risk assessment

Irene Sanz-Corbalán¹, Aroa Tardáguila García¹, Ibon Uribe², Arià Jaimejuan², José Luis Lázaro-Martínez^1
1Diabetic Doot Unit. Universidad Complutense de Madrid, Madrid, Spain, ²Clinicgram, Barcelona, Spain

Aim: To validate a smartphone-based thermal imaging tool, enhanced by Artificial Intelligence (AI), for assessing diabetic foot risk (DFR) in patients with diabetes.

Method: A cohort of 145 patients, including 15 healthy controls, was assessed. Thermal imaging results were compared to clinical tests recommended by international guidelines for DFR stratification. Neuropathy was assessed using Semmes-Weinstein monofilament and 128 Hz tuning fork, peripheral arterial disease was evaluated through ankle-brachial index, toe-brachial index and TcPO2 measurements. After 15-minute supine rest to achieve thermodynamic equilibrium, thermal and visible images of participants’ feet were captured alongside relevant clinical data. AI algorithms then segmented the plantar surface into seven regions, integrating clinical variables, visible imaging, and thermal data to analyze patterns associated with DFR.

Results / Discussion: Eighty-nine (61.3%) were men with a mean age of 65.2±12.4 years. Fifty-three patients (36.5%) had neuropathy, 44 (30.3%) ischemia and 65 (44.8%) arterial calcification without ischemia. The tool demonstrated a sensitivity of 92.6% and a specificity of 55.6%. These metrics indicate its utility in reliably identifying high-risk cases, enabling efficient allocation of diagnostic resources. Current DFR assessments require physical tests that are time-intensive and prone to variability due to inter-operator subjectivity. Additionally, arterial calcification in patients with diabetes complicates traditional assessment accuracy.

Conclusion: With high sensitivity and favorable specificity, this AI-enhanced tool demonstrates strong potential as an accessible, faster, reproducible, and objective early diabetic foot ulcer screening method. By combining thermal, visible and clinical data, it streamlines assessment, minimizes subjectivity, and supports effective management in diabetic foot care.

 

EP0027 Use of thermography in the evaluation of incontinence-associated dermatatis and other injuries: case series

Vera Lucia Conceição Gouveia Santos¹, Lais Wojastyk^1
1School of Nursing - University of Sao Paulo, Sao Paulo, Brazil

Aim: To analyze the correlation between average temperatures in areas with IAD and other lesions detected by thermography.

Method: This study stems from the research on cultural adaptation and validation of the Ghent Global IAD Monitoring Tool into Brazilian Portuguese. During the validation process, thermography was employed to assess average temperatures in IADs alongside other injuries. Six patients exhibited IAD along with another lesion in the same area. Thermography was performed on hospitalized patients with IAD who participated in the interobserver reliability assessment of the original study.

To capture thermographic images, the researcher followed a protocol based on existing literature, ensuring the following precautions: maintaining a distance of 60 cm between the camera and the patient, positioning the patient adequately, exposing the skin for 20 minutes, and acclimatizing the environment to a temperature between 18 and 25 ºC with humidity below 60% prior to thermography.

Results / Discussion: Among the six patients with mixed lesions, four had pressure injuries, one had medical adhesive-related skin injuries, and one had Fournier’s syndrome. The temperature difference between the IAD area and the contralateral healthy skin showed a Linear Mixed Model (LMM) of 1.88 (p-value: 0.005). The difference between the IAD and the other lesion showed an LMM of 2.16 (p-value: 0.002), indicating that IAD lesions had an average temperature 2°C higher than the other lesions.

Conclusion: A significant temperature difference was noted between IAD and other injuries, which may assist in differential diagnosis. Studies with a larger sample should be considered.

 

OP064 Translation and content validation of the skin tear knowledge assessment instrument (OASES) into Chilean Spanish

Heidi Marie Hevia Campos¹, Paula Alviña  Olavarria², Dimitri Beeckman^{3 4
1}Universidad de Sao Paulo, Viña del Mar, Chile, ²Hospital Naval Almirante Nef, Viña del Mar, Chile, ³Ghent University, Ghent, Belgium, ⁴Orebro University, Örebro, Sweden

Aim: Translate and validate the content of the OASES - Skin Tear Knowledge Assessment Instrument for application in Chilean Spanish.

Method: This study employed a cultural adaptation and validation approach, focusing on the precise translation and content validation of the OASES instrument following the framework proposed by Beaton et al. (2007). The process included an initial translation of the instrument, followed by evaluation by a panel of 10 experts to assess content validity and calculate the Content Validity Ratio (CVR).  Subsequently, a back-translation into English was performed, and the back-translated version was reviewed by one of the original authors to complete the content validation.

Results / Discussion: During the first round of evaluation, 7 out of 20 items showed low levels of agreement, with CVR values ranging from 0 to 0.4. Specifically, items 13 and 56 had a CVR of 0, items 73, 74, and 84 a CVR of 0.2, and items 53 and 59 a CVR of 0.4. These items (CVR < 0.5) were re-evaluated by the panel in a second round to improve consensus. In the subsequent assessment, all items achieved a CVR of 1, except for item 84, which obtained a CVR of 0.8.

Conclusion: The Chilean Spanish version of OASES instrument provides a culturally adapted tool for skin tear prevention and management, meeting local linguistic needs and supporting standardized training across clinical settings in Chile. Future applications may include adapting it for broader use in other Spanish-speaking countries, fostering a unified approach to skin tear prevention in Latin America.

 

OP193 Stabilized hypochlorous acid solutions: A promising approach for enhanced wound healing and bioburden reduction in acute and chronic wounds

Klaus Kirketerp-Møller¹, Thomas Bjarnsholt², Magnus Ågren³, Magnus Mustafa Fazli⁴, Elin Jørgensen³, Ewa Anna Burian⁵, Lubna Sabah^6
1Steno Diabetes Center Copenhagen, Copenhagen, Denmark, ²University of Copenhagen and Rishospitalet, Copenhagen, Denmark, ³University of Copenhagen, Copenhagen, Denmark, ⁴Soft-Ox Solutions, Copenhagen, Denmark, ⁵Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, ⁶Bispebjerg Hospital, Copenhagen, Denmark

A reduction in the bioburden in non-infected wounds has, until now, not showed improved wound healing. This consolidated study investigates the safety, tolerability, and efficacy of stabilized hypochlorous acid (HOCl) solutions in the management of acute and chronic wounds. Three studies were conducted: a pilot study on acute wounds using a split-skin graft model (n=12), a randomized controlled trial employing a suction blister model (n=20), and a first-in-human randomized clinical trial focusing on chronic leg ulcers (n=28).

The pilot study demonstrated a 41% reduction in colony-forming units (CFUs) post-treatment with HOCl+buffer, alongside a high epithelialization rate of 96% by days 14 and 21, despite some reported pain. The suction blister trial revealed a 14% improvement in re-epithelialization by day 4 with HOCl compared to saline (p=0.00051), alongside consistently lower bacterial counts by 99,3%. In the chronic wound study, the stabilized hypochlorous acid showed significant reductions in bioburden, with a median 98% reduction post-treatment, and a notable dose-dependent decrease in wound size.

Across all studies, HOCl solutions were well-tolerated, with no significant differences in pain levels compared to controls except in the split-skin graft model. These findings collectively support the antimicrobial efficacy and wound healing potential of stabilized HOCl solutions, warranting further large-scale investigations to confirm these promising results in diverse wound care settings.

 

 

ANTIMICROBIALS

OP104 Nanocomposite sponge with enhanced hemostatic and antimicrobial properties for clinical wound care

Hadi Zomorrodian¹, M. Raoufi^2
1VITUS Privatklinik, Frankfurt am Main, Germany, ²Physical Chemistry I, Departmentof Chemistry and Biology & Research Center of Micro and Nanochemistry and Engineering (Cμ), Siegen, Germany

Aim: This study presents a novel chitosan-tannic acid (CS-TA) sponge, enhanced with zinc oxide nanoparticles (ZnO NPs) through epichlorohydrin (ECH) crosslinking, for improved hemostatic and antimicrobial applications.

Method: The nanocomposite sponge was synthesized via ECH crosslinking and ZnO NP embedding for antimicrobial properties. Comprehensive characterization involved Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and zeta potential measurements. Morphological and elemental analysis using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDAX) confirmed a homogeneous ZnO NP dispersion with sizes under 20 nm. Mechanical properties were evaluated for compressive strength and flexibility. Biocompatibility was assessed using MTT assays, while hemostatic efficacy was tested through prothrombin time (PT), activated partial thromboplastin time (aPTT), and blood clotting time (BCT) assays. Antimicrobial activity was tested against E. coli, S. aureus, and C. albicans.

Results / Discussion: Chemical and morphological analyses confirmed uniform ZnO NP dispersion. Mechanical testing revealed that ECH crosslinking significantly increased compressive strength from 0.614 MPa in CS-TA to 1.16 MPa in ZnO@TA/CS-ECH, while maintaining flexibility. The sponges absorbed 9-10 times their dry weight with improved stability. MTT assays indicated ECH preserved cell viability, while TA/CS-ECH mitigated ZnO NP cytotoxicity. Hemostatic testing showed a reduction in blood clotting time from 349 s to 49 s, significantly outperforming Celox™. ZnO@TA/CS-ECH also demonstrated substantial antimicrobial activity comparable to antibiotics.

Conclusion: The ZnO@TA/CS-ECH nanocomposite sponge shows significant promise for infected wound management, offering enhanced hemostatic performance and broad-spectrum antimicrobial activity.

 

 

ATYPICAL WOUNDS

OP105 The efficacy and mechanism of CO2 fractional laser in the treatment of difficult-to-heal wounds

Zhuoqun Li¹, Saisheng Zhang^2
1Shiyan People’s Hospital, Hubei, China, ²Shiyan People’s Hospital, Hubei, China

Aim: Provide clinical evidence of CO2 laser treatment for wounds.

Method: 100 patients with difficult-to-heal wounds were randomly divided in 2 groups. In the control group, cleansing and dressing changes were performed every 2-3 days and debridement every 4-5 days. Sharp debridement was performed to remove all secretions and necrotic tissue until fresh reddish tissue was seen. Petroleum jelly gauze was covered and sterile dressings were applied. In the laser group, on the basis of the treatment of control group, KL carbon dioxide fractional laser treatment machine (energy: 120 mJ, spacing: 0.6 mm, coverage: 11.1%; repetition number: 2 times) was used to treat wound bed as well as 1 cm of skin beyond the wound edge for 1 time.

Results / Discussion: The healing time in laser group (30±11 d) was significantly shorter than control group (43±18d); the relative BWAT score was significantly lower in laser group at 1, 2 weeks after treatment. Positive bacterial culture before debridement was significantly lower in laser group than in control group. Microvessels in granulation tissue were significantly higher in laser group at 7 days after treatment.

Conclusion: The advantages of CO2 laser in the treatment of chronic wounds is that it’s more effective in reducing bacterial load, promoting an increase in wound perfusion, the stripping effect of the laser is precise and limited, avoids collateral damage to the living tissue, and the vaporization of tissue during the treatment reduces hemorrhage. Aggressive CO2 fractional laser therapy on top of dressing changes can promote the healing of difficult-to-heal wounds.

Figures:

 

OP106 Moisture-associated skin damage (MASD) in hidradenitis suppurativa (HS): Mechanisms, clinical implications, and targeted management strategies

Alessandra Michelucci¹, Flavia Manzo Margiotta¹, Giorgia Salvia¹, Bianca Cei¹, Antonella Vietina¹, Marco Romanelli¹, Valentina Dini^1
1University of Pisa, Pisa, Italy

Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful nodules, abscesses and scarring, primarily affecting apocrine gland-bearing areas. The risk of Moisture-Associated Skin Damage (MASD) in patients with HS is significant due to persistent moisture from sweat, exudate from lesions, and chronic inflammation. This study aims to explore a novel type of MASD, associated with HS, focusing on the underlying mechanisms, clinical implications and management strategies.

Method: We evaluated 75 patients with HS, followed by the Department of Dermatology of Pisa, Italy, from June to September 2024. For each patient, we assessed the current or past presence of MASD, clinical and anamnestic characteristics and the presence of active HS lesions at the MASD site.

Results / Discussion: We enrolled 75 patients (27 males, 48 females) with a mean age of 37,2 years (standard deviation: 15). Univariate and multivariate analysis of risk factors for MASD development revealed an increased incidence of MASD in patients with higher BMI (OR: 1.201, p value: 0.002) and patients with higher disease severity score (OR: 2.662, p value: 0.016). Additionally, we observed that active HS lesions are more frequently detected in subjects with current presence of MASD.

Conclusion: The constant moisture environment, caused by HS draining lesions, leads to maceration, and erosion, exacerbating skin damage. Addressing the underlying inflammatory component of HS with systemic and topical therapies is crucial in reducing moisture and preventing recurrent lesions. In conclusion we advocate for the inclusion of MASD associated with HS into the classification of MASD, highlighting the importance for targeted and specific prevention and management plan.

 

OP107 Retrospective analysis of pyoderma gangrenosum: trends and demographic insights from multicentric data

Alessandra Michelucci¹, bianca cei¹, Giammarco Granieri¹, Chiara Moltrasio², Giacomo Clarizio³, Federico Bardazzi³, Angelo Marzano², Marco Romanelli¹, Valentina Dini^1
1University of Pisa, Pisa, Italy, ²Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy, ³IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy

Aim: Pyoderma gangrenosum (PG) is a rare, ulcerative skin disorder associated with significant morbidity. This study aims to evaluate the demographic and clinical trends of PG cases over a 15-year period (2009-2024) using data from the centers in Pisa, Milan, and Bologna.

Method: A retrospective analysis was conducted, examining the total number of cases, gender distribution, and mean age of patients over time. Correlation analyses were performed to assess relationships between variables, including the year of diagnosis, number of cases, and patient demographics. Pearson’s correlation coefficient was used to explore these associations.

Results / Discussion: A total of 171 cases of PG were documented, with an average of 13.15 cases per year. The overall patient population consisted of 38.6% males and 61.9% females. The mean age of the patients was 56.45 years (SD: 8.13), with a minimum of 45 years and a maximum of 74 years. Over the study period, there was a moderate positive correlation between the year of diagnosis and the total number of cases (r = 0.70), indicating a rising trend in PG diagnoses. Additionally, there was a strong correlation between the total number of cases and female patients (r = 0.90). No significant correlation was found between the number of cases and the mean age of patients (r = 0.09).

Conclusion: This multicentric analysis highlights a notable increase in PG diagnoses over time, with a predominance of female patients. These findings may reflect improved diagnostic capabilities or an increasing incidence of PG. Further studies are needed to elucidate the underlying factors contributing to this trend.

 

OP108 Comparative analysis of inflammatory markers in pyoderma gangrenosum disease activity

Bianca Cei¹, Serena Corraro, Flavia Manzo Margiotta¹, Marco Romanelli¹, Valentina Dini^1
1University of Pisa, Pisa, Italy

Aim: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by frequent relapses and lacks validated biomarkers for disease monitoring. This study evaluated serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and systemic immune-inflammation index (SII) as potential markers of disease activity in PG.

Method: A retrospective analysis was conducted on 35 blood samples from 10 PG patients, each categorized as either inflammatory or non-inflammatory based on clinical criteria, including the Wound Bed Score, Visual Analog Scale (VAS) for pain, satellite lesions, undermining, and the lilac ring sign.

Results / Discussion: SAA showed the highest discrimination between inflammatory and non-inflammatory phases (906.95 vs. 21.30), compared to ESR (55.5 vs. 21.0) and CRP (2.81 vs. 0.78). Pearson correlation analysis indicated that SAA had the strongest association with inflammatory phase (r = 0.57), followed by CRP (r = 0.55) and ESR (r = 0.51). Multiple regression analysis revealed that SAA was moderately influenced by weight and BMI but less affected by comorbidities compared to ESR and CRP, which showed strong associations with hypertension (ESR: β = 129.17, p < 0.001; CRP: β = 0.99) and diabetes (ESR: β = -168.29, p < 0.05). SII demonstrated poor correlation with disease activity (r = -0.06).

Conclusion: In conclusion, SAA emerged as the most reliable inflammatory marker for monitoring PG activity, demonstrating superior performance and less interference from comorbidities compared to traditional markers. This suggests its potential value for more objective and accurate PG disease monitoring in clinical practice.

 

 

BASIC SCIENCE

OP007 Implant stiffness-driven fibrotic wound response mediated by YAP/TAZ mechanotransduction: Implications for improving wound healing and reducing capsular contracture

Jun Ho Park¹, Ji-Ung Park¹, Ji Won Jeong^1
1Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Rep. of South Korea
Aim: This study examines how the stiffness of silicone breast implants influences the fibrotic wound-healing response, particularly focusing on YAP/TAZ mechanotransduction pathways. The goal is to explore strategies for reducing capsular contracture and improving wound outcomes associated with implant-based reconstruction.

Method: Silicone implants with varying stiffness (60 kPa to 2000 kPa) were tested in vitro using human dermal fibroblasts and in vivo in rat models. Key fibrotic markers related to wound healing, including α-SMA, COL1A1, and CTGF, were analyzed using qPCR, Western blotting, and immunofluorescence staining. Capsule formation, collagen deposition, and inflammatory responses were evaluated histologically at four and twelve weeks post-implantation.

Results / Discussion: Higher implant stiffness was associated with increased fibrotic capsule formation, collagen deposition, and inflammatory cell infiltration. Enhanced YAP/TAZ signaling and activation of integrin-FAK mechanotransduction pathways were observed with stiffer implants. This mechanotransductive response drove myofibroblast activation and upregulated the expression of wound-related fibrotic markers, such as COL1A1 and α-SMA, both in vitro and in vivo.

Conclusion: Stiffer implants promote a more severe fibrotic wound response through the YAP/TAZ pathway, contributing to increased fibrosis and capsular contracture. Softer implants may reduce wound fibrosis by limiting YAP/TAZ activation and myofibroblast differentiation, offering a potential strategy for improving wound healing outcomes and reducing complications in implant-based surgeries. These findings provide insight into designing implants that minimize fibrosis and improve post-surgical wound management.

 

OP008 Comparison of keratinocyte and fibroblast scratch wound models and 3D skin wound models to assess healing progression

Cornelia Wiegand¹, Jörg Tittelbach^1
1Department of Dermatology, University Hospital Jena, Jena, Germany

Aim: Wound healing is a complex, highly regulated process entailing diverse epidermal and dermal cells among white blood cells involved in inflammatory reactions. While 2D scratch wound assays with keratinocytes or fibroblasts are often employed as fast and cheap wound models, they lack the complexity of the 3D environment, limiting their comparability to in vivo conditions. 3D skin models consisting of dermis and epidermis present a more complex wound environment to assess healing. Here, various matrices, including fibroblast-derived matrix (FDM), fibrin, and gelatin, were tested to evaluate their impact on wound closure, cytokine production, and gene expression.
Method: 2D scratch wound models with keratinocytes or fibroblasts were investigated over 48 hours. 3D skin models were created, where fibroblasts either produced their own matrix (FDM) or were seeded onto provisional matrices (fibrin, gelatin). Wounds were induced by punch biopsies and wounded models were placed on acellular collagen or dermal equivalents. Wound closure was monitored over 9 days with assessments on days 1, 3, 6, and 9.
Results / Discussion: Macroscopically, FDM on collagen showed more contraction compared to dermal equivalents, while fibrin models exhibited the opposite trend. Gelatin models showed strong contraction on both matrices. Fibrin-based models had superior wound closure, with enhanced re-epithelialization, while also showing the highest levels of regenerative cytokines and growth factors like FGF-2 and TGF-β.
Conclusion: The 3D models, particularly fibrin on dermal equivalents, provided a more accurate representation of tissue regeneration and cell-matrix interactions. These findings suggest that while 2D models are useful for initial assessments, 3D models better mimic in vivo wound healing dynamics, making them more relevant for studying complex tissue regeneration and potential therapeutic applications.

 

OP009 Study of the chemical composition and structure of slough during delayed wound healing

Assem Nurlybayeva¹, Ariane Deniset-Besseau¹, Maëva L’héronde², Emmanuel Letavernier³, Hester Colboc^4
1Institute of Physical Chemistry, Paris-Saclay University, Orsay, France, ²IPANEMA, SOLEIL Synchrotron, Saint-Aubin​, France, ³Tenon Hospital, APHP, Sorbonne University, Paris, France, ⁴Rothschild Hospital, APHP, Sorbonne University, Paris, France

Aim: Slough is a common feature of chronic wounds that remains an under-researched area of wound care. The study aims to characterize slough structure and chemical composition through multimodal and multiscale analysis, providing insights for improving wound debridement strategies.

Method: Slough debridement samples were classified into two groups based on adherence to the wound bed: non-adherent and adherent. Experimental strategy includes complementary use of histological staining for a general overview of tissue structure, scanning electron microscopy (SEM) for deeper analysis of tissue microstructure and infrared (IR) micro-spectroscopy for detailed chemical mapping of corresponding regions of interest.

Results / Discussion: Based on results obtained from an initial cohort of 6 samples (4 non-adherent and 2 adherent), both tissue structure and IR response are different between non-adherent and adherent slough. It appears that the major structural component of non-adherent slough is fibrin, which demonstrates a specific “honeycomb” fibrous protein matrix. Meanwhile, adherent slough contains necrotic dermis, displaying a distinct IR signal and sophisticated protein organization (Figure 1).

Complex cellular and bacterial composition of slough was also confirmed. Organization of bacteria and bacterial proteins around colonies suggests presence of biofilm in slough, challenging modern clinical indicators for biofilm detection.

Figure 1. Hematoxylin&Eosin staining and SEM images of a)non-adherent slough and b)adherent slough. H&E staining illustrates highly inflammatory nature of slough: neutrophils (yellow arrows) and bacterial aggregations (black circles).

Conclusion: The multimodal analysis strategy proposed in this study has shown promising results for structural and chemical characterization of slough from chronic wounds. In the first attempt to use vibrational spectroscopy methods with slough, IR micro-spectroscopy offers various advantages as a non-destructive and label-free tool for spatially resolved chemical characterization.

 

OP010 Extracellular vesicles from 3D-cultured adipose-derived stem cells: Potential application in diabetic wound healing

Nai-Chen Cheng^1
1National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

Aim: The management of diabetic wounds remains a significant clinical challenge. This study aimed to explore a novel approach using human adipose-derived stem cells (ASCs) cultured in 3D morphologies to enhance extracellular vesicle (EV) production and their qualitative angiogenic properties for treating diabetic wounds.

Method: ASCs were cultured in both 2D and 3D configurations, including sheets and spheroids. EVs were harvested, and microRNA (miRNA) analysis was conducted to assess the presence of wound healing-associated miRNAs. In vitro studies were performed to evaluate the impact of these EVs on fibroblast and endothelial cell proliferation, migration, and function. The therapeutic potential of EVs was further assessed in vivo using a diabetic rat model, with specific attention to collagen production, re-epithelialization, and angiogenesis.

Results / Discussion: Spheroid culture of human ASCs led to a significant increase in EV secretion. The miRNA analysis revealed an enrichment of miRNAs associated with wound healing in the EVs from spheroids. In vitro, these EVs enhanced fibroblast and endothelial cell migration and proliferation. In vivo studies on diabetic rats demonstrated improved wound healing, characterized by increased collagen deposition, re-epithelialization, and angiogenesis, following EV treatment. These findings highlight the potential of spheroid-derived EVs to address both yield and angiogenic limitations seen in conventional EV preparations.

Conclusion: The use of 3D spheroid culture for human ASC-derived EVs represents a promising strategy to enhance EV yield and improve their wound healing efficacy. This approach could significantly advance the therapeutic application of EVs for addressing key clinical challenges in diabetic wound healing.

 

OP011 Enhancement of wound healing in hyperglycaemic conditions using withaferin-a-loaded topical gel: A study on cellular responses

Mandeep Marwah^{1 2}, Karan Rana³, Yukta Hindalekar³, Shakil Ahmad³, Lissette Sanchez-Aranguren^{1 2}, Irundika Dias^{1 2}, Srikanth Bellary^3
1ARCHA, Aston University, Birmingham, United Kingdom, ²Translational Research Medicine Group, Aston University, Birmingham, United Kingdom, ³Aston University, Birmingham, United Kingdom

Aim: Diabetic wounds are challenging to treat due to persistent inflammation and impaired tissue repair in hyperglycaemic environments. This project aims to evaluate therapeutic potential of a novel topical gel containing Withaferin-A to promote wound healing and reduce inflammation in conditions that mimic diabetic wound environments.

Method: Hydroxypropyl-methylcellulose (5% w/v) gels were formulated with 5% v/v propylene glycol and Withaferin-A (0.01% w/w). HUVEC (Human Umbilical Vein Endothelial Cells) and HDF (Human Dermal Fibroblasts) viability post-treatment exposure were evaluated. A cell culture skin model composed of HUVECs and HDFa cells were cultured under hyperglycaemic conditions and stimulated with TNF-α. Anti-inflammatory activity of the treatment was assessed by measuring IL-6 levels released using ELISA. Additionally, MMP-9 levels were measured by ELISA in HDF’s.

Results/Discussion: HUVEC and HDF’s remained viable after 24-hour exposure to Withaferin-A. Inflammatory response in HUVECs, indicated by elevated IL-6 levels due to TNF-α exposure (65.67±6.66pg/mL vs. 16.40±4.16pg/mL, p<0.001), was reduced with Withaferin-A to 39.65±4.67pg/mL (p<0.0001). Untreated HDF’s exhibited IL-6 levels of 19.82±3.12pg/mL. TNF-α exposure increased IL-6 to 52.54±6.66 pg/mL, which decreased to 36.04±4.67pg/mL (p<0.0001) following Withaferin-A treatment, again demonstrating its anti-inflammatory properties. MMP-9, involved in extracellular-matrix degradation, was increased in HDFs following TNF-α exposure (378.23±13.43pg/mL) compared to controls (70.12±4.12pg/mL)(p<0.0001). Withaferin-A reduced MMP-9 levels to 202.23±10.12pg/mL (p<0.0001).

Conclusion: Withaferin-A loaded gel is non-toxic and reduces inflammation in HUVEC and HDFs while modulating MMP-9 levels. Reduction of MMP-9 suggests an improved tissue-remodeling capacity, crucial for effective wound healing. These findings suggest a potential role for Withaferin-A in treatment of diabetic wounds.

 

OP012 Single-cell RNA-seq identify RAB17 as a potential regulator of angiogenesis by human dermal microvascular endothelial cells in diabetic foot ulcers

Hong-Wei Liu^1
1Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Guangzhou, China

Aim: This study aimed to comprehensively analyse human dermal microvascular endothelial cells (HDMECs) from diabetic foot ulcers (DFUs) patients and healthy controls and find the potential regulator of angiogenesis in DFUs.

Method: HDMECs were isolated from skin specimens of DFU patients and healthy controls. The proliferation, migration, and tube formation abilities of the cells were then compared between the experimental groups. Both bulk RNA sequencing and single-cell RNA-seq (scRNA-seq) were used to identify RAB17 as a potential marker of angiogenesis, which was further confirmed via weighted gene co-expression network analysis and least absolute shrink and selection operator (LASSO) regression. The role of RAB17 in angiogenesis was examined in vitro and in vivo.

Results / Discussion: HDMECs isolated from DFU patients showed considerably impaired tube formation, rather than proliferation or migration, compared to those from healthy controls. The gene set enrichment analysis (GSEA), fGSEA, and gene set variation analysis (GSVA) of bulk-seq and scRNA-seq indicated that angiogenesis was downregulated in DFU-HDMECs. LASSO regression identified two genes, RAB17 and CD200, as characteristic of DFU-HDMECs; additionally, the expression of RAB17 was found to be significantly reduced in DFU-HDMECs compared to that in the HDMECs of healthy controls. Overexpression of RAB17 was found to enhance angiogenesis and diabetic wound healing.

Conclusion: Our findings suggest that the impaired angiogenic capacity in DFUs may be related to the dysregulated expression of RAB17 in HDMECs. The identification of RAB17 as a potential molecular target provides a potential avenue for the treatment of impaired angiogenesis in DFUs.

 

OP080 Genomic and phenotypic insights into wound infection persistence

Tim Jakobsen¹, Isabel Diaz-Pines Cort¹, Rasmus Kristensen¹, Anne Iversen¹, Klaus Kirketerp-Møller², Hans Gottlieb³, Thomas Bjarnsholt^1
1University of Copenhagen, Copenhagen, Denmark, ²Bispebjerg University Hospital, Copenhagen, Denmark, ³Herlev and Gentofte Hospital, Herlev, Denmark

Aim: Persistent bacterial infections from opportunistic pathogens often involve extensive adaptation, leading to increased bacterial fitness and specialization. These adaptations make therapy and healing more challenging. This study aims to characterize the diversity and environmental adaptation of pathogenic species in chronic wounds to understand clonal differences.

Method: Biopsies and clinical isolates were longitudinally collected from 13 patients undergoing Split-Thickness Skin Graft surgery, both before and after debridement and during follow-up visits. We examined 181 Enterococcus faecalis, 98 Pseudomonas aeruginosa, and 47 Staphylococcus aureus isolates through whole genome sequencing (WGS) and assessment of species-specific phenotypic traits, including toxin production, antibiotic susceptibility, motility, quorum sensing, metabolic activity, and gene expression, to identify strain differences.

Results / Discussion: WGS analysis revealed that strains cluster into distinct branching patterns specific to individual patients. Multi-Locus Sequence Typing (MLST) showed patient-specific mutations, with some diversity among isolates from the same patient, indicating genetic evolutionary trajectories. Remarkably, the genome clusters remained consistent from surgery through follow-up, suggesting that these specific strains persist despite surgical intervention. Phenotypic analysis identified numerous subpopulations within each species, displaying diverse antibiotic resistance pattern and toxin production across different patient wounds and within individual wounds indicating phenotypic evolutionary trajectories.

Conclusion: These findings demonstrate significant intra-strain diversity and distinct clonal populations within single wounds, shedding light on factors contributing to treatment resistance. This underscores the vital role of bacterial adaptation in the wound environment and highlights the potential to identify genetic markers that can predict infection persistence, offering new avenues for targeted therapeutic strategies.

 

OP081 GCN5-mediated lactylation-driven METTL3 regulates wound healing by enhanceing the m6A/HNRNPA2B1/DNMT1 signaling in keratinocytes

Xiang Xu¹, Xueting Hu¹, Xiaofeng Wu^1
1Department of Stem Cell and Regenerative Medicine, Daping Hosptial, Arm Medical University, Chong Qing, China

Aim: To explore the roles and mechanisms of m6A modification in wound healing.

Method: In this study, m6A dot blot, qRT-PCR, MeRIP-qPCR ,Western blot, Single-cell sequencing analysis, Full transcriptome RNA sequencing, RNA-binding protein immunoprecipitation, CUT&RUN assay, siRNA interference and gene overexpression were used to identify the roles and mechanism of METTL3-mediated m6A modification as well as its specific upstream and downstream target gene in wound healing.

Results / Discussion: We found that the RNA m6A methyltransferase METTL3 expression gradually increases during the process of wound healing, and its low expression is closely related to diabetic chronic wounds. Further, by interfering with and inhibiting METTL3 activity, we discovered that METTL3 promotes keratinocyte proliferation and acts as a positive regulator of wound healing. Mechanistically, we found that METTL3 regulates the RNA m6A modification of DNMT1, upregulating its expression and promoting cell proliferation. Additionally, we found that HNRNPA2B1 is an m6A “reader” that assists in regulating DNMT1 expression; HNRNPA2B1 can recognize m6A modifications on DNMT1 mRNA and increase its stability. Moreover, we discovered that wound microenvironment lactate regulates METTL3 expression by inducing histone H3K18 lactylation, and the acetyltransferase GCN5 is the lactylation “writer” that upregulates METTL3 expression. Finally, using a mouse wound model, we found that applying lactate or the HDAC inhibitor LBH589 to the wound site can promote wound healing by upregulating METTL3 expression.

Conclusion: Our study reveals that GCN5-mediated lactylation upregulates METTL3 expression and promotes wound healing through the m6A/HNRNPA2B1/DNMT1 signaling axis, providing new targets and therapeutic strategies for chronic non-healing wounds.

 

OP082 Topical treatment with novel quaternary polyethyleneimine compounds significantly accelerates wound healing in a preclinical animal model

Bithi Chatterjee¹, Andrea Bell², Leah Cooksey³, Michelle Rudden³, Markus Rothmaier¹, Holly Wilkinson³, Jeff Hart², Matthew Hardman³, Ran Frenkel^1
1Polaroid Therapeutics AG, Zurich, Switzerland, ²Cica Biomedical Ltd., York, United Kingdom, ³Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom

Aim: The prevalence of chronic and complex wounds is a significant public health issue requiring novel and innovative approaches to improve patient outcomes. Here, we evaluated the potential of newly developed quaternary polyethyleneimine (QPEI) compounds to directly promote wound healing.

Method: Standardized full-thickness excisional wounds were created on the dorsal flank skin of male Balb/c mice. A single topical application of QPEI or vehicle was applied immediately after injury, and wound closure was quantified until post-wounding day 8 - using scaled digital wound images taken at regular intervals. Wound tissues harvested on post-wounding days 2, 4, 6 and 8 were examined histologically and by RNA sequencing analysis to confirm wound closure findings and to explore the mechanism(s) by which QPEI impacts the wound healing process.

Results/Discussion: A single topical application of QPEI immediately after injury significantly accelerated wound closure by promoting both re-epithelialization and contraction. QPEI-treated wounds displayed significantly greater contraction and re-epithelialization from post-wounding day 3 onwards. These findings were confirmed by histological analysis of wound tissues. RNA sequencing-based transcriptome analysis provided key insights into the pathways and processes influenced by QPEI treatment.

Conclusion: While QPEIs are known for their antimicrobial properties, this study is the first to report QPEI-mediated acceleration of wound healing in a preclinical wound model. Further studies are essential to fully elucidate QPEI mechanism of action. Here, we show that our QPEI compounds demonstrate novel activity to promote wound healing, highlighting the potential of QPEI compounds to significantly advance wound management and improve patient outcomes.

 

OP083 Tissue-engineered full-thickness artificial skin using gelatin for wound healing

Kyung-Chul Moon^1
1Korea University Guro Hospital, Seoul, Rep. of South Korea

Aim: The purpose of this presentation would like to share the progress of several experiments on tissue-engineered full-thickness artificial skin using gelatin for wound healing.

Method: Forty-eight wounds on six pigs were created and randomly divided into the full-thickness artificial skin using gelatin (n=16), artificial dermis (n=16), and control group (n=16). Full-thickness artificial skin with keratinocytes and fibroblasts, artificial dermis composed of collagen were applied on wounds and traditional wet dressing were applied in the control group. We evaluated the efficacy of the full-thickness artificial dermis using gelatin by assessing wound healing time. In the first and the second week after application, tissues on wounds were harvested and the histopathologic evaluation were compared. All possible adverse events were also recorded.

Results / Discussion: The wound reduction rate at 1 weeks post-treatment was 72.5±14.9% in the full-thickness artificial skin group, 56.8±19.1% in the artificial dermis group, and 7.1±6.3% in the control group. Complete wound healing was achieved after 2 weeks in 16 out of 16 wounds (100%) in the full-thickness artificial skin group, 13 out of 16 wounds (81%) in the artificial dermis group, and 9 out of 16 wounds (56%) in the control group. No serious adverse events related to full-thickness artificial skin were observed.

Conclusion: These results demonstrate that full-thickness artificial skin using gelatin with epidermal keratinocytes and fibroblasts are superior to artificial dermis in terms of their effect on wound healing in vivo.

 

OP084 Exploring the transcriptomic and metabolomic profiles of adipose tissues: Insights and implications for fat grafting

Taehee Jo^1
1Keimyung University School of Medicine, Daegu, Rep. of South Korea

Aim: Chronic wounds present a complex healing challenge, often necessitating innovative approaches to tissue regeneration, such as fat grafting. Expanding on our prior research on murine fat grafts’ metabolic shift, this study delves deeper into the metabolic profiles of human adipose tissues, specifically the superficial subcutaneous adipose tissue (SSAT) and deep subcutaneous adipose tissue (DSAT).

Method: Utilizing RNA-sequencing, metabolome, and metabolic flux analyses, we examined SSAT and DSAT samples obtained during deep inferior epigastric perforator flap breast reconstructions. Transcript data underwent unsupervised hierarchical clustering and Gene set enrichment analysis. Metabolomics involved analyzing samples for cationic and anionic metabolites via Capillary Electrophoresis Time-of-Flight Mass Spectrometry (CE-TOFMS), followed by principal component analysis (PCA) and heat map generation. Additionally, primary adipocytes from SSAT and DSAT were assessed using the extracellular flux analyzer.

Results / Discussion: PCA and heat map analyses highlighted distinct transcriptome and metabolome differences between SSAT and DSAT. SSAT predominantly upregulated genes linked to adipogenesis (false discovery rate [FDR] q < 0.0001), oxidative phosphorylation (FDR q < 0.0001), fatty acid metabolism (FDR q <0.0001), and glycolysis (FDR q = 0.001). In contrast, DSAT showed a significant upregulation in inflammatory response genes (FDR q <0.05). Metabolite analysis revealed an abundance of glycolytic metabolites in SSAT, whereas DSAT was rich in metabolites associated with fatty acid metabolism and oxidative phosphorylation. Cellular flux analysis further confirmed SSAT’s elevated glycolysis and spare oxidative phosphorylation capacities.

Conclusion: Our results highlight the metabolic uniqueness of SSAT and DSAT in humans, with SSAT exhibiting superior metabolic flexibility. The implications of these metabolic differences, especially in fat grafting procedures, necessitate further research and exploration in future studies.

 

OP085 Experimental studies on a novel wound healing method using Lorentz fields

Reyhan Zengin¹, Aliye Gürcan², Merve Kömür¹, Rabia Tutuk¹, Elif Feyza Aydın^1
1Deparment of Biomedical Engineering, Inonu University, Malatya, Turkey, ²Department of Biomedical Engineering, Malatya, Turkey

Aim: This study investigates the effectiveness of a novel wound healing method using Lorentz fields to accelerate healing in rats, comparing healing rates across different treatment modalities.

Method: A total of 32 rats were divided into four groups of eight: Control (C), Static Magnetic Field (SMF), Ultrasound (US), and Lorentz Fields (LF). A 2x2 cm² wound was generated on each rat’s back. Treatments were applied daily for 14 days for 5 minutes as follows: The SMF group received either a uniform DC magnetic field of 3.3 mT from a Helmholtz coil or a 0.1 T field (around the wound) using permanent magnets. In the US Group, a single-element ultrasonic transducer driven by a 100 Vpp sinusoidal signal generates pressure in the wound area. In the LF group, permanent magnets generated an SMF, and the ultrasound-induced pressure distribution (as in the US Group) was applied. The wounds were monitored and measured with a ruler daily to track the healing process.

Results / Discussion: The LF group showed the fastest wound healing. By day 9, wound sizes reduced to 1.4x1.5 cm² in the SMF group, 1.1x1.3 cm² in the US group, 0.9x1.2 cm² in the LF group, and 1.5x1.6 cm² in the control group. By the final day, sizes decreased to 0.6x0.9 cm², 0.44x0.7 cm², 0.42x0.6 cm², and 0.8x1.1 cm², respectively.

Conclusion: LF application significantly enhanced wound healing compared to other methods, suggesting that the combined effect of SMF and ultrasound may be a promising approach for accelerated wound healing.

 

OP086 Therapeutic potential of olive leaf and stem extracts in human skin fibroblasts

Rebeca Illescas-Montes^{1 2}, Ismael Loonsri-Pizarro¹, Anda Duca-Luca³, Anabel  González Acedo^{2 4}, Olga  García Martínez^{1 2}, Javier  Ramos Torrecillas^{1 2
1}Grupo Biosanitario (BIO277). Departamento de Enfermería. Facultad de Ciencias de la salud. Universidad de Granada, Granada, Spain, ²Instituto de Investigación Biosanitaria, Ibs.Granada, Granada, Spain, ³Servicio de urgencias, Hospital de Alta Resolución de Guadix. Servicio Andaluz de Salud, Granada, Spain, ⁴Grupo Biosanitario (BIO277). Departamento de Enfermería. Facultad de Ciencias de la salud de Melilla. Universidad de Granada, Granada, Spain

Aim: Olive leaves and stems, the main byproducts of olive tree pruning, are rich in polyphenols with reported health-promoting properties. These compounds may positively impact fibroblast, the main cellular population responsible for wound repair. Consequently, the main objective of this study was to evaluate the in vitro therapeutic potential of phenolic extract from leaves and stems of the Picual and Gordal varieties on human skin fibroblast.

Method: The human fibroblast cell line CCD-1064Sk was cultured with phenolic extracts from Picual and Gordal leaves and stems at concentrations from 0.1% to 0.0000001%. After 24 hours, viability was measured via the spectrophotometric assay, and migration capacity by the in vitro scratch wound healing assay. A control group was cultured under identical conditions but without phenolic extracts.

Results / Discussion: The findings showed a significant increase in fibroblast viability following treatment with phenolic extracts from both olive leaves and stems at all tested doses (p< 0.005), except at the highest dose (0.1%), where a significant decrease in cell viability was observed compared to the control (p< 0.005). The in vitro wound healing assay demonstrated a higher percentage of gap closure for all extracts at doses of 0.01% and 0.001% after 12 hours (p< 0.005), with complete closure observed by 24 hours, except in the control cells.

Conclusion: Phenolic extracts from olive leaves and stems of Picual and Gordal varieties significantly increase viability and wound closure capacity in human skin fibroblast, suggesting beneficial properties for skin repair. However, further studies are needed to evaluate their effects on additional parameters and in actual skin wounds.

 

 

BURNS

EP0317 PSP (pancreatic stone protein) as an early marker for detecting sepsis in burn patients

Wojciech Łabuś¹, Adam Kurek¹, Przemysław Strzelec¹, Karolina Ziółkowska¹, Justyna Glik¹, Katarzyna Czerny¹, Anna Słaboń¹, Mikołaj  Rybka¹, Marcin Ludyga¹, Jacek Węgrzyk¹, Mariusz Nowak^1
1Dr Stanislaw Sakiel Centre for Burn Treatment in Siemianowice Slaskie, Poland, Siemianowice Slaskie, Poland

Aim: The protein biomarker Pancreatic Stone Protein (PSP) has demonstrated high diagnostic accuracy for identifying sepsis and provides additional prognostic value. Assessing PSP levels enables earlier sepsis prevention and initiation of antibiotic therapy even before clinical symptoms of infection appear. The aim of this study was to compare PSP results with CRP, WBC, and PCT results in burn patients with burn injuries covering at least 20% of IIB degree and 5% of III degree TBSA.
Method: To date, 32 patients have been enrolled in the study. The study began on June 26, 2023, and is ongoing. PSP, CRP, WBC, and PCT measurements have been taken on subsequent days following patient admission to the Dr. Stanisław Sakiel Burn Treatment Center in Siemianowice Śląskie to monitor the patient’s clinical condition. When elevated PSP levels were observed, a decision was made to initiate antibiotic therapy, followed by monitoring of inflammation markers for subsequent decreases.
Results / Discussion: The use of PSP testing for early sepsis prediction enables medical staff to act sooner, thus increasing patient survival chances.
Conclusion: Early detection of elevated CRP, WBC, and PCT levels is challenging in patients who have sustained severe burn injuries. Due to the burn condition itself, these parameters are significantly above normal levels. Measuring PSP levels proved to be a useful prognostic tool for early sepsis detection.

 

OP068 Examination of the relationship between social appearance anxiety and body perception and affecting factors in patients with burn injuries

Hatice Ayhan¹, Fadime Koyuncu¹, Nilgun Sert Bas², Ali Akgun³, Burcu Yilmaz³, Emine İyigun^1
1University of Health Sciences Turkey, Ankara, Turkey, ²Ankara Medipol University, Ankara, Turkey, ³Ankara City Hospital, Ankara, Turkey

Aim: The aim of this study was to determine the factors affecting social appearance anxiety after burns and to examine its relationship with body perception.

Method: This cross-sectional study was conducted between July-September 2024. The study sample consisted of 92 patients. The data of the study were collected through face-to-face interviews using the Introductory Information Form, Social Appearance Anxiety Scale (SAAS) and Body Perception Scale (BPS). In data analysis, independent sample t-test, one-way analysis of variance, Pearson correlation analysis and multiple linear regression analysis were used.

Results / Discussion: Most of the patients (75%) had second-degree burns, and 73.9% had moderate burn severity. The mean SAAS score of burn patients was 45.15±10.104 and the mean BPS score was 136.47±14.474. Being female, married, having a higher level of education, a burn on the face, head or neck, and being a student were found to be factors that significantly increased social appearance anxiety (p<0.05). Body mass index was found to be the only factor that affected body perception (p<0.05). A weak positive correlation was found between the SAAS and BPS (r=0.373, p<0.01). A multiple linear regression model was created between the SAAS and independent variables.

Conclusion: The results of this study show that there is a positive relationship between body image and social appearance anxiety of individuals after burns, and that this is affected by gender, marital status, body part and education level. In this context, it is recommended that evidence-based treatment interventions should be prioritized to reduce social appearance anxiety.

 

 

DEVICES AND INTERVENTION

OP087 Use of a remote thermovisual monitoring system in high-risk patients: A pilot study

Caroline Abbott¹, Kerryn Franklyn², David Stuart², Ellen Kirwan, Sinead Flynn³, Andrew J. M. Boulton¹, Caroline McIntosh
¹Manchester Metropolitan University, Manchester, United Kingdom, ²Manchester Royal Infirmary, Manchester, United Kingdom, ³University of Galway, Galway, Ireland

Aim: This study aimed to investigate patient adherence and effects of, a remote thermovisual monitoring system (Bluedrop Medical) in people with diabetes at high risk of foot ulcers.

Method: In this single arm, open-label, 12-week pilot study in 2 countries, 27 patients with a DFU history were recruited to remote monitoring alongside routine podiatry care. Plantar thermal and visual data were captured and transmitted to a cloud-based server for daily review. Primary endpoint was mean patient adherence across the study.

Results / Discussion: Sixteen patients completed 12 study weeks, 11 were withdrawn early (new DFU (7), technical issues (4)) after 59.2 ± 22.3 days. 1,547 daily scans were taken during 1,940 active study days. Mean patient adherence to daily device use was 80% (± 19) and 91% had high adherence (≥3 scans/wk). From 73 reported scans: in 62% of cases HCPs did remote interventions (25%) or continued to monitor (37%); in 39% of cases HCPs scheduled in-person care. HCPs strongly agreed/agreed that they could use these data to remotely assess patients’ foot health (96% reports) and help identify issues earlier than standard care (82% reports). HCPs found temperature data useful in 12% of reports vs. 90% for visual data. All patients agreed they were satisfied with the device and found it easy to use.

Conclusion: Remote monitoring of vulnerable patients was achieved with good adherence, clinical utility and patient satisfaction.

 

OP088 A prospective single-site case-controlled study comparing the microcirculatory stress response in the diabetic and non-diabetic foot using near infrared imaging

Windy Cole^1
1Kent State University College of Podiatric Medicine, Cleveland, United States

Aim: This study compared the microcirculatory response of patients without diabetes to patients with diabetic neuropathy after exposure to a series of controlled stresses. The objective was to demonstrate that the microcirculatory stress response is impaired in the diabetic neuropathic foot and Near-infrared spectroscopy (NIRS) is an effective tool to detect these changes.

Method: This was a prospective study comparing the microcirculatory stress response in 20 subjects with 1:1 diabetic to nondiabetic cohort ratio. Subjects were >18 and had normal ABIs. All subjects with diabetes had confirmed DPN. The right foot of all subjects was exposed to various stresses (heat, cold, elevation, dependency) for a duration of 10 minutes each. Baseline NIRS and post-stressor images were obtained from the dorsum and plantar right forefoot of each subject.

Results / Discussion: Overall, the NIRS readings were stable in the healthy patient cohort as compared to the DPN cohort. The readings in the DPN cohort fluctuated considerably after the various stresses were introduced. These findings are consistent with the dysregulation of the autonomic nervous system seen in the development of DPN.

Conclusion: Endothelial dysfunction, derangements in numerous biochemical pathways, and autonomic neuropathy have been implicated as causes of microcirculation impairment in the diabetic neuropathic foot thus contributing to functional ischemia. The results of this pilot study contribute to the idea that NIRS imaging is also an effective tool for the detecting of changes within the microcirculatory system of the diabetic foot.

 

EP0086 Autologous whole blood clot (AWBC) therapy: A promising approach for healing venous leg ulcers

Sharon Sirota¹, Stephen  Heisler², Naz Wahab³, Sr. Liezl Naude⁴, Rene Lessing⁵, Febe Bruwer^6
1RedDress, NN, United States, ²University of North Carolina at Chapel Hill, Chapel Hill, United States, ³Wahab Consulting and Research LLC, Las Vegas, United States, ⁴Eloquent Health & Wellness, Tyger Valley, South Africa, ⁵Haute Care, Lyttelton, South Africa, ⁶Wound Care South Africa, Germiston, South Africa

Aim: Venous leg ulcers (VLUs) pose a significant health challenge worldwide, particularly in the aging population, mainly caused by venous insufficiency. Despite compression therapy being the standard of care treatment, up to 50% of VLUs remain unhealed after 2 years, creating a substantial burden on the healthcare system.

Autologous whole blood clot (AWBC), has been shown to be safe and effective in healing chronic, hard-to-heal cutaneous wounds, by initiating the healing process in stagnant wounds.

Method: Forty-five (45) VLUs were treated with AWBC after failing previous treatments. All the patients signed informed consent to share their wound data and demographics. Data from 43 was sufficient for analysis (NCT04699305). Patients were followed weekly for wound progression, with 4 patients discontinuing the study due to adverse events (AEs).

Results / Discussion: Forty-three (43) patients were included in the analysis with a mean age of 72.7±9.3 years and an average wound size of 15.9±21.1 cm². By week 20, 46.5% of the wounds had achieved complete healing, with a percent area reduction (PAR) of 69.34%. Additionally, 72.1% of the wounds reached at least 70% PAR by the last treatment. There were 4 reported AEs that were determined as unrelated to the treatment.

Conclusion: AWBC treatment for VLUs led to an improvement in 72.1% of cases, with 46.5% of the treated wounds achieving complete healing by week 20, highlighting AWBC as a promising treatment option in VLUs.

 

OP089 Thermal imaging suggests prolonged enhancement of microvascular flow following photobiomodulation of diabetic foot ulcers

Rose Raizman^{1 2}, David Ben Daniel³, Sarah Grinbaum², Rita Lo², Oshrit Hoffer⁴, S. David Gertz⁵, Lilach Gavish^5
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, Department of Professional Practice, Scarborough Health Network, Centenary site, Toronto, Canada, Toronto, Canada, ²Scarborough Health Network, Centenary Hospital, Toronto, Canada, ³The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, ⁴Afeka Tel-Aviv Academic College of Engineering, Tel Aviv, Israel, ⁵The Hebrew University of Jerusalem, Jerusalem, Israel

Aim: Insufficient microvascular blood flow resulting in delayed healing is a major pathogenetic feature of diabetic foot ulcers (DFUs). Photobiomodulation (PBM) has been shown to stimulate microvascular blood flow in healthy volunteers and accelerate healing of DFUs. Thermal imaging has been recognized as a reliable method for non-invasive assessment of microvascular flow. The present study was designed to assess the effect of PBM on microvascular blood flow in patients with DFUs as analyzed by infrared thermal imaging.

Method: Fourteen patients (mean age 61±17 years; male:female ratio 12:2) from the hospital outpatient clinic, with 22 diabetic ulcers were included. PBM (808nm, 250mW peak power, 15kHz, 1.1J/cm²/min*) was applied to the ulcer bed, ulcer margins, and the inguinal and popliteal lymph nodes. Thermal images were captured before treatment and every 5 minutes up to 30 minutes post-PBM. Minimal and maximal superficial wound temperature were measured automatically with dedicated software.

Results / Discussion: The temperature of the wound bed at baseline was 27.5±3.2°C, which was 4.9±2.5°C colder than that of the wound margins (p<0.001), reflecting underlying reduced microvascular flow. Following PBM treatment, a significant increase in wound bed temperature of 2.1±2.2°C (p<0.001) was observed, lasting at least 30 minutes post-PBM, which is considerably longer than that reported following simple heating. The response to PBM correlated strongly with baseline temperature (r=0.720), suggesting a more robust effect in cases with lower initial tissue perfusion.

Conclusion: Thermal imaging suggests that photobiomodulation initiates a long-lasting increase in microvascular blood flow that may subtend the enhanced healing of diabetic foot ulcers by this non-invasive modality.

*Erika B-Cure Laser Ltd

 

EP0096 Low frequency contact ultasonic debridement (LFCUD) and its effectiveness in reducing colny forming units (CFUs) in chronic wounds

Alison Vallejo¹, Marianne Wallis², David McMillan^3
1University of the Sunshine Coast, Sippy Downs, Australia, ²Southern Cross University, University of the Sunshine Coast, Gold Coast, Australia, ³Univsersity of the Sunshine Coast, Sippy Downs, Australia

Aim: The aim of this research was to determine the effectiveness of Low frequency contact ultrasonic debridement (LFCUD) as an intervention for reducing the bacterial load of colony forming units (CFUs) in chronic wounds.

Method: These data were collected during a single blinded, randomised controlled trial that originally compared the use of an antiseptic versus no antiseptic, after the LFCUD intervention. All participants (both groups, n=50) had a wound tissue sample or swab taken before and after the ultrasonic debridement, at baseline, before the introduction of the antiseptic solution. The samples were subsequently plated onto bacterial growth media for determination of total CFUs and species identification.

Results / Discussion: The median age of the participants was 82 (IQR = 13) years, they had a median wound duration of 18 weeks (IQR =37) and the majority were venous leg wounds (64%). The data analysis comparing the mean difference in CFUs before and after LFCUD showed a statistically significant difference (CFUs pre = 1.5 E+10⁸, CFUs post = 1.2E+10⁶, p<0.001).

Conclusion: LFCUD treatment is an effective method of reducing the CFUs in chronic wounds. By reducing the bacterial load and destroying biofilm the wound environment is more conducive to healing with a reduced risk of infection.

 

EP0100 Retrospective comparison of an innovative sternal preserving therapy with cold atmospheric plasma (CAP) to standard therapy for sternal infection

Marie  Dugdale¹, Angelo Dell’Aquila², Heinrich Rotering¹, Andreas Hoffmeier^3
1University Hospital Münster, Münster, Germany, ²University Hospital Halle, Halle (Saale), Germany, ³University Hospital Münster, Münster, Germany

Aim: Sternal wound infections following open-heart surgery are associated with a high mortality rate and increased healthcare costs. CAP has already proven its effectiveness in the treatment of complicated wounds. The current study aims to compare the results in terms of clinical outcomes and costs of standard therapy of sternal infections with the new CAP-based treatment concept avoiding sternal resection.

Method: The new treatment concept includes CAP and advanced negative pressure wound treatment (aNPWT) consisting of NPWT combined with carbon cloth dressing. Prospectively collected data of 50 patients treated with CAP between January 2019 and December 2020 were compared to data of a historical cohort comprising 35 patients, who underwent conventional treatment.

Results / Discussion: The statistical comparison showed clearly advantage of the new treatment concept with a significant higher in hospital success rate of 98% patients in the CAP group compared to only 74,3% in the control group. The treatment time between debridement and wound closure could be reduced from average 44 days in the control group to 18 days in the CAP group. The number of surgical interventions could be reduced from 5,1 to 2,2 in the CAP group. There is a tendency towards a shorter duration of antibiotic therapy and less use of different antibiotic agents.

Conclusion: CAP-based treatment has the potential to improve patient outcomes, decrease number of interventions and treatment time leading to reduced workload, resource costs and benefits for the patient’s wellbeing. Further research with larger groups of patients is necessary to emphasize the results of this study.

 

OP090 The use of sonication in bacterial load identification in non-healing wounds

Adéla Holubová¹, Niels Cremers², Martin Krause³, Lada  Cetlová⁴, Jana Matějková⁵, Andrea Pokorná^6
1Faculty of Health and Social Sciences, University of South Bohemia, České Budějovice, Czech Republic, ²Triticum Exploitatie BV, Department of Gynecology and Obstetrics, Maastricht University Medical Centre, Maastricht, Netherlands, ³Medical College, Department of Nursing, Prague, Czech Republic, ⁴Department of Health Sciences, College of Polytechnics Jihlava, Jihlava, Czech Republic, ⁵Synlab laboratory, Prague, Czech Republic, ⁶Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Aim: The main objective of the presented study was to find out which laboratory method would allow the detection of the greatest number of pathogens at the wound bed. The aim was to assess whether the bacterial load (number of pathogens) would be detected in the sampled material and to test whether the sonication method would allow the detection of a greater bacterial load (number of pathogens) than the swab.

Method: A prospective observational study - a case-control series. Six patients with tibial ulcer of venous etiology were included in the study. The selected patients were applied different materials for moisture wound healing: medical grade honey dressing, hydroactive dressing or ceramic dressing. The wound bed swab was sent in a sterile tube with culture medium, the first sonicate was transported in a sterile tube (sonication fluid) and the second sonicate was transported in a hemoculture tube. The bacterial load of pathogens collected in all three samples was examined and monitored.

Results / Discussion: The results of the study showed that more pathogens were found by sonication than by normal wound bed swabbing. The greatest number of pathogens was detected in sonication fluid transported in hemoculture tubes in four of the six patients.

Conclusion: Collection of the sonication fluid and subsequent transport to the laboratory in hemoculture tubes was verified to be a good method to verify a variety of pathogens present in the wound bed and in the dressing material itself. More cases are needed to generalize the results.

 

OP091 New technology vs conventional dressings on graft donor areas: electrospun nanofibrous polymeric matrix

Müge Sert¹, Alperen Pala², Gaye Filinte^3
1University of Health Sciences Kartal Dr.Lütfi Kırdar City Hospital, Istanbul, Turkey, ²University of Health Sciences Kartal Dr.Lutfi Kırdar City Hospital, Istanbul, Turkey, ³University of Health Sciences Hamidiye International Medical Faculty Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey

Aim: To evaluate the clinical efficacy of a portable electrospinning wound care system in the treatment of graft donor sites.

Method: A total of 30 patients were equally divided into three groups following three separate treatment options; portable electrospinning of a fully synthetic nanofibrous matrix (test group), polyurethane foam dressing (control group 1), and paraffin gauze dressing (control group 2) Allocation of patients was conducted thorough a randomized process. Primary research objectives were healing times (complete healing), epithelialization rates, and pain levels (VAS score). Patients were examined at the first week and at the one-month mark.

Results / Discussion: The electrospun nanofibrous matrix demonstrated accelerated epithelialization in partial-thickness wounds, initiating within 48 hours. (Figure 1) The average healing time for wounds treated with this matrix was 5.9 days (±1.1), versus polyurethane foam dressing 7.6 days (+-1.9) and paraffin gauze dressings 9.5 days (+-2.1). Pain significantly reduced upon initial application of the electrospun nanofibrous matrix. VAS score for test group was 7.4 and after using this matrix it reduced to 5.3. But no significant changes occurred at both control groups. It was further noted that long term results of wounds treated with electrospun nanofibrous matrix was remarkable (especially when it is used in extremities) as it allowed early extremity movement.

Conclusion: This study demonstrates using a portable electrospinning wound care system in wound closure is a promising technique when it is compared to wound dressings, as in it improves patients’ comfort by its fast and easy application, facilitation of rapid epithelization and decreased healing time, and pain reduction.

Figure 1. Epithelization starts in 48 hours and complete wound healing in a week.

 

EP0106 The use of Fluorescent Ligjht Energy on ischemic lesions consequent to septic shock in pediatric patients

Roberta Carpenito¹, Antonio Amabile², Carlotta Scarpa², Franco Bassetto^2
1Clinic of Plastic Surgery at the University Hospital of Padua, Padua, Italy, ²Plastic and Recontructive Surgery Clinic, Padova, Italy

Aim: To verify the effectiveness of Fluorescent Light Energy in the treatment of ischemic lesions due to septic shock in pediatric patients.

Method: We treated 2 infants affected by ischemic lesions on upper and lower arms. These lesions were due to pyogenes septic shock.  We performed the treatment twice a week. In order to activate the wound healing process via Led blue lamp, we applied a gel containing exogenous chromophores on the wound bed.

Results / Discussion: The infants have been treated for a maximum of two weeks and the mean number of sessions was 4. No adverse event has been reported. After the very first application we appreciated an improvement in vascularization with a consequent decreasing of ischemic area.

Conclusion: Fluorescent Light Energy can be a useful aid in treatment of ischemic lesion after septic shock in pediatric patients. Further cases are required.

 

OP092 The effects of blue light photobiomodulation on complex wounds

Viviana Gonçalves^1
1Centro Hospitalar e Universitário de São João, Porto, Portugal

Aim: Photobiomodulation with blue light is an innovative technology in the healing of complex wounds, promoting cellular modulation, reducing inflammation and inducing the promotion of the healing process. The regulation of metalloproteinases in complex wounds is fundamental, as the presence of these structures is a precursor to delays in healing. The application of blue light promotes the production of ATP, which is essential for cellular metabolic processes and which leads to effective healing.

Method: Application of photobiomodulation with blue light, in complex wounds (deep dehiscences and leg ulcers), once a week, as a complement to the treatment carried out. It was applied to 32 patients, of which 17 had deep dehiscences (sternotomy and saphenectomy), 15 had leg ulcers that had been in progress for more than 3 years.

Results / Discussion: Wounds resulting from dehiscence all close without resorting to surgery, with an average closure time of 8 weeks. After the start of the technology, the healing process occurred uneventfully and with a reduction in pain with each treatment, with a resulting very functional scar. In leg ulcers, the shortest time was 3 years and the longest time was more than 30 years, and the average time to closure was 13 weeks. All patients report a reduction in pain after the third application, having maintained the same type of previous treatment.

Conclusion: The use of this technology as a complement to the treatments carried out, promotes the healing process, managing to enhance the dressing material that is placed later. Reducing pain associated with increasing quality of life is essential to promote the healing process.

 

EP0118 Evaluation of the efficacy and safety of a new one-bandage multicomponent system in the treatment of lower limb secondary lymphoedema

Pascal Filori^1
1Centre Mediterraneen de Lymphologie, Marseille, France

Aim: Secondary lymphoedema is a chronic illness due to a lymphatic system dysfunction after a surgical procedure of the pelvic area, characterized by an abnormal collection of lymph in the subcutaneous tissues affecting the lower limbs.

There is no curative treatment for this lower extremity lymphoedema disease which is associated to an impaired quality of life; however, a combination of cutaneous care, lymphatic drainage, exercises, and movements in association with compression bandage system leads to an appropriate management of this pathology.

Method: A clinical evaluation an innovative multicomponent compression system in a single unique bandage* was conducted in a French private lymphologist office expert in lymphoedema, to assess efficacy/tolerance of this one-layer compression therapy in this pathology; the volume reduction of the lower limb after a one month treatment, was chosen as the primary criteria.

Among the secondary criteria, ease of application, acceptability by the patient, change frequency, tolerance and Quality of Life (EuroQuol 5D-5L).

Results / Discussion: 20 patients with a lower limb secondary lymphoedema were included in this clinical evaluation.

After a one-month treatment, a volume reduction was documented, combined with a very good local tolerance and the acceptability of the tested compression system was considered by the patient as “good” and “very good” for day/night comfort.

The author will present clinical data’s details for the 20 patients included and treated in this evaluation.

Conclusion: This new system is judged as effective and well-tolerated and may represent a relevant alternative in the management of lower limb lymphoedema.

*URGO K1

 

 

DIABETIC FOOT

OP013 Exploration of gene expression profiling showed local peroxisome proliferator-activated receptor expression levels were critical in diabetic foot ulcers

Jing Wu¹, Shiyi Sun¹, Xingwu Ran^1
1West China Hospital, Sichuan University, Chengdu, China

Aim: The exact pathogenesis and difficult healing mechanisms of Diabetic Foot Ulcer (DFU) have not been fully elucidated, and conventional therapies remain unsatisfactory. Peroxisome proliferators-activated receptors (PPARs) are reported to be excellent in regulating inflammation and immune responses and promoting angiogenesis. We aim to identify if PPARs are predictive and prognostic biomarkers and therapeutic targets of DFU.

Method: Full-thickness foot skin tissues gathered from diabetic patients with or without foot ulcers were subject to RNA sequencing. The differentially expressed genes (DEGs) landscape, their functions, and enriched signaling pathways were analyzed by bioinformatic strategies. We also established high-glucose-induced human immortal keratinocyte line (HaCaT) and diabetic Sprague-Dawley (SD) rat models to verify the PPARs expression.

Results / Discussion: Six samples in each group were completely sequenced, while the clinical characteristics were completely matched. Compared to diabetic non-foot ulcer tissues, there were 812 up- and 1631 downregulated genes in DFU tissues. GO/KEGG enrichment analysis illustrated that DEGs enriched significantly in the PPAR signaling pathway, neuroactive ligand-receptor interaction, cAMP signaling pathway, etc. High-glucose-induced HaCaT and diabetic SD rat models were successfully established which mimicked the damaged healing of DFU. The verified expression of PPARs in human tissues, in vivo and in vitro models suggested the scarcity of PPARs in DFU environment.

Conclusion: Healing disorders of DFU are associated with underlying histological and anatomical changes that may relate to the PPARs expression and the PPAR signaling pathway, suggesting that the above genes and pathways may be pivotal targets in promoting DFU healing.

 

OP014 Autologous whole blood clot therapy in diabetic foot ulcers: efficacy and safety results from a randomized controlled trial

Eric Lullove¹, Robert Snyder², Ulloa Jesus³, Aksone Nouvong⁴, Naz Wahab⁵, Terry Treadwell⁶, Febe Bruwer⁷, Sr. Liezl Naude⁸, James McGuire⁹, Alex Reyzelman¹⁰, Tim  Graham¹¹, Rene Lessing¹², Emre Özker¹³, Hau Pham¹⁴, Michael Pasternac¹⁵, Shira Cohen^16
1Eric J Lullove DPM PA, Coconut Creek, FL, United States, ²Barry University Clinical Research, North Miami Beach, FL, United States, ³VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States, ⁴Olive View UCLA Education & Research Institute, Sylmar, CA, United States, ⁵Wahab Consulting and Research LLC, Las Vegas, NV, United States, ⁶Institute for Advanced Wound Care at Baptist Medical Center South, Montgomery, AL, United States, ⁷Wound Care South Africa, Germiston, South Africa, ⁸Eloquent Health & Wellness, Tyger Valley, South Africa, ⁹Temple University School of Podiatric Medicine, Philadelphia, PA, United States, ¹⁰California college of pediatric Medicine, Center for Clinical Research Inc, San Francisco, CA, United States, ¹¹Memorial Health System, Belpre, OH, United States, ¹²Haute Care, Lyttelton, South Africa, ¹³Acinadem Altunizade, Istanbul, Turkey, ¹⁴Foot Care Specialists of Boston Medical Center, Boston, MA, United States, ¹⁵Future Health Research Clinic, Miami, FL, United States, ¹⁶RedDress Medical, Ponte Vedra Beach, FL, United States

Aim: Diabetic foot ulcer (DFU) continues to be a worldwide health problem, with a huge burden on the medical system. An autologous whole blood clot is a bedside device, previously found to be safe and effective in treating hard to heal wounds.

We hereby present a randomized controlled trial comparing the efficacy and safety of an autologous whole blood clot (AWBC) to standard of care (SoC).

Method: Following a 2-week run in period, 119 eligible patients were treated weekly by AWBC+SoC or SoC alone for 12 weeks or until the wound closure. Healed wounds were confirmed at the healing confirmatory visit, 2 weeks after healing was first observed. Confirmed healed wounds were followed for an additional 12 weeks to assess treatment durability. Healing was validated by an independent remote blinded assessor (NCT04185558).

Results / Discussion: AWBC treatment resulted in 41% healing (24/59) compared to 15% (9/60) in the SoC group in the Intent to Treat (ITT) population (p=.002). In the Per Protocol (PP) population, AWBC resulted in 51% healed (24/47) compared to 18% in SoC (9/49) (p = .0075). AWBC showed a high safety profile with 21 wound-related Adverse Events (AEs) (16%) compared to 23 (13%) in the control group. There were no treatment-related AEs in both arms.

Conclusion: AWBC treatment showed superiority compared to SoC, in healing outcomes of DFUs, achieving a 2.73-fold increase in complete wound closure. Moreover, AWBC had a safety profile comparable to SoC, with no reported device-related AEs, indicating AWBC is a promising solution for DFUs.

 

OP015 When two debilitating diseases collide: diabetic foot makes even non-geriatrics frail

Hikmet Erhan Güven¹, Mehtap Günel¹, Cansu Cambaz², Hulya Yagcioglu¹, İbrahim  Yılmaz¹, Gözde Şengül Ayçiçek^1
1University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey, ²Hacettepe University, Faculty of Nursing, Surgical Nursing Department, Ankara, Turkey

Aim: This study set out to investigate, for the first time in the literature, the frailty status and contributing factors of diabetic foot (DF) patients under the age of 65.

Method: This prospective study comprised 97 consecutive patients under 65 years of age who applied to our outpatient clinic for DF disease between January 1st and September 30th, 2023. Patients older than 64 years old, those who are already receiving follow-up care, and who had no ulcers (Wagner grade 0) were excluded. The 9-scale Clinical Frailty Scale (CFS) was used to measure frailty at the initial evaluation. Based on their CFS scores, the patients were divided into two groups: non-frail patients were those with a level of 1 to 4, and frail patients were those with a level of 5 or higher.

Results / Discussion: The mean age of the patients was 54.6±7.6 (30-64). Based on their CFS levels, 36 (37.1%) patients were defined as frail (18 level 5, 16 level 6, and 2 level 7). Frailty in this non-geriatric cohort was associated with male gender and long duration of diabetes (Table 1). There were considerably more patients in the frail group with Wagner stages 3 and 4 DF disease. More than half of the patients in the frail group required a minor amputation for their DF (Table 2).

Conclusion: According to this very first study looking for a relationship between DF and frailty among the non-geriatric population, DF showed to cause frailty in more than one-third of patients younger than 65 years of age. In addition to its direct effects on disability and mobility, DF may also cause general vulnerability.

 

OP059 Effects of customized digital orthoses on plantar pressure and foot functionality in people with diabetic neuropathy: preliminary results of a clinical trial

Maria Lucoveis¹, Leticia Pinto¹, Jane Ferreira¹, Ronaldo Cruvinel-Júnior¹, Maria Silva¹, Sharon Admoni¹, Monica Gamba², Isabel Sacco^1
1University of São Paulo, São Paulo, Brazil, ²Universit Federal of São Paulo, São Paulo, Brazil

Aim: To evaluate the effectiveness of the use of a customized silicone digital orthosis for 3 months on plantar pressures and pre-ulcerative injuries in people with diabetes and neuropathy (DPN).

Method: These preliminary results involved 21 participants, distributed between the Intervention Group (IG) and the Control Group (CG), all with deformities on the toes (hallux valgus, claw/hammer toes, and/or overlapping toes) and/or hyperkeratosis in the toes. Both groups received a standard care program, which included callus removal, foot and leg skin hydration, technical nail cutting and cleaning, guidance on the use of therapeutic footwear, and molded insoles. In addition to these treatments, the Intervention Group was provided with custom-made silicone orthoses to realign the toes and redistribute plantar pressure to help reduce excesso callus on the toes, over a 3-month period. The reduction of pre-ulcerative injuries or the decrease in their severity, as well as the distribution of plantar pressure during gait (with and without orthosis – Emed-Q plate), were assessed at baseline and after 3 months (T3). The data were analyzed using mixed ANOVA (p<0.05), followed by Newman-Keuls post hoc tests, while categorical results were compared using the chi-square test.

Results / Discussion: IG had more calluses that reduced in severity (63%) than CG (27%) (p=0.006); and fewer calluses that remained at the same severity at T3 (4%) compared to CG (61%) (p<0.001). The orthosis significantly reduced hallux (p=0.043) and toes (p=0.049) peak pressure and hallux pressure-time integral (p=0.029) compared to IG without orthosis at T3. There was a significant increase in heel peak pressure at T3 in CG (p<0.05), which was not observed in the IG.

Conclusion: The use of silicone orthoses for 3 months demonstrated to be effective in reducing plantar pressure, preventing the formation of pre-ulcerative injuries, reducing its severity compared to usual care, thus mitigating two risk factors for the development of ulcers in people with DPN.

 

OP016 Recurrence rates after healing in patients with neuroischemic diabetic foot ulcers (dfu) healed with and without sucrose octasulfate impregnated dressings. A one-year comparative prospective study*

José Luis Lázaro-Martínez¹, Yolanda García Álvarez¹, Marta García-Madrid¹, Irene Sanz Corbalan¹, Aroa Tardáguila García¹, Serge Bohbot^2
1Complutense University, Madrid, Spain, ²Laboratoires Urgo, Paris, France

Aim: To compare recurrence rates after a 1-year follow-up of healed neuroischemic DFU after they healed with sucrose octasulfate impregnated dressing comparing with patients treated and healed with other local dressings.

Method: A one-year prospective study with 2 arms was conducted on 92 patients with neuroischemic DFU healed in a specialized diabetic foot unit. Patients were divided into two groups; treatment group that includes patients healed with a sucrose octasulfate impregnated dressing and control group that includes patients treated with other local treatment. The main outcome of the study was ulcer recurrence after wound healing within one year follow-up. Secondary outcomes were minor or major amputation and all causes of mortality.

Results / Discussion: A total of 92 patients were included in the study, 50 were treated with sucrose octasulfate dressings and 42 were treated with hydrocellular dressings. Recurrence rate was more than twice in the control group 66.7% compared to 30.4 % in the treatment group (p < 0.001). All the four major amputations (p=0.05) happened in the treatment group due a complication derived from a recurrence event that was complicated by infection during SARS-CoV-2 period in the same limb. 7 patients died in the treatment group due complications not related with local therapy (p=.008). RR of recurrence was 20.18 times higher in the control group that in the treatment group (p < 0.001).

Conclusion: Treating with sucrose octasulfate impregnated dressing reduce recurrence rates of neuroischaemic DFU after healing compared to neutral dressings.
*Published in Int Wound J. 2024;21:e70028

 

OP017 Protective effect of regular physical activity against diabetes-related lower extremity amputation (national wide population study)

Yoon Jae Lee¹, Jun Hyeok Kim¹, Jae Won Kim^1
1Yeouido St Mary’s Hospital, The Catholic University of Korea, Seoul, Rep. of South Korea

Aim: Foot ulcers are a major complication of diabetes mellitus that increase morbidity and mortality in patients with diabetes, affect their quality of life, and increase the overall social burden. A considerable number of patients with diabetic foot ulcers (DFUs) require amputations every year.

Method: This nation population–based study included 1 923 483 patients with diabetes who underwent regular health screening through the National Health Insurance Service during January 2009 and December 2012. We investigated the association between changes in physical activity (PA) status and the incidence of lower extremity amputation (LEA). Based on changes in PA status, participants were categorized into four groups: “remained inactive,” “remained active,” “active-to-inactive,” and “inactive-to-active.”

Results / Discussion: Regular PA is an independent factor associated with a decreased risk of LEA in patients with diabetes. During the follow-up period, 0.23%(n=4454) of the patients underwent LEA. Compared with the “remained in active” group, the “remained active” group were at the lowest risk of LEA (adjusted hazard ratio 0.5888; 95% confidence interval 0.524–0.66). A protective effect of regular PA against LEA was observed in the “remaining active” group.

Conclusion: Our findings suggest a protective role of PA against LEA in individuals with diabetes. This highlights the importance of recommending appropriate levels of PA for patients with diabetes. The study also showed a dose–response relationship, indicating that engaging in vigorous-intensity PA was most beneficial, and higher amounts of PA may provide additional benefits.

 

OP018 The effect of usinge a bone biopsy guided antibacterial therapy on remission of diabetic foot osteomyelitis: a randomized controlled trial

Rimke Lagrand¹, Louise Sabelis¹, Meryl Gramberg¹, Tabby Ahmad², Anna Van den Bosch¹, Wouter Brekelmans³, Vincent De Groot¹, Martin Den Heijer¹, Willemijn Kortmann⁴, Max Nieuwdorp¹, Edgar Peters^1
1Amsterdam UMC, Amsterdam, Netherlands, ²Liverpool Hospital, Sydney, Australia, ³Alrijne Ziekenhuis location Leiderdorp, Leiderdorp, Netherlands, ⁴Noordwest Ziekenhuisgroep, location Alkmaar, Alkmaar, Netherlands

Aim: The reference method to guide antibacterial therapy in diabetes-related osteomyelitis of the foot (DFO) is culture of a percutaneous bone biopsy. In practice, treatment is often guided by ulcer bed biopsies. It is unknown whether treatment outcomes of DFO improve if treatment is based on bone biopsy instead. This study aimed to assess outcomes of DFO treated conservatively with antimicrobial therapy based on either percutaneous bone biopsy or ulcer bed biopsy 12 months.

Method: A multicenter double-blinded randomized clinical trial was conducted. Eighty-four participants aged ≥ 18 years underwent both a percutaneous bone biopsy and an ulcer bed biopsy. They received randomly allocated treatment based on either bone biopsy cultures or ulcer bed biopsy cultures. Remission of DFO was the primary outcome determined at 12 months of follow-up. Intention to treat (ITT) as well as per protocol (PP) generalized linear model analyses were conducted.

Results / Discussion: The bone biopsy group had a (non-significantly) higher risk of not achieving remission in this study in all analyses (ITT: RR = 1.13, 95% CI = [0.80;1.60], PP: RR = 1.18, 95% CI = [0.68;2.04]). In 61 cases (85.9%) all bacteria from the blinded sampling method were susceptible to the prescribed antibiotics targeted at bacteria in the unblinded sampling method.

Conclusion: No significant difference was found between remission outcomes in subjects treated based on cultures of a bone- and an ulcer bed biopsy. In most cases, the antibiotics targeted bacteria in both samples, possibly explaining results. Future studies may determine the presence of remission at an earlier timepoint.

 

OP019 Comparative study on the effect of amputation and limb salvage on the survival rate of patients with diabetes foot

Binghui Li¹, Zhi Wang¹, Gongchi Li^2
1Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, ²Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Aim: To evaluate the effect of amputation and limb salvage on the survival rate of patients with diabetes foot.

Method: 350 patients with diabetes foot hospitalized in two Hospital were included in the study. According to different treatment modalities, they were divided into the major amputation group (50 cases; 25 patients≥65y, 25 patients <65y), the minor amputation group (103 cases; 47 patients≥65y, 56 patients <65y)  and the limb salvage group (197 cases; 95 patients≥65y, 102 patients<65y). The Kaplan-Meier survival analysis was employed to compare the differences in survival times among three patient groups. Electronic medical record data were collected, and a Cox multivariate survival analysis was conducted to identify additional risk factors that may influence survival rates.

Results / Discussion: According to the Kaplan-Meier survival curves, the overall survival rates were 54.0% for the major amputation group, 52.4% for the minor amputation group, and 66.0% for the limb salvage group. The mean five-year survival times were (37.3±6.9) months for the major amputation group, (39.9±4.2) months for the minor amputation group, and (44.3±3.2) months for the limb salvage group; these differences were statistically significant (P<0.05). Furthermore, multivariate Cox regression analysis identified three variables associated with significantly reduced survival time: age ≥ 65 years (HR=3.291; 95% CI of Exp(B)=2.248-4.891; P<0.001), anemia (HR=1.761; 95% CI=1.182-2.263; P<0.05), and infection (HR=1.471; 95% CI=1.026-2.108; P<0.05).

Conclusion: Limb salvage significantly increased the survival rate and survival time of diabetic foot patients compared with major and minor amputations. A minor amputation has a longer survival time than a major  amputation. Age ≥65 years, anemia and infection were the risk factors affecting survival time.

 

EP0187 Validation of the ACHILES tool

Polly Cox¹, Nichola Beard², Elizabeth Merlin-Kwan^1
1Urgo Medical, Loughborough, United Kingdom, ²National Health Service, Shrewbury, United Kingdom

Aim: The incidence and prevalence of pressure ulceration (PU) varies widely across organisations within the UK. The ACHILES tool was developed due to disparity in PU categorising and reporting heel ulcers on people with diabetes (PWD).

Method: To validate this tool studies were undertaken to determine the decisions clinicians made regarding reporting and referring foot ulcers and how they differentiated between PU and diabetes foot ulcer (DFU).

Results/Discussion: Two months apart, 2 short questionnaires, with and without the ACHILES tool, were posted on social media groups for podiatrists and nurses working in acute settings. They presented 3 scenarios of a. Participants were requested to categorise wounds and answer questions to understand the actions they would take.

Despite working within this speciality, the initial questionnaire results demonstrated the participants displayed huge variation as to how they would categorisation and report each wound.

There were 32 responses of each of the 3 questions: 75% vs 25%, 55% vs 45% and 41% vs 59% correctly identified the wounds as a pressure ulcer.

The same questionnaire has recently been distributed again with the inclusion of the ACHILES reporting tool.  Results will validate the tool for wider use by reducing variation and inequality in  PU reporting in PWD.

Conclusion: Experienced clinicians differ in their opinions in diagnosing wounds in PWD. Where accurate assessment and diagnosis are key to effective care, it is essential that a tool is introduced to reduce under reporting and improve much needed quality improvement in this area of wound care.

 

OP103 Neuromuscular electrostimulation of the common peroneal nerve increases microvascular flux in the wound bed of diabetic foot ulcers

Keith Harding¹, Melissa Blow², Faye Ashton³, David Bosanquet^2
1University of Cardiff, Cardiff, United Kingdom, ²South East Wales Vascular Network, Aneurin Bevan University Health Board, Cwmbran, United Kingdom, ³Glenfield University Hospital, Leicester, United Kingdom

Aim: To measure the effect of neuromuscular stimulation of the common peroneal nerve on the microvascular blood flow within the wound bed of diabetic foot ulcers.

Method:13 patients with diabetic foot ulcers (11 neuropathic, 2 neuroischemic) were recruited. Microvascular flux and pulsatility were measured in real time in the wound bed, and at the wound edge, using Laser Speckle Contrast Imaging (Moor FLPI-2; Moor Instruments Ltd, UK). Changes from baseline were measured when the leg muscle pump was activated by 1Hz neuromuscular stimulation of the common peroneal nerve, using a wearable device (geko®, Firstkind Ltd, UK). The geko® device is a commonly available CE and UK CA marked, self-adhesive, disposable, internally powered NMES that is applied externally to the leg and is indicated to increase blood circulation and promote wound healing.

Results / Discussion: In the 11 neuropathic ulcers, significant increases were seen in all microvascular parameters. Wound bed flux increased by 36% (95%CI 11%-68%, p=0.002), and peri-wound flux increased by 92% (95%CI 46%-160%, p=0.001). Pulsatility in the wound bed increased by 183% (95%CI 61%-517%, p=0.005), while pulsatility in the peri-wound increases by 359% (95%CI 264%-455%, p=0.001). Additionally, an increase in flux and pulsatility was observed in the neuroischemic ulcers.

Conclusion: Neuromuscular stimulation of the common peroneal nerve presents a mode of activating the leg muscle pump without additional pressure insult to the foot and has potential to support the microcirculation during wound-healing, effectively emulating exercise without any of the attendant risks of exercise to the neuropathic or neuroischemic foot. This mechanistic study is of short duration, with the intervention applied only for a few minutes, and so no long-term clinical outcome is determined.

 

OP020 Successful treatment of moderately ischemic DFU’s using cyclical pressuerized topical oxygen therapy (TWO2)

Matthew Garoufalis^1
1PFCS, PC, Chicago, United States

Aim: This study evaluated topical oxygen therapy (TWO2) in the treatment of moderately ischemic DFUs.

Method: Patients included in this study were part of a post hoc analysis of a randomized prospective double-blind study that evaluated TWO2 in treating DFU. Inclusion criteria were as follows: diabetic patients with nonhealing, full-thickness DFUs measuring between 1cm2 < UT grade 1 or 2 DFU < 20 cm2 post debridement. The duration of the DFU was between 4 weeks and 1 year and all had received standard care for at least 4 weeks.

Patients received the same foam dressings, a below knee offloading device, equivalent to TCC and optimal standard care. Patients who then failed a 2-week run-in period received either a TWO2 or sham device, both devices looked and operated identically.

Moderate ischemia, according to IWGDF criteria, as defined as anyone or combination of the following ABI ≥ 0.7, TBI < 0.75, monophasic biphasic Doppler waves below the knee, TCPO2 < 60, great toe pressure < 60 or skin perfusion pressure < 60.

Results / Discussion: 18 patients each were included in the study group and sham group. At 12 weeks, 7 of 18 patients (39%) in the TWO2 healed completely compared to 0 of 18 patients (0%) in the sham group (p < 0.0076).

Conclusion: This randomized study demonstrated that moderately ischemic diabetic foot ulcers had significantly higher healing rates using TWO2 than the sham treatment. TWO2 provides a multimodal approach to achieve higher healing rates by increasing oxygenation, providing non-contact compression and humidification.

OP051 Effectiveness of a novel polylactic acid matrix for diabetic foot ulcer closure: results from a single center interim analysis

Jose Ramirez-GarciaLuna, Brock Liden^1
1Cutting Edge Research LLD, Circleville, United States

Aim: Diabetic foot ulcers (DFUs) present a significant challenge due to delayed healing. Previous studies indicate potential benefits of polylactic acid (PLA) matrices in promoting DFU closure over standard care. Therefore, the objective of this study was to evaluate the efficacy of PLA closure matrices compared to collagen dressings in DFU healing.
Method: This single-centre interim analysis of a large randomized clinical trial (RCT) included 50 patients with DFUs, randomized to receive weekly PLA matrices (n=25) or collagen dressings (n=25). Primary endpoints were time to full wound closure and the rate of full healing by 12 weeks. Secondary endpoints included multispectral imaging metrics (oxygen saturation, and temperature), histology, and molecular biomarkers. 
Results / Discussion: Patients treated with PLA matrices achieved significantly faster wound closure, with a median time of 9 weeks versus 17 weeks in the collagen group (p<0.001), and an 84% versus 32% healing rate by 12 weeks (p<0.001). Multispectral imaging demonstrated enhanced oxygenation and elevated temperatures in PLA-treated wounds. Gene expression analysis revealed upregulation markers of angiogenesis, cellular adhesion, and immune modulation. Histology confirmed increased CD31+ vessel density and CD68+ cellular changes, supporting enhanced vascularization and immune response.
Conclusion: The findings suggest that PLA matrices facilitate DFU healing by promoting neo-angiogenesis, immune regulation, and bacterial control, with faster closure times and improved vascularization. These results underscore the potential of PLA matrices as a superior treatment for DFUs, providing a promising alternative to collagen dressings. Further studies are warranted to validate these findings across multiple centres.

 

OP052 The effect of diabetes-related amputations on renal function in patients with renal insufficiency: An observational, single-centre, retrospective cohort study

Hong-Wei Liu^1
1Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Guangzhou, China

Aim: The study aimed to analyze the effect of the lower extremity amputation (LEA) on renal function in diabetic patients with renal insufficiency, focusing on the changes of the estimated glomerular filtration rate (eGFR) and associated inflammatory indicators pre- and post-amputation.

Method: A retrospective cohort study analyzed 240 patients with diabetic foot ulcer (DFU) between 2020 and 2023 at a single university center for treating diabetic foot. Patients were categorized into five groups based on baseline eGFR and into three groups according to post-amputation changes in eGFR (improvement, stability, and deterioration). Univariate and multivariate logistic regression analyses were performed to identify predictors of renal function changes following amputation. Key inflammatory markers evaluated included white blood cells, neutrophil count, neutrophil percentage, neutrophil-to-lymphocyte ratio, and C-reactive protein (CRP).

Results / Discussion: Lower baseline eGFR was associated with a higher risk of major amputation and more severe DFUs. Post-amputation, 66.2% of patients exhibited improved eGFR, with reductions in serum creatinine, blood urea nitrogen, cystatin C, and inflammatory indicators such as CRP. Multivariate analysis was identified by changes in ΔCRP as a significant predictor of post-amputation renal function changes.

Conclusion: LEA in patients with DFU, particularly those with renal insufficiency, may improve renal function post-amputation, likely due to reduced systemic inflammation. Monitoring CRP and other inflammatory markers before and after amputation could help optimize management strategy in this high-risk population.

 

OP053 Systematic intraoperative bone sampling increases healing chances in diabetic foot osteomyelitis

Chiara Goretti¹, Elisabetta Iacopi¹, Francesco Giangreco¹, Alessandro Leonildi², Valerio Ortenzi³, manuela pogliaghi⁴, Letizia Pieruzzi¹, Simona Barnini², Marco Falcone⁴, giuseppe naccarato³, Alberto Piaggesi^1
1Diabetic Foot Section, Department of Endocrino-Metabolic and Transplantation Medicine, Pisa, Italy, ²Microbiology Unit, University of Pisa, Pisa, Italy, ³Histology and Anatomo-Pathology Service, Department of Translational Research, Pisa, Italy, ⁴Infectious Diseases Unit, Department of Medical and Surgical Specialities, University of Pisa, Pisa, Italy

Aim: To evaluate outcomes of a proactive multidisciplinary diagnostic program in multidrug resistant (MDR) diabetic foot osteomyelitis (DFO) management.
Method: All consecutive patients surgically treated for DFO between July and December 2022 in our department (Group A) were evaluated. Intraoperative bone specimens for microbiological and histological analysis were collected, with consequently antibiotic adjustment. The controls were admitted in the same period with the same indications (Group B), but without systematic intraoperative bone sampling. Clinical-demographic characteristics, procedures, healing rate (HR), healing time (HT) and recurrence rate (RR) were compared between the groups.
Results / Discussion: From 165 patients,  84 were in Group A [50.9%; Male/female 79.3/20.7%; age 70.2±11.2 yrs; Type 1/2 diabetes 6.3/93.7%; diabetes duration (DD) 21.5±12.4 yrs;  Hba1c 57.8±19.4 mmol/mol; BMI 27.6±5.1 kg/m²] and 81 in Group B [49.1%; Male/female 82.7/17.3%; age 70.5±11.6 yrs; Type 1/2 diabetes 5.2/94.8%; DD 19.5±11.6 yrs;  Hba1c 60.4±21.8 mmol/mol; BMI 27.3±4.8 kg/m²]. Group A had a higher healing rate at six months (84.9% vs 66.9%, p<0.002), a shorter healing time (65±52 days vs 126±92 days, pz<0.001) and a lower recurrence rate at 1 year of follow up (32.5% vs 58.7%, p<0.05) compared to Group B. Group A had an higher prevalence of polymicrobial infections (51.1 vs 35%, p<0.002),  an higher prevalence of Ps. Aeruginosa (19.7 vs 11.1%, p<0.05) and a lower prevalence of Staph Aureus (22.3 vs 29.6%, p<0.05) than Group B.

Conclusion: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adjustment, increases healing rates and reduces healing times and recurrences rates in DFO surgically treated patients.

 

OP054 Accelerated healing or added burden? Patient perspectives of success and challenges of ambulatory negative pressure wound therapy for diabetic foot syndrome

Alexandru Tigla^1
1Innklinikum Altötting, MVZ Med Bayern Ost, Burghausen, Germany

Aim: This study assessed patient perspectives on the effectiveness and wound healing outcomes of ambulatory negative pressure wound therapy (NPWT) for diabetic foot syndrome (DFS). After therapy, patients completed a survey evaluating treatment success, therapy experience, advantages, and challenges.

Method: Eighteen consecutive DFS patients treated with ambulatory NPWT at our specialized diabetic wound care clinic were surveyed.

Results / Discussion: The cohort consisted of 67% men, and for 67%, this was their first NPWT experience. Therapy began at discharge for 40% and within one week for 45%, with durations of 1-2 weeks (22%), 2-4 weeks (28%), and 4-6 weeks (39%). NPWT impacted daily life minimally for 39%, though 67% had difficulties with daily activities, and 61% required mobility aids. The dressing was comfortable for 44%, though 61% struggled to maintain an airtight seal. Complete wound closure was achieved in 20% of cases, while 43% received additional skin grafts. Overall, 83% reported positive healing progress, and 96% would recommend the therapy.

Conclusion: Ambulatory NPWT is viewed positively by DFS patients, demonstrating promising wound healing outcomes and high satisfaction levels. Over 80% of patients reported favorable progress, with most willing to recommend or repeat the therapy, highlighting benefits such as faster healing and reduced hospitalization. These findings underscore NPWT’s potential to support quicker recovery and enhance quality of life by reducing hospital dependency. However, challenges such as maintaining an ambulant airtight dressing seal and ensuring effective patient education and support during the transition from inpatient to outpatient care could further optimize outcomes.

 

OP055 Metabolic decompensation indexes and anemia as independent predictors of worse outcomes in diabetic foot (DF) patients

Alberto Piaggesi¹, Francesco Giangreco¹, Letizia Pieruzzi¹, Chiara Goretti¹, Elisabetta Iacopi^1
1Diabetic Foot Section - Pisa University Hospital, Pisa, Italy

Aim: To evaluate the role of the new metabolic decompensation indexes and of anemia as predictors of outcomes in a cohort of DF inpatients.

Method: We retrospectively analyzed data of all patients admitted to our department for DF in 2021 dividing into two groups according to whether they achieved healing within 6 months (group A) or not (group B). We compared groups for clinical and hematologic characteristic, and parameters of metabolic severity [Fibrosis 4 (FIB4) index, triglyceride/glucose ratio (TYG)].

Results / Discussion: Data were obtained from 280 patients: 195 in Group A [69.6%; age 71.3±10.6 years; male/female 75.9/24.1%; DM1/2 6.7/93.3%; BMI 28.8±6.3 kg/m2; Hba1c 62.3±19.9 mmol/mol; diabetes duration (DD) 16.9±13.8 years] and 85 in Group B (30.4%; age 70.2±10.3 years; male/female 75.2/24.8%; DM1/2 7.9/92.1%; BMI 29.1±5.7 kg/m2; Hba1c 59.3±20.7mmol/mol; DD 24.7±9.6 years). Group B had a longer (p<0.04) DD, while Group A had higher prevalence of ischemic cardiopathy (p<0.05) and hypertension (p<0.05). Group B had higher levels of FIB4 (p<0.002), TYG (p<0.002) and lower levels of triglycerides (p<0.05) and total hemoglobin (p<0.05). In Cox logistic multivariate regression analysis, healing was negatively influenced by FIB4 (HR 0.38, CI 95% 0.16-0.51, p=0.034) and TYG (HR 0.61, CI 95% 0.40-0.76, p=0.022) and positively by higher total hemoglobin (HR 1.39, CI 95% 1.14-1.56, p=0.016). The same three parameters were also associated with healing time (FIB 4 p<0.001, TYG p<0.001 and total hemoglobin p<0.001).

Conclusion: Our data demonstrated how anemia and metabolic decompensation, when adequately detected, correlate to worse clinical outcomes in DF patients.

 

OP022 The conjuring chances in diabetic foot (DF) patients of anemia and multidrug resistant bacteria on healing

Letizia Pieruzzi¹, Elisabetta Iacopi¹, Francesco Giangreco¹, Manuela Pogliaghi², Alessandro Leonildi³, Chiara Goretti¹, Simona Barnini³, Marco Falcone², Alberto Piaggesi^1
1Diabetic Foot Section, University Hospital of Pisa, Pisa, Italy, ²Infectious Disease Operative Unit, University Hospital of Pisa, Pisa, Italy, ³Microbiology Operative Unit, Pisa, Italy

Aim: Our study aimed to evaluate if the presence of anemia may complicate and increase the pathogenetic effect of MDR on clinical outcomes in DF patients.
Method: We retrospectively analysed all patients admitted in our Department in 2022 for DF, dividing them in two groups according to presence(Group A) or absence(Group B) of anemia, defined as both total Hemoglobin(HB) and red blood cells (RBC). We compared groups for clinical, demographic characteristics, blood chemistry, procedures and clinical outcomes: healing rate (HR) and time (HT) and recurrence rate (RR). We compared clinical outcomes between Groups according to the detection of MDR.

Results / Discussion: We derived data of 280 patients: 164 patients in Group A [58.6%; age 70.7±11.2yrs; male/female 77.4/22.6%; DM1/DM2 6.9/93.1%; Hba1c 57.8±19.1mmol/mol; diabetes duration (DD)21.2±12.4yrs] and 116 in Group B (41.1%; age 71.1±10.7yrs; male/female 73.2/26.8%; DM1/DM2 8.1/91.9%; Hba1c 59.1±17.2mmol/mol; DD 19.9±13.8 yrs). In the overall cohort Group A showed a lower healing rate (45.7% vs 78.4%, p<0.002), a longer healing time (98±62 days vs 82±54 days, p<0.05) and a higher recurrence rate (29.4% vs 21.2%, p<0.05). When considering separately Staphilococcus Aureus (SA), Pseudomonas Aeruginosa (PA) and Enterobacteriaceae (EN), their relative effect is greater on Group A than on Group B: SA determines a higher reduction in HR (17.5% vs 14.2%, p<0.05) and a greater increase in HT (21±16 vs 9±6 days,p<0.002) and in RR (7.3% vs 3.0%, p<0.002). PA is associated with a higher reduction in HR(8.9% vs 4.7%,p<0.002) and greater increase in RR (6.4% vs 3.3%,p<0.05) and EN with a greater reduction in HR (9.5% vs 4.8%,p<0.02).
Conclusion: Anemia and MDR are able to play a synergistic role on clinical outcomes of DF patients worsening healing chances.

 

OP056 Results of a pilot study of diabetes-related foot disease (DFD) screening in an at-risk group

Justyna Cwajda-Białasik¹, Paulina Moscicka², Maria Teresa Szewczyk^2
1Nicolaus Copernicus University in Torun, Ludwic Rydygier Collegium Medicum in Bydgoszcz, Department of Perioperative Nursing, Outpatient Department for Chronic Wound Management, University Hospital No 1 in Bydgoszcz, Bydgoszcz, Poland, ²Department of Perioperative Nursing, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Outpatient Clinic for Chronic Wound Management, University Hospital No 1 in Bydgoszcz, Bydgoszcz, Poland

Aim: The aim of this study was to pilot screening of diabetes-related foot disease in a group of people with glycemic disorders.

Method: We recruited 143 volunteers over 40 years with impaired glycemia. We examined them for peripheral arterial disease (PAD) by measuring: ankle-brachial index, toe-brachial index, TcPO2; and diabetic neuropathy (loss of protective sensation, LOPS) by measuring: temperature and pressure perception and pedobarography.

Results / Discussion: In total, we examined 170 feet of patients with glycemic disorders (diabetes – 30% or prediabetes – 70%). Disorders on at least 1 foot (PAD or LOPS) occurred in 66.7% of diabetics and 17% of prediabetics. As many as 35% of the examined had symptoms of PAD or LOPS. Higher risk and DFD category were correlated with duration of diabetes (r=0.68, p=0.007), glycemic levels (r=0.56, p=0.001), age (r=0.57, p=0.007), and the presence of other diabetes complications.

Conclusion: Our study was pilot in nature but showed that peripheral complications of diabetes, such as DFD, often remain undiagnosed and untreated despite high risk of ulceration and amputation. The true incidence of DFD may be many times higher than the data recorded in the health care system, which most often include symptomatic and advanced stages of DFD. There is a need for multicenter screening studies that will allow to identify all cases of DFD.

Figure 1. DFD risk categories according to IWGDF guidelines in the study group

 

Figure 2. Correlation of selected sociodemographic and clinical variables with the risk of DFD according to IWGDF

 

OP023 Anemic patients suffering from diabetic foot show an higher susceptibility to multidrug resistant bacteria

Letizia Pieruzzi¹, Francesco Giangreco¹, Elisabetta Iacopi¹, Manuela Pogliaghi², Alessandro Leonildi³, Chiara Goretti¹, Simona Barnini³, Marco Falcone², Alberto Piaggesi^1
1Diabetic Foot Section, University Hospital of Pisa, Pisa, Italy, ²Infectious Disease Operative Unit, University Hospital of Pisa, Pisa, Italy, ³Microbiology Operative Unit, Pisa, Italy

Aim: Our study aimed to test if anemia could be related with an increased prevalence of multidrug resistant bacteria (MDR) in Diabetic Foot (DF) infection.
Method: We retrospectively analyzed all patients admitted in our Department in 2022 for DF, dividing them in two groups according to presence (Group A) or absence (Group B) of anemia, defined as both total Hemoglobin concentration (HB) and red blood cells count (RBC). We compared then groups for prevalence of MDR and resistance profiles and for their different impact on healing rate (HR), healing time (HT) and recurrence rate (RR) in the two groups.
Results/Discussion: We derived data of 280 patients: 164 patients in Group A[58.6%; age 70.7±11.2yrs;male/female 77.4/22.6%; DM1/DM2 6.9/93.1%; Hba1c 57.8±19.1mmol/mol; diabetes duration(DD) 21.2±12.4yrs] and 116 in Group B(41.1%; age 71.1±10.7 yrs; male/female 73.2/26.8%; DM1/DM2 8.1/91.9%; Hba1c 59.1±17.2mmol/mol; DD 19.9±13.8 yrs).We evaluated the prevalence of the most represented bacterial strains: Staphylococcus Aureus(SA) was detected in 31.1% in Group A vs 21.6% in Group B (p<0.001): with prevalence of Meticillino-resistant SA of 28.4% vs 18.2% respectively(p<0.001). Pseudomonas Aeruginosa(PA) was present in 18.3% of patient in Group A and in 14% of Group B (p<0.05). No difference between two Groups in terms of resistance profile of PA. Enterobacteriaceae (EN) was detected in 16.4% of patients in Group A and in 11.2% of patients in Group B (p<0.05) and we observed EN resistance to Fluoroquinolones in 53% of patients in Group A and 27% of patients in Group B (p<0.005) and EN producer of Extended Spectrum beta lactamase in 39% of patients in Group A vs 17% of patients in Group B(p<0.002).

Conclusion: Our results suggest a higher susceptibility to MDR-bacterial infection in DF ulcers in anemic patients.

 

OP057 The application of the ACT NOW risk assessment tool in dark skin tones – reducing health inequalities and increasing patient engagement

Jayne Robbie^{1 2 3}, Bernadette Adeyileka-Tracz⁴, Luxmi Dhoonmoon⁵, Anne Phillips^{6 7}, Mike Edmonds^8
1Birmingham City University, University Hospitals Birmingham NHS Foundation Trust, Birmigham, United Kingdom, ²Insights for Diabetes Excellence, Access and Learning (iDEAL), London, United Kingdom, ³University Hospitals Birmingham NHS Foundation Trust, Birmigham, United Kingdom, ⁴Diabetes Africa, London, United Kingdom, ⁵London Northwest Healthcare NHS Trust, London, United Kingdom, ⁶Birmingham City University, Birmigham, United Kingdom, ⁷Insights for Diabetes Excellence, Access and Learning (iDEAL), Birmigham, United Kingdom, ⁸Kings College Hospital, London, United Kingdom

Aim: The application of the Diabetes Africa Handbook: Diabetes footcare in dark skin tones along with the six-stage ACT NOW (Accident, Change, Temperature, New Pain, Oozing, Wound) skin tone risk assessment tool empowers people with diabetes and healthcare professionals to detect foot problems and expedite referral to specialist footcare.

Method: Developed by iDEAL (Insights for Diabetes Excellence, Access and Learning) group, ACT NOW is designed to help recognise the early warning signs in all skin tones that might lead to amputation and which, if identified, should activate urgent specialist referral in vulnerable patients

Results / Discussion: Over 7,000 people in the UK annually undergo lower limb amputation which impacts on quality of life. ACT NOW has been co-created as a one-size-fits-all tool for foot problem recognition promoting earlier referrals in all skin tones.  Addressing quality of life factors by improving patient engagement will improve the patient’s lived experience and clinical outcomes.

Dark skin should not be seen as a ‘challenge’ in clinical practice.  Using the Diabetes Africa Handbook: Diabetes footcare in dark skin tones will reduce health inequalities and misdiagnosis, by giving clinicians the knowledge and awareness to provide optimal care for all regardless of skin tone.

Conclusion: The Diabetes Africa Handbook and ACT NOW skin tone infographic are practical, low cost and innovative tools to reduce delays in accessing specialist foot care services by enabling vulnerable people and healthcare professionals to recognize the warning symptoms and disease progression in foot problems associated with diabetes in all skin tones.

 

OP058 The interplay of fatalism, death anxiety, and treatment compliance  in amputated diabetic patients

Tuba Şengül¹, Dilek Yilmaz Akyaz², Lercan Aslan³, Murat Korkmaz⁴, Tuba Cevizci⁵, Elif  Lale Pakdil⁶, Omer Faruk Atalay⁷, Holly Kirkland-Kyhn^8
1Koç University School of Nursing, İstanbul, Turkey, ²Graduate School of Health Sciences, Koç University, İstanbul, Turkey, ³Department of Orthopaedics and Traumatology, Koc University School of Medicine, İstanbul, Turkey, ⁴Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey, ⁵Koç University Hospital, İstanbul, Turkey, ⁶Isparta City Hospital, Isparta, Turkey, ⁷Ortopodoloji Health Services, İstanbul, Turkey, ⁸UC DAVIS, Betty Irene School of Nursing, Sacramento, United States

Aim: This study aimed to investigate the relationship between fatalism, death anxiety, and compliance with Type 2 Diabetes Mellitus (DM) treatment in patients who have undergone limb amputation due to diabetic complications. The objective was to explore how psychological factors influence treatment adherence in this population.

Method: A mixed-method design was used, incorporating quantitative and qualitative data collection. The study sample included 93 amputated diabetic patients who completed surveys and 20 patients who participated in in-depth interviews. Quantitative data were analyzed using a phenomenological approach. Scales included the Fatalism Scale, Thorson-Powell Death Anxiety Scale, and the Type 2 DM Treatment Adherence Scale.

Results / Discussion: Significant differences were found between education levels in terms of death anxiety, adherence to DM treatment, and fatalism (p<0.05). The quantitative analysis revealed a significant positive effect of fatalism on DM treatment compliance (ß = 0.427, p < 0.001), indicating that higher fatalism scores were associated with greater adherence. Death anxiety did not have a significant effect on treatment adherence (ß = -0.177, p = 0.072). Qualitative findings supported these results and identified three main themes: Challenges in Adapting to Amputation, Challenges in Managing Diabetes Treatment, and Psychological and Belief-Based Challenges. Also, identified three sub-themes: Issues with Adapting to the Condition, Issues with Treatment Adherence, and Issues with Treatment Adherence.

Conclusion: Fatalism plays a crucial role in treatment adherence for diabetic foot and amputation-related DM cases, while the impact of death anxiety is less direct. To improve compliance, addressing fatalistic beliefs and offering psychological support is essential. Tailored interventions, including psychological counseling and patient-specific educational programs, could significantly enhance treatment adherence in amputated diabetic patients.

 

OP095 Health-related quality of life in patients with diabetic foot ulcer: Associated factors and the impact of illness belief and diabetes distress

Jiayi Weng¹, Konstadina  Griva², Eng Sing Lee², Frederick H. F.  Chan², Phoebe Xin Hui Lim², Voon Hooi Lim³, Yee Chui Chen³, Julia Xiaoli Zhu^2
1Khoo Teck Puat Hospital, Singapore, Singapore, ²Lee Kong Chian School of Medicine, Singapore,  ³National Healthcare Group Polyclinicis, Singapore

Aim: Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. This study aimed to analyze the associations among and contributions of sociodemographic, clinical, and psychological variables to health-related quality of life related to DFUs.

Method: 186 adults (male 73.7%) with DFU were assessed with the brief illness perception questionnaire, diabetes distress scales and wound-specific health-related quality of life (Wound-QoL) consisting of three dimensions (body, psyche/emotion, and everyday life). Associations among measured variables were examined using hierarchy regression.

Results / Discussion: The highest means were for items on the emotional subscale with means from 0.74 to 3.18. Illness perceptions (β= 0.351, 95% confidence interval [CI] =0.015 to 0.034) and diabetes distress (β= 0.347, 95% CI =0.236 to 0.551) were significantly associated with overall HRQoL after controlling for sociodemographic and clinical factors. Three more regressions also performed for the three subscales and results remain similar with illness perceptions and diabetes distress shown to be significant predictors consistently across models. Compared with male, female expressed more negative emotions (β= 0.188, 95% CI =0.150 to 0.891). HbA1c ≥7% (β=0.161, 95% CI = 0.095 to 0.767) and dependent activities of daily living (ADL, β= -0.171, 95% CI = -0.932 to -0.109) were associated with greater HRQoL impairments related to everyday life.

Conclusion: HRQoL was more influenced by sociodemographic and non-wound related clinical factors (gender, ADL and HbA1c) than by wound parameters. Illness perceptions and diabetes distress were significantly associated with HRQoL. Holistic DFU treatment interventions are needed to address psychological distress to improve HRQoL.

 

OP096 Tissue and serum concentrations of ceftazidime in patients with infected diabetic foot ulcers during bolus or continuous administration of antibiotic therapy - DFIATIM substudy

Radka Jarosikova^{1 2}, Vladimíra Fejfarová^{3 4}, Michal Dubsky³, Veronika Woskova³, Dominika Sojakova³, Andrea Nemcova³, Istvan Modos⁵, Simona Antalová⁵, Pavol Beca⁵, Jakub Mrázek^6
1Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, ²PDepartment of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Prague, Czech Republic, ³Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia, Prague, Czech Republic, ⁴Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague,, Prague, Czech Republic, ⁵Department of Clinical Pharmacy and Drug Information Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, ⁶Laboratory of Anaerobic Microbiology, Institute of Animal Physiology and Genetics,Czech Academy of Sciences, Prague, Czech Republic

The clinical effect of ATB therapy in patients with infected diabetic foot ulcers (iDFUs) is dependent on the sufficient serum and tissue concentrations.

Aim: The aim of this substudy was to assess the ATB availability (ceftazidime – CTZ) in serum and tissue in patients with iDFUs and compare bolus and continuous administration of CTZ.

Method: Into study we enrolled 30 patients with iDFUs (mean age 66±10years, BMI 33.8kg.m^-2). Patients were subdivided into 2 groups according to the type of CTZ administration - by boluses (groupB;n=15) or continuously (groupC;n=15). After induction of ATB steady state, microdialysis was performed near to iDFU to collect fluid samples from tissue within next 6 hours. Simultanously serum samples have been taken. Bactericidal activity of CTZ has been demonstrated by maximal serum (Cmax) and tissue (Cmax_tissue) concentrations, AUC24_serum, AUC24_tissue, clinical effect by ≥60%fT>MIC.

Results: The highest Cmax was detected in groupB (165.9mm/mL in 5^th minute after CTZ administration; p < 0.001) in comparison to groupC (42.3mm/mL in 330^th minute; p=0.008). The Cmax_tissue was the highest in groupB (16.3mm/mL; p < 0.001) after 1 hour and in groupC (6.1mm/mL; p=0.259) after 6 hours post CTZ administration. AUC24_serum didn´t differ significantly, however AUC24_tissue was significantly higher in groupB compared to groupC (p < 0.001). Clinically effective ≥60%fT>MIC was reached in serum in all study subjects, however slightly more patients from groupC compared to groupB (73%vs.60%; p=0,7).

Conclusion: Study proved that bolus cephalosporin ATB administration has reached more powerful bactericidal effect of anti-infectious therapy compared to continuous ATB treatment in patients with iDFUs.

Supported by NU20-01-00078, NW24-09-00184, LX22NPO5104

 

OP097 Impact of heel ulcers on clinical outcomes of patients admitted for diabetic foot ulcers

Martina Salvi¹, Federico Rolando Bonanni¹, Ermanno Bellizzi¹, Aikaterini Andreadi¹, Alfonso Bellia¹, Davide Lauro¹, Marco Meloni^1
1University of Rome “Tor Vergata”, Department of Systems Medicine, Rome, Italy

Aim: This study aimed to evaluate the clinical outcomes of patients admitted for diabetic foot ulcers (DFUs) located in the heel.

Method: The current study is a prospective observational study including a population of patients admitted for DFUs from April 2024 to September 2024. According to the wound location, patients were divided in two groups: those with heel ulcers and those with forefoot/midfoot ulcers without calcaneal involvement. All patients have managed based on international guidelines. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay, reconstructive surgery (need for dermal-epidermal graft).

Results / Discussion: Overall 150 patients were included. The mean age was 70.2±12.2 years, most patients were male (76.0%), had type 2 diabetes (92.7%) with a mean duration of 22.1±13.2 years; 27 (18%) patients had heel ulcers, while 123 (82%) had forefoot/midfoot lesions. Outcomes for patients with heel location and without were: minor amputation (18.5vs32.5%,p=0.1), major amputation (7.4vs0.8%,p=0.02), mortality (0vs0.8%p=0.5), hospital stay (17.5±8.5vs14.4±8.7 days,p=0.08), need for reconstructive surgery (48.1vs19.5%,p=0.003) respectively. In addition, heel ulcer was found to be an independent predictor for major amputation [OR 5.06, CI95%(3.1-11.4), p=0.02] and reconstructive surgery through dermal-epidermal graft. [OR 6 CI95%(3.6- 10.9),p=0.003].

Conclusion: Wounds located in the heel are associated to an increased risk of major amputation and need for reconstructive surgery using dermal-epidermal grafts in hospital patients admitted for DFUs. These data underline the need for tailored management strategies in this high-risk subgroup of patients.

 

OP098 Incidence and causes of major amputation in patients with diabetic foot ulcers: data from a retrospective research

Ermanno Bellizzi¹, Luigi Uccioli², Laura Giurato², Aikaterini Andreadi¹, Alfonso Bellia¹, Davide Lauro¹, Marco Meloni^1
1University Hospital of Tor Vergata, Rome, Italy, ²Centro Traumatologico Ortopedico A. Alesini, Rome, Italy

Aim: The study aimed to evaluate the rate, characteristics and causes of major amputation (MA) in a population of persons admitted for diabetic foot ulcers (DFUs).

Method: The study is a retrospective observational study including admitted patients with DFUs referring to a tertiary-level diabetic foot service from January 2020 to October 2023, and managed by a multidisciplinary team. Patients who received indication for primary amputation at the first assessment were excluded. The outcome measures were: the rate of MA, clinical characteristics of amputees and causes of MA after one year of follow-up.

Results / Discussion: One thousand two hundred twenty-six patients were included. The main age was 69.9±10.7 years, 73.3% were male, and 93.3% had type 2 diabetes. Overall, 30 (2.4%) patients received MA after failing any procedure of limb salvage. Among amputees, 86.7% had ischemic DFUs, 98.3% had infected DFUs, 90% had bone involvement, 73.3% had severe infections, 83.3% had ischaemic heart disease and 26.7% had end-stage-renal-disease requiring dialysis; 56.7% had MA due to untreatable lower limb ischaemia, defined by mechanical revascularization failure, 16.7% due to calcaneus osteomyelitis, 16.7% due to necrotizing fasciitis and 10% due to tarsal osteomyelitis at the first assessment. Three patients (10%) died after major amputation and during their hospitalization.

Conclusion: The study shows low rate of MA in DFUs patients managed by a multidisciplinary foot team when compared to literature data. Amputees showed in several cases cardiorenal complications. Untreatable ischaemia resulted the main cause of MA in more than half of patients.

 

OP099 Small artery disease increases the risk of non healing and major amputation in patients with ischaemic diabetic foot ulcers

Marco Meloni¹, Ermanno Bellizzi¹, Martina Salvi¹, Federico Rolando Bonanni¹, Luigi Uccioli¹, Davide Lauro^1
1University of Tor Vergata, Rome, Italy

Aim: Small artery disease (SAD) is responsible for the “distribution failure” of blood flow to the foot tissues. The study aimed was to evaluate the impact of SAD in patients with ischaemic diabetic foot ulcers (DFUs) and peripheral arterial disease.

Method: The study is a prospective study, including patients with ischaemic DFUs requiring lower limb revascularization, managed in a diabetic foot service from January/2021 to September/2023. Only patients who received a successful revascularization of at least one artery below-the-ankle (pedal, medial and lateral arteries) were included. Based on the presence or not of SAD, patients were divided in 2 groups: those with SAD (SAD+) and those without (SAD-). SAD was defined by the presence of arterial disease affecting the plantar arch and small arteries (tarsal, metatarsal, digital, calcaneal branches). After 1 year of follow-up, the following outcomes were evaluated: healing, minor and major amputation, survival.

Results / Discussion: Overall 128 patients were included, 80(62.5%) with SAD and 48(37.5%) without. The mean age was 70.3±11.1, 71.8% were male, 81.1% had type 2 diabetes with a mean duration of 24.3±12.4 years. SAD+ were older (72.4±9.5vs66.1±13,p=0.03), had more cases of ischaemic heart disease (80vs40%,p=0.0002), dialysis (30vs20%,p=0.02), and heel ulcers (40vs16.7%,p=0.007) than SAD-. The outcomes for SAD+ and SAD- were: healing (57.1vs90.9%,p<0.0001), minor amputation (80vs45.4%,p<0.0001), major amputation (15vs0%,p<0.0001), survival (85vs100%,p=0.003) respectively. The presence of SAD resulted an independent predictor of non-healing [OR 5.6, CI95%(2.4-13.3),p=0.0001] and major amputation [OR 2.8, CI95%(1.6-8.5),p=0.003].

Conclusion: SAD independently increases the risk of non-healing and major amputation.

 

OP100 Efficacy and profitability of using the TCC orthosis in various foot injuries

Arkadiusz Krakowiecki¹, Marcin Malka², Elżbieta Sobol², Bartosz Ziemiecki^2
1Podos, Warsaw, Poland, ²Podos, Narbutta 46/48, Warsaw, Poland

Aim: The TCC orthosis is considered the gold standard in treating diabetic neuropathic foot. However, it is also regarded as challenging to apply and time-consuming.

Method: Between 2022 and 2023, 852 TCC orthoses were applied to 268 patients at the Podos Clinic. The orthosis was made using both rigid and flexible synthetic plaster casts. The use of flexible cast for TCC allows dressing changes while reusing the same orthosis. Decisions to create a new orthosis were based on orthosis damage, significant edema reduction, contamination by exudate, or the need for further adaptation or improved bone stabilization.

Among the patients, there were 210 men (age 63.3 ± 11.1 years) and 57 women (59.7 ± 16.9 years). Indications for TCC included Charcot foot (70M, 19F); metatarsal or toe ulceration (55M, 12F), heel ulceration (22M, 11F), extensive foot wounds (59M, 12F), and other deformities or ulcerations (8M, 4F). Four patients used TCC on both lower limbs.

Results / Discussion: The average number of orthoses applied per condition was as follows: Charcot foot 3.7; metatarsal or toe ulceration 2.3; heel ulceration 2.4; extensive foot wound 2.7; and other deformities or ulcerations 2. The average duration of each orthosis application across all conditions was 24.2 ± 20.9 days, with an average of 5.3 ± 3.9 visits utilizing the orthosis.

The application time for one TCC orthosis is 10-15 minutes. The cost of the orthosis at the Podos Clinic is 88,4 €. The average total cost of using the TCC orthosis is 233,7 PLN, with an additional 3 minutes per visit.

Conclusion: Treatment using the reusable TCC orthosis is convenient, cost-effective, and efficient.

 

OP102 The impact of acute kidney injury on outcomes in patients with diabetic foot osteomyelitis

Arthur Tarricone¹, Lawrence A. Lavery¹, Michael Siah^2
1University of Texas Health Science Center, San Antonio, United States, ²University of Texas Southwestern Medical Center, Dallas, United States

Aim: This study investigated the prevalence and impact of acute kidney injury (AKI) on outcomes in patients hospitalized with diabetic foot osteomyelitis, a serious infection that can lead to amputation and other complications. Understanding the implications of AKI in this population is crucial for optimizing treatment strategies and improving patient outcomes.

Methods: This retrospective study analyzed data from 202 patients hospitalized for diabetic foot osteomyelitis at a tertiary care center. Patients were categorized based on the presence or absence of AKI at the time of admission, defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcomes of interest were rates of rehospitalization and reinfection within a one-year follow-up period. Secondary outcomes included amputation, mortality, and time to wound healing.

Results/Discussion: Of the 202 patients enrolled in the study, 88 (43.6%) presented with AKI. Statistical analysis revealed a significant association between AKI and an increased risk of both rehospitalization (odds ratio [OR] 2.72 [2.00, 6.75]) and reinfection (OR 1.92 [1.09, 3.38]). Interestingly, no significant associations were found between AKI and amputation, mortality, or the overall proportion of wounds that healed. However, a notable difference was observed in the time to wound healing, with patients without AKI experiencing significantly faster healing times (138.22 ± 111.62 days) compared to those with AKI (176.18 ± 106.32 days, p=0.037).

Conclusion: This study demonstrates that AKI is a frequent complication in patients with diabetic foot osteomyelitis and is independently associated with increased rates of rehospitalization and reinfection. Early identification and management of AKI are essential to mitigate these risks and potentially improve outcomes, including facilitating faster wound healing, in this patient population.

 

 

DRESSINGS

OP069 The variation of the reimbursement of the  wound care products in different counties in Finland

Leena Berg¹, Heli Kallio², Kirsti Ahmajärvi^3
1University of Oulu, Oulu, Finland, ²Turku University Hospital, Turku, Finland, ³University of Helsinki, Helsinki, Finland

Aim: Successful wound management is based on wound aetiology and treatment according to it, multidisciplinary aspect especially for hard-to heal ulcers and patient-centred care. Wound care product play a role in wound management, especially if there are restrictions in availability of the products. EWMA reimbursement project aimed at gathering information about delivery of wound care products in different European countries.

Method: For the projects we sent a questionnaire to all (n=46) authorized wound care nurses in Finland and to the doctors of the Committee of Finnish Medical Associations for Special competence in wound management(n=22). The questionnaire included the questions with which criteria the counties are delivering the wound care products to the patients. Results / Discussion: We received results from 14 of 21 Social and welfare districts in Finland and from 3 doctors. Wellbeing service counties have their own treatment supply for wound care products and a referral or prescription.
Some counties provide all products for free (2/14), some provide free products according to a diagnose (6/14) or after evaluation of a professional (4/14) and 1 does not supply at all free products. We received from 2 counties 2 answers from different setting.
Mostly the reimbursement is restricted for a chronic wound which has lasted for 3 three months in Finland. Excluded are acute wounds and post-operative wounds.

Conclusion: There is a significant variety of the reimbursement criteria’s in wound care products between counties in Finland. This means that the patients are treated inequal dependent of their living area.

 

EP0138 French clinical evaluation of TLC-NOSF dressings in the local treatment of chronic wounds: intermediate results of a prospective multicenter study in 273 patients

Sylvie Meaume¹, Philippe Léger², Jean Michel Petit³, Anne Sauvadet⁴, Doan Julie⁵, Agnes Hartemann^6
1Hopital Rothschild - APHP, Paris, France, ²Clinique Pasteur, Toulouse, France, ³CHU Dijon, Dijon, France, ⁴Laboratoires Urgo, Chenove, France, ⁵Laboratoires Urgo, Paris, France, ⁶GH Pitié-Salpêtrière, Paris, France

Aim: The superior efficacy of TLC-NOSF (sucrose octasulfate) dressings in chronic wound healing, demonstrated in several robust randomized controlled trials, was evaluated for its transposability to an unselected population of patients suffering from diabetic foot ulcers (DFUs) or venous leg ulcers or mixed venous-predominant ulcers (VLUs), in real-life conditions in France.

Method: This was a prospective, multicentric, observational study using TLC-NOSF dressings (UrgoStart Plus Pad, UrgoStart Plus Border, and UrgoStart Contact). Patients were followed for up to 12 weeks. Primary endpoint was complete wound healing, with secondary endpoints including subgroup analysis by wound duration, clinical wound progression, local tolerance and acceptability of the dressings. Study was registered under NCT06135987 (ClinicalTrials).

Results / Discussion: From June 2022 to September 2023, 273 patients were included (173 with VLU, 100 with DFU). At final visit, 49% of VLUs patients and 41% of DFUs patients had healed. Optimal healing results were achieved when TLC-NOSF dressings were used on recent VLUs (<3 months), with 63% wound healing (compared with 26.5% in VLUs >6 months). The tolerance and acceptability of these dressings were rated as very good or good by the vast majority of patients and healthcare professionals.

Conclusion: These results align with previous clinical evidence on TLC-NOSF dressings, confirming their effectiveness and good tolerance in DFUs/VLUs patients treated in daily practice. Consistent with a recent systematic review, they support the use of these dressings as a first-line treatment until wound closure, when incorporated into an appropriate care protocol.

 

OP070 Comparative clinical study on the use of topical probiotics in soybean concentrate for managing split-thickness skin graft donor sites

Honda Hsu¹

¹Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Taiwan, School of Medicine, Tzu Chi University, Hualien, Taiwan, Dalin, Taiwan

Aim: Split-thickness skin graft (STSG) donor sites are traditionally treated with paraffin gauze for its simplicity and cost-effectiveness. However, due to the pain and slower healing associated with gauze, hydrofiber dressings (Aquacel® Extra) have become one of the preferred dressing for their fluid absorption and moisture retention capabilities. Recently, there has been interest in using topical probiotics in wound care, showing promise in reducing infection and promoting healing, especially in cases like diabetic foot ulcers. No clinical studies, however, have yet explored using probiotics in a soybean concentrate for STSG donor sites. This study aims to assess the efficacy and safety of combining topical probiotics with hydrofiber dressings versus hydrofiber alone.
Method: This retrospective cohort study (January 1 - December 31, 2023) evaluated healing outcomes in STSG donor sites treated with a single application of probiotics in a soybean-based concentrate (Lactera, Bao Geng Biotechnology Co., Taiwan) along with standard care. Daily data, including wound records and digital photos, were collected.
Results / Discussion: Fifty-four patients participated (30 in the study group; 24 controls), with mean defect sizes of 69.2 cm² and 86 cm², respectively. The study group achieved complete epithelialization in 11 days on average, compared to 17 days in the control group, a statistically significant reduction (p<0.0001).
Conclusion: This study suggests that topical probiotics in soybean concentrate are both effective and safe for wound care, promoting faster epithelialization in STSG donor sites, and may be a beneficial addition to standard wound care practices.

 

EP0151 Enabling patient empowerment: The impact of versatile dressings on wound healing and quality of life – a case series

Iva Pranjic¹, Mary Costello^2
1St James’s Hospital, Dublin, Ireland, ²Laois/Offaly, Mountmellick, co Laois, Ireland

Aim: Wound management requires a tailored approach based on the patient’s specific condition. Identifying treatment aims, along with location, size, and depth, plays a significant role in determining appropriate care. The right dressing promotes healing, prevents complications, and suits both the wound type and the patient’s overall condition. This case series will explore the versatility of an Enzyme Alginogel in treating various wound types.

Method: A retrospective review examined 30 patients treated with the Enzyme Alginogel in acute and community settings in Ireland. Enzyme Alginogel promotes healing by facilitating debridement of devitalised tissue, absorbing exudate and providing antimicrobial protection. Over 12 weeks, the study assessed wound types, patient demographics, tissue type, moisture management, time to closure, and quality of life improvements, including pain and independence.

Results / Discussion: The study showed that Enzyme Alginogel effectively reduced pain, managed moisture, and facilitated debridement. Pain levels dropped significantly, with average VAS scores decreasing from 9.4 to 0.6 over 12 weeks. Debridement improved, noted by 90% of healthcare professionals. Patients also experienced reduced signs of infection and enhanced independence in wound care. Overall, the product contributed positively to wound healing and quality of life, addressing pain and enhancing self-management.

Conclusion: Enzyme Alginogel is a versatile wound dressing that can assist patients to actively manage their healing whilst significantly reducing pain. Demonstrating proven efficacy across various wound and tissue types, this product facilitates supported self-care, ensuring primary treatment objectives are achieved. Furthermore, it positively influences patients’ quality of life enhancing overall experience during recovery.

 

EP0153 Evaluating hydro-active colloid gel for preventing deterioration of incontinence-associated dermatitis in critical care

Emma Hale¹, Danielle Burnside², Charlotte Johnson^2
1University Hospital North Tees and Hartlepool, Stockton-On-Tees, United Kingdom, ²North Tees and Hartlepool NHS Foundation Trust, County Durham, United Kingdom

Aim: Moisture-associated skin damage (MASD), especially incontinence-associated dermatitis (IAD), is common in critical care units (CCU) due to faecal incontinence and diarrhoea, leading to discomfort and infection risks. Historically, a locally produced skin integrity guide promoted assessments and barrier creams but lacked treatment guidance to prevent deterioration of excoriation. Through internal research, a hydro-active colloid gel was identified. An evaluation was commenced to assess its efficacy in preventing IAD deterioration compared to existing treatments.

Method: A pathway for preventing and managing MASD in the CCU was introduced. A 14-week evaluation in intensive care and high dependency units assessed the clinical efficacy of a hydro-active colloid gel for treating excoriation and preventing deterioration. Clinicians were instructed to apply the product upon identifying excoriation and monitor MASD. Feedback was collected from staff, patients, and relatives.

Results / Discussion: To compare clinical outcomes, data on pressure ulcers (PUs) and moisture lesions were collected 24 weeks before and 14 weeks during the evaluation. In the CCU, moisture lesions averaged 0.62 per week and PUs averaged 0.88. After introducing the hydro-active colloid gel for 15 patients, moisture lesions decreased by 53% to 0.29 per week, while pressure ulceration dropped by 84% to 0.14 per week. Staff found the gel easy to apply and effective, with 100% recommending continued use. The connection between PUs and MASD was noted for further investigation.

Conclusion: This quality improvement initiative aimed to reduce MASD in critical care by implementing a structured pathway and introducing a hydro-active colloid gel. Based on recorded outcomes and staff feedback, it has launched across the CCU and will soon be implemented Trust-wide.

 

OP071 Efficacy of synthetic polylactic acid matrix for the closure of complex wounds with exposure of fascia, peritendon, osteosynthesis material and periosteum

Mario Aurelio Martínez-Jimenez¹, Jose Ramirez-GarciaLuna, Ana Lorena Novoa-Moreno¹, Natalia  Sanchez-Olivo², Víctor Manuel Loza González^3
1Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ²Facultad de Medicina Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ³Hospital Central Dr. Ignacio Morones Prietox, San Luis Potosí, Mexico

Aim: To describe the effectiveness of polylactic acid matrix in the use of complex wounds of more than 1 month’s evolution with exposure of fascia, peritendon, osteosynthesis material and periosteum.
Method: Describe 19 patients with complex wounds of more than 1 month of evolution were included, 9 women, 10 men, the average age was 52.42 years (minimum 18, maximum 92), 3 patients with diabetic foot with exposure of the periosteum, 8 post-surgical wound dehiscence, 1 pyogenic granuloma, 4 trauma with exposure of tendon and periosteum, 1 pressure ulcer with exposure of peritendon, 1 due to lack of integration of the skin graft due to burn, and 1 varicose ulcer.
Results / Discussion: The average evolution time was 3 months (minimum 1 month, maximum 12 months), the average measurement of the wound area was 15.44 cm2 (minimum 4.5 cm2 and maximum 37.1 cm2) patients with lower limb injury, 2 upper limb, 1 abdomen and 1 skull, 2 patients with venous insufficiency, 3 patients with diabetes mellitus, 1 with rheumatoid arthritis, and 1 patient with arterial insufficiency. The results of the placement of SUPRA SDRM dermal matrices showed that the mean closure time of all wounds was 9.36 weeks (minimum 2 weeks, maximum 12 weeks), 17 patients with wound closure by re-epithelialization, 1 with temporary use of 2 weeks for preparation of the wound bed for graft placement and 1 patient with temporary use of 2 weeks for flap creation.
Conclusion: It is important to highlight that the use of polylactic acid matrix leads to complete wound closure in 9.36 days with practical and simple use due to its good adhesiveness and low degradation.

 

OP072 Is treatment variability dependent on wound aetiology and severity?

Diana Herrera-Valenzuela¹, Jose Manuel Rosendo Fernandez^2
1Gradiant, Vigo, Spain, ²Complejo Hospitalario Universitario de Pontevedra Área Sanitaria Pontevedra-Salnés, Pontevedra, Spain

Aim: To quantify the treatment variability for each etiology and category of the wounds registered in the last year at a set of healthcare facilities.

Method: The wound registry of 2023 of a health area serving approximately 301.664 inhabitants was retrieved. Descriptive statistics for the frequency for each wound aetiology and category, and the number of different products that were used for each of them were computed.

Results / Discussion: In total, 5323 wounds were retrieved. Distribution of wound’s body locations are shown in Figure 1. Most of them were pressure wounds (Figure 2). Figures 3 and 4 summarize the frequency of each wound aetiology by classification level (bubble size) and the number of different products applied to each subgroup, for chronic and acute wounds respectively.

There is a pattern of more treatment variability with respect to higher wound frequency, as could be expected. There is no trend of increased treatment variability related to increased wound severity for any aetiology. Nonetheless, for all aetiologies in the highest category excluding pressure and surgical wounds, the number of different products used is larger than the number of wounds treated; these are as well more complex wounds with characteristics such as infection or abundant exudate, which require more treatment products to properly manage a wound. Interestingly, the same pattern is seen for arterial and diabetic foot wounds of categories 2º and 3º, and 3º moisture associated skin damage (MASD).

Conclusion: Descriptive statistics show higher treatment variability for arterial, diabetic foot wounds and MASD of categories above 1º.

Figure 1

 

Figure 2

 

Figure 3

 

Figure 4

 

EP0234 Efficacy, tolerance, and acceptability of a TLC dressing in the treatment of epidermolysis bullosa skin lesions

Natividad Romero Haro¹, Macarena Ramirez^2
1DEBRA Spain, Marbella, Spain, ²Laboratorios Urgo, Sevilla, Spain

Aim: To evaluate the efficacy and safety of a 100% lipid-colloid, extra-flexible dressing in the healing of skin lesions in patients with Epidermolysis Bullosa (EB). Secondary objectives include assessing pain upon dressing removal, treatment tolerance, the condition of perilesional skin, and the acceptability of the dressing by healthcare professionals and patients.

Methods: This case series study included 15 patients diagnosed with EB. Treatment with the 100% lipid-colloid, extra-flexible dressing was applied for up to 4 weeks, with 12 scheduled evaluation visits to document healing progress, pain, and tolerance. Parameters such as wound condition and the ease of dressing application and removal were assessed.

Results/Discussion: A high percentage of lesions showed favorable progress over 4 weeks, defined as a reduction of at least 40% of the initial wound surface area. Additionally, adherence to treatment was high, with reduced pain upon dressing removal.

Conclusion: The 100% lipid-colloid, extra-flexible dressing provided a safe and effective treatment for EB lesions, promoting healing and improving patients’ quality of life by reducing pain and trauma during the healing process.

 

 

EDUCATION

OP037 Neglected tropical diseases of the skin: Birth of a World Health Organisation e-learning initiative for wound management in resource-limited settings. A new training tool for national and district-level health workers

Hubert Vuagnat^{1 2}, Michele Murdoch³, Jadesola Akinwuntan⁴, Sarah Anwar^{5 6}, Kingsley Asiedu⁷, Jannine Ebenso⁸, Esther Freeman⁹, Cristina Galván-Casas¹⁰, Linda Lehman¹¹, Melina Longoni^{12 13}, Nelson Mosha¹⁴, Indra Bahadur Napit¹⁵, Jose Antonio Postigo⁷, Jan Rice^{2 16}, Valeria Silvestri¹⁷, Terry Treadwell^18
1Geneva university hospitals, Health care directorate, Program for wounds and woundhealing, Geneva, Switzerland, ²World Alliance for Wound and Lymphedema Care (WAWLC), Geneva, Switzerland, ³West Herts Teaching Hospitals NHS Trust, Departement of Dermatology, Watford, United Kingdom, ⁴School of Medicine, University of Kansas, Kansas City, United States, ⁵Massachusetts General Hospital, Department of dermatology, Boston, United States, ⁶Tufts University, Boston, School of Medicine, Boston, United States, ⁷World Health Organisation, Neglected Tropical Diseases, Geneva, Switzerland, ⁸The Leprosy Mission International, London, United Kingdom, ⁹Massachusetts General Hospital, Departement of Dermatology, Boston, United States, ¹⁰Hospital Universitario de Móstoles, Department of dermatology, Madrid, Spain, ¹¹Disability Prevention and Rehabilitation in NTDs, Independant consultant, Rio Rancho, United States, ¹²Universidad Abierta Interamericana, Departement of Rehabilitation, Buenos Aires, Argentina, ¹³Los Madronos Hospital, Departement of Rehabilitation, Madrid, Spain, ¹⁴Kilimandjaro Christian Medical Centre, Regional Dermatological Training Centre, Moshi, Tanzania, ¹⁵The Leprosy Mission International, Nepal, Department of Research, Kathmandu, Nepal, ¹⁶Aged Care, Wound Care Services, Melbourn, Australia, ¹⁷Muhimbili University of Health and Allied Sciences, Departement of Parasitology, Dar es Salaam, Tanzania, ¹⁸Woundcare Solutions, Woundcare, Montgomery, United States

Aim: More than half of the WHO-listed neglected tropical diseases (NTDs) affect the skin and primarily occur in resource-limited settings, often presenting with moderate to severe wounds.

Method: In March 2023, WHO held the first Meeting on skin related NTDs in Geneva, gathering over 800 experts and stakeholders.

A “Skin Health, Woundcare and Rehabilitation” Working Group was established. As a first step, it developed an e-learning course on wound management, specifically oriented towards primary health care workers, who treat most patients.

Results / Discussion: The course is built on evidence-based knowledge, consists of 5 modules, each containing 20 to 30 slides.

Module 1: Introduction, epidemiology of NTD’s and other wound types.

Module 2: Clinical history, presentation, differential diagnosis.

Module 3: Six basic principles for woundhealing.

Module 4: General local woundcare, when to refer, treatment of underlying NTDs.

Module 5: Public health considerations, socioeconomic and psychosocial impacts, basic infrastructure required.

Accessible with low bandwidth it can be downloaded for offline use. Since August 2024, it has been freely available on the OpenWHO platform (www.https://openwho.org) in English and will be translated into additional languages.

Each module includes a short quiz. Learners who score 80% or higher on the final assessment are awarded a certificate of achievement.

Conclusion: This WHO woundcare course is one of several initiatives aimed at empowering primary health care workers in enhancing their skills. This curriculum has the potential to help millions of people recover more quickly and with better outcomes from wounds related to both NTDs and other causes.

 

OP038 Wound nurses’ knowledge, attitude and practice on wound hygiene: A cross-sectional study in mainland China

Changbin Lei¹, Dengbin Liao^2
1Trauma center , West China Hospital, Sichuan University, West China School of Nursing, Sichuan University, Chengdu, China, ²Trauma Center, West China Hospital, Sichuan University, West China School of Nursing, Sichuan University, Chengdu, China

Aim: Due to population aging and disease spectrum changes, hard-to-heal wounds remain prevalent, which bring huge challenges to medical system globally. Wound Hygiene presents a structured approach to tackle the challenges posed by biofilms in wound healing. China is also facing significant negative impacts caused by hard-to-heal wounds. Wound nurses are the main practitioners of Wound Hygiene. This study is to analyse the knowledge, attitude, and practice (KAP) of wound nurses regarding wound hygiene, as well as the factors that shape these elements in mainland China.

Method: We used a cross-sectional study design by a self-made electronic questionnaire based on two Wound Hygiene consensus documents. Data were collected on nurses’ demographics, Wound Hygiene knowledge, attitude, and practice. Questionnaires were carried out in the hospitals in mainland China.

Results / Discussion: A total of 1013 valid questionnaires were analyzed. The cumulative score for Wound Hygiene was 178.24 ± 21.49, with specific scores of 13.86 ± 4.19 for knowledge, 82.14 ± 9.45 for attitude, and 82.24 ± 12.28 for practice. Significant correlations were found between wound nurses’ KAP and variables such as age, work experience, technical title, and Wound Hygiene training.

Conclusion: This is first study exploring the dissemination of Wound Hygiene KAP among wound nurses in mainland China. The KAP level of wound nurses still need to be improved through education, training, and other means. Additionally, it is crucial to assess the outcomes achieved through the implementation of Wound Hygiene strategies in order to comprehensively evaluate their effectiveness.

 

OP039 The effect of mobile augmented reality application on nursing students’ knowledge skills and motivation regarding the prevention and assessment of pressure injuries

Emine Sezgünsay¹, Tülay Başak^2
1Izmir University of Economics, İzmir, Turkey, ²University of Health Sciences, Ankara, Turkey

Aim: The aim of this study was to examine the effects of a mobile augmented reality application on nursing students’ knowledge, skills, and motivation regarding pressure injuries.

Method: The research is a randomized controlled, quasi-experimental study. The population of the study consisted of 200 first-year students enrolled at Gülhane Faculty of Nursing, University of Health Sciences. In the study, a mobile augmented reality application was used for the training of students in the intervention group regarding pressure injury prevention. The training of the control group students continued with traditional education methods. The data collection process of the study was carried out in two stages: preparation and implementation. Prior to the commencement of the study, ethical committee approval and institutional permissions were obtained. In the analysis of the data, descriptive statistical methods such as number, percentage, min-max values, median, mean, and standard deviation were used, along with independent t-test, dependent t-test, and Chi-square analysis.
Results / Discussion: In the study, the post-test total knowledge scores regarding pressure injury prevention were found to be similar between the intervention and control groups. The mean performance scores of the intervention group students for pressure injury assessment skills were statistically significantly higher than those of the control group (p=0.001). The mean motivation scores of the intervention group students were also found to be statistically significantly higher than the control group students’ scores (p=0.001).
Conclusion: As a result of this study, it was found that the education provided using a mobile augmented reality application increased nursing students’ skill levels and motivation regarding pressure injuries.

 

OP040 Results of implementing a complex intervention on prevention of pressure ulcers in long term care units in portugal

Katia Furtado¹, Paulo Infante², Manuel Lopes^3
1Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal, Outpatient Department, Hospital of Portalegre, Unidade Local de Saúde do Alto Alentejo, 7300-312 Portalegre, Portugal, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof Egas Moniz,1600-096 Lisbon, Portugal, Portalegre, Portugal, ²CIMA, IIFA, Universidade de Évora, 7000-671 Évora, Portugal, Departamento de Matemática, ECT, Universidade de Évora, 7000-671 Évora, Portugal, Évora, Portugal, ³Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal, Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal

Aim: Pressure ulcers (PU) can be painful and negatively affect health-related quality of life and healthcare costs. This study aims to explore implementation strategies to promote knowledge transfer, capacity building, and evidence-based practice, and their interaction within the context of long-term care units.

Method: Firstly, three quantitative studies on knowledge, healing rates and documentation, were performed to identify barriers and facilitators in structure and process and results associated with prevention and treatment of patients with PU. Secondly, an intervention that included education on prevention, nursing leadership in wound care, sustained engagement with focus group and dynamic intervention design was implemented as a pilot study.

Results / Discussion: The sample comprised wounds from all patients admitted between June 2023 and March 2024. During this period, a total of 1145 wounds were assessed in 447 patients. From these wounds, 1005 (87.8%) were pressure ulcers. The subsample in the units where interventions were conducted consisted of a total of seventy-seven wounds (67 pressure ulcers). In these units 96.2% of cases had adequate nutrition, compared with 76.1% without intervention. In the three units 100% of the cases were hydrated, compared with 84.0% without intervention. 63.2% of cases had protein supplements, while in the units without intervention, this percentage was 53.2%. In the units where intervention took place, 98.2% of cases had patient-based positioning, while without intervention, this percentage was 88.9%.

Conclusion: Despite limitations inherent to the significant size difference between the two subsamples, the intervention group performed better in all items except pain control.

 

OP041 Experiences of patients with hard-to-heal wounds: Insights into health outcomes, and socioeconomic variables from a pilot survey

Naz Wahab^1
1Roseman University College of Medicine, 10530 Discovery Dr, Las Vegas, NV 89135, United States

Aim: Understanding the patients’ journey who seek treatment for hard-to-heal wounds, via a nationwide pilot survey.

Method: Qualitative data self-reported from patients with hard-to-heal wounds in a pilot chatbot survey. Wound Expert Survey provided online in the US on Meta platforms between 2021 and 2022.

Results / Discussion: The US national pilot survey attracted responses from 780 patients, with 27 providng a video testimonial. 57% of patients delayed treatment because they believed their wound would heal on its own, and only 4% saw a wound specialist. Respondents reported cost of care as the most frequent reason for noncompliance with doctor’s prescribed treatment. Quality of life queries revealed more than half (65%) admitted to negative thoughts associated with their wound. 19% of respondents reported an odour and, of them, 34% said odour had a negative impact on their self-confidence. Economically, nearly one-quarter of respondents reported wounds led to decrease total household income and 17% responded wounds led to change in employment status.

Conclusion: US pilot survey of patients with hard-to-heal wounds revealed delays seeking professional assistance and a small minority saw a wound care specialist. Experiencing an ulcer has negative effects on QoL. Patients frequently had negative thoughts about their wound; odour compounded this negativity, leading to severe negative impacts on self-confidence. Households experienced declining incomes, from direct reduction/loss of patient employment and the additional time by families assisting in patients’ recovery. Explaining that a variety of factors contribute to poor outcomes with hard-to-heal wounds. To validate preliminary results, future surveys should focus why patients do not seek professional help sooner. To improve health outcomes, assessment of patient socioeconomic variables should occur whenever wound closure stalls.

 

 

E-HEALTH

OP024 Co-creation and evaluation of an algorithm for the development of a mobile application for wound care among new graduate nurses: a multimethod research

Julie Gagnon^{1 2}, Julie Chartrand^{1 3}, Sebastian Probst^{4 5 6 7}, Éric Maillet⁸, Michelle Lalonde^{1 9
1}University of Ottawa, Ottawa, Canada, ²Université du Québec à Rimouski, Rimouski, Canada, ³Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada, ⁴HES-SO, University of Applied Sciences and Arts Western, Geneva, Switzerland, ⁵Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia, ⁶College of Medicine, Nursing and Health Sciences, University of Galway, Ireland, ⁷Geneva University Hospitals, Geneva, Switzerland, ⁸University of Sherbrooke, Sherbrooke, Canada, ⁹Institut du Savoir Montfort, Montfort Hospital, Ottawa, Canada

Aim: To co-create and validate an algorithm for developing a mobile wound care application for newly graduated nurses in BLIND.

Method: The guidance on developing complex interventions by O’Cathain et al., 2019 was followed. A conceptual data model was designed based on a scoping review (Peters et al., 2020), a systematic search and evaluation of available wound care applications (Lau et al., 2021), and an e-Delphi (Keeney et al., 2011). The model was refined through qualitative exploration of the users’ needs (focus group), and quantitatively validated with a questionnaire (sequential exploratory mixed methods, Creswell and Creswell, 2018). Stakeholders were also involved.

Results/Discussion: Eleven studies from 14 publications met the scoping review criteria. The initial search of wound care applications retrieved 1,550 apps, of which 260 were screened, and 5 were evaluated. Twenty-five experts in wound care participated in the three rounds of e-Delphi and 75 items (93.75%) achieved consensus. Five overarching themes emerged from the focus group (n=21 participants), guiding the model’s development and refinement into an algorithm. Quantitative results (n=34 participants) revealed positive feedback on usability [score of 6.33 (±0.19) on a scale of 1–7], reinforcing the algorithm’s quality. These findings provide a solid foundation for developing a mobile application that addresses real-world clinical needs and strengthens professional autonomy.

Conclusion: This research demonstrates a methodology for mobile application development. The process can continue with prototype development and validation. The application is expected to enhance patient care by supporting newly graduated nurses, reducing complications, and improving outcomes.

 

OP025 Multimodal machine learning to automate remote postoperative wound surveillance services

Kenneth McLean¹, Alessandro  Sgrò², Leo Brown³, Louis  Buijs², Katie Mountain³, Catherine Shaw¹, Tom Drake¹, Riinu Pius⁴, Stephen  Knight⁴, Cameron Fairfield⁴, Richard  Skipworth³, Sotos Tsaftaris⁵, Prof Stephen Wigmore³, Mark Potter², Matt-Mouley  Bouamrane⁶, Prof Ewen Harrison¹, TWIST Collaborators^3
1Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, UK, EH16 4SA, Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, UK, EH16 4UX, Edinburgh, United Kingdom, ²Colorectal Unit, Western General Hospital, Edinburgh, UK. EH4 2XU, Edinburgh, United Kingdom, ³Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, UK, EH16 4SA, Edinburgh, United Kingdom, ⁴Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, UK, EH16 4UX, Edinburgh, United Kingdom, ⁵AI Hub for Causality in Healthcare AI with Real Data, University of Edinburgh, Edinburgh, UK, EH9 3FG, Edinburgh, United Kingdom, ⁶Division of Computing Science, Faculty of Natural Sciences, University of Stirling, Stirling, UK, Stirling, United Kingdom

Aim: To develop a multimodal neural network for automated assessment of patient-generated data from remote postoperative wound monitoring.

Methods: Two interventional studies on remote postoperative wound monitoring were analysed: “Tracking wound infection with smartphone technology” (TWIST) and “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). Adult gastrointestinal surgery patients submitted wound images and SSI-related patient-reported outcome measures (PROMs) for 30-days postoperatively. Neural network models were developed within INROADE for PROMs (Multi-Layer Perceptrons [MLP]) and wound images (convolutional neural networks [CNN]). These were combined (multimodal neural network) to predict diagnosis of SSI within 48h, and externally validated within TWIST. The impact of implementation was simulated to “rule-out” low-risk responses.

Results/Discussion: 423 patients received the intervention: 52.7% (n=223) in TWIST and 47.3% (n=200) in INROADE. Within INROADE, there were 3.8% (n=44/1167) responses and 3.5% [n=74/2125] images submitted within 48h of an SSI. Model discrimination was excellent for both PROMs (AUC: 0.811, 0.732-0.890), and images (AUC: 0.841, 0.790-0.892). The multimodal neural network model to predict confirmed SSI within 48h remained comparable to clinician triage (0.762 [0.690-0.835] vs 0.777 [0.721-0.832]), with an excellent performance on external validation. Simulated usage reduced staff-time to deliver remote postoperative wound monitoring by over 80% (51.5 to 9.1 hours), while maintaining diagnostic accuracy (AUC: 0.744 [0.678-0.809] vs 0.789 [0.728-0.850]).
Conclusion: Multimodal neural network models can be successfully deployed within remote monitoring pathways to reduce burdens on staff to deliver without compromising care, and allow resources to be appropriately directed to those at greatest risk postoperative complications.

 

OP026 The experiences and perceptions of pressure injury prevention and management devices and e-health technology in community dwelling individuals

Anna  Rose¹, Nina Marquard-Karp², Nick Moore², Mitch Baker², Peta Tehan^3
1The University of Newcastle, Hunter Medical Research Institute Equity in Health and Wellbeing Research Program, Newcastle, Australia, ²The University of Newcastle, Newcastle, Australia, ³Monash University, Melbourne, Australia

Aim: Pressure injuries (PI) are a prevalent and challenging global healthcare problem. Technology including e-Health presents an exciting opportunity to both prevent and manage PI. E-health involves information and communications technologies to manage illnesses and health risks and to promote wellness. This study explored the perceptions of consumers on the use and applicability of e-health technology for the prevention and management of PI in the community.

Method: This was a qualitative study which took place between January- July 2023. A purposeful, heterogenous sample of participants were recruited from the community who were either at high risk or had lived experience of PI. Semi-structured interviews were transcribed verbatim, and researchers were familiarised with the data. Once the researchers determined that data saturation had been reached, data were analysed using reflexive thematic analysis, and themes were derived.

Results / Discussion: Ten participants were recruited. Four themes were derived; ‘You’ve got to make them listen to you’ reflecting the challenge of finding consistent PI care; ‘It makes life so much easier’; were reflections of potential for e-Health; ‘No one really tells us how to stop it’; ‘I can’t even move’, which relates to the immobility related to PI.

Conclusion: The experience of PI is debilitating, and consumers often feel they are not heard. E-Health has potential to improve the lives of people at risk of or with PI, and patients are interested in engaging with e-Health. E-Health solutions should be designed in consultation with the consumer to ensure acceptability and suitability as part of person-centred care plans.
Keywords: Pressure injury, pressure ulcer, assistive technology, co-design, e-health.

 

OP027 Automated wound type classification for clinical decision support

Nils Gessert¹, Johannes Kilian¹, Michael Perkuhn^1
1Mölnlycke Health Care, Gothenburg, Sweden

Aim: The correct diagnosis of a wound is the basis for effective treatment and for the correct billing of the services provided. However, the shortage of wound care specialists often leads to misdiagnosis and improper treatment of wounds. To address this issue, we aim to develop an AI tool for classifying wound images. This tool could assist non-specialists in selecting appropriate treatments and provide experts with a reliable cross-check or second opinion.

Method: We used four publicly available datasets (DFU Challenge, AZH, SIH, and Medetec) to train and evaluate a wound classification AI model. Three of these datasets were used for training and validation (1162 and 125 images, respectively), while the AZH dataset (439 images) was reserved for testing to prevent data leakage. We focused on four wound classes that are well-represented across all datasets: diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure ulcers (PUs), and surgical (dehisced) wounds. The model (EfficientNetV2-S) was trained using the three training datasets.

Results / Discussion: Receiver operating characteristic (ROC) curves are shown in Figure 1 and classification metrics are shown in Table 1. We observe that classification generally works well with an average area-under-curve (AUC) of 92%. Performance for VLUs and DFUs is higher which might be linked to a class imbalance in the dataset.

Conclusion: We developed an AI model for classifying four wound types. This tool could aid treatment selection for non-specialist HCPs and serve as a cross-check for experts. The model reaches an overall high AUC. Future work could extend this work to more classes and larger datasets.

 

Table 1: Classification metrics for the test set

 

OP028 Diabetic Foot TeleHealth Lab – Arezzo - The right timing and the right pathway

Alessia Scatena¹, Emanuele Bartolini², Rosa Nigro¹, Sofia Butini³, Teresa Scognamiglio², Romina Golini², Elisa Marinelli⁴, Stefania Fabrizi⁵, Sara Sandroni^6
1Diabetology and Diabetic Foot Unit Director, San Donato Hospital, Local Health Authority South East Tuscany, Arezzo, Italy, ²Diabetology and Diabetic Foot Unit San Donato Hospital, Local Health Authority South East Tuscany, Arezzo, Italy, ³Diabetology and Diabetic Foot Unit  San Donato Hospital, Local Health Authority South East Tuscany, Arezzo, Italy, ⁴Wound care nurse network Arezzo - Local health authority South East Tuscany, Arezzo, Italy, ⁵Wound care nurse network Arezzo - Local health Authority South East Tuscany, Arezzo, Italy, ⁶Wound care nurse network Arezzo Coordinator - Local Health Authory South East Tuscany, Arezzo, Italy

Aim: Natural history of diabetic foot ulcer is characterized by a high risk of sudden worsening but telemedicine could improve management. Aim of this study is to evaluate the use of teleHealth tools to intercept the need and improve clinical and management outcomes.
Method: 1020 patients with neuroischemic DFU were monitored and divided into two groups:  460 managed with planned visit every 30 days and 460 managed at home in teleassistance between Diabetic Foot Unit and wound care nurses equipped with tools regarding ulcer features and off-loading device adherence for a simple hand-over.
Results / Discussion: Follow-up was 211±89 days. In the intervention group telecooperation was activated for 336 changing in clinical evolution, 230 off-loading device adherence, 84 antibiotical therapy issue, 17 new ulcers. 484 requests were solved remotely, 183 with a scheduled visit. Admissions were significatively lower in the intervention group than in the control group (31 vs 74; p<0.00001); healed ulcers were significantly higher in the intervention group than in the control group (237 vs 198; p.01) and amputations were 1 in the intervention group and 2 in the control group (n.s.); deaths were 12 in the intervention group and 9 in the control group (n.s.).
Conclusion: TeleHealth tools intercepts the criticality and allows the patient to be assessed in the appropriate times and ways, improving healing and avoiding hospitalizations.

 

 

HEALTH ECONOMICS & OUTCOME

EP0610 A quality improvement project: Supporting timely and cost-effective care for patients with leg ulcers

Polly Cox¹, Rachel Jump², Deborah Margerison², Elizabeth Merlin-Kwan^1
1Urgo Medical, Loughborough, United Kingdom, ²NHS, Blackpool, United Kingdom

Aim: Due to capacity a district nursing team repeatedly worked on average 300 additional hours leading to a poor work-life balance and decreased staff morale. To promote effective use of clinical time and to reduce disproportionate workloads, a Quality Improvement Programme (QIP) for leg ulcer management was introduced which highlighted that lower limb wound care was not viewed as a priority and holistic assessments including Ankle Brachial Pressure Index (ABPI) were being deferred.

Method: It was determined that the aim of the 12-month project period was to ensure ABPI assessment was completed and treatment initiated with compression hosiery where appropriate and considering the criteria for tolerability and ability to self-care.  All team members attended education days and were assessed as being confident and competent to apply compression hosiery.

Results / Discussion: The project began in August with a caseload of 64 patients. Initially, 5 patients had been assessed including an ABPI and were recommended compression bandaging. In September, patients without red flags, as identified by the National Wound Care Strategy⁽²⁾, were provided with hosiery ≤20mmHg.

By November, all patients on the caseload had been assessed. Thirteen were deemed unsuitable for compression and 8 patients were placed in compression bandaging as they did not meet the criteria for hosiery.
Conclusion: This QiP resulted in savings of 15,840 minutes/264 hours/35.2 days of nursing time per month, equating to an average financial saving of £5,944.75 in nursing time and £1,066 in dressings per month.

 

OP029 The results of a needs analysis wound audit across a UK region; A story of inequity and unecessary nursing workload

Alison Hopkins¹, Carole Taylor^2
1Accelerate CIC, London, United Kingdom, ²East London Foundation Trust, London, United Kingdom

Aim: Local Quality leads, community nursing and tissue viability leaders in wound care delivery within a UK Integrated Commissioning Board, identified the requirement for real-world data on workload attributable to wound care, patient demographics and access to evidence based care. The aim was to collect data from community nursing and tissue viability teams across 7 Boroughs to support a business case for transforming wound care provision.

Method: A validated online audit and needs analysis tool was used to survey all those with wounds during a week in January 2024. Collaboration and local ownership to maximise data collection was fostered through training of local champions

Results / Discussion: 1956 patients were surveyed across 7 boroughs, with 1872 having 1 or more wounds. Wound care accounted for 26% of the community nursing caseload and c50% of the weekly activity. 18% had wounds for longer than 1 year with 21% having one or more wound related admission. Main categories: leg ulcers 36%, Pressure ulcers 20%, surgical 16%, trauma 8%. Wounds on the leg: 47%. Compression usage varied from 45% in the home to 96% in a leg ulcer clinic. Specialist nurse involvement increased compression usage from 28% to 93%. Compression therapy usage reduced activity by 25%.

Conclusion: Ambition for local data provided the motivation to deliver this audit. Evidence demonstrating unnecessary workload, inequity of provision and the impact of specialists in increasing the use of evidence-based care for lower leg wounds has provided a powerful story to be acted upon by health leaders

 

EP0616 A new strategy for managing the hospital admission system in the context of microbiology

Wojciech Łabuś¹, Justyna Glik¹, Marcin Ludyga¹, Katarzyna Czerny¹, Karolina Ziółkowska¹, Artur Wielgórecki¹, Przemysław Strzelec¹, Jacek Węgrzyk¹, Anna Hepa-Banasik¹, Magdalena Szatan¹, Anna Słaboń^1
1Dr Stanislaw Sakiel Centre for Burn Treatment in Siemianowice Slaskie, Poland, Siemianowice Slaskie, Poland

Aim: The spread of Enterobacterales gut bacteria in Poland and worldwide (CPE, Carbapenemase-Producing Enterobacterales), poses one of the most severe public health threats and significant challenges in medicine. Treating infections caused by carbapenemase-producing bacteria is extremely difficult, sometimes even impossible, due to these bacteria’s typical resistance to a broad spectrum of antibiotics and chemotherapeutics, often resulting in a lack of effective therapeutic options. One of the critical elements of prevention seems to be strengthening the patient admission system, where screening tests are performed. According to current international and national recommendations, CPE screening is conducted for a selected group of patients. In the traditional screening model used in many hospitals, rectal swabs are taken for microbiological testing. Since each screening test takes 72 hours and limited isolation rooms make it impossible to isolate every high-risk patient for the entire duration, a patient may be admitted to or even discharged from a ward before test results are obtained.
Method: The admission screening system is based on rapid diagnostic methods based on RT-PCR technology enabling identification of potential CPE carriers within one hour.

Results / Discussion: The implementation of the screening management system led to an increased number of isolations from 43 (in 2022) up to 63 (in 2023), resulting in enhanced service safety and a significant reduction in hospital-acquired infections. The number of infections felt from 192 (2022) up to 93 (2023). The absence of cross-infections increased safety for patients not placed in isolation.

Conclusion: The introduction of a strict monitoring system for admission screenings can bring measurable benefits in improving the hospital’s epidemiological situation without reducing service availability or negatively impacting the institution’s financial stability.

 

 

HOME CARE

OP110 The role of enzymatic debridement combinated with hyaluronic acid in home care

Pierluigi Gallo^1
1Mavi Center, San Sebastiano al Vesuvio, Italy

Aim: Collagenases play a key role in managing skin lesions, especially in homecare patients. Vibrio Alginolyticus collagenases target non-vital tissues, breaking down collagen to promote chronic wound healing and lower infection risks. Hyaluronic acid (HA) with its moisturizing and anti-inflammatory properties, supports cellular proliferation, neoangiogenesis, tissue regeneration and repair.

Method: Clinical studies on collagenase use in home-based patients were analyzed, focusing on healing times and quality of life. Between September 2023 and September 2024, we treated around 600 patients with stage II-IV pressure ulcers, using enzymatic debridement with collagenase from non-pathogenic Vibrio Alginolyticus and HA in 450 cases. A thin layer of ointment was applied twice daily, while avoiding harsh antiseptics to enhance treatment efficacy. Treatment was performed by specialists (in complex cases) and family caregivers (in simple cases) ensuring proper preparation of the wound bed (WBP). Wound size and clinical conditions were regularly measured.

Results / Discussion: Using collagenase from Vibrio Alginolyticus in combination with hyaluronic acid resulted in a notable reduction in wound size and accelerated healing compared to standard treatments. Patients also reported better quality of life and less wound-related pain.

Conclusion: Collagenase from Vibrio Alginolyticus, combined with HA, effectively promotes wound healing and improves patient well-being in homecare settings. This combination offers a promising treatment, further research will be performate to refine protocols and and establish standardized treatment following WBP guidelines.

 

OP111 Reimaging wound care – A virtual approach The outcomes & value of a multi-organisation ‘complex wound’ virtual ward (hospital at home) across an NHS region

Rebecca Housley¹, David Cruttenden-Wood², Caroline French^2
1Hampshire Hospital Foundation Trust, Alton, United Kingdom, ²Hampshire Hospitals Foundation Trust, Winchester, United Kingdom

Aim: Patients with complex wounds often receive inequities in community care, resulting in avoidable hospital admissions, morbidity and mortality. Hospital discharges are often delayed due to challenges organising continued complex wound care at home. 

To address these issues a complex wound virtual ward (CwVw) was established in a region in England. It aimed to create a one-team approach across individual care providers to deliver safe and effective complex wound care to patients at home. 

Method: Mixed-methods service evaluation; prospective quantitative data collection from electronic patient records, highlighting patient characteristics, safety, service use and costs. A rapid ethnography further explored the value of the CwVw, collecting qualitative data from staff and analysing data using Translational Mobilisation Theory.  

Results / Discussion: 87 patients were admitted to the CwVw over 15 months, with 56% early supported discharges and 44% admission avoidance. Median length of stay was 9 days. 67% were elderly. 84% had significant comorbidities.  The readmission rate was 13.8%. Mortality was 5.7%. 356 hospital bed days were saved equating to £89,000. 

Figure 1 shows how the CwVw organises care differently for patients with complex wounds: 

Staff perceived value included improved wound healing, patient outcomes and experiences, and enhanced professional satisfaction, education and relationships.   

Conclusion: This is the first time a virtual ward/hospital-at-home has delivered care for people with the most complex wounds. Previously, these patients would have mandated hospital admission.  

Our multi organisational ‘one-team’ virtual ward delivered high quality safe care, bringing widespread benefit to patients and society. This demonstrates an evolution in healthcare away from hospital admission. 

 

 

INFECTION

OP109 Examining the frequency of biofilm-forming bacteria in 24 excised hidradenitis suppurativa samples

Ayşenur Botsalı¹, Ilgaz  Kazaz², Tugrul Hosbul², Yavuz Cekli³, Ercan Caliskan^1
1University of Health Sciences, Gülhane Faculty of Medicine, Dermatology Department, Ankara, Turkey, ²University of Health Sciences, Gülhane Faculty of Medicine, Medical Microbiology Department, Ankara, Turkey, ³University of Health Sciences, Gülhane Faculty of Medicine, Infectious Diseases and Clinical Microbiology Department, Ankara,Turkey

Aim: Recent insights classify Hidradenitis suppurativa (HS) as an autoinflammatory keratinization disorder. Nonetheless, microbial dysbiosis is believed to contribute to inflammation, especially in advanced stages. This study aims to evaluate the frequency of biofilm-forming bacteria in lesional HS samples.

Method: Thirty-three isolates from 24 excisional samples collected from 21 patients with HS were included. Of the 24 regions, 12 were classified under Hurley stage II and 12 under stage III disease. Bacterial identification was conducted using MALDI-TOF MS (Bruker Daltonics, Germany). Biofilm formation was evaluated through the microtiter plate method utilizing crystal violet dye, with the optical density of the stained wells measured at 600 nm for quantification.

Results / Discussion: The axillary region was the predominant site of sample collection (75%, n=18), followed by the gluteal region (12.5%, n=3). The most frequently isolated strain was Staphylococcus epidermidis (24.2%, n=8). Other notable bacterial agents included Escherichia coli (15.1%, n=5), Corynebacterium striatum (12.1%, n=4), and Staphylococcus hominis (12.1%, n=4). Of the 33 isolates, three (9.1%) had strong, six (18.1%) had moderate, and 14 (43.7%) had mild biofilm formation, while 10 (30.3%) did not produce biofilm.

Overall, the detection rate of biofilm in chronic HS lesions was 69.7%. This finding aligns with the data reported by Ring et al., which indicated the prevalence of biofilm in chronic HS lesions within perilesional and lesional skin samples as 69% and 75%, respectively.

Conclusion: Biofilm formation is a common phenomenon during HS disease course. While anti-inflammatory treatments are regarded as the primary approach for treating HS, those who exhibit an insufficient response to these treatments, including biological agents, necessitate deep tissue cultures and the integration of long-term antimicrobial therapies.

 

EP0601 Microbial load in wounds related with antiseptics

Paula Nogueira¹, Saskia Fleury², Carol Gonzalez³, Vera Lucia Conceição Gouveia Santos^1
1University of São Paulo, São Paulo, Brazil, ²ConvaCare Clinics, São Paulo, Brazil, ³University Nacional da Colombia, São Paulo, Colombia

Aim: To describe the microbial load of wounds without a diagnosis of infection that used antiseptics in treatment.

Method: A cross-sectional study evaluated 101 adult patients without wound infection diagnosis in a private large hospital, 54 of which were followed-up seven days after baseline assessment. To identify high microbial load, the fluorescence camera was used, which detects bacterial when the concentration is >10⁴ CFU/g. Results showing red and cyan light were considered “positive” for high microbial load. The Brazilian version of the Wounds At Risk Score was applied to identify the risk of infection. Information about treatment, signs, and symptoms of infection was collected. The data were collected after the approval of the research ethics committee.

Results / Discussion: Microbial load showed that 58% (59) were negative and 42% (42) were positive for high load. Among the 54 re-evaluated patients, 19 (35.1%) were using antiseptic solution. The use of antiseptic was significantly positive in the camera (p<0.001). Among patients using antiseptic, 78% (15) had positive results in the fluorescence re-evaluation (OR 17.918; p=0.013). Five (26.3%) patients using antiseptic were classified as “low risk for infection” by the Wounds at Risk Score.

Conclusion: The results highlight the need to discuss microbial resistance to antiseptics and the importance of healthcare professionals’ knowledge regarding appropriate indications for treating biofilm and infection, considering hygiene, debridement, and topical antimicrobial therapy.

 

 

LEG ULCER

OP050 A randomised trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy neuropathic foot

Indra Bahadur Napit¹, Dilip Shrestha², Sopna Choudhury³, Eleni Gkini³, Onaedo Ilozumba³, Paramjit Gill⁴, Jon Bishop³, Karuna Neupane², Anju Adhikari², Jo Sartori³, Samuel Watson³, Richard Lilford^3
1The Leprosy Mission Nepal, University of Birmingham, University of Warwick, Lalitpur, Nepal, ²The Leprosy Mission Nepal, Lalitpur, Nepal, ³University of Birmingham, Birmingham, United Kingdom, ⁴University of Warwick, Coventry, United Kingdom

Aim: Autologous blood products, Leukocyte and Platelets Rich Fibrin (L-PRF) have been used for treatment of leg ulcers. However, the effectiveness of autologous blood products on wound healing is not well established. The aim of this study was to evaluate the efficacy of L-PRF dressings compared to normal saline dressings on healing rates for leprosy foot ulcers.

Method: We evaluated the autologous blood product- Leukocyte and Platelet-Rich Fibrin (L-PRF) on patients with neuropathic leprosy foot ulcers. We conducted a 1:1 (n=130) individually randomised trial of L-PRF (intervention) vs. normal saline dressing (control) to compare rate of healing and time to complete healing. Rate of healing was estimated using blind assessments of ulcer areas based on three different measurement methods. Time to complete healing was measured by the local unblinded clinicians and by blind assessment of ulcer images.

Results / Discussion: The point estimates for both outcomes were favourable to L-PRF but the effect sizes were small. Unadjusted mean differences (intervention vs control) in mean daily healing rates (cm²) were respectively 0.012 (95% confidence interval 0.001 to 0.023, p=0.027); 0.016 (0.004 to 0.027, p=0.008) and 0.005 (-0.005 to 0.016, p=0.313) across the three measurement methods. Time to complete healing at 42 days yielded Hazard Ratios (unadjusted) of 1.3 (0.8 to 2.1, p=0.300) assessed by unblinded local clinicians and 1.2 (0.7 to 2.0, p=0.462) on blind assessment.

Conclusion: While our findings are compatible with small benefit for L-PRF, it warrants the need of a larger clinical trial to confirm/exclude benefits within the confidence limits described here.

 

OP042 the outcomes of hbot in peripheral arterial disease and the assessment of predictive factors of hbot success

Kübra Özgök Kangal¹, Kübra Canarslan Demir^2
1University of Health Sciences, Gülhane Faculty of Medicine, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey, ²University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey

Aim: The outcomes of hyperbaric oxygen therapy (HBOT) in arterial leg ulcers are not very well documented in the literature. This study focused on the short-term HBOT outcomes of chronic wound patients with peripheral arterial disease (PAD) component and evaluated the prognostic parameters.

Method: We retrospectively reviewed the medical records of patients underwent HBOT due to non-healing wounds with PAD component in the Department of Underwater and Hyperbaric Medicine.

Results / Discussion: Forty-five PAD patients were included. Eighteen patients (36.4%) underwent invasive vascular procedures for PAD, and 12 of them (75%) were successfully revascularized. The median number of HBOT sessions was 30 (8-60). The treatment outcomes of 77.8% of patients (n=35) were defined as “recovery”, and 22.2% of patients (n=10) had “no recovery”. Three (6.7%) major amputations, two minor (4.4%) amputations, and one (2.2%) graft surgery were performed. With univariate analyses, age, wound duration, WBC count, CRP, and sedimentation rate were identified as the possible prognostic factors. According to multivariate analyses, a 1 (× 10⁹/L) unit increase in WBC count increases the risk of treatment failure 1.600 times.

Conclusion: The major amputation rate was similar with existing literature. It is quite striking that the success of HBOT in the DM group, which is an independent risk factor of major amputation, is similar to that of other arterial ulcers. This study demonstrated that WBC count at admission can significantly predict the treatment failure, underlying the importance of infection and inflammation control for better HBOT outcomes.

 

EP0332 Improved patient outcomes for patient with leg ulcers in primary care

Polly Cox¹, Sue Dunning², Elizabeth Merlin-Kwan^3
1Urgo Medical Limited, Loughborough, United Kingdom, ²National Health Service, Dudley, United Kingdom, ³Urgo Medical, Loughborough, United Kingdom

Aim: Within general practice only simple wound care is part of a practice nurses care provision with all complicated wounds, i.e. leg ulcers, being referred on.

The National Wound Care Strategy published recommendations for immediate and necessary care resulting in a Trust updating their leg ulcer pathway, to include initiation of treatment by practice nurses.

Method: The pathway was restructured to include initiation of up to 20mmHg of compression for immediate and necessary care for patients presenting with leg ulceration. This new pathway identified in the absence of red flags practice nurses would now be able to apply compression hosiery or liners ≤20mmHg for the treatment of venous disease.

Although practice nurses continued to refer all leg ulcer patients to the leg ulcer service (LUS), patients were now able to receive appropriate timely treatment from presentation whilst on the waiting list for specialist assessment.

Results / Discussion: Data captured for 50 patients who presented with leg ulceration from a single GP practice included: referral date to the LUS, wound description, pathway followed and date of vascular assessment.

Thirty-eight patients were commenced on the pathway, leading to 53% healing without further specialist intervention.

Case studies demonstrate that implementing evidence-based care for a venous leg ulcer on first presentation can achieve timely full healing, even where multiple co-morbidities exist.

Conclusion: Fifty percent of patients healed following introduction of the updated pathway, leading to improved patient outcomes, plus the potential to positively impact the overall patient caseload and reduce the financial burden.

 

OP043 Optimising compression therapy for inpatients with venous ulcers. The ‘octopus’ interview study findings - semi-structured interviews with hospital clinicians

Yaping Lian^1
1University of Leicester, Leicester, United Kingdom

Background: Venous leg ulcers (VLUs) affect over 270,000 people in the UK costing the NHS around £2 billion annually. VLUs last for many years and can be painful and distressing to patients and more common in people over 65 years old. VLUs need compression therapy treatment, however, this is often not provided in the UK hospitals.

Aim: This research aims to understand barriers and enablers of hospital clinicians providing or not providing compression therapy in NHS hospitals.

Method: Semi-structured interviews were conducted with hospital clinicians (Tissue Viability Nurses, Vascular Nurse Specialists, Vascular Consultants and other clinicians) working in NHS hospitals in the UK. Interviews were inductively analysed using thematic analysis, which will then be mapped with Theoretical Domains Framework to develop theory-informed intervention.

Results / Discussion: 14 interviews completed and preliminarily analysed, which identified a wide range of factors influencing compression therapy care provision in hospitals. This includes lack of leg ulcer education and skill development for ward nurses and some specialist nurses. The Environmental context and resources such as finance resource, workforce, operational and organizational challenges also impact hospitals provide compression therapy. Crucially, the interview data demonstrated wide variations in the level of compression therapy service provision in NHS hospitals across the UK.

Conclusion: All these results are preliminary if compression therapy is implemented by hospital clinicians in NHS hospitals. Any designed interventions need to go beyond the traditional training and skills development.

 

OP044 Analysis of the bacterial microflora of venous leg ulcers –  cross-sectional study of 754 patients

Paulina Mościcka¹, Justyna Cwajda², Arkadiusz Jawien³, Maria Teresa Szewczyk^1
1Department of Perioperative Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland, Outpatient Department for Chronic Wound Management, A. Jurasz University Hospital No.1, Bydgoszcz, Poland, Bydgoszcz, Poland, ²Department of Perioperative Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland, Bydgoszcz, Poland, ³Department of Vascular Surgery and Angiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland, Bydgoszcz, Poland

Aim: The aim of the study was to analyze the microbiological status of venous ulcers and to identify clinico-demographic predictors of positive ulcer cultures, especially ulcers colonized by alarm pathogens.

Method: The study included 754 patients with chronic venous leg ulcers. Material for microbiological analysis was collected by swabs only from patients who did not receive any antibiotic treatment.

Results / Discussion: A total of 636 (84.3%) patients presented with culture-positive ulcers. Alarm pathogens, mainly Pseudomonas aeruginosa, were detected in 28.6% of positive cultures. Long ulcer duration >12 months and age >65 years were identified as predictors of positive cultures and colonization with alarm pathogens

Conclusion: Special attention should be paid to individuals with large ulcers for the presence of colonization/infection.

 

OP045 PARACELSUS score performance for the diagnosis of pyoderma gangrenosum: An international multicenter study with 1,403 cases with 85 different wound entities

Maurice Moelleken¹, Alex G. Ortega-Loayza², Joachim Dissemond, MD^1
1University of Essen, Essen, Germany, ²Oregon Health & Science University, Portland, United States

Aim: The PARACELSUS score is the most sensitive instrument to diagnose pyoderma gangrenosum (PG). A score of ≥ 10 indicates that a PG diagnosis is highly likely; however, it has been discussed that performance was compromised by low specificity. Therefore, we aim to evaluate the performance of this score in wounds of different etiologies.

Method: Experts from 14 different institutions from 7 countries and 3 continents retrospectively applied the PARACELSUS score to a wide range of wounds. A statistical analysis included descriptive and diagnostic accuracy statistics.

Results / Discussion: We included data from 1,403 cases with 85 different wound entities; 180 cases were a definitely confirmed cohort with PG diagnosis. We compared the diagnostic accuracy of the PARACELSUS score using different cut-offs with the current standard. Here, the diagnosis of PG with a score > 10 points (rather than ≥ 10) showed the best performance with a significant improvement in specificity (93.2% vs. 96.8%), positive predictive value (68.4% vs. 81.9%), accuracy (94.1% vs. 97.0%) and positive likelihood ratio (14.7 vs. 30.7) and a reduction in the false positive rate (6.8% vs. 3.2%) with only a slight reduction in sensitivity (100% vs. 98.3%) and the negative predictive value (100% vs. 99.7%).

Conclusion: The PARACELSUS score has now been validated worldwide against a large number of different wound entities and is confirming to be a reliable tool for the diagnosis of PG. With the cut-off change from ≥ 10 to > 10 points to diagnose PG, the PARACELSUS score optimizes its performance.

 

OP046 Comparative effectiveness of ovine forestomach matrix* and collagen/oxidized regenerated cellulose^ in the management of venous leg ulcers: A large retrospective real-world evidence analysis

Abigail Chaffin¹, Gregory Bohn², Mark Melin³, Rebecca Aburn⁴, Patrick Hunt^5
1Tulane University, New Orleans, United States, ²Rural Physicians Group, Onekama, United States, ³Mayo Clinic, Rochester, MN, United States, ⁴New Zealand Wound Care Society, Dunedin, New Zealand, ⁵Aroa Biosurgery, Auckland, New Zealand

Aim: The purpose of this retrospective, pragmatic real-world evidence (RWE) study was to compare the healing outcomes of venous leg ulcers (VLU) treated with ovine forestomach matrix (OFM) or collagen/oxidized regenerated cellulose (collagen/ORC).

Method: Cohorts consisted of VLUs treated with OFM or collagen/ORC. Data was extracted from a wound database from 2014 to 2020, representing 449 wound care centers across the United States. A total of 31,883 wounds were identified and filtered based on the inclusion and exclusion criteria. The median time to wound closure and the percentage of wounds closed at various timepoints were estimated using Kaplan-Meier survival analysis. The percentage of VLUs closed were statistically compared between treatment groups using Greenwood’s standard error estimates.

Results / Discussion: A sub-analysis was performed comparing 470 wounds treated with OFM and 360 wounds treated with collagen/ORC. OFM demonstrated a significantly faster median time to closure (P = 0.045).. The incidence of closure at 12-, 24- and 36-weeks was increased  in OFM-treated VLUs relative to the collagen/ORC cohort. Using Cox proportional hazard analysis, there was 40% increase in healing probability in the most difficult to treat wounds with OFM versus collagen/ORC.

Conclusion: The results of this large RWE study support the clinical efficacy of OFM in the treatment of challenging VLU. Further, real-world data studies should be considered an impactful study design in wound healing as they can more accurately reflect the typical patient population suffering from complex wounds compared to randomized controlled trials.

 

OP047 Effectiveness of combining a multi-component low-compression therapy with a TLC-NOSF matrix

Rodrigo Rial¹, Pilar Ruiz Alvarez², Luis Sanchez Hervás², Guillermo Moñux Ducajú¹, Jose Miguel Gallego^3
1Hospitales Universitarios HM Madrid y HM Torrelodones, Madrid, Spain, ²University Hospital Clínico San Carlos, Madrid, Spain, ³Laboratios URGO, Barcelona, Spain

Aim: To evaluate the effectiveness and safety of a combined therapy using a TLC-NOSF dressing combined with a multi-component low-compression system (20 mmHg) for the healing of venous and mixed (venous and arterial) leg ulcers.

Methods: Multicenter observational study. Vascular Surgery Departments with Wound Care Units (University Hospitals HM Madrid, HM Torrelodones and Clinico San Carlos).  It included 40 patients, both inpatients and outpatients, with venous (23) or mixed (17) leg ulcers and an ankle-brachial pressure index (ABPI) > 0.6. Patients with ulcer areas between 2 and 25 cm² and an ankle circumference between 18-25 and 25-32 cm were included. The follow-up period extended until wound closure or up to 12 weeks.

Results/Discussion: During the 12-week follow-up period, all ulcers (both venous and mixed) showed positive healing progress, with 68 % of them achieving full closure within the specified period. In all cases, wound area reduction exceeded 76% in the same period. After the first week of treatment, 80% compliance was achieved with weekly treatments. No treatment-related complications were observed.

Conclusion: The combined treatment using TLC-NOSF and a multi-component low-compression system, which incorporates both elastic and inelastic elements, is an effective and safe option to promote healing in venous and mixed leg ulcers. While low compression is recommended for mixed ulcers, its use for venous ulcers (ABPI > 0.8) also appears beneficial, especially for patients who cannot tolerate high compression or lack clear diagnostic methods to rule out an arterial component.

 

OP048 Survival of patients treated for lower limb ulcer due to critical ischemia

Arkadiusz Krakowiecki¹, Łukasz` Drelicharz², Paweł Maga², Marcin Malka³, Maria Krajczynska³, Elżbieta Sobol^3
1Podos, Warsaw, Poland, ²Clinical Department of Angiology and Internal Diseases, University Hospital in Krakow, Krakow, Poland, ³Podos, Narbutta 46/48, Warsaw, Poland

Method: Between 2021 and 2024, 2,883 patients with hard-to-heal wounds were treated at the Podos Clinic. Among them, 374 (M 225; F 149) were qualified for revascularization, resulting in a total of 499 procedures. The average age of the patients was 72.9 ± 10.7 years (M 71.1 ± 7.8; F 75.5 ± 10.6).

High amputations were ultimately performed on 9 patients: 3 were disqualified due to extensive soft tissue damage, and 6 following unsuccessful revascularizations. 62 patients required repeat procedures due to re-occlusion (13) or expansion of the procedure due to insufficient outcomes from the initial surgery (49). 17 patients required 3 or more procedures on the same leg, and 34 underwent procedures on both legs.

Results / Discussion: Three years after revascularization, 50 of the 111 patients (45%) had died. In the group of 62 patients whose wounds had healed, 22 (36%) passed away. In the group of 49 patients without healed during treatment at the Clinic, 28 (57%) died.

Two years after revascularization, 21 of the 81 patients (26%) had died. In the group of 51 patients with healed wounds, 6 (12%) passed away. In the group of 30 patients without healed, 15 (50%) died.
One year after revascularization, 24 of the 109 patients (24%) had died. In the group of 55 patients with healed wounds, 3 (1%) passed away. In the group of 54 patients without healed, 21 (39%) died.
Conclusion: Ulcers resulting from critical ischemia carry a high risk of death within three years.
Unhealed ulcers are associated with a significantly higher risk of mortality, regardless of the time elapsed since the procedure.
A further, detailed analysis should be conducted.

 

OP049 A placebo-controlled, double-blind study of mesoglycan in the treatment of chronic venous ulcers

Carlo Rivellini¹, Ordonez Esther^1
1Geneal Surgery Unit of Mondovì Hospital, Cuneo, Italy

Aim: To assess the effect of treatment with mesoglycan, a sulphated polysaccharide compound, on the healing of venous ulcers. Design randomised, placebo-controlled, double-blind, monocentre study.
Methods: non-diabetic outpatients with chronic venous insufficiency confirmed by duplex ultrasound, normal ankle/arm pressure index and presence of a leg ulcer were eligible. Patients were randomised to mesoglycan, 100 mg/day orally for 12 weeks followed or until healing, or matching placebo, as an adjunct to compression therapy and topical wound care. Treatment and observation were continued until complete ulcer healing or for 24±1 weeks. Time to ulcer healing and healing rates were estimated with the Kaplan–Meier method.

Results: One hundred and forty patients were randomised and included in the analysis (70 mesoglycan, 70 placebo). Median ulcer area upon inclusion was 3.9 cm² in the mesoglycan group and 3.5 cm² in the placebo group. The estimated time to heal 75% of the patients was 94 days on mesoglycan versus 136 days on placebo, while the cumulative rate of healing by the end of observation was 97% versus 82%, respectively. The difference in favour of mesoglycan was statistically significant (p<0.05, centre-stratified Cox’s model). The relative risk of ulcer healing with mesoglycan was 1.48. The rate of adverse events was 7/92 on mesoglycan and 6/91 on placebo.

Conclusions: Treatment with mesoglycan in addition to established venous ulcer therapy resulted in a significantly faster and more frequent ulcer healing, and did not raise any safety concerns.

 

 

NEGATIVE PRESSURE WOUND THERAPY

OP093 Negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention: The SWHSI 2 trial results

Catherine Arundel¹, Ian Chetter^{2 3 4}, SWHSI-2 Trial Investigators^5
1University of York, York, United Kingdom, ²Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, ³Hull York Medical School, Hull, United Kingdom, ⁴University of Hull, Hull, United Kingdom, ⁵United Kingdom

Aim: The SWHSI-2 trial evaluated the effectiveness of Negative Pressure Wound Therapy (NPWT) compared with usual care (no NPWT) for improving time to SWHSI healing.

Method: A pragmatic, two arm, parallel group, unblinded randomised controlled superiority trial. The study planned to randomise 696 UK patients (1:1) with a SWHSI to receive NPWT or usual care (no NPWT).

The primary outcome was time to wound healing (days since randomisation). Secondary outcomes included wound infection, additional treatments, death, wound pain, health-related quality of life (HRQoL) and resource use.

Results / Discussion: In total, 686 participants were randomised and analysed (NPWT n=349; usual care n=337). Most SWHSI were foot or leg wounds (n=620, 90.4%) and followed vascular surgery (n=619, 90·2%).

There was no clear evidence that NPWT reduced the time to wound healing compared to usual care (HR 1·08, 95%CI 0·88 to 1·32, p=0.47).

There were no statistically significant differences between NPWT and usual care in the odds of wound infection, antibiotic use, readmission, reoperation, amputation or death.

There were no statistically significant differences in HRQoL or wound pain scores at any time point. Serious adverse events were rare (9 NPWT; 4 usual care).

Average treatment costs were higher for NPWT (£18,554; 95%CI: £14,804 to £21,971) than for usual care (£13,702; 95%CI: £12,349 to £15,101). At NICE thresholds of £20,000 and £30,0000 / QALY gained, the probability of NPWT being cost-effective was 25.3% and 26.4% respectively.

Conclusion: The use of NPWT in the management of SWHSI in this patient population cannot be supported based on clinical and cost-effectiveness analysis.

 

OP094 Negative pressure wound therapy in military trauma

Vasyl Savchyn¹, Andrii Vilenskyi¹, Yarema Vares¹, Stepan Kuchabskyi^1
1Medical Center of the Charitable organization “Charitable Fund “Superhumans”, Lviv, Ukraine

Aim: This study aimed to evaluate the effectiveness of Negative Pressure Wound Therapy (NPWT) in managing complex injuries sustained in the war, including gunshot wounds, shrapnel wounds, explosive trauma, non-firearm combined trauma, and wounds with secondary fragments. Both military personnel and civilians have suffered increasingly severe, multi-faceted injuries involving multiple anatomical areas due to high-caliber weapons, rockets, mortars, and precision-guided munition. Rapid closure of tissue defects is essential to prevent complications and restore function as fully as possible; however, the decisive factor remains the readiness of the wound for closure.

Method: The treatment outcomes of 96 patients with combat-related soft tissue injuries were analyzed. NPWT was applied over a 2-10 day period, with dressings changed every 1 to 3 days. Key evaluation criteria included the duration of bacterial clearance, the condition of granulation tissue, and wound readiness for plastic closure.

Results / Discussion: NPWT significantly improved wound healing, accelerating bacterial clearance and granulation tissue formation, enabling plastic wound closure 1.5 to 2 times faster than traditional methods. Given the complex nature of combat injuries with extensive soft tissue damage and bacterial contamination, NPWT effectively prepared wounds for reconstruction, facilitating both functional and aesthetic recovery.

Conclusion: NPWT has been shown to be an effective treatment modality for gunshot-related soft tissue injuries, reducing the necessity for reoperations by 2.5 times and significantly improving the speed and quality of wound closure. This approach offers a promising solution for managing complex combat injuries and enhancing recovery outcomes in military surgical settings.

 

 

NUTRITION

OP112 Knowledge, attitudes, and practices of healthcare professionals in nutritional management of patients with pressure ulcers: An online survey in Flanders and The Netherlands

Flore De Vylder^{1 2}, Inge Tency^{1 3}, Dimitri Beeckman^{4 5}, Tim Torsy^{1 4
1}Department of Nursing and Midwifery, Odisee University of Applied Sciences, Sint-Niklaas, Belgium, ²Research Group Physical Activity & Health, Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, ³University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, ⁴Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, ⁵Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Aim: To investigate knowledge, attitudes, and practices of Flemish and Dutch healthcare professionals regarding nutritional management in the treatment of patients with pressure ulcers (PUs) in hospitals, nursing homes, and home care; and to identify barriers to implementing nutritional interventions for patients with PUs across these settings.

Method: Online survey in a convenience sample of 284 healthcare professionals (medical doctors, nurses, healthcare or nursing assistants, dietitians, speech therapists, occupational therapists, management) working in hospitals, nursing homes and home care in Flanders and the Netherlands. Data were analyzed using descriptive statistics and ordinal logistic regression.

Results / Discussion: Participants (94.0%, n = 267) acknowledged the importance of nutritional interventions in PU management, with dietitians reporting higher self-perceived knowledge than nurses (p < 0.01). Overall knowledge about the role of glutamine and arginine supplementation was low, with 64.7% (n = 184) reporting insufficient knowledge and comprehension. Key barriers for nutritional management of patients with PUs were the lack of conclusive nutritional guidelines (63.3%, n = 180), inadequate knowledge of effective nutritional interventions (70.4%, n = 200), and nutritional supplementation cost (80.3%, n = 228).

Conclusion: Although healthcare professionals in this study acknowledge the importance of nutrition in PU management, nutritional guidelines are inconclusive and lack clarity to support clinicians, especially non-dieticians. Quality improvement projects should focus on translating nutrition guidelines into scalable initiatives (e.g., decision support tools) to improve care. Moreover, policies are needed to support the adoption and use of nutritional interventions, including the provision of adequate resources and expertise.

 

 

PAIN

OP113 Evaluation of reported comfort and pain during wound cleaning with heated saline solution: a crossover clinical trial

Helio Galdino Junior¹, Suelen Malaquias¹, Emilson Oliveira Segundo¹, Vanessa Neres Lima^1
1Nursing School of Federal University of Goiás, Goiânia, Brazil

Aim: To evaluate the use of heated saline solution during wound cleaning on the intensity of pain related to the procedure and the comfort of patients with chronic wounds. Further, to investigate patient preference in relation to the temperature of the solution used for cleaning.

Method: Crossover, single-blind, clinical trial with 32 people with chronic wounds. Providers cleaned the wounds with room temperature (27.1 ± 1.1 °C) and heated saline solution n (39.8 ± 0.6 °C). Participants were randomized into group 1 A/B (heated solution first, room temperature second) or group 2 B/A (room temperature solution first, heated solution second), with a 10-minute washout period. Investigators evaluated pain intensity, obtained via a numeric rating scale ranging from 0 (no pain) to 10 (the most intense pain).  instrument was applied before dressing change (pain before the experiment), after the first cleaning (pain after the first intervention), and after the second cleaning (pain after the second intervention/after the procedure), and patient-reported comfort and preference.

Results / Discussion: 65.6 % preferred the heated solution (P = .04) and was more often referred to as comfortable 46.6 %. (P = .04) by the participants. There was no difference in pain intensity before and after cleaning with room temperature (2.03; P = .155) and heated saline (2.25; P = .44).

Conclusion: Although heating saline solution could be an important comfort measure during dressing changes, quantitatively, the temperature of the solution did not significantly change the intensity of pain patients experienced.

 

OP114 Painful diabetic neuropathy (PDN) as a social illness - an empirical study

Paul Chadwick^1
1Birmingham City University, Birmingham, United Kingdom

Aim: This study explores the experience of painful diabetic neuropathy (PDN). Although PDN has a prevalence of a third of the general diabetes population it is often an ill-considered problem. It has a poor level of recognition from clinicians and from the general population. While the effects of PDN are very common there is little research which explores PDN from the sufferer’s perspective. This study uses sociological perspectives to understand how people make sense of the condition.

Method: Twenty-eight people who were referred to a specialist clinic with suspected PDN were interviewed and their illness narratives collected. In addition, the sample completed the Neuropathic Pain Scale. This was undertaken pre-consultation and two to four weeks post-consultation. The data was thematically analysed using a modified grounded theory approach.

Results / Discussion: This study shows that PDN creates uncertainty, disturbs and disrupts a person’s expected life trajectory, causing a person to review who and what they are, their selfhood. It creates tension in families as people struggle to tolerate new medical regimens. The medical consultation provides a diagnosis but does little to help their understanding.

Conclusion: There is a failure of medical services and society to recognise PDN. This compounds the adverse feelings created. The use of a patient centred consultation style and an increase in the availability of health education materials are crucial to rectify these feelings and ensure that greater attention is given to PDN in medical circles and beyond.

 

 

PRESSURE ULCER

EP0395 Incidence and risk factors of pressure injuries in the ICU: A prospective analysis using advanced imaging techniques

Gisele Chicone¹, Tânia Manuel², Viviane Carvalho¹, Paulo Alves², Vera Lucia Conceição Gouveia Santos^3
1Guarulhos University, Guarulhos, Brazil, ²Universidade Católica Portuguesa, Porto, Portugal, ³São Paulo University, São Paulo, Brazil

Aim: To evaluate the incidence, related risk factors and the time interval required for the development of Pressure injury (PI) in the sacral and heels regions of adult patients hospitalized in the ICU.

Method: This is a prospective cohort study, approved by the Research Ethics Committee. Adult patients with a Braden score ≤16 and age ≥18 years were included, totaling 91 participants. Previous PI, skin diseases, palliative care, pregnant women; total immobilization or with a prescription for prone positioning were excluded. Thermographic photographs and the measurement of subepidermal moisture (SEM) were taken on the bone prominences of the sacrum and heels, using a C5 FLIR® infrared camera and PROVIZIO® SEM SCANNER. Quantitative data was analyzed using descriptive statistics. The Cox logistic regression model was used for the longitudinal variables.

Results / Discussion: The incidence of PI was 9.89%, with an average of six days for its development. The sacral region was the most affected (77.78%), with 55.52% in stage 2. Diabetes mellitus, systemic arterial hypertension, glycemia and C-Reactive Protein (CRP) were risk factors. The temperature difference between the central and peripheral regions of the bone prominence was a risk indicator and could predict the development of PI three days before visualization.

Conclusion: Comorbidities and physical biomarkers, such as thermography, were revealed as a PI´s predictor risk three days before the visual appearance of PI. Further studies with more extensive and diverse samples are needed to establish the relationship between SEM and skin temperature, as assessed by thermography, and the early detection of PI. 

 

OP001 Prevention and treatment of pressure injuries in individuals with spinal cord injuries

Knaerke Soegaard^1
1Odense University Hospital, Department of Plastic Surgery, J B Winsløws Vej 4, Odense C, Denmark

Aim: Although guidelines for PI prevention and treatment exist, a gap remains between these recommendations and their implementation in clinical practice. The objective is to develop, validate and implement a Danish clinical practice guideline aimed at enhancing the prevention and treatment of PI in individuals with SCI.
Method: The guideline was developed by adapting existing guidelines into the Danish healthcare context using the ADAPTE method. This process involved extensive stakeholder engagement, including individuals with SCI and multidisciplinary healthcare providers. The guideline´s implementation is supported by the Model for Improvement (Institute for Healthcare Improvement), and focuses on practical application in clinical settings.
Results / Discussion: The finalized Danish clinical practice guideline includes 22 topics and 121 recommendations focused on PI prevention and treatment. Targeted, user-friendly quick guides and educational materials, along with continuous stakeholder involvement, support the guideline´s implementation and ensure its integration into clinical practice.
Conclusion: The development of this Danish clinical practice guideline represents a significant advancement in improving the prevention and treatment of PI in individuals with SCI. Effective implementation, with an emphasis on targeted education, training, and the use of accessible quick guides, is crucial for enhancing knowledge transfer and wound management in clinical settings. Ongoing efforts will focus on the continuous and effective implementation of the guideline in practice.

 

OP002 Sepsis in stage 3-4 pressure injuries- what is the origin?

Holly Kirkland-Kyhn^1
1University of California, Davis, Betty Irene Moore School of Nursing, University of California, Davis, Medical Center, Sacramento, United States

Aim: To determine the prevalence of sepsis due to cutaneous source vs non-cutaneous source in patients with full thickness (stage 3 or 4) PU/I. To facilitate antibiotic stewardship, it is important to identify factors that may be predictive of a primary cutaneous source of sepsis.

Method: A single institution retrospective chart review was conducted. Data was analyzed using simple and multiple hierarchical logistic regression models to estimate the effects of several risk factors for both skin lesions and death.

Results / Discussion: Sepsis cases were overwhelmingly due to non-skin etiology (89.07%) vs skin etiology (10.93%). Interestingly, no growth was commonly seen from blood (84.65%) and urine (43.26%) cultures. Sepsis cases due to non-skin etiology was associated with a 56% increased likelihood of death compared to cases due to skin etiology. Several factors may be predictive of a primary cutaneous source of infection including higher white blood cell count or temperature at time of presentation. Patients with spinal cord injury (SCI) accounted for 169 (39.30%) of the patient encounters.

Conclusion: The prevalence of sepsis in patient with full thickness PU/I was most often due to non-cutaneous source.

 

OP003 Recurrent pressure ulcers and chronic pain: Genomic biomarkers provide a deeper understanding for interactions

Kath Bogie¹, Letitia Graves², E. Chan³, Katie Schwartz⁴, Kristi Henzel⁴, Marinella Galea⁵, Anna Toth^6
1Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, United States, ²Louis Stokes Cleveland VA Medical Center, University of Texas Medical Branch, Cleveland, United States, ³Case Western Reserve University, Cleveland, United States, ⁴Louis Stokes Cleveland VA Medical Center, Cleveland, United States, ⁵James J Peters VA Medical Center, Bronx, United States, ⁶Minneapolis VA Health Care System, Minneapolis, United States

Aim: The study is investigating why some high-risk individuals, particularly those with spinal cord injury (SCI), remain pressure ulcers (PU) free whilst others experience a continuous cycle of recurring PU. Symptoms experienced from a systemic disease process or injury, such as SCI, are also more likely to be multitudinous and co-occurring, such as recurrent PrI and chronic pain. Genomic biomarkers that may facilitate earlier identification of individuals at the highest risk for recurrent PU and intersections with chronic pain are being investigated.
Method: Whole blood samples, demographics and clinical history were collected from a diverse cohort of 163 Veterans with complete or incomplete SCI (AIS A-D). Samples were collected at 6-12 month intervals and RNA isolated from each sample. Quality control for RNA was carried out using the Qubit™ RNA broad range kit and normalized to 50ng/uL prior to sequencing using the NovaSeq 6000 (Illumina) system. Methylation levels were measured using EPICv2 Methylation array (Illumina) and quality control was performed using R/Bioconductor packages minfi and wateRmelon.
Results: Seventyfour differentially methylated sites (DMP) were co-related with recurrent PrI and chronic pain while only a few DMPs were specific to recurrent PrI or chronic pain.
Conclusion: The huge impact of recurrent PU and chronic pain on quality of life remains challenging. 21st century approaches to an age-old problem are providing greater understanding of the role of genomic biomarkers. A multisite repeated measures study is providing further insights into multi-omic risk for secondary health complications following SCI.

 

OP004 Does nurses’ fatigue level affect their self-efficacy in pressure ulcer management?

A multi-center cross-sectional study

Elif Acar¹, Tuba Şengül^1
1Koç University, Istanbul, Turkey

Aim: To investigate the impact of nurses’ occupational fatigue on their self-efficacy in managing pressure injuries (PIs).

Method: A descriptive cross-sectional study surveyed 682 nurses across three institutions between May 15 and July 31, 2023. Fatigue and exhaustion levels were assessed using the Occupational Fatigue Exhaustion Recovery Scale (OFER), and self-efficacy in pressure injury management was evaluated with the Pressure Ulcer Management Self-Efficacy Scale (PUM-SES). Data were analyzed using correlation and multiple linear regression, following the STROBE checklist.

Results / Discussion: Of the 682 nurses, 85.3% were female, with a mean age of 29.99 years and 7.52 years of work experience. Most (70.7%) worked in public hospitals, and 48% worked mixed day-night shifts. On average, nurses managed 1-5 patients per shift. As measured by the OFER, chronic fatigue had a mean score of 67.54, indicating high fatigue levels. The PUM-SES scores averaged 48.39, reflecting low self-efficacy in pressure injury management. Nurses with a stoma and wound care certifications and those who attended relevant training scored significantly higher on the PUM-SES. Additionally, correlations were identified between OFER recovery scores, professional experience, and self-efficacy levels.

Conclusion: This study demonstrates that occupational fatigue, compounded by inadequate sleep and unfavorable work environments, severely undermines nurses’ self-efficacy in managing pressure injuries. However, targeted interventions, such as improving work conditions, promoting better sleep hygiene, and offering specialized training and certification in wound care, can significantly enhance self-efficacy, positively impacting patient outcomes. Additionally, preventing pressure injuries requires a dual focus: considering the patient’s condition and addressing nurse-specific factors like fatigue and professional preparedness. Occupational fatigue, often unseen, can be a hidden challenge in our fight against pressure injuries.

 

OP005 Mid-term recurrence rates and post-operative complications using flap reconstruction for pressure injury

Norihiko Ohura¹, Yuki Morishige², Avelino Fujimoto³, Yuka Nagasaka⁴, Yu Kagaya^5
1Kyorin University School of Medicine, Department of Plastic Surgery, Tokyo, Japan, ²Juntendo University Graduate School of Medicine, Division of Regenerative Therapy, Tokyo, Japan, ³Kyorin University, School of Medicine,, Department of Plastic Surgery,, Tokyo, Japan, ⁴Kyorin University, School of Medicine, Department of Plastic Surgery, Tokyo, Japan, ⁵Kyorin University, School of Medicine, Suginami Hospital, Department of Plastic Surgery, Tokyo, Japan

Aim: Flap reconstruction for pressure injury is a useful treatment that can quickly heal pressure ulcers. However, the healing period is extended if postoperative wound dehiscence or infection occurs. The aim of this study is to retrospectively review consecutive cases of pressure ulcer reconstruction using flap reconstruction performed in our department.

Method: Patients operated on as flap reconstruction cases from 2007 to 2024 were identified through our database. Hospital records were then retrospectively reviewed for perioperative variables such as postoperative complications, time to healing, and recurrence rate after complete healing. If obvious infection was observed, wound bed preparation was performed, followed by NPWT and reconstruction using skin flaps.

Results / Discussion: There were 51 cases, with an average age of 61.7 ± 20.15 years, and 29 cases (56%) were male. The sites of the wound were the sacrum in 30 cases, the ischium in 17 cases, and the greater trochanter in 4 cases. The median time from surgery to healing was 29 ± 31.1 days. Perioperative complications included seroma in 4 cases and wound dehiscence in 2 cases (11.7%). There were 5 complications in the one-stage procedure. The cumulative recurrence rate after healing at 3 years was 7 cases (13.7%) (ischial 4 cases, sacral 3 cases).

Conclusion: In our study at our institution, the results were almost the same as past reports, at 11.7%. Postoperative wound complications were common in first-stage surgery, which suggests the importance of wound bed preparation.

 

OP006 Construction of a risk prediction model for intraoperative acquired pressure ulcers: A retrospective study

Mine Yoshimura¹, Hajime Matsumura², Shunichiro Orihara², Masataka Taguri², Yoshimi Toei¹, Hideaki Fukuda¹, Yui Hatakeyama¹, Sana Hemmi¹, Shion Yokoyama¹, Ai Ohtake^1
1Tokyo Medical University Hospital, tokyo, Japan, ²Tokyo Medical University, Tokyo, Japan

Aim: The prevention of intraoperative acquired pressure ulcers (IAPUs) is one of the most important perioperative complication prevention measures. Laparoscopic surgery has recently become the mainstream surgical technique. Therefore, there is a discrepancy between the existing global IAPU grading scale and the current medical practices. The present study investigated the risk factors and developed an assessment scale for IAPUs.

Method: Medical records related to IAPUs were collected retrospectively and consecutively from the medical records of 4517 patients ≥20 years old who underwent elective surgery under general anesthesia between January and October 2023. Risk factors for IAPUs were selected from the candidate variables, and a disease score was generated using a logistic regression model with or without IAPUs as the outcome.

Results / Discussion: The incidence of IAPUs was 3.7%. The factors contributing to the disease score were the age, sex, body mass index, surgical procedures, positioning, ASA PS classification, and extracorporeal circulation. The area under the curve (95% confidence interval) of this model was 0.874 (0.812-0.937). For surgical procedures, a score was assigned for laparoscopic surgery. Recently, it has been reported that pressure ulcers are caused by not only ischemia but also shear and deformation. These aspects are thought to be significantly associated with the development of IAPUs due to laparoscopic surgery. High scores on this scale may reflect modern medical treatment in predicting the development of IAPUs.

Conclusion: This scale accurately predicts the development of IAPUs preoperatively and may contribute to the provision of appropriate preventive measures.

 

OP073 Nurses’ insights on the braden scale and their vision for artificial intelligence innovations: A mixed methods study

Tuba Şengül¹, Holly Kirkland-Kyhn², Dilek Yilmaz Akyaz³, Tuba Cevizci^3
1Koc University School of Nursing, Istanbul, Turkey, ²UC Davis, Betty Irene School of Nursing, Sacramento, United States, ³Koc University Hospital, Istanbul, Turkey

Aim: This study aimed to investigate nurses’ perspectives on the Braden Scale and explore their readiness for integrating artificial intelligence (AI) technology and the advancements they envision in patient care.

Method: The study included 118 nurses in the quantitative data and 42 nurses in focus groups for qualitative data. Quantitative data were obtained using the MAIRS-MS while qualitative data were analyzed through phenomenological approaches with MAXQDA software. An explanatory sequential mixed design guided the study.

Results / Discussion:  Participants had an average age of 33.38±7.42 years, with 88.1% being women, and an average of 11.66±8.22 years of professional experience. Administering the Braden Scale took approximately 5.02±4.36 minutes. Notably, 55.1% of nurses found the Braden Scale inadequate, and 55.9% indicated a need for a more comprehensive risk assessment tool, an average MAIRS-MS score of 78.48±16.66. Key sub-themes emerged from the data: Simple and Quick Applicability, Early Risk Determination, Non-Specificity, Necleting Other Risk Factors, Making It More Comprehensive and Specific, Development of a New Risk Assessment Scale, Technological Improvements, Patient Data Treasure Chest, Avatar Creation and Converting Speech to Text.

Conclusion: This study underscores significant gaps in the Braden Scale’s clinical effectiveness, as nurses highlighted issues like lack of specificity and overlooked risk factors. Participants advocated for AI-enhanced assessments to improve accuracy in risk prediction and facilitate personalized care plans, reflecting a readiness to embrace AI in clinical settings.

 

OP074 A review of the surgical department’s approach to pressure ulcer treatment over the past decade

Lenka Veverkova¹, Petr Doležal², Jakub Habr¹, Michal Reška³, Petr Vlček³, Jan Žák^3
11st Surgical Dept., Masaryk University and the Saint Anne University Hospital,, Brno, Czech Republic, ²1st Surgical Dept., Masaryk University and the Saint Anne University Hospital, Consulting s.r.o, Brno, Czech Republic, Brno, Czech Republic, ³1st Surgical Dept., Masaryk University and the Saint Anne University Hospital, Consulting s.r.o, Brno, Czech Republic 2, Brno, Czech Republic

Aim: This study evaluates the efficacy of preventive measures aimed at reducing the prevalence of pressure ulcers (PUs), a common complication of hospitalization.

Method: A retrospective analysis was conducted using data from patients who underwent surgical procedures at a hospital, leveraging the hospital information system (HIS) to assess PU prevalence. The analysis was performed at a significance level of 0.05 using T-tests, focusing on variables such as age, number of pressure ulcers, grade and location, principal diagnosis, surgical procedure, and length of hospital stay.

Results / Discussion: The period under observation, 2015-2024. The study examined the incidence of PUs among 26,486 patients. Out of this cohort, 1,731 developed PUs, predominantly on the sacrum (37.6%), heel (33%), and buttocks (17%). The primary diagnosis most frequently associated with PUs was femoral neck fracture (36.7%), followed by oncological diseases (12.03%) and conditions like acute cholecystitis and ileus (10.6%). Notably, the number of patients with PUs has decreased significantly over the years, from 33 and 42 cases in 2015 and 2016, respectively, to only 12 cases in 2023.

Conclusion: Our findings highlight the necessity of a comprehensive assessment of patients with chronic wounds to create individualized care plans that enhance quality of life and recovery prospects. Notably, the implemented preventive measures led to a significant reduction in PU prevalence in the surgical ward, achieving a decrease of nearly one-third. This study underscores the importance of continuous monitoring and proactive interventions in mitigating pressure ulcer risks in hospitalized patients.

 

OP075 Pressure injury reduction in prone-positioned spinal surgery patients: The PRONE QI project

Myong-Shin Kim¹, Nick Santamaria^2
1Yonsei University Gangnam Severance Hospital, Seoul, Rep. of South Korea, ²University of Melbourne, Melbourne, Australia

Aim: To identify key risk factors contributing to pressure injuries (PIs) in patients undergoing long-duration, multi-level spinal surgery in the prone position and to implement a sustainable, effective prevention strategy within a quality improvement (QI) framework.

Method: At a teaching hospital in South Korea, a multidisciplinary team—including nurses, neurosurgeons, and anesthesiologists—conducted a QI project targeting the reduction of intraoperative PIs. Using the PDCA (Plan-Do-Check-Act) framework, the project began with a comprehensive analysis of PI risk factors specific to prone spinal surgeries. Preventive interventions were designed and implemented, including preoperative application of soft silicone, multi-layer foam dressings to high-risk areas (such as the face, chest, and anterior iliac crests), and intraoperative facial repositioning. These measures were further supported by structured postoperative PI surveillance and the development of standardized, protocol-driven approaches.

Results / Discussion: Our findings demonstrated that it was possible to eliminate these intraoperative injuries from a historical rate of 2.5% and to maintain a zero incidence rate through the use of an integrated multidisciplinary, evidence-based intervention that employs sophisticated preoperative risk assessment, prophylactic intraoperative dressings and postoperative PI surveillance

Conclusion: The PRONE Project demonstrates the impact of a multidisciplinary QI approach in reducing PIs in high-risk spinal surgeries. It provides a replicable model for similar settings, highlighting the potential of quality-focused preventive strategies to enhance patient outcomes and set new standards in perioperative care.

 

OP076 An iceberg phenomenon in pressure injuries: Micronutrient deficiencies

Busra Gokce¹, Ebru Caran Karabacak¹, Meltem Koca¹, Ekin Oktay Oguz¹, Suheyla Coteli¹, Pelin Unsal¹, Gözde Şengül Ayçiçek^1
1Ankara Etlik City Hospital, Ankara, Turkey

Aim: The formation of pressure injuries is related to the individual’s nutritional status. This study investigates the effect of micronutrient levels on the development of pressure injuries.

Method: We included 78 patients with pressure injuries and 102 patients without pressure injuries admitted to the geriatrics ward. The Mini Nutritional Assessment (MNA) and NRS-2002 tests were used to assess nutritional status. Serum levels of iron, total iron-binding capacity, ferritin, vitamin B12, folate, and 25-hydroxyvitamin D were measured upon hospital admission.

Results / Discussion: The median age of the patients was 81 (65-99) and 69.6% (n=116) were female. Most pressure injuries were stage 2 (32.1%) and unstageable (17.9%). Patients with pressure injuries were older and had lower Body Mass Index (BMI) values than those without (p=0.001 and p=0.002, respectively). They had lower MNA scores and higher NRS-2002 scores (both p<0.001). Iron, total iron-binding capacity and 25-hydroxyvitamin D levels were lower in patients with pressure injuries (p=0.001, p<0.001 and p=0.023, respectively), while ferritin levels were higher (p<0.001). Vitamin B12 and folate levels were found to be similar in both groups (p=0.170 and p=0.575, respectively)  Multivariate analysis showed that MNA score [β=0.771 95% CI (0.666-0.893), p=0.01] and iron level [β=0.979 95% CI (0.959-0.999), p=0.038] were associated with pressure injuries, independent of all other causes.

Conclusion: Evaluating micronutrient status and offering supplements when necessary is vital for the successful prevention and treatment of pressure injuries.

 

OP077 Healing - Reducing hospital-acquired pressure injuries (HAPI) and enhancing patient care through early detection of pressure injuries

Nitu K S¹, Elizabeth David^1
1Rajagiri Hospital, Kerala, India

Aim: The study aimed to decrease the incidence of HAPI in the operating theatre during prolonged surgeries, as well as in both critical and non-critical areas, by strengthening the process and enhancing nurses’ knowledge and awareness

Objectives:

1. Reduce the Incidence Rate of Pressure injuries below benchmark (0.36 per 1000 IP Days) (ref. MDPI).

2. Implement Pressure Injury management protocol

3. Enhance the knowledge and awareness of nurses regarding Pressure Injury assessment, prevention and management protocol by >90%.

Method: This study employed a quantitative research design and retrospective data analysis. Overall prevalence of pressure injuries (PI) and rates of hospital-acquired pressure injuries (HAPI) were obtained and analyzed using the DMAIC tool. Root cause analysis (RCA) was conducted with Fishbone analysis, and corrective and preventive actions (CAPA) were implemented for improvement.

Preventive methods used

 

Results / Discussion: This QIP resulted in

Conclusion: The study successfully identified key factors contributing to hospital-acquired pressure injuries (HAPI) in high-risk areas, including the operating theatre during prolonged surgeries. The study enhanced understanding of HAPI prevalence and root causes. Implementation of targeted interventions and increased awareness among nursing staff led to a noticeable reduction in HAPI rates, demonstrating the effectiveness of a structured approach in minimizing pressure injuries and improving patient care.

 

OP078 Update on pressure ulcer diagnosis and management: Appraising the utility of wound imaging technology through clinical trial and real-world data

Charles Andersen¹, Katherine Mcleod^1
1Vascular/Endovascular/Limb Preservation Surgery Service, Madigan Army Medical Center, Joint Base Lewis-McCord, TACOMA, United States

Aim: This study explores the possibility of a novel multimodal strategy for the prevention and management of pressure injuries (PIs) by integrating thermal imaging and fluorescence (FL) imaging into the assessment of patients at risk of or who have developed PIs.

Method: Three data sources were utilized in this study. First, a point-of-care FL-imaging device was employed in a prospective longitudinal study involving 25 patients to assess its effectiveness in monitoring and managing pressure injuries (PIs). Second, a post-hoc analysis of clinical trial data from 22 PIs was conducted to compare the device’s bacterial detection sensitivity against standard of care (SOC). Lastly, a small subset of at-risk patients utilized thermal imaging to highlight findings on pressure points.

Results / Discussion: In the prospective study, most patients had a single active PI, primarily located in the ischial (39%) and sacral/coccygeal (45%) areas. Positive FL signals were found in 70% of PIs, leading to modified treatment plans (e.g., more/new debridement, antibiotics, etc.) in 58% of visits. Continuous monitoring showed fluctuating bacterial loads in 30% of cases. Biopsies confirmed all PIs had concerning bacterial loads, but standard assessments only detected 10% as positive; FL imaging increased detection to 64%. None of the PIs developed complications (e.g. Osteomyelitis, sepsis) and all progressed positively without requiring hospitalization. Thermal imaging showed warmer areas indicating early pressure injuries, while lower temperatures correlated with visible tissue damage.

Conclusion: Integrating thermal and fluorescence imaging for pressure injury management enhances prevention and treatment, improving patient outcomes and reducing healthcare burdens and legal risks.

 

 

PREVENTION

OP079 The effects of a 12-week supervised rehabilitation exercise program on patients with peripheral artery disease with or at-risk of lower limb wound: a retrospective cohort study

Jérôme Patry¹, Emma Fontaine², Andrée-Anne Hébert³, Marie-Kristelle Ross⁴, Magali Brousseau-Foley^5
1Laval University, Centre de recherche du CISSS de Chaudière-Appalaches, VITAM - Centre de recherche en santé durable, Québec City, Canada, ²Laval University, Lévis, Canada, ³PREV du CISSS de Chaudière-Appalaches, Lévis, Canada, ⁴Centre de recherche du CISSS de Chaudière-Appalaches, PREV du CISSS de Chaudière-Appalaches, Lévis, Canada, ⁵Université du Québec à Trois-Rivières, Université de Montréal, CIUSSS de la Mauricie et du Centre-du-Québec, Trois-Rivières, Canada

Aim: The aim of this study was to describe a cohort of patients participating to a 12-week supervised exercise program as part of a comprehensive cardiovascular rehabilitation program for patients with peripheral artery disease (PAD) with or at-risk of wound on maximal walking distance, wound healing and cardiovascular outcomes in the year following participation.

Method: A retrospective cohort study was conducted and all adult patients with PAD admitted to the rehabilitation program between January 1^st 2021 to January 1^st 2023 were included.

Results / Discussion: Forty-two patients with PAD were enrolled of which 85.7% had intermittent claudication and 38.1% had severe PAD (toe pressure measurement <30 mmHg). Mean maximal walking distance at the 6-minute walking test was 301.8 meters (median: 300.0; SD: 106.3) at baseline and increased to 408.3 meters (median: 440; SD: 123.8) at the end of the program. All patients with a wound at baseline (n=8) were healed, except for one patient who died before healing. One year following the program, only one patient developed a new wound, four benefited from a percutaneous angioplasty, none required a surgical revascularization, and one had a major lower limb amputation.

Conclusion: A 12-week supervised exercise program appears beneficial to improve walking distance for patients with moderate to severe PAD. It also appears safe for patients with or at-risk of a lower limb wound, providing tailored exercises pre-specified for each patient and adequate supervision. However, prospective studies are required before making clinical recommendations of such a program for the at-risk foot with PAD.

 

EP0283 Satisfaction regarding use and prevention of pressure injuries with a powered reactive air support surface at the pediatric ICU of a 3rd level hospital

Pablo García-Molina¹, Marta Bargos Munárriz², María José Espíldora González³, Evelin Balaguer-López^4
1Unidad Enfermera de Úlceras y Heridas Complejas (pediatría). Hospital Clínico Universitario de Valencia, Departamento Enfermería. Universidad de Valencia, Valencia, Spain, ²Hospital Regional Universitario de Málaga, Málaga, Spain, ³Hospital Regional Universitario de Málaga, Recursos Materiales UCIP, Málaga, Spain, ⁴Hospital Clínico Universitario Valecia, Departamento Enfermería. Universidad de Valencia, Valencia, Spain

Aim: To determine the satisfaction of the healthcare staff of the Paediatric ICU of a university hospital with a powered reactive air support surface (PRASS)*.

Method: Descriptive study with a satisfaction questionnaire for nurses, paediatricians, and nursing assistants in the PICU. An ad hoc questionnaire of 22 questions was conducted using the Limesurvey program. 5 sociodemographic questions, 5 questions about the type of use of the PRASS, 2 questions about ease of assembly, 5 questions about cleaning and storage, and 5 about the effectiveness of the PRASS in reducing Pressure Injuries (PI). There were dichotomous and scoring questions to assess their satisfaction.

Results / Discussion: Two paediatric nurses (one an expert in wounds), 2 paediatricians, and 5 nursing assistants participated. All were women, between 42 and 65 years old, with an average of 14.66 years of experience in the ICUPN. 55.5% had training in PPE. PRASS was used in patients with ECMO, invasive ventilation, vascular access, and even CPR. The satisfaction score was 9 points higher than the mattress placement on another surface. PRASS had been tested by 50 paediatric patients in the PICU, where 2 (4%) had 4 PI. Two were category II and two were deep tissue injuries.

Conclusion: For the health professionals, the PRASS demostrated to be a useful tool to prevent PI, easy to use, clean, and store at the PICU.

*PRO-CARE AUTO PEDIATRIC. Mattress provided by the company Wellell

 

EP0295 Essential strategies for the prevention and management of diabetic foot in primary health care

Ana Paula dos Santos Albuquerque¹, Wanessa Karla Regis da Silva², Vanessa Azevedo³, Blanck Mara⁴, Mariana Santo⁵, José Luis Lázaro-Martínez⁶, Aroa Tardáguila García⁷, Guilherme Mortari Belaver^8
1Universidad Complutense de Madrid, Madrid, Brazil, ²Curamed, Recife-PE, Brazil, ³Urgo Medical, São José dos Campos, Brazil, ⁴Sobenfee, Rio de Janeiro, Brazil, ⁵Urgo Medical, São Paulo, Brazil, ⁶Complutense University, Madrid, Spain, ⁷Complutense University of Madrid, Madrid, Spain, ⁸Secretaria Municipal de Saúde de Florianópolis, Madrid, Spain

Aim: To train Primary Health Care (PHC) professionals in the preventive and therapeutic management of diabetic foot, one of the most serious complications of Diabetes Mellitus (DM), affecting 10.5% of the global adult population and presenting high morbidity rates.
Methods: This technical manual was developed as a conclusion of the Master’s in Diabetic Foot at the Complutense University of Madrid, based on the latest guidelines from the International Working Group on the Diabetic Foot (IWGDF). It covers the definition, epidemiology, and clinical and educational management of foot lesions, featuring evidence-based practices for use in PHC. It includes QR Codes with videos and images to demonstrate all aspects of at-risk foot follow-up according to international guidelines.
Results: The manual emphasizes risk detection, strict glycemic control, and patient education on daily foot care. Highlighted strategies include the use of practical protocols and ongoing training for health teams to reduce the risk of amputations and improve patients’ quality of life. Clinical experience indicates that preventive care can reduce severe foot complications by up to 70%.
Conclusions: This manual is an essential tool for PHC professionals, promoting a multidisciplinary and integrated approach. By prioritizing preventive and educational interventions, the aim is to reduce morbidity and improve health outcomes, transforming patient care and quality of life.

 

EP0292 A collaborative strategy to optimise prevention: Lower limb integrated management for Birmingham & localities of Solihull & Sandwell: STOP LIMB LOSS

Helena Meally¹, Louise Mitchell², Rachel Sam³, Lisa Mallett^4
1University Hospitals Birmingham, Solihull, United Kingdom, ²University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom, ³University Hospitals Birmingham NHS Trust, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom, ⁴Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom

Aim: To provide a platform for key healthcare partners to work in collaboration to address the National Wound Care Strategy Programme (NWCSP) Long Term Plan (2020-2025), as well as identifying inequities, poorly organised care, lack of meaningful data and information to inform quality improvement.

Method: Members include Podiatry, Podiatric Surgery, Vascular Surgery, Specialist and District Nursing, as well as external partners, (Health Innovation West Midlands and Industry) who meet three times a year. The NWCSP guides the structure and focus of the meetings to support a cross-system approach to address local wound care inefficiencies.  Utilising a questionnaire, members were asked to identify priorities and results relevant to their desired patient outcomes.

Results / Discussion: From 18 respondents key themes were identified including: education, shared communication and IT, patient involvement, inclusion of primary care stakeholders and clearer referral and treatment pathways. Since inception in 2021 appropriate referrals have been streamlined across the organisations, a referral form amnesty has been implemented, a funding bid for digital utilisation submitted and a virtual MDT set-up for complex patients who can’t access specialist teams. The group have reviewed and agreed educational resources to address knowledge gaps and collected local data alongside industry partnership working.

Conclusion: Each meeting allows stakeholders to remove barriers and improve interdisciplinary relationships and has delivered improved equitability and efficiencies for all service users across systems involved.  It has also improved clinician interaction and awareness, allowing patients to receive the right care at the right time.

 

 

QUALITY OF LIFE

OP115 The effect of socioeconomic status of patients with chronic wounds on wound follow-up and healing times

Hilal Samur¹, Fevziye Duygu Avlar¹, Hakan Uncu^1
1Ankara University School of Medicine,General Surgery Department, Ankara, Turkey

Aim: This study aimed to explore the impact of socioeconomic status on wound follow-up and healing among chronic wound patients in the wound care center.

Method: This retrospective study included 56 patients with venous, arterial, and diabetic ulcers treated at the Wound Care Center, Ankara University Faculty of Medicine. Parameters such as distance to the clinic, education, and living arrangements (family or alone, urban vs. rural) were evaluated. Patients were grouped based on treatment completion: Group A (n=23) discontinued treatment, while Group B (n=33) completed treatment. The mean age of patients in Group A was 64.6 years (47-69 years).60.8% of patients in Group A were male and 39.2% were female. The mean age of patients in Group B was 61.7 years. (42-80 years) 81.8% of patients in Group B were male and 18.2% were female.

Results / Discussion: Group A had an average education duration of 9.04 years, compared to 12.4 years in Group B. Clinic distance averaged 271.4 km for Group A and 122.26 km for Group B. Living alone was more common in Group A (47.8%) than in Group B (15%). Urban living rates were 60.8% in Group A and 72.7% in Group B.

Conclusion: Patients who discontinued wound follow-up had lower levels of education, greater distance to the clinic, less family support  and higher rates of living far from the city center. These socioeconomic factors significantly affected the continuity of wound care. Sociocultural conditions play an important role in chronic ulcer outcomes. Barriers to access and awareness of specialized care are associated with worse clinical outcomes. Knowledge of patients’ socioeconomic status has an important role in wound care follow-up and treatment management.

 

EP1204 Autocuidados en condiciones desfavorables: Empoderando al paciente

Veronica Sierra¹, Adrian Díaz Bermejo², Nerea Mogeda Marina², Pilar Miranda Arto³, Maria Jose Gil Mosteo³, Laia Sastre Martínez^2
1Instituto Catalan de la Salut, Barcelona, Spain, ²Institut Català de la Salut, Barcelona, Spain, ³Servicio Aragones de Salud, Zaragoza, Spain

Aim: Varón de 30 años, obeso sin más antecedentes. Durante una carrera de Karting sufre una lesión por fricción y presión (LPP) en el muslo derecho.  Valorado en otro centro el mismo día donde pautan curas con hidrofibra de hidrocoloide y antibiótico vía oral. A las 48h se valora en nuestro centro se realiza desbridamiento y se inician curas cada 48h con apósito de membrana polimérica multifuncional (AMPM). Tras dos curas el paciente debe viajar al sur de Marruecos.

Method: Se realiza educación sanitaria para autocuras cada 72 horas y se le suministra el material necesario: AMPM de mayor absorción con y sin plata.  Durante los 20 días de estancia se realizó seguimiento telemático por parte de la enfermera, realizando los cambios de pauta necesarios.

El paciente realizó, en Marruecos, un total de 8 curas autónomas con AMPM con plata.

Results / Discussion: Durante su estancia en Marruecos se objetiva placa de tejido desvitalizado que inicia desbridamiento por los bordes únicamente con la aplicación del AMPM.

A su vuelta realizamos desbridamiento cortante en una sola sesión, se constata UPP grado III, objetivando un lecho de la lesión granulado al 80%.

Dolor controlado, escala de valoración analógica (EVA) de 8 a 3 en dos curas, siendo 0 a la semana.

Conclusion: Destacamos la facilidad para los autocuidados referida por el paciente, el buen control de la carga bacteriana pese a las condiciones higiénico-sanitarias y de temperaturas extremas y el manejo del tejido desvitalizado por el AMPM.

 

 

SURGICAL APPROACHES

OP065 Fibrillar gelatin hemostatic in pediatric posterior fossa tumor resection

Rafael Colodetti¹, Walter Fagundes², João Augusto Moura², Sonia Gouvea^2
1Federal University of Espírito Santo (UFES), Foundation Coordination for the Improvement of Higher Education Personnel (CAPES), Federal Government, Vitória, Brazil, ²Federal University of Espírito Santo (UFES), Vitória, Brazil

Aim: Evaluate the efficacy of a fibrillar gelatin-based hemostatic (FGBH) to bleeding control during tumor resection in children.

Method: This was a prospective longitudinal study. We assessed 26 children aged between 0 and 18 years-old who underwent posterior fossa tumor resection by the same neurosurgeon. The FGBH was used in the operation for hemostasis. The effectiveness of the topical hemostatic to intraoperative bleeding control, capacity of absorption, handling, repositioning, adherence to wound bed and postoperative complications or side-effects was rated.

Results / Discussion: The majority of patients ranged between 2 and 5 years-old (46.1%). The follow-up was from over 1 year. The most prevalent histological type was pilocytic astrocytoma (34.6%). In 69.2% of procedures, intraoperative active bleeding was considered as “light or habitual”. In the majority of patients (80.8%) the hemostasis time was “<30 seconds”. The effectiveness on intraoperative bleeding control was “excellent” with “excellent” absorption capacity in 80.8%. 76.9% showed “excellent” overall handling. 73% showed “excellent” adherence to wound bed. 50% showed “excellent” ease of repositioning. A hemostasis time of “<30 seconds” influenced a higher prevalence of “excellent” evaluation for absorption capacity and adherence to wound bed (p=0.01). There was no need to hematoma drainage. Absence of blood was found in 50% on the control postoperative CT scan. MRI performed up to 60 days demonstrated total biodegradation in all cases. There were no adverse events.

Conclusion: FGBH seems effective and safe to bleeding control during pediatric posterior fossa tumor resection with satisfactory absorption capacity and adherence to the injured tissue.

 

OP066 Comparative analysis of autologous skin cell-suspension technology and split-thickness skin grafting for non-thermal wounds: A propensity-matched cohort study

Lisa Gould¹, Cheryl Acampora^1
1South Shore Health, Weymouth, United States

Aim: Autologous skin cell-suspension (ASCS) has significantly minimized donor site morbidity in burn injury. This retrospective, propensity-matched cohort study compared outcomes of non-thermal wounds treated with ASCS versus traditional split-thickness skin grafts (STSG).

Method: A retrospective cohort study of patients with non-thermal wounds treated with ASCS (treatment) was compared to traditional meshed STSG (control).  Seven patients treated with ASCS were propensity-matched according to age and gender to seven controls. The ASCS were applied as spray only (“ASCS alone”, off-label) or combined with a widely meshed ultrathin STSG (“ASCS+STSG”, 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate and multivariable analyses to assess the impact of treatment on wound healing.

Results / Discussion: A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6±11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9±4.5 vs 99.4±26.7 days). Wounds treated with ASCS alone healed in 80.8±5.1 days, while those treated with ASCS and STSG healed in 68.5±7.6 days.

Conclusion: ASCS were FDA approved for non-thermal wounds in June 2023. This study suggests ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared to traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.

 

 

TRANSLATIONAL SCIENCE

OP030 Single-cell and spatial transcriptomics decodes wharton’s jelly-derived mesenchymal stem cells heterogeneity and a subpopulation with wound repair signatures

Penghong Chen¹, Rongrong Xie¹, Xingong Lin¹, Huiyong Liu¹, Yongbin Li¹, Chaoyang Wang^1
1The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China

Aim: Exploration of WJ-MSC heterogeneity with multimodal single-cell technologies will aid in establishing accurate MSC subtyping and developing screening protocols for dominant functional subpopulations.

Method: (1) Single cell suspensions of P0 and P3 WJ-MSCs from three donors were obtained, and single cell transcriptome sequencing was performed. (2) The dominant subgroups with efficient wound repair function were preliminarily determined and enriched by flow cytometry. The effects of dominant functional subgroups and unsorted WJ-MSCs on the proliferation and migration of wound healing related cells were compared in vitro. The skin wound model of zebrafish was established, 10 μL cells or PBS were injected subcutaneously into the edge of the wound. Wound measurements were performed at 0,5,15 and 30 days after surgery, and wound healing rates were calculated. (3) Spatial transcriptome sequencing was used to map the interregional and intraregional spatial expression maps of Wharton’s Jelly tissue. Single-cell data and spatial transcriptome data were integrated by SPOTlight analysis.

Results / Discussion: Single-cell transcriptomics analysis identifies four WJ-MSC subpopulations, namely proliferative MSCs, niche-supporting MSCs, metabolism-related MSCs and biofunctional-type MSCs. Furthermore, the transcriptome, cellular heterogeneity, and cell-state trajectories of these subpopulations are characterized. Intriguingly, the biofunctional-type MSCs (marked by S100A9, CD29, and CD142) exhibit promising wound repair properties in vitro and in vivo. Finally, by integrating omics data, it has been found that the S100A9⁺CD29⁺CD142⁺ subpopulation is more enriched in the fetal segment of the umbilical cord, suggesting that this subpopulation deriving from the fetal segment may have potential for developing into an ideal therapeutic agent for wound healing.

Conclusion: The presented study comprehensively maps the heterogeneity of WJ-MSCs and provides an essential resource for future development of WJ-MSC-based drugs.

 

OP031 Identification of AKR101 as potential new drug for chronic wound therapy

Barbara Wolff-Winiski¹, Nicole Schöfmann¹, Petra Doerfler¹, Gabriela Cabral¹, Anton Stuetz^1
1Akribes Biomedical GmbH, Vienna, Austria

Aim: Wound exudates (WEs) can transfer the clinical phenotype of healing or non-healing wounds onto primary human dermal fibroblasts in cell culture. In contrast to healing WEs, non-healing WEs impair fibroblast proliferation. We used this assay to screen substance libraries and identify compounds with so far unknown potential for chronic wound therapy.

Method: Compounds were added to human fibroblasts in the presence of exudates from chronic wound patients and incubated for 72 hours (2D cultures) or 4 – 8 days (3D cultures). IL-1ß was determined in supernatants and RNA was extracted for RT-PCR. Cell proliferation was determined after fixation and staining.

Results / Discussion: Adding the investigational compound AKR101 to fibroblast cultures that were incubated with WEs from individual chronic wound patients rescued cell growth in 2D culture (EC₅₀ at low nanomolar concentrations) and enhanced fibroblast-derived matrix formation in 3D culture, accompanied by mRNA expression of collagen 1 and collagen 3. Moreover, AKR101 dose-dependently inhibited the production of the inflammatory cytokine IL-1ß. The compound rescued fibroblast proliferation with ~90% of the 101 non-healing WEs tested, indicating transition from a chronic/non-healing to a healing phenotype ex vivo. These rescue effects were independent of wound etiology and superior to the wound therapeutics, platelet-derived growth factor and silver sulfadiazine (rescue effects 4% and 34%, respectively).

Conclusion: Compound AKR101 was identified as a promising candidate to reverse the inhibitory and damaging effect of exudates from a multitude of chronic wound patients. It is currently being developed for a clinical proof-of-concept study in chronic wound patients.

 

OP032 Modelling the absorption and evaporation of wound care dressings in a novel clinically relevant wound model

Daniel Waddington¹, Adam Keech¹, Euan Motion^1
1Smith + Nephew, Hull, United Kingdom

Aim: Investigating a novel in vitro wound model to measure absorption and evaporation of a simulated wound fluid (SWF) with a range of different wound care dressings over their wear time, that incorporates clinically relevant features to determine their mechanism of managing fluid.

Method: Five wound dressings, hydrocellular foam dressings (HFPD) with and without superabsorber and hydrocolloid, (dressings A-E) were evaluated.

SWF was pumped into the dressings over 7 days at a clinically relevant rate and performed using an interface at 32 ^oC to simulate wound temperature.

Balances were placed under the SWF source and the dressing. The change of masses was used to calculate absorbency, sampled every 5 minutes. The change in mass of the SWF source provides the quantity of fluid delivered, this compared to the change in mass of the dressing allows the calculation of the volume of fluid absorbed in the dressing and the volume evaporated.

Results / Discussion: Dressings A, B, C and D’s primary mechanism was evaporation within 48 hours. Evaporating 87.5%, 87.4%, 81.5% and 92.1% respectively by 7 days.

Dressing E’s primary mechanism was absorption, leaking after 72 hours. Absorbing 29.7% and evaporating 26.9%.

Conclusion: The model successfully elucidated how the different wound dressings manage fluid. The primary mechanism for HPFD’s is evaporation while the hydrocolloid dressing’s is via absorption. The point of change of mechanism from absorption to evaporation and the ratio of HPFD’s varied. Improved understanding of dressing function using this model may better inform the choice of dressing for managing wound exudate.

 

OP034 Exploring the relationship between cellular senescence and oxidative stress in wound exudate of pressure injuries: A preliminary study

Chihiro Takizawa^{1 2}, Qi Qin¹, Sanai Tomida¹, Gojiro Nakagami^{1 3}

¹Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, ²Japan Society for the Promotion of Science, Tokyo, Japan, ³Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Aim: Cellular senescence in the wound exudate of pressure injuries is associated with delayed wound healing, though the mechanisms driving this senescence remain unclear (Takizawa et al., 2024). We supposed that oxidative stress may contribute to cellular senescence in the wound exudate of pressure injuries because high oxidative stress can be related to hard-to-heal wounds. As a first step in exploring this relationship, we aimed to identify patterns in oxidative stress gene expression between samples with high and low cellular senescence levels.

Method: Two wound exudate samples with high and low CDKN1A gene expression, taken on different dates from a single patient’s pressure injury at a university hospital’s pressure injury round, were selected from samples previously analyzed in our study (Takizawa et al., 2024). We performed an oxidative stress array to compare expression levels of 84 oxidative stress-related genes and identify genes with the large expression differences.

Results / Discussion: Among 84 genes, 78 genes showed higher expression in the high cellular senescence sample than in the low cellular senescence sample, with a median relative expression of 10.88 (6.98–15.65) times that of the latter. Especially, NOX5, CYGB, STK25, GCLM, and TTN genes exhibited high relative expression.

Conclusion: These expression patterns suggest that a high cellular senescence state may be associated with increased oxidative stress in the wound exudate of pressure injuries. The oxidative stress-related genes with the high relative expression could serve as markers for investigating the relationship between cellular senescence and oxidative stress in wound healing.

 

OP035 Comprehensive proteomic analysis of platelet-rich and platelet-poor plasma for therapeutic wound healing applications

Anna Buisan-Farre^{1 2 3}, Montserrat Serra-Mas^{1 4}, Elisabet Sarri-Plans^{1 5}, Verónica Salgado Pacheco^{1 2 3}, Clara Masó Albareda^{1 3 6}, Marta Casals Zorita^{1 3 6}, Marta Ferrer Solà^{1 6 7}, Marta Otero Viñas^{1 2
1}Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, ²Department of Biosciences. Faculty of Science, Technology and Engineering. University of Vic- Central University of Catalonia, Vic, Spain, ³Doctoral School. University of Vic- Central University of Catalonia, Vic, Spain, ⁴Faculty of Health Sciences and Welfare, University of Vic- Central University of Catalonia, Vic, Spain, ⁵Faculty of Medicine, University of Vic- Central University of Catalonia, Vic, Spain, ⁶Fundació Hospital de la Santa Creu de Vic (FHSC-CHV), Vic, Spain, ⁷Hospital Universitari de Vic, Vic, Spain

Aim: To characterize the protein profile of platelet-rich plasma (PRP) and platelet-poor plasma (PPP) to identify the fraction with enhanced therapeutic potential for wound healing.

Method: A prospective observational study involving 32 patients from an intermediate care hospital. PRP was obtained by centrifuging blood samples at 400g 9 min 25ºC, and further centrifuged at 900g 10 min to separate platelet concentrates from PRP, and PPP (as control). PRP platelets were activated with calcium gluconate (10%) in the presence of heparin (2 IU/ml) at 37ºC for 30 min, then platelet factors were isolated by centrifuging at 5000g 15 min. Proteomic analysis included depletion of abundant proteins via immunoaffinity, peptide digestion, and LC-MS/MS separation, with data analyzed using bioinformatics tools.

Results / Discussion: A total of 1378 proteins were detected in the two plasma fractions, 324 exclusives to PRP. Hierarchical clustering revealed two distinct abundance protein profiles for PRP and PPP. The first profile shows mostly proteins without differential abundance between both fractions. Among the proteins included in the second profile, 67% of proteins are overabundant in PRP. Functional analysis revealed that 38 of the overabundant proteins in PRP are involved in the wound healing process.

Conclusion: PRP and PPP fractions exhibit distinct protein profiles. The PRP fraction presents overabundant proteins related to biological processes associated with wound healing, suggesting its superior therapeutic potential. Larger patient studies are necessary to validate these findings for PRP potential application in wound healing.

 

OP036 The accuracy and ethical implications of artificial intelligence in predicting wound healing trajectories: A systematic review of predictive models and clinical applications

Wan Zuraini  Mahrawi^1
1Cardiff University, National Cancer Institute Malaysia, Cardiff, United Kingdom

Aim: Artificial intelligence (AI) is transforming wound management, particularly in automating wound measurement, classification, and predicting healing trajectories. This systematic review evaluates the accuracy and ethical implications of AI in predicting wound healing outcomes to inform its practical applications in clinical settings.

Method: A systematic search was conducted across PubMed, Ovid, and ScienceDirect, identifying 42 studies. After a rigorous screening process, eight studies met the inclusion criteria and were analyzed. Core themes assessed included AI’s predictive accuracy, model interpretability, and ethical considerations, with quantitative comparisons of accuracy across AI models.

Results / Discussion: The analysis revealed three primary AI applications in wound care: wound measurement, healing stage classification, and healing outcome prediction. Approximately 75% of the studies (6/8) confirmed AI’s effectiveness in automating wound measurement and classification, enhancing clinical efficiency. Comparative analysis indicated that deep learning models consistently achieved higher accuracy rates, surpassing traditional machine learning techniques by an average of 10-15%. However, ethical challenges were prevalent, with 50% of the studies citing concerns regarding data privacy and model interpretability, which may hinder clinical implementation. Findings suggest that while AI has potential in predicting wound healing trajectories, variability in accuracy and ethical issues must be addressed to ensure reliable clinical use.

Conclusion: This research showcasing AI’s capability in wound management through predictive modeling, providing both accuracy and operational efficiency. However, addressing ethical concerns and accuracy limitations is important for broader adoption in clinical practice. Detail research is recommended to refine AI models, integrate multi-modal data, and develop ethical frameworks that ensure data security and equitably in wound care applications.

 

 

WOUND ASSESSMENT

OP116 Impact of digital infrared thermographic imaging for limb salvage in patients at risk of limb amputation

Víctor Manuel Loza González¹, Eleazar Samuel  Kolosovas-Machuca², Patricia Aurea Cervantes Báez³, José Luis  Ramírez GarcíaLuna⁴, Mario Aurelio Martínez-Jimenez^5
1Doctorado Institucional en Ingeniería y Ciencia de Materiales (DICIM-UASLP), Universidad Autónoma de San Luis Potosí, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, ²Coordinación para la Innovación y Aplicación de la Ciencia y Tecnología, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ³Facultad de Medicina UASLP, San Luis Potosí, Mexico, ⁴Division of Experimental Surgery , Faculty of Medicine, McGill University, Faculty of Science, Universidad Autónoma de San Luis Potosí, Quebec, Mexico, ⁵Burn Unit, Hospital Central Dr. Ignacio Morones Prieto, Tissue Bank-wound Care Center, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico

Aim: Clinical scores like the MESS score for trauma, and the Wifi classification for diabetic foot ulcers help in the decision-making process of amputation, however, they can be subjective. Therefore, we propose the use of infrared thermal imaging as an adjunct tool to assess a limb’s viability through perfusion changes.

Method: Patients with MESS scores <7 or Wifi classification ≤4 who sought a second opinion after an amputation recommendation were included in this study. Clinical data and infrared thermographic images were acquired on the first and fifth day of evaluation, and for the limbs saved, after wound healing at 12 weeks. Temperature differences (ΔT) between regions of interest of injured and uninjured limbs were analyzed using computer software.

Results / Discussion:  From 29 patients enrolled in the study, 27 limbs were saved. Thermographic images allowed the discrimination of two groups: one with ischemic characteristics (18 patients, initial ΔT -3.6°C ± 1.99, fifth day ΔT -1.98°C ± 1.9 and twelfth week ΔT 0.12°C ± 0.69) and an inflammatory group (9 patients initial ΔT of 3.36°C ±2.71, fifth day ΔT 1.68°C ± 1.2 and twelfth week ΔT 0.36°C ± .48). ΔT values approached to 0°C in both groups at wound closure. The two patients who required amputation showed an initial negative  ΔT of >5°C, which worsened by day 5.

Conclusion: Digital infrared thermography is a tool that can help guide limb salvage. This imaging modality allows visualization of thermal patterns derived from perfusion changes in patients at risk of limb amputation.

 

OP117 Automatic wound severity index (AWOSI) estimation and characterization using deep learning

Taig Mac Carthy¹, Daniel Dagnino², Alfonso Medela², Gerardo Fernández², Andy Aguilar¹, José Francisco Villalba Salazar^3
1Department of Clinical Endpoint Innovation, Legit.Health, Bilbao, Spain, ²Department of Medical Data Science, Legit.Health, Bilbao, Spain, ³Responsable de Heridas Complejas, Hospital Universitario del Vinalopó, Elche, Spain

Aim: Wounds affect millions of people worldwide, and an accurate assessment is essential for preventing their progression. Manual assessment of wound size is often inaccurate and time-consuming. This study introduces an automated framework for wound assessment that provides an objective methodology for accurate evaluation. We propose an automatic wound characterization system that segments several items within the lesion, quantify the ulcer severity using an Automatic Wound Severity Index (AWOSI) and automatically classify ulcer stages along with 24 distinct visual signs.

Method: A dataset of 1050 images, annotated by four wound care specialists, was used to train and evaluate the deep neural networks within the AWOSI framework. These networks employ a Feature Pyramid Network architecture with three specialized encoder models to segment, classify, and assess the wounds.

Results / Discussion: Experimental results demonstrate that AWOSI achieves Intersection over Union scores of 0.853, 0.244, 0.452, 0.452, 0.198, 0.165, and 0.348 for the segmentation of the entire wound, the granulation tissue, the slough, the necrotic tissue, the macerated tissue, the orthopedic materials, and bones and cartilage, respectively. Additionally, AWOSI classifies the lesion stage with an accuracy of 0.845.

Conclusion: Our study introduces the AWOSI framework as a novel and effective tool for the automatic assessment of wounds, addressing the limitations of current manual evaluation methods. AWOSI framework offers significant benefits to clinicians by providing a more objective, rapid, and reliable approach to wound severity assessment, potentially serving as a novel endpoint in clinical trials.

 

EP0478 Evidence of validity of the Brazilian version of the wounds at risk score instrument

Paula Nogueira¹, Saskia Fleury², Carol Gonzalez³, Vera Lucia Conceição Gouveia Santos^1
1University of São Paulo, São Paulo, Brazil, ²ConvaCare Clinics, São Paulo, Brazil, ³University Nacional da Colombia, Bogota, Colombia

Aim: To analyze the validity and reliability of the W.A.R. score in Brazilian Portuguese for adults.
Method: A clinimetric study with 11 steps proposed by the Patient-reported Outcome Measurement Information System (PROMIS). The W.A.R. score was developed to identify patients at risk of infection in wounds, assisting in the prevention of complications in both acute and chronic wounds. The instrument consists of 20 items; results equal to or greater than 3 are interpreted as indicating a risk of infection. The Brazilian version was applied to 87 patients with wounds showing no signs of infection in a private hospital, who were re-evaluated 1 to 7 days after application to check for the presence of infection. To identify high microbial load in the wound, the fluorescence camera was used. Data were analyzed using descriptive and inferential statistics. The data were collected after the approval of the research ethics committee.
Results / Discussion: The expert committee and pre-test participants showed borderline agreement in content validation. A total of 101 wounds were evaluated, with 54 re-evaluated; 13 showed signs of infection. A score of 3 was not predictive of infection, and the W.A.R. score exhibited low accuracy (38.1%) and specificity (29.3%) in identifying patients with infection. Items such as “Wounds exposed to high bacterial loads due to location (e.g., perineum, genitals)” and “Highly contaminated acute wounds” had odds ratios of 10.4 and 9.7, respectively, with a p-value < 0.05 in the assessment using the fluorescence camera for positive results for high microbial load.

Conclusion: There was insufficient evidence of validity and reliability for the instrument in its Brazilian version.

 

EP0649 Using a handheld digital wound assessment platform to scrutinise healing data and gain clinical insights for an NHS community caseload

Debbie Foley¹, Zoe Wood², Zoe Larmour^3
1Healthy.io, London, United Kingdom, ²Healthy IO, London, United Kingdom, ³NCIC, Whitehaven, United Kingdom

Aim: Healing rates are indicative of a wound healing progression however from a healthcare organisations perspective they are extremely difficult to measure and particularly over time. Handheld digital technology can demonstrate its support to improving healing rates over a timeline and moreover this can be shown by wound aetiology.

Method: Through analysis of the dashboard within the digital platform healing rates within an NHS community organisation were compared before and after implementation of the digital wound assessment platform. Visualisation of the overall healing trajectory defines real time improvements and or changes. The dashboard facilitates scrutiny at a much deeper level than using their EPR system, which can in turn offer clinical insights into caseloads previously not possible.

Results / Discussion: The NHS organisation has implemented and embedded the digital wound assessment platform throughout their community organisation over the last 3 years. Using a smartphone to capture wound assessments is now the standard of care. Analysing the data captured healing rates can be seen to improve at various points during the deployment of the device and markedly with full end to end interoperability with the EPR system (Table 1).

Conclusion: The use of the handheld smartphone in conjunction with clear local guidance and education of wound pathways can illustrate an improvement in overall healing rates with the ability for the organisation to deep dive into the data.

 

OP118 Candidate biomarkers for prediction of hard-to-heal wounds via single-cell RNA sequencing of cells in wound fluid

Qi Qin¹, Daijiro Haba², Chihiro Takizawa¹, Sanai Tomida¹, Ai Horinouchi¹, Mikako  Katagiri³, Seitaro Nomura^{3 4}, Gojiro Nakagami^{1 2
1}Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, ²Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, ³Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan, ⁴Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Aim: Despite extensive research on the pathophysiology of hard-to-heal wounds, wound healing remains complex and poses challenges in treatment and management. This study utilizes single-cell RNA sequencing (scRNA-seq) of host cells in wound fluid from various delayed models, aiming to explore shared biomarkers that can be applied to complex, hard-to-heal wounds in clinical settings.

Method: Wound fluid cells collected from wound dressings of three delayed wound healing models (aged, diabetic, and lipopolysaccharide-induced inflammation) were analyzed and compared to those from a normal healing model (young mice). ScRNA-seq was conducted to explore shared dysregulated gene expression patterns. Gene ontology (GO) enrichment analysis was performed to understand the biological implications of observed changes.

Results / Discussion: Gene expression changes identified across all delayed models include the upregulation of cell cycle and senescence-associated genes (Rpl11, Rps20, Ccl2, Cdk2ap2, Ccnd3), and the downregulation of immune response regulation genes (Tnfaip3, Junb, Il1r2, Plaur, Il1a, Cxcl2, S100a8, S100a9). Although dysregulated genes vary in different cell subgroups, shared GO terms were found in most immune cell groups, including macrophages.

Conclusion: The findings suggest that cellular senescence in wound fluid cells plays a crucial role in the pathology of hard-to-heal wounds. The use of scRNA-seq on cells from wound dressings, combined with the analysis of multiple delayed wound models, has identified biomarkers that could potentially enhance wound assessment and therapeutic strategies for complex wound conditions. This study highlights the potential of targeting cellular senescence in host cells within wound fluid as a preventive strategy for hard-to-heal wounds.

 

OP119 Stress in people with hard-to-heal wounds during treatment at an enterostomal therapy outpatient clinic: cohort study

Vera Lucia Conceição Gouveia Santos¹, Beatriz Costa Ferreira¹, Carol Serna González¹, Kevin Woo², Beatriz Farias Yamada^1
1School of Nursing - University of São Paulo, São Paulo, Brazil, ²Queens University, Kingston, Canada

Aim: To analyze the relationship between perceived stress and healing in individuals with hard-to-heal wounds (HHW) treated in an Enterostomal Therapy outpatient clinic.

Method: Secondary, prospective, and correlational cohort study with 32 patients followed up from 2 to 6 consultations, approved by the Ethics Committee. For data collection were Sociodemographic and clinical forms, Numerical Rating Scale - NRS, Brief Pain Inventory - BPI, McGill Pain Questionnaire - MPQ, Bates-Jensen Wound Assessment Tool - BWAT, and Perceived Stress Scale - PSS, composed of distress and coping scores.

Results / Discussion: Patients were 66.3 years old (SD 13.6), with HHW mainly in lower limbs (75%), with a mean duration of 4.4 (SD 8.6) years. Patients with Diabetic Foot Ulcers had a greater PSS decrease (-9.7 SD 7.7). The perceived stress was characterized as moderate, high, and very high at 46.9%, decreasing to 34.4% in the endpoint. Baseline coping score showed moderate positive correlations with the wound’s duration and BPI. Total PSS and distress had a moderate positive correlation with McGill pain descriptors. A weak correlation was found between total PSS, distress, and coping with BWAT, indicating that the greater the severity of the wound, the higher the stress and distress scores and the lower the coping score.

Conclusion: Stress is a biopsychosocial complex phenomenon affecting individuals with HHW and should be assessed in wound clinics. Patients with longer wound duration showed psychosocial adaptation, resulting in higher coping. Patients with higher pain and wound severity showed higher perceived stress.

 

OP120 Assessment of stress in people with hard-to-heal wounds: case reports

Vera Lucia Conceição Gouveia Santos¹, Beatriz Costa Ferreira¹, Carol Serna González¹, Beatriz Farias Yamada^1
1School of Nursing - University of São Paulo, São Paulo, Brazil

Aim: to exemplify the evaluation of stress, distress, and coping perceived by patients with hard-to-heal wounds (HHW) treated in an Enterostomal Therapy outpatient clinic.

Method: secondary, observational, and prospective cases series of 10 adult patients with HHW, followed up for two to six consultations, approved by the Ethics Committee. For data collection were used sociodemographic and clinical data forms; the Brief Pain Inventory (sensitivity - BPIS (0-10) and interference in daily life activities - BPII (0-10)); the Bates Jensen Wound Assessment Tool - BWAT (13-65) for wound severity; and the Perceived Stress Scale - PSS (0-56), including coping and distress (both 0-28), with data expressed as means.

Results / Discussion: Patients had HHW mainly in the lower limb, lasting 1.8 years; BWAT 23.7; BPIS 4; BPII 3.2. Stress was characterized by a total PSS of 28.5 points, distress of 16.4, and coping of 16. Patients’ baseline perceived stress was categorized as moderate. At the last appointment, BWAT decreased by 4.3 points, BPIS by 0.8 points, total PSS by 7.6 points, and distress by 5.3 points; the number of patients with moderate, high, or very high stress also decreased. BPII increased by 0.7, and coping by 2.2.

Conclusion: Perceived stress results from the wound’s interference in the patient’s biopsychosocial dimension. Coping stands out as a determining factor in the perception of stress, and a multidisciplinary approach is essential for its management and distress assessment.

 

 

Electrónicos en español

HERIDAS AGUDAS

EP1387 Cuidados de enfermería en pacientes frágiles con hematomas subcutáneos: serie de casos clínicos

Cristina Gálvez García¹, Alejandro Campos Zafra², Manuela Soriano Ruiz³¹UGC Ciudad Jardín, Málaga, Spain, ²UGC Puerto de la Torre, Málaga, Spain, ³Residencia de Personas Mayores Ilugo, Jaén, Spain

Objetivo: Mostrar la necesidad de la detección precoz tanto de hematomas subcutáneos como de pacientes vulnerables a padecerlos y sus posibles complicaciones. Además, describir los conceptos y los cuidados de enfermería sobre las intervenciones o tratamientos realizados en los hematomas subcutáneos.

Métodos: Se recogió la información objetiva y subjetiva de tres series de casos clínicos para poder llegar a diagnósticos de enfermería que guiaron las intervenciones de los profesionales. Para la presentación de estos casos clínicos, se recogió una anamnesis y se utilizó el cuestionario por patrones funcionales de Marjory Gordon.

Resultados: Se estableció un plan de cuidados compuesto por una fase diagnóstica, fase de planificación, fase de ejecución y fase de evaluación. Se identificaron los diagnósticos (NANDA), resultados (NOC) e intervenciones (NIC) presentes en nuestros casos clínicos por orden de priorización, centrándose en aquellos relacionados con el riesgo y estado de las lesiones agudas en activo. De los tres casos clínicos que se presentan, el abordaje principal en dos de ellos fue el desbridamiento cortante y en uno de ellos se abordó mediante la técnica Roviralta.

Conclusiones: Los profesionales de enfermería han de realizar una valoración holística e integral de los pacientes con riesgo a sufrir hematomas subcutáneos. En los casos clínicos que se presentan en este trabajo, la prioridad principal es la detección precoz y abordaje correcto para que la evolución de la lesión sea favorable hasta su cicatrización, por lo que se han resuelto los casos acordes a la situación del paciente, gravedad de la lesión y habilidades del equipo de enfermería.

 

EP1388 Evaluación de los cuidados enfermeros en una herida aguda por mordedura de perro: a propósito de un caso

Paula Guerrero Fuertes¹, Ascensión Niubó López^1
1Cap Poblenou, Institut Català de la Salut, Barcelona, Spain

Objetivo: Analizar un caso clínico basado en el manejo enfermero de una herida aguda por mordedura de perro, evaluando la efectividad de los cuidados proporcionados y recopilando las últimas recomendaciones basadas en la evidencia científica.

Métodos: Se ha realizado un análisis del caso clínico de una paciente de 60 años que presentó una mordedura de perro doméstico en la mano dominante. Se registraron los procedimientos de manejo inicial y seguimiento de la herida por parte de enfermería, así como la pertinencia del uso de antibióticos y/o profilaxis antitetánica y antirrábica. Además, se llevó a cabo una búsqueda bibliográfica en bases de datos científicas para revisar las últimas recomendaciones clínicas disponibles.

Resultados: Los resultados muestran que el abordaje de la infección local de la herida, el desbridamiento del tejido desvitalizado y el uso de antibioterapia oral redujeron significativamente el riesgo de infección. Además, el seguimiento periódico de la herida por parte de enfermería permitió valorar la aparición de otras complicaciones. Sin embargo, en los centros de Atención Primaria se observa una gran variabilidad en la aplicación de los protocolos, lo que sugiere la necesidad de estandarización.

Conclusiones: El análisis del caso clínico ha permitido identificar áreas de mejora en el manejo de heridas por mordedura de perro en Atención Primaria. Se recomienda la implementación de un protocolo estandarizado que incluya un manejo adecuado de la herida, el uso de profilaxis antibiótica, antitetánica y/o antirrábica, así como un seguimiento estricto para optimizar los resultados clínicos y reducir las complicaciones.

 

EP1389 Caso clínico de una herida post-quirúrgica por absceso perineal

Nuria Babot-Pereña¹, Ángela María Correa Rubio^1
1SSIBE, Palamós, Spain

Objetivo: Hombre 55 años, fumador, antecedentes de gota e insuficiencia venosa, presenta absceso anal desde el 2 de enero de 2023, que se interviene quirúrgicamente 23 de febrero. No existen conflictos de intereses. El paciente da autorización para realizar fotografías.

El objetivo es la curación de la herida por segunda intención, con los indicadores disminución del tamaño, secreción serosa y olor.

Métodos: Evaluación de la herida siguiendo la metodología Tejido-Infección-Humedad-Bordes y se utiliza la Escala Visual Analógica para evaluar el dolor.

Resultados: Herida profunda de lecho esfacelado, sin signos de infección, exudado seroso abundante y bordes endurecidos y frágiles. Se realiza cura húmeda con distintos métodos durante 40 días (enzimas proteolíticas, alginato de plata, fibra gelificante y mecha con fibra poli-absorbente) sin ninguna mejoría.

El 3 de abril se inician las curas con pasta de cadexómero yodado, tras las que mejora el desbridamiento instrumental del esfacelo. Tras 2 semanas las zonas esfaceladas desaparecen, pero hay exudado abundante y se percibe olor fuerte, por lo que se sustituye el cadexómero yodado por alginato de plata. 

Durante el mes de mayo disminuye la profundidad de la herida y se van acercando los bordes perilesionales hasta su re-epitelización total el 22 de junio de 2023.

Conclusiones: Se alcanzó el objetivo de curación de la herida quirúrgica por segunda intención. Destaca la adaptación de cuidados según la evolución de la herida y la relevancia del correcto registro para facilitar el trabajo entre distintos profesionales.

 

EP1390 Quemadura química, manejo desde atención primaria: rol esencial de la enfermería en el cuidado integral del paciente

Paula Martinez Souto¹, Raquel Barreiro Ramos², Fátima López López^3
1Enfermera interno residente Familiar y Comunitaria en el Centro de Salud de Bueu, Atención Primaria, EOXI Pontevedra-Salnés, Pontevedra, Spain, ²Enfermera en el ESAD Terra de Montes - Campolameiro, Atención Primaria, EOXI Pontevedra Salnés, Pontevedra, Spain, ³Médico interno residente Familiar y Comunitaria en el Centro de salud de Bueu, Atención Primaria, EOXI Pontevedra-Salnés, Pontevedra, Spain

Objetivo: Exponer el abordaje retardado local de una quemadura química, haciendo énfasis en las intervenciones de enfermería, y subrayando la importancia del cuidado, educación al paciente y prevención de complicaciones.

Métodos: Se propone el caso de un varón de 71 años, (comorbilidades) que presenta quemadura química de tercer grado, en zona supraumbilical con hidróxido sódico al 28%. El paciente realiza en domicilio limpieza con agua y jabón, haciendo fricción con estropajo de metal. Tras empeoramiento acude a su enfermera, que pauta de 3 días de sulfadiazina de plata crema y posterior alta. Ante la mala evolución acude a nuestro centro.

A su llegada, presenta dos lesiones claramente definidas, escara blanquecina desvitalizada, endurecida, bordes irregulares, erosionados con exudado escaso.

Precisó un abordaje complejo y una monitorización estrecha. Realizamos cura en ambiente húmedo, colagenasa y ácido hialurónico¹ en lecho, crema de óxido de zinc en bordes, apósito secundario de hidrofibra de hidrocoloide con adhesivo².

Resultados: Al quinto día del inicio de la cura en ambiente húmedo, muestra mejoría significativa, reducción del dolor y aparición de zonas epitelizadas, decidiendo cambiar de pauta con malla DACC con hidrogel³, en la última fase, apósito de espuma multicapa con tecnología hidrofibra⁴.

Epitelización completa en 45 días.

Conclusiones: El abordaje con cura en ambiente húmedo permite la cicatrización de quemaduras químicas por alcalis independientemente de que sea tardío. Subrayar la importancia de la correcta intervención temprana, así como la necesidad de educación sobre manipulación segura.

 

EP1391 Revisión sobre el abordaje de la hipergranulación en las heridas

Laura Sedano Jimenez^1
1Instituto Catala De La Salut, Barcelona, Spain

Objetivo: Observar cuáles son los tratamientos para la hipergranulación que utilizan los profesionales. Analizar la ficha técnica de los productos utilizados.
Métodos: Se realizó una revisión bibliográfica consultando las bases de datos: Dialnet, Pubmed, Scielo y Google Scholar. Las palabras utilizadas fueron hipergranulación, tratamiento y heridas.
Resultados: En la evidencia revisada los profesionales utilizaban como tratamiento para la hipergranulación: Nitrato de plata, corticoide tópico en pomada (Betametasona 0,5mg/g, propionato de clobetasol al 0.05% e hidrocortisona al 1%) y corticoide tópico en fomento (metilprednisolona diluida en suero fisiológico). Además, también se utilizaron antimicrobianos, apósitos de plata y alginato según la posible etiología de la hipergranulación (exceso de humedad, infección, etc). Revisando las fichas técnicas de todos los productos utilizados se puede observar la ausencia de la indicación para la que se utilizan.

Conclusiones: La mayoría de los artículos analizados son casos clínicos. Solo un estudio comparaba la reducción del tamaño en heridas hipergranuladas sometidas a dos tipos de tratamiento: nitrato de plata y esteroides tópicos. En cuanto a la ficha técnica, en el caso de los corticoides tópicos está indicado aplicar varias veces al día, siendo esto poco habitual según la evidencia revisada y la práctica clínica diaria. Además, en los corticoides en fomento al no estar indicado para este uso no hay consenso en cuanto a la dosis, la dilución ni cada cuánto se debería utilizar. No hay suficientes estudios para recomendar un tratamiento como primera elección ni para saber cuál sería la forma de administración, ni sus posibles contraindicaciones. Sería interesante realizar estudios experimentales para tener indicaciones del tratamiento adecuado.

 

EP1392 Úlcera traumática en paciente con insuficiencia venosa crónica: claves del vendaje compresivo

Marta Lloveras^1
1Serveis Sanitaris Baix Empordà, Palamós, Spain

Objetivo: Presentar un caso clínico de una herida traumática donde el vendaje compresivo ha sido clave para su resolución.

Métodos: Paciente de 52 años con diagnósticos de obesidad mórbida, diabetes tipo II, HTA e insuficiencia venosa crónica. El 04/11/2022 acude a la consulta de enfermería con una herida de origen traumático en la pierna izquierda de 4cm x 4 cm, EVA=8 donde se inician curas con diferentes apòsitos. La herida presenta muy mala evolución siendo maloliente, lecho con tejido esfacelado, elevada presencia de biofilm y con elevado exudado verdoso. Acude a la consulta de heridas complejas de nuestro centro y iniciamos tratamiento cada 48 horas con fomentos de ácido hipocloroso, curetage, apósitos con plata nanocristalina, óxido de zinc en spray en lecho y perilesional, alginato, apósito super absorbente y se inicia terapia compresiva de corta tracción de 40 mmHg siendo clave para su curación. Al mes ya no hay signos de infección ni exudado. Se retira la plata nanocristalina y se continúan las curas con fomentos de ácido hipocloroso, óxido de zinc, alginato y compresión 40 mmHg hasta la curación un mes más tarde.

Resultados: Se consigue la curación de la lesión en 2 meses aproximadamente.

Conclusiones: La terapia compresiva ha sido clave para reducir el exudado, controlar la infección y proporcionar las condiciones óptimas para lograr la curación de la herida por enfermería de Atención Primaria. Resaltar la importancia de una correcta valoración y abordaje integral de las úlceras de extremidad inferior.

 

EP1393 Uso de insulina tópica para la cicatrización de heridas

Raquel Gil Marín¹, Patricia Rial Lorenzo¹, Paula Borras Lecha¹, Ana Sanchez Micó¹, Elena Guillén Marañes^1
1CST (Cap Sant Llàtzer), Terrassa, Spain

Objetivo: Investigar la evidencia científica disponible acerca del uso de insulina tópica para la cicatrización de heridas. 

Métodos: Se ha realizado una revisión bibliográfica en base de datos como Pubmed y Elsevier utilizando las palabras clave: “Insulin”, “Would Healing”, “Wound” y el operador booleano AND. Los criterios de inclusión empleados son artículos en inglés y español publicados en los últimos cinco años, con acceso libre y completo e intervención en humanos. Se han revisado 6 artículos. 

Resultados: El proceso de cicatrización es complejo y está influenciado por factores microbiológicos, inmunológicos y fisiológicos.

La insulina ha demostrado ser beneficiosa, reduciendo el tiempo de cicatrización y siendo especialmente útil en la fase inflamatoria y en la formación de tejido de granulación. Ayuda en la proliferación, migración y producción de queratinocitos, células endoteliales y fibroblastos, además de promover la angiogénesis, lo que favorece un adecuado aporte de nutrientes y oxígeno. 

No existe consenso sobre la mejor forma de aplicación, que puede ser por impregnación de apósitos, en loción o en su forma líquida, siendo escasos los efectos secundarios. No obstante, estos pueden aparecer cuando se aplica en forma de inyección local. 

Conclusiones: La aplicación de insulina tópica es una opción efectiva y segura para el tratamiento de heridas, en pacientes diabéticos y no diabéticos. 

A pesar de los buenos resultados, es importante realizar más investigaciones para establecer criterios claros sobre el tipo de heridas que se beneficiarían más, las dosis óptimas de insulina y la frecuencia de aplicación, con el fin de lograr una buena práctica clínica.

 

EP1037 Enfermería y cuidados compartidos: pilar clave en el tratamiento multidisciplinar de la gangrena de fournier

Maria de la cruz vaca suárez^1
1Hospital Universitario de Badajoz, Badajoz, Spain

Objetivo: Resaltar el papel fundamental de la enfermería en la implementación y seguimiento de un protocolo de curas avanzadas para la Gangrena de Fournier, fomentando la colaboración entre el equipo multidisciplinar, el paciente y sus cuidadores, para asegurar la continuidad de los cuidados.

Métodos: Caso clínico de un varón de 63 años con una Gangrena de Fournier. El tratamiento incluyó dos desbridamientos quirúrgicos y la implementación de un protocolo avanzado de curas basado en una solución de hipoclorito de sodio y sal, un alginogel enzimático, y una gasa de captación bacteriana. Este enfoque permitió la creación de un entorno húmedo óptimo, controlando la infección y promoviendo la formación de tejido de granulación.

Resultados: El manejo multidisciplinar y el protocolo de curas avanzadas controlaron eficazmente la infección y aceleraron la cicatrización. El tejido necrótico fue eliminado completamente a los 22 días, logrando un lecho de granulación adecuado. El paciente fue dado de alta a los 25 días, con la continuidad de los cuidados domiciliarios bajo la supervisión de un familiar capacitado, lo que permitió una reepitelización completa a los 115 días

Conclusiones: El manejo exitoso de la Gangrena de Fournier requiere un enfoque multidisciplinar, donde la enfermería es clave tanto en los cuidados avanzados como en la formación de cuidadores para asegurar la continuidad del tratamiento. Además, se destaca la efectividad de los productos antimicrobianos y la importancia de un protocolo bien definido para lograr la cicatrización completa y la recuperación de las actividades diarias.

 

EP1394 Técnica mölndal en atención primaria: una alternativa desconocida

Meritxell Garcia Romero^1
1Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo: Efectividad de la técnica Mölndal como alternativa a la cura de lesiones con sutura habituales en Atención Primaria.

Métodos: Se realiza una búsqueda amplia en base de datos PUBMED y Cochrane Library, también en revistas científicas, con los siguientes de términos de búsqueda (infection, surgical wound, surgery y technique Mölndal); los criterios de elección han sido: artículos publicados de 2016-2024, en inglés y español, con acceso completo a texto, con diseño de ensayos clínicos aleatorizados (ECA) y revisiones sistemáticas con o sin metaanálisis (RS). 

Se identificaron 663 artículos que se revisaron, a partir del título y resumen, seleccionando 6 documentos para revisión a texto completo. Según la síntesis cualitativa se descartaron 3 por baja calidad según las recomendaciones de la Red EQUATOR. 

Resultados: La evidencia apoya la aplicabilidad de la técnica Mölndal en el proceso de curación de la incisión, muestra gran disminución de infección en las heridas, lo que conlleva además menos dolor para los/las pacientes y disminuye el gasto de material y disminución de la frecuencia de visitas (consultas de enfermería). 

Conclusiones: Los resultados apoyan la técnica Mölndal aplicable en atención primaria por su bajo coste, además de la disminución del dolor y menor incidencia de infecciones.

Palabras clave: Infection, Surgical Wound, Surgery, Technique Mölndal.

 

EP1395 Manejo de cierre de ostomía con cura en ambiente húmedo aumentando la calidad de vida del paciente

Amaya Cardona Martinez¹, Ángela Álvarez Aguilar^2
1Hospital Universitario La Moraleja, Madrid, Spain, ²Hospital Sanitas La Moraleja, Madrid, Spain

Objetivo: Reducir tiempo de cicatrización de la herida postquirúrgica por cierre de ostomía. Disminuir complicaciones asociadas a este tipo de lesiones. Favorecer autonomía del paciente espaciando el tiempo entre curas utilizando materiales de cura en ambiente húmedo.

Métodos: Mujer de 73 años, independiente para las actividades de la vida diaria. En Junio de 2023 se le realiza una colostomía en asa de protección en flanco Izquierdo tras una resección de sigma y yeyuno por una neoplasia.Tras un año de tratamiento con quimioterapia oral, se decide cierre de la ostomía y reconstrucción del tránsito intestinal.

Se realiza reparación quirúrgica sin incidencias con apertura de cavidad de cinco centímetros en zona previa de ostomía, con drenaje pasivo tipo penrose. Duante la hospitalización, se realizan cura diarias haciendo hincapié en la limpieza de arrastre a través de drenaje.

A la semana de la intervención, se retira drenaje, la lesión presenta cavidad de cuatro centímetros con tejido de granulación.

Se realiza cambio a cura húmeda, con apósito bioactivo de colágeno y apósito de espuma de poliuretano adhesivo manteniendo la cura durante una semana.

Tras quince días manteniendo la pauta de tratamiento y la realización de una cura entre medias, la herida se encuentra cerrada.

Resultados: Cierre de la lesión en un mes recuperando la autonomía del paciente y la realización de las actividades básicas de la vida diaria sin complicaciones asociadas.

Conclusiones: El uso de las terapias avanzadas en el cuidado de heridas mejora la calidad de los cuidados y reduce el tiempo de cicatrización.

Los productos bioactivos de cura en ambiente húmedo aumentan la calidad de vida durante el proceso de cicatrización.

 

EP1396 Uso del ringer lactato en heridas. Caso clínico

Laura Vila Ávila¹, Mireia Solé Baella¹, Marina Jimenez Liébanas^1
1Consorci Sanitari Terrassa, Terrassa, Spain

Objetivo: En el siguiente estudio se pretende evaluar el uso de Ringer Lactato en una herida, no solo para conseguir este desbridamiento, sino con el fin de acelerar el crecimiento del tejido de granulación con una técnica de curas costo – efectiva.

Métodos: Se expone el caso clínico de una usuaria del centro de salud en la que se utilizó Ringer Lactato impregnado en Alginato para la cura de su dehiscencia de la herida quirúrgica tras abdominoplastia. La búsqueda se centra en artículos publicados entre los años 2014 - 2024, utilizando las bases de datos Medline, Scielo, Science - Direct y Dialnet. Se valora que existe poca bibliografía referente a la cura de heridas con solución de Ringer Lactato. 

Resultados: El alginato impregnado en Suero Ringer lactato con curas periódicas resultó ser efectivo para acelerar el proceso de desbridamiento del tejido no viable, efecto del producto ya conocido. Fue destacable el crecimiento del tejido de granulación en un tiempo menor del esperado y la cicatrización total de la herida gracias a la creación de un ambiente húmedo continuo óptimo.

Conclusiones: Sería necesario crear guías de práctica clínica para el uso de Ringer Lactato en la cura de heridas. Las heridas complejas pueden tener un tiempo de cura prolongado que con productos adecuados se podría disminuir, reduciendo las visitas en el centro sanitario, mejorando la percepción del dolor, el confort y, por tanto, potenciando la calidad de vida de la paciente.

 

EP1040 Úlceras de lipschütz: la infección por SARS-CoV-2 como desencadenante

Rebeca Mesa Vera^1
1Consorci Sanitari De Terrassa, Terrassa, Spain

Objetivo: Incluir la infección por SARS-CoV-2 en el diagnóstico diferencial de la úlcera genital de Lipschütz. 

Métodos: Se ha realizado una revisión bibliográfica de las investigaciones publicadas desde 2020 hasta la actualidad, en castellano e inglés y con acceso al texto completo. Las principales han sido Pubmed y Scielo. Tras realizar la lectura crítica, se seleccionaron 27 artículos. 

Resultados: De los 27 artículos elegidos, 15 sugieren la infección por SARS-CoV-2 como desencadenante de las úlceras de Lipschütz, 8 de ellos señalan a las vacunas y 4 hacen referencia tanto a la enfermedad como a la vacuna. En dichos artículos destacan la población adolescente y adulta-joven femenina. En cuanto al abordaje de la lesión, se mencionan lavados de asiento, antisépticos y corticoides tópicos.

Conclusiones: Las úlceras de Lipschütz son úlceras genitales agudas poco frecuentes pero muy dolorosas. Presentan una incidencia baja, pero pueden estar relacionadas tanto con la infección por SARS-Cov-2 como con la administración de la vacuna. Aunque existen pocos estudios, seguimos diagnosticando SARS-CoV-2 y vacunando, lo que puede aumentar la incidencia de estas lesiones en los próximos años. Al ser inusuales, desconocemos cuál es el abordaje de curación más eficaz. 

 

EP1397 Abordaje de una úlcera por traumatismo por los equipos asistenciales en las residencias geriátricas

Sandra Lago¹, Gemma Roda¹, Mónica Hidalgo¹, Maria Leonor Vilaseca^1
1Mutuam, Barcelona, Spain

Objetivo: Mostrar la evolución de una herida en una persona institucionalizada a través de un enfoque colaborativo entre equipos asistenciales.

Métodos: A propósito de un caso: mujer, 85 años, residente en centro residencial. Diagnósticos de Demencia tipo Alzheimer, hipertensión arterial e hipercolesterolemia. Deterioro cognitivo moderado (Cuestionario de Pfeiffer = 6 ), dependencia moderada ( Índice de Barthel = 50) y riesgo medio de úlceras por presión (Escala de Braden = 15).

15/06/2024, sufrió una contusión con borde de la cama, desarrollando una úlcera traumática categoría III de 6x3 cm en extremidad inferior derecha, con tejido esfacelar en parte del lecho de la herida. Exudado abundante, bordes irregulares y zona perilesional con eritema y rubor. Con el objetivo de cicatrizar la herida en el menor tiempo posible, se decidió abordaje conjunto entre los profesionales del centro residencial (CR) y el equipo de atención residencial (AR), con visitas conjuntas: CR: Medidas preventivas con elevación extremidad, actividad física moderada y ácidos grasos hiperoxigenados AR: Plan de cuidados con método TIME (Tejido, inflamación/infección, exudado y bordes).
Resultados: Se realizaron curas c/48h con apósito desbridante antimicrobiano con componentes lipídicos + fibras de poliacrilato de Amonio + apósito secundario. Tratamiento con antibiótico sistémico durante 7 días. Cicatrización de la úlcera en dos meses.
Conclusiones: La coordinación entre el equipo del CR y AR fue clave para optimizar el tratamiento de la úlcera y acelerar su cicatrización. Este enfoque colaborativo demuestra la importancia de un trabajo multidisciplinario para ofrecer una atención integral a personas que viven en centros residenciales.

 

EP1398 Colgajo de gastrocnemio medial para el tratamiento de prótesis de rodilla infectadas: un estudio retrospectivo.

Giuseppe Rovere¹, Amarildo Smakaj², Francesco Liuzza³, Pasquale Farsetti⁴, Giulio Maccauro⁵, Elisabetta Pataia^5
1Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy, Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome „Tor Vergata“, Rome, Italy, Roma, Italy, ²Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome „Tor Vergata“, Rome, Italy, Roma, Italy, ³Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy, Roma, Italy, ⁴Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy, Roma, Italy, ⁵Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy., Roma, Italy

Objetivo: Los colgajos musculares pueden representar una opción de tratamiento válida para la infección protésica después de una artroplastia de rodilla.

Métodos: Presentamos los resultados de 20 pacientes consecutivos tratados con el uso de colgajo de gastrocnemio medial para el manejo de diferentes tipos de lesiones o defectos integumentarios después de una artroplastia total de rodilla. La necrosis tisular o la dehiscencia ocurrieron entre 1 y 2 meses después de la artroplastia. El seguimiento promedio fue de 23,4 (12-60) meses.

El resultado clínico se evaluó de acuerdo con la tasa de control de la infección y el puntaje postoperatorio del Knee Society Score (KSS).

Resultados: El rescate de la prótesis y la restauración completa de la cobertura cutánea se lograron en todos los pacientes. La evaluación funcional se realizó utilizando el puntaje KSS. El puntaje final de la rodilla en el KSS fue clasificado como excelente (puntaje: 80-100) en 0 pacientes, bueno (puntaje: 70-79) en 17 pacientes, regular (puntaje: 60-69) en 2 pacientes y pobre (puntaje: <60) en 1 paciente. Déficit residual de extensión: 0-20° Muy satisfactorio en 17 pacientes; 30-70° Satisfactorio en 2 pacientes; 80-90° Insatisfactorio en 1 paciente.

Los pacientes que fueron sometidos exitosamente al tratamiento con colgajo experimentaron un aumento mucho mayor en ambos componentes del puntaje KSS.

Conclusiones: Los resultados destacan la efectividad del colgajo muscular de gastrocnemio medial para el tratamiento de la infección protésica de rodilla, en términos de función preservación del miembro, rentabilidad y calidad de vida postoperatoria.

 

EP1399 Uso de la kinesioterapia en el tratamiento de hematomas y la cicatrización de heridas

María Elena Vergara Sánchez¹, María Angélica Magro Guillén^2
1Fremap, Guadalajara, Spain, ²Fremap, Zafra, Spain

Objetivo: Evaluar el impacto del kinesiotape en la reabsorción de los hematomas.

Estudiar el efecto del kinesiotape sobre la cicatrización de heridas traumáticas

Métodos: Se realizó un estudio descriptivo de serie de casos desde agosto de 2023 hasta la actualidad.

Criterios de inclusión: Pacientes que presenten hematomas de origen traumático, consentimiento informado firmado y posibilidad de seguimiento.

Revisión bibliográfica en las bases de datos MEDLINE, CUIDEN, COCHRANE Y Google académico con las palabras clave: “Kinesiotaping”, “Wound”, “haematoma” y operador booleano “and”.

Contamos con 35 pacientes, 28 presentaban únicamente hematoma y 7 de ellos, además, heridas agudas suturadas de origen traumático. La relación de género ha sido de 23 varones y 12 mujeres de edades comprendidas entre los 21 a los 64 años.

Resultados: Basándonos en la bibliografía consultada, se realizó la técnica en una serie de casos, observando un aclaramiento evidente del hematoma a las 24/48 horas en la totalidad de los casos, en 12 de ellos se hizo más evidente ya que presentaban hematomas adicionales que no se trataron, pudiéndose establecer una comparación directa.

Aunque ha habido una clara mejoría en el caso de la cicatrización de heridas, no se ha podido relacionar directamente con el uso del kinesiotape al no contar con un grupo de control.

Conclusiones: El impacto del uso del kinesiotape en el tratamiento de los hematomas ha resultado muy beneficioso al disminuir la coloración de forma evidente en 24/48 horas y de forma progresiva en cada evaluación.

Faltan estudios científicos de casos y controles para poder afirmar que el uso del kinesiotape tiene un efecto positivo sobre las heridas traumáticas agudas.

 

EP1400 Éxito en la resolución de una herida traumática en la extremidad inferior derecha mediante terapia de presión negativa de un solo uso

Emilia Mateo Marin¹, Anna Gruas Vila², Xavier Merino Jordán³, Elena Cercós Blasco³, Maria Sala Jounou³, Silvia Balielles Prat³, Anna Vidal Santolaria^4
1Institut Català de la Salut, Equipo de Atención Primaria de Súria, Enfermera referente de Heridas de la Cataluña Central, Socia y Miembro Consultivo del GNEAUPP, Socia de la SEHER, Callús, Spain, ²Institut Català de la Salut, CAP Sagrada Familia, Manresa, Spain, ³CAP Sant Llorenç de Morunys, Sant Llorenç de Morunys, Spain, ⁴ICS, CAP Sagrada Familia, Manresa, Spain

Objetivo: Presentar el caso clínico de una mujer de 71 años con una herida crónica producida tras un accidente de moto, con una evolución de tres meses.
Métodos: La primera cura fue en el hospital donde suturaron la herida, que tuvo dehiscencia a la semana, las siguientes curas se realizaron en el consultorio del pueblo de la paciente, utilizando un enfoque de cura en ambiente húmedo durante tres meses. Tiempo durante el cual la herida sufrió múltiples infecciones y se estancó en la fase inflamatoria.

La paciente, que conocía a una enfermera en la ciudad más próxima, se auto derivó y, a través del circuito establecido con la enfermera referente de heridas del Territorio, se implementaron nuevas curas que incluían un sistema de compresión.
Resultados: Tras una semana de cambio en el tratamiento, sin observar mejoras significativas, se introdujo la terapia de presión negativa (TPN) de un solo uso, combinada con un sistema dual de compresión, realizando curas cada cuatro días, debido al exceso de exudado, ajustándose posteriormente a una frecuencia semanal. Tras cuatro semanas de TPN, la herida mostró una cicatrización del 80%, permitiendo la transición a un tratamiento más sencillo con apósitos de membrana y curas semanales junto con terapia compresiva hasta la total curación.
Conclusiones: Este caso resalta la importancia de cicatrizar las heridas cuanto antes para prevenir su cronificación, lo que no solo mejora la calidad de vida del paciente, sino que también reduce significativamente los costos asociados a materiales sanitarios y el tiempo invertido por el personal de enfermería. Además vuelve a demostrar la eficiencia de la TPN de un solo uso aplicada a las heridas crónicas.

 

EP1401 Tratamiento y manejo multidisciplinario de pacientes pediátricos con herida en el cuero cabelludo por mordedura de perro

Francesco Spione¹, Guido Ciprandi^1
1Bambino Gesù Children’s Hospital, Rome, Italy

Objetivo: Nuestro objetivo fue evaluar nuestra experiencia y analizar específicamente dos casos clínicos en
pacientes pediátricos. 

Métodos: Realizamos análisis de dos pacientes de 6 y 3 años que llegaron a urgencias y
posteriormente fueron atendidos en nuestro departamento de Cirugía Plástica y MF. La gestión de estas lesiones incluyó un enfoque multidisciplinario, centrándose en reparación de los tejidos blandos con sustitutos dérmicos de colágeno bovino y posteriormente con injertos cutáneos a espesor parcial tomados de la superficie lateral o del interior del muslo bilateralmente. Apoyados por terapias antibióticas específicas, así como por vacunación, la gestión de la fase aguda y las complicaciones a largo plazo se basó en: apoyo psicológico a familia y paciente; cuidadosa medicación de las zonas de unión y prevención de la sintomatología dolorosa; apoyo anestesiológico durante toda la hospitalización; asesoramiento parental riguroso para mejorar la gestión posterior a domicilio, con apoyo de consulta dedicada.

Resultados: El resultado de tratamientos fue satisfactorio en términos de cicatrización, ausencia de complicaciones infecciosas y recuperación psicológica del trauma.

Conclusiones: En heridas por mordedura de perro, es fundamental tener en cuenta el área anatómica involucrada, profundizar mediante exámenes instrumentales de III nivel. Es crucial evaluar características de la herida como la extensión y la profundidad, así como realizar una evaluación infectológica y microbiológica de muestras de tejido. Los sustitutos dérmicos se han mostrado como una herramienta reconstructiva valiosa para la reparación de defectos complejos del cuero cabelludo a todo espesor post-traumáticos. La resultante cutánea en nuestros casos fue flexible, elástica. La técnica propuesta de reconstrucción del cuero cabelludo en pacientes pediátricos produce resultados estéticos positivos. El seguimiento a distancia requerirá atención por la ausencia de cabello.

 

EP1402 Creacion de piel mediante autoestimulacion celular experimentacion estudio de casos

Manuel Sanchez Haro^1
1Haro Art y Siluet, (Centro de Cirugia Plastica Reparadora Lima Peru) Hospital Ventanilla, Lima Callao, Lima, Peru

Objetivo: Lograr el cierre de heridas sin necesidad de recurrir al AUTOINERTO de PIEL creando tejido dérmico de base y luego epitelio superficial, usando solo el método de estimulación mecánica o “pérdida de solución de continuidad” sin recurrir a cirugías demoradas y que podrían dejar estigmas cicatriciales en la zona dadora de piel.

Métodos: Comenzamos la estimulación de la region ventral de los bordes de la herida, buscamos la capa más superior y luego con movimientos circulares o laterales despegaremos los bordes sanos de la herida con pérdida de solución de continuidad , en un plano de CLIVAGEM que preparará los bordes sanos de la herida PER SE desde donde con los Micro Traumas Controlados ,saldrán los factores creadores. Tecnica de autoreparación, basada en mini traumas, despertamos la MITOSIS, con aumento de consumo de oxígeno y de la humedad en el área de la herida reparada. y luego colocamos el Unguento de β -Sitosterol por (tapono o cubro x 3 dias) como medio y vehiculo de estimulacion de fibroblastos, macrofagos y factores de reparacion.
Resultados: Estimulando los bordes de la herida y colocando el Unguento de β -Sitosterol, se logro el cierre con formacion de piel de buena calidad en la totalidad de casos. Se observa formacion de nueva piel a partir de la primera semana de uso con formacion de piel de alta calidad en un tiempo de 4 semanas, en regiones esteticas como : frente,rodillas y muñon de amputacion supracondileo.

Conclusiones: La estimulacion de los bordes inferiores o ventrales, logra producir celulas de reparacion formadoras de piel las cuales se reproducen en un medio graso brindado.por el Unguento de β -Sitosterol.

Figuras

 

EP1403 Cura por segunda intención tras exéresis de 2 carcinomas basocelulares (CBC) en cuero cabelludo en consulta de dermatología

María Jaria¹, Rosa Milagros Torrente¹, Cecilia Valles Quintilla¹, Meritxell Alcoverro¹, Mónica Trillo¹, Elvira Seró², Carmen María Carmona^3
1Ics, Lleida, Spain, ²ics, Lleida, Spain, ³Ics, lleida, Spain

Objetivo: Valorar evolución de cures de exéresis de CBC en cuero cabelludo.

Métodos: Revisión de historia clínica y fotografías durante el tratamiento.

Resultados: Paciente de 98 años valorada por 2 CBC en cuero cabelludo de los que se reliza exèresis en quirúrgica. Antecedentes personales sin interès, a excepción que va antiagregada. Se interviene el 17/09/2024 y se programa en 1 semana para ampliar márgenes vs cierre de la misma mediante injerto.

En la segunda cita quirúrgica, se informa que los bordes no presentan lesión, se decide no realitzar injerto y curar por 2ª intención. Por prescripción médica se usa cera ósea. En la primera cura de enfermería (1/10/2024) la herida no sangra y presenta abundantes esfacelos, zona ennegrecida en contacto con chalota cranial (la cual se visualiza).

Cura: limpieza de la piel circundante, se realiza fomentos de solución electrolítica para heridas, aplicación de apósito de fibras poliabsorbentes tecnologia TLC-NOSF y apósito secundario. Se recita a los 15 días y mientras realizan las curas enfermería de Atención Primaria (AP) cada 48h y posteriormente pudieron ampliarse a cada 96h.

En la siguiente cura en dermatología (17/10/2024) la herida presenta abundante tejido de granulación, ya no se visualiza la chalota cranial y la paciente está contenta puesto que ha mejorado su comfort.

Conclusiones: En resumen, este informe de caso destaca la eficàcia de la Cura en Ambiente Húmedo (CAH) de heridas quirúrgicas como alternativa a cierre mediante injerto.

Primera cura con Cera ósea

Tras 15 días de CAH

 

EP1404 Alternativas a la cirugía: estrategias de manejo conservador

Diana Romero Navarro¹, Eva Sánchez Roch^1
1GNEAUPP, Alicante, Spain

Objetivo: Mejorar la calidad de vida de la paciente a través de un enfoque conservador y personalizado en el tratamiento de la herida.

Métodos: Paciente mujer de 87 años con antecedentes de hipertensión arterial, dislipemia, insuficiencia cardíaca crónica, insuficiencia renal crónica, hiperuricemia, enfermedad pulmonar obstructiva e insuficiencia venosa. No tiene deterioro cognitivo, vive sola con apoyo familiar. Desplazamiento en silla de ruedas y con andador. La paciente se cayó el 09/06/24 produciéndose hematomas y heridas con pérdida de sustancia en miembros inferiores. Se realizaron curas en su centro de salud y fue ingresada para realizarle un desbridamiento quirúrgico, posteriormente se trató con terapia de presión negativa de un solo uso. El 16/07/24 se deriva a cirugía plástica para valorar la realización de injertos. Debido a sus comorbilidades se decide aplazar quirófano y ver evolución. El 24/07/24 se retira TPN e iniciamos curas (cada 72 h) con solución hipertónica de sal marina y ácido hipocloroso como antiseptico, alginogel enzimático, crema barrera y vendaje compresivo.La paciente se dio de alta el día 08/10/2024

Resultados: En un periodo de 84 días, se alcanzó la cicatrización completa de la herida, evitando así la necesidad de cirugía en la paciente.

Conclusiones: Hemos logrado evitar una intervención quirúrgica en una paciente con múltiples comorbilidades con un plan de tratamiento centrado en mejorar su calidad de vida. La combinación del alginogel enzimático con la solución de sal marina y ácido hipocloroso como antimicrobiano favoreció significativamente la regeneración del tejido, facilitando una pronta recuperación y eliminando la necesidad de cirugía.

 

EP1405 Manejo de heridas complejas en hospitalización a domicilio

Carmen Mias Carballal¹, Rafael Villalobos¹, Ramón Ribalta², Fulthon Vela¹, Maria Rufas¹, Yolanda Maestre², Alfredo Escartín^1
1Hospital Universitario Arnau de Vilanova de Lleida, Facultad de medicina de la UdL, IRB LLeida, Lleida, Spain, ²Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Conocer el tipo de pacientes con heridas complejas que se pueden tratar en una unidad de hospitalización a domicilio quirúrgica (HADQ)

Métodos: Estudio descriptivo retrospectivo de los pacientes ingresados en la HaDQ de nuestro hospital para curas de heridas durante el 2023.

Variables estudiadas: tipo herida, tipo cura, otras prestaciones (drenajes, curas, medicación endovenosa, pruebas complementarias, analíticas),lugar de residencia, tipo de visitas.

Se realizó un análisis estadístico descriptivo y un análisis cualitativo de los resultados.

Resultados: Durante el 2023 se ingresaron en la HaDQ 132 pacientes para curas de heridas , (64% dehiscencias de heridas quirúrgicas , 17% desbridamientos , y 19% UPP). Todas fueron curas para cierre por segunda intención, de los cuales 72 pacientes precisaron TPN.

Un 15% de pacientes precisaron además control de drenajes (75% intrabadominales), antibi0terapia endovenosa (5%), analíticas (31%), o pruebas complementarias (18%), mayoritariamente TAC abdominales (87,5%).

El 73% de los pacientes fueron atendidos en su domicilio, con un máximo de 2 visitas al día, y un 37% se atendieron en el hospital (HD (24%), o consultas externas preferentes (26%)) por el propio equipo de HaDQ, y se realizaron un 15% de controles telefónicos.

La continuidad asistencial fue gestionada por las gestoras de casos hospitalarias.

Conclusiones: 1. Los pacientes que ingresan en HADQ para curas de heridas son pacientes complejos, con heridas complejas y a veces, con otros problemas relacionados con su postoperatorio complicado. 2. La HADQ puede ofrecer una atención más frecuente e intensa en curas complejas, (máximo 2 visitas/día), siendo un soporte para la Atención Primaria, permiitendo liberar camas hospitalarias.

 

EP1406 Anestesia periapical, ¿miedo o desconocimiento? - a propósito de un caso

Paula Barnés Anglada¹, Mar Gainza Sancha¹, Carmen Prieto Hernández¹, Claudia Martinez Menendez^1
1Serveis de Salut Integrats Baix Empordà, La Bisbal d‘Empordà, Spain

Objetivo: Empoderar a los profesionales de enfermería a desarrollar sus capacidades, ante la realización de técnicas complejas. 

Métodos: Niño de 13 años con herida suturable en boca, tras un golpe. 

1. Empatía y seguridad.
2. Entrevista: sin antecedentes patológicos ni alergias medicamentosas conocidas. Vacunación antitetánica correcta.
3. Valoración: herida aguda (hacía 30 minutos) incisa-contusa, lineal y limpia, en zona interna del labio inferior izquierdo. De 4cm de extensión y 0,5cm de profundidad, afectación de mucosa oral y tejido subcutáneo. Valoración sensitiva, funcional y vascular normal.
4. Anestesia: debido al edema, se decidió administrar el anestésico mediante el bloqueo nervioso con la técnica periapical, anestesia troncular donde conseguimos dormir el nervio alveolar anterior y el nervio mentoniano. Se administró Mepivacaína 2% con aguja hipodérmica, entre primero y segundo premolar, y entre el incisivo central y lateral. A los 10 minutos no sentía dolor.
5. Revaloración y limpieza profunda.
6. Planificación: se optó por sutura reabsorbible 5/0 y aguja punta redonda 1⁄2 círculo de curvatura, mediante técnica Halving.
7. Sutura: se realizaron 4 puntos simples teniendo en cuenta la alineación de tejidos, simetría de planos y puntos, afrontamiento de dermis, eversión de bordes, y tensión del anudado.
8. Curas posteriores: analgesia, hielo local, higiene bucal.

Resultados: Revisión a los 4 días, herida prácticamente cicatrizada, dos puntos centrales desprendidos, y el edema y dolor habían reducido.

Conclusiones: Enfermería apuesta por la formación continuada. Tiene los estudios y las capacidades suficientes para abordar, de forma autónoma y satisfactoria, casos como el descrito. Potenciemos su figura. 

 

EP1042 Infección del sitio quirúrgico (SSI) diagnóstico precoz por termografía infrarroja

Ana Cortiñas¹, Elena Herrador¹, Mónica Calle¹, Ariadna Castro¹, Juan Ignacio González¹, Ana Salinas^1
1GNEAUPP, Cordoba, Spain

Objetivo: La infección del sitio quirúrgico representa un problema de salud cuya prevalencia varía en función de la ubicación y del tipo de cirugía, siendo la abdominal la más habitual. Esta oscila entre el 5 y el 38% dependiendo del origen y características de la población. Se produce en los 30 días postcirugía (sin implantes) o en el año siguiente con implantes. La literatura referida al uso de la termografía infrarroja en la detección de la SSI es escasa, según nuestra revisión.

Queremos demostrar la utilidad en la detección temprana de SSI en heridas quirúrgicas abdominales y de la aparición de seromas quirúrgicos, mediante termografía infrarroja, secundarios a condiciones individuales o a Técnica quirúrgica de alta complejidad.

Métodos: Estudio prospectivo, descriptivo y observacional del que disponemos en este momento de datos parciales, de los pacientes del H.C. Valle de los Pedroches en el Área Sanitaria Norte de Córdoba (ASNC) intervenidos en cirugía abdominal y cirugía de cadera y rodilla. A cada paciente que reúne los criterios de inclusión se le fotografía la herida quirúrgica y se realizan tomas por termografía infrarroja para crear un modelo 3D que permita la detección temprana de los puntos de infección.

Resultados: Lo obtenido hasta ahora difiere poco de los que revelan los estudios de nuestra revisión. 

Conclusiones: La termografía infrarroja es muy útil para la detección temprana y tratamiento de la infección de sitio quirúrgico, por aumentar la morbilidad, acortar los tiempos de cicatrización.

 

EP1407 La importancia de la adherencia terapéutica junto con terapia coadyuvante en el proceso de optimización de la cicatrización de una lesión cutánea. A propósito de un caso

Iris Torrent¹, Montserrat Cabero Jiménez¹, Paula Gris Martínez¹, Cristina Ibáñez De La Vega¹, Claudia Martínez Martín
¹CAP Terrassa Nord, Terrassa, Spain

Objetivo: Demostrar la eficacia de la terapia compresiva como coadyuvante en la cura de desgarros cutáneos. Identificar la importancia de la adherencia terapéutica para reducir el tiempo de curación y favorecer la correcta cicatrización. 

Métodos: Se expone un caso clínico de una paciente de 86 años pluripatológica que presenta un desgarro cutáneo ISTAP 2 en el miembro inferior izquierdo derivado de un traumatismo. Lecho de la herida con tejido de granulación. Exudado seroso leve, piel perilesional íntegra, bordes regulares y definidos, sin signos de infección. Candidata a terapia compresiva coadyuvante por insuficiencia venosa crónica, tras descartar contraindicaciones. 

Resultados: Iniciamos pauta de cura mediante apósito de espuma de poliacrilato junto con vendaje de corta tracción a 20 mmHg como tratamiento coadyuvante. Presenta tórpida evolución, sin adherencia a la terapia compresiva, con gran aumento del edema, enrojecimiento de la piel perilesional, así como aumento del dolor y del exudado. A fin de gestionarlo, aplicamos apósito de alginato cálcico. Logramos que se comprenda la importancia del vendaje multicomponente para la correcta cicatrización y comenzamos terapia compresiva mediante vendaje bicapa. Objetivando correcta gestión del exudado, espaciamos las curas a una vez por semana hasta observar ligera hipergranulación del lecho. Para tratarla, aplicamos apósito absorbente modulador de proteasas, revalorando a los cuatro días. En todas las curas empleamos solución de copolímero acrílico en zona perilesional y ácidos grasos hiperoxigenados en todo el miembro. Logramos la completa cicatrización en un total de 37 días. 

Conclusiones: Realizando un abordaje individualizado que comprende la correcta pauta de cura, adaptada a la evolución de la lesión, la educación sanitaria a la paciente y la terapia coadyuvante, se demuestra la aceleración de la curación. 

 

EP1408 Eficacia de las Intervenciones de enfermería en el manejo de complicaciones de una fractura de cadera y síndrome compartimental agudo: estudio de caso

Quetty Previl Seide¹, Maria Mercedes Terribas García², María Concepción Barquero Vargas³, María Ángeles Roldán Yañez^2
1Hospital Clínico San Cecilio, Granada, Spain, ²Hospital Clínico San Cecilio, Granada, Spain, ³Hospital Virgen De Las Nieves, Granada, Spain

Objetivo: Evaluar la efectividad de las intervenciones de enfermería en el tratamiento y recuperación de una herida compleja asociada a síndrome compartimental, promoviendo la cicatrización y reduciendo el riesgo de infecciones.
Métodos: Paciente de 73 años con antecedentes de hipertensión y cáncer en remisión, intervenida por fractura de cadera con prótesis parcial. Tras una extravasación de contraste en diagnóstico, desarrolló síndrome compartimental en la mano derecha. La intervención enfermera incluyó: 1. Curas con Prontosan, apósitos de alginato y vendajes de compresión para manejar el exudado. 2. Desbridamiento estéril de tejido no viable y aplicación de colágeno para mejorar la granulación. 3. Seguimiento constante de signos de infección y ajustes de tratamiento según evolución.
Resultados: Las intervenciones enfermeras lograron una cicatrización adecuada de la herida sin signos de infección. Las técnicas de cura y el uso de colágeno promovieron una rápida granulación y el cierre de la herida, alcanzando epitelización completa a las seis semanas.
Conclusiones: El manejo enfermero es esencial en heridas complejas, especialmente en pacientes geriátricos con síndrome compartimental postquirúrgico. Las técnicas avanzadas de cura, junto con un seguimiento activo y ajuste constante del tratamiento, favorecen la cicatrización y reducen complicaciones, mejorando significativamente el pronóstico del paciente.

 

EP1409 Traumatismos de bajo impacto, hematomas disecantes, serie de casos

Jose Manuel Rosendo Fernandez¹, María Isabel Campos González², Rocío Barral Fernández², José Antonio Esperón Güimil³, Ana García Fernández⁴, Ana María Bello Jamardo⁵, Carla Rosendo Lafuente^6
1Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ³Atención Primaria, Enfermero, Anafans, Pontevedra, Spain, ⁴Complejo Hospitalario Universitario de Pontevedra, Enfermera, Subdirección de enfermería, Pontevedra, Spain, ⁵Complejo Hospitalario Universitario de Pontevedra, Supervisora de Unidad, Cirugía, Vilagarcía de Arousa (Pontevedra), Spain, ⁶Complejo Hospitalario Universitario de Pontevedra, Enfermera, Servicio de Psiquiatría, Pontevedra, Spain

Objetivo: Presentar una serie de casos de hematomas disecantes producidos por traumatismos de bajo impacto.

Material y método: Una vez que se haya definido en la piel y quede perfectamente delimitado el hematoma, hay que proceder a su drenado. Hasta ese momento, se aplica solución astringente en la zona afectada. A los 7 días, se comienza con la preparación del lecho de la herida que consiste en retirar el tejido no vascularizado, o con pérdida estructural, generalmente coágulos, hasta conseguir la visualización del tejido de granulación. A veces es necesario realizlo en varias sesiones entre las cuales se aplica Colagenasa y apósitos para el correcto manejo del exudado. En ocasiones es necesario suprimir la anticoagulación y pasar a tratamiento con heparinas de bajo peso molecular (HBPM) subcutánea. El vendaje de contención puede ser beneficioso para realizar hemostasia en un primer momento y como tratamiento en pacientes con Insuficiencia venosa crónica, en cuyo caso, será de compresión.

Resultados: Se presenta una serie de casos clínicos de traumatismos de bajo impacto con hematomas disecantes.

Caso 1. Traumatismo de bajo impacto con la taza del inodoro.

Caso 2. Traumatismo cara lateral de la pierna izquierda

Caso 3. Traumatismo tras caída.

Conclusiones: Se consigue en cierre de todas las lesiones de forma efectiva, siguiendo la metodología propuesta. Es importante realizar un completo drenaje del hematoma para evitar infecciones del tejido subcutáneo. El vendaje de contención para realizar hemostasia en es una elección y será de compresión de como tratamiento adyuvante en pacientes con Insuficiencia venosa crónica.

 

EP1410 Mastitis necrotizante, complicación poco frecuente post parto

Rocío Barral Fernández¹, María Isabel Campos González¹, Jose Manuel Rosendo Fernandez², Marta Ortega Recio³, María del Pilar Rodriguez⁴, Marta Rosendo Lafuente⁵, Carla Rosendo Lafuente^6
1Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ³Complejo Hospitalario Universitario de Pontevedra, Supervisora de Unidad, Medicina Interna, Pontevedra, Spain, ⁴Complejo Hospitalario Universitario de Pontevedra, Supervisora de Unidad, Cirugía Vascular, Pontevedra, Spain, ⁵Complejo Hospitalario Universitario de Pontevedra, Enfermera, Unidad de Urología, Pontevedra, Spain, ⁶Complejo Hospitalario Universitario de Pontevedra, Enfermera, Unidad de Psiquiatría, Pontevedra, Spain

Objetivo: Cicatrizar seno de mujer en proceso lactancia, tras una mastitis necrotizante

Objetivos específicos: Manejo de la secreción láctea de forma efectiva. Aumentar el confort de la paciente.

Material y método: Mujer sin antecedentes de interés, que requirió hospitalización para dar a luz, presentando en el post parto edema, calor local en el seno, con fiebre, dolor intenso con una puntuación en la Escala Visual Analógica (EVA) de 6 puntos y placa necrótica en el seno izquierdo de 12 x 8 cm. Se inició tratamiento con abordaje quirúrgico desbridando del tejido necrótico. Se avisa para valoración a la Unidad de Heridas.

Se comienza cura en ambiente húmedo (CAH) con la siguiente pauta: limpieza con solución salina, apósitos primarios malla de cloruro de diaquilcarbamilo, para manejo de la carga bacteriana. Refuerzo por abundante secreción láctea con alginato cálcico y apósito multicapa con tecnología flex de silicona adhesivo. La frecuencia de curas se realiza inicialmente cada 12 horas espaciando a 24, 48 y 72 h. según secreción láctea.

Resultados: La evolución óptima de la herida, así como el manejo de la infección, el manejo de la secreción láctea y el confort de la paciente.

Conclusiones: La utilización de apósitos de CAH, favorece la migración de las células y la formación de nuevo tejido sin dificultad. Escoger el producto correcto a utilizar en la CAH en función de los signos de infección, tejido presente , características del exudado, localización de la lesión, piel perilesional de la herida, sin olvidar el confort de la paciente.

 

EP1411 El reto de emplear apósitos de membrana poliméricamultifuncional (AMPM) en pérdidas de sustancia en el tercio distal de los dedos de la mano

Mònica Fernández Sabatés¹, Juan Antonio Martínez García², Juan Miguel Morales Labrat¹, Carmen Sánchez Sánchez¹, Alba Clarens Giralt¹, Marta Pons Mallol³, Marta Ochoa López^4
1FREMAP, Barcelona, Spain, ²FREMAP, Sabadell, Spain, ³FREMAP, Sant Boi Llobregat, Spain, ⁴FREMAP, Granollers, Spain

Objetivo: Ampliar el estudio realizado en 2019 de unos apósitos de membrana polimérica multifuncional en el que se pretendía comprobar, la eficacia y eficiencia, así como la reducción del dolor en heridas en la parte distal de los dedos de las manos.

Métodos: Se trata de un estudio experimental y descriptivo que compara la evolución de las heridas tratadas con otro tipo de apósitos con las tratadas en 2019 y 2024 en los meses de julio a septiembre en distintos centros con el apósito de membrana polimérica multifuncional.

Los criterios de inclusión han sido: Pacientes afectos de heridas en entorno laboral con pérdida de sustancia en tercio distal de dedos de mano que curen por segunda intención, que no tengan patologías que afecten a los procesos de epitelización y que den su consentimiento para participar en el estudio y publicar sus fotografías.

Se han valorado aspectos como el dolor en escala EVA y los días de baja laboral que han precisado en un caso y en otro.

Resultados: Dolor: se observan mejoras con la colocación del apósito y los cambios son poco traumáticos.

Evolución de las heridas: aunque que en algunas ocasiones producen maceración, ésta es autolimitada o fácilmente resoluble adaptando el pósito a la superficie del lecho.

Respecto a los días de baja, en comparación con el promedio nacional en heridas de características similares se reducen casi 2 días.

Conclusiones: El empleo de estos apósitos concretamente en las heridas descritas, ha demostrado ser, no sólo eficaz y eficiente, sino que además contribuye a una mejor experiencia del paciente por la reducción del dolor.

 

EP1412 Caso clínico: úlceras de lipschütz

Rebeca Mesa Vera^1
1Consorci Sanitari De Terrassa, Barcelona, Spain

Objetivo: Valorar los apósitos de hidrofibra® de plata como tratamiento de las úlceras de Lipschütz.

Métodos: Se ha realizado una revisión bibliográfica. El mayor volumen de publicaciones se encuentra desde 2020 hasta la actualidad, ya que se identifica como posible desencadenante a la infección por SARS-CoV-2, aunque el primer reporte donde se describe este tipo de úlcera es en 1913. Se centran en la etiología, pero muy pocas mencionan el tratamiento realizado. Se indican lavados de asiento, antisépticos y corticoides tópicos.

Resultados: Presentamos el caso de una mujer de 27 años, con un primer episodio de úlcera de Lipschütz (UL) en 2017, con una amigdalitis bacteriana como desencadenante. El segundo episodio ha ocurrido en 2024 tras un resfriado de varios días con fiebre altas y aftas bucales, sin determinar el patógeno que lo provocó. Presentaba úlceras diseminadas en labios menores con esfacelo, edema, exudado moderado y mal control del dolor. Dada la poca bibliografía existente, se eligió la hidrofibra® de plata por su acción contra el biofilm, aportación de humedad, retirada indolora y fácil aplicación. Realizó curas diarias en su domicilio tras la higiene con agua y jabón neutro. El diagnóstico se atrasó 2 semanas. Las lesiones se resolvieron en 3 semanas y se consiguió la cicatrización total con la aplicación de blastoestimulina® una semana más tarde.

Conclusiones: Las úlceras genitales agudas son poco frecuentes. Se debe realizar un diagnóstico diferencial temprano. El tratamiento de las UL con apósitos de hidrofibra® con plata Iónica es una opción a tener en cuenta, pero se necesitan más estudios que apoyen esta propuesta.

 

EP1413 Tratamiento tópico de las lesiones producidas por herpes zóster

Nerea Herrero Arnedo¹, Sandra Patricia Bravo¹, Paula Suárez^1
1Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo: Conocer la evidencia actual sobre los diferentes tratamientos tópicos utilizados para manejar las lesiones producidas por el herpes zóster.

Métodos: Se realizó una revisión bibliográfica en las siguientes bases de datos: Cochrane, Dialnet y Pubmed. Las palabras clave utilizadas fueron herpes zóster, tratamiento, lesiones. Los criterios para la inclusión de artículos fueron que hubiesen sido publicados en los últimos 5 años, en español o inglés y a texto completo. Se obtuvieron 5 artículos que fueron revisados por pares.

Resultados: El virus del herpes zóster provoca edema del citoplasma por acumulación de agua, que ocasiona la aparición de vesículas intraepidérmicas. Generalmente, estas lesiones presentarán humedad y exudación que, primero, controlaremos mediante la aplicación de un tratamiento secante. Lo más adecuado, son las soluciones aplicadas en forma de fomentos, ya que al evaporarse, producen vasoconstricción por enfriamiento, produciendo un efecto antiinflamatorio y secante, además de eliminar costras y detritus, ayudando a limpiar las heridas. Deben aplicarse durante 15-30 minutos, 2-3 veces al día. Destaca el óxido de zinc 10% en linimento oleocalcáreo (acción astringente, calmante y protectora de la piel) y el Permanganato potásico 1/10000 (acción antiséptica y astringente). La segunda parte del manejo es el tratamiento etiológico con antivirales tópicos que puede realizarse posteriormente o de forma concomitante a los anteriores, destacando Aciclovir o Famciclovir.

Conclusiones: No existe un consenso sobre cuál es el mejor abordaje de las lesiones provocadas por el herpes zóster aunque la literatura más actual aboga por la utilización de soluciones secantes, incluso pudiendo prescindir de los antivirales tópicos.

 

EP1414 Cuando lo inesperado cura

Silvia Martinez Salmeron¹, Laura Brazo Quero¹, Susana Blanco Torralba¹, Norma Garriga Peralta¹, Noelia Carricondo Mesa¹, Nerea Garcia Olmos¹, Guillermo I. Chacón Pérez^1
1CSC Vitae, Barcelona, Spain

Objetivo: Analizar la evolución y resolución del caso clinic excepcional de una quemadura facial, destacando que el abordaje con Sulfazina de plata, a pesar de no haber consenso no es el tratamiento estándar indicado

Métodos: Se presena el caso de una paciente que sufrio quemadura facial de Segundo grado provodada por un accidente doméstico.

Mantuvimos tratamiento habitual de limpieza y desbridamiento de tejido desvitalizado y aplicamos de manera insula la pomade de sulfamida de plata directamente en la zona afectada. Se documenta la respuesta al tratamiento, el manejo del dolor y el seguimiento durante el proceso de curación hasta completar cicatrización.

Resultados: A las 24h se observe una disminución significativa de la inflamación y el trascurso de los días siguientes la zona quemada comenzó a cicatrizer sin complicaciónes.

No hubo la necesidad de porcedimientos adicionales, y la paciente recuperó movilidad facial complete sin secuelas visibles a largo plazo

Conclusiones: Este caso representa una clara excepción a las normas de tratamiento para quemaduras facialees, que suelen requerir cuidados expecífivos y prolongados.

Este resultado desfaía la práctica estándar, pero subraya que cada paciente puede responder de manera diferentea intervencioens fuera de lo convencional, reconrdando que estas no deben generalizarse sin una evalución clínica adecuada.

 

EP1415 La acción de la insulina tópica en la cura de heridas

María Agramunt-Renau, Laura Moya-Bustamante¹, Arantxa Sales-Buj², Nuria Lario-Marin³, Teresa Hernández Hernández, Leyre Aldunate-Cia⁴, Maider Lara Zabala^4
1Osakidetza, Organización Sanitaria Integrada Debagoiena, Centro de Salud de Bergara, Bergara, Spain, ²Osakidetza, Organización Sanitaria Integrada Araba, Centro de Salud Olaguibel, Vitoria-Gasteiz, Spain, ³Osakidetza, Organización Sanitaria Integrada Araba, Centro de Salud Zaramaga, Vitoria-Gasteiz, Spain, ⁴Osakidetza, Organización Sanitaria Integrada Araba, Centro de Salud Lakua-Arriaga, Vitoria-Gasteiz, Spain

Objetivo: Describir la acción de la insulina tópica en la cura de heridas.

Métodos: Revisión bibliográfica en las bases de datos Cochrane, PubMed, Cuiden Google Scholar y Scielo. Se establece el límite de antigüedad de la búsqueda a 10 años, en inglés y en español. Palabras claves utilizadas: “wound”, “wound healing”, “insulin”.

Resultados: La insulina es una hormona comúnmente utilizada para regular los niveles de glucosa en sangre, sin embargo, estudios afirman su eficacia en la aceleración del proceso de cicatrización en la cura de heridas, ya sea en pacientes diabéticos o no.

El mecanismo de acción se basa en aumentar los factores de crecimiento, crear un ambiente antiinflamatorio gracias a la proliferación de macrófagos M2 y regular la respuesta oxidativa. Además, contiene un efecto angiogénico, ayuda a la migración de queratinocitos y favorece la re-epitelización y los depósitos de colágeno. No hay consenso sobre cuál es el método de aplicación idóneo debido a la falta de estudio, sin embargo, éstos afirman que la aplicación tópica no muestra efectos secundarios sistémicos (hipoglucemia, hipocalcemia…) ni locales (infección, dolor, alergia…).

Conclusiones: La insulina tópica se muestra como una potencial herramienta a la hora de la cura de heridas, promoviendo un cierre más temprano de las mismas y favoreciendo cada una de sus fases. Aunque hay falta de consenso y estudio acerca de este tema, la literatura coincide en que la aplicación tópica no provoca efectos secundarios en los pacientes.

 

EP1416 Desgarro cutáneo. Revisión bibliográfica

Paula Gris¹, Iris Torrent¹, Montserrat Cabero Jiménez¹, Cristina Ibáñez De La Vega¹, Meritxell Garcia Romero¹, Maria Teresa Carvajal García^1
1CAP Terrassa Nord, Terrassa, Spain

Objetivo: Identificar cuál es el mejor abordaje de tratamiento de los desgarros cutáneos.

Métodos: La búsqueda de información se realizó mediante una búsqueda bibliográfica en las bases de datos científicos Pubmed y BVS, y en las sociedades científicas más destacadas. Los descriptores utilizados han sido: desgarro cutáneo, skintear, tratamiento y treatment. Se han incluido los documentos de los últimos 5 años.

Resultados: Se ha obtenido 438 documentos. Se ha cribado por tipo de documento incluyendo estudios observacionales, revisiones, revisiones sistemáticas, guías de práctica clínica y metaanálisis; elegibilidad por texto completo y abstract; por idioma, inglés y español; obteniendo 41 documentos. Se identificaron 6 documentos válidos verificados con la lista PRISMA 2020.

La revisión de la literatura recomienda la recuperación del colgajo habiendo retirado del lecho hematomas y tejido no viable, la cura en ambiente húmedo con apósitos atraumáticos de base silicona, marcar la dirección de la retirada del apósito, optimizar los cuidados de la piel sana y adaptar el entorno.

Conclusiones: Debido a la reciente estandarización, y de su bajo registro, no se dispone de datos de prevalencia de DC, pero se estima que podrían superar a las úlceras por presión. Sería recomendado para investigaciones futuras identificar este tipo de heridas para poder realizar estudios de diferentes abordajes, así como las estrategias de prevención con mayor calidad en la evidencia científica.

 

EP1417 Insulina tópica para la cicatrizzación de heridas? Una revisión bibliográfica

Mireia Torres Signes¹, Luis Martí Santaolaria¹, Nerea Gómez Almendral^1
1Hospital de la Ribera, Alzira, Spain

Objetivo: Revisar la evidencia actual sobre la efectividad de la insulina tópica en la cicatrización de heridas.

Métodos: Se ha llevado a cabo una revisión bibliográfica en las bases de datos científicas. Se han utilizado principalmente las bases de datos Pubmed, Google Scholar, Dialnet y Scielo.

Los criterios de inclusión utilizados para nuestra búsqueda son: Artículos publicados a partir del año 2014, publicados en inglés y español, a texto completo y de acceso gratuito. Se utilizaron los descriptores: “insulina”, “cicatrización”, “metformina”, “topical insuline”, “wound” y el operador booleano “and”.

Resultados: A través de los diferentes estudios encontrados, se han evidenciado los beneficios de la utilización de la insulina tópica para la cicatrización de úlceras por presión, heridas corneales postoperatorias, heridas por traumas, heridas abiertas y quemaduras de tipo agudo y crónico tanto en pacientes diabéticos como no diabéticos. También se ha observado que en la muestra curada con insulina tópica se ha producido una aceleración en el cierre de la herida, el depósito de colágeno y la vascularización, promoviendo así significativamente la cicatrización de la herida.

Los estudios actuales han demostrado que la utilización de insulina tópica en las heridas es segura y efectiva tanto en personas diabéticas como no diabéticas, ya que no se han producido efectos secundarios.

Conclusiones: Los pacientes tanto diabéticos como no diabéticos se pueden beneficiar de la utilización de la insulina tópica para la cicatrización de sus heridas. Sin embargo, es necesario la realización de más estudios clínicos con una gran muestra, la realización de estudios para conocer el costo-efectividad de esta técnica y la creación de protocolos.

 

EP1418 Plan de curas en paciente con hematoma subcutáneo a tensión

Anna Solà Tayant¹, Anna Martinez Sibat^1
1Fundació Hospital de Campdevànol, Campdevànol, Spain

Objetivo: Dar a conocer el plan de curas de una paciente con un hematoma subcutáneo a tensión por anticoagulantes.
Método/Curas: Paciente anciana institucionalizada, presenta hematoma subcutáneo en extremidad inferior derecha tras iniciar tratamiento con Heparina de Bajo Peso Molecular para una Trombosis Venosa profunda fémoro-poplítea izquierda con importante edema subcutáneo.En fase de hemostasia, la lesión requirió de varias incisiones cortantes hasta la aparición de una placa necrótica, la cual se retiró, dejando al descubierto una lesión con tejido de granulación y restos de coágulos adheridos en el lecho.La lesión en fase inflamatoria se abordó con la técnica Roviralta, la cual consiste en la irrigación de Heparina de bajo peso molecular 0.4mg La heparina tiene la capacidad de estimular los neutrófilos, degradar el hematoma y liberar factores de crecimiento.Una vez tuvimos el lecho de la herida con tejido de granulación entramos en la fase proliferativa en que utilizamos terapia de presión negativa. Con este método conseguimos estimular la proliferación celular (angiogénesis), junto con el acercamiento de bordes nos permitió reducir el tiempo de cicatrización. En la fase de proliferación y epitelización utilizamos ácido hialurónico hasta su completa resolución. 
Conclusiones/Resultados: Ante hematomas en tensión se debe valorar el compromiso cutáneo y en caso de existir signos de sufrimiento cutáneo se recomienda realizar un drenaje de forma precoz.La aplicación de las diferentes técnicas utilizadas para la resolución del caso nos permitió un mayor control del dolor, evitar complicaciones como la infección y reducir el tiempo de curación.

 

EP1419 Prevención ISQ con apósitos hidropolimericos transparentes estéril

Carlos Ramirez Mañas¹, Jose Puentes Sanchez¹, Carmen Maria Pardo González^2
1Hospital Universitario Torrecardenas, Consulta De Heridas Cronicas Y Complejas, Almeria, Spain, ²Hospital Universitario Torrecardenas, Consulta De Enfermedades Infecciosas, Almeria, Spain

Método: Evaluación observacional de 101 pacientes de Cirugía general y aparato digestivo sometidos a colecistectomía abierta y/o laparoscópica intervenidos en el Hospital Universitario Torrecárdenas

Objetivo: beneficios del uso de utilizar apósitos hidropoliméricos en pacientes de cirugía General como prevención ISQ. Barrera frente a gérmenes; permitiendo una inspección visual de la incisión.

Resultados: La evolución en los 101 pacientes ha sido satisfactoria, no se presentó ninguna complicación, se han evitado curas programadas, no se ha producido ninguna infección. Es confortable y favorece la higiene, el paciente puede ducharse sin que interfiera en el apósito. Valoración del estado de la herida al ser transparente.

Conclusiones: Fácil de aplicar y retirada atraumática. Favorece la cicatrización. El apósito proporciona una barrera frente a los microorganismos. Visibilidad en todo momento del sitio postoperatorio. Minimiza la maceración y mima la piel perilesional. Y un gran ahorro económico pues acelera el alta hospitalaria, ahorra material, pues no necesita ningún curetaje y ahorro coste enfermero.

 

EP1420 Prevención de la infección del sitio quirúrgico en cesáreas programadas con apósitos estériles leukomed control

Carlos Ramirez Mañas¹, Jose Puentes Sanchez¹, Carmen Maria Pardo González^2
1Hospital Universitario Torrecardenas, Consulta De Heridas Cronicas Y Complejas, Almeria, Spain, ²Hospital Universitario Torrecardenas, Consulta De Enfermedades Infecciosas, Almeria, Spain

Método: Estudio observacional descriptivo retrospectivo. La muestra estuvo compuesta por 58 mujeres, de entre 17 a 44 años, que dieron a luz por cesárea Programada en el Hospital Universitario Torrecárdenas de Almería.
Objetivo: Comprobar si el uso de los apósitos Leukomed Control previenen la infección del sitio quirúrgico en mujeres con obesidad intervenidas de cesárea. Valorar si los apósitos Leukomed Control mejoran la calidad de los cuidados de enfermería postparto reduciendo el dolor y el número de cambios del apósito.

Resultados: Todas las heridas cicatrizaron con bordes de la herida sanos. Ninguna de las heridas mostró signos de exudado o infección. Cabe destacar que los pacientes no percibieron dolor general de la herida durante todo el periodo que mantuvieron el apósito.
Conclusiones: Leukomed Control es un apósito postoperatorio® adecuado que reduce los cambios de apósito a través de tiempos de uso más largos, lo que permite que la herida cicatrice sin ser molestada. Además, previene las infecciones del sitio quirúrgico y aumenta la calidad de vida / independencia de los pacientes al proporcionar acceso visual inalterado a la herida. En consecuencia, todos los profesionales sanitarios de este estudio recomendarían el uso de Leukomed Control como apósito postoperatorio.

 

EP1421 Variación de la técnica roviralta en una herida aguda traumática en consulta de atención primaria

Noemí Sánchez Ferreño¹, María Sebastián Rodriguez¹, Zara Doctama Ayong¹, Lidia Fernández Ginés¹, Lucía Requena Valencia¹, Estefanía Valcarce Moreno¹, María Costa Zaldívar^1
1Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Exponer la práctica y viabilidad de una variación de la técnica Roviralta en una consulta de atención primaria (AP)
Métodos: Varón, 77 años, accidente cerebro vascular, Raynaud, hiperlipidemia, bloqueo de rama derecha.
Tratamiento con antiagregantes.
Evolución: 1) Presenta escara supra maleolar externa en extremidad inferior derecha, de 7 días de evolución. Curado previamente con colagenasa sin conseguir desbridamiento satisfactorio. 2) Tras sospechar hematoma subcutáneo, se opta por desbridamiento cortante tras inyección de heparina de bajo peso molecular, cura en ambiente húmedo y vendaje compresivo. 3) Cadencia: curas 1-2 por semana, según exudado. El 20/09/24 el paciente viaja a Japón y asume autocuras.

Resultados:

Conclusiones: Cura eficaz en ambiente húmedo sin necesidad de drenaje ni suturas. Diminución del dolor y aumento de sensación de confort referida por el paciente (EVA=7-5-0). Técnica susceptible de aplicar en AP:

• Eficaz: reducción del 88% en 5 semanas
• Segura en pacientes antiagregados.
• Fácil implementación por no requerir excesivo entrenamiento.

 

EP1422 El yeso una dificultad en la cura de la herida

Norma Garriga Peralta¹, Laura Garcia Quero^1
1ICS, Barberà del Vallès, Spain

Es importante que en la enfermera en la consulta de Atención Primaria observe bien los signos que nos puede informar el paciente después de la colocación de un yeso en la pierna por una fractura.

Objetivo: Explicar la dificultad de la cura cuando hay fractura que precisa yeso.

Realizar guía de intervenciones enfermeras en el cuidado de la herida.

Métodos: A partir de la revisión bibliográfica y la experiencia profesional de las autoras se elabora un plan de cuidados enfermeros de acuerdo con la metodología NANDA.

Se desarrollan intervenciones enfermeras en el cuidado de la herida que presenta la pierna mientras lleva el yeso de la fractura.

Resultados: Realizaremos la guía de los cuidados de enfermería teniendo en cuenta los Diagnósticos de enfermería NANDA:

Deterioro de la integridad cutánea relacionado con la factura que precisa yeso manifestado por alteraciones de la superficie de la piel.

Alteración de la imagen corporal relacionado con la herida manifestado por tristeza, preocupación y miedo.

Riesgo de infección relacionado con la herida.

Conclusiones: Las heridas que se hacen cuando se ha puesto yeso después de una fractura tienen más dificultad en la curación y más riesgo de infección. Tener una guía de intervenciones de enfermería teniendo en cuenta los diagnósticos de la NANDA mejora la calidad del cuidado en la consulta de Atención Primaria. Permite que los profesionales que curan la herida puedan realizar un cuidado de calidad.

 

EP1423 Manejo de la necrosis cutánea tras la administración de terlipresina endovenosa en infusión contínua

Andrea Jimenez Rosal¹, Clara Ugas Dubreuil¹, Raquel Campo Moliner^1
1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Objetivo: Describir el manejo, evolución y los resultados en la cicatrización de lesiones necróticas causadas por el tratamiento con terlipresina a través de un caso clínico.
Métodos: Hombre de 48 años diagnosticado de cirrosis hepática que ingresó en una unidad de cirugía general y digestiva en marzo de 2024 por hepatitis aguda alcohólica. A raíz del empeoramiento de la función renal (síndrome hepatorrenal tipo I) se inició tratamiento con terlipresina endovenosa. A las 48 horas, el paciente presenta hematoma espontáneo (30cm x 20cm) a nivel hipogástrico y lesiones tipo flictenas que empeoran en los días posteriores y que requiere altas dosis de analgesia debido al dolor. Se realizó higiene de las lesiones con solución antimicrobiana y desbridamientos cortantes programados y se establecieron curas cada 24 horas con un apósito modulador de las metaloproteasas. Este apósito está indicado en heridas con exudado y actúa estimulando la angiogénesis local. Actualmente es el único tratamiento local que ha demostrado reducir el tiempo de cicatrización y restaurar la neovascularización.
Resultados: Se presenta el proceso de evolución y cicatrización final tras 4 semanas de tratamiento. La herida presentó tejido de granulación a los 15 días y éste fue creciendo de manera favorable hasta la etapa final de epitelización.
Conclusiones: Este apósito podría ser útil en el manejo de las lesiones necróticas causadas por terlipresina, destacando su potencial en la mejora de los resultados clínicos y en la calidad de vida de los pacientes que presentan esta complicación.

 

EP1424 Abordaje de un hematoma subcutáneo mediante la técniva Roviralta desde atención primaria

Laia Alonso ^1
1Nurse, Figueres, Spain

Los hematomas subcutáneos son heridas agudas secundarias a traumatismos, y es muy importante realizar un abordaje correcto donde se priorice la limpieza y el drenaje. Uno de los tratamientos posibles para resolver dichos hematomas es la técnica Roviralta.

Objetivo: El objetivo de este trabajo es valorar la utilización de la técnica Roviralta en una paciente con un hematoma subcutáneo de 2 semanas de evolución.

Métodos: Para ello, se expone un caso donde se realizó un pequeño corte en la lesión y se insinuó una gasa impregnada con 4.000 UI de heparina de bajo peso molecular junto con una espuma.

Resultados: Los resultados de este caso clínico muestran la resolución del hematoma en 7 días y la curación en 2 meses.

Conclusiones: Como conclusión, la aplicación de la técnica Roviralta nos ayudó en reducir el tiempo de cicatrización y evitar posibles complicaciones.

 

EP1425 Efectos secundarios de apósito de miel en tul en una herida por abrasión

Salome Riquelme Moreno^{1 2}, Carmen Sansano Gilabert¹, Ruth Belmar Belmonte^3
1Centro Salud Orihuela, Orihuela, Spain, ²Centro De Salud Orihuela, Orihuela, Spain, ³Centro De Salud Orihuela I, Orihuela, Spain

Objetivo: Identificar eficacia y efectos secundarios de apósito de miel en tul en herida por abrasión.
Métodología: Niño de 12 años presenta herida en rodilla por abrasión de una semana de evolución. No presenta conmorbilidad asociada. Según madre no se evidencia mejoría en herida tras haber sido tratada en domicilio con Sulfadiacina de plata en crema, aplicada 1 vez cada 24 horas desde que se produjo, es por ello que decide consultar con enfermería de atención primaria.En exploración física se aprecia herida en rodilla de 3x 4 con tejido amarillento, no exudativa, bordes rojos y calientes.
Resultados: Se realiza limpieza de herida, posterior descontaminación y se aplica apósito de miel en tul, Alginato y contención con apósito secundario.Inicialmente se pautan curas cada 48 horas en enfermaría, con una mejoría notable, se procede a realizar curas cada 72 horas hasta su epitelización completa.
Conclusiones: El apósito de miel ha tenido un efecto tanto antiinflamatorio como antimicrobiano, acelerando la cicatrización. A pesar de poseer este efecto antiinflamatorio el paciente manifestó durante los primeros minutos de aplicación del tul impregnad en miel, dolor intenso según la escala de Eva de 10 solo en las primeras curas.No debemos olvidar que se deben proteger bien los bordes perilesionales con óxido de zinc para evitar maceración. El caso se resuelve en 10 días y 4 curas, resultando un tratamiento costo-efectivo.

 

EP1426 Infección del sitio quirúrgico en cirugía abdominal en un hospital general. Una alternativa. Como le trataremos?

Alan Querevalu Olivares^1
1Hospital Nacional Arzobispo Loayza. Departamento Cirugía General, Aparato Digestivo y Pared Abdominal. Pabellón 6 II, Lima, Peru

Objetivo: Determinar los beneficios de la aplicación tópica de Ungüento β-Sitosterol, en pacientes con Infección de heridas operatorias abdominales gigante dehiscente para su posterior cierre.

Métodos: En el área de cirugía general en Perú, la tasa de infección de sitio quirúrgico (ISQ) varía según el tipo de cirugía y otros factores. Un estudio realizado en el HNAL mostró que la incidencia de ISQ en cirugías abdominales de emergencia fue del 12.3%. Factores de riesgo incluyen la edad, el género masculino, y (IMC) superior a 25. Paciente mujer edad 64 años, ingreso EMG HNAL, con cuadro clínico de dolor abdominal cólico en CII, náuseas y vómitos, deposiciones liquidas y SAT. Examen Clínico; taquicárdica. Abdomen globuloso RHA disminuidos. Dolor difuso a predominio de CII. Intervenida Quirúrgicamente con diagnóstico de sepsis pp abdominal: Diverticulitis Aguda. Diverticulitis Hinchey III. Al día uno y 14 se reintervino.

Resultados: Paciente presento durante su hospitalización ISQ con dehiscencia de herida. Lo que prolonga su estadía. Se aplico curación diaria de las heridas con SF y Ungüento tópico β-SITOSTEROL

Conclusiones: Ungüento β-SITOSTEROL en aplicación tópica repetidamente en heridas abdominales grandes y contaminadas. Ayudan en la limpieza de las heridas para un cierre posterior. Disminuye estancia hospitalaria.

Figuras:

 

EP1428 Manejo de autolesiones por rascado en adolescente. Favoreciendo su autocuidado

Laura Gómez Pardos¹, Carmen Blasco-García¹, Monica Castella^1
1HUGTIP-ICS, Badalona, Spain

Objetivo: Manejo de autolesiones por rascado de repetición en antebrazo izquierdo en joven de 17 años con antecedentes psicopatológicos y conductas autolesivas.

Métodos: Joven con Trastorno del Espectro Autista y trastorno depresivo recurrente que ha requerido seis ingresos hospitalarios por conductas autolesivas. Actualmente, presenta lesiones por rascado en el antebrazo izquierdo con difícil manejo por su localización y las características de la unidad de ingreso (Unidad de Psiquiatría Infantil) donde no se pueden colocar mallas ni vendas de cobertura.

Se deriva a enfermera clínica de heridas complejas para la valoración y tratamiento de las lesiones. Se inician curas con solución tópica de ácidos grasos hiperozonizados, favoreciendo la aplicación por parte de la joven.

Resultados: En dos semanas se consigue el cierre total de las heridas y la implicación de la paciente en su autocuidado.

Conclusiones: Tras un abordaje integral de la joven, se consiguió un manejo que favorecía la cicatrización de las lesiones y con la implicando a la paciente en su autocuidado y consiguiendo un tratamiento efectivo y muy valorado en la unidad de hospitalización, dado las características de la misma.

 

EP1429

Hidradenitis supurativa en ámbito de las heridas

Marta García Nuñez-Garcia¹, Casto Barbero¹, Rafaela Moraes Souza², Alba Sánchez Orta^3
1Hospital Universitario La Paz, Madrid, Spain, ²Hospital La paz, Madrid, Spain, ³Hospital la paz, madrid, Spain

Objetivo: Dar visibilidad al ámbito de las heridas y lesiones supurativas crónicas en pacientes con HS.

Métodos: La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica del folículo piloso, no infecciosa, que afecta principalmente las zonas intertriginosas. La fase aguda (brotes) cursa con nódulos, abscesos y trayectos fistulosos que pueden abrirse, dejando tejido inflamado expuesto y, en ocasiones, sobreinfectado. Puede progresar a un estado inflamatorio crónico con trayectos fistulosos, supuración maloliente, fibrosis dérmica y cicatrices hipertróficas.

Utilizamos el enfoque TIME para tratar las heridas de hidradenitis, teniendo como base las fases de cicatrización: eliminación de tejido no viable (Tissue), control de la infección e inflamación (Infection/Inflammation), mantenimiento de un adecuado balance de humedad (Moisture balance) y estimulación de los bordes de la herida para favorecer su cierre (Edge of wound). Dado que la HS no tiene una base infecciosa, los cuidados están dirigidos a la fase inflamatoria, controlando el exudado, la inflamación, la piel periulceral, el dolor y el picor. Además, en ocasiones se observan biofilms bacterianos que requieren tratamiento para prevenir sobreinfecciones y reducir la amplificación de la inflamación.

Resultados: La aplicación del enfoque TIME en el tratamiento de heridas de HS demostrando una mejora significativa en la reducción de la inflamación, el control de infecciones y la promoción de la cicatrización.

Conclusiones: La aplicación del enfoque TIME en el tratamiento de heridas de HS demostrando una mejora significativa en la reducción de la inflamación, el control de infecciones y la promoción de la cicatrización.

 

EP1430 Nuevos retos en enfermería: atendiendo el síndrome de piel escaldada en neonatos

Verónica Fernández Gronewold¹, Catarina Sevivas¹, María Sande Piñeiro¹, Sara Fernández Pereira¹, Lucía López Sande¹, Ana González Baleirón¹, Luis Couselo García^1
1Complejo Hospitalaria Universitario de Santiago de Compostela, Santiago de Compostela, Spain

Objetivo: Presentar un análisis detallado de un caso representativo de Síndrome de Piel Escaldada Estafilocócica (conocido por sus siglas en inglés como SSSS) en un recién nacido, destacando los cuidados de enfermería y la complejidad del tratamiento.

Métodos: Se seleccionó un paciente neonatal con unos de vida con diagnóstico de SSSS para aplicar un enfoque de cuidados basados en cura en ambiente húmedo (CAH) y contando con la implicación de los padres a través de cuidados centrados en el desarrollo del paciente y la familia (CCDF).

Se procedió a la limpieza del lecho de la herida con soluciones antimicrobianas¹ y según características de cada herida, los apósitos² apropiados para ello, además de utilizar gel desbridante³ on enzimas y alginato. Se mantuvo en todo el proceso una buena hidratación de la piel con gel lipófito⁴ con alto contenido en vitamina E pura.

Resultados: El uso de la cura húmeda junto a apósitos especializados resultó en una notable mejoría clínica. Se observó una reducción en el eritema, en la formación de ampollas hasta la curación completa.

La participación activa de los padres en el cuidado se tradujo en una mayor comodidad y adaptación durante el tratamiento.

Conclusiones: Los retos en los cuidados de enfermería, especialmente en la aplicación de cura húmeda y el uso de apósitos especializados y los CCDF demostraron ser efectivos en el manejo del SSSS. Este caso sugiere la necesidad de integrar estos enfoques en futuros protocolos de atención para optimizar los resultados clínicos en recién nacidos.

1. Protosan^R Solución
2. Biatain ContactR y Urgotull^R
3. Flaminal Hydro^R
4. VeaR Lipogel

 

EP1431 Manejo ambulatorio de heridas en zonas anatómicas complejas mediante técnica de empapamiento con ácido hipocloroso: serie de casos

Carolina Hernandez Fonseca¹, Belen Brantt Parejas^1
1Hospital Claudio Vicuña, San Antonio, Chile

Objetivo: Describir el estándar de manejo ambulatorio en heridas ubicadas en zonas anatómicamente complejas mediante la técnica de empapamiento con solución de ácido hipocloroso (HOCl) 330ppm y pH 5.5.

Métodos: Estudio observacional descriptivo. Se incluyó una serie de casos de pacientes con heridas postquirúrgicas en zonas complejas (perianal, interglútea y perineo), tratados de forma ambulatoria con técnica de empapamiento utilizando solución HOCl 330ppm y pH5.5, para favorecer el cierre por segunda intención. Los pacientes debían contar con red de apoyo, conocimiento de su patología y adherencia a las instrucciones. Se les indicó aplicar gasas saturadas en HOCl en el lecho de la herida, con cambios tras cada micción y/o deposición. El seguimiento de enfermería fue inicialmente dos veces por semana, ajustado a una vez por semana según adherencia y evolución clínica. Todos los participantes otorgaron su consentimiento informado.

Resultados: Los pacientes mostraron una reducción del tamaño de las heridas y del tejido no viable, logrando cicatrización completa en un promedio de 6 a 9 semanas, sin presentar infección local ni reacciones adversas. Refirieron que la técnica fue fácil de implementar, lo que facilitó la adherencia.

Conclusiones: El manejo ambulatorio fue exitoso gracias a la efectividad y simplicidad de la técnica de empapamiento con HOCl. Se evidenció un proceso de cicatrización sin complicaciones, mostrando que este abordaje es una medida costo-efectiva para el tratamiento de heridas complejas, optimizando el tiempo de enfermería, mejorando la gestión de recursos institucionales y reduciendo las visitas al centro de salud por parte de los pacientes.

 

EP1432 Abordaje conservador de herida compleja en pie con destrucción tendinosa frente a amputación funcional electiva

Mercè Piazuelo Pont¹, Carla Martin Calvo¹, Anzhela Kvasnytsya Liber¹, Roshni Alejandra Echaccaya Saenz¹, M Carmen Gallardo Batet¹, Sonia Riera Manzano¹, Maria Cera Pich^1
1Hospital Clinic de Barcelona, Barcelona, Spain

Objetivo: Describir el abordaje de un paciente con herida compleja en pie que rechaza la indicación médica de amputación.

Métodos: Mujer de 78 años, sin antecedentes médicos conocidos. Autónoma para actividades básicas de la vida diaria. Ingresa por empeoramiento y sobreinfección de múltiples lesiones de larga evolución en extremidades inferiores de componente vascular. Sin seguimiento por Atención Primaria. Destaca herida compleja en dorso pie derecho, tras vendaje compresivo mantenido durante semanas sin indicación terapéutica, con destrucción tendinosa y abundante tejido desvitalizado que se extiende hasta zona plantar. La paciente rechaza indicación médica de amputación infracondilea tras valoración de inviabilidad funcional del pie, iniciándose curas basadas en ambiente húmedo con miel médica como desbridante, antimicrobiano y antiinflamatorio. Se establecen curas cada 48h consiguiendo a la semana mejoría del exudado, limpieza de herida y disminución del dolor.

Resultados: A las tres semanas de iniciar curas con miel médica, la herida presenta crecimiento de tejido de granulación con cobertura del defecto cutáneo, así como cicatrización de la zona plantar. Se consigue controlar la infección, el edema y, el dolor durante las curas, rechazando analgesia a los 5 días de iniciar tratamiento con miel.

Conclusiones: La indicación médica de amputación ante heridas con destrucción profunda de tejidos, puede ser rechazada por el paciente a pesar de conocer las consecuencias en la funcionalidad de la extremidad afectada. La miel médica, con propiedades antimicrobianas, antiinflamatorias, regeneradoras y antisépticas, puede ser una opción terapéutica eficaz ante heridas complejas sobreinfectadas y desvitalizadas, mejorando el dolor y favoreciendo la cicatrización.

 

EP1433 Injertos en sello una nueva oportunidad para el cierre de heridas

Begoña Cabero García¹, Laura García Caridad¹, María Alonso Gonzalez^1
1Hospital Clínico Universitario de Valladolid, Valladolid, Spain

Objetivo: Disminuir el tiempo de cicatrización de herida por hematoma profundo disecante en la región pretibial izquierda tras golpe accidental.

Métodos: Se realiza una valoración integral de la paciente y la herida siguiendo el triángulo de valoración de las heridas. Dada la fragilidad de la paciente se opta por un abordaje con injertos en sello junto con terpia de presión negativa coadyuvante para reducir el tiempo de cicatrización y así disminuir las complicaciones asociadas. Se realiza una limpieza exhaustiva y adecuación de la lesión hasta obtener tejido de granulación. Se procede a extraer los injertos de la zona donante de la cara externa del muslo izquierdo, realizándose posteriormente cura con alginato calcico. Se colocan los injertos en sello en la lesión aplicando posteriormente terapia de presión negativa de un solo uso.

Resultados: Se produce el cierre completo de la herida en 45 días.

Conclusiones: La combinación de ambas terapias proporciona una solución rápida y eficaz en el cierre de heridas, manteniendo la seguridad y confort de la paciente.

 

EP1434 Apósito de membrana polimérica multifuncional en lesión aguda: experiencia
de uso

Veronica Sierra¹, Sergio Valero Sierra¹, Juan Antonio Martínez García², Nuria Serra Perucho³, Noelia Martín Ruiz⁴, Adrian Díaz Bermejo^1
1Institut Català de la Salut, Barcelona, Spain, ²Mutua FREMAP, Mataró, Spain, ³Angiogrup, Barcelona, Spain, ⁴EAP Vic, Vic, Spain

Objetivo: Varón de 65 años, sin antecedentes de interés. Intervenido de Dupyutren el 13/12/2023, intervención quirúrgica sin incidencias. Tras la retirada de puntos de sutura a los 7 días, se aprecia dehiscencia de sutura en la parte central de la lesión post quirúrgica.

Métodos: Se realizó tratamiento inicial de la dehiscencia con yodo y gasas, objetivándose a las 24 horas una maceración de los bordes de la lesión. Se decide cambio de cura a cura en ambiente húmedo con varios apósitos diferentes, sin obtener resultados positivos, y tras 5 días se cambió la pauta de cura a apósito de membrana polimérica multifuncional (AMPM) tras realizar limpieza y desbridamiento de la dehiscencia.

Ante la evolución positiva de la lesión, se continuó curas cada 48h.

Resultados: La limpieza y epitelización de la herida se consiguió en dos curas resultando fácil la aplicación y manipulación del apósito.

Conclusiones: El uso de AMPM en heridas agudas nos ayuda a prevenir infecciones, minimizar el gasto y el número de días del proceso de cicatrización. Se consiguió la cicatrización completa en una semana. Hubo una reducción en gasto de materiales respecto a las curas anteriores.

 

EP1435 Manejo de herida traumática en región tibial mediante vendaje compresivo, a propósito de un caso

Ana Belén Milán Casero¹, Clara Rodríguez De Gea², Maria Eugenia Carrillo Molina³, Noelia Rodas Martínez⁴, Nieves Garre Baños^3
1Servicio Murciano de Salud, Yecla, Spain, ²Servicio Murciano de Salud, Cehegín, Spain, ³Servicio Murciano de Salud, Caravaca, Spain, ⁴Servicio Murciano de Salud, Calasparra, Spain

Objetivo: Describir el uso de vendaje compresivo como técnica efectiva para el abordaje de heridas traumáticas orientado a disminuir el tiempo de cicatrización de la herida.

Métodos: Revisión bibliográfica en Pubmed, a partir de la cual se elaboró la estrategia de abordaje de la herida, siendo esta: lavado con suero fisiológico, fomento con solución de polihexanida 0,1% durante diez minutos, cadexómero yodado, óxido de zinc en piel perilesional, alginato cálcico, hidratación de la piel con crema emoliente y vendaje compresivo de corta tracción. Se dieron recomendaciones de actividad física y se aconsejó aumentar el aporte proteico.

Resultados: Durante los primeros quince días de seguimiento se mantuvo el tratamiento aplicando los cuidados locales dos veces por semana de acuerdo al exudado. Además, se procedió mediante desbridamiento cortante, a la retirada del tejido necrótico y biofilm, y acondicionamiento de los bordes en cada una de las curas. Posteriormente, se cambió el tratamiento al día dieciséis por óxido de zinc tanto en lecho como en piel perilesional debido a la hipergranulación que se estaba produciendo en la herida consiguiendo una notable mejoría.

Conclusiones: Aunque la cicatrización de las heridas es un proceso complejo, los resultados avalan el uso de la terapia compresiva de corta tracción como un tratamiento seguro y eficaz que disminuye el tiempo de cicatrización de heridas y aumenta la tasa de éxito interviniendo en la disminución de la inflamación y el edema. Sin embargo, el uso de esta terapia en heridas traumáticas debe seguir estudiándose.

 

EP1436 Capacitación de profesionales para el uso correcto de la guía de tratamiento de heridas: relato de experiencia

Cristielle Montenegro¹, Alyne Duarte², João Patto², Nayane Cunha², Bárbara Pompeu², Herleis Maria², Blanck Mara^3
1Emad/Semsa, Rio Branco, Brazil, ²Ufac, Rio Branco, Brazil, ³Sobenfee, Rio De Janeiro, Brazil

Objetivos: Capacitar a los profesionales de la Red de Atención en Salud para el uso adecuado de la Guía de Tratamiento de Heridas, estandarizando la calidad de los procesos de trabajo y asegurando la correcta solicitud de insumos hospitalarios para atención domiciliaria, conforme a las directrices actualizadas del Servicio de Atención Domiciliaria (SAD) y el Programa Mejor en Casa (PmeC).
Métodos: El proceso incluyó reuniones de alineación por segmento de salud, con la participación de representantes de las Unidades de Referencia en Atención Primaria (URAPs) y Unidades Básicas de Salud (UBSs), para presentar los instrumentos estándar de solicitud de insumos, estableciendo periodicidad y designación de responsables. Durante las reuniones, se presentó la Portaría Ministerial n.° 3.005/2024, que actualiza las normas del SAD y del PmeC, aclarando las nuevas normativas y responsabilidades. También se llevó a cabo la I Jornada Científica “Tecnologías aplicadas al cuidado de heridas en la Atención Primaria de Salud”, además de capacitaciones específicas para el tratamiento y prevención de heridas y ostomías.
Resultados: Las capacitaciones mejoraron la comprensión de los procedimientos actualizados, promoviendo mayor seguridad en la atención y en la solicitud de insumos. La jornada científica también fortaleció la práctica clínica de los profesionales, proporcionando herramientas para una atención basada en evidencias.
Conclusiones: La experiencia resalta la importancia de la capacitación continua y la estandarización para la calidad en la atención de heridas. La capacitación promovió autonomía y seguridad en los procesos, garantizando una atención eficiente conforme a las nuevas directrices.
Palabras clave: Capacitación, tratamiento de heridas, estandarización, calidad de la asistencia, salud.

 

EP1437 Revisión bibliográfica de la aplicación de insulina tópica en la cicatrización de heridas

Lucía Requena Valencia¹, Lidia Fernández Ginés¹, Estefanía Valcarce Moreno¹, María Sebastián Rodriguez¹, Zara Doctama Ayong¹, Noemí Sánchez Ferreño¹, María Costa Zaldívar^1
1Cap Larrrard. Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Revisar la evidencia disponible del uso de insulina tópica en la cicatrización de heridas.

Métodos: Revisión bibliográfica en las bases bibliográficas de Pubmed, Cochrane y Scielo.

Los criterios de inclusión son: ensayos clínicos, revisiones sistemáticas y estudios observacionales en español e inglés y publicados a partir del 2012. Estrategia de búsqueda: ((injuries, wounds[MeSH Terms]) OR (wounds and injury[MeSH Terms]) OR (wounds and injuries[MeSH Terms])) OR (ulcer[MeSH Terms]) OR (leg ulcer[MeSH Terms])) AND (wound healing[MeSH Terms]) AND (insulin[MeSH Terms]) AND ((administration, topical[MeSH Terms]) OR (administration, cutaneous[MeSH Terms])) 

Resultados: Se han obtenido un total de 20 artículos. Los estudios revisados indican que la insulina tópica puede acelerar la cicatrización de heridas, incluso en pacientes no diabéticos, al promover la angiogénesis y la proliferación celular, favoreciendo la granulación y la reducción del área de la herida. También se destaca su efecto antiinflamatorio.

Conclusiones: La insulina tópica se presenta como una opción prometedora para mejorar la cicatrización de heridas, destacando su capacidad para estimular procesos biológicos esenciales, sin efectos secundarios en pacientes no diabéticos y con capacidad de reducción del dolor. La evidencia disponible sugiere que la insulina no solo es útil en el manejo de la diabetes, sino que también puede ser un agente terapéutico valioso en el tratamiento de heridas, abriendo nuevas vías para investigaciones futuras en este campo en la medicina regenerativa.

 

EP1438 Cicatrización de heridas complejas mediante el manejo del estrés oxidativo

Patricia Martínez López^1
1Hospital de Cruces, Barakaldo, Spain

Objetivo: Evaluar el impacto del manejo del estrés oxidativo en la cicatrización de heridas complejas, centrándose en la mejora de la respuesta reparadora y la reducción de complicaciones.

Métodos: Se llevó a cabo un ensayo clínico controlado con 8 pacientes que presentaban heridas complejas. Se dividieron en dos grupos: uno recibió tratamiento estándar y el otro un enfoque combinado que incluía antioxidantes específicos y agentes que modulan el estrés oxidativo. Se midieron parámetros de cicatrización como el tiempo de cierre de la herida, la inflamación y la formación de tejido granuloso.

Resultados: El grupo tratado con antioxidantes mostró una reducción del 40% en el tiempo de cicatrización en comparación con el grupo control. Además, se observó una disminución significativa en los marcadores de inflamación y un aumento en la calidad del tejido reparador. Los pacientes en el grupo de intervención reportaron menos complicaciones y una mejora en su calidad de vida.

Conclusiones: El control del estrés oxidativo es una cuestión importante para adelantar la fase inflamatoria y para mejorar significativamente la cicatrización de heridas complejas. Este enfoque no solo acelera el proceso de cicatrización, sino que también reduce la inflamación y las complicaciones asociadas. Se sugiere que la incorporación de estrategias antioxidantes en el tratamiento de heridas complejas sea considerada como parte de un protocolo integral para optimizar los resultados clínicos.

 

EP1439 Guía de práctica clínica para el manejo de lesiones periostomales según la clasificación de la escala SACS 2.0

Sandra Guerrero Gamboa^{1 1}, Diana Pinilla Ortiz^1
1Universidad Nacional de Colombia, Bogotá DC, Colombia

Objetivo: Diseñar una guía de práctica para el manejo y cuidado de las lesiones periostomales, según la clasificación del instrumento SACS 2.0 adaptado y validado para Colombia.

Métodos: Se realizó una búsqueda de literatura en 10 bases de datos, 1 motor de búsqueda y 3 revistas indexadas utilizando palabras claves en inglés y español. Se seleccionaron 12 artículos de 73 revisados. Se realizó la calificación del nivel de evidencia por medio del sistema de clasificación del SIGN.

Resultados: Se establecieron 23 recomendaciones de nivel 1+, 2++, y 3 según la clasificación SIGN y las recomendaciones generadas son grado A B, C y D las cuales fueron organizadas según el tipo de lesión de la clasificación SACS 2.0.

Conclusiones: Las evidencias identificadas se constituyen en una base sólida para la estandarización del manejo por el equipo interdisciplinar, la justificación de la inclusión de insumos y productos en los paquetes de atención y la elaboración de bases de datos para estudios posteriores sobre eficacia y efectividad del manejo propuesto.

 

EP1440 Diseño de un protocolo para la prevención de úlceras por presión en pacientes de piel oscura

Soraya Blanco Jorge¹, Patricia Ferreira López¹, Covadonga López Viejo¹, Estefanía Castro González¹, Fernando Valdés Tascón², María Méndez Ramos³, Rocío López López^4
1Servicio de Medicina Interna, Hospital público da Mariña, Servizo Galego de Saúde, Lugo, Spain, ²Servicio Dermatología, Hospital da Mariña, Servizo Galego de Saúde, BURELA, Spain, ³Centro de Saúde de Burela, Área Sanitaria Lugo, A Mariña y Monforte de Lemos, Servizo Galego de Saúde, Lugo, Spain, ⁴Grupo de investigación en Gerontología y Geriatría, Universidad de A Coruña, Instituto de Investigación Biomédica de A Coruña, Servizo Galego de Saúde, A Coruña, Spain

Objetivo: Diseñar y evaluar un protocolo para la detección temprana de riesgo de úlceras por presión (UPP) para pacientes de piel oscura.

Métodos: Se incorporó la evaluación de la tonalidad de la piel mediante la Escala de Skin Tone Assessment dentro al algoritmo del servicio autonómico de salud. En pacientes identificados con riesgo de UPP, se implementaron medidas preventivas específicas, incluyendo: inspecciones frecuentes de zonas de presión utilizando técnicas de palpación para detectar cambios de temperatura y textura; uso preferente de superficies especiales de manejo de presión; monitorización continúa de signos de lesión temprana mediante imagen térmica para detectar áreas de inflamación subclínica; e interconsulta con dermatología para apoyo diagnóstico.

Resultados: La inclusión de la valoración del tono de piel en el protocolo facilitó una evaluación de riesgo más precisa, permitiendo la detección precoz de daño tisular en pacientes de piel oscura. El pilotaje hospitalario mostró que los pacientes, en los que se aplicó el protocolo reforzado de prevención, presentaron una reducción significativa en la progresión de UPP al alta en comparación con aquellos que siguieron el algoritmo estándar vigente.

Conclusiones: La evaluación adaptada de la tonalidad de piel mejora la identificación temprana de cambios cutáneos en pacientes de piel oscura. Integrar esta valoración en los protocolos de prevención puede aumentar la precisión diagnóstica y reducir la incidencia de UPP, optimizando la gestión de recursos. Este enfoque promueve el desarrollo de intervenciones preventivas y permite adaptar los algoritmos para el manejo de UPP a la diversidad poblacional.

 

EP1441 Dehiscencia de herida craneal tratada con apósito modulador de metaloproteasas de matriz (MMP)

Cecilia Valles Quintilla¹, Pilar Ibars Moncasi¹, Judit Panades Cabre¹, Núria Sogas Vicente¹, Núria Elena Alba Miro¹, Luz Maria Figueiras Mareque¹, Rosa Maria Pedra Sola^1
1Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Presentar la evolución de una herida con dehiscencia y perdida del colgajo primario aplicando apósito modulador MMP.

Método: Seguimiento del caso a través de la historia clínica e imágenes tomadas durante las curas.

Resultados/Discusión: Paciente de 70 años intervenida el día 7/03/24 exéresis de melanoma cuero cabelludo vértex, reconstrucción con colgajo de rotación parcial y ganglios centinelas bilaterales. Antecedentes: Diabetes, Hipercolesterolemia, Asma, Fumadora, Obesidad.

Evolución tórpida con sangrado a las 24 horas y posterior perdida completa del colgajo.

A nuestra valoración la paciente presenta cuatro heridas en el cuero cabelludo en la zona parietal central. La de mayor tamaño mide 6x3cm y 0.3 cm profundidad, sin exposición de calota. Las otras tres conservan puntos de sutura y presentan dehiscencias en alguna zona.

En la pauta de curas aplicamos los cuatro pasos de higiene de la herida:

- Limpieza de la herida con solución de hipoclorito de sodio; bordes y perilesión, con agua y jabón.

- Desbridamiento proactivo de tejido no viable, biofilm y restos de detritus.

- Acondicionamiento de los bordes mediante curetaje

- Aplicación de apósito:

• Apósito primario que acelere la cicatrización de la herida y para prevenir la infección.
• Apósito secundario adherente, cómodo y con gestión óptima del exudado para espaciar las curas.

Conclusión: El procedimiento de la higiene de la herida en cada cura nos proporcionó una herramienta para estandarizar los cuidados, ya que se compartieron con el equipo de atención primaria. El apósito con MMP con octosulfato de sacarosa fue muy efectivo, rápido y seguro para el cierre de lesiones de poca profundidad.

 

EP1442 Avances en el manejo de heridas: innovaciones terapeuticas y efectividad clinica

Adrian Montoya Ortega¹¹Hospital Universitario De Toledo, Toledo, Spain

Objetivo: Las heridas crónicas y agudas representan un desafío significativo en la práctica clínica, debido a su impacto en la calidad de vida del paciente y la carga económica para los sistemas de salud. Los avances en el manejo de heridas han introducido varias opciones terapéuticas como los parches súper absorbentes y las terapias de presión negativa. Estas innovaciones han demostrado mejorar la eficiencia del proceso de curación a través de la optimización del ambiente de la herida y facilitar la eliminación del exudado.

Métodos: Para efectuar esta revisión sistemática, se efectuó una búsqueda comprensiva en bases de datos como PubMed, Cochrane Library y Embase, utilizando términos como “heridas”, “parches súper absorbentes” y “terapia de presión negativa”. Se incluyeron artículos en inglés, publicados hasta marzo de 2023. Se excluyeron estudios no clínicos y aquellas publicaciones sin acceso completo.

Resultados: La revisión identificó 120 estudios relevantes, de los cuales 30 cumplieron con los criterios de inclusión para el análisis cualitativo. Se observó una tendencia positiva en la eficacia de los parches súper absorbentes en el manejo de heridas exudativas sobre terapias convencionales. Con respecto a la terapia de presión negativa, se corroboró una mejora significativa en la cicatrización de heridas postoperatorias y úlceras crónicas.

Conclusiones: El análisis sistemático de la literatura sugiere que tanto los parches súper absorbentes como la terapia de presión negativa ofrecen ventajas significativas en el manejo de heridas sobre opciones tradicionales. Estas tecnologías favorecen un ambiente húmedo óptimo y facilitan la eliminación de exudado, lo que puede acelerar la cicatrización y reducir la morbilidad asociada.

 

EP1443 Complicación en la exéresis de una lesión en miembro inferior tratada con terapia de presión negativa (TPN)

Cecilia Valles Quintilla¹, Pilar Ibars Moncasi¹, Elvira Seró¹, Núria Sogas Vicente¹, María Jaria¹, Elena Balaña Prim¹, Rosa Maria Pedra Sola^1
1Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Presentar la evolución de una dehiscencia de herida quirúrgica en extremidad inferior en un paciente con comorbilidades.

Método: Seguimiento clínico del paciente y reporte fotográfico de su evolución.

Resultados: Varón de 77 años con diabetes y claudicación intermitente, intervenido de exéresis de lesión en región lateral externa de la pierna izquierda, que cursa con infección y dehiscencia de herida. Indican tratamiento antibiótico oral.

Acude a nuestro servicio para cura por segunda intención.

Se retiran la totalidad de los puntos quedando herida de 7 x 3 cm y menos de 1 cm de profundidad. Lecho de la herida con tejido de granulación rosado y esfacelos. Abundante exudado seropurulento. Bordes inflamados y macerados. Piel perilesional con eritema extenso. Extremidad no edematosa. Pulsos presentes.

Pauta de curas:

- Higiene de toda la pierna con agua y jabón. Limpieza de la herida con suero fisiológico y fomento de solución de polihexanida buguanida.

- Aplicación de anestésico tópico local para el desbridamiento cortante de gran parte escara y esfacelos.

- Aplicamos cadexómero yodado en restos de tejido desvitalizado, fibra absorbente y apósito de espuma con silicona.

- Curas cada 72 horas.

En la tercera cura ya se observa poco tejido desvitalizado y se decide combinar el desbridante con la TPN de un solo uso con contenedor, pudiéndose espaciar las curas cada 5-7 días. En aproximadamente dos meses conseguimos la cicatrización de la herida.

Conclusión: Creemos que la TPN es un gran aliado para tratar heridas de pacientes con comorbilidades y factores de riesgo que de otra manera probablemente se nos cronificarían.

 

EP1444 Abordaje de herida en un paciente tras picadura de araña: reporte clínico

Raquel Cogollor Velez¹, Dayanna Lizeth Anasi Sañay², Carmen Maria Sanchez Garcia³, María Victoria Juan Campos^2
1Enfermera, Madrid, Spain, ²Enfermera, Linares, Spain, ³Enfermera, Caravaca de la Cruz, Spain

Objetivo: Describir la evolución de la cura realizada en una herida producida por una picadura de araña, evaluando la respuesta terapéutica.

Métodos: Se presenta el caso de un paciente varón de 41 años que tras la picadura de una araña presenta lesión necrótica de 3-4 centímetros y exantema perilesional de más de 15 centímetros en la región dorsal del brazo derecho. Se realiza desbridamiento enzimático y autolítico combinando iruxol e hidrogel. Se inician curas diarias, se aplica crema barrera en zona perilesional, crema corticoide en la zona del exantema y se coloca apósito oclusivo. Tras dos semanas de seguimiento con buena evolución se cambia tratamiento de la herida aplicando alginato con óxido de zinc en lecho y crema barrera en bordes perilesionales.

Resultados: Tras dos meses de seguimiento se observó una reducción significativa del dolor al realizar el desbridamiento de la lesión. Así mismo, disminuyeron el eritema perilesional y la inflamación. El paciente fue dado de alta con una notable mejoría de la piel afectada y de la sensación de confort.

Conclusiones: En este caso, el desbridamiento de la herida demostró ser la opción terapéutica más eficaz para el tratamiento de la misma, favoreciendo la preparación del lecho para la regeneración del tejido. Además, la aplicación de óxido de zinc directamente en el lecho permitió la formación tejido de granulación al proporcionar al lecho zinc de manera sostenida, promoviendo la acción de los factores de crecimiento. Así, se proporcionó alivio sintomático y mejoría en la afectación cutánea de la lesión.

 

EP1445 Manejo del tejido de hipergranulación en heridas

Nuria Lario-Marin¹, Teresa Hernández Hernández¹, Leyre Aldunate-Cia¹, Maider Lara Zabala¹, Sara Larraz-Giganto¹, María Agramunt-Renau², Laura Moya-Bustamante^2
1Osakidetza, OSI Araba, Vitoria, Spain, ²Osakidetza, OSI Debagoiena, Vitoria, Spain

Objetivo: Conocer las posibles opciones de tratamiento para el abordaje de heridas con tejido de hipergranulación

Métodos: Se ha realizado una búsqueda en diferentes bases de datos, PubMed, Dialnet y Google Académico, aplicando los filtros: últimos 10 años y texto libre disponible. Palabras clave: corticoesteroides, hipergranulación, herida.

Resultados: El tejido de hipergranulación aparece por una alteración en la fase proliferativa del proceso de cicatrización pudiendo producirse por diversas causas (fricción, oclusión, infección) y el tratamiento debe estar asociado al control de los factores desencadenantes. Existen diferentes métodos de abordar este tejido, entre ellos encontramos: cauterización con nitrato de plata utilizado frecuentemente como tratamiento de primera línea, aunque no está exento de complicaciones siendo doloroso y pudiendo producir necrosis tisular. Los corticoides tópicos tienen un efecto antiinflamatorio siendo una opción de tratamiento eficaz, no invasiva, indolora y de fácil manejo. Uso de apósitos no oclusivos que permitan un manejo correcto del exudado evitando así el sobrecrecimiento tisular, no obstante, son un método complementario al tratamiento primario descrito anteriormente, así como una terapia compresiva adecuada. Otros tratamientos menos utilizados: desbridamiento quirúrgico e inmunomoduladores como el imiquimod. En los casos en los que el tratamiento falla habría que realizar una biopsia del tejido para descartar una malignización de la lesión.

Conclusiones: Existen diversas opciones de tratamiento tanto físicas como farmacológicas para el manejo de heridas con tejido de hipergranulación teniendo que valorar cada caso individualmente.

 

EP1446 Desgarros cutáneos: la historia se repite

Irene Cespedes I Feliu^1
1SSIBE ABS Torroella de Montgrí, Torroella de Montgrí, Spain

Objetivo: Reconocer la etiología y realizar una buena primera actuación para una mejor evolución de los desgarros cutáneos.

Métodos: Paciente de 90 años con antecedentes de cáncer de piel y con fragilidad importante de la piel, que a lo largo de un año ha visitado repetidamente la consulta de enfermería tras presentar múltiples desgarros cutáneos por múltiples causas.

Durante semanas, ha realizado los diversos controles semanales combinándose su vida diaria con los traslados al centro de salud.

A pesar de mantener mucha precaución, mantener unos buenos hábitos de la piel y aplicar las diferentes estrategias de prevención, a menudo ha ido presentando sus desgarros cutáneos habituales.

Resultados: Conocer la etiología, realizar una correcta actuación en el inicio de presentación de la lesión, utilizar el mismo tipo de apósitos que han dado buenos resultados en anteriores ocasiones, respetando los tiempos planteados entre curas, realizando los controles correspondientes y educando y empoderando a la paciente, se han conseguido resolver con el menor tiempo posible y favoreciendo una buena evolución en la mayoría de ellas.

Conclusiones: Aunque se consiga un buen empoderamiento del paciente, realizar las curas correctamente y con el material adecuado, nunca es suficiente para evitar un desgarro cutáneo en una piel altamente frágil.

 

EP1447 Skin tears: revisión de la literatura científica y abordaje de casos clínicos

María Pilar Perez Hernández¹, Samia Bellahmar Lkadiri¹, Arantxa Vázquez Rodríguez¹, Alberto Rodríguez Salmonte², Rocío García Rodríguez³, Alba Rocío Siverio Diaz¹, Adriana Rodríguez Brito^1
1Gaptf Scs, Santa Cruz De Tenerife, Spain, ²sergas, Santiago De Compostela, Spain, ³Sas, Sevilla, Spain

Objetivo: 1. Describir los desgarros cutáneos según la clasificación actual de ISTA. 2 Explorar diferentes líneas de tratamiento recogidos en la bibliografía 3. Se exponen casos clínicos, con abordajes acordes a la literatura científica, de diferentes desgarros cutáneos.
Métodos: Se realiza una revisión sistemática de la literatura científica consultando diferentes bases de datos (Scopus, Dialnet y PubMed) y buscadores (Google académico). Se utilizan como palabras clave para la búsqueda “Lacerations / etiology” (MeSH)”, “Lacerations / prevention & control” (MeSH), “Lacerations / therapy” (MeSH)”, “Skin / injuries” (MeSH)” y “Wound Healing” (MeSH)”, combinados mediante los booleanos AND y OR, y se restringe la búsqueda a artículos publicados en los últimos 10 años.
Resultados: Los cambios fisiológicos que acontecen durante el proceso de envejecimiento disminuyen la capacidad de la piel para resistir el esfuerzo cortante y/o la fricción y aunque no son exclusivo de la población mayor, sí se dan con relativa frecuencia en este colectivo. Tras realizar la revisión bibliográfica se expone en un cuadro resumen de la clasificación según ISTAP y se exponen los objetivos terapéuticos en el tratamiento de los desgarros cutáneos acorde a la literatura científica. Por último se exponen varios casos clínicos explicando la pauta de cura que se sustenta en el abordaje recomendado por las diferentes guías y manuales de BPC (Buena Práctica Clínica)
Conclusiones: Los skin tears o desgarros cutáneos son heridas de espesor parcial que tienen como característica principal la presencia de un colgajo cutáneo. Realizar un diagnóstico correcto, permite llevar a cabo un abordaje adecuado, optimizando la cicatrización de la herida, el uso racional de los productos sanitarios y el confort y bienestar del paciente.
Palabras clave 

 

 

ANTIMICROBIANOS 

EP1131 Antimicrobianos tópicos: una necesidad en el manejo de heridas crónicas complejas en la consulta de atención primaria

Alejandra Caballero Jiménez¹, Daniel de la Cruz Tomé¹, Beatriz Pinero Jimenez^2
1Consultorio El Escorial. Centro de Salud San Carlos. Gerencia de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain, ²Consultorio El Escorial. Centro de Salud San Carlos. Gerencia Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain

Objetivo: Subrayar la relevancia del uso de antimicrobianos tópicos en el manejo de heridas complejas, prevenir la resistencia antimicrobiana y minimizar la utilización de antibióticos sistémicos.

Métodos: Se incluyeron pacientes con heridas crónicas (evolución superior a 6 semanas) atendidos en la consulta de Enfermería de Atención Primaria, con diferentes etiologías. Y se excluyeron pacientes con infecciones sistémicas o antecedentes de reacciones alérgicas a antimicrobianos.

Las lesiones presentaban las características similares: signos de infección local sutil.

El tratamiento consistió en la administración de un antimicrobiano tópico (cadexómero yodado), aplicado según protocolos establecidos.

La evolución clínica se monitorizó durante tres semanas, evaluando signos de infección y cicatrización a través de mediciones de superficie y cambios en el tejido, registrando todos los hallazgos en la historia clínica.

Resultados: Se observó una mejoría clínica significativa en todos los pacientes tratados, sin requerir antibióticos sistémicos durante el periodo de seguimiento.

A partir de la segunda semana de tratamiento tópico, las heridas mostraron reducción de los signos de infección y avance en la cicatrización.

No se reportaron cepas resistentes ni efectos adversos relacionados con el uso de cadexómero yodado, lo que valida su eficacia y seguridad.

Conclusiones: El uso de antimicrobianos tópicos en heridas crónicas complejas con signos de infección local sutil fue eficaz en el control de la infección, evitando antibióticos sistémicos y contribuyendo a la prevención de resistencia antimicrobiana.

Estos hallazgos destacan la importancia de optimizar el manejo de antimicrobianos en Atención Primaria, favoreciendo la seguridad y eficacia en el tratamiento de heridas.

 

EP1132 Estrategias para el manejo de patogenos resistentes en heridas: rol del personal de enfermeria y alternativas antimicrobianas

Elena Guillén Marañés¹, Verónica Fernández Martins¹, Izarbe Molina Domec¹, Paula Borras Lecha¹, Ana Sanchez Micó¹, Raquel Gil Marin^1
1Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo:

• Identificar el rol de enfermería en el control de las resistencias antimicrobianas. 
• Determinar las estrategias implementadas para su prevención. 
• Estudiar el uso racional de antimicrobianos (URA). 

Métodos: Se realizó una búsqueda bibliográfica en Pubmed, Cochrane Library y CINAHL durante septiembre de 2024. Se utilizaron como palabras clave “Resistencia a los antimicrobianos”, “Optimización de antimicrobianos”, “Enfermería” y “Heridas”, combinándose con el operador booleano “AND”. Se excluyeron aquellos estudios publicados antes del año 2020. 

Resultados: Los artículos revisados (n= 8) han puesto de manifiesto que dentro de las competencias de enfermería en el uso adecuado de antibióticos se identifican factores como el conocimiento, las actitudes y las prácticas como determinantes en su eficacia (1). Especialmente destaca la formación basada en competencias (8), así como, la integración más plena de este colectivo en la toma de decisiones para optimizar el URA (7). 

Por otra vía, se analiza el uso de nuevas tecnologías (2-4), resaltando la necesidad de controlar la humedad para lograr mayor eficacia en la reducción de infecciones (5). Así, se diferencian principalmente apósitos recubiertos con cloruro de dialquilcarbamilo (2) frente a aquellos más innovadores que ayudan a prevenir infecciones de heridas crónicas (3).

Conclusiones: La formación continua es fundamental para optimizar el uso de antimicrobianos en enfermería, aunque requiere de la combinación con programas de concienciación de los pacientes para prevenir su uso irracional. 

Por lo tanto, una estrategia integral que combine actualización constante en enfermería, la educación de los pacientes y la exploración de alternativas seguras podría enfrentar la resistencia antimicrobiana creciente en el manejo de heridas. 

 

EP1133 Abordaje de lesiones herpéticas con un apósito DACC

Jose Puentes Sanchez¹, Carmen Maria Pardo González², Carlos Ramirez Mañas^2
1Hospital Universitario Torrecardenas, Consulta de Heridas Cronicas y Complejas, Almeria, Spain, ²Hospital Universitario Torrecardenas, Almeria, Spain

Objetivo: El herpes Zoster es una erupción cutánea vesicante y dolorosa. Este virus se reactiva cuando el sistema inmunitario está debilitado por medicamentos o enfermedad. En la mayoría de las veces el tratamiento suele incluir la toma de medicación retroviral Y curas por parte del personal sanitario El objeto es llevar a cabo ttº de la carga vírica con apósitos de acción física, basada en la presencia de un revestimiento hidrófobo de Cloruro de diaquilcarbamilo. DACC) y tratar las complicaciones y sintomatología de dichos herpes.

Metodología: Se hace un estudio descriptivo transversal a 8 pacientes que en algún momento han sido derivados a la consulta de heridas crónicas. 6 mujeres, 2 hombres Los pacientes No han necesitado tratamiento retroviral ni analgesia.

Resultados: FAVORABLE, ya que los apósitos han minimizado el picor, el dolor y han resecado la herida en una semana.

Conclusiones: El tratamiento con tecnología DACC con gel del herpes Zoster, evita complicaciones, minimiza la sintomatología y se puede prescindir el uso de retrovirales y otros fármacos (analgésicos, cremas)

 

EP1134 Coste-efectividad de unos cuidados optimos en una herida cronica de mas de 2 años de evolucion mal diagnosticada

Jose Puentes Sanchez¹, Carlos Ramirez Mañas¹, Carmen Maria Pardo González^2
1Hospital Universitario Torrecardenas, Consulta de Heridas Cronicas y Complejas, Almeria, Spain, ²Hospital Universitario Torrecardenas, Almeria, Spain

Las heridas crónicas son aquellas que no progresan a través del proceso normal de curación en un periodo de 3 meses o más. Tienen un impacto sustancial en quienes las sufren, en sus cuidadores y en el sistema de atención de la salud. Durante este tiempo los pacientes pueden experimentar dolor, angustia emocional, ansiedad, hospitalizaciones prolongadas, problemas de movilidad y aislamiento social.

El mayor coste económico del tratamiento de las heridas está relaciona con el uso del tiempo de los profesionales de la salud y el coste de las estancias hospitalarias. Sin embargo, la elección de materiales y tratamientos puede tener una gran influencia en el coste total.

Este trabajo describe el caso de una herida traumática en la que se hizo un mal diagnóstico inicial y se convirtió en una herida crónica de casi 2 años de evolución.

Metodo:

Valoración del caso

Paciente de 83 años derivado desde su centro de salud a la consulta de heridas crónicas y complejas del Hospital Universitario Torrecárdenas por herida traumática de evolución tórpida de más de 730 días

Objetivo: Determinar el costo económico del cuidado de una herida crónica mal diagnosticada y el beneficio de unos cuidados óptimos de enfermería

Resultado: El tratamiento comenzó el 13 de enero de 2022 y fue dado de alta el 4 de marzo de 2022. Se consiguió la curación en 50 días

Conclusiones: Este caso es un buen ejemplo de cómo una buena valoración inicial y la elección del tratamiento adecuado reduce los tiempos de cicatrización y los costes económicos

 

EP1135 Eficacia y controversias de la miel de grado médico en el tratamiento de heridas: revisión de evidencias

Mónica Morcillo¹, Marta Benítez Madir¹, Maria Atienza Rodriguez¹, Elia Reyes Tena¹, Laia Vallejos¹, Judit Fabregat Polo^1
1Centro de Atención Primaria, Barcelona, Spain

Objetivo: Actualizar los conocimientos basados en la evidencia científica sobre la terapia de las curas con miel de grado médico y consensuar y protocolizar un procedimiento según las más eficaces y eficientes en el equipo de atención primaria.

Métodos: Revisión bibliográfica de estudios que evalúan la eficacia de la miel en el tratamiento de heridas agudas, crónicas y quirúrgicas. Bases de datos utilizadas: PubMed, Cochrane y Scielo. Palabras clave: miel, cicatrización de heridas, enfermería de atención primaria. Los artículos se buscaron entre los meses de mayo a septiembre. Se incluyeron estudios que comparaban la miel con otros tratamientos excluyendo aquellos con limitaciones metodológicas.

Resultados: Se escogieron una decena de artículos relevantes, a partir de 2019 y coinciden que la miel es buen método para cicatrización de heridas debido a algunas de sus propiedades como desbridante autolítico, antibacteriana, antioxidante o antiinflamatoria. Los autores, resaltan su potencial como una alternativa natural y costo-efectiva en el tratamiento de heridas, quemaduras y úlceras con buen nivel de tolerancia en los pacientes. Se procedió a impartir formaciones en centros de Atención Primaria para comenzar con su aplicación en aquellas heridas difíciles de curación, obteniendo buenos resultados.

Conclusiones: La miel es una alternativa prometedora y efectiva en diversos contextos de cicatrización de heridas, con beneficios en términos de eficacia, seguridad y accesibilidad. Pero, aun así, se requieren estudios adicionales para confirmar su eficacia en diferentes tipos de heridas y establecer protocolos para su uso clínico sobre todo en el ámbito de atención primaria. 

 

EP1136 Uso del apósito recubierto de cloruro dialquilcarbamolio (DACC) en heridas crónicas

Laura Pérez Somavilla¹, Elena González Arroyo¹, Ignacio Olias de Lima Pancorbo¹, Irene Sánchez González², Elena De Miguel Azores^2
1Sociedad Madrileña de Enfermería Familiar y Comunitaria, Madrid, Spain, ²Gerencia Asistencial de Atención Primaria, Madrid, Spain

Introducción: Las heridas crónicas son aquellas que presentan un retraso en la cicatrización debido a una inflamación prolongada, lo que conlleva a la colonización de microorganismos y formación de biofilm. Existen diversas estrategias para tratar estas infecciones, aunque el uso sistemático de antimicrobianos tradicionales se desaconseja por el riesgo de resistencia. Nuevos agentes antimicrobianos, como los apósitos recubiertos con cloruro de dialquilcabamoilo (DACC), ofrecen una alternativa reducir la carga bacteriana.

Objetivo: Evaluar la efectividad del apósito antimicrobiano DACC en una úlcera venosa.

Métodos: Se presenta el caso de un varón de 50 años con una úlcera venosa en miembro inferior derecho de grandes dimensiones y 3 años de evolución tórpida. El paciente se realizaba las curas de forma autónoma y acudía de forma desorganizada al centro de salud.

En marzo 2023 se comienza un seguimiento más riguroso en consulta de enfermería. Presenta miembro inferior edematoso y lesiones con presencia de biofilm, bordes perilesionales macerados y exudado abundante. Se realiza índice tobillo brazo (ITB) con resultado de 0,9 y se inician curas con fomentos de PHMB, oxido de zinc perilesional, alginato y vendaje multicomponente.

Después de un estancamiento en mayo de 2023 se incluye apósito DACC en el tratamiento.

Resultados: En curas sucesivas se observó reducción del tamaño de las lesiones, bordes íntegros, y disminución del exudado y el dolor. Después de 4 meses de tratamiento, se logró la cicatrización de la mayoría de las lesiones.

Conclusiones: Los apósitos antimicrobianos impregnados en DACC resultaron ser una buena alternativa para el tratamiento de heridas de larga evolución.

 

EP1137 Uso del metronidazol tópico para el control del olor en ulceras tumorales

Arantxa Sales-Buj¹, Nuria Lario-Marin¹, Teresa Hernández Hernández, Leyre Aldunate-Cia¹, Maider Lara Zabala¹, Sara Larraz-Giganto¹, María Agramunt-Renau

¹Osakidetza, Organización Sanitaria Integrada Álava, Vitoria-Gasteiz, Spain

Objetivo: Revisar la eficacia del uso del metronidazol para el tratamiento del olor en úlceras tumorales y su impacto en la calidad de vida de los pacientes.

Métodos: Se realizó una revisión bibliográfica en bases de datos como PubMed, Scielo, Cochrane, CINAHL, así como literatura gris. Se incluyeron ensayos clínicos, metaanálisis y revisiones previas que abordaran el control del olor en heridas tumorales publicados en los últimos 10 años, se revisaron también 4 guías de práctica clínica.

Palabras clave: “odorant”, “wounds and injuries”, “metronidazole”, “skin ulcer”.

Resultados: De la búsqueda se obtuvieron 104 documentos para revisar, de los cuales se seleccionaron 27, finalmente se descartaron 17 por no ajustarse al objetivo o estar duplicados.

Las guías de práctica clínica consultadas recomiendan fuertemente su uso y el resto de la literatura revisada muestra que el uso del metronidazol tópico puede reducir de forma significativa la intensidad del olor.

Partiendo de grados iniciales III (olor percibido aún sin descubrir la herida) y IV (olor fétido y nauseabundo), la reducción del olor tras el tratamiento suele alcanzar los grados 0 (sin olor) y I (olor percibido sólo al descubrir la herida), lo que permitiría a los pacientes llevar una vida normal y liberarse del estigma social asociado a las úlceras.

Conclusiones: El metronidazol se presenta como una opción efectiva para el manejo del olor en úlceras tumorales produciendo beneficios clínicos y podemos inferir que también psicosociales para el paciente y su familia, pero harían falta estudios más específicos para medir este campo.

 

EP1139 Manzanilla y cicatrización de heridas: una revisión bibliográfica.

Paula Suarez Cabrera¹, Nerea Herrero Arnedo², Sandra Bravo Quiñonez^2
1CAP Terrassa Nord, Terrassa, Spain, ²CAP Can Roca, Terrassa, Spain

Objetivo: Evaluar los efectos de la manzanilla en la cicatrización de las heridas.

Métodos: En octubre de 2024 se realizó una búsqueda bibliográfica en 9 bases de datos: Pubmed, SCOPUS, LILACS, IBECS, Biblioteca Cochrane plus, Web of Science, Cinahl, Cuiden y Scielo. Los descriptores utilizados fueron ‘Chamomile’, ‘Wound*’ y ‘healing’. También se utilizó el booleano ‘AND’. Asimismo, los criterios de selección fueron: artículos publicados entre 201 y 2024, en inglés y español, acceso a texto completo, ensayos clínicos aleatorizados (ECA), y revisiones sistemáticas con y sin metaanálisis (RS). 

Resultados: Se obtuvo un total de 53 documentos que, a partir del título y resumen, resultaron 11 documentos para lectura a texto completo. Posteriormente, 7 fueron eliminados por no cumplir con los criterios de inclusión y 1 por no estar disponible a texto completo en inglés. Finalmente, se seleccionaron 2 RS y 1 ECA. 

Conclusiones: La manzanilla muestra efectos bioactivos relevantes para la salud bucal, mostrando propiedades antisépticas y antiinflamatorias que podrían ofrecer protección contra úlceras en la mucosa oral. Si bien algunos estudios sugieren su eficacia en la reducción del dolor y de las ulceraciones orales, los resultados son controvertidos. Además, no se han documentado resultados significativos de su uso para la cicatrización de otras lesiones fuera de la mucosa oral. Es por todo ello, que se requiere más investigación al respecto para validar su uso y caracterizar sus principios activos, especialmente en el contexto de lesiones y la cicatrización postoperatoria de la mucosa oral.

 

EP1140 Eficacia de la octenidina en heridas complejas de diferente etiología infectadas por staphylococcos aureus resistentes a la meticilina

Lucía Ruz Agulló¹, Marina Quesada¹, Carmen Martinez Castillo¹, Maria Aasunción Rodenas Gimenez^2
1Hospital General Elche, Elche, Spain, ²Hospital General Elche, Elche, Spain

Objetivo: Medir la eficacia de Octenidina en heridas complejas infectadas por SARM en un muestra de 10 pacientes en el Hospital General Universitario de Elche

Métodos: Se trata de un estudio observacional prospectivo realizado en heridas complejas con cultivo positivo a SARM. Para realizar el presente estudio se han tenido en cuenta las siguientes variables: etiología de la lesion, fecha de cultivo positive, fecha de cultivo negativo, días de tratamiento, cantidad de Octenidina empleada en la cura local. La cura local a cada paciente consistía en un fomento de Octenidina con un tiempo estimado entre 1 a 5 minutos en función de la extensión de la herida. Cada semana se le realizaba un cultivo de control.

Resultados: En la muestra se incluyeron a 10 pacientes los cuales con cultivos positivos en SARM: 3 presentaban heridas complejas neoplásicas; 3 traumáticas y 4 UPP.El tiempo medio de la negativización fue de 10+/-3, con un tiempo máximo de 15 días y mínimo de 7 días.La cantidad de Octenidina empleada en cada paciente hasta la negativización fue =/< de 350 ml y 20 gr

Conclusiones: Se podría considerar eficaz ya que el 50% de las lesiones negativización en 1 semana. La cantidad empleada total en cada cura 350 ml y 20 gr supone una buena relación coste- beneficio. No se han evidenciado resistencias antibacterianas locales con la aplicación de Octenidina. Esta investigación sigue en curso con ampliación de muestra, deja la puerta abierta a la comunidad científica a seguir investigando en esta línea con dos fines, combatir las resistencias antibacterianas y conseguir una mejora en nuestros pacientes.

 

EP1141 Potencial antiinflamatorio de la punicalagina en fibroblastos de piel humana

Victor Costela-Ruiz¹, Patricia Caballero-Navarro¹, Enrique García Recio¹, Concepción Ruiz¹, Olga García Martínez¹, Javier Ramos Torrecillas^1
1Universidad de Granada. Departamento de Enfermería, Granada, Spain

Introducción: El proceso de cicatrización comprende las fases de hemostasia, inflamación, proliferación y remodelación¹. Sin embargo, se conoce que una inflamación prolongada puede afectar negativamente a la proliferación y migración de diversas poblaciones celulares entre las que se encuentran los fibroblastos².

Objetivo: Analizar el potencial antiinflamatorio de la punicalagina, un compuesto fenólico presente en la granada, en fibroblastos humanos.

Métodos: Los fibroblastos CCD-1064Sk se cultivaron con citoquinas proinflamatorias (IL-6, IL-1b y TNF-alfa) o con lipopolisacáridos (LPS). Tras el tratamiento con punicalagina (10^-6 y 10^-7 M), se evaluó la viabilidad celular mediante el ensayo MTT, la capacidad migratoria mediante el scratch assay, y los niveles de citoquinas proinflamatorias mediante ELISA.

Resultados: Los resultados mostraron un aumento significativo (p<0.05) en la viabilidad de los fibroblastos cultivados en un ambiente inflamado con citoquinas proinflamatorias o con LPS cuando fueron tratados con punicalagina en ambas dosis, en comparación con los controles. Además, se observó un incremento en la migración celular a las 24 horas del tratamiento y una reducción en los niveles de IL-6 (ambas dosis) e IL-1b (10^-7 M).

Conclusiones: La punicalagina posee un efecto antiinflamatorio, incrementando tanto la viabilidad como la migración de fibroblastos en condiciones inflamadas y reduciendo los niveles de citoquinas proinflamatorias. Estos datos sugieren que este compuesto fenólico podría presentar un potencial terapéutico para modular la inflamación y optimizar el proceso de cicatrización en tejidos dañados.

 

EP1096 Efectividad de los apósitos de cloruro de diaquilcarbamilo (DACC) con hidrogel en el tratamiento tópico de las lesiones herpes zóster

Isabel Patron Manzano¹, María González Vallejo¹, Inés González Vallejo¹, María Motiño Paredes², María Tejado Carmona², María Plaza Terán¹, Alberto Corchete Serviá^1
1Servicio Extremeño de Salud, Cáceres, Spain, ²Servicio Extremeño de Salud, Badajoz, Spain

Objetivo: Evaluar los signos clínicos de la piel en los pacientes con herpes zóster, tamaño y expansión de las lesiones, días de evolución y control del dolor (EVA), una vez que sale la erupción cutánea y después del tratamiento pautado con apósitos DACC hidrogel.

Métodos: Estudio observacional, descriptivo, longitudinal, no aleatorizado, que incluye a 32 pacientes con lesiones compatibles con diagnóstico de herpes zoster, desde marzo a octubre de 2024.

Las variables a medición es dolor escala EVA, clínica, localización, aspecto y tamaño del área en cm, seguimiento fotográfico.

Procedimiento cura tópica: higiene piel, aplicación apósito DACC hidrogel mínimo cada 24 horas, sujeción tubular.

El periodo de seguimiento es de una a dos semanas, mínimo 3 intervenciones.

Resultados: El 81,25% de la muestra se observa que se produce un control de la clínica, secando las lesiones, disminuyendo la expansión en una media de 4 días. La escala EVA se observaron valores medios iniciales de 9,03 pasando en el último control a 1,18. Un 18,75% no mejoría por abandono o por falta de material de cura.

Ha disminuido el número de visitas al facultativo, la prescrición de fármacos y no se ha derivado a ningún paciente a la unidad del dolor.

Conclusiones: Los apósitos DACC son una buena opción terapéutica para el tratamiento de las lesiones dérmicas en el tratamiento virus herpes zoster, son eficaces, no citotóxico y fáciles de aplicar. Facilita la curación y el confort, lo que produce un ahorro a nivel de salud y de recursos.

 

EP1142 Eficacia del ácido acético en el tratamiento de heridas infectadas por pseudomona aeruginosa

Manuela Walteros Villa^1
1ICS, Barcelona, Spain

Objetivo: Evaluar la eficacia del ácido acético en el tratamiento de heridas infectadas por Pseudomona Aeruginosa.

Métodos: El trabajo consiste en una revisión de la literatura científica sobre la eficacia del ácido acético para el tratamiento de heridas infectadas por Pseudomona Aeruginosa. Para ello, se llevó a cabo una revisión en Pubmed, Dialnet, Scielo así como guías del Ministerio de Sanidad, durante un periodo de diez años. Los idiomas de las fuentes bibliográficas han sido castellano e inglés, usando “AND” como operador booleano de las palabras de búsqueda “Pseudomona Aeruginosa, ácido acético, herida”.

Resultados: Las heridas infectadas por Pseudomona Aeruginosa son consideradas un problema de salud pública. Uno de los antisépticos utilizados para su tratamiento ha sido el ácido acético.

Gran variedad de artículos revisados concluyen que el ácido acético es eficaz para el tratamiento de la Pseudomona Aeruginosa. Sin embargo, la gran variabilidad entre el método de empleo, unos utilizaban el ácido acético en fomentos y otros lo diluían con agua, así como la diferencia entre la concentración utilizada, algunos estudios sugieren que es necesaria una dosis mínima eficaz del 0,5% y otros una dosis del 2%, hacen que resulten necesarios más ensayos clínicos con grupos de control adecuados con el fin de obtener resultados más fiables y útiles.

Conclusiones: Múltiples artículos coinciden en que el ácido acético es un antimicrobiano eficaz, barato, seguro y de fácil uso. Sin embargo, actualmente no hay suficientes estudios que determinen a qué concentraciones resulta beneficioso o perjudicial.

 

EP1143 Antibioticos topicos de forma rutinaria en la cura quemaduras en atencion primaria

Mario Sanchez Gonzalez¹, German Ortiz Zafra^1
1Servicio Murciano de Salud, Murcia, Spain

Objetivo: Revisar la bibliografia disponible para evaluar el uso de antibioticos topicos (AT) de forma rutinaria en quemaduras en Atención Primaria.

Métodos: Revisión de la bibliografía relacionada y guías de práctica clínica (GPC) sobre el tratamiento de heridas y quemaduras.

Resultados: Una revisión sistemática en 2022 que analizó 11 GPC determinó que la recomendación de AT dependía del escenario, gravedad y presencia de dolor. Solo dos GPC recomendaban el uso general de AT en quemaduras. Existe una fuerte tendencia a recomendar compuestos de plata para la prevención de infección en quemaduras, siendo la sulfadiazina de plata la más recomendada.
La GPC del servicio gallego de salud propone que en las quemaduras de primer grado no es necesario el uso de AT salvo para el alivio del dolor. En las quemaduras de segundo grado se pueden aplicar diversos AT dependiendo de la fase en la que se encuentre la quemadura.
Varios sumarios de evidencia como Uptodate y BMJ Best Practice concuerdan en que los AT solo deberían usarse en quemaduras no superficiales, y resalta sobre el uso de sulfadiazina de plata puede ralentizar la epitelización.

Conclusiones: Existe controversia sobre el uso rutinario de AT en quemaduras, sin embargo, a la vista de las recomendaciones de las GPC podemos concluir que deberíamos limitar el uso de AT a quemaduras no superficiales o aquellas con signos de infección. Sobre el AT de elección, los compuestos de plata presentan menor frecuencia de reacción en los pacientes y son bien toleradas, si bien se debe ser cauto y vigilar signos de ralentización en la epitelización de la quemadura.

 

EP1144 Uso de apósitos con cloruro de dialquilcarbamolio a raíz de un caso

Elena González Arroyo¹, Ignacio Olías de Lima Pancorbo¹, Laura Pérez Somavilla¹, Irene Sánchez González¹, Elena De Miguel Azores^1
1Gerencia de Atención Primaria, Madrid, Spain

El DACC (cloruro de dialquilcarbamolio) es un agente antimicrobiano que se utiliza para el tratamiento de heridas por su acción hidrófoba, que tiene efecto bacteriostático. Además, diferencia de otros tratamientos, como la plata o el yodo, el DACC evita toxicidades y sensibilizaciones, contribuyendo a la cicatrización más rápida y segura de las heridas.

Objetivo: Evaluar la eficacia del DACC en una herida de evolución tórpida.

Métodos: Se presenta el caso de una mujer de 82 años pluripatológica que el 24/04/24 acude a nuestra consulta con una herida de 15 días de evolución en zona gemelar de miembro inferior derecho de 3 cm de diámetro con forma ovalada, lecho de granulación y esfacelar al 50%, bordes regulares no sobreelevados y exudado escaso seroso.

Tras dos meses de mala evolución, la herida presenta un aumento del tejido esfacelar al 90%, así como aumento del dolor durante las curas.

Posteriormente, el 20/06/24 se realiza el índice tobillo brazo con resultado de 1,75 y se deriva a cirugía vascular. En este momento, se cambia la pauta de curas a limpieza con suero salino fisiológico, óxido de zinc en piel perilesional, apósito que contiene DACC y alginato.

Resultados: Tras mantener la frecuencia de curas cada 72-96h el 05/08/24 se consigue la epitelización completa de la herida.

Conclusiones: Aunque los resultados sobre la reducción de la carga bacteriana no son concluyentes en todos los estudios, el DACC ofrece una alternativa prometedora en el cuidado de las heridas.

 

EP1145 Cloruro de dialquilcarbamoilo para manejo de infección en heridas crónicas de difícil cicatrización en la edad pediátrica: una serie de casos

Priscila Cantú Saucedo¹, Ana Moreno Martínez^2
1UANL, Monterrey, Mexico, ²ITESM, Monterrey, Mexico

Objetivo: La prevalencia global de las heridas agudas y crónicas en la edad pediátrica va en aumento cada día. Las heridas agudas son relativamente frecuentes en el paciente pediátrico debido a su alta actividad física y exploración constante de su entorno.

La prevalencia de heridas crónicas en niños es menor, pero su impacto es significativo debido a que generan complicaciones más frecuentes y prolongan los tiempos de cicatrización. Es de vital importancia generar evidencia clínica que permita desarrollar y estandarizar protocolos de tratamiento efectivos y seguros, adaptados a las necesidades específicas de los pacientes pediátricos.

Con un mejor entendimiento de las heridas crónicas en la edad pediátrica, se pueden implementar estrategias preventivas que reduzcan la incidencia de complicaciones graves, como infecciones y cicatrización deficiente.

Métodos: En esta serie de casos se sintetiza y analiza el proceso de cicatrización por segunda intención con la aplicación de apósitos impregnados de cloruro de dialquilcarbamoilo (DACC) para manejo de infección en heridas crónicas en pacientes pediátricos. Se incluyeron 10 pacientes pediátricos con las siguientes condiciones: dehiscencias quirúrgicas, heridas traumáticas, mielomeningoceles, gastrosquisis, quemaduras de espesor completo y lesiones por presión

Resultados: En los 10 pacientes incluidos se reportó una mejoría significativa desde periodos tempranos de la intervención, haciendo control de la carga bacteriana dentro de las primeras 2 semanas de tratamiento en todos los casos; dando paso a la generación de tejido de granulación y posteriormente el cierre total de las heridas en un rango de 1 a 2 meses.

Conclusiones: El uso de apósitos impregnados con DACC constituye una alternativa segura, eficaz y sin contraindicaciones conocidas para el tratamiento de heridas crónicas de difícil cicatrización en la población pediátrica.

 

 

HERIDAS ATÍPICAS 

EP1448 Abordaje de úlcera neoplásica en Vulva: las curas enfermeras en atención domiciliaria

Eva Boix¹, Ana Varela Pardo², Eva Prat^3
1Serveis de Salut Integrats del Baix Empordà, ABS Palafrugell, Consultorio Medic Local de Pals, Pals, Spain, ²Serveis de Salut del Baix Empordà, ABS Palafrugell, Consultorio Medic Local de Pals, Pals, Spain, ³Serveis de salut integrats baix empordà, ABS Palafrugell, Palafrugell, Spain

Objetivo: Presentamos un caso de manejo enfermero de una úlcera neoplásica en zona vulvar en situación de crecimiento y pre-radioterapia paliativa en atención domiciliaria.

Métodos: Revisión bibliográfica sobre las curas en este tipo de úlceras.

Resultados: Mujer de 79 años, que presenta úlcera vulvar neoplàsica , la lesión es abierta presentando ruptura de la integridad cutánea con un crecimiento exofítico es decir con aspecto de coliflor, la lesión va creciendo desde la vagina al ano, con tejido necròtico y esfacelado, con necesidad de control del exudado y la mala olor, ante esta situación tenemos que hacer las curas de la lesión mientras nos citan para radioterapia paliativa.

Aplicamos el algoritmo terapéutico de úlceras neoplásicas, al ser abierta pondremos hidratación ( gasa y alginato) y óxido de zinc perilesional, el olor lo controlaremos con metronidazol fórmula magistral , el control del sangrado se informa a los familiares en caso de ser abundante de hacer compresión a la herida y cambiar apòsito de alginato y de forma preventiva se retira anticoagulante oral y se pasa a heparina sc i también el equipo de Paliativos nos complementa el tratamiento del dolor con manejo de mòrficos indicados en patología oncológica.

Conclusiones: Es muy importante para el abordaje buscar el manejo indicado para el tipo de lesión que tenemos, tener claras las expectativas paliativas de la úlcera y proporcionar el máximo de confort a la paciente. Intentar controlar el exudado y el mal olor hace mejorar la situación y también el manejo del dolor.

 

EP1449 Caso clínico: lesión por cuerpo extrano, 10 años después

Mireia Cuella Serres¹, Elena Langarita Llorente¹, Daniel Gonzalez Tobías¹, Elke Herranz Almirall¹, Antonio Egidos Plaja¹, María Elena Rodenas Soria¹, Inmaculada Concepción Hernandez Cebrian^1
1Instituto Catalán de la Salud, Barcelona, Spain

Objetivo: Los cuerpos extraños pueden introducirse en la piel mediante traumatismos quedando insertados en los tejidos blandos durante mucho tiempo. Un estudio afirma que el 38% de éstos no se detectaron en la evaluación inicial por lo que es posible que después de una lesión los pacientes no se alarmen por la presencia de un objeto extraño en su cuerpo. Sin embargo, pueden surgir complicaciones a largo plazo si no se tratan de manera adecuada, como dolor crónico o incluso deterioro neurovascular.

Métodos: En este caso, un hombre de 59 años acude a un centro de atención primaria por dolor, edema y una pequeña herida en el codo derecho. El paciente refiere que tuvo un accidente de motocicleta hace 10 años aproximadamente, con una gran abrasión en la zona y desde entonces, siente la presencia de un cuerpo extraño en el codo. 

Resultados: Es importante una evaluación adecuada de la herida, conocer la naturaleza del cuerpo extraño, así como un paciente cooperativo y con buen manejo del dolor, para asegurar una exitosa extracción. 

Conclusiones: El proposito principal es lograr la recuperación del tejido, evitar posibles complicaciones y conseguir una buena cicatrización ante un caso poco frecuente de herida atipica en atención primaria. 

 

EP1450 Abordaje de enfermería en el paciente con pioderma gangrenoso

Clara Rodríguez Hernández^1
1ABS Palafrugell, SSIBE, Girona, Spain

Objetivo: Dar a conocer el pioderma gangrenoso, enfermedad inflamatoria rara de la piel caracterizada por pústulas que evolucionan rápidamente a úlceras dolorosas, con bordes violáceos y eritema perilesional.

Métodos: Caso clínico de un varón de 79 años con antecedentes de prostitis ulcerosa, en tratamiento que consulta por dolor y lesión sobrelevada de color violáceo en miembro inferior derecho. Se inicia antibioterapia empírica durante 15 días sin mejoría clínica.

En una nueva exploración se observa una úlcera de aspecto cribiforme con zonas que impresionan costras hemáticas y zonas con esfacelo. Además aparecen tres lesiones satélites de menos de 1 cm de diámetro. Se realiza una biopsia de la lesión en la que se describen hallazgos compatibles con pioderma gangrenoso.

Se inició tratamiento sistémico con 60 mg de prednisona diarios, con dosis decrecientes de 10 mg semanales, y curas tópicas con betametasona y fusidato de sodio. Tras 6 semanas de tratamiento se suspende la corticoterapia al no detectarse actividad inflamatoria y se comienzan curas con apósitos de hidrofibra y vendajes compresivos.

Resultados: Cicatrización en 10 semanas.

Conclusiones: Las úlceras evolucionan a través de fases inflamatorias y curativas, lo que requiere un enfoque diferenciado en función del momento en el que se encuentra. Es muy importante adecuar el algoritmo TIME para el tratamiento del pioderma gangrenoso y evitar así la patergia.

 

EP1451 Abordaje integral del impétigo ampolloso: manejo de un caso clínico exitoso en paciente pediátrico

Paula Martinez Souto¹, Elba Docampo Gacio², Raquel Barreiro Ramos³, Adrián Golpe Freijomil⁴, Pilar Pérez López⁵, Maria Teresa Rodas Gallego^6
1Enfermera Residente Familiar y Comunitaria Eoxi Pontevedra-Salnés, Atención Primaria, Centro de Salud de Bueu, Pontevedra, Spain, ²Mir Fyc R2 Eoxi Pontevedra-Salnés, Atención Primaria, Centro de Salud de Bueu, Pontevedra, Spain, ³Enfermera Eoxi Pontevedra-Salnés, Atención Primaria, Esad Terra de Montes, Pontevedra, Spain, ⁴Enfermero Eoxi Pontevedra-Salnés, Atención Primaria, Centro de Salud de Bueu, Pontevedra, Spain, ⁵Enfermera Pediatrica Eoxi Pontevedra-Salnés, Atención Primaria, Centro de Salud de Bueu, Pontevedra, Spain, ⁶Médico Pediatra Eoxi Pontevedra-Salnés, Atención Primaria, Centro de Salud de Bueu, Pontevedra, Spain

Objetivo: Presentar un caso clínico complejo de impétigo ampolloso en paciente pediátrico, describiendo su presentación, diagnóstico, tratamiento y evolución, con el fin de resaltar la importancia del reconocimiento temprano y el manejo adecuado de esta infección cutánea.

Métodos: Consulta en pediatría, madre de un niño de 9 años con lesiones vesiculosas de 9 días de evolución, dolor, malestar, y aparición de nuevas lesiones en axila derecha, aumento progresivo en los días posteriores hasta ampollas y extensión en otras zonas (hombro, hemitórax, hueco poplíteo derecho, ambos brazos y hemiescroto izquierdo). Realizamos una historia clínica detallada, incluyendo antecedentes médicos, hábitos de higiene, llevando a cabo examen físico exhaustivo, donde se observaron múltiples lesiones vesiculosas grandes, algunas de las cuales estaban rotas y formando costras color miel.

Resultados: La intervención conjunta de la cura en ambiente húmedo, con el uso de apósito malla DACC con hidrogel¹ y el antibiótico sistémico, consiguió disminuir el picor y el dolor causado por las lesiones en 24 horas, mejorando el confort, así como detener el avance de las lesiones y su completa epitelización en 9 días.

• Primer día:

• A las224 horas:

• A las 72 horas:

• 9º día:

• Fin monitorización lesiones a los 12 días:

Conclusiones: El manejo del impétigo ampolloso requiere de diagnóstico temprano y tratamiento antibiótico adecuado. La vigilancia estrecha es crucial para evitar complicaciones, especialmente en casos con mala respuesta inicial, donde puede ser necesario ajustar el tratamiento o considerar hospitalización para un manejo más intensivo.

¹Essity. Cutimed Sorbact gel

 

EP1035 Lesiones cutáneas asociadas a azacitidina: un estudio de caso

Clara Rodríguez Hernández¹, Consuelo Fernández Marcuello²

¹SSIBE, Palamós, Spain, ²SERGAS, Ourense, Spain

Objetivo: Analizar la correlación entre terapia oncológica y la manifestación de heridas atípicas.

Métodos: Caso de un paciente varón de 79 años con antecedentes de mielofibrosis primaria con mielodisplasia en tratamiento con azacitidina y darbopoetina alfa subcutáneos y danazol que ingresa por fiebre sin foco. Inicialmente, el diagnóstico se orienta como una celulitis secundaria a un desgarro cutáneo por traumatismo.

El paciente presenta una placa eritematosa y caliente de 10-15 cm en el antebrazo derecho y otra lesión de aspecto nodular en deltoides derecho. Tras una semana continúa el empeoramiento, con necrosis y una nueva lesión en forma de diana en deltoides izquierdo. Hasta ese momento se realizaron curas tópicas con apósitos de silicona y antibioterapia endovenosa.

La valoración de la unidad de heridas en su contexto integral sospecha de lesiones secundarias a azacitidina, debido a su potencial citotóxico, optando por la suspensión temporal del tratamiento y un régimen de curas con óxido de zinc tópico y alginato.

Resultados: Se documenta una cicatrización completa de las lesiones en la región de los deltoides en una semana tras la interrupción de la azacitidina, y una notable reducción del edema y eritema en la lesión del antebrazo. Se alcanza la cicatrización completa en dos semanas.

Conclusiones: Las lesiones cutáneas son difíciles de diagnosticar por lo que es necesario abordarlas con un enfoque holístico.

Es importante monitorear a los pacientes en tratamiento con azacitidina por riesgo de lesiones cutáneas debido a su acción sobre la regulación genética sobre las células epiteliales.

 

EP1452 Microperforaciones óseas y fenitoina tópica en úlcera por radioterapia

Marianela Geloso¹

¹Hospital de Infeccionas, F.J Muñiz, Hospital italiano de Ciudad Autonoma de Buenos Aires, Hospital Municipal del Carmenn, Buenos Aires, Argentina

Objetivo: Se presenta el caso de un paciente con ulcera secundaria a radioterapia donde por exposición de hueso se realizaron perforaciones óseas y se aplicó fenitoína tópica para favorecer la granulación.

Métodos: Paciente visto en consultorio particular durante el año 2023.

Resultados: Acude a la consulta paciente de 80 años con antecedentes de carcinoma espinocelular invarsor en oreja derecha, por lo cual recibió tratamiento con radioterapia y Pembrolizumab.

Al examen físico en oreja derecha presentaba edema doloroso, que deformaba anatomía local, ulcera retroauticular cubierta por fibrina y costras hemáticas.

Se realizó desbridamiento mecánico con bisturí y químico con colagenasa y se cubrió con apósitos de alginato de calcio.

Por presentar exposición ósea de apófisis mastoides, se indicó Fenitoína tópica una vez al día para fomentar tejido de granulación. Se realizaron además microperforaciones óseas con torno ondontológico, de 2-3 mm de diámetro,

cada 1cm de distancia. Evolucionando favorablemente en la actualidad.

Conclusiones: El tejido irradiado es considerado problemático, las ulceras por radiación causan morbimortalidad, incluyendo dolor, infección y reducción en la calidad de vida. Las complicaciones como la exposición ósea son difíciles de abordar, injertos y colgajos no han tenido éxito, en este caso la fenitoína tópica y las perforaciones óseas para estimular medula ósea, fueron de gran aporte.

 

EP1453 Optimización del protocolo de curas en heridas oncológicas complejas: un enfoque basado en la evidencia y casos clínicos

Maria Del Coral Robles Benitez^1
1Hospital Universitario de Badajoz, Badajoz, Spain

Objetivo: Determinar la efectividad de un protocolo de cuidados basado en la evidencia para el manejo de heridas oncológicas, enfocado en promover la cicatrización, controlar la carga bacteriana, aliviar el dolor el olor, y mejorar la calidad de vida de los pacientes mediante un plan de cuidados integral.

Métodos: Se seleccionaron pacientes oncológicos con heridas de diversa etiología, incluyendo lesiones asociadas a la humedad y Radiodermitis. El protocolo incluyó una solución limpiadora de acción hipertónica con propiedades antimicrobianas y un Alginogel enzimático para facilitar el desbridamiento autolítico y la regeneración tisular. Las heridas fueron evaluadas durante un período de 4 semanas, con revisiones semanales para monitorear la cicatrización, el control del exudado, el alivio del dolor y la reducción del olor.

Resultados: Los pacientes presentaron mejoras significativas en la cicatrización de sus heridas, con una reducción marcada del exudado y control eficaz de la infección. Asimismo, se observó una rápida formación de tejido de granulación, acompañada de una disminución notable del dolor y el olor, lo que contribuyó a una mejora global en la calidad de vida de los pacientes.

Conclusiones: El protocolo evaluado ha demostrado ser una intervención eficaz en el manejo de heridas oncológicas complejas, acelerando la cicatrización y mejorando síntomas como el dolor y el olor, con un impacto positivo en la calidad de vida de los pacientes. Los casos clínicos revisados apoyan su implementación rutinaria en el manejo de estas lesiones, promoviendo tanto la recuperación física como el bienestar emocional de los pacientes.

 

EP1036 Abordaje integral de los tofos gotosos: un enfoque en atención primaria

Isabel Cervan Casanova¹, Lucia Fernandez Ramos¹, Laura Garcia Cervan¹, Cristina González Corral¹, Maria Francisca Rios Gil¹, Inmaculada Oliva Jimenez^1
1Servicio Andaluz de Salud, Malaga, Spain

Los tofos gotosos (TG) son depósitos de cristales de urato en las articulaciones en pacientes con gota crónica. Son dolorosos y disminuyen la calidad de vida.

Objetivo: El objetivo es ofrecer recomendaciones basadas en la evidencia para el manejo integral de los TG en atención primaria.

Métodos: Se realizó una revisión sistemática de la literatura en Guía Salud, PubMed, Cochrane y Cinahl, IECAs y revisiones sistemáticas, incluyendo estudios de los últimos cinco años en inglés y español. De 19 artículos y una guía de práctica clínica (GPC), se seleccionaron 1 GPC y 4 artículos tras un análisis crítico (CASPe).

Palabras clave: heridas, gota, afectación tisular, artritis gotosa, atención primaria

Resultados: Se demostró que el tratamiento de los TG desde una perspectiva de enfermería requería una valoración integral del paciente:

1. Valoración del dolor: Evaluar intensidad, localización y factores relacionados, estableciendo protocolos de analgesia.
2. Tratamiento farmacológico: AINE y colchicina como primera línea; en casos severos, alopurinol, febuxostat o pegloticasa, y combinar lesinurad con inhibidores de la xantino-oxidasa en casos refractarios.
3. Cuidados locales y prevención de infecciones: Curas locales. Usar antibióticos si es necesario y terapia de presión negativa en heridas complicadas.
4. Educación del paciente: Dieta baja en purinas, evitar alcohol y fomentar adherencia al tratamiento.
5. Seguimiento continuo: Monitorización regular para ajustar el tratamiento según sea necesario.

Conclusiones: El manejo de los TG requiere un enfoque multidisciplinar adaptado al paciente. La enfermería en Atención Primaria es clave para su detección y seguimiento, mejorando la calidad de vida con un abordaje temprano.

Es primordial una formación de los profesionales para un diagnóstico e inicio de tratamiento precoz.

 

EP1454 Absceso frío tuberculoso en la pared torácica: un desafío en el diagnóstico de heridas atípicas

Isabel Gracia Marco¹, Albert Fernandez Borreguero¹, Rebeca Rodriguez Corbaton^1
1institut Catalá de la Salut, Lleida, Spain

Objetivo: Presentar el caso y el prolongado proceso de un absceso frío tuberculoso destacando los desafíos en el diagnóstico y manejo de las heridas atípicas.

Métodos: Paciente que es atendido en urgencias por dolor en región torácica derecha con diagnóstico de etiología musculo esquelética, gradualmente desarrolla una masa nodular en la parte posterior del hemitórax derecho por la que consulta tras ocho meses de evolución. Los estudios de imagen sugirieron un neoplasma benigno por lo que se realiza una extirpación quirúrgica durante la que se drena una importante colección purulenta, tras lo que se inicia terapia de cierre asistido por vacío (VAC). Acude a múltiples consultas en diferentes servicios debido a complicaciones por una dehiscencia y una fístula, posteriormente la biopsia y los cultivos microbiológicos confirmaron Mycobacterium tuberculosis por lo que se pauta tratamiento antituberculoso. El seguimiento es llevado a cabo por un equipo multidisciplinar incluyendo cirugía torácica, medicina interna, atención primaria y especialistas en heridas.

Resultados: El diagnóstico tardío se atribuyó a la ausencia de signos inflamatorios típicos y la lenta progresión. La cicatrización se complicó por una sobreinfección bacteriana, lo que requirió una prolongada terapia VAC. El tratamiento antituberculoso llevó a una mejora gradual de la herida, precisando de curas y atención continuada para su resolución completa.

Conclusiones: Los abscesos fríos tuberculosos, aunque son infrecuentes, deben considerarse en el diagnóstico diferencial de heridas atípicas. La colaboración multidisciplinar es esencial para un diagnóstico oportuno y un manejo efectivo de estas lesiones. Este caso también destaca el papel esencial de las unidades de especializadas en el manejo de heridas, asegurando una atención integral de que aborde tanto los componentes infecciosos como estructurales de la enfermedad.

 

EP1455 Cura de lesión en neurofibroma plexiforme de extremidad inferior

Carmen Blasco-García¹, Laura Gómez Pardos², Laia Valls Creus², Jaume Guitart Hormigo², Monica Castella^2
1HUGTIP, Badalona, Spain, ²HUGTIP, ICS, Badalona, Spain

Objetivo: Abordaje de herida crónica compleja (más de 5 años) en paciente varón de 24 años con patología poco frecuente (Neurofibromatosis Tipo 1) afectando la movilidad y la realización de las ABVD.

Métodos: Varón con neurofibromatosis tipo 1 desde el nacimiento. A los 12 años presenta incremento importante de la extremidad inferior derecha (EID) con asimetría de 7cm respecto a extremidad inferior Izquierda (EII).

En la adolescencia se le realizaron varias intervenciones quirúrgicas para reducir el tamaño del neurofibroma plexiforme, con aparición de lesiones de difícil curación tras cada intervención.

Después de ser valorado por el Comité de Facomatosis, se decide tratamiento sistémico y se deriva a enfermera clínica de heridas complejas para la valoración y tratamiento de la lesión en la EID, donde presenta neurofibroma gigante con lesión cutánea de 5,4 centímetros.

En la Unidad de Heridas Complejas, se inician curas locales de la lesión con dificultad en el cumplimiento de las curas por parte del paciente.

Resultados: De un total de 9 meses de curas con una interrupción (por decisión del propio paciente) durante los meses de verano; se consigue el cierre total de la herida.

Conclusiones: Tras un abordaje interdisciplinar y un seguimiento continuo se consigue la implicación activa del paciente y un exitoso resultado después de 5 años de existencia de la herida.

 

EP1456 Lesiones cutáneas derivadas de lepra lepromatosa multibacilar con fenómeno de lucio

Ángela Álvarez Aguilar¹, Amaya Cardona Martinez¹, Paula Galdós Rodrigo¹, Elena Rodríguez Rubio^1
1Hospital Universitario Sanitas La Moraleja, Madrid, Spain

Objetivo: Realizar un tratamiento local para control de signos y síntomas hasta el diagnóstico de las lesiones.

Recuperar la integridad cutánea en lesiones derivadas de Lepra Lepromatosa multibacilar con Fenómeno de Lucio como complicación.

Métodos: Mujer de 67 años. Independiente para las actividades básicas de la vida diaria, con movilidad reducida. Nacionalidad dominicana (zona urbana pobre), dos años residiendo en España con su hija.

Ingreso previo en su hospital comarcal de referencia, en el que se identifican las lesiones como dermatitis ampollosa y hemorrágica en miembros inferiores y tras biopsia se diagnostica inicialmente de vasculitis leucocitoclástica. Referenciando mala higiene, necrosis ungueal completa y flictenas.

Tras alta acude a consultas de Medicina Interna de nuestro centro por aparición de nuevas lesiones y mal olor de las mismas. Se deriva al servicio de urgencias donde se realiza cultivo de exudado de lesiones, se cursa ingreso y se realiza biopsia.

Se comienza con curas locales priorizando la limpieza de las lesiones y la piel perilesional utilizando distintos productos de tratamiento hasta el diagnóstico definitivo. Iniciaremos entonces pauta de cura húmeda con apósito de espuma de poliuretano con plata, película barrera no irritante y ácidos grasos hiperoxigenados.

Resultados: Se consiguió control de signos y síntomas previo al diagnóstico.

Se recuperó la integridad cutánea en miembros inferiores en dos meses de tratamiento en un 80%.

Sin diagnóstico:

Con diagnóstico:

Conclusiones: Teniendo en cuenta que el Fenómeno de Lucio se asocia a una elevada morbimortalidad, es importante llegar al correcto diagnóstico para un tratamiento adecuado.

 

EP1038 Pioderma gangrenoso asociado a enfermedad de Behçet: manejo y cura en atención primaria

Jaione Echarte Sutil^1
1ABS Palafrugell, Palafrugell, Spain

Objetivo: Presentar un caso del tratamieno de un pioderma gangrenoso en Atención Primaria en un paciente diagnosticado de enfermedad de Behçet.

Métodos: Se presenta el caso de un paciente de 71 años de edad con el diagnóstico de enfermedad de Behçet. Acude a la consulta de enfermería por la aparición de una pequeña escara necrótica en la zona gemelar del miembro inferior derecho de color violáceo y muy dolorosa. Se retira la escara y en dos días aparece una lesión ulcerada dolorosa (Eva 10/10) con borde bien definido, sobreelevado y eritemato-violáceo, rodeado por un área eritematosa e indurada de 4x3cm. Con el diagnóstico clínico de pioderma gangrenoso se inicia tratamiento con fomentos de polihexamida 0,1%, apósitos con plata nanocristalina, corticoides tópicos y óxido de zinc. Se dobla su dosis habitual de corticoides orales, metilprednisolona 8mg, y se pauta analgesia con tramadol oral.

Resultados: Se consigue la curación de la lesión en 5 meses aproximadamente.

Conclusiones: Una vez diagnosticada la lesión como pioderma gangrenoso hay que proceder a su correcto tratamiento tanto tópico como sistémico y evitar el desbridamiento.

 

EP1457 Cuidados enfermeros de lesiones ulceradas producidas por viruela del mono (VM): Análisis de un caso clínico y revisión bibliográfica

Elia Gomez Losada^1
1Hospital del Mar, Barcelona, Spain

Objetivo: Analizar la literatura científica para identificar las mejores evidencias en el abordaje de lesiones producidas por la infección de viruela del mono a partir de un caso clínico. 

Objetivos específicos:

• Describir un plan de cuidados aplicado a un paciente infectado por VM con lesiones extensas, evaluando las necesidades del tratamiento. 
• Identificar las evidencias en el abordaje local a partir de una revisión clínica. 

Métodos:

1. Caso clínico retrospectivo y plan de cuidados. Consentimiento informado verbal. 
2. Revisión bibliográfica en 3 bases de datos (PubMed, Medline, Scielo), términos MESH (“monkeypox”, “wound”, “anal ulcel”, “ulcer”, “cure” y sus combinaciones), con criterios de elegibilidad de los documentos obtenidos y siguiendo las recomendaciones PRISMA, revisando el nivel de calidad (Red EQUATOR) y de evidencia (SING). 

Resultados:

1. Hombre. 34 años. HIV sin tratamiento e infección por VM.

Diagnósticos enfermeros:

- Deterioro de la integridad cutánea (00046) 

- Dolor agudo (00132)

- Riesgo de infección (00004) 

Abordaje de las lesiones según TIME. 

2.  N=25.

8 cumplen criterios (n=2 revisión bibliográfica, n=4 casos clínico, n=1 observacional, n=1 pronóstico) 

Cumplimiento de calidad: 7 (87,5%)>50%

Nivel de evidencia: n=2 con 2++, n=1 con 2-, n=4 con 3 

Nivel de recomendaciones: C-D 

Conclusiones: La complejidad del abordaje de las lesiones producidas por VM y la escasez de evidencia científica ha puesto de manifiesto la necesidad de abrir una nueva línea de investigación para la descripción de cuidados de estas lesiones. Se ha identificado una oportunidad de liderar la elaboración de una guía de práctica clínica siguiendo la metodología Delphi. 

 

EP1039 Desafíos en el tratamiento de la fascitis necrotitzante: un caso clínico

Arola Olivera¹, Desire Perez Carmona ¹, Sílvia Vilalta Seriols^1
1Fundació Althaia - Xarxa Assistencial Universitària Manresa, Manresa, Spain

Objetivo: Presentar el abordaje terapéutico de un paciente con fascitis necrotizante en la extremidad superior izquierda, destacando la importancia de un diagnóstico y tratamiento precoz.

Métodos: Hombre de 65 años con antecedentes médicos no significativos, acudió a urgencias por una herida en el 5º dedo de la mano izquierda, causada por un corte con un cuchillo hacía 4 días. En la exploración presenta edema extenso des de los dedos hasta el codo con dolor y limitación funcional. Se realizan radiografías y análisis de sangre que muestran elevación de reactantes de fase aguda (PCR 380 mg/dl) por lo que se inicia tratamiento empírico con antibioterapia intravenosa y se realiza desbridamiento quirúrgico del tejido desvitalizado.

Resultados: El paciente es ingresado en la unidad de semicríticos y, tras confirmarse la infección por Streptococcus pyogenes, se le modifica la cobertura antibiótica. Las curas se realizan cada 12 horas con fomentos de ácido hipocloroso y aplicación de sulfadiazina de plata. Tras 16 días, se realiza una segunda intervención quirúrgica con injerto autólogo con colocación de la terapia de presión negativa.

El proceso de curación de la herida se considera exitoso, logrando una cicatrización total a los 9 meses de seguimiento.

Conclusiones: Este caso enfatiza la importancia de un diagnóstico y tratamiento precoz en la fascitis necrotizante para mejorar el pronóstico y la calidad de vida del paciente. Se considera un éxito debido a la conservación de la extremidad y la funcionalidad, a pesar de las complicaciones. Este abordaje multidisciplinario es crucial para el manejo de esta grave patología.

 

EP1458 Úlcera terminal de Kennedy - ¿has oido hablar de ella?

Natalia Gómez¹, Marta Gómez^1
1Sacyl, Segovia, Spain

Objetivo: La falta de conocimiento acerca de la úlcera terminal de Kennedy (UTK), lesión cutánea relacionada con el final de la vida y frecuentemente mal entendida dentro de las lesiones por presión, puede producir un inadecuado tratamiento.

El objetivo general es identificar los principales hallazgos para un diagnóstico adecuado de la UTK, diferenciándola de otras lesiones relacionadas con la dependencia (LRCD), que son tratables y prevenibles, consiguiendo establecer un correcto abordaje.

Métodos: Búsqueda bibliográfica: Google académico, Elsevier, Scielo, Pubmed, Medline.

Rango de publicación:2014-2024

Idioma: Inglés, español.

Selección: Artículos tipo cuantitativo y cualitativo, revisiones sistemáticas cumplan criterios de inclusión casos similares.

Resultados: La UTK, descrita por primera vez en 1989, está causada por hipoperfusión e isquemia cutánea en etapas finales de la vida, irreversible, inevitable, progresión rápida, color rojizo, purpura, amarilla o negro azul, con forma de mariposa, pera o herradura. Tiene mal pronostico.

Existen dos tipos de UTK:

1. Lesión clásica, que progresa en semanas.
2. Lesión no clásica, mucho más agresiva, que puede evolucionar en horas y llevar a la muerte en 24 horas.

Las LRCD están causadas por presión y/o cizalla, ocasiona isquemia local y daño tisular, reversible,evitable, progresión lenta, color rojo persistente, formas redondeadas. Pronostico variable.

Conclusiones: Es esencial un diagnóstico preciso de la UTK para proporcionar cuidados paliativos enfocados en el confort y la calidad de vida, ya que la curación total no es posible. Se debe educar a los pacientes y familiares sobre la naturaleza de estas úlceras, evitando atribuirlas a negligencias en el cuidado.

 

EP1459 Rechazo de un injerto de piel de la mama

Laura Codina¹, Julita Griñon¹, Rosa Maria Ibars¹, Iria Labara¹, Ester Castellano¹, Elisabet Comino^1
1ICS Girona Sud, Sils, Spain

Objetivo:

- Describir la evolución de la lesión a través de diferentes tratamientos y técnicas.
- Describir la lesión según la escala de valoración Resvech.

Métodos: Paciente de 58 años que el 23 de mayo de 2023 hace una recidiva neo de mama y se la interviene poniendo un injerto.
Unos días después de la operación la paciente hace un rechazo al injerto y se abre la lesión
El 14 de junio la lesión presenta la zona inferior y superior de la herida con tejido necrosado i bordes con biofilm. Se inician curas con hidrogel y apósitos de espuma.
El 18 de junio se decide un cambio de cura y se aplica un apósito hidroactivo que tiene por componente principal el poliacilato superabsorbente (SAP) con fibras de celulosa empapadas en solución Ringer.
El 14 de julio se coloca un PICO de 15x20. Que contribuye a la limpieza del lecho de la herida, pero siguen permanecendo restos de biofilm y se decide a cambio a terapia VAC. El 29 de agosto la paciente se realiza una cirugía para un nuevo injerto con buen resultado.

Resultados: La cura semanal que se han ido haciendo a nivel de atención primaria y de atención hospitalaria han sido claves para poder realizar un nuevo injerto.

Conclusiones: Hace falta un buen estudio y descripción de una lesión con la ayuda del TIME y del Resvech para poder identificar que cura es la más adecuada.

 

EP1460 Curación de necrobiosis lipoídica ulcerante con dapson y remedio quirúrgico

Tina Uhlmann^1
1Wundzentrum Bundeswehrkrankenhaus Berlin, Berlin, Germany

Objetivo: La necrobiosis lipoídica es una enfermedad granulomatosa rara de etiología aún inexplicada. En un tercio de los casos se producen úlceras extremadamente dolorosas en la parte inferior de las piernas. Dado que hasta la fecha no se conoce ninguna terapia causal, nos gustaría informar sobre un caso que pudo curarse completamente en pocos meses.

Métodos: Presentamos el caso de una paciente de 66 años con úlceras circulares en las piernas de ambos lados, de configuración inusual y refractarias al tratamiento, debidas a una necrobiosis lipoídica.

Resultados: Bajo terapia sistémica antiinflamatoria con dapsona y corticosteroides, las heridas se repararon quirúrgicamente y cicatrizaron.

Conclusiones: Este caso demuestra que incluso las heridas crónicas debidas a causas poco frecuentes pueden curarse utilizando un régimen de tratamiento multimodal e interdisciplinar tras un diagnóstico estandarizado previo.

 

EP1461 Pioderma gangrenoso postquirúrgico con exposición tendinosa: el complicado camino hacia la cobertura

Víctor Cassini Gómez de Cádiz^1
1Servicio Andaluz de Salud, Granada, Spain

El pioderma gangrenoso es una enfermedad inflamatoria poco frecuente, caracterizada por la formación de úlceras cutáneas dolorosas y progresivas. Se asocia con trastornos autoinmunes, como la enfermedad inflamatoria intestinal o artritis, y puede ser desencadenada por factores traumáticos, como intervenciones quirúrgicas o radioterapia. Este

proceso inflamatorio descontrolado es una respuesta exagerada del sistema inmunológico que puede complicar de manera significativa el manejo postoperatorio.

Presentamos el caso de una paciente de 76 años sometida a cirugía para la extirpación de un melanoma. En el postoperatorio, a pesar de varios intentos de cobertura con injertos autólogos, la lesión no cicatrizó adecuadamente, de modo que el defecto quirúrgico continuó aumentando en tamaño y profundidad, hasta llegar a exponer tejido tendinoso (calcáneo y peroneo). Tras una nueva biopsia cutánea, se diagnosticó un pioderma gangrenoso, complicando de forma crítica la situación. La gravedad de la úlcera llevó a considerar la amputación como último recurso.

En esta presentación, describiremos de manera detallada los pasos seguidos en el manejo interdisciplinario de este caso, que incluyó el uso de curas convencionales, microinjertos en sello y terapia con cámara hiperbárica. Se intentó evitar a toda costa el doloroso desenlace antes señalado adaptando las estrategias terapéuticas a la evolución de la lesión.

Este caso resalta la importancia del manejo multidisciplinar y flexible en la atención de pacientes con pioderma gangrenoso, subrayando la necesidad de ajustar las pautas terapéuticas a la respuesta clínica y a los cambios que presenta la lesión durante su evolución.

 

EP1462 Glutectomía como tratamiento de sarcoma Pleomórfico ulcerado en glúteo

Asuncion Merino¹, Ixone Ibarrola¹, Saioa Vañes¹, Carmen Yoldi¹, Anouska Jimenez^1
1Osasunbidea, Navarra, Spain

Objetivo: Desarrollar el plan de tratamiento y cuidados individualizados a partir del caso clínico de una paciente de 85 años que presenta una tumoración de 16 cm en glúteo de crecimiento insidioso. Inicialmente sospecha de absceso pero durante la cirugía se observa apariencia de tumor sólido confirmando SARCOMA PLEOMÓRFICO INDIFERENCIADO de alto grado histológico, ulcerado, que infiltra tejido celular subcutáneo y musculoesquelético.

Métodos: Valoración inicial: Deterioro de la integridad cutánea que afecta a la imagen corporal de la paciente y su autoestima. Sangrado moderado y mal olor difícilmente controlables produciendo aislamiento social. Pronóstico de vida muy limitado. No dolor. Control farmacológico de ansiedad e insomnio. Pérdida de peso del 6% en las últimas semanas. Se identifica malnutrición mediante escala Mini Nutricional Assessment (MNA) Puntuación de 14 puntos. Precisa inicialmente Nutrición Parenteral por desnutrición proteocalórica y trasfusión y suplementación con Fe por anemia. Valoración del estado funcional mediante escala de Karnofsky, interpretando que requiere asistencia y cuidado médico frecuentes. Evolución de herida neoplásica: Inicialmente herida extensa que precisa de hemostasia, curas frecuentes mediante alginatos. Mal estado general, precisando ingreso hospitalario y cirugía urgente: exéresis amplia de nódulo metastásico en subcutáneo sobre cresta iliaca Izda y colgajo V-Y de perforantes iliacas y rotacional basado en perforantes glúteas.

Resultados: Tras dos meses de postoperatorio actualmente presenta buen aspecto general. Heridas completamente cicatrizadas. Mejora notable del estado general y de la calidad de vida. Tratamiento oncológico bien tolerado.
Conclusiones: El tratamiento de úlceras neoplásicas exige profesionales altamente cualificados debido a la complejidad y variabilidad de las curas. Es clave la intervención enfermera sobre los cuidadores. La pauta terapéutica se individualizará y siempre se establecerá priorizando el confort del paciente. 

 

EP1463 Diagnostico diferencial de abscesos cutáneos a partir de dos casos clínicos

Ana Molina Gracia¹, Justo Rueda Lopez², Monica Recio Losilla^3
1Enfermera Especialista en Enfermería Familiar y Comunitaria, Terrassa, Spain, ²Doctor Rueda, Terrassa, Spain, ³Enfermera, Terrassa, Spain

Objetivo: Realizar el diagnóstico diferencial de abscesos cutáneos por reacción adversa a tatuaje vs picadura de insecto vs SARM comunitario, a partir de dos casos clínicos.

Métodos: Se realizó el seguimiento clínico por parte de enfermería, para identificar la tipología de las lesiones. Los datos para el diagnóstico se obtuvieron a partir de la entrevista clínica, el seguimiento y la evolución, se registraron en la historia clínica y se tomaron imágenes de la evolución.

Resultados: Caso 1: Hombre 28 años, presentó abscesos cutáneos en zona de tatuaje reciente con tintas verdes y rojas, evolucionando con abscesos en zonas no tatuadas y tatuadas durante las 12 semanas siguientes a las lesiones iniciales. Estas lesiones aparecían de forma abrupta con clínica de infección local, se realizó derivación al servicio de dermatología. Se procedió a estudio para identificar el reservorio del SARM, indicándose antibiótico sistémico ajustado a los resultados de los cultivos y además tratamiento tópico en áreas de estudio y lavado con soluciones jabonosas con antiséptico para negativizarlo.

Caso 2: Hombre 52 años, presentó absceso en muslo de crecimiento rápido con signos de infección y necrosis de zona central. Se procedió al desbridamiento y toma de muestras para cultivo. Se identificó como SARM comunitario y se indicó tratamiento antibiótico combinado con la cura de las lesiones aplicando apósitos basados en la cura húmeda.

Conclusiones: Conocer la etiología de las lesiones y realizar un diagnóstico diferencial por parte de enfermería, es clave para el abordaje y resolución de procesos que conllevan un gasto importante para el sistema sanitario y padecimiento para el paciente, que, como en estos casos puede ser el reservorio de procesos infecciosos de gran calado.

 

EP1464 Ectima gangrenoso genital en lactante de 4 meses

Gemma Pérez Acevedo¹, Laura Muriel Martinez¹, Joan Enric Torra i Bou^2
1Hospital Sant Joan de Déu, Barcelona, Spain, ²Universitat de Vic, Vic, Spain

Objetivo: Tratamiento de lesiones por ectima gangrenoso.

Métodos: El ectima gangrenosa es una lesión cutánea infecciosa provocada principalmente por Pseudomonas aeruginosa que acostumbra a aparecer en pacientes con inmunodepresión. Su tratamiento requiere un abordaje multidisciplinar. Se describe el caso de un lactante que ingresa en cuidados intensivos con ectima gangrenoso por pseudomona en genitales.

Tras estabilización hemodinámica del paciente, se cubre con antibioticoterapia sistémica, se sonda vesicalmente y se inician curas con hipoclorito sódico para reducción de carga bacteriana e inflamación. El plan terapéutico consistió en desbridamiento quirúrgico, antibioticoterapia y tratamiento tópico de las lesiones. El tratamiento tópico inicial duró 10 días con hipoclorito sódico, gestión bacteriana y tejidos desvitalizados con tul de miel y gestión de exudado con polivinilo de alcohol junto a espuma polimérica secundaria, con cambios tras deposiciones. Ante eritema perilesional se decidió cambiar tratamiento con terapia de presión negativa con base de tul de miel y aislamiento de heces mediante sondaje y lavados cada 24-48h durante 11 días. Tras epitelización parcial de las lesiones, se completó en 8 días mediante tul de miel y polivinilo de alcohol más apósito impermeable para evitar contacto con heces.

Resultados: Epitelización completa de graves lesiones anales sin complicaciones y sin realización de colostomía.

Conclusiones: El ectima gangrenosos es una lesión muy grave y dolorosa que puede precisar de tratamientos muy invasivos para su resolución. El hipoclorito sódico, el tul de miel y la terapia de presión negativa es un tipo de tratamiento muy efectivo que facilita su cicatrización sin complicación.

 

EP1465 Quemadura química en lactante por ingesta de pila de botón

Laura Muriel Martinez¹, Gemma Pérez Acevedo¹, Joan Enric Torra i Bou^2
1Hospital Sant Joan de Déu, Barcelona, Spain, ²Universitat de Vic, Vic, Spain

Objetivo: Manejo interdisciplinar del paciente. Gestión del dolor, control nutricional, reducción del proceso inflamatorio, desbridamiento y epitelización de los tejidos.

Métodos: La ingesta de una pila de botón es un problema emergente con riesgo de complicaciones como la perforación/necrosis de los tejidos si la pila pierde su integridad. Se describe el caso de un lactante de 9 meses con quemadura química en zona genital y escrotal tras la expulsión de una pila de botón.

El paciente requirió ser intubado y sedarlo. Ante una mucosa intestinal ulcerada y friable se redujo su actividad digestiva mediante nutrición parenteral. Se inició cobertura antibiótica y reducción de inflamación mediante corticoterapia sistémica y solución de hipoclorito sódico en fomento continuo sobre la zona afectada. Progresivamente se inició desbridamiento cortante y autolítico, con hipoclorito sódico, de los tejidos necrosados. Una vez desbridadas las lesiones y ante la extubación del paciente e inicio de nutrición enteral, se realizó tratamiento con barrera cutánea cianocroylato octyl, dimeticona y tul para evitar contacto y adherencias sobre las lesiones, reduciendo con ello el dolor del paciente. Epitelizado el 60%, se finaliza el proceso con cura seca de las lesiones. Ante una posterior retracción anal se inician dilataciones y en una de ellas el paciente sufre una perforación que requiere colostomía de urgencia.

Resultados: Epitelización completa de las lesiones en 2m con requerimiento de colostomía y posterior cirugía reconstructora.

Conclusiones: La ingesta de una pila de botón puede producir lesiones muy graves. Su manejo precisa de un enfoque multidisciplinar.

 

EP1466 Gangrena de Fournier en el lesionado medular, apropósito de un caso

Ana Maria Herraiz Diaz^1
1Hospital Universitario Vall d‘Hebron, Barcelona, Spain

Objetivo: Describir las características clínicas, diagnósticas y terapéuticas de un caso de gangrena de Fournier en persona con lesión medular.

Métodos: Hombre con lesión medular crónica nivel neurológico D8 AIS A de 21 años de evolución.

Antecedentes de interés aneurisma de aorta, portador de colostomía, bomba de baclofeno y sonda permanente.

Acude a urgencias el 29 de febrero 2024.

Al ingreso presenta constantes normales, auscultación cardio pulmonar normal, abdomen blando y depresible, colostomía normo funcionante, se observa lesión isquiática derecha.

Se realiza TAC de pelvis y desbridamiento quirúrgico en dos ocasiones

Se prepara el lecho de la herida inicialmente con curas húmedas continuando con terapia de presión negativa, hasta la cobertura con colgajo, se produce dehiscencia de la herida quirúrgica que se resuelve con curas en ambiente húmedo.

Resultados: El TAC confirma diagnóstico de Gangrena de Fournier en compartimento posterior del muslo y tercio proximal de la pierna derecha, preciso de varias cirugías de desbridamiento. Antes del abordaje de cobertura final se prepara el lecho de la herida durante. Una vez realizada la cirugía de reparación surge complicación por zona de congestión y dehiscencia de herida quirúrgica. Fue dado de alta con heridas parcialmente cerradas y manejo ambulatorio, hasta resolución.

Conclusiones: La gangrena de Fournier es una patología de baja incidencia con unas compilaciones severas, los cuidados enfermeros son esenciales para el manejo tanto del lecho de la herida como de las posibles complicaciones.

 

EP1467 Úlcera atípica: diagnóstico de microangiopatía a propósito de un caso clínico

Emi Camprubi Rodríguez¹, Magda Tarrés Nogués¹, Laura Escoriza Lusilla^1
1Institut Català de la Salut, Santa Eugènia de Berga, Spain

Objetivo: Detectar elementos diferenciales para el diagnóstico de herida microangiopática.

Métodos: Mujer de 90 años que acude por herida de aparición sin antecedente traumático, de 0.4cm² con tejido fibrinoso, bordes difusos, exsudado escaso y sin signos de infección. Antecedentes de interés: Insuficiencia renal crónica (IRC), Hipertensión Arterial (HTA) de >10 años de evolución, Hipercolesterolemia e insuficiencia venosa crónica. Analítica: FG 38ml/min, Glucosa basal: 139mg/dl. Exploración: Pulsos presentes, niega sintomatología isquémica, ITB pedio=1.03, ITB tibial posterior = 0.83, CEAP C4c sin terapia compresiva, dolor a la palpación. Barthel: 90 puntos. Braden: 21 puntos.

Resultados: Se realiza cura con descarga provisional y terapia compresiva a 20mmHg. Se descarta causa maligna con imagen dermatoscópica y osteomielitis con imagen radiológica. Se incrementa analgesia debido a aumento de dolor localizado a punta de dedo con predominio nocturno, se retira terapia compresiva por intolerancia y se sospecha de Úlcera Hipertensiva o Calcifilaxis fundado por dolor y empeoramiento a las 6 semanas, aun con cura teoricamente correcta. Se acuerda derivación a Unidad de Heridas Complejas para terapia avanzada con microinjerto o plasma rico en plaquetas (PRP) y se realiza Angiotac que descarta patología isquémica. Se inicia cura con PRP sin mejoría, aumentando el tamaño y el dolor descontroladamente requiriendo ingreso, en el que la herida se expande a tendón de Aquiles y también aparece en extremidad contralateral.

Conclusiones: El diagnóstico de herida microangiopática se realiza como diagnóstico diferencial, aunque se debe sospechar de forma precoz en pacientes con pulsos presentes, antecedentes de HTA >10 años, IRC y dolor que no cede incluso con tratamiento analgésico.

 

EP1041 Uso de terapia compresiva multicapa en una lesión de etiologia atípica

Raül Gisbert Barrué¹, Elena Juanós Álvarez¹, Eulalia Pegueroles Ferré¹, Seila Estopiñà Vitutia¹, Marta Ginovart Prieto¹, Alexandru Bejenari Bordei¹, Marta Lattur Valero¹

¹Hospital de la Santa Creu, Tortosa, Spain

Objetivo: Cicatrización de úlcera postradioterapia de extremidad inferior izquierda (EII) mediante el tratamiento de infecciones, gestión del exudado, potenciación del tejido de granulación y control del dolor.

Métodos: Experiencia en el uso de terapia compresiva para cicatrización de una lesión postradioterapia de más de 5 años de evolución, en cara interna de la EII, categoría IV (12x8cm).

Resultados: Recomendaciones de Dermatología: “IRUXOL NEO POMADA + DIPROGENTA periulceral, tapar con LINITUL + GASAS y venda crepé sin apretar. Realizar tratamiento 4 meses”.

Desestimamos recomendaciones, iniciamos tratamiento con descarga de Ag por infección tras cultivo. Tras comprobar pulsos efectuamos Índice Tobillo-Brazo, lo cual nos da confianza para iniciar terapia compresiva a pesar de ser una lesión postradioterapia y no úlcera venosa.

La lesión evoluciona excelentemente, se consigue controlar exudado hasta espaciar curas a semanales, se potencia granulación y epitelización. A los 4 meses y medio se da de alta a la paciente con úlcera cicatrizada.

Conclusiones:

• La capacidad y autonomía de enfermería ha resultado clave a la hora de tomar decisiones y llevarlas a cabo, incluso contradiciendo la opinión de otros profesionales.
• El control del dolor y la mejora progresiva de la lesión han resultado muy importantes a la hora de favorecer la implicación de la paciente.
• Muchas veces relacionamos la terapia compresiva con el cuidado de úlceras venosas y no debemos olvidar que nos puede ayudar en muchas otras situaciones siempre que la utilicemos habiendo descartado patología arterial.
•  

EP1468 Efectividad de las intervenciones de enfermería en el tratamiento de una herida por mordedura de perro

Maria Mercedes Terribas García¹, Quetty Previl Seide¹, María Concepción Barquero Vargas², María Ángeles Roldán Yañez^1
1Hospital Clínico San Cecilio, Granada, Spain, ²Hospital Virgen de las Nieves, Granada, Spain

Objetivo: Evaluar la efectividad de estas intervenciones de enfermería en la cicatrización de heridas por mordedura de perro.

Métodos: Paciente de 47 años con heridas inciso-contusas y desgarro muscular en la pierna derecha, tratadas con un plan de curas que incluyó lavado con suero fisiológico y clorhexidina, antibióticos intravenosos, cierre primario, terapia de presión negativa, apósitos de alginato y vendajes de tracción corta, además de colágeno y medias de compresión progresiva para reducir el edema.

Resultados: La terapia de presión negativa promovió la formación de tejido de granulación y aceleró el cierre de la herida. Posteriormente, el colágeno mejoró la calidad del tejido, logrando una herida menos profunda. Los vendajes de tracción y las medias de compresión ayudaron a controlar el edema y mejoraron la circulación. A los cuatro meses, la herida se encontraba completamente cicatrizada sin signos de infección.

Conclusiones: Las intervenciones de enfermería con presión negativa, colágeno y vendajes de tracción corta demostraron ser efectivas en la cicatrización de heridas complejas. Este caso subraya la importancia de un seguimiento adecuado y la adaptación de los tratamientos según la evolución de la herida.

 

EP1469 Multidisciplinariedad, cuando las cosas no van bien

María Isabel Campos González¹, Rocío Barral Fernández², Jose Manuel Rosendo Fernandez³, María del Pilar Rodriguez⁴, Marta Ortega Recio⁵, Carla Rosendo Lafuente⁶, Marta Rosendo Lafuente^7
1Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ³Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ⁴Complejo Hospitalario Universitario de Pontevedra, Supervisora de Unidad, Cirugía Vascular, Pontevedra, Spain, ⁵Complejo Hospitalario Universitario de Pontevedra, Supervisora de Unidad, Medicina Interna, Pontevedra, Spain, ⁶Complejo Hospitalario Universitario de Pontevedra, Enfermera, Unidad de Psiquiatría, Pontevedra, Spain, ⁷Complejo Hospitalario Universitario de Pontevedra, Enfermera, Servicio de Urología, Pontevedra, Spain

Objetivo: Presentar los resultados de un caso clínico, en el peor escenario de interdisciplinariedad.

Material y método: Paciente de 86 años derivada por enfermera de Atención primaria a la unida de heridas. Presenta lesión en MII con placa necrótica extensa, con forma irregular, en cara anterior y laterales de pierna izquierda, lesiones por vasculopatía livedoide, EVA de 10. Se contacta con secretaria de dermatología que recomiendan interconsulta por Telederma desde atención primaria. Se comunica a su enfermera la decisión ante la alta sospecha de Califilaxis. Se realiza un primer abordaje con la siguiente pauta de curas. Se realiza limpieza con clorhexidina jabonosa y secado+ crema barrera perilesional+ Colagenasa en lecho+ apósito combinado + vendaje sujeción. Se ceomienza abordaje interdisciplinar cirugía vascular, dematología, unidad de heridas y enfemrera de su centro de salud.

Resultados: Negativo en la biopsia para sospecha de Calcifilaxis, a pesar de la clínica compatible que presenta la paciente. La mala evolución de la lesión, después de realizar varias limpiezas quirúrgicas para la preparación del lecho de la herida y tras fracaso, se realiza amputación de la pierna izquierda en agosto 2024. Inicio de lesión de características similares en pierna derecha en septiembre. Exitus en octubre.

Conclusiones: En heridas atípicas y a pesar de la multidisciplinariedad a veces no es posible llegar a establecer un diagnóstico correcto de forma rápida. La evolución de las lesiones nos coloca en el peor escenario. A pesar de iniciar un abordaje compartido y diligente se produce el fallecimiento en un corto espacio de tiempo.

 

EP1470 Hemoglobina tópica, una nueva estrategia de tratamiento en ulceras de la pierna, serie de casos

Jose Manuel Rosendo Fernandez¹, María Isabel Campos González², Ana García Fernández³, José Antonio Esperón Güimil⁴, Ana María Bello Jamardo², Rocío Barral Fernández², Marta Rosendo Lafuente^5
1Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ³Complejo Hospitalario Universitario de Pontevedra, Enfermera, Subdirección de enfermería, Pontevedra, Spain, ⁴Atención Primaria, Enfermero, Centro de Salud Anafans, Ponteverdra, Spain, ⁵Complejo Hospitalario Universitario de Pontevedra, Enfermera, Unidad de Urología, Pontevedra, Spain

Objetivo: Presentar los resultados de la utilización de hemoglobina tópica en úlceras del miembro inferior.

Material y método: Después de un adecuado desbridamiento y limpieza de la herida, ésta debe de ser aplicado sobre la herida limpia. La boquilla debe encontrarse a 5-10 cm de la herida, aplicando el producto hasta que la herida quede completamente cubierta por una fina capa. Uno o dos segundos normalmente son suficientes para cubrir una herida de 2 x 3 cm. El espray debe ser aplicado en cada cambio del apósito o, al menos, cada tres días. Tras su uso, se aconseja que la herida sea cubierta con un apósito transpirable no oclusivo para realizar un correcto intercambio gaseoso.

Resultados: Se presenta una serie de casos clínicos de heridas en la pierna cuya evolución es progresiva y favorable al uso de hemoglobina tópica hasta su completa cicatrización.

Caso 1. Herida atípica en la pierna.

Caso 2. Desgarro cutáneo en la pierna.

Caso 3. Ulcera venosa.

Conclusiones: Se consigue el doble de cicatrizaciones de heridas crónicas una vez transcurridas entre 8 y 16 semanas de tratamiento en comparación con el tratamiento habitual, un 50% menos de tiempo de cicatrización de úlceras de pie diabético en comparación con el tiempo de cicatrización con el tratamiento habitual. La aplicación de hemoglobina tópica es un avance en el tratamiento de las heridas complejas, siendo mucho más efectiva después de la preparación del lecho de la herida y con el tejido granulado.

 

EP1471 Debajo de las vendas: documento audiovisual sobre el proceso de cura en la epidermólisis bullosa. Una herramienta formativa

Álvaro Villar Hernández¹, Elena Perona², Natividad Romero Haro³, Ángela Segura Elías⁴, Sara Garcia Vidal^3
1ONG DEBRA España Piel de Mariposa, Sevilla, Spain, ²ONG DEBRA España Piel de Mariposa, Madrid, Spain, ³ONG DEBRA España Piel de Mariposa, Marbella, Spain, ⁴ONG DEBRA España Piel de Mariposa, Barcelona, Spain

Objetivo: Mejorar los conocimientos y habilidades en Epidermólisis bullosa (EB) de los profesionales de la salud y cuidadores informales, a través de una guía audiovisual de alta calidad sobre el proceso de cuidados de las heridas en EB.

Métodos: Se conformó un equipo multidisciplinar compuesto por enfermeras especialistas en EB y expertos en producción audiovisual. Se realizó grabaciones en el domicilio de una persona adulta afectada con EB. Se documentó cada etapa del proceso de cura y se llevó a cabo entrevistas para recoger experiencias y recomendaciones en el cuidado de la EB.

Resultados: El material grabado fue editado resaltando los aspectos clave del proceso de cuidados. Se realizó una revisión del contenido por expertos en EB para garantizar la relevancia de la información presentada. Dicha grabación se adaptó en varios formatos de tiempo: 2, 6 y 43 minutos.

Conclusiones: El material obtenido es una herramienta educativa óptima para profesionales de la salud que quieran conocer más sobre los cuidados específicos que requiere la EB.

 

EP1472 Uso de un gel de base oleica enriquecido con oxígeno en la cura de 2 casos de heridas atípicas en población pediátrica

Pablo García-Molina¹, Biagio Nicolosi², Evelin Balaguer-López³, Laura Pla Marzo⁴, Tamara Blasco Pérez⁵, María Valls Reig⁵, Josué Estébanez Frías⁵

¹Unidad Enfermera de Úlceras y Heridas Complejas (pediatría). Hospital Clínico Universitario de Valencia, Departamento Enfermería. Universidad de Valencia, Grupo de Investigación en Cuidados INCLIVA, Valencia, Spain, ²Burns Unit and Complex Wounds, Department Health Professions, Meyer Children’s Hospital IRCCS, Florence, Italy, ³Servicio Pediatría. Hospital Clínico Universitario Valencia, Departamento Enfermería. Universidad de Valencia, Grupo de Investigación en Cuidados INCLIVA, Valencia, Spain, ⁴Departamento Enfermería. Universidad de Valencia, Valencia, Spain, ⁵Unidad Enfermera de Úlceras y Heridas Complejas (pediatría). Hospital Clínico Universitario de Valencia, Valencia, Spain

Objetivo: Evaluar el uso de un gel oleico enriquecido con oxígeno, en la reducción de los tiempos de curación de heridas en 2 pacientes pediátricos.

Métodos: Descripción de 2 casos clínicos donde en un principio se utilizaron un plan de curas en ambiente húmedo con apósitos tradicionales usados en la etapa adulta. La forma de curación inicial fue el uso de higiene de la herida con fomento de solución octenidina, desbridamiento mecánico con cureta, y aplicación de apósito de cura en ambiente húmedo de espuma y silicona. Con curas cada 48 h. En la siguiente fase se usó misma pauta de cura pero se cambió el apósito por un producto primario de gel de base oleica (aceite de oliva virgen extra orgánico) enriquecido con oxígeno capaz de liberar cantidades limitadas de especies reactivas de oxígeno (ERO) y como secundario apósito de tejido sin tejer (con cambios cada 3 días) Se usó HELCOS para hacer seguimiento y análisis.

Resultados: Niño de 10 años con herida en pecho por dehiscencia de sutura con RESVECH de 15 con 50% tejido necrótico-tras primera fase- que, tras 14 días con cura con gel de base oleica pasa 6 puntos con tejido de granulación y epitelización. Niño de 14 años con herida en brazo RESVECH 19 con 56% tejido necrótico -tras primera fase-, en 30 días consigue epitelización directa (RESVECH 3).

Conclusiones: El gel con base oleica enriquecido con oxígeno ha demostrado ser un producto efectivo y seguro en la aplicación a estos dos casos clínicos.

 

EP1473 Lesiones cutáneas relacionadas con la enfermedad de bowen, importancia de la detección precoz por parte de enfermería

Isabel Hernández, Núria Pagès¹, Marta Duran¹, Ivet Rabat¹, Lorena Mora¹, Raquel Peña¹, Laura Solé^1
1Institut Català de la salut, Girona, Spain

Autoras: Pagès Cadena, Núria; Rabat i Martín-Consuegra, Ivet; Hernández Maldonado, Isabel; Mora Espinosa, Lorena; Peña Vargas, Raquel; Duran Asparó, Marta; Solé Llombart, Laura.

Objetivo: Determinar la importancia de la detección precoz de lesiones cutáneas relacionadas con la enfermedad de Bowen

Métodos: Mujer de 89 años en programa de atención domiciliaria con dependencia total (Barthel 20), deterioro cognitivo leve-moderado (Pfeiffer: 4 i Mini Mental: 23) y con Depresión moderada - severa (Patient Health Questionnaire9: 18). Antecedentes patológicos: Hipertensión arterial, infarto cerebral, demencia senil, glaucoma, incontinencia urinaria y fragilidad. Consulta el 5/2/2024 por lesión en parte posterior pierna derecha. Presenta 3 lesiones circulares dos de 0’6 x 0’7cm y otra de 0’5 x 0’5cm, hiperqueratósicas, sobre placa eritematosa. Lesión de larga evolución, que ha ido aumentado en extensión y grosor.

Se observa crecimiento centrífugo con lesión solitaria de una parte descamativa y de la otra verrugosa, con relieve de aproximadamente 1 x 1 cm.

Se realizaron capturas de imágenes con teléfono y dermatoscopio pre y post-retirada de la hiperqueratosis. Se hace interconsulta con dermatología.

Resultados: 22/3/24 recibimos respuesta: sospecha de enfermedad de Bowen. Dada la dificultad para la confirmación diagnóstica presencial por las características de la paciente y el riesgo de evolucionar a carcinoma invasivo, se pauta tratamiento cutáneo con fluorouracilo y ácido fusídico. La lesión experimenta un efecto irritativo ya esperado. A las 6-8 semanas presenta notable mejoría

Conclusiones: Enfermería realiza las primeras curas, de ahí la importancia que tenga formación en dermatoscopia y sepa identificar lesiones de riesgo.

Tener claros los criterios de derivación, los signos de alarma y los circuitos existentes, ayudará a actuar de manera precoz en aquellos casos que así lo requieran.

 

EP1474 Dermatitis pustulosa erosiva: un reto diagnóstico a la luz de un caso clínico

Alba Arroyo^1
1SALUD, Zaragoza, Spain

Objetivo: Analizar el manejo de un paciente con dermatitis pustulosa erosiva en cuero cabelludo, destacando la importancia de un diagnóstico y tratamiento adecuados.

Métodos: Se evaluó a un paciente de 78 años que sufrió laceraciones profundas en cuero cabelludo tras una caída. Durante tres meses, se realizaron curas en ambiente húmedo con apósitos oclusivos, observándose un empeoramiento de las lesiones y la aparición de pústulas.

Resultados: Ante el deterioro de la herida, el paciente fue derivado a la consulta de heridas complejas, donde se aplicó un tratamiento inicial de efecto costra que resultó ineficaz, evidenciándose costras fluctuantes y nuevas pústulas. Se realizó un cultivo por sospecha de infección y se inició antibiótico vía oral, pero tampoco se observó mejoría clínica. Tras revisar la evolución del paciente y la clínica, se estableció un diagnóstico de dermatitis pustulosa erosiva, condición común en pieles envejecidas y afectadas por la exposición solar, que puede agravarse con tratamientos tópicos oclusivos. Se comenzó el tratamiento correspondiente a la patología (corticoide de potencia alta) con la aplicación de Fluocinolona acetónido pomada cada 12 horas, cubriendo con gasas o alginatos, evitando así apósitos oclusivos. Con la mejora de las lesiones, se alternó el corticoide con una crema* con componentes reparadores cutáneos y calmantes.

Conclusiones: A los 30 días de tratamiento, se logró la epitelización completa de las lesiones, sin nuevas pústulas. Este caso subraya la necesidad de reevaluar el diagnóstico en lesiones resistentes y resalta la importancia de un diagnóstico certero y un tratamiento adecuado en pacientes con dermatitis pustulosa erosiva.

*Crema reparadora Epitheliale A.H Ultra

 

EP1475 Aplicación de una matriz polimérica bioabsorbible con plata anoparticulada: Coadyuvante en el tratamiento de heridas por leishmaniasis cutánea. Serie de casos

Helen Teherán García¹, Laura Juliana Suesca Bustacara^1
1Innovacure S.A, Bogotá, Colombia

Objetivo: Describir los resultados clínicos de la aplicación de una matriz polimérica bioabsorbible con plata nanoparticulada como coadyuvante en el tratamiento en heridas por Leismaniasis Cutánea (LC).

Métodos: Se trata de serie de casos, según guía de reporte CARE, para la aplicación de la matriz polimérica Bioreabsorbible con plata nano particulada en pacientes con lesiones cutáneas causadas por LC. Posterior a la firma del consentimiento informado, se aplicó la Matriz de Superficie de Polielectrolitos 1,33%, Plata iónica y Metálica 0,67%, 2 veces a la semana, y siguiendo el protocolo de cuidado estándar, con los objetivos propuestos como el mantenimiento del lecho de la herida limpio y desbridamiento del tejido necrótico.

Resultados: Se aplicó la matriz polimérica Bioreabsorbible con plata nano particulada a 3 hombres y 1 mujer, con edades comprendidas entre los 11 y 75 años. Los pacientes presentaban (n=12) lesiones confirmadas por prueba directa positiva y todos en tratamiento sistémico con Antimoniato de N- Metil Glucamina. Edad promedio de las lesiones (4 meses). El (100%) de los pacientes tuvieron 100% de cicatrización. El tiempo menor de cicatrización fue de 27 días y el mayor tiempo fue de 64 días. El tiempo promedio de cicatrización fue de 46 días. Ninguno de los pacientes presento efectos adversos secundarios.

Conclusiones: Las lesiones asociadas a LC, podrían ser consideradas según su evolución como heridas de difícil cicatrización a pesar de recibir tratamiento sistémico. Acorde con los resultados de los pacientes de esta serie de casos, su uso podría significar una alternativa coadyuvante en el tratamiento tópico, acortando los tiempos de cicatrización y las complicaciones asociadas como sobreinfección y aumento de la morbilidad. Para futuras investigaciones, se recomienda aumentar el tamaño de la muestra e identificar previamente el subgénero de Leishmania.

Conflictos de interés: Las enfermeras Hellen Teherán García y Laura Juliana Suesca Bustacara, laboran en Innovacure S.A.

Referencias bibliográficas:

1. Mokni M. Leishmanioses cutanées [Cutaneous leishmaniasis]. Ann Dermatol Venereol. 2019 Mar;146(3):232-246. French. doi: 10.1016/j.annder.2019.02.002. Epub 2019 Mar 15. PMID: 30879803.
2. Hernández AM, Gutierrez JD, Xiao Y, Branscum AJ, Cuadros DF. Spatial epidemiology of cutaneous leishmaniasis in Colombia: socioeconomic and demographic factors associated with a growing epidemic. Trans R Soc Trop Med Hyg. 2019 Sep 6;113(9):560-568. doi: 10.1093/trstmh/trz043. PMID: 31140567.
3. Vélez ID, Jiménez A, Vásquez D, Robledo SM. Disseminated Cutaneous Leishmaniasis in Colombia: Report of 27 Cases. Case Rep Dermatol. 2015 oct 7;7(3):275-86. doi: 10.1159/000441120. PMID: 26557074; PMCID: PMC4637797
4. I. Abadías-Granado, A. Diago, P.A. Cerro, A.M. Palma-Ruiz, Y. Gilaberte, Leishmaniasis cutánea y mucocutánea,Actas Dermo-Sifiliográficas, Volume 112, Issue 7, 2021,Pages 601-618,https://doi.org/10.1016/j.ad.2021.02.008.
5. Manning SW, Humphrey DA, Shillinglaw WR, Crawford E, Pranami G, Agarwal A, Schurr MJ. Efficacy of a Bioresorbable Matrix in Healing Complex Chronic Wounds: An Open-Label Prospective Pilot Study. Wounds. 2020 nov;32(11):309-318. PMID: 33465043

 

EP1476 Monitorizar heridas sorprende

Jennifer Otero Páez¹, Beatriz Montero Arias¹, Laura Martínez Martínez¹, María Elena González Fernández², jorge rodriguez gomez^1
1Hospital El Bierzo GASBI, Ponferrada, Spain, ²Sacyl Gasbi, Ponferrada, Spain

Objetivo: Recalcar la importancia que tiene la monitorización exhaustiva de las heridas de difícil cicatrización y alertar sobre diagnósticos diferenciales sobrevenidos clínicamente relevantes.

Métodos: Caso clínico de una mujer de 71 años, parapléjica, con antecedente de bursectomía e isquiectomía izquierda con fístulas crónicas a piel. Presenta úlcera por presión en glúteo izquierdo de años de evolución que comienza a presentar tejido anormal que ocupa toda la superficie ulceral por lo que se programa intervención quirúrgica con resección de dicho tejido. La anatomía patológica desvela carcinoma verrucoso. Contactamos con Dermatología quien recomienda exéresis de tejido córneo recidivante y vacunación contra el virus del papiloma humano, descartando tratamiento adyuvante. Continuamos seguimiento realizando curas habituales en ambiente húmedo y haciendo desbridamiento cortante de excrecencias córneas que se envían periódicamente a AP.

Resultados: Tras ocho meses de seguimiento de la úlcera la cobertura de epitelio normal es del 90%, y las muestras de tejido recogidas han sido negativas para malignidad.

Conclusiones: El carcinoma verrucoso se identifica raramente sobre úlceras de Marjolin Es un tumor maligno que rara vez metastatiza, pero puede causar destrucción local significativa si no se trata. Es importante pensar en este diagnóstico diferencial en úlceras crónicas de comportamiento anómalo. Una correcta y exhaustiva monitorización de las heridas permite realizar diagnósticos diferenciales que pueden suponer cambios relevantes en el plan terapéutico. No debemos suponer que lo que hoy es lo más adecuado lo será siempre.

 

EP1477 Curación de herida en paciente con dermatopolimiositis refractaria. Como los ácidos hiperozonizanos nos han ayudado a cicatrizar una herida después de varias recidivas de la misma

MªElena Saba^{1 2 3 4 5 6
1}MªElena Saba. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ²Mª del Mar Novis Berenguel. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ³Meritxell Torà Rey. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ⁴Anna Carbonell Pérez. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ⁵Susset Maria Figueiredo Pereira. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ⁶Ana Rita Gonçalves Zeferino. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra

Objetivo: Curación de herida en el codo después de una intervención quirurgica y recidiva en la cicatrización.

Métodos: Después de 8 meses de realización de curas con diferentes productos, se forma una zona hiperqueratosica y a las 10 semanas de darle el alta acude para realización de nuevas curas.

Manifiesta que cada vez que se le forma la hiperqueratosis, le produce prurito, rasca involuntariamente, esta salta y se le hace otra vez herida.

Empezamos tratamiento con aceite hiperozonizado el 12 de julio del 2024 con la herida cicatrizada. Se aplica el aceite 2 veces al día en casa ya que el paciente marcha de vacaciones.

El día 1 de agosto hacemos revisión de la herida, está curada. No presenta hiperqueratosis y el paciente refiere que desde que se ha aplicado el aceite hiperozonizado no se le ha vuelto a formar la hiperqueratosis.

Actualmente la zona del codo con las mismas características que el resto del cuerpo con su dermatopoliomisitis refractaría.

Resultados: Curación de la herida sin recidivas en 3 semanas de aplicación de aceite hiperozonizado.

Conclusiones: El tratamiento con aceites hiperozonizados permite curar las heridas, modelar la piel para preservar su integridad y mantener su continuidad evitando que se rompa y se produzca herida.

 

EP1478 Técnica crusting para el abordaje de lesiones por humedad no ocluibles. A propósito de un caso clínico

Mª Jesús Lanillos de la Cruz¹, Teresa Olivas Asensio¹, Blanca Morales Ortega¹, Alejandra García Rodrigo¹, Luisa Ortiz Mejía¹, Leticia Torres Fernández¹, Verónica del Amo Rodríguez^1
1Sescam, Guadalajara, Spain

Objetivo: Conseguir estrategia terapéutica eficaz en lesión cutánea asociada a la humedad (LESCAH) que dada su localización perianal es imposible de ocluir y es proclive a sobreinfecciones de hongos.

Métodos: Tras revisión bibliográfica se aplica técnica Crusting, consistente en la aplicación secuenciada de película barrera no irritante (PBNI) y polvos hidrocoloides, creando una costra artificial que aísla la piel de los fluidos irritantes contribuyendo a la cicatrización. Esta cura es utilizada para la dermatitis periestomal con buenos resultados y consideramos que podría ayudar en lesiones con etiopatogenia similar.

Resultados: Varón de 48 años ingresado entre el 23/08/2023 y el 11/12/2023.

25/09: Lesión perianal categoría I. Apósito hidrocoloide + silicona.

29/09: Categoría II, 2,5 X 2cm, se añade PBNI.

01/10: Se registran dos lesiones perianales (2X1 y 2,5X2). Primer registro de escala PUSH: 7 ambas.

06/10: Mala evolución (PUSH 8). Se inicia técnica Crusting.

08/10: Categoría IIB, 4X2 (se unifica a 1 lesión).

Conclusiones: Las LESCAH requieren un abordaje complejo y dinámico ya que presentan complicaciones como: dolor, presencia de biofilm y sobreinfección por hongos.

La técnica Crusting ofrece una estrategia eficaz en el abordaje de las LESCAH no ocluibles.

 

EP1043 Aportaciones al modelo de lesiones cutáneas por compromiso vital severo

Rosario Malia Gázquez¹, Alberto Rodríguez Malia², Fernando Ares Camerino³, Manuel Rodriguez-Palma^3
1Hospital Universitario Puerta del Mar, Cádiz, Spain, ²Hospital General Universitario Gregorio Marañón, Madrid, Spain, ³Residencia de Mayores José Matía Calvo, Cádiz, Spain

Objetivo: Determinar si el rápido deterioro de una herida ya instaurada, distinta de una lesión cutánea relacionada con la dependencia (LCRD), puede ser indicativo de muerte inminente.

Métodos: Análisis inductivo a partir de la exposición de un caso clínico.

Resultados: Varón, 87 años, pluripatológico y polimedicado. Independiente parcial para las actividades básicas e instrumentales de la vida diaria. No deterioro cognitivo. Presenta úlcera en cara externa de miembro inferior derecho (MID) desde Agosto de 2022, diagnosticada como úlcera hipertensiva de Martorell en Marzo de 2023, tratada según evolución y características clínicas con progresión favorable. En septiembre de 2023 es ingresado tras proceso agudo de deshidratación y fallo renal, sufriendo un empeoramiento de la lesión de forma rápida y brusca, manifestada por cambios en el color de la herida y piel perilesional, deterioro del tejido del lecho y aumento del dolor localizado, falleciendo a los 16 días.

Conclusiones: La repentina e inevitable aparición de heridas como premonición del final de la vida de la persona queda expresada en la úlcera terminal de Kennedy, lesiones de Trombley-Brennan, SCALE, fallo cutáneo y el reciente modelo de lesiones cutáneas por compromiso vital severo (LCCVS). Pero ninguno de estos cuadros clínicos establece el rápido deterioro de una úlcera ya existente como indicativo de una muerte próxima o inminente.

A partir de esta experiencia planteamos a la comunidad científica el análisis y reflexión sobre si este tipo de lesiones (ya instauradas y tratadas adecuadamente, pero con rápido deterioro previo al fallecimiento) pueden ser consideradas e incluidas dentro del modelo de LCCVS.

 

EP1044 Retos de los cuidados de enfermería en el abordaje del carcinoma epidermoide en epidermólisis bullosa. A propósito de un caso

Ángela Segura Elías ¹, Álvaro Villar Hernández², Sara Garcia Vidal³, Elena Perona⁴, Natividad Romero Haro^3
1ONG DEBRA España Piel de Mariposa, Barcelona, Spain, ²ONG DEBRA España Piel de Mariposa, Sevilla, Spain, ³ONG DEBRA España Piel de Mariposa, Marbella, Spain, ⁴ONG DEBRA España Piel de Mariposa, Madrid, Spain

Objetivo: Analizar el abordaje y los desafíos de los cuidados de enfermería en el tratamiento de carcinomas de células escamosas (CCE) en personas con Epidermólisis Bullosa (EB). Proponer estrategias de mejora en el abordaje de dichos cuidados.

Métodos: A raíz de un caso clínico se realiza una revisión y análisis de las estrategias de cuidado empleadas en el abordaje del CCE en EB, recogidas en las guías de prácticas clínicas en EB y en guías de abordaje integral en heridas tumorales.

Resultados: Se describen las principales complicaciones asociadas al manejo de los CCE en EB: dolor, exudado, infección, olor y sangrado. Se proponen una serie de intervenciones enfermeras que promuevan el confort del paciente y mejoren su calidad de vida. Además, se describen los desafíos encontrados durante el proceso de cuidados debido a la extrema complejidad y manejo de la enfermedad.

Conclusiones: Existen importantes desafíos específicos en el manejo del CCE en personas con EB y se subraya la importancia de una atención especializada de enfermería. Es necesario una adaptación constante de las intervenciones enfermeras, individualizando los tratamientos en función de la idiosincrasia y necesidades del paciente y su familia.

 

EP1045 Cura atípica compleja en lesión necrótica infiltrante por gangrena de fournier en paciente frágil con comorbilidad asociada

Germán Freire Coscullano¹, Jose Alfredo González Olivas^1
1Complex Hospitalari Universitari Moisès Broggi, CSI, L‘hospitalet de Llobregat, Spain

Objetivo: Realizar una descripción de la evolución clínica del caso: “cura atípica compleja de lesión por gangrena de Fournier (GF) en paciente frágil con comorbilidad asociada”.

Métodos: Se realiza una selección focalizada de un paciente con lesión sacra necrótica infiltrante por cuadro incipiente de GF secundaria a neoplasia de recto tras su ingreso en centro de atención intermedia. Se lleva a cabo una búsqueda bibliográfica semiestructurada (Fournier’s gangrene) AND (clinical case) AND (cancer) con la cual se seleccionan 13 casos para el desarrollo del caso clínico en cuestión.

Resultados: Paciente frágil de 66 años intervenido de manera multidisciplinar para tratamiento de cura atípica compleja en lesión necrótica infiltrante por GF. Tras valorarse no indicación de terapia de presión negativa, se lleva a cabo un método con cura en ambiente húmedo y desbridamiento quirúrgico inicial y autolítico con la que describe una evolución favorable. El proceso de cura ha requerido una evaluación constante de la herida y la adaptación del tratamiento debido a una evolución inicial tortuosa de sus características.

Conclusiones: El lecho de la herida describió un curso favorable hacia tejido de granulación con cura húmeda convencional y desbridamiento autolítico. Debido a la extensión y características de la lesión, el método con mayor evidencia con terapia de presión negativa (TPN) no ha sido indicado como tratamiento de primera elección. La evidencia de los casos con cura por lesión en contexto de GF, reflejan la necesidad de mayor publicación al respecto que de soporte científico y apoye la práctica clínica.

 

EP1479 Infradiagnóstico de las úlceras hipertensivas de Martorell

Iván Segura Quintana¹, Ana María Quintana Afonso¹, Acoraida García López¹, Patricia María Brito Rodríguez¹, Miguel Angel Diaz Barreiros^1
1Gerencia de Atención Primaria, Las Palmas de Gran Canaria, Spain

Introducción: Las úlceras de Martorell se presentan generalmente en la parte inferior de las piernas. Son ulceraciones dolorosas, de bordes definidos y de apariencia necrosada. Suelen asociarse con trastornos venosos, como la insuficiencia venosa crónica, y pueden aparecer en pacientes con antecedentes de hipertensión arterial o diabetes.

Su origen se relaciona con una alteración en el flujo sanguíneo venoso, lo que provoca una acumulación de líquidos y una mala oxigenación de los tejidos.

Al diagnóstico es fundamental descartar otras causas de ulceración.

Varón de 58 años, con antecedentes de Parkinson, insuficiencia venosa y Diabetes Mellitus mal controlada (Hba1c 9.1) e HTA que presenta úlceras bimaleolares, redondeadas con bordes necróticos y lecho esfacelado, muy dolorosas. No han resuelto con curas secas.

Objetivo: Mejorar el diagnóstico de la herida para acelerar la curación

Métodos: Tras contrastar la etiología con úlceras de Martorrell, se hace una revision de dieta, tratamiento y ejercicio físico para mejorar cifras de Hba1c y de TA. No tolera compresión por lo que aumentamos EF para favorecer bomba muscular. El tratamiento que se utiliza para la herida es un hidropolimérico con plata, tras curetaje inicial con anestésico local.

Resultados: En las primeras semanas con tratamiento antimicrobiano las heridas mejoran bordes necróticos, tejido esfacelado y dolor. Continuamos con apósitos hidropolímérico adhesivos y apósitos de fibra hidrocoloide para controlar el exudado, hasta cierre completo de las úlceras en dieciocho semanas.

Conclusiones: Un rápido y correcto diagnóstico permite un tratamiento más preciso. En muchas ocasiones tratamos la mayoría de las úlceras como venosas y cabe destacar el infradiagnóstico de las úlceras de Martorell.

 

EP1480 La úlcera hipertensiva: un abordaje integral

Nuria Babot-Pereña¹, Blanca Mascarell², Ángela María Correa Rubio¹, Mercè Portè Llotge², Maria Carmen Marquilles Bonet², Sandra Alexandre Lozano², Iraida Gimeno Pi^2
1Serveis de Salut Integrats del Baix Empordà (SSIBE), Palamós, Spain, ²Institut Català de la Salut, Lleida, Spain

Objetivo: Describir el abordaje clínico y biopsicosocial de una persona con úlcera hipertensiva.

Métodos: Mujer de 91 años viuda con sobrepeso, diabetes desde 2005 y hipertensión arterial desde 2001, mal control desde hace tiempo ya que no acudía a su centro, actualmente tratada con amlodipino5mg-hidroclorotiazida50mg-losartan50mg. Independiente en su vida diaria; a partir de la aparición de la úlcera tiene movilidad reducida y mal descanso nocturno por el dolor y desde entonces convive con su hija y su familia.

Presenta 3 heridas en piernas, en maleolo externo bilaterales. Izquierda 1x2,5cm, dos en la derecha 2x2cm y 1,5x1cm de un mes de evolución, lecho esfacelado, exudado moderado, bordes violáceos-necróticos y piel perilesional eritematosa.

Presenta dolor 10/10 en la Escala Visual Analógica (EVA) durante la cura, y resto del dia EVA8/10 (gabapentina300mg-tramadol37,5mg/paracetamol325mg-metamizol575mg). Índice Tobillo-Brazo 1,1, cribado Mini-Nutritional-Assessment 12 puntos, valor analítico de vitamina B12 a 155 pmol/L.

Resultados: Diagnóstico diferencial de úlcera hipertensiva por síntomas clínicos. Se prioriza el control de la tensión arterial y del dolor. La paciente no tolera anestesia tópica por prurito intenso. Se consigue un control del dolor EVA 4/10 en las primeras 48h con apósito impregnado de ibuprofeno y vendaje de tracción corta. Se administran suplementos de vitamina B12 para conseguir una mejor regulación metabólica (menor riesgo de hiperhomocisteínemia). Una vez controlados los niveles de tensión arterial y dolor, se plantea la realización de microinjertos de piel autóloga.

Conclusiones: Un buen manejo de las cifras tensionales, la diabetes y el dolor es esencial para evitar la progresión de las úlceras hipertensivas.

 

P1481 Tratamiento de patologías dermatológicas poco frecuentes en la Sección de Medicina Hiperbárica del Complejo Hospitalario Universitario de Canarias

Jose Perez Rodriguez¹, Esteban Siverio Gonzalez², Carmen Hernandez Alvarez^2
1Complejo Hospitalario Universitario de Canarias, La laguna, Spain, ²Complejo Hospitalario Universitario de Canarias, La Laguna, Spain

Introducción: El pioderma gangrenoso es una enfermedad inflamatoria cutánea caracterizada por la aparición de úlceras dolorosas y puede ser resistente a tratamientos convencionales. La hiperdermólisis bullosa es un trastorno genético de la piel que se caracteriza por la formación de ampollas en respuesta a traumas menores. Este estudio explora los beneficios de la combinación de oxigenoterapia hiperbárica (OHB) y apósitos gelificantes en el manejo de estas patologías.

La OHB mejora la cicatrización al aumentar la oxigenación de los tejidos, reducir la inflamación y estimular la reparación celular. Por su parte, los apósitos gelificantes crean un entorno húmedo que favorece la curación, protege las lesiones y alivia el dolor.

Objetivo: Analizar los resultados de la combinación de OHB y apósitos gelificantes en el manejo de lesiones cutáneas en pacientes diagnosticadas con pioderma gangrenoso e hiperdermólisis bullosa en la Sección de Medicina Hiperbárica del CHUC.

Métodos: Revisión de casos con lesiones cutáneas en pacientes diagnosticadas con pioderma gangrenoso e hiperdermólisis bullosa, tratados en la Sección de Medicina Hiperbárica del CHUC entre 2019- 2024.

Resultados: Los resultados preliminares muestran que la combinación de OHB y apósitos gelificantes no solo acelera la recuperación de las lesiones, sino que también mejora la calidad de vida de los pacientes, reduciendo el riesgo de infecciones y complicaciones asociadas.

Conclusiones: Estos hallazgos sugieren que esta estrategia terapéutica podría ser un enfoque eficaz en el manejo de estas patologías, lo que justifica estudios adicionales para confirmar su eficacia y seguridad.

 

EP1482 Evaluar la efectividad clinica de la polihexanida y betaina en el aborddaje de una úlcera escrotal dolorosa secundaria a extravasación de mitomicina

Rosa Maria Bonilla¹, Belen Vazquez Rodriguez¹, Valentina Osses González¹, Yolanda Baños Lazaro^1
1Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain

Objetivo: Evaluar la efectividad clínica de la Polihexanida y Betaína en el abordaje de una úlcera escrotal dolorosa secundaria a extravasación de Mitomicina.

Métodos: Caso clínico observacional en paciente oncológico inmunodeprimido positivo a VHC en remisión que, tras recibir ciclos de Mitomicina intraoperatoria se produce una extravasación con afectación escrotal debido a una malformación peritoneal. Como consecuencia, el paciente desarrolla una lesión compleja de dimensiones 9x3cm² con lecho necrótico, sin signos de infección inicialmente y EVA 8/10.

Desde la Unidad de Heridas Complejas, se inician curas ambulatorias diarias aplicando Gel de Betaína y PHMB para limpiar y descontaminar la zona, realizando desbridamiento cortante del tejido necrótico en bordes. A los 10 meses del inicio de tratamiento se toma cultivo con resultado positivo a SARM y se pauta tratamiento antibiótico ambulatorio y se decide mantener la misma pauta de curas disminuyendo la frecuencia a cada 72h, llegando así hasta el cierre total de la lesión.

Resultados: Se observó que tras el abordaje con la Betaína y PHMB la lesión evolucionó favorablemente ayudando a controlar la biocarga y microorganismos multirresistentes, reduciendo el intenso dolor del paciente y facilitando el desbridamiento del tejido desvitalizado durante el proceso de cura. La cicatrización completa se consiguió a los 420 días.

Conclusiones: Se observa la eficacia clínica de la Betaína y PHMB en el abordaje de la úlcera necrótica, ya que ayudó a controlar la biopelícula, a prevenir sobreinfecciones reduciendo el uso de antibioterapia vía sistémica, estancia hospitalaria y aumentando la calidad de vida del paciente.

 

EP1046 Abordaje holistico hospitalario en pacientes con ulceras por calcifilaxis no uremica

Maria Angeles Benet Perez¹, Eloisa Ruda Resina¹, Gema Jiménez¹, Mireia Hernández Ruda¹, Elisabet Vilar Fontarnau¹, Lourdes Sola González^2
1Hospital General de Granollers, Granollers, Spain, ²Hospital General de Granollers, Granollers, Spain

Objetivo: Presentar los resultados obtenidos en los pacientes desde 2019 hasta 2024, afectados por calcifilaxis no urémica, tras afrontar el tratamiento y cuidados de manera multidisciplinar.

Métodos: Revisión de historias clínicas de pacientes que desde 2019 hasta la actualidad, presentaban úlceras por calcifilaxis no urémica; la calcifilaxis es un síndrome caracterizado por la formación de úlceras necróticas en la piel, las cuales se extienden y son muy dolorosas. Estas son debidas al depósito de cristales de calcio en las arteriolas del tejido subcutáneo y, en menor medida, en vísceras. Los pacientes recibieron los cuidados protocolizados, siguiendo la estrategia TIME y el tratamiento médico adecuado en cada caso clínico.

Resultados: Se ha observado en los pacientes analizados una mortalidad al año del 44.5%, dato que mejora el referenciado en la literatura para esta patología, así como una evolución menos tórpida en el control del dolor, la infección y la cicatrización de las úlceras.

Conclusiones: Al detectarse un alto grado de incidencia de estas úlceras respecto a las que se manejan de forma general en la literatura, se elaboró un protocolo unificando criterios de actuación para su abordaje, evidenciando mejores resultados mediante un tratamiento multidisciplinar, y promoviendo un enfoque holístico. Además, es transcendental para la adherencia al tratamiento empoderar al paciente y su entorno familiar en las curas.

 

EP1483 Evaluar la efectividad clinica de la polihexanida y betaina en el abordaje de lesiones necroticas de ectima secundario a infeccion por candida

Belen Vazquez Rodriguez¹, Rosa Maria Bonilla¹, Yolanda Baños Lazaro¹, Valentina Osses González^1
1Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain

Objetivo: Evaluar la efectividad clínica de la Polihexanida y Betaína en el abordaje de lesiones necróticas de Ectima secundaria a infección por Candida.

Métodos: Caso clínico observacional en paciente de 71 años con DM2 mal controlada, hipertensión, Enfermedad Inflamatoria Intestinal sin filiar y antecedentes de varios abscesos cutáneos. Presenta múltiples lesiones pseudopustulosas ulceradas y muy dolorosas en cara, cuello y espalda con escara necrótica central, prurito y sobreinfección inicial con cultivos positivos para E. Coli y 2 tipos de hongos posteriormente. Se realiza abordaje interdisciplinar de las heridas con curas ambulatorias desde la Unidad de Heridas Complejas y Servicio de Dermatología. Durante las curas se realizaban limpieza y fomentos con Betaína y Polihexanida (PHMB) solución y desbridamiento de bordes necróticos previos a los correspondientes tratamientos pautados desde Dermatología. A las 4 semanas se continuó el tratamiento aplicando Betaína y PHMB en gel sobre el lecho de las heridas tras la limpieza, consiguiendo la curación completa a los 180 días.

Resultados: Se observó que tras el abordaje con la Betaína y PHMB las lesiones evolucionaron favorablemente, logrando controlar la biocarga y facilitando el desbridamiento cortante del tejido desvitalizado durante todo el proceso de cura. Se consiguió la completa cicatrización sin necesidad de antibioterapia ni ingreso hospitalario.

Conclusiones: Se valora la eficacia clínica de la Betaína y Polihexanida en el abordaje de heridas complejas, consiguiendo un óptimo abordaje de la biopelícula, facilitando la eliminación del tejido desvitalizado, previniendo la infección durante todo el proceso de cura y aumentando la calidad de vida del paciente.

 

EP1484 Abordaje clinico de heridas complejas en zona injertada

Leire Barrutia Feijoo¹, Ainara Rodriguez Vicario¹, Cristina Archeli Mesonero¹, Naiara Eizaguirre Jauregui¹, Nagore Arza Alonso¹, Xabier Barquero Garate^1
1Osakidetza, Mendaro, Spain

Objetivo: Se presenta el caso de un paciente con una herida de difícil cicatrización en una zona previamente injertada, resultado de un traumatismo. Este tipo de heridas pueden ser particularmente desafiantes debido a la alteración en la estructura de la piel y los tejidos subyacentes, lo que puede afectar negativamente el proceso de cicatrización. A pesar de ello, la cicatrización se complicó debido a la insuficiencia venosa existente.

Métodos: Se expone un caso de un paciente con herida traumática, en zona injertada previamente. A pesar de la dificultad que suponen este tipo de heridas, se complicó con una insuficiencia venosa previa. Se implementó un tratamiento de compresión para mejorar el retorno venoso y optimizar la cicatrización.

Resultados: Tras la aplicación del tratamiento compresivo, se observó una mejora significativa en la circulación sanguínea de la zona afectada. La herida comenzó a mostrar signos de cicatrización, con reducción del exudado y formación de tejido granulación. La calidad de vida del paciente también mejoró.

Conclusiones: El enfoque multidisciplinario que incluyó un diagnóstico preciso y la intervención con compresión resultó ser efectivo en el manejo de la herida de difícil cicatrización. Este caso resalta la importancia de un diagnóstico completo y un tratamiento adaptado a las necesidades individuales del paciente, así como el valor de la compresión en el manejo de heridas complicadas.

 

EP1485 Identificación etiológica precoz de las lesiones cutáneas: un enfoque para la mejora diagnóstica y terapéutica

Luis Martí Santaolaria¹, Laura Donat Beneyto¹, Nerea Gómez Almendral¹, Mireia Torres Signes², Susana Castillo March¹, Noelia García Valero¹

¹Centro de Salud Integrado Alzira Ii, Alzira, Spain, ²Centro de Salud Algemesí, Algemesí, Spain

Objetivo: Exponer la importancia de identificar de forma precoz la etiología de las lesiones cutáneas.

Métodos: Se presenta el caso de un paciente con antecedentes de Diabetes Mellitus, HTA y trasplante pulmonar siguiendo tratamiento con inmunosupresores y corticoides orales. Presenta una herida en región supramaleolar externa del miembro inferior derecho de varios meses de evolución y con una extensión de 1,5x1,3cm. El paciente refiere evolución tórpida de la lesión, no mejorando con tratamiento pautado y curas realizadas con anterioridad. En un primer lugar, se comprueban antecedentes personales y ambientales, patologías de base y fármacos pautados. Se realiza un índice tobillo-brazo descartando posible enfermedad arterial periférica al obtenerse un resultado normal. Tras presentar signos infecciosos en la herida se inicia tratamiento antibiótico y tras su resolución, se continúa con curas programadas asociadas a terapia compresiva que reduce el tamaño de la lesión considerablemente.

Resultados: Tras evidenciar un estancamiento en la cicatrización, y contando con los antecedentes personales del paciente, se valoran posibles etiologías, entre ellas la existencia de un proceso neoplásico cutáneo, ya que se habían descartado con anterioridad posibles etiologías infecciosas y vasculares. Contando con los antecedentes del paciente como es el empleo de inmunosupresores, corticoides orales y un fototipo bajo (Fitzpatrick II), se deriva a dermatología para biopsia y estudio histopatológico confirmando finalmente la existencia de un carcinoma basocelular.

Conclusiones: Se remarca la importancia de un diagnóstico precoz de las lesiones cutáneas, especialmente aquellas de mala evolución, que se encuentran en zonas fotoexpuestas y en personas con fototipos bajos.

 

EP1486 Úlceras atípicas: un reto clínico en la continuidad asistencial

Irene Sánchez-Pascuala Dones¹, Giovanna Cristofory¹, Margarita González Becerra^1
1Hospital Central de la Cruz Roja, Madrid, Spain

Objetivo: Analizar el abordaje de una paciente con úlcera atípica desde el ingreso hospitalario a través de la continuidad asistencial en el ámbito sociosanitario.

Métodos: Recogida de datos sociodemográficos y clínicos a través de la historia clínica electronica del HCIS.

Resultados: Paciente de 92 años, dependiente leve (Índice de Barthel modificado 80/100), deambulación con andador e institucionalizada. Durante un ingreso hospitalario de larga duración, detección de una lesión con sospecha de etiología vascular en cara lateral externa del miembro inferior izquierdo, colonizada por Staphylococcus aureus multiresistente en una paciente diabética y anticoagulada con acenocumarol.

En la continuidad asistencial, progresión de la lesión con aparición de características de úlcera atípica: rápidamente progresiva, dolor, lecho con hipergranulación (sobrepasando bordes), bordes violáceos e irregulares. Se realiza estudio de la lesión en el ámbito residencial con biopsia cutánea (PUNCH) y diagnóstico de Carcinoma epidermoide bien diferenciado.

Debido a cuadro clínico complejo se plantea cirugía, pero por deterioro funcional, desnutrición asociada a la enfermedad, neumonía con recaída temprana y diarrea por Clostridium, se desestima y se realiza planificación con paciente, equipo multidisciplinar y familia. Se prioriza tratamiento del dolor y el abordaje de complicaciones como sangrados, medienta medidas hemostáticas absorbibles y alginato, considerando el abordaje quirúrgico como medida paliativa en caso de dolor no controlado con analgesia.

Conclusiones: Las úlceras atípicas representan un reto clínico y diagnóstico, donde la continuidad asistencial juega un papel fundamental para la detección y el abordaje de las mismas en un entorno de alta complejidad clínica.

 

EP1047 Ascitis en onfalocele gigante en proceso de epitelización

Gemma Pérez Acevedo¹, Laura Muriel Martinez¹, Joan Enric Torra i Bou^2
1Hospital Sant Joan de Déu, Barcelona, Spain, ²Universitat de Vic, Barcelona, Spain

Objetivo: Determinar el factor causante del retroceso en el proceso de epitelización.

Métodos: El onfalocele es un defecto de la pared abdominal con saco de las vísceras abdominales. El cierre del onfalocele gigante se realiza mediante epitelización del saco y cierre quirúrgico posterior. Durante el proceso de epitelización, múltiples factores pueden favorecer su retraso.

Se describe el caso de un paciente neonato con onfalocele gigante que tras gestión de colonización crítica se valora estancamiento en el proceso de epitelización.

Para la epitelización del saco se inició tratamiento tópico con hipoclorito sódico y gel bacteriostático más gasas cada 24h, ante la buena evolución se espaciaron las curas a cada cuatro días con posterior colonización por pseudomona. Tras la gestión de la infección se apreció un aumento progresivo del perímetro abdominal y estancamiento del proceso de epitelización. Mediante ecografía se visualizó ascitis abdominal candidata a punción.

Se realizó paracentesis lateral extrayendo 600 ml y reduciendo con ello la tensión del onfalocele.

Para la epitelización final del saco se mantuvo tratamiento tópico diario con hipoclorito y gel de colistina más bacteriostático cada 24h durante dos semanas, concluyendo su epitelización con gel bacteriostático más gasa cada 24h.

Resultados: La reducción de la presión intraabdominal y la gestión de la carga bacteriana permitieron la epitelización completa del onfalocele sin mayores complicaciones a los 5 meses de vida.

Conclusiones: La presión intraabdominal repercute en la epitelización completa del onfalocele aumentando el riesgo de su colonización crítica, por ello su valoración y gestión es esencial para su epitelización completa.

 

EP1487 Manejo de una herida compleja en paciente diabética: Un enfoque integral

Arola Olivera¹, Desire Perez Carmona¹, Sílvia Vilalta Seriols^1
1Fundació Althaia - Xarxa Assistencial Universitària Manresa, Manresa, Spain

Objetivo: Evaluar y gestionar una úlcera pretibial de una paciente de 83 años con antecedentes de hipertensión arterial, osteopenia y diabetes mellitus tipo 2 mal controlada, con el fin de lograr la cicatrización de la herida y prevenir posibles complicaciones.

Métodos: La paciente fue derivada por evolución tórpida de úlcera pretibial derecha con exposición tendinosa. En la primera consulta, se observó la ausencia de signos de infección, por lo que se iniciaron curas húmedas con agentes antimicrobianos.

Dado que no se observó mejoría después de varias semanas, se realizó una consulta conjunta con diversos especialistas. En esta se decidió realizar un cultivo del tejido ubicado debajo del tendón afectado, el cual reveló la presencia de Proteus mirabilis y Enterococcus faecalis.

Con base a estos hallazgos, la paciente fue ingresada para un manejo intensivo con antibióticos dirigidos y desbridamiento quirúrgico para eliminar tejido necrótico. Tras finalizar el tratamiento antibiótico, se aplicó una cobertura con matriz sintética. Sin embargo, ante la falta de mejora, se programó una cirugía plástica para realizar un injerto de piel.

Resultados: Después de 9 meses de cuidados y tratamientos especializados, la paciente logró una completa cicatrización de la úlcera. Finalmente, fue dada de alta, mostrando una evolución favorable y sin complicaciones adicionales.

Conclusiones: El manejo integral y multidisciplinario de la úlcera permitió una mejora significativa en la condición de la paciente. El uso de técnicas de cuidado avanzadas y un enfoque colaborativo entre los equipos resultaron cruciales para el tratamiento exitoso de la herida.

 

EP1488 Cura de úlceras complejas en pacientes con esclerosis sistémica: caso clínico

Susana Fernández-Sánchez¹, Ivan Castellví Barranco¹, Jose L. Tandaipan Jaime¹, Maria Urbano Alcaraz¹, Esther Roe Crespo¹, Rubén Medina Maestro¹, Héctor Corominas Macias^1
1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Introducción: La Esclerosis Sistémica (ES) es una enfermedad caracterizada por fibrosis, vasculopatía y alteraciones inmunes. La vasculopatía se caracteriza por presencia del fenómeno de Raynaud que puede complicarse con lesiones isquémicas en los pulpejos de dedos y en zonas de prominencia ósea¹. Estas lesiones presentan un elevado impacto en la funcionalidad² y requieren de una valoración precoz ya que tardan en cicatrizar y pueden complicarse con infección o gangrena. El tratamiento tópico es fundamental para reducir los tiempos de curación y evitar la aparición de complicaciones³^-4.

Objetivo: Evaluar la cura en ambiente húmedo en úlceras isquémicas de ES.

Métodos: Varón de 50 años afroamericano diagnosticado de ES difusa. En el momento del diagnóstico presentó 5 úlceras (evolución > 4 meses) en pulpejos y zonas de prominencia ósea que habían sido tratadas con curas en ambiente seco. Las úlceras provocaban un dolor intenso y un alto impacto en la funcionalidad.

Resultados: En el momento del diagnóstico se instauró tratamiento analgésico y vasodilatador y se observó buena perfusión en las manos. Las úlceras presentaban gran cantidad de tejido desvitalizado y poco exudado.

Se hizo un plan de cuidados según V Henderson y se siguieron las recomendaciones TIMERS, comenzando curas en ambiente húmedo. Las curas se realizaron cada dos días con supervisión de enfermería. El dolor mejoró progresivamente y se consiguió la cura de las lesiones a los 3 meses.

Conclusión: Conocer las lesiones cutáneas características de las ES nos ha permitido la cura de las lesiones, disminuir el dolor y el riesgo de complicaciones.

 

EP1489 Fibras de alcohol polivinílico como estrategia para el tratamiento de heridas atípicas: casos clínicos

Lorena Sabel Iglesias¹, Natalia Vidal Ferro¹, Jorge Arenaz Bua¹, Joaquim Megias Barrera¹, Patricia Lopez Carral¹, Dolores Pardiñas Rio^1
1Sergas, Santiago De Compostela, Spain

Objetivo: Evaluar la seguridad y eficacia de un apósito de PVA en la gestión de exudados, prevención de maceración perilesional, promoción del desbridamiento autolítico y preservación de la integridad de la fibra en heridas atípicas.

Métodos: Se realizó un análisis retrospectivo de dos casos de pacientes con heridas atípicas. Se documentaron los resultados clínicos y la respuesta al tratamiento con fibras de PVA, extraídos de valoraciones médicas y de enfermería.

Resultados:

Caso 1:

Paciente de 79 años con antecedentes oncológicos, presentaba una úlcera postquirúrgica en la hemicara, de difícil manejo con abundante exudado, 60% tejido de granulación y 40% esfacelo. Tras aplicar un protocolo con irrigación, fomentos y apósitos de PVA, la herida mejoró con reducción del esfacelo y signos de granulación. La paciente fue dada de alta en cuidados paliativos.

Caso 2:
Mujer de 68 años con múltiples comorbilidades, ingresó por sepsis urinaria y fístula vesico-cutánea. La lesión, de 6 cm con abundante exudado purulento, fue tratada con desbridamiento mecánico seguido de apósitos de PVA. En 24 horas se observó un control del exudado y una mejoría en la piel perilesional. La evolución favorable permitió iniciar terapia de presión negativa.

Conclusiones: El apósito de PVA demostró ser eficaz en la gestión del exudado y la cicatrización, especialmente en heridas con trayectos fistulosos, mejorando el bienestar de los pacientes y permitiendo espaciar los tratamientos. Estos resultados subrayan la importancia de opciones terapéuticas seguras para la gestión de heridas atípicas en el ámbito hospitalario.

 

EP1490 Abordaje de lesión por vasculitis en una consulta de heridas crónicas de un hospital comarcal

Pedro Rubén Martín Montañez¹, Joana María Rossinyol Crespí¹, Francisca Mójer Sastre^1
1Hospital Comarcal de Inca. Servei de Salut de les Illes Balears, Inca, Spain

Objetivo: El objetivo de este caso es evitar la progresión de las lesiones y facilitar la curación completa en un varón de 79 años con placas nacaradas en los tobillos, resultado de una supuesta “vasculitis livedoide”. El paciente presenta dolor severo y úlceras en el dorso de los pies, tratadas sin éxito previamente.

Métodos: Se descartó una patología autoinmune y paraneoplásica. Se intentaron varias pautas de cuidados avanzados con apósitos de plata, también sin éxito. Tras una biopsia, se determinó que las lesiones eran compatibles con vasculitis leucocitoclástica. A partir de este hallazgo, se inició tratamiento con Bosentán y terapia inmunosupresora con corticoides. La cura tópica más efectiva fue la limpieza con PHMB, la protección de la piel perilesional con pomadas de óxido de zinc y corticoides, y el uso de apósitos de alginato con plata. No se pudo aplicar terapia compresiva debido a la intolerancia del paciente.

Resultados: Se logró la resolución completa de las lesiones tras 10 meses de cuidados.

Conclusiones: Las vasculitis leucocitoclásticas, que afectan principalmente a vasos de pequeño calibre en la piel, son una causa frecuente de heridas en las piernas. Este caso resalta la importancia de abordar las heridas atípicas de manera integral, con la intervención de un equipo interdisciplinar. La detección temprana de la gravedad de las lesiones por parte de enfermeras y la colaboración con otros especialistas son clave para garantizar una atención de calidad al paciente.

 

EP1491 Dermatoporosis, cicatrización retardada

Ester Cunill Marsó¹, Mònica Arjona Soler^2
1EAP Tona GTCC Institut Català de la Salut, Tona, Spain, ²EAP Vic Nord- GTCC-ICS, Vic, Spain

Descripción del caso: Hombre de 87 años que vive solo, con dependencia leve para las actividades de la vida diaria (Barthel 95) y fragilidad inicial (frágil-VIG 0,24) con multimorbilidad y polimedicación. Entre sus antecedentes patológicos cabe destacar una insuficiencia cardíaca congestiva y una fibrilación auricular tratadas con dapagliflozina, edoxaban y furosemida.

Acude al centro de atención primaria el 25 de junio tras haber padecido laceración superficial con colgajo en brazo derecho. Tras varias curas con apósito modulador de proteasas, presenta hipergranulación dolorosa en todo el lecho de la herida con prurito perilesional.

Objetivo: Determinar la causa de la hipergranulación e instaurar el tratamiento adecuado para poder cerrar la herida. 

Métodos: Anamnesis y valoración integral del paciente y de la herida con método TIME e interconsulta del caso en unidad de curas de referencia de la zona.

Paciente que presenta dermatoporosis con hipergranulación y dermatitis irritativa por exceso de exudado. Se descarta sobreinfección al no haber más que un aumento de exudado.

Revisión bibliográfica sobre dermatoporosis e hipergranulación.

Curas cada 48-72h con hidrocortisona tópica perilesional, alginato y apósito de espuma de poliuretano con bordes adhesivos como apósito secundario. Control del prurito con ebastina.

Resultados: Se consigue epitelización de la herida el 25 de octubre, 4 meses después de la primera cura.

Conclusiones: Es básico hacer una buena anamnesis y una valoración sistemática de la herida para poder realizar un buen abordaje y cura de la herida.

La dermatoporosis puede complicar una herida que en principio parecía ser simple de curar.

 

EP1492 El control del estres oxidativo y el bioburden, factores clave en las heridas de difícil cicatrización

Zohartze Larizgoitia Elejalde¹, Estibaliz Ortiz Yartu¹, Estela Rodriguez Rodriguez², Henar Alonso Torre², Maria Aranzazu Ortega Merino²

¹Osakidetza, Bilbao, Spain, ²Cruces, Bilbao, Spain

Objetivo: Analizar el efecto de la combinación de la terapia antioxidante y antimicrobiana en heridas de difícil cicatrización.

Métodos: Serie de casos, de 3 pacientes, donde se administraron de forma conjunta gel antioxidante* directamente en el lecho de la herida y apósito de hidrofibra de hidrocoloide con plata como apósito antimicrobiano, en pacientes con heridas de difícil cicatrización y con cuadros previos de sobreinfección. La evolución de la cicatrización se realizó mediante la determinación del RESVECH 2.0.

Resultados: La combinación de la terapia consiguió avanzar en el proceso de cicatrización y realizar una contención sobre la carga bacteriana.

Conclusiones: La acción conjunta del control de la carga bacteriana y la acción antioxidante se postula como una terapia prometedora en las heridas de difícil cicatrización.

*Reoxcare Gel.

 

EP1493 Matrices de ácido poliláctico como solución innovadora para heridas complejas de mano en pediatría: Cicatrización rápida y control de infecciones

Waldo Jimenez Valenzuela^1
1Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic

Objetivo: Las heridas en pacientes pediátricos requieren estrategias avanzadas para evitar la infección, promover la regeneración tisular y lograr un cicatrización rápida. Las matrices de cierre de heridas de ácido poliláctico (PLA) representan un material bioactivo novedoso, capaz de inducir neoangiogénesis, reclutamiento y proliferación de células, deposición de matriz extracelular, modulación de la inflamación y cambios de pH favorables para la cicatrización.

Métodos: Aplicación única de matrices de cierre de heridas de PLA.

Resultados: El primer caso corresponde a una bebé de 6 meses con una herida profunda por mordedura de rata en la mano derecha. La herida se extendía por el dorso de la mano, exponiendo hueso, tendones y estructuras vasculares, y estaba altamente contaminada. Tras el desbridamiento quirúrgico, se realizó una aplicación de la matriz de PLA. La herida sanó completamente en 10 semanas, con cicatrización mínima, función normal y sin complicaciones. Se administraron antibióticos intravenosos durante una semana, y la estancia hospitalaria (LOS) fue de solo una semana, completando el tratamiento en forma ambulatoria.

El segundo caso involucró a un recién nacido en la UCI pediátrica con una lesión necrótica en la mano debido a infiltración de gluconato de calcio. Tras desbridamiento hasta tendones y grasa, se aplicó una matriz de PLA. Aunque se planeaba una cobertura con colgajo libre, la rápida formación de tejido de granulación y bordes epiteliales gruesos en una semana permitió la cicatrización secundaria sin cicatrices significativas. La herida se cerró completamente en tres semanas.

Conclusiones: El uso de matrices de PLA en heridas complejas de mano en pediatría es una alternativa eficaz para la reconstrucción quirúrgica, asociada a menor riesgo de infección, menor LOS y cicatrización acelerada.

 

EP1494 Heridas típicas-atípicas. Presentación de casos

Isabel Plaza Vicente¹, Eva Abaijon Pons¹, Roser Segura Castell¹, Núria Vidal Martínez¹, Marta Prats Guardiola¹, Montse Villanueva Villanueva¹, Lydia Sanchez Fernandez^1
1Institut Català de la Salut, Barcelona, Spain

Objetivo: Describir casos clínicos con lesiones en ubicación atípica.

Definir la importancia de una correcta anamnesis en el cribado de las heridas

Métodos: Se realiza reclutamiento de casos clínicos con lesiones de localización atípica.

Se realiza anamnesis y exploración detallada de dos casos seleccionados:

Caso 1: Paciente con lesiones de gran magnitud en pliegues abdominales.

Inicio: Se sospechó malignidad

Valoración realizada: anamnesis, cultivos, biopsia

Resultado: lesiones asociadas a humedad y fricción que empeoran tras retrasar valoración sanitaria y tratamiento.

Caso 2: Paciente con lesiones en medio pie plantar

Inicio: Pie diabético con localización atípica y sospecha de isquemia

Valoración realizada: anamnesis, exploración y valoración por cirugía vascular

Resultado: la presión en contexto de enfermedad neurológica y problemática social como desencadenante y mantenedor de la lesión.

Resultados: Se presentan dos casos con localizaciones de la lesión atípicas en los que tras realizar un análisis exhaustivo de la información obtenida con la anamnesis y la exploración detallada concluimos con una etiología típica como lesión relacionada con la humedad y pie diabético.

Se descartaron causas atípicas, se asociaron como factor común causas personales, familiares y sociales en general que favorecieron el inicio y desarrollo de las lesiones y dificultaron el cierre de las mismas.

Conclusiones: Estos casos plantean un desafío cada vez más presente en los pacientes con lesiones complejas como es el contexto socioeconómico que condiciona la aparición, la progresión y la curación de este tipo de heridas.

 

EP1495  Úlceras de martorell: Sospecha, diagnóstico y abordaje

Daniel Fernández Cotelo¹, Belén Fernández Villabrille¹

¹Osakidezta, Organización Sanitaria Integrada de Bidasoa, Irún, Spain

Objetivo: Facilitar el diagnóstico de la Úlcera de Martorell por parte de los profesionales sanitarios desde distintos niveles asistenciales y servicios para adecuar el tratamiento de estas lesiones.

Métodos: El método seguido es la revisión bibliográfica de la evidencia disponible sobre el diagnóstico y tratamiento de las Úlceras de Martorell.

Resultados: Las úlceras de Martorell son heridas producidas por la hipertensión a lo largo del tiempo. Además de la hipertensión arterial, también se ven asociadas frecuentemente a la diabetes mellitus tipo 2.

Se caracterizan por la aparición de manchas violáceas que evolucionan rápidamente a heridas necróticas, con bordes irregulares e inflamados.

Frecuentemente se manifiestan de manera secuencial o bilateral, en el tercio distal del lateral de la pierna y en el talón de Aquiles. En este tipo de heridas el dolor suele ser desproporcionado y tiene difícil control. Además, frecuentemente presentan pulsos distales y un ITB anodino.

Estas lesiones pueden confundirse con otras lesiones, por lo que es recomendable realizar una biopsia para su diagnóstico, observando una arteritis subcutánea oclusiva en ausencia de vasculitis.

Confirmado el diagnóstico, abordaremos la herida de manera sistémica (control hipertensión, diabetes y supresión de antagonistas de la vitamina K) y local (desbridamiento, microinjertos, terapia de presión negativa).

Conclusiones: Para abordar una herida es sumamente importante identificar a qué nos enfrentamos, de manera que si reconocemos la clínica de las Úlceras de Martorell y realizamos un correcto diagnóstico podremos llevar a cabo intervenciones más eficaces y efectivas de cara a curar las heridas y proporcionar un mayor confort.

 

1496 Caso clínico: Calcinosis cutis distrófica. ¿Qué podemos hacer?

Patricia Romero Lopez¹, Laura Ibañez Canal², Inmaculada Concepción Hernandez Cebrian², Ana Rios Baile², Elena Langarita Llorente², Mireia Cuella Serres², Matilde Garrido Luque²

¹Institut Catala de la Salut, Barcelona, Spain, ²Institut Catalá de la Salut, Barcelona, Spain

Objetivo: La calcinosis cutis (CC) es un trastorno caracterizado por depósitos de calcio en el tejido subcutáneo, siendo la forma distrófica la más común. Puede surgir en diversas condiciones, incluidas enfermedades autoinmunitarias, y también puede ser iatrogénico, relacionado con la venopunción repetida. El tratamiento inicial consiste en tiosulfato sódico al 10%, aunque también se consideran la extirpación quirúrgica y el láser de CO2.

Métodos: En el caso presentado, se trata de un paciente de 72 años con un complejo historial médico que incluye hepatitis C, hepatocarcinoma en tratamiento con Durvalumab, ex consumo de drogas por vía parenteral y antecedentes de insuficiencia venosa. Desde hace 12 años, presenta úlceras en extremidades inferiores, secundarias a venopunción de drogas, diagnosticadas como calcinosis cutis distrófica y úlceras de etiología venosa.

Resultados: A pesar de haber iniciado tratamiento con tiosulfato sódico y vendaje compresivo, su evolución ha sido deficiente, con infecciones recurrentes y problemas para manejar el exudado. En el último año se han realizado curas con tratamientos antimicrobianos y con antibióticos sistémicos. Se ha usado alginato cálcico para manejar el exudado. El paciente presenta una situación social que dificulta acudir a realizar las curas con la frecuencia requerida, porque vive fuera de zona y rechaza acudir a visitas de Unidad Especializada de Curas.

Conclusiones: Este caso subraya la necesidad de un enfoque integral en la atención, que considere las limitaciones personales y sociales del paciente. El objetivo principal es ofrecer cuidados paliativos, centrándose en el manejo del exudado y en mejorar el confort del paciente, respetando sus decisiones y acompañándolo en su proceso de enfermedad.

 

EP1497 Cuidados en pacientes con lesiones digitales asociadas a esclerosis sistémica y fenónmeno de raynaud

Vicente Carro Vera¹, Maria Conesa Jimenez¹, Eva Maria Madrid Clemente¹, Juan Manuel Romero Pelegrin^1
1Hospital Universitario Santa Lucia, Cartagena, Spain

Objetivo: El principal objetivo es:

• Conocer las intervenciones terapéuticas que han demostrado mayor eficacia y seguridad en el tratamiento de lesiones digitales asociadas a la esclerosis sistémica y fenómeno de Raynaud.

Otro objetivo sería:

• Proponer unas pautas de tratamiento unificadas para el tratamiento de las lesiones digitales.
• Aportar información que permita mejorar los tratamientos de las lesiones digitales.

Métodos: Se realizó una revisión bibliográfica sobre Esclerodermia sistémica, fenómeno de Raynaud y lesiones digitales. Para ello se realizó una búsqueda en diferentes bases de datos como Elsevier science y Google Scholar utilizando los operadores booleanos.

Los conocimientos extraídos de dicha revisión bibliográfica se aplicaron en un caso clínico en el que se trabajó.

Resultados: Existen diferentes pautas de curas. La cura seca al producir una costra dura puede ocasionar en el paciente dolor y también puede dificultar la cicatrización, siendo la cura húmeda la que mejor resultados en el manejo del dolor y la cicatrización ha demostrado. Es fundamental tener un buen manejo del dolor debido a que las lesiones digitales de estos pacientes son muy dolorosas.

Conclusiones: La mayoría de los pacientes acuden a las consultas con las lesiones digitales ya en curso. Es necesario mejorar los mecanismos de detección de la enfermedad para evitar que las lesiones digitales afecten a la calidad de vida de estos pacientes ocasionando diversos grados de discapacidad. Se necesita aumentar la investigación en nuevas formas de intervención terapéutica a nivel de lesiones digitales para mejorar los cuidados de dichas lesiones.

 

EP1520 Epidermólisis bullosa juntural severas en lactantes: Cuidado integral y manejo de heridas en casos limitantes de la vida

Sara Garcia Vidal¹, Natividad Romero Haro¹, Ángela Segura Elías^{2 2}, Álvaro Villar Hernández³, Elena Perona^4
1ONG DEBRA España Piel de Mariposa, Marbella, Spain, ²ONG DEBRA España Piel de Mariposa, Barcelona, Spain, ³ONG DEBRA España Piel de Mariposa, Sevilla, Spain, ⁴ONG DEBRA España Piel de Mariposa, Madrid, Spain

Objetivo: Difundir sobre la gravedad y letalidad de los casos severos de Epidermólisis bullosa Juntural (EBJ), así como la complejidad en el manejo y cuidados de los que limitan la vida en los lactantes. Informar de la importancia de fomentar el apoyo a los familiares.

Metodo: Se hizo una recopilación y analisis de los casos severos de EBJ, letales dentro de los primeros años de vida, tratados por enfermeras especialistas en EB desde el año 2010 hasta el 2024, en todo el territorio español. Además, se hizo una revision de la literatura sobre la EBJ.

Resultados: Se describe el concepto de EBJ y sus variantes mas letales, manifestaciones clinicas, así como los cuidados de la piel y las mucosa. En estos años se han atendido 14 lactantes por enfermeras expertas en Epidermólisis bullosa, apoyando a los famliares y profesionales del entorno. Se hace un analisis de la repercusion familiar que conlleva el nacimiento de un recien nacido con una enfermedad grave y poco conocida.

Conclusiones: El material obtenido es una herramienta educativa óptima para profesionales de la salud que quieran conocer y profundizar sobre los casos más severos de EBJ desde el nacimiento, su pronóstico, así como, los cuidados específicos que requieren desde el principio hasta el final de su vida. Es fundamental que el enfoque de los profesionales de salud incluya no solo la atención al paciente, sino también apoyo emocional y educativo para las familias, permitiéndoles involucrarse en los cuidados, en la toma de decisiones y facilitar la despedida de su hijo/a de una forma respetada.

 

P1498 Abordaje de las curas de las lesiones en extremidades inferiores secundaria a vasculitis de pequeño vaso

Maria del Mar Guillén Conejos^1
1Hospital Clínic, Barcelona, Spain

Objetivo: Limpiar de tejido necrótico y desvitalizado, preservar el tejido viable y procurar las condiciones óptimas para conseguir la cicatrización.

Espaciar la frecuencia de curas para minimizar las manipulaciones y el riesgo de infección.

Control y disminución del dolor.

Métodos: Estudio observacional durante 4 meses y revisión bibliográfica.

Durante los primeros dos meses, realizamos curas cada tres o cuatro días por la dificultad de eliminar el tejido necrótico y el tejido desvitalizado. Para eliminar el tejido necrótico utilizamos hidrogeles, hidrocoloides, apósitos desbridantes y pomada enzimática durante cuatro semanas. Posteriormente, el tejido esfacelado lo tratamos con pomada enzimática y desbridamiento cortante y evidenciamos cambio a tejido de granulación en unos veinte días aproximadamente, mejorando el control del dolor. A los dos meses, al conseguir mayor porcentaje de tejido de granulación, espaciamos las curas cada siete o nueve días hasta curación, procedimos a aplicar pomada de óxido de zinc, alginato y terapia compresiva hasta epitelización.

Resultados: Mujer de 53 años, independiente para las actividades básicas de la vida diaria sin hábitos tóxicos y vasculitis de Schölein-Henoch con nefropatía por IgA asociada, diagnosticada tras biopsia cutánea de lesiones purpúricas. 

Se realizaron curas cada 72 horas hasta retirar escara y posteriormente, según evolución, consiguiendo disminuir el dolor y la epitelización total.

Conclusiones: Al conseguir retirar la escara y la posterior combinación de aplicación de pomada de óxido de zinc, alginato, compresión y espaciamiento de las curas, se ha conseguido la epitelización de las lesiones, mejorando la calidad de vida de la paciente y el control del dolor.

 

EP1499 Efectividad de la terapia de presión negativa en herida compleja de miembro superior: a proposito de un caso

Yolanda Arteaga Ramírez¹, Sílvia Camón Pañella¹, Montserrat Palacios Garcia¹, Marina Rodríguez Milan¹, Eva María Alba Montero¹, Elena Querol Valles¹, Mariona Matas Avellà^1
1Hospital Clínic Barcelona, Barcelona, Spain

Objetivo: Favorecer, a través de la terapia de presión negativa (TPN), el óptimo cierre de una herida compleja; disminuyendo tanto el tiempo de cicatrización como el riesgo de infección.

Métodos: Se presenta el caso de una mujer de 45 años, con antecedentes de lupus eritematoso sistémico, anemia hemolítica autoinmune y trasplante renal, que ingresa para una sustitución de válvula mitral y puente mamario-coronario. 

Tras la intervención desarrolla una descompensación de su patología autoinmune en forma de síndrome autoinmune fosfolipídico que, asociada a una miopatía del enfermo crítico (con pérdida importante de masa y tono muscular), favorece la aparición de un hematoma antero-posterior en zona axilo-braquial derecha de 12cm x 15cm. 

Resultados: El abordaje inicial se hace mediante desbridamiento mecánico de la escara necrótica durante 2 semanas hasta que se puede acceder y limpiar el hematoma. El plan de cuidados se elabora y reevalúa periódicamente por un equipo multidisciplinar lo que ayuda a optimizar aspectos claves como el estado nutricional, la rehabilitación y mejora de su condición física, y el abordaje de la cura de la herida. Se instaura TPN con reservorio mediante técnica en puente. A las 6 semanas se hace transición a TPN de un solo uso durante una semana. 3 semanas después, se consigue epitelización completa mediante curas con moduladores de metaloproteasas. 

Conclusiones: El abordaje integral, multidisciplinar y centrado en la persona, es crucial para implementar planes de cuidados individualizados; optimizando el manejo de heridas complejas y permitiendo transitar entre las diferentes terapias disponibles en el momento correcto. 

EP1500 A propósito de un caso de ulceración de tofos gotosos

Cristina González Corral¹, Maria Cadiz escobosa¹, Laura Garcia Cervan¹, Inmaculada Oliva Jimenez¹, Maria Francisca Rios Gil¹, Lucia Fernandez Ramos¹, Isabel Cervan Casanova¹
Servicio Andaluz De Salud, Malaga, Spain

Objetivo: Describir los cuidados en paciente con ulceración de tofos gotosos a través de la aplicación del método científico con un proceso de atención de enfermería.

Métodos: Paciente varón de 62 años, diabetes mellitus II con hemoglobina glicosilada en rango y tofos en articulaciones de ambas manos y codos con gran deformidad. En pie derecho se observa tofo en fase aguda inflamatoria en talón y primer dedo del pie con 40 días de evolución sin tratamiento farmacológico sistémico, en ambas localizaciones se observan tofos con salida de cristales de ácido úrico con sintomatología asociada de edema, rubor, calor local y dolor limitando la movilidad. Piel perilesional dañada por presión-fricción.

Resultados: Tras valoración y pruebas complementarias para diagnóstico diferencial, analítica sanguínea con valores de ácido úrico elevados e ITB no patológico, se establece un plan de cuidados individualizado. La monitorización de la lesión ulcerada se lleva a cabo con la escala RESVECH 2.0. Se realiza un plan de cuidados que prioriza el tratamiento farmacológico de la hiperuricemia con colchicina 1 mg diario y posteriormente con alopurinol 300 mg diario asociados al abordaje local.

Conclusiones: El diagnóstico definitivo de gota tofácea se realiza mediante aspiración del tejido afectado. En el caso presentado la triada de artritis monoarticular, hiperuricemia y respuesta con colchicina proporciona un diagnóstico de presunción de artritis gotosa. Sin eludir las pruebas diagnósticas para la prevención, el control de la enfermedad y su progresión, hay que realizar seguimiento y valorar la alteración radiológica en articulaciones, tejido óseo y subyacente.

 

EP1501 Esquivando la amputación: Éxito en el Tratamiento ante una Herida complicada. A propósito de un caso

Susana Castillo March¹, Nerea Gomez Almendral¹, David Gómez Salas¹, Joaquin Trescoli Serrano¹
Departamento de la Ribera, Alzira, Spain

Objetivo: Conseguir la cicatrización de la herida en el menor tiempo posible.

Destacar la importancia de realizar una correcta valoración de la herida para poder aplicar el tratamiento correcto.

Métodos: Se presenta el caso de un hombre de 75 años, diabético y con patología renal, que ingresa en UCI tras un infarto agudo de miocardio desarrollando úlceras por presión (UPP) grado II en sacro y talones. Tras tratamiento, se resuelven las heridas del sacro y talón derecho, pero la del talón izquierdo avanza a grado IV con necrosis y exposición ósea. Se descarta infección y se detecta falta de pulsos pedio y tibial posterior, por lo que se le realiza una angioplastia de poplítea y distal. Tras alta, persiste la UPP grado IV, que abordamos con apósitos de alginato y espuma, pero el abundante exudado requiere curas diarias por lo que se opta por un apósito de presión negativa consiguiendo así una buena evolución con curas semanales.

Resultados: Una lesión que inicialmente parecía ser una úlcera por presión resultó ser una isquemia que, gracias a la detección precoz, se consiguió evitar una amputación. La aplicación de un apósito de presión negativa con tecnología hydrofiber, demostró ser muy efectivo controlando el exudado y optimizando recursos.

Conclusione: Es de vital importancia identificar la causa que nos entorpece la sanación de la herida y actuar en consecuencia. Escoger el apósito que mejor se adapte a las necesidades del paciente y que gestiones bien el exudado es clave para el éxito en la cicatrización.

 

EP1503 Terapia de presión negativa controlada con tecnologia EasyDress: ¿Un ahorro de tiempo para el personal de enfermeria?

Pol Miguel¹, Laura González Gilarte^2
1Hospital Vall d‘Hebron, Barcelona, Spain, ²Hospital Vall d‘Hebron, Barcelona, Spain

Objetivo: Valorar la colocación del dispositivo de presión negativa controlada con tecnología EasyDress en cuánto a cargas y tiempo destinado por parte del personal de enfermería en comparación con el método tradicional.

Métodos: Una vez seleccionados los casos adecuados para el uso de este dispositivo (teniendo en cuenta las heridas a tratar), se cuantificará el número de recursos humanos que se invierten en su adecuada colocación, así como el tiempo que destinan a ello. Igualmente, se registrarán características de la propia terapia de presión negativa (grado de presión, cambios en la presión, cambios de receptáculo...) así como aspectos sobre el paciente (EVA durante la terapia, estado de la piel perilesional...).

Resultados: Una vez seleccionados los casos adecuados para el uso de este dispositivo (teniendo en cuenta las heridas a tratar), se cuantificará el número de recursos humanos que se invierten en su adecuada colocación, así como el tiempo que destinan a ello. Igualmente, se registrarán características de la propia terapia de presión negativa (grado de presión, cambios en la presión, cambios de receptáculo...) así como aspectos sobre el paciente (EVA durante la terapia, estado de la piel perilesional...).

Conclusiones: La obtención de estos datos nos proporcionará la opción de implantar mejoras tanto a nivel organizativo cómo de recursos asistenciales para poder aplicar más fácil y cómodamente el dispositivo de terapia de presión negativa controlada con tecnología EasyDress y así obtener una mayor satisfacción y confort del paciente con este dispositivo.

 

EP1504 A propósito de un caso: detección y abordaje de la hidrosadenitis supurativa en atención primaria

Maria Taulé Sánchez¹, Laia Tobella Andreu¹, Anna Mata Ayet¹, Beatriz García Mónaco¹, Marta Ribas Torres¹, Marta Villanueva Pérez¹, Alba Òdena Gómez^1
1ICs, Sant Pere De Ribes, Spain

Objetivo: Dar a conocer una entidad presente en la atención primaria que cuenta con un infradiagnóstico importante.

Ofrecer las herramientas para la detección de la hidrosadenitis y un correcto abordaje terapéutico.

Métodos: Se presenta el caso de una mujer de 28 años con lesiones abscesificadas axilares recurrentes en los últimos 10 años. Como antecedentes patológicos de interés se identifican: SOP y tabaquismo activo. 

Una anamnesis exhaustiva y la revisión de las características de las lesiones ha permitido establecer un diagnóstico y una estratificación de la gravedad de las lesiones mediante la escala de Hurley.
El tratamiento farmacológico inicial ha combinado antibioterapia (rifampicina y clindamicina), analgésicos y antiinflamatorios. Debido a una mala evolución, desde dermatología se inician fármacos biológicos. El tratamiento tópico ha sido básicamente conservador: mantener la lesión limpia y un correcto manejo de la humedad. Cabe destacar la dificultad de las curas por la localización lesional.

Resultados: Un correcto diagnóstico de la hidrosadenitis se ha conseguido establecer un tratamiento dirigido y multidisciplinar, que ha permitido reducir el número de recidivas así como realizar una prevención activa de las mismas. La educación sanitaria en torno a la patología y sus factores precipitantes ha resultado esencial en su manejo.

Conclusiones: La detección precoz junto con un tratamiento dirigido mejoran significativamente el pronóstico.

Incidir en los hábitos de vida es esencial en el tratamiento, motivo por el cual cobra especial relevancia la educación sanitaria.

La hidrosadenitis tiene afectación tanto a nivel físico como psicosocial, por lo que es preciso un manejo holístico.

 

EP1505 Tratamiento combinado en ulcera atipica de Martorell

María josefa Garcés Fernández¹, Francisco Javier Barroso Méndez^2
1Servicio Canario de Salud, Santa Cruz de Tenerife, Spain, ²Servicio Canario de Salud, Santa Cruz de Tenerife, Spain

Objetivos:

• Determinar la importancia de una valoración integral del paciente y su entorno para poder prestar cuidados de calidad y conseguir la cicatrización de las heridas.
• Demostrar la eficacia del tratamiento combinado: farmacológico, apósitos y terapia compresiva.
• Demostrar la eficacia de apósitos con efecto antimicrobiano (DACC) en la disminución del uso de antibióticos.

Métodos: Mujer de 90 años que acude a consulta con lesiones bilaterales en MMI AP: HTA de larga evolución, DM2, Dislipemia, Enfermedad arterial coronaria de 2 vasos. Anticoagulacion oral. Artritis reumatoide en tratamiento con metotrexato y deflazacort.

• Se realiza valoración holística de la paciente.
• Uso del acrónimo DOMINATE dentro de la valoración integral.
• Abordaje multidisciplinar
• Ajuste del tratamiento farmacológico para mejorar la calidad de vida de la paciente y disminuir del dolor, y modificación del tratamiento farmacológico (sustitución de anticoagulacion oral con acenocumarol por HBPM) para favorecer la cicatrización
• Uso de apósitos DACC, colágeno nativo y terapia compresiva.
• Seguimiento de la evolución hasta la cicatrización total.

Resultados:

• Evolución favorable desde el inicio del tratamiento, minimizando los síntomas y mejorando la calidad de vida del paciente.
• Cicatrización de las lesiones.

Conclusiones:

• Realizar una valoración integral aporta cuidados de calidad.
• El uso del acrónimo DOMINATE permite establecer de forma estructurada las intervenciones adecuadas para el manejo de la herida.
• El tratamiento combinado: farmacológico, apósitos y terapia compresiva acelera el proceso de curación.
• El uso de apósitos con efecto antimicrobiano (DACC) para previene la infección y disminuye la carga bacteriana, minimizando el uso de antibióticos y de resistencias.
• Usado en combinación con apósito de colágeno nativo acelera la cicatrización de forma rápida y efectiva.
• El uso de terapia compresiva controla el edema, disminuye la inflamación, mejora la circulación y acelera la curación.

 

EP1506 Caso clínico: abordaje del hematoma necrosante: desbridamiento, terapia de presión negativa y cura en ambiente húmedo

Nieves Garre Baños¹, Mª Eugenia Carrillo Molina², Noelia Rodas Martínez³, Marina Martínez Sánchez⁴, Esperanza Caballero Sánchez⁴, Pilar Tomás Rivero⁴, Francisco Javier Mateu Garcia^4
1centro De Salud Caravaca, Murcia, Spain, ²hospital Comarcal Noroeste, Murcia, Spain, ³centro De Salud De Calasparra (Servicio Murciano De Salud), Murcia, Spain, ⁴hospital Comarcal Noroeste (Servicio Murciano De Salud), Murcia, Spain

Objetivo: Facilitar cierre de la herida traumática tras realizar desbridamiento de un hematoma necrosante.

Métodos: Mujer de 79 años. HTA, obesidad, ICC, anticoagulada por FA. No palpación de pulsos distales.

Presenta un gran hematoma localizado en la cara anterior, medial y lateral del tercio distal de la pierna izquierda por traumatismo accidental. Se descarta para tratamiento con injerto cutáneo.

Comienza el tratamiento con la limpieza de la herida, solución antimicrobiana en fomento, protección de bordes con spray polimérico, desbridante osmótico sobre lecho de la herida (miel de grado medico), malla siliconada, alginato y sujeción con malla tubular.

Posteriormente se retiran coágulos y restos de necrosis húmeda en el quirófano manteniendo misma cura durante 24 horas. A las 48 horas, se inicia TPN dejando herida a plano y en tejido de granulación.

Después de una semana con TPN, se realiza limpieza de herida con agua y jabón, solución antimicrobiana en fomento, protección de bordes con óxido de zinc, apósito de DACC hidrogel, alginato y sujeción con malla tubular durante 15 semanas.

Resultados: Tras 4 meses valorado y curado por enfermería, alternando dos tipos de desbridamiento (osmótico y quirúrgico), TPN hasta dejar herida a plano y finalizando con cura en ambiente húmedo, se consigue cierre total de herida.

Conclusiones: El desbridamiento quirúrgico alternado con el osmótico para tartar de limpiar restos del hematoma, TPN hasta conseguir tejido de granulación a plano y cura en ambiente húmedo podrían ser el tratamiento adecuado para facilitar el cierre de la herida ante un hematoma necrosante.

 

EP1507 Control de la infección en paciente con gangrena de fournier

Victor Lucha Fernandez¹, Fernando Santonja Sahuquillo², Teresa Carmona Galvez³, Jose Benedicto Llorens⁴, Pilar Anton Dura³, Pilar Mut Camarasa^3
1Supervisor de enfermería del servicio de cirugía del Hospital Marina Baixa, Villajoyosa, Spain, ²Enfermero unidad ostomías y heridas complejas Hospital Marina Baixa, Villajoyosa, Spain, ³Enfermera servicio de cirugía del Hospital Marina Baixa, Villajoyosa, Spain, ⁴Enfermero servicio de cirugía del Hospital Marina Baixa, Villajoyosa, Spain

Objetivo: Describir los cuidados de enfermería orientados al control de la infección en un paciente con gangrena de Fournier extensa, en la unidad de cirugía general de nuestro hospital.

Métodos: El paciente ingresó con fiebre y taquicardia. Presento infección en la región glútea y una placa necrótica escrotal. Se realizó un desbridamiento extenso en quirófano, con exposición del tejido subcutáneo de escroto izquierdo, paquete inguino-escrotal, glúteo izquierdo, fosa isquiorectal, y hemiabdomen izquierdo hasta el ombligo.

El tratamiento incluyó antibióticos intravenosos de amplio espectro, fluidoterapia para estabilización hemodinámica y analgesia epidural para el control del dolor.

Los cuidados de la herida fueron lavados de suero fisiológico y fomentos de 10 minutos con polihexanida. Se aplicó apósito de tul de silicona sobre el pedículo testicular y resto de herida. Se usaron compresas como apósito secundario y se colocó un sondaje rectal permanente para el control de heces durante las dos primeras semanas. Las curas se realizaban diariamente.

Resultados: Con la estabilización hemodinámica y la mejoría de la herida, el paciente fue derivado a cirugía plástica para el cierre de la lesión.

Conclusiones: El uso de soluciones de polihexanida y antibióticos específicos, junto con el control de las heces mediante sonda rectal permanente en el periné, favoreció una evolución rápida de la cicatrización y permitió un control de la infección de la herida durante todo el proceso.

Bibliografia:

- Alonso M, Buil G, Fuenmayor A, González B, Laguna E, Sandino E. Análisis descriptivos de tratamientos tópicos en gangrena de Fournier. Enfuro [revista de internet] 2011 octubre-noviembre-diciembre; 120 (18-22).

- Romero-Collado, Á., Verdú-Soriano, J., Homs-Romero, E. Recomendaciones del uso de antimicrobianos en heridas crónicas. [2022]Gerokomos, 33(2); 111-118.

 

EP1508 Desafíos y lecciones en el manejo de heridas por extravasación de quimioterapia en flexura de codo: Reporte de tres casos

Fátima Cerón Molina¹, Jose Ramón Martínez Méndez¹, Luis Landín Jarillo¹, Paula Álvarez Hernández¹, Francisco Leyva Rodríguez^1
1Hospital Universitario La Paz, Madrid, Spain

Objetivo: Describir los desafíos y aprendizajes derivados del manejo de tres casos de heridas por extravasación de agentes quimioterapéuticos en la flexura del codo, analizando la evolución clínica, el manejo aplicado y los resultados obtenidos.

Métodos: Se realizó un reporte de tres casos de pacientes oncológicos que presentaron extravasación de quimioterapia en la flexura del codo. Se documentó el manejo de cada caso, incluyendo el tipo de agente quimioterapéutico, tratamiento inicial para minimizar el daño tisular, técnicas de curación aplicadas y frecuencia de las intervenciones.

Resultados: En los tres casos, los agentes extravasados incluyeron doxorrubicina y vincristina, conocidos por su potencial citotóxico. A pesar de la aplicación temprana de medidas preventivas, las lesiones avanzaron a ulceraciones dolorosas, con tiempos de cicatrización prolongados. Se expresaron resultados en términos de funcionalidad y complicaciones como infección o linfedema.

Conclusiones: El manejo de heridas por extravasación de quimioterapia en la flexura del codo presenta desafíos específicos debido a la localización anatómica y la toxicidad de los agentes involucrados. Este reporte subraya la importancia de un enfoque multidisciplinario y de protocolos específicos para mejorar los resultados clínicos. La experiencia obtenida resalta la necesidad de estrategias de prevención y la adecuación del tratamiento para minimizar las complicaciones y optimizar la cicatrización.

 

 

EP1755 Manejo de lesión por uso de fármaco vesicante por vía periférica

Belén Conde Estévez¹, Cristina Holguín Fernández^1
1Hospital Lucus Augusti, Lugo, Spain

Objetivo: Se establecen como objetivos controlar la carga bacteriana, reducir/manejar del dolor y la pronta epitelización.

Métodos: Mujer, 45 años, sin antecedentes destacables, con adenocarcinoma pulmonar en tratamiento adyuvante con Cis-Platino y Vinorelbina. Rechaza colocación de catéter central y se administra por vía periférica, pese a que la Vinorelbina es un fármaco vesicante. Siete días después del último ciclo, acude con lesión en el dorso y zona radial de la mano derecha, donde tuvo el catéter periférico, eritematosa, con flictenas, calor, y dolor EVA: 8.

El 18/09/2024 se realiza primera cura con desbridamiento cortante y se aplica una malla antimicrobiana no oclusiva y flexible de poliéster recubierta con partículas de hidrocoloide, componentes lipídicos y sales de plata y apósito de espuma con adhesivo siliconado. Siguiente cura a las 48 horas (EVA: 5) y las posteriores, semanalmente hasta completar 15 días de antimicrobianos (EVA: 3). EL 2/10/2024 (EVA: 0) se inicia tratamiento semanal con apósito de colágeno y alginato cálcico y espuma con adhesivo siliconado hasta completa resolución el 15/10/2024.

Resultados: El correcto abordaje de la herida y la adecuada elección de apósitos han permitido un adecuado manejo del dolor, así como la pronta epitelización de la lesión sin complicaciones.

Conclusiones: Los productos de cura en ambiente húmedo cubren de forma eficaz la mayoría de las necesidades de la herida para cada una de sus fases. Favorecen la cicatrización, manteniendo el grado de humedad apropiado y gracias facilidad de uso reducen el dolor y permiten una menor frecuencia en las curas.

 

EP1509 Comparativa de las úlceras de Martorell y las calcifilaxias

Alicia Rodríguez Sánchez¹, Paula Gomez Fauro^1
1Hospital Galdakao, Usansolo, Spain

Objetivo: El objetivo es comparar y contrastar las úlceras de Martorell y de calcifilaxia, destacando sus diferencias y similitudes en cuanto a causas, presentación clínica y tratamiento.

Métodos: Se realizó una revisión de literatura médica para identificar características clínicas, etiológicas, localización de las lesiones y enfoques terapéuticos de ambas condiciones. Se evaluaron fuentes clínicas y estudios de casos relevantes.

Resultados: Las úlceras de Martorell son lesiones crónicas asociadas a la hipertensión venosa y la insuficiencia venosa, que se presentan principalmente en las piernas con bordes irregulares y un fondo limpio. Por otro lado, la calcifilaxia se relaciona con trastornos metabólicos, especialmente en pacientes con enfermedad renal crónica, manifestándose como lesiones dolorosas y necrosis cutánea, a menudo con depósitos de calcio. Ambas condiciones pueden aparecer en las extremidades, lo que puede llevar a confusiones diagnósticas.

Conclusiones: Aunque las úlceras de Martorell y la calcifilaxia presentan similitudes en la localización y en la posibilidad de ulceración, sus etiologías y características clínicas son distintas. Las úlceras de Martorell se originan principalmente por problemas venosos, mientras que la calcifilaxia está vinculada a disfunciones metabólicas y vasculares en pacientes con enfermedad renal. La diferenciación precisa es crucial para el manejo adecuado de cada condición, lo que requiere una evaluación clínica exhaustiva y, en ocasiones, estudios adicionales.

 

EP1510 Abordaje holistico de herida producida por loxoscelismo cutáneo dermonecrótico en compartimento posterior de muslo: reporte de un caso

Priscila Cantú Saucedo^1
1UANL, Monterrey, Mexico

Objetivo: Las arañas del género Loxosceles tienen distribución mundial, en México se conocen más de 40 especies, entre ellas Loxosceles reclusa, especie de mayor presencia a nivel nacional. Los accidentes por arácnidos venenosos constituyen un problema de salud pública, las estadísticas de SSA indican que de todos los casos de envenenamiento por animales ponzoñosos, 11% son causados por arácnidos, por lo cual es de vital importancia generar evidencia clínica de la terapéutica empleada en dichos casos con la finalidad de establecer diversas opciones de tratamiento local de este tipo de heridas.

Métodos: Masculino de 39 años sin APP/AHF de importancia, con diagnóstico de loxoscelismo cutáneo dermonecrótico por mordedura de loxosceles reclusa, (placa livedoide de 47 cm x 23 cm) se decidió realizar desbridamiento quirúrgico en tres ocasiones y continuar la preparación del lecho de la herida con terapia de presión negativa (3 recambios); posteriormente se inició tratamiento con apósitos de manejo avanzado de heridas, con la finalidad de cerrar por segunda intención. Además se implemento un programa de readaptación y rehabilitación neuromuscular para el miembro inferior afectado.

Resultados: El tratamiento estuvo basado en el uso de malla de acetato impregnada con cloruro de diaquilcarbamoilo (DACC), apósito de fibras hidrocinéticas con hidropolímeros gelificantes con respuesta a la hidratación e hidrogel.

La herida mostró datos clínicos de mejoría desde la primera semana de tratamiento con dicha terapéutica, la cual fue eficaz para estimular granulación y epitelización, se logró cierre completo de la herida en 120 dias.

Conclusiones: Los apósitos de alta tecnología para cuidado avanzado de heridas pueden ser utilizados de manera exitosa para estimular cierre por segunda intención en herida producida por loxoscelismo cutáneo dermonecrótico.

 

EP1511 Abordaje de las lesiones de Martorell

Roser Jove Estor¹, Rosa Bragos Duch¹, Jordi Antonio Noria Tomàs^1
1Hospital Santa Maria, lleida, Spain

Objetivo: Identificar de manera correcta las ulceras de Martorell y definir el mejor abordaje de estas según la evidencia científica actual.

Métodos: Búsqueda bibliográfica entre abril y mayo de 2024 en diferentes bases de datos científicas (PUBMED, GNEAUPP, Schielo y Google Scholar).

Criterios de inclusión:

- Menos de 10 años de antigüedad.

- Idiomas: catalán, castellano y ingles.

Criterios de exclusión:

- Artículos de pago.

Resultados: Las ulceras de Martorell son una complicación de la hipertensión arterial descritas por primera vez en 1945 por Fernando Martorell. Se dan con mayor frecuencia en mujeres de entre 55 a 65 años.

Estas lesiones pueden ser provocadas por traumatismos (55.6%) o de aparición espontanea (44.4%) y se manifiestan como maculas eritematosas y dolorosas que rápidamente evolucionan a heridas. El diagnostico se hace mediante una biopsia un ITB y un eco-doppler arteriovenoso en el que destaca arterioesclerosis arteriolar.

El tratamiento incluye un control estricto de la presión arterial, técnicas de curación como la cura en ambiente húmedo, fármacos para mejorar la vasodilatación y gestión del dolor.

Conclusiones: Las ulceras de Martorell son lesiones con diversas causas, consideradas una complicación poco frecuente de la hipertensión arterial. El diagnostico y el tratamiento son complejos por la falta de consenso. Las opciones de tratamiento incluyen un buen control de la tensión arterial, técnicas avanzadas como la oxigenoterapia hiperbárica y la terapia de presión negativa, destacando la importancia de la personalización de las curas y el principio de beneficencia.

 

EP1512 A propósito de un caso: Celulitis en miembros inferiores secundaria a picaduras de arácnidos

Mª del Carmen Corpas Betancor^1
1Sociedad Estatal de Correos y Telégrafos S.A., Madrid, Spain

Objetivo: Se trata de un caso de una paciente que, durante sus vacaciones en Alemania, se lava los pies en una playa fluvial del río Rin y una hora después comienzan a aparecer en los dos miembros inferiores numerosas picaduras. A las ocho horas del evento, las lesiones comienzan a dar problemas de prurito y dolor intenso. Doce horas después, los miembros inferiores comienzan a presentar edema y celulitis, además de aumentar los síntomas iniciales. La paciente empieza a presentar escalofríos y fiebre de 38,5ºC. Los objetivos del tratamiento son:

• Tratar la infección de las lesiones
• Controlar el dolor
• Reducir el edema
• Reducir el prurito

Métodos: A las 24 horas de iniciarse los síntomas, acude a urgencias donde diagnostican picaduras por arácnidos y reacción alérgica a las mismas. Le pautan corticoide tópico, antihistamínico oral, fomentos de dicloruro de fenoxial y frío local. A las 48 horas del inicio de los síntomas, empeora su estado y vuelve a urgencias donde le realizan una analítica, presenta infección local y añaden al tratamiento inicial, corticoterapia oral, antibiótico oral, antitérmico, reposo relativo y mantener elevados los miembros inferiores.

Resultados: A los 7 días del inicio del tratamiento, el edema, el prurito y el dolor desaparecieron. La celulitis había mejorado y las pápulas redujeron su tamaño, pero tardaron 45 días en desaparecer.

Conclusiones: El tratamiento aplicado fue efectivo evitando que la celulitis empeorara, reduciendo el prurito, el dolor, el edema y tamaño de las lesiones. Una intervención más temprana hubiese ayudado a evitar la aparición de la celulitis y el edema y reducir la reacción alérgica a las picaduras que empeoraron considerablemente el estado general de la paciente.

 

EP1513 Caso clínico: úlcera atípica en paciente compleja tratada con gel de miel de grado médico

Sonia Almansa Saura¹, Elena Garcia Gil¹, Cristina Ortin Martinez^1
1Enfermera Unidad de Heridas Complejas Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

Objetivo: Conseguir la cicatrización de úlcera atípica en miembro inferior en paciente compleja con gel de miel de grado médico

Métodos: Paciente que acude a la Unidad de Heridas Complejas derivada de Cirugía Vascular para valoración de úlcera en zona media tibial anterior, de 2 años de evolución. Tratada anteriormente con tratamiento antibiotico, además de sesiones de cámara hiperbárica. La úlcera recidivante presenta unas dimensiones de 4x5 centrimetros, el tejido del lecho es de granulación, fibroso cubierto por biofilm y con exudado moderado. Se realiza una anamnesis completa y exploración física, resaltando en lo encontrado, alergia al yodo y a apósitos de plata; hipertensión; enfermedad renal crónica estadio III; sindrome fibromialgico; insuficiencia venosa crónica con clasificación CEAP, C6EpAdPr y el diagnóstico de sindrome linfoproliferativo crónico T tipo leucemia de linfocitos granulares T, con tratamiento de corticoides e inmunosupresores. Tras valoración se aplica terapia compresiva con sistema de velcro en la extemidad y curas con gel de miel de grado medico, dadas las alergias de la paciente, y las necesidades que la úlcera presentaba.

Resultados: Cicatrización de la úlcera tras 9 meses de tratamiento.

Conclusiones: La miel de grado medico ofrece una alternativa de tratamiento local a aquellos pacientes complejos, con heridas atípicas, que suponen un reto para las unidades especializadas en su tratamiento, cómo en el caso que se presenta, en el que se deben combinar el desbridamiento osmótico y la capacidad antimicrobiana en un mismo producto, para conseguir la cicatrización.

 

EP1514 Injertos en sello, una oportunidad para la cicatrización en heridas complejas.

María Pilar Perez Hernández¹, Samia Bellahmar Lkadiri¹, Arantxa Vázquez Rodríguez², Patricia De Paz Pérez³, Alberto Rodríguez Salmonte⁴, Rocío García Rodríguez⁵, Adriana Rodríguez Brito^1
1GAPTF SCS, Santa Cruz de Tenerife, Spain, ²GAPTF SCS, Santa Cruz de Tenerife, Spain, ³Gerencia de Servicios Sanitarios de La Palma, Santa Cruz de la Palma, Spain, ⁴SERGAS, Santiago de Compostela, Spain, ⁵SAS, Sevilla, Spain

Objetivo:

1. Realizar una revisión bibliográfica, centrándose en la técnica correcta, beneficios, inconvenientes y precauciones a tener en cuenta.
2. Describir la técnica correcta para la realización de los MAS.

Métodos: Se realiza una revisión sistemática de la literatura científica consultando diferentes bases de datos (Scopus, Dialnet y PubMed) y buscadores (Google académico). Se utiliza como palabras clave para la búsqueda “microinjertos autólogos en sello”, “injerto de piel”, “dermis”, “epidermis” y “cicatrización de heridas”; combinados mediante los booleanos AND y OR, y se restringe la búsqueda a artículos publicados en los últimos 5 años.

Resultados: Las heridas crónicas afectan negativamente a la calidad de vida de quienes las padecen, deteriorando de forma importante su salud y empeorando su pronóstico general. La alta prevalencia de las lesiones cutáneas, junto a la alta cronicidad y recidivas, genera un impacto biopsicosocial importante, además de representar un alto costo para el sistema sanitario y una carga considerable para el individuo, su familia y la sociedad.

Se expone el procedimiento y se explica paso a paso, apoyándose en el registro fotográfico que se obtiene durante el abordaje de lesiones cutáneas complejas de difícil cicatrización en la consulta de la Unidad de Heridas Complejas de la Gerencia de Atención Primaria de Tenerife.

Conclusiones: Los MAS (microinjertos autólogos en sello) son un método alternativo en el tratamiento de heridas crónicas, especialmente en aquellas de difícil cicatrización. Este procedimiento ha mostrado importantes beneficios, es un método costo-efectivo y conlleva un bajo riesgo de complicaciones. No obstante, es necesario una mayor divulgación de esta técnica, ya que su conocimiento y uso son todavía limitados.

 

EP1515 Cura en ambiente húmedo en herida necrótica en antebrazo

Cecilia Valles Quintilla¹, Pilar Ibars Moncasi¹, Núria Cortes Andreu¹, Victoria Lorenzo Garcia¹, Mónica Trillo¹, Núria Elena Alba Miro¹, Maria Rosa Gonzalez Farre^1
1Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objectivo: Presentar la evolución de una herida necrótica aplicando cura en ambiente húmedo y así evitar una cirugía con injerto cutáneo.

Método: Paciente de 47 años sin antecedentes de interés, que tras ingreso prolongado en unidad de cuidados intensivos (UCI) por fracaso multiorgánico por neumonía necrotizante por S. Pyogenes, presenta lesión necrótica extensa en antebrazo izquierdo de 17 x 6 cm. Posible etiología: necrosis tisular secundario a un cateterismo arterial.

Resultados/Discusión: Inicialmente se optó por el desbridamiento enzimático con colagenasa y posteriormente proteasa, llevándose a cabo durante 15 días.

Una vez el tejido se reblandeció procedimos a realizar un desbridamiento cortante a pie de cama. Tratamos el tejido más adherido que íbamos encontrando con cadexómero yodado, aunque ya empezamos a aplicar productos estimuladores de la epitelización y moduladores de las metaloproteasas de matriz en las lesiones más superficiales con tejido viable.

Curación de la herida en 7 semanas. Posteriormente, se trató la cicatriz para reducir adherencias y mejorar el resultado estético con productos específicos y fisioterapia.

Conclusión: La cura en ambiente húmedo es una alternativa válida a los injertos para cierre de defectos y lesiones superficiales.

 

EP1516 Aplicación de apósitos en lesiones cutáneas extensas con piel perilesional comprometida

Estefanía Castro González¹, Covadonga López Viejo¹, Patricia Ferreira López¹, Soraya Blanco Jorge¹, Fernando Valdés Tascón², María Méndez Ramos³, Rocío López López^4
1Servicio de Medicina Interna, Hospital público da Mariña, Servizo Galego de Saúde, Lugo, Spain, ²Servicio Dermatología, Hospital da Mariña, Servizo Galego de Saúde, Lugo, Spain, ³Centro de Saúde de Burela, Área Sanitaria Lugo, A Mariña y Monforte de Lemos, Servizo Galego de Saúde, Lugo, Spain, ⁴Grupo de investigación en Gerontología y Geriatría, Universidad de A Coruña, Instituto de Investigación Biomédica de A Coruña, Servizo Galego de Saúde, A Coruña, Spain

Objetivo: Describir técnicas de cobertura aplicadas en pacientes con lesiones cutáneas extensas, enfocadas en proteger la piel perilesional y reducir complicaciones asociadas al contacto directo con adhesivos.

Métodos: Se analizaron casos de pacientes con diagnóstico de pénfigoide ampolloso y pioderma gangrenoso, quienes requerían abordajes específicos debido a la extensión de sus lesiones y la fragilidad de la piel perilesional. Los cuidados incluyeron el uso apósitos no adhesivos combinados con vendajes secundarios y fijación sin presión mediante redes elásticas o gasas hipoalergénicas, evitando la adhesión directa sobre la piel dañada. Los parámetros evaluados fueron: tiempo de cicatrización, incidencia de infecciones perilesionales, necesidad de reintervenciones por daño provocado por los métodos de fijación y la percepción de dolor.

Resultados: Los pacientes reportaron mayor comodidad y bienestar general. La aplicación de apósitos no adhesivos y vendajes de soporte disminuyó las complicaciones asociadas a la retirada de apósitos y el riesgo de nuevas lesiones. Las técnicas de fijación alternativas facilitaron la cicatrización más rápida al reducir la fricción y el trauma perilesional. Sin embargo, no se observó una disminución significativa de infección. Estudios respaldan el uso de apósitos avanzados y terapias de presión negativa no adhesivas como alternativas para minimizar el riesgo de infecciones.

Conclusiones: Las técnicas de cobertura descritas proporcionaron una solución segura y efectiva para el tratamiento de lesiones cutáneas extensas y mejoraron la calidad de vida de los pacientes, subrayando la necesidad de flexibilizar las guías clínicas y adaptar los cuidados a las necesidades individuales del paciente.

 

EP1518 Kennedy: El último combate

Vanessa Gutiérrez Leon¹, Claudia Terradillos Gonzalez², Javier Varas de la Fuente³, MARIA ISABEL Blazquez Blanco⁴, Clara Jiménez Andrinal⁵, Eva Maria Santiago Sanchez^6
1Centro de Salud Ávila Sur-Oeste (SACYL), Avila, Spain, ²Centro de Salud Ávila Sur-Oeste (SACYL), Avila, Spain, ³Residencia de Tercera Edad (JCYL), Avila, Spain, ⁴Centro de Salud Cebreros (SACYL), Avila, Spain, ⁵Centro de Salud de Sotillo de la Adrada (SACYL), Avila, Spain, ⁶Centro de Salud Avila Norte (SACYL), Avila, Spain

Objetivo:

• Disminución de dolor asociado a la Ulcera por presión
• Proporcionar ambiente tranquilo y confortable
• Prevención de infecciones
• Apoyo psicológico a los cuidadores mediante educación sanitaria

Métodos: Mujer de 91 años de edad con antecedentes de Hipertensión arterial, Diabetes Mellitus, ictus isquémico y en la última semana broncoaspiracion con mal pronóstico que se aplican cuidados paliativos domiciliarios, debuta con ulcera por presión en sacro en fase final de su vida de inicio repentino y rápida evolución.

Presenta placa necrótica seca que impide determinar la categoría de la misma. Se inicia cura húmeda con hidrogel, alginato y apósito secundario de espuma, colchón antiescaras programando cambios posturales e higiene adecuada, se realiza apoyo psicológico y educacion a cuidadores para tratar de mantener a la paciente lo más confortable posible, evitando técnicas agresivas que puedan incrementar el dolor de la paciente y crear disconfort.

La paciente no muestra signos de dolor, excepto en los cambios posturales y cuando se realizan las curas, permanece en ambiente tranquilo y aparenta confort, falleciendo diez dias despues del diagnóstico de la lesión.

Resultados: Debido a la naturaleza de las úlceras de Kennedy, la cicatrización completa no siempre es posible, por ello, mediante un adecuado control del exudado se mantiene la herida lo más limpia posible evitando la maceración y espaciando las curas hasta 72 horas, además que el ambiente húmedo puede ayudar a reducir la sensibilidad y aliviar el dolor.

Conclusiones: Las úlceras de Kennedy representan un desafío clínico complejo que requiere un enfoque individualizado y centrado en el paciente, además de un apoyo psicológico a familia y cuidadores.

 

EP1519 Ulceras perianales y el uso de pomadas antihemorroidales: un efecto secundario inesperado

Claudia Terradillos Gonzalez¹, Vanessa Gutiérrez Leon¹, Javier Varas De La Fuente², Maria Isabel Blazquez Blanco³, Clara Jiménez Andrinal^4
1Centro de Salud Ávila Sur-Oeste (SACYL), Avila, Spain, ²Residencia de Tercera Edad (JCYL), Avila, Spain, ³Centro de Salud Cebreros (SACYL), Avila, Spain, ⁴Centro de Salud De Sotillo de la Adrada (SACYL), Avila, Spain

Objetivo:

- Identificar la relación entre el uso prolongado de pomadas antihemorroidales y la aparición de úlceras perianales.

- Fomentar el uso adecuado de pomadas antihemorroidales para evitar complicaciones y promover una cicatrización efectiva de las úlceras perianales.

Métodos: Mujer de 82 años con antecedentes de melanoma en espalda estadio IIA, FA y cardiopatia isquémica.

Acude a consulta de dermatología por la aparicion de lesiones perianales en relación con la aplicacion de pomada antihemorroidal de venta libre en farmacia que habia adquirido semanas antes. Se realizó PRC de herpesvirus y cultivo bacteriologico que resultaron ambos negativos. El cultivo fúngico demostró la presencia de cándida.

Se indicó retirar la pomada, biconazol tópico y violeta de genciana, logrando la cicatrización en 4 semanas.

Resultados: La aparición de úlceras perineales es un efecto secundario poco común pero relevante asociado con el uso de pomadas antihemorroidales. La piel en el área perineal es particularmente vulnerable debido a su delicadeza y alta sensibilidad, lo que aumenta el riesgo de lesiones por el contacto con sustancias irritantes.

Si bien estos casos son relativamente raros, el aumento en la automedicación sin supervisión médica adecuada resalta la importancia de seguir las recomendaciones de uso y de consultar a un profesional de la salud si aparecen síntomas inusuales. La educación de los pacientes sobre los riesgos potenciales y las alternativas de tratamiento es fundamental para reducir la incidencia de estos efectos secundarios.

Conclusiones: Los pacientes deben ser educados sobre los riesgos asociados con el uso incorrecto de estos productos. La conciencia sobre los posibles efectos adversos y el uso adecuado de medicamentos son fundamentales para prevenir complicaciones, como las úlceras perineales.

 

 

CIENCIA BÁSICA 

EP1205 Prevalencia de heridas y lesiones cutáneas relacionadas con la dependencia de una región sanitaria en 2024

Cristina Lopez Alayeto¹, Sandra Alexandre Lozano¹, Maria Carmen Marquilles Bonet¹, Iraida Gimeno Pi¹, Mercè Bernis Domenech¹, Gianella Balladares Altamirano¹, Jennifer Lopez Perez^1
1Institut Català de la Salut, Lleida, Spain

Objetivo: Conocer la prevalencia de personas que presentan heridas en los centros de atención primaria (AP) de una Región Sanitaria.

Métodos: Estudio descriptivo, observacional, de corte transversal, dirigido a atención primaria (AP), durante una semana de 2024. La recogida de datos se ha realizado mediante formulario seguro online. Se ha recogido información sobre características de la persona con heridas y características clínicas de la herida.

Resultados: Se ha obtenido una participación del 100% de los centros de AP. Se han registrado 920 heridas, lo que representa una prevalencia del 0,3%. El 51% de heridas fueron presentadas por hombres. El grupo de edad con más heridas corresponde al de 80-89 años. El 27% de las heridas fueron atendidas en los domicilios, siendo la tipología de herida más frecuente las úlceras por presión (UPP), que constituyeron el 35,74% de los casos. En cambio, la tipología de herida más frecuente en la población atendida en los centros de salud fue la úlcera venosa, con un porcentaje del 24%. El 53,70% de las heridas tuvieron una evolución menor de 3 meses. Destaca que el 13% presentaran una evolución de 1 a 3 años y el 5 % de más de 3 años.

Conclusiones: Estos resultados posibilitan obtener indicadores para valorar los programas de prevención, los conocimientos para el abordaje de los distintos tipos de heridas y replantear los recursos destinados al tratamiento de las heridas.

 

EP1080 Curcumina como compuesto terapéutico estimulante en fibroblastos de piel humana

Rebeca Illescas-Montes^{1 2}, Lucía Melguizo Rodríguez^{1 2}, Patricia Caballero-Navarro¹, Elvira De Luna Bertos^{1 2}, Concepción Ruiz^{1 2
1}Grupo Biosanitario (BIO277), Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain, ²Instituto de Investigación Biosanitaria, Ibs. Granada., Granada, Spain

Objetivo: La curcumina es un fitoquímico obtenido del rizoma de la planta de la cúrcuma al que se le ha atribuido diferentes propiedades, entre las que destaca sus efectos antitumorales, antiinflamatorios, antibacterianos y antioxidantes en diferentes patologías. Por lo que este compuesto puede poseer beneficios en el proceso de reparación cutánea. El objetivo de este trabajo fue evaluar el efecto de la curcumina sobre la viabilidad y capacidad migratoria de fibroblastos de piel humana.

Métodos: La línea celular de fibroblastos humanos CCD-1064Sk fue tratada curcumina a las dosis de 10^-5 y 10^-14 M por 24 horas. Se estudió la viabilidad celular mediante la técnica espectrofotométrica de MTT y la capacidad de migración empleando la técnica de herida in vitro en scratch. En todos los ensayos, se utilizó un cultivo control al cual se mantuvo en las mismas condiciones, salvo que recibieron medio sin curcumina.

Resultados: Los resultados mostraron que el tratamiento con la curcumina incrementó significativamente la viabilidad de los fibroblastos a las concentraciones entre 10^-6 a 10^-9 M) con respecto a las células control, así como una reducción del scratch a la concentración de 10^-6 y 10^-7 M tanto a las 12 como a las 24 h.

Conclusiones: La curcumina aumenta la viabilidad y capacidad migratoria de los fibroblastos humanos, lo que le confiere propiedades potencialmente beneficiosas en la reparación de la piel. Si bien, son necesarios más estudios que permitan evaluar su efecto sobre otros parámetros y en heridas de la piel.

 

EP1206 La terapia compresiva esta considerada como el tratamiento „gold standard“ para el cuidado de ulceras venosas

Pere Coca-Alves¹, Mariano Bermejo², Manuel Carpintero Pino³, Maria Marins⁴, Marcos Gonzalez^5
1Parc Sanitari Sant Joan de Déu, Barcelona, Spain, ²Hospital Universitario Ramon y Cajal, Madrid, Spain, ³EPA Heridas Cronicas Distrito Huelva Costa, Huelva, Spain, ⁴Hospital General de Villalba, Villalba, Spain, ⁵Hospital 12 de Octubre, Madrid, Spain

Objetivo: Evaluar la efectividad clínica y la aceptabilidad de un kit de terapia compresiva multicapa (TCM) en el tratamiento de úlceras venosas (UV).

Métodos: Serie de casos clínicos analizando el tratamiento con compresión de pacientes con úlceras venosas de un kit de TCM formado por una venda elástica de tracción corta, una de compresión y protección y una media.

Seguimiento durante 8 semanas de pacientes con UV sin signos de infección clínica ni intolerancia a la compresión. Se analizan variables descriptivas de la muestra, de evolución clínica (Resvech 2 y estado de la piel perilesional con el índice FEDPALLA), evolución fotográfica de las lesiones, tiempo para la cicatrización, opinión del paciente y opinión del profesional.

Resultados: Se han incluido 12 lesiones de 121 días (mediana) de evolución en pacientes con una edad media de 74 años. 5 de las lesiones son recidivas. 5 pacientes han cerrado sus lesiones a las semanas 3, 4, 6 y 8(2) respectivamente. 1 paciente ha abandonado el seguimiento por criterios no clínicos y los 6 restantes siguen incluidos en la evaluación. En todos los pacientes se ha producido una reducción de la severidad de la lesión y mejora de la piel perilesional.

Conclusiones: El kit ha demostrado ser efectivo para el tratamiento de UV en lo que hace referencia a la evolución clínica de las lesiones y a su aceptabilidad por parte de pacientes y profesionales.

 

EP1207 Desbridamiento larval en heridas crónicas: alternativa eficaz frente a terapias convencionales

María Alonso Gonzalez¹, Begoña Cabero García¹, Laura García Caridad^1
1Hospital Clínico Universitario de Valladolid, Valladolid, Spain

Objetivo: Revisar la efectividad de la Terapia de Desbridamiento Larval en heridas crónicas, comparándola con otras terapias de desbridamiento.

Métodos: Se realizó una revisión bibliográfica de publicaciones en PubMed, Cochrane y Up to Date, seleccionando ensayos clínicos, revisiones sistemáticas, estudios observacionales y de casos, en inglés y español, que compararon la Terapia de Desbridamiento Larval con métodos convencionales en el tratamiento de heridas crónicas.

Resultados: La Terapia de Desbridamiento Larval mostró mayor rapidez en la fase de desbridamiento, reducción en la carga bacteriana y menor coste en comparación con tratamientos convencionales. En heridas de difícil cicatrización, la Terapia también favoreció la formación de tejido de granulación. Aunque se reportó dolor en algunos casos, mejoró con analgésicos leves.

Conclusiones: La Terapia de Desbridamiento Larval es efectiva para acelerar la limpieza y cicatrización de heridas crónicas, siendo una alternativa válida y económica frente a otros métodos, pudiendo reducir las tasas de infección y el tiempo de recuperación sin hospitalización prolongada.

 

 

QUEMADURAS

EP1051 Efectividad de la fisioterapia de masaje en cicatrices post-quemaduras. Revisión bibliográfica

Paula Borras Lecha¹, Izarbe Molina Domec¹, Elena Guillén Marañes¹, Marina Jimenez Liébanas¹, Raquel Gil Marin¹, Javier Mateo Colilla^1
1CST Cap Sant Llatzer, Terrassa, Spain

Objetivo: Conocer el grado de efectividad del uso de fisioterapia en cicatrices post quemaduras.Estudiar si los efectos de la fisioterapia se mantienen más allá del período de intervención.
Métodos: Se realiza revisión bibliográfica de evidencia actual en pubmed y Cochrane. Palabras clave: scars AND physiotherapy.
Resultados: La aparición de cicatrices anormales post quemadura conllevan tasas de prevalencia entre el 30-70% y se asocian a alteraciones físicas, como contracturas, adherencias, prurito, dolor y disminución de movimiento, además de consecuencias estéticas, psicológicas y sociales. La fisioterapia utiliza el masaje para que las fibras del tejido cicatricial y la fascia se alineen mejor, se reduzca la tensión y aumente el flujo sanguíneo de la zona, mejorando el dolor, elasticidad, prurito, funcionalidad, calidad de vida y estética. Esta intervención es uno de los métodos de tratamiento más comúnmente empleados, de bajo coste, segura, fácil de implementar y que genera una mejoría en las características de la cicatriz. Además, estos beneficios clínicos podrían reducir el número de cirugías posteriores.
Conclusiones: La literatura consultada refiere que existe beneficio clínico ya que el masaje del tejido cicatricial puede ser beneficioso para reducir el dolor, aumentar el movimiento y mejorar las características de la cicatriz. A pesar de los resultados clínicos positivos obtenidos con los tratamientos de fisioterapia, falta evidencia de que estos generen mejoras a largo plazo tras la intervención y existe necesidad de estudios bien diseñados para determinar la eficacia del tratamiento con masaje.

 

EP1589 Evaluación del dolor con sustituto de nanocelulosa epicite hydro versus cura convencional en pacientes adultos con quemaduras de segundo grado profundo

Enrique Chau Ramos¹, Crhistian Chau Ramos¹, Guillermo Wiegering Cecchi^2
1Skin Medical, Lima, Peru, ²Clinica Javier Prado, Lima, Peru

Objetivo: Evaluación del dolor utilizando sustituto de nanocelulosa (EPICITE Hydro); versus cura convencional en quemaduras de segundo grado profundo en pacientes adultos.

Métodos: El estudio es de tipo intervención, analítico, retrospectivo a través del historial clínico, comparativo. Participaron 142 pacientes de ambos sexos, con edades entre 30 a 75 años, atendidos en consultorio externo entre enero de 2022 a julio 2024, realizado en la clínica Skin Medical. Todos presentaban quemaduras de segundo grado intermedio profundo, afectando menos del 20% de la dermis expuesta. Utilizándose como medición del dolor la escala de ( EVA) para ambos grupos y tomándose las mediciones a las 24 horas, 72 horas, una semana, tres semanas.

Resultados: Indicándose en promedios con la escala de dolor y comparándose entre ambos grupos, la nanocelulosa (Epicite Hydro) versus cura convencional. Reflejando menores promedios de dolor, en el grupo de la nanocelulosa en el periodo de seguimiento respecto al tratamiento convencional. Dando especial atención a una mejoría del dolor en las primeras 24 horas y de manera sostenida en las tomas realizadas a las 72 horas, una semana y tres semanas, corroborándose con los resultados estadísticamente significativos (p<0.05).

Conclusiones: Se evidenció la mejoría del dolor con la escala de (EVA), con el uso del sustituto de nanocelulosa. Se destaca la existencia del dolor leve para el grupo que usó la nanocelulosa en contraste con el dolor moderado que fue característica en los casos con tratamiento de cura convencional.

 

EP1053 Tratamiento de herida de difícil resolución con ungüento de beta-sitosterol (MEBO) versus cura convencional realizado durante el año 2021-2023

Enrique Chau Ramos¹, Crhistian Chau Ramos^2
1Skin Medical, Lima, Lima, Peru, ²Skin Medical, Javier Prado, Lima, Lima, Peru

Objetivo: Evaluar el tiempo de cicatrización en ambos grupos – con uso de ungüento de beta-sitosterol versus de uso cura convencional ; medido por la longitud mayor y menor en pacientes con heridas en extremidades.

Métodos: El estudio es de tipo intervención, analítico, retrospectivo y comparativo. Participaron 26 pacientes de ambos sexos, con edades entre 20 a 95 años, atendidos en consultorio externo entre los meses de enero a diciembre de 2023, realizado en la Clínica especializada de regeneración de tejidos “Skin Medical”. Todos los casos presentaban heridas crónicas de difícil resolución multidimensional. Fueron clasificados en dos grupos. 12 pacientes fueron tratados con cura convencional y 14 pacientes con el uso de ungüento de beta-sitosterol . Se tomaron mediciones secuenciales en la segunda, cuarta y sexta semana. Todos los pacientes cumplieron los criterios de inclusión.

Resultados: Presentando mejor resultado en la velocidad de regeneración de las heridas crónicas complejas, en comparación con el tratamiento de curaciones convencionales. No reportándose infecciones sobreagregadas para el caso del tratamiento con beta-sitosterol. Y reactivando tempranamente la reacción cicatrizal; corroborándose con resultados estadísticamente significativos (p<0.05).

Conclusiones: Se evidenció la progresión de la velocidad de cicatrización del grupo que utilizó ungüento de beta-sistosterol en comparación con cura convencional. No presentaron infecciones sobreagregadas en el grupo que utilizó beta-sitosterol. Al término de la sexta semana se refleja una marcada diferencia con el uso de ungüento, con características de homogenización del tejido de granulación regenerado.

 

EP1590 Quemadura por congelación en el primer dedo del pie: evolución y manejo en condiciones extremas

Emilia Mateo Marin¹, Daniel Antolin Hernandez², Gemma Simón Millán³, Aina Ayats Ruiz^2
1Institut Català de la Salut, Equipo de Atención Primaria de Súria, Enfermera referente de Heridas de la Cataluña Central, Socia y Miembro Consultivo del GNEAUPP, Socia de la SEHER, Callús, Spain, ²Institut Català de la Salut, Equipo de Atención Primaria de Ripoll, Ripoll, Spain, ³Institut Català de la Salut, unitat de continuïtat assistencial UCA H. U. Josep Trueta, Girona, Spain

Objetivo: Presentar un caso clínico de una quemadura por congelación en el primer dedo del pie izquierdo de un hombre de 34 años, ocurrido durante una excursión en Laponia a temperaturas extremas de -40 grados Celsius, a pesar de utilizar calzado diseñado para condiciones climáticas severas.

Métodos: La evaluación de la quemadura se inició a distancia, a través de una red social conocida, por foto y por audio, debido a la distancia y la falta de cobertura telefónica del lugar. Por foto se pudo ver el alcance inicial de la lesión y pautar una cura, condicionada a los materiales existentes en la zona y unas actividades iniciales.

Resultados: Inicialmente, el paciente presentó una quemadura por congelación de segundo grado, caracterizada por enrojecimiento, ampollas y dolor. Sin embargo, a medida que pasaron los días, la profundidad de la lesión aumentó, mostrando necrosis y la exposición del hueso. Se implementó un tratamiento que incluyó el calentamiento gradual del área afectada, la limpieza de la herida, la aplicación de apósitos específicos y, en última instancia, la evaluación para posible intervención quirúrgica. El seguimiento mostró una evolución compleja, con la necesidad de cuidados avanzados y un enfoque multidisciplinario.

Conclusiones: Resaltar la importancia de la educación sobre la prevención de lesiones por congelación, incluso utilizando equipo especializado. La progresión de la lesión conciencia sobre la evaluación y tratamiento correctos en este tipo de quemaduras. Es necesaria mayor concienciación sobre los riesgos asociados con la exposición prolongada a temperaturas extremas y la revisión de los pies en situaciones de frío extremo.

 

EP1591 Cuidados de enfermería en el post desbridamiento con enzimas de bromelaína en grandes quemados: manejo de la herida y tipos de cobertura

Laura González Gilarte¹, Marta Barroso Sala², Pol Miguel³, Rocio Tabernero Gallego⁴, Jonathan Rubio García⁵, Alberto Blanca^5
1Hospital Universitario Vall Hebron, Barcelona, Spain, ²Hospital UnitariVall Hebron, Barcelona, Spain, ³Hospital Universitari Vall hebron, Barcelona, Spain, ⁴Hospital Universitari Vall Hebron, Barcelona, Spain, ⁵Hospital Universitari Vall Hebron, Barcelona, Spain

Objetivo: El tratamiento de pacientes grandes quemados requiere un abordaje multidisciplinario donde el manejo de las heridas es crucial para la evolución del paciente. La bromelaína como desbridante enzimático, ha revolucionado el tratamiento de las quemaduras. Sin embargo, el éxito del proceso también depende en gran medida de los cuidados de enfermería posteriores al desbridamiento, especialmente en la correcta aplicación de las coberturas y el manejo integral de las heridas y el paciente. Esta revisión evaluará su eficacia en términos de cicatrización, control del exudado, control del dolor y prevención de infecciones liderado por el personal de enfermería.

Métodos: Revisión retrospectiva de las coberturas utilizadas en la Unidad de Quemados del Hospital Vall d’Hebron en pacientes grandes quemados tratados con bromelaína. El análisis de estos resultados permitirá establecer recomendaciones más claras sobre las coberturas más adecuadas en este contexto clínico.

Resultados: El monitoreo constante del estado de las heridas, la detección precoz de signos de infección, y el control del dolor son responsabilidades clave del personal de enfermería. Su intervención no solo asegura una correcta recuperación, sino que minimiza complicaciones y mejora la calidad de vida del paciente.

Conclusiones: El uso de desbridante enzimático ha cambiado el manejo de pacientes grandes quemados, ofreciendo una alternativa eficaz al desbridamiento quirúrgico. El éxito del tratamiento no solo radica en la aplicación del producto. Los cuidados posteriores liderados por el equipo de enfermería y la correcta elección y aplicación de coberturas, junto con un monitoreo continuo del estado de las heridas, son esenciales para una recuperación óptima.

 

EP1592 Eficacia de apósitos de cura en ambiente húmedo versus cura tradicional con sulfadiazina argéntica en quemaduras de segundo grado

María Pilar Mombiela Romeo¹, Esther Ortega Ojeda^2
1Asepeyo, Zaragoza, Spain, ²Asepeyo, Madrid, Spain

Objetivo: Evaluar la efectividad de los productos de cura en ambiente húmedo (CAH) para el tratamiento de las quemaduras de segundo grado versus la cura tradicional con Sulfadiazina de argéntica (SSD) basándonos en los tiempos de cicatrización y los efectos adversos.

Métodos: Elaboramos una revisión bibliográfica con búsqueda en bases de datos: Pubmed, Cochrane, Medes, Scielo y Cuiden. Con las palabras claves Quemadura, efectos adversos, SSD, CAH, tratamiento. La búsqueda de artículos se realizó durante los meses de enero y marzo de 2024.
Resultados: Se incluyeron un total de 20 artículos: 14 revisiones, 6 estudios originales. 2 artículos fueron rechazados por considerarse de escasa calidad científica. 16 de los artículos hacen referencia al tiempo de cicatrización, 6 a las reacciones adversas. En todos los artículos seleccionados se menciona a la SSD como tratamiento o casos control.
Conclusiones: Las quemaduras son un problema de salud pública a nivel mundial. El tratamiento de las mismas es un reto diario para el personal sanitario. Muchos de esos tratamientos están arraigados sin evidencias científicas que los avalen, como el binomio quemadura- Sulfadiazina de argéntica (SSD). Las conclusiones obtenidas son que la cura en ambiente húmedo parece ser más eficaz frente a la cura tradicional con SSD, la cual presenta severos efectos adversos. Su uso debería restringirse a las quemaduras infectadas en el último escalón del tratamiento. Existen otros tratamientos alternativos a la SSD que requieren más investigación para poder sentar las bases de nuevas estrategias en el abordaje de las quemaduras.

 

EP1059 Elaboración de una guía práctica para el tratamiento integral de las personas que sufren quemaduras

Laura Suárez-Barcena González¹, José Manuel Corral Castellanos¹, Jose María Flores López-Ibarra, Miguel López Reyes, Maria Dolores Valencia Ruiz¹, Cristina de la Cruz Maeso¹, Nuria Terriza Cabrera^1
1SESCAM, Ciudad Real, Spain

Objetivo: Establecer directrices basadas en evidencia para el manejo integral de las personas que sufren quemaduras, con el fin de optimizar la atención, prevenir comorbilidades, y asegurar un tratamiento adecuado desde la fase inicial hasta la cicatrización.

Métodos: Se realizó una revisión los principales estudios relevantes en español e inglés publicados desde 2019 sobre el manejo y tratamiento de quemaduras, extraídos de bases de datos como Pubmed, Scopus, Cochrane, Science Direct y Google Scholar, asegurando la inclusión de guías clínicas y revisiones sistemáticas recientes.

Resultados: Los hallazgos mostraron que el uso de un enfoque multidisciplinario mejora significativamente los resultados de cicatrización, destacando la importancia de la intervención temprana y el tratamiento especializado. El análisis de los protocolos actuales reveló áreas de mejora en el manejo del dolor y en la implementación de técnicas de tratamiento avanzadas. Se observaron deficiencias en la continuidad de la atención posthospitalaria y en el seguimiento psicológico de los pacientes.

Conclusiones: La elaboración de una guía de atención para personas con quemaduras ha sido esencial para estandarizar la excelencia en cuidados, mejorar la calidad de vida de las personas y optimizar los recursos de salud. La guía propone pautas claras sobre los pasos a seguir desde la atención inicial hasta la rehabilitación integral. Busca facilitar la capacitación del personal y fomentar la implementación de mejoras en los protocolos de atención para lograr una recuperación más efectiva y una menor tasa de complicaciones en las personas con quemaduras.

 

EP1060 Eficacia de la miel frente a la sulfadiazina de plata en el tratamiento de quemaduras

Adela Goñi Irigoyen¹, Miriam López De Los Dolores², Andrea Carbonell Olivera³, Nelson Colque Siacara³, Júlia Casanova De Casacuberta^4
1Fundación Asistencial Mútua Terrassa, CAP Valldoreix, Sant Cugat del Vallés, Spain, ²Fundación Asistencial Mútua Terrassa, CAP Can Trias, Viladecavalls, Spain, ³Fundación Asistencial Mútua Terrassa, CAP Rubí, Rubí, Spain, ⁴Fundación Asistencial Mútua Terrassa, CAP Sant Cugat del Vallés, Sant Cugat del Vallés, Spain

Objetivo: Evaluar y comparar las evidencias sobre la efectividad de la miel como tratamiento de quemaduras en relación con la sulfadiazina de plata (SSD).
Métodos: Se realizó una revisión bibliográfica de artículos científicos publicados en las bases de datos PubMed, Scopus y Cochrane. Se utilizaron descriptores Mesh como “honey”, “burns”, “silver sulfadiazine cream”, “wound healing” junto con el operador booleano “AND” para filtrar la información. Se excluyeron artículos que no abordaban el tema y artículos duplicados. Se incluyeron artículos en inglés. De 38 artículos encontrados, se seleccionaron 10.
Resultados: Los artículos muestran una mayor eficacia de la miel comparando con la SSD. Resaltan sus propiedades antiinflamatorias, antimicrobianas y cicatrizantes y su capacidad de mantener la humedad y reducir el dolor, lo que favorece una cicatrización más rápida. Esto se respalda con resultados que indican un promedio de cicatrización de 18 días con miel frente a 32 días con SSD. En dos semanas, el 52% de las heridas tratadas con miel estaban completamente cicatrizadas, alcanzando el 100% en 21 días. En contraste, solo el 20% de las heridas tratadas con SSD estaban cicatrizadas en dos semanas y un 84% en 21 días. Sin embargo, se destaca la escasez de estudios de alta calidad que justifique el uso sistemático de la miel.
Conclusiones: La miel se considera una opción más beneficiosa para el tratamiento de quemaduras. Es fundamental realizar más estudios, establecer pautas claras en la práctica clínica y fomentar el conocimiento de los beneficios de este producto entre el personal sanitario.

 

EP1062 Protocolo de atención temprana para quemaduras en atención primaria

Miguel López Reyes, José Manuel Corral Castellanos¹, Laura Suárez-Barcena González¹, Jose María Flores López-Ibarra, Nuria Terriza Cabrera¹, Maria Dolores Valencia Ruiz¹, Cristina de la Cruz Maeso^1
1SESCAM, Ciudad Real, Spain

Objetivo: Desarrollar un algoritmo que estandarice y optimice el manejo inicial de las quemaduras en atención primaria, con un enfoque en la identificación precisa de su profundidad y el tratamiento adecuado en las primeras horas post-lesión
Métodos: Se llevó a cabo una revisión exhaustiva de la literatura científica y protocolos clínicos existentes relacionados con el manejo inicial de quemaduras. Se han incluido estudios relevantes en español e inglés publicados desde 2019 sobre el manejo y tratamiento de quemaduras, extraídos de bases de datos como Pubmed, Scopus, Cochrane, Science Direct y Google Scholar.
Resultados: El algoritmo propuesto se centra en cuatro aspectos principales del manejo de quemaduras en atención primaria: (1) Criterios de manejo: Se establecen las características de las quemaduras menores, según la clasificación de la American Burn Association (ABA), que son susceptibles de tratamiento ambulatorio. (2) Enfriamiento: Se recomienda un enfriamiento inmediato de la zona afectada con agua potable a una temperatura entre 15 y 20 °C durante 20 minutos para reducir la inflamación. (3) Limpieza: Dependerá de las condicinones de la herida (4) Valoración de la profundidad y tratamiento: Se debe realizar una evaluación de la profundidad de la quemadura mediante técnicas como el signo del pelo. Según la profundidad y características de la quemadura, se seleccionarán las opciones de tratamiento adecuadas, priorizando la aplicación de apósitos específicos y técnicas de curación apropiadas.
Conclusiones: La implementación de este algoritmo en atención primaria mejora la atención de las quemaduras, garantizando intervenciones adecuadas y disminuyendo el riesgo de complicaciones. La capacitación del personal de salud en estas pautas es esencial para optimizar los resultados en los pacientes con quemaduras y minimizar secuelas a largo plazo.

 

EP1593 Injertos de piel mediante microfragmentación mecánica en quemaduras. Técnica y cuidados

Juan Javier Ferrer Lopez¹, Beatriz Cano Marin¹, Maria De Los Remedios Folch Esteve², Sara Marin Tebar¹, Gema Roig Roig^1
HHospital Universitario Y Politécnico La Fe, Unidad Quemados, Valencia, Spain, ²Hospital Universitario y Politécnico La Fe, Unidad De Quemados, Valencia, Spain

Objetivo: Describir la técnica de microfragmentación de tejidos autólogos mediante Hy Tissue Micrograft Tecnology® y su posterior cobertura con un apósito de ácido hialurónico y colágeno. Exponer los cuidados de enfermería post tratamiento. Analizar posibles utilidades en el tratamiento de las quemaduras.

Métodos: Revisión bibliográfica de la literatura científica. Bases de datos a las que se accede: PubMed, Scielo, Medline y Cuiden de estudios relacionados con el tema.

Ficha técnica del producto.

Resultados: Mediante la microfragmentación mecánica de pequeñas muestras de piel total se consiguen microinjertos para su posterior implantación autóloga a través de punción y sembrado en el lecho de la herida. Esta técnica permite su realización en consultas sin necesidad de quirófano. Los cuidados inmediatos posteriores son sencillos, se realizan mediante un apósito de ácido hialurónico y colágeno, la revisión de la herida se efectúa a los 7 días post microinjertos.

Conclusiones: Los microinjertos de piel total son capaces de promover el proceso regenerativo de los tejidos, proporcionan una alta concentración de células madre presentes en el tejido celular subcutáneo y factores de crecimiento que estimulan y aceleran la cicatrización.Existe escasa información en la literatura científica sobre la microfragmentación mecánica en la cobertura de lesiones por quemaduras, no obstante, esta técnica puede ser una opción más en determinados pacientes.

 

EP1594 Tatuajes: un aliado inesperado en el desbridamiento enzimático con bromelaína

Marcos Bayo Montoliu¹, María García García¹, Carlos Guijarro Pérez¹, Maria Dolores Pérez del Caz^1
1Servicio de Cirugía Plástica y Quemados, Hospital Universitari i Politècnic La Fe, Valencia, Spain

Objetivo: Presentar a través de un caso clínico el rendimiento diagnóstico además de terapéutico que ofrece el desbridamiento enzimático con bromelaína, pudiendo utilizar referencias como los propios tatuajes del paciente para guiar la toma de decisiones terapéuticas.

Métodos: Presentamos el caso de un varón de 36 años con quemaduras de segundo grado del 32% de superficie corporal tras accidente laboral, incluyendo ambos miembros superiores, los cuales presentaban numerosos tatuajes en las zonas quemadas. Tras una evaluación inicial, se decide realizar desbridamiento enzimático precoz de ambos miembros superiores.

Resultados: Tras aplicar la bromelaína durante 4 horas, a su retirada observamos que su acción selectiva sobre el tejido desvitalizado había borrado prácticamente por completo los tatuajes en las zonas con quemaduras más profundas (la tinta del tatuaje se aloja en la dermis profunda), mientras que en aquellas zonas más superficiales se respetaba la integridad de los mismos. Con esta información, decidimos manejo conservador de las zonas más superficiales con curas dirigidas hasta obtener la epitelización y manejo quirúrgico mediante desbridamiento y autoinjerto de aquellas zonas más profundas, obteniendo excelentes resultados en ambas zonas.

Conclusiones: El desbridamiento enzimático con bromelaína no solo es una herramienta terapéutica vital en el manejo precoz del paciente quemado, sino que su aplicación y especialmente el aspecto del lecho a la retirada del producto aporta información diagnóstica acerca del grado de la quemadura, sirviendo de apoyo en la toma de decisiones terapéuticas. En algunas ocasiones, podremos ayudarnos de referencias propias del paciente, como sus tatuajes, para complementar esas decisiones.

 

EP1595 Estandarización del manejo de quemaduras superficiales en el paciente pediátricos. Revisión sistemática

Paula Suarez Cabrera¹, Sandra Patricia Bravo¹, Justo Rueda¹, Marina Carós², Meritxell Garcia Romero¹, Meritxell Coll^1
1Consorci Sanitari de Terrassa (CST), Terrassa, Spain, ²Consorci Sanitari de Terrassa (CST), GNEAUPP, Terrassa, Spain

Objetivo: Identificar y analizar los tratamientos más adecuados para quemaduras de hasta segundo grado superficial en pacientes pediátricos a partir de una revisión sistemática. 

Métodos: Se realizó una búsqueda en las bases de datos de PUBMED, CINAHL, CUIDEN, LILACS, IBECS, Scielo, Scopus, Cochrane Library y Web of Science, con la utilización de los descriptores: ‘Burn*’, ‘Wound*’, ‘healing’, ‘Pediatric*’ y ‘Child*’. Los criterios de elección fueron: artículos publicados entre 2019-2024, en inglés y español, acceso a texto completo, ensayos clínicos aleatorizados (ECA) y revisiones sistemáticas con y sin metaanálisis (RS). 

Se establecieron 3 grupos de trabajo para la revisión de los documentos y un grupo de consenso para establecer las principales recomendaciones a partir de los datos obtenidos. 

Asimismo, se evaluó la calidad de los documentos según las recomendaciones de EQUATOR. 

Resultados: Se obtuvieron 640 documentos, revisados por pares, a partir del título y resumen, obteniéndose 50 documentos para lectura a texto completo, se eliminaron 21 por no cumplir criterios de selección y 1 por no estar disponible en inglés. En la síntesis cualitativa se descartaron 13 por baja calidad. Se seleccionaron 1RS, 2RS con metaanálisis, 2 Estudios económicos, 2 Metaanálisis y 9ECA

Conclusiones: La escasez de estudios sobre el tratamiento de quemaduras en pediatría y la variedad de opciones terapéuticas existentes, evidencian la necesidad de directrices para estandarizar su manejo clínico. A pesar de los avances en quemaduras, persisten discordancias en el uso de determinados productos, muchos de los cuales carecen de evidencia sólida para el uso en población pediátrica.

 

EP1596 Abordaje y tratamiento de quemaduras de segundo grado

Fernando Virgilio Martínez Corbalán¹, Luisa Navarro Luján^1
1Servicio Murciano de Salud, Murcia, Spain

Objetivo: Analizar el abordaje y tratamiento de quemaduras de segundo grado en base a la literatura científica disponible.

Métodos: Se ha realizado una revisión bibliográfica, revisando una gran cantidad de bases de datos como Scielo, Cochrane o PubMed, y utilizando algunos términos como “quemadura de segundo grado”, “second-degree burn management”, “infection control”, entre otras. Se ha utilizado el filtro de publicaciones en los últimos 5 años tanto en inglés como en español. Y como criterios de exclusión, los estudios que abarcan quemaduras de otro grado o que sean estudiadas en un ser vivo no humano.

Resultados: Destacamos que los apósitos (sobre todo los que contengan Ag o hidrocoloides) son muy efectivos a la hora de cicatrizar este tipo de quemaduras, reduciendo el dolor y acelerando la recuperación en relación con otros apósitos más tradicionales. El uso de terapias no farmacológicas y su combinación con analgésicos sistémicos, mejora el dolor y la comodidad en este tipo de pacientes. Únicamente está indicado el uso de terapia antibiótica en quemaduras de alto riesgo de infección. Asegurar que el desbridamiento suave y su limpieza diaria son esenciales para conseguir una correcta curación de la quemadura, qué combinada con un seguimiento regular por parte de Atención Primaria (AP) conseguiríamos un trato óptimo.

Conclusiones: Los apósitos mencionados mejoran la cicatrización y redicen las complicaciones en las quemaduras de segundo grado. Además, un adecuado manejo del dolor y profilaxis antibiótica (en caso necesario) optimizarán la recuperación, evitando posibles infecciones y cicatrices hipertróficas.

 

EP1065 Nuevo enfoque en el tratamiento de las quemaduras pediátricas que requieren ingreso hospitalario con el uso de alginogel enzimático

Silvia Minguez Abia¹, Naiara Santín Pérez¹, Patricia Martin Playa^1
1Osakidetza, Cruces - Barakaldo, Spain

Objetivo: Las quemaduras pediátricas representan una causa significativa de morbilidad y mortalidad a nivel mundial, generando un impacto profundo en la salud física y emocional de los pacientes. El objetivo de este estudio es compartir nuestra experiencia con el uso de alginogel enzimático en niños menores de 14 años hospitalizados por quemaduras, describiendo los cambios a nivel asistencial y los beneficios obtenidos tanto para el niño como para su familia.

Métodos: Tras los buenos resultados observados en pacientes quemados adultos a los que se les fue aplicado el protocolo de uso del alginogel enzimático, se inicia su uso en niños en el 2023. Se realizó una revisión retrospectiva de los 16 casos tratados con alginogel enzimático entre 2023 y 2024.

Resultados: Se analizaron los casos de menores de 14 años hospitalizados por quemaduras en los que se aplicó alginogel enzimático. Entre los beneficios destacados se incluye la posibilidad de espaciar los intervalos de curas, lo cual disminuyó la necesidad de sedoanalgesia, redujo el uso de recursos humanos y materiales, y aminoró la ansiedad percibida por los pacientes y sus familias.

Conclusiones: Nuestra experiencia sugiere que el uso de alginogel enzimático en pacientes pediátricos permite espaciar las curas, posibilitando el alta domiciliaria entre estas. Esto ha contribuido a reducir el impacto psicosocial de la hospitalización en los niños y sus familias.

 

EP1597 Necrólisis epidérmica tóxica: la importancia de un abordaje multidisciplinar

Carlos Guijarro Pérez¹, Marcos Bayo Montoliu¹, Mar Merino Romero¹, Maria Dolores Pérez del Caz^1
1H. U i P La Fe, Valencia, Spain

Objetivo: Exponer el protocolo de actuación de nuestra unidad ante el paciente con Necrolisis Epidérmica Tóxica (NET).

Métodos: la necrólisis epidérmica tóxica es una enfermedad multisistémica, con su principal y característica afectación en piel y mucosas. Su baja incidencia, así como su compleja fisiopatología, aún foco de constante investigación, impide un consenso sobre su tratamiento entre los distintos centros y fuentes consultadas. Además, destaca por su complejidad en el manejo debido a las comorbilidades que subyacen en el paciente y su tasa de complicaciones durante el ingreso.

Se realiza una búsqueda en los motores de búsqueda PUBMED y Cocrhane con las siguientes palabras clave: “Toxic Epidermal Necrolisis”, “Lyell Syndrom”, “Drug adverse reaction”; resultando 81 artículos, utilizando los publicados en los últimos 6 años y aquellos que nos permitan enfocar las novedades del manejo médico y de las complicaciones.

Resultados: Tras la revisión de la literatura vigente, hemos actualizado el protocolo terapéutico utilizado durante los últimos años por nuestra unidad para el manejo de estos pacientes, enfocando holísticamente la patología.

Conclusiones: Se necesitan estudios de mayor evidencia para el tratamiento de los pacientes con NET.

 

EP1598 Efectividad de los antibióticos tópicos en la cura de quemaduras en atención primaria

Alba Díaz Ros¹, Marina Bernal Ros^1
1Sistema Murciano de Salud, Murcia, Spain

Objetivo: Evaluar la efectividad de los antibióticos tópicos en la cura de quemaduras en el ámbito de atención primaria.

Métodos: Se ha llevado a cabo una revisión sistemática, en la que para crear las cadenas de búsqueda se han utilizado los descriptores: Burn y antibiotec topic, consultando en las bases de PubMed, Cochrane library, UpToDate y Scopus. Seleccionando estudios clínicos, revisiones sistemáticas y metaanálisis publicados de los últimos cinco años. Los estudios elegidos analizaron resultados como tiempo de cicatrización, tasa de infección y efecto secundarios.

Resultados: Con las búsquedas realizadas se obtuvieron 108 estudios, de los que se escogieron 15 para incluirlos en la revisión. La revisión mostró que los antibióticos tópicos pueden reducir la tasa de infecciones en superficies de quemaduras importantes debido a que estas suelen ser propensas a una rápida colonización bacteriana con el potencial de una infección invasiva. Sin embargo, las quemaduras superficiales rara vez desarrollan tales infecciones y no es necesario el requerimiento de antibiótico tópico. Algunos estudios no encontraron diferencias significativas en el tiempo de cicatrización en comparación con otros métodos, como el uso de apósitos no antibióticos. Se encontraron variaciones en la efectividad dependiendo del tipo de antibiótico usado y del tipo de quemadura.

Conclusiones: La presencia de un nivel bajo de evidencia, refleja la falta de estudios que confirmen o desmientan el resultado sobre la aplicación de antibiótico tópico en quemaduras. Para futuras investigaciones, se deberían realizar comparaciones directas entre antibióticos tópicos y otras alternativas de tratamiento para establecer mejores recomendaciones sobre este tipo de heridas en atención primaria.

 

EP1599 Beneficios del uso de flaminal vs flamazine en curas de grandes quemados

Shivani Ramchandani Hotchandani^1
1Hospital Universitario La Paz, Madrid, Spain

Objetivo: El objetivo principal de este estudio es comparar Flaminal® y Flamazine® para comprobar si reduce el número de días de ingreso en UCI en pacientes con quemaduras de segundo y tercer grado.

Métodos: Se realizará un estudio cuantitativo, observacional, descriptivo, transversal y de carácter retrospectivo, recogiendo datos de las historias clínicas de los pacientes ingresados en el Hospital La Paz entre el 1 de enero al 31 de diciembre de 2023.

Resultados: La bibliografía actual es escasa y no se han obtenido diferencias estadísticamente significativas en el tiempo de cicatrización de las heridas en ambos productos. No obstante, hay más variables determinantes en la mejora del paciente.

Conclusiones: Se espera concluir que Flaminal® reduce los días de ingreso en UCI frente a Flamazine®.

 

EP1600 Tratamiento de quemaduras de espesor parcial con alginogel enzimático antimicrobiano: experiencia y protocolo de aplicación en la unidad de quemados

Paula Álvarez Hernández¹, Fátima Cerón Molina¹, Jose Ramón Martínez Méndez¹, Francisco Leyva Rodríguez^1
1Hospital Universitario La Paz, Madrid, Spain

Objetivo: Este trabajo tiene como objetivo describir el protocolo de aplicación de alginogel enzimático antimicrobiano en el tratamiento de quemaduras de espesor parcial en una unidad de quemados, así como evaluar su efectividad en términos de cicatrización y manejo de infecciones en heridas.
Métodos: Se llevó a cabo un estudio retrospectivo y observacional de pacientes atendidos entre enero de 2020 y diciembre de 2022 en la unidad de quemados del hospital. Se incluyeron pacientes con quemaduras de espesor parcial tratados exclusivamente con Flaminal, sin comparaciones con otros tratamientos. El protocolo consistió en la aplicación tópica de Flaminal a diario o cada dos días, evaluando la evolución de la herida en términos de exudado, dolor y signos de infección.
Resultados: Se incluyeron pacientes entre junio de 2022 y julio de 2023 con quemaduras de espesor parcial de distintas etiologías y áreas anatómicas. Los resultados sugieren que Flaminal es eficaz en el control de infecciones y en la promoción de una cicatrización rápida y sin complicaciones.
Conclusiones: La aplicación de alginogel enzimático antimicrobiano en quemaduras de espesor parcial demostró ser segura y efectiva, facilitando la cicatrización y previniendo infecciones. El protocolo presentado puede servir como guía para la implementación en otras unidades de quemados, optimizando el manejo de este tipo de lesiones.

 

EP1601 Manejo de quemaduras faciales mediante desbridamiento enzimático con bromelaína y tratamiento conservador con miel medicinal: protocolo de aplicación y experiencia en la unidad de quemados

Fátima Cerón Molina¹, Paula Álvarez Hernández¹, Jose Ramón Martínez Méndez¹, Francisco Leyva Rodríguez^1
1Hospital Universitario La Paz, Madrid, Spain

Objetivo: El manejo de las quemaduras faciales presenta desafíos únicos debido a la importancia estética y funcional de esta área. Este estudio describe la experiencia en el Hospital Universitario La Paz de Madrid con desbridamiento enzimático a base de bromelaína y tratamiento conservador con miel medicinal.

Métodos: Se incluyeron pacientes con quemaduras faciales de segundo y tercer grado tratados entre enero de 2019 y diciembre de 2023. Se aplicó el desbridamiento enzimático según protocolo estándar, enfatizando en los tiempos de preparación y aplicación. El tratamiento posterior con miel medicinal se utilizó para promover la curación. Se evaluaron las indicaciones, el protocolo de uso, los resultados estéticos y funcionales y las secuelas comunes.

Resultados: El desbridamiento enzimático con bromelaína logró la eliminación rápida y selectiva del tejido necrótico en la mayoría de los casos, reduciendo la necesidad de intervenciones quirúrgicas adicionales. El tratamiento posterior con miel medicinal facilitó la curación rápida y redujo las infecciones secundarias. Estéticamente, la mayoría de los pacientes reportaron una alta satisfacción con los resultados y funcionalmente, se observó una recuperación completa. Las secuelas más comunes fueron hiperpigmentación y cicatrices hipertróficas.

Conclusiones: El protocolo combinado de desbridamiento enzimático con bromelina y tratamiento conservador con miel medicinal resultó eficaz para el tratamiento de las quemaduras faciales, proporcionando buenos resultados estéticos y funcionales con mínimas secuelas. Esta experiencia sugiere que esta estrategia podría ser una valiosa incorporación al tratamiento de las quemaduras faciales en las unidades de quemados terciarias.

 

EP1602 Curación y evolución de una quemadura de segundo grado superficial derivada a la unidad de quemados

Irene Cespedes I Feliu¹, Maria José Sánchez Doblado^1
1SSIBE, Torroella de Montgrí, Spain

Objetivo: Curación de una quemadura de segundo grado superficial, evitando sus posibles complicaciones y recuperando el estado basal del paciente en el menor tiempo posible.

Métodos: Paciente de 88 años que presentó una quemadura de segundo grado superficial en el dorso del pie derecho, con una extensión del 1% de SCTQ y sin dolor de doce horas de evolución. En las primeras curas se retiró el tejido desvitalizado y se aplicaron diferentes apósitos. Pasados unos días se observaron signos de infección local. A pesar de la toma de antibiótico oral, la introducción de batidos proteicos en la dieta, realizar reposo relativo, mantener la extremidad elevada y realizar las curas correspondientes, se derivó a la unidad de quemados de la capital, quedando ingresado durante quince días para hacerle un injerto. La evolución fue favorable, presentando una buena cicatrización.

Resultados: Después de dos meses de evolución, haber derivado al paciente a la unidad de quemados, realizar las curas y controles correspondientes y haber realizado una buena intervención educativa al paciente, se consiguieron obtener todos los objetivos planteados.

Conclusiones: Realizar una correcta actuación desde el inicio, hacer una buena valoración integral de la persona y trabajar basándote en la evidencia actual, se puede resolver en el menor tiempo posible la curación de una quemadura.

 

EP1603 Tratamiento de quemaduras con una matriz impregnada con tecnología lípido coloidal y factor nano oligosacárido (TLC-NOSF)

Estefanía Valcarce Moreno¹, María Sebastián Rodriguez¹, Zara Doctama Ayong¹, Lucía Requena Valencia¹, Lidia Fernández Ginés¹, Noemí Sánchez Ferreño¹, Anna Oliver Olius^1
1Cap Larrrard. Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Mostrar la efectividad de un apósito TLC-NOSF en soporte de malla poliéster en la cicatrización de quemaduras de segundo grado. 

Métodos: Dos casos: Varón, 17 años y mujer, 66 años. Ambos acuden para su primera cura a Centro de Urgencias de Atención Primaria (CUAP) por quemadura de grado 2 con aceite caliente en dedos de mano y pie respectivamente. Escala analógica del dolor EVA 9-7 respectivamente. Tras dos curas diarias con sulfadiazina de plata tópica y malla impregnada en bálsamo de Perú acuden al Centro de Atención Primaria (CAP) por edema, exudado moderado y maceración. Se inicia cura de espacios interdigitales y dedos por separado con una matriz impregnada con tecnología TLC-NOSF, apósito secundario de poliuretano espuma sin bordes no adhesivo y sujeción con venda de gasa.

Resultados: Ambos casos epitelizaron en 6-8 días. Curas espaciadas cada 3-4 días y disminución significativa del dolor y el exudado.

Conclusiones: El apósito es una matriz impregnada con tecnología TLC-NOSF (reductora de exceso de metaloproteinasas) no oclusiva y que no se adhiere a la herida en soporte de malla de poliéster. Lo que la hace flexible y de fácil manejo especialmente en dedos.

Ha demostrado ser efectivo en el tratamiento de quemaduras de segundo grado acelerando el tiempo de cicatrización, mejorando la regeneración de la piel y reduciendo el dolor.

 

EP1604 Evolución de las quemaduras en pacientes con piel tatuada

Shivani Ramchandani Hotchandani¹, Alfonso De Lorenzo Rodero^2
1Hospital Unversitario La Paz, Madrid, Spain, ²Hospital Universiario La Paz, Madrid, Spain

Objetivo: Describir la evolución de las quemaduras en un paciente con la piel tatuada.

Métodos: Realización de un caso clínico.

Resultados: El paciente presentaba una Superficie Corporal Quemada (SCQ) del 26% en miembro inferior derecho, flanco derecho, miembro superior derecho, tórax y zona lumbar. Las quemaduras eran de segundo grado profundo y tercer grado. En el miembro superior derecho presentaba parte de la piel tatuada con tinta negra y zonas de color verde.

Durante los dos primeros días de ingreso, debido a la inestabilidad hemodinámica, se realizó una cura húmeda con suero salino fisiológico e Hibiscrub. La parte de piel quemada tatuada, presentaba la tinta muy brillante, como si se acabara de realizar recientemente. Cuando la estabilidad hemodinámica del paciente lo permitió, se realizó un desbridamiento enzimático con Nexobrid. La tinta del tatuaje permaneció intacta. Sin embargo, las zonas colindantes a la tinta, se enrojecieron, como es habitual al realizar esta técnica. Posteriormente, se aplicó Suprathel, que es una membrana sintética. Se dejó actuar cinco días, tal y como indica su ficha técnica. Al retirar el producto, la piel se recuperó en su totalidad.
Conclusiones: En este caso clínico, no se observan diferencias en el tratamiento ni en los resultados entre la piel tatuada o no. Tampoco se ha visto evidencia significativa en cuanto al síndrome compartimental en piel quemada.

 

EP1605 ¡Alerta! El agua hirviendo y sus peligros inesperados

Claudia Terradillos Gonzalez¹, Vanessa Gutiérrez Leon², Javier Varas de la Fuente³, Maria Isabel Blazquez Blanco⁴, Clara Jiménez Andrinal^5
1Centro De Salud Ávila Sur-Oeste (Sacyl), Avila, Spain, ²Centro de Salud Ávila Sur-Oeste (Sacyl), Avila, Spain, ³Residencia de Tercera Edad (Jcyl), Avila, Spain, ⁴Centro de Salud Cebreros (Sacyl), Avila, Spain, ⁵Centro de Salud De Sotillo De La Adrada (Sacyl), Avila, Spain

Objetivo: Lograr adecuada cicatrización. Aliviar el dolor. Evitar complicaciones.

Método: Mujer de 86 años con antecedentes personales de tumor vesical, acude a consulta presentando quemadura de segundo grado profunda con fondo blanco nacarado en glúteo, con dimensiones de 18cm x 14cm, tras caída accidental sobre olla de agua hirviendo. Presenta dolor según escala EVA 8/10.

Se procede a la retirada de restos de piel quemados y desvitalizados presentes en el lecho.

Se inician curas en ambiente húmedo con carboximetilcelulosa sódica impregnada en plata iónica, poliexanida 0,1% y apósito de espuma cubierto de silicona. Se programan curas cada 48 horas en función del exudado.

Tras 3 semanas, se espacian las curas a 72 horas, sustituyendo hidrofibra con plata por fibra de hidrocoloide, manteniendo el resto de la cura sin cambios con cierre definitivo y sin secuelas en 5 meses.

Resultados/Discusión: Tras 1 mes realizando curas en ambiente húmedo, se consiguió reducir el dolor de la paciente asociado a la lesion tisular de 8/10 a 1/10 en la escala EVA, logrando la cicatrización sin complicaciones asociadas en 5 meses.

Conclusión: La cura húmeda en el tratamiento de las quemaduras ofrece una estrategia eficaz para promover una cicatrización más rápida y menos dolorosa, ya que mantiene el entorno adecuado para la regeneración celular y prevenir infecciones. Este método en el manejo de quemaduras es esencial para una recuperación más efectiva y con menores secuelas a largo plazo.

 

 

DISPOSITIVOS E INTERVENCIÓN

EP1209 Utilidad del vendaje compresivo en la resolución de úlceras venosas

Ana Varela Pardo¹, Eva Boix^1
1Consultorio Médico Local de Pals, SSIBE, Palafrugell, Spain

Objetivo: Determinar la efectividad del empleo del vendaje compresivo como método para la resolución de úlceras venosas de miembros inferiores.

Métodos: Se ha realizado una búsqueda bibliográfica, a través del planteamiento de una pregunta PICO para determinar las palabras clave y siguiendo el esquema de la pirámide de Haynes, primero examinando guías y sumarios en bases de datos secundarias (UptoDate, ClinicalKey) y posteriormente artículos en bases de datos primarias (PubMed, TripDataBase, Cochrane y LILACS).

Resultados: En un primer rastreo se han obtenido 535 artículos, de los cuales tras implementar los criterios de búsqueda y primeras lecturas resultaron 8 documentos a destacar, entre los que se encuentran revisiones sistemáticas, meta-análisis, guías de práctica clínica, estudios observacionales y estudios comparativos.

Conclusiones: Actualmente, no existe un consenso firme acerca del método de compresión más óptimo a implementar, pero si se corrobora la necesidad de individualizar la elección del mismo mediante una valoración integral y multidisciplinar de los pacientes (presentación de la herida, circulación venosa y micro circulación, autonomía y autocuidado, pruebas complementarias, etc). Convirtiéndose esta técnica en una medida altamente beneficiosa que muestra mejores resultados de cicatrización (menor tiempo de curación), un aumento de la calidad de vida de los pacientes y un ahorro asistencial económico. No obstante, también se pone en evidencia la necesidad de realizar nuevos estudios para consolidar y profundizar en el análisis coste-efectividad de esta terapia.

 

EP1108 Realidad virtual para el manejo del dolor en el cuidado de heridas complejas: un ensayo clínico

José Luis Rodríguez García¹, José Ferrer Costa¹, Mireia Fernandez López^1
1Badalona Serveis Assistencials, Badalona, Spain

Objetivo: Este estudio tiene como objetivo evaluar el impacto de la Realidad Virtual (RV) en la percepción del dolor, la ansiedad y la satisfacción de los pacientes durante el cuidado de heridas complejas. Además, se analiza la usabilidad de la tecnología de RV en un entorno clínico, tanto para los pacientes como para los profesionales de la salud.
Métodos: Se realizó un ensayo clínico no aleatorizado, de medidas repetidas, en la Unidad de Úlceras Complejas del CSSC. Los participantes recibieron sesiones alternas de cuidado de heridas con y sin RV. Se evaluaron el dolor (EVA), la ansiedad (STAI-6), la percepción del tiempo (SPST) y la satisfacción (SUS) antes y después de cada sesión.

Resultados: Los resultados preliminares sugieren una reducción significativa en la percepción del dolor y la ansiedad durante las sesiones asistidas por RV en comparación con los cuidados estándar. Los pacientes mostraron mayor satisfacción con las sesiones de RV, y los profesionales de la salud informaron una integración sencilla de la tecnología en el flujo de trabajo clínico. Las evaluaciones de usabilidad fueron positivas en ambos grupos.

Conclusiones: La integración de la RV en el cuidado de heridas complejas muestra potencial para mejorar la experiencia del paciente al reducir el dolor y la ansiedad, aumentando además la satisfacción. Se necesita más investigación para explorar su aplicación más amplia en entornos clínicos.

 

EP1210 Avances en la cicatrización de heridas vasculares mediante el uso de la neuroestimulación en extremidades inferiores: revisión sistemática

Joan Blanco-Blanco¹, Jordi Ballesté-Torralba², Josep Maria Martínez-Barriuso³, Benjamí Monsonís-Filella^3
1Universitat de Lleida, Lleida, Spain, ²Hospital Nadal Meroles, Lleida, Spain, ³CAP Rural Nord - GSS, Lleida, Spain

Las heridas vasculares crónicas suponen un desafío significativo en la práctica clínica debido a su manejo complicado y la dificultad en su cicatrización. En los últimos años, la neuroestimulación ha surgido como una técnica prometedora para mejorar la circulación sanguínea y promover la cicatrización de este tipo de heridas, específicamente en las extremidades inferiores.
Objetivos: Evaluar la evidencia existente sobre el uso de la neuroestimulación para mejorar la circulación arterial y venosa y acelerar la cicatrización de heridas vasculares en extremidades inferiores.
Métodos: Se llevó a cabo una revisión sistemática de la literatura utilizando el método de Arksey y O’Malley. Se seleccionaron estudios que evaluaban el uso de la neuroestimulación en la mejora de la cicatrización de heridas vasculares. Se emplearon criterios de inclusión y exclusión para delimitar los estudios pertinentes y se analizó la calidad de los estudios seleccionados.
Resultados: Los estudios revisados concluyen que la neuroestimulación es una técnica efectiva para mejorar la circulación y potenciar una cicatrización de las heridas vasculares en extremidades inferiores. Se observó un aumento significativo del flujo sanguíneo en las extremidades tratadas, lo que debería contribuir a una mejor oxigenación y nutrición de los tejidos, favoreciendo la curación de las heridas.
Conclusiones: Los resultados de esta revisión apoyan el uso de la neuroestimulación como un complemento eficaz a los tratamientos convencionales para heridas vasculares en extremidades inferiores. Esta técnica parece ofrecer una alternativa eficiente y económica para tratar heridas de difícil cicatrización, lo que contribuirá a mejorar la calidad de vida de los pacientes.

 

EP1211 Experiencia en la utilización de la aplicación móvil en el seguimiento de heridas

Andoni Carrion¹, Antonia Salas Durán², Miriam Garcia González^2
1Centro de Salud Levante La Línea, La Línea, Spain, ²Servicio Andaluz de Salud, Centro de Salud Levante La Línea, La Línea, Spain

Objetivo: El objetivo de este estudio fue evaluar la efectividad de una aplicación móvil para el seguimiento de heridas crónicas de evolución tórpida (más de tres meses de duración) en pacientes de un centro de Atención Primaria. Se pretendía medir el impacto de la aplicación en la monitorización de las heridas y en la coordinación de los cuidados administrados por diferentes profesionales.

Métodos: Se llevó a cabo entre agosto de 2023 y agosto de 2024, incluyendo un total de 14 heridas en 12 pacientes. Las heridas monitorizadas incluyeron: 3 úlceras de pie diabético, 1 úlcera oncológica, 1 úlcera por presión, 7 úlceras de miembros inferiores y 2 lesiones relacionadas con la dependencia. La evolución de las heridas fue seguida mediante la aplicación móvil, permitiendo un seguimiento tanto individual como colaborativo entre varias enfermeras, en consulta y a domicilio.

Resultados: De las 14 heridas incluidas, se realizó un seguimiento activo en 13 de ellas, logrando la cicatrización en menos de seis meses. La única herida oncológica no fue tratada a través de la aplicación debido a que se resolvió mediante un abordaje quirúrgico. Seis heridas fueron seguidas de forma colaborativa por dos o más enfermeras, facilitando la coordinación entre los profesionales.

Conclusiones: El uso de la aplicación móvil permitió un seguimiento eficaz de la evolución de las heridas y mejoró la coordinación multidisciplinar de los cuidados. Aunque el tamaño de la muestra fue reducido, los resultados muestran una buena usabilidad y viabilidad de la app en el manejo de heridas crónicas, coincidiendo con estudios previos. Se propone una investigación adicional para obtener conclusiones más robustas sobre la fiabilidad y eficacia de la herramienta.

 

EP1212 Revisión bibliográfica: reconstrucción de heridas con ingeniería regenerativa

Marina Jimenez Liébanas¹, Mireia Solé Baella², Laura Vila Ávila², Paula Borras Lecha², Javier Mateo Colilla², Clara de Cal Revilla^2
1Consorci Sanitari de Terrassa (CAP Sant Llátzer), Terrassa, Spain, ²Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo: Analizar la literatura científica disponible sobre la regeneración de heridas empleando la tecnología tridimensional.
Métodos: Revisión bibliográfica en Pubmed y revistas científicas empleando términos estandarizados. Se han seleccionado 10 artículos publicados en los últimos 5 años.
Resultados: Las heridas son una alteración de la integridad de la piel que atraviesan distintas fases a lo largo de su cicatrización. Para favorecer y facilitar dicho proceso ha surgido el empleo de la ingeniería regenerativa. Los componentes usados en estas reconstrucciones son células cultivadas in vitro y posteriormente incorporadas en un tejido funcional con estructura tridimensional. Las técnicas emergentes de regeneración tisular emplean moléculas bioactivas, células genéticamente modificadas y factores de crecimiento para superar las limitaciones de la curación de heridas. El objetivo es favorecer un ambiente inmunológico óptimo basado en equilibrar los mecanismos proinflamatorios y antiinflamatorios. Estos procedimientos de innovación se han acelerado gracias a la impresión tridimensional. Debido a la capacidad de ajuste estructural y funcional, aumentaría la eficacia de la respuesta inmunológica en la regeneración de los tejidos.
Conclusiones: A pesar de los avances en la terapia de regeneración tisular, uno de los mayores obstáculos era replicar los vasos sanguíneos, folículos pilosos y glándulas sudoríparas. Recientemente, se han descubierto en una investigación de la Universidad Estatal de Pensilvania células correspondientes a la fase inicial de los folículos pilosos. Los resultados de avances en esta línea conllevarán mejoras en la reconstrucción de heridas y la formación de cicatrices, permitiendo así aumentar la calidad de vida de las personas.

 

EP1213 Infiltración microfragmentada de tejido cutaneo la solución para una cicatrización más rápida y segura de las heridas

Jorge Zamora Ortiz¹, Federico Palomar Llatas², Marta Escuder Martinez³, María Isabel Pastor Orduña⁴, Alba Naranjo Cuéllar², David Palomar Albert^2
1Consorcio Hospital General Universitario Valencia, Valencia, Spain, ²Cátedra Integridad y Cuidado de la Piel de la UCV, Valencia, Spain, ³Cátedra Integridad y Cuidado de la Piel UCV, Valencia, Spain, ⁴Escuela Doctorado UCV, Hospital de Sagunto, Valencia, Spain

Objetivo: Una rápida generación de tejido granulado, tiempo de cicatrización más corto, reducción del dolor, aspecto estético y funcional satisfactorio, reducción del edema intersticial.

Métodos: Se presentan 4 casos de lesiones cutáneas de distinta etiología con una evolución tórpida (2 años), donde tras consentimiento informado se les realiza biopsia cutánea profunda (tejido graso) y colocandolas en el HY-TISSUE MICROGRAFT (microfragmentador) junto a 15cc de solución salina, se obtiene una solución con la microfragmentación que se inyecta subcutaneamente en bordes y lecho de la úlceras, aplicando un apósito regenerador con colágeno y ácido hialurónico.

Resultados: El promedio de cicatrización ha sido de 2 meses y medio, disminuyéndoles el dolor y sin ninguna complicación como pudiese ser la colonización o la infección. La mínima casuistica al respecto hace que, tras los resultados obtenidos, su sencillez y eficiencia es aconsejable. La técnica es sencilla, no requiere equipos complejos y los microinjertos prenden fácilmente. Rápida Recuperación: El área donante se recupera rápidamente (7-15 días). Puede realizarse en Atención Primaria sin necesidad de hospitalización. Requisitos: Similar a otros injertos, requiere buen estado de salud del paciente, tejido receptor limpio y sin infección, y el consentimiento del paciente.

Conclusiones: A pesar de su efectividad, la técnica es poco conocida y utilizada, lo que destaca la necesidad de su difusión como una alternativa válida para heridas crónicas y la necesidad de realizar estudios más amplios

 

EP1214 Impacto de la higiene de la herida incorporando un apósito antibiofilm de fibras gelificantes en heridas de difícil cicatrización en una población española

Diego Sevilla Martinez¹, Daniel Metcalf², Rachel Torkington-Stokes^2
1Centro de Salud Just Ramírez, Valencia, Spain, ²Convatec, Deeside, United Kingdom

Objetivo: Evaluar el impacto de la Higiene de Herida (HH), una estrategia de tratamiento de heridas de 4 pasos (limpieza, desbridamiento, acondicionamiento de bordes y aplicación de apósito), en heridas de difícil cicatrización en una población Española.

Métodos: Se realizó un análisis de pacientes con heridas de difícil cicatrización tratadas con HH (incorporando un apósito antibiofilm de fibras gelificantes) durante 4 semanas. El criterio de valoración principal fue el cambio en el tamaño de la herida.

Resultados: Se incluyeron 178 pacientes (duración media del tratamiento 30 días). De 139 pacientes con evaluaciones iniciales y finales, 66 (47%) obtuvieron un cierre completo de la herida. El tamaño de la herida se redujo de media 84% en la evaluación final. Los niveles de exudado cambiaron de altos/moderados (63%) a bajos/ninguno (62%). Los signos de infección clínica estuvieron presentes en el 47 % al inicio del estudio y se redujeron al 1 % en la evaluación final. La sospecha de biofilm fue del 75% al inicio y del 15% en la evaluación final. En la evaluación final, el 30% de las heridas habían cicatrizado y el 66% habían mejorado.

Conclusiones: En España, el manejo con HH resultó en curación o mejoría en casi todas las heridas de difícil cicatrización (96%), y una disminución notable en el tamaño de la herida, nivel de exudado, sospecha de biofilm e infección local. Nuestros hallazgos sugieren que la HH que incorpora un apósito antibiofilm es una estrategia de tratamiento eficaz para heridas de difícil cicatrización.

 

EP1215 Importancia del conocimiento y la prevención de las lesiones MARSI

Júlia Casanova De Casacuberta¹, Adela Goñi Irigoyen², Miriam López De Los Dolores³, Andrea Carbonell Olivera⁴, Nelson Colque Siacara^4
1Fundación Asistencial Mútua Terrassa, CAP Sant Cugat del Vallès, Sant Cugat del Vallès, Spain, ²Fundación Asistencial Mútua Terrassa, CAP Valldoreix, Sant Cugat del Vallès, Spain, ³Fundación Asistencial Mútua Terrassa, CAP Can Trias, Viladecavalls, Spain, ⁴Fundación Asistencial Mútua Terrassa, CAP Rubí, Rubí, Spain

Objetivo: Búsqueda bibliográfica con el objetivo de describir las lesiones MARSI (“Medical adhesive-related skin injury”), exponer la prevalencia según estudios recientes y cómo podemos evitar su aparición.

Métodos: Se realizó una búsqueda en bases de datos PubMed, Scielo y Elsevier, así como la lectura de Guías de Práctica Clínica en el cuidado de heridas. Las palabras clave utilizadas fueron: medical adhesive related skin injury, prevalence, lesiones MARSI, prevalencia. Se limitó la búsqueda de artículos publicados en los últimos 4 años, redactados en español o inglés y de lectura completa. Se seleccionaron un total de 12 artículos.

Resultados: En los artículos analizados, coincide la definición de las lesiones MARSI, sus desencadenantes (mecánicas, dermatitis y otras) así como los factores de riesgo de la piel. En cuanto a la prevalencia reciente, se documentaron 4 estudios en los cuales la media de prevalencia era del 14,5% (independientemente del territorio). Para prevenir la aparición de dichas lesiones es importante conocer los factores de riesgo y la aplicación correcta de los apósitos, así como de los productos para su retirada. Por ello, los estudios destacan la importancia de revertir el desconocimiento de esta problemática por parte del personal sanitario.

Conclusiones: La revisión concluye que se trata de una problemática subregistrada. La integridad de la piel es un indicador de la calidad asistencial que recibe un paciente y por ese motivo, el profesional sanitario debe tener un buen conocimiento del correcto uso de los adhesivos tisulares que se usan más frecuentemente y los problemas asociados.

 

EP1216 Tratamiento de úlceras de pie diabético con plasma rico en plaquetas, ¿futuro o descarte?

Carlos Sanz Ortega¹, Jorge Calatayud Ros¹, Sara Navas Gorgojo², Mariana Vicente Merchán³, Alba Mira Molto, Alba Martín Mediero⁴, Teresa Vidal Vilaplana^5
1Ics, L´Hospitalet De Llobregat, Spain, ²Ics, Sant Boi De Llobregat, Spain, ³Ics, Martorell, Spain, ⁴Ics, El Prat De Llobregat, Spain, ⁵Ics, Cornella De Llobregat, Spain

Objetivo: Conocer las propiedades que aporta el PRP, sus múltiples formas de terapia, así como su proceso de preparación (centrifugación).

Métodos: Revisión bibliográfica. Palabras clave: Plasma Rico en Plaquetas, pie diabético, cicatrización, injertos autólogos. Se ha realizado la búsqueda de datos en PubMed y WOS. Se han encontrado 18 artículos, de los cuales se ha incluido la lectura de 8 artículos.

Resultados: El Plasma Rico en Plaquetas (PRP) es un producto sanguíneo autólogo rico en factores de crecimiento y citoquinas, involucradas en respuesta inflamatoria y reparación. Tiene propiedades como la angiogénesis, proliferación de fibroblastos o desarrollo de matriz extracelular, que permiten una mejor regeneración. Hay tantas formas de administrar el PRP como estudios se realizan. No se consigue una estandarización. Las diferencias en su eficacia se deben a disparidades en la preparación del PRP. Asimismo, es necesario determinar la mayor efectividad; si su aplicación en el lecho de la herida en formato hidrogel (a través de alginato) o, bien, su inyección en zona perilesional. Se ha evidenciado una mejoría significativamente estadística en cicatrización de úlceras de pie diabético en comparación con tratamiento estándar.

Conclusiones: De esta forma, se podrá establecer los parámetros necesarios para la realización de un protocolo que nos permita obtener un PRP más efectivo en la cicatrización de úlceras de pie diabético, entre ellos, una centrifugación de 480microgr. durante 10 minutos, previa activación con cloruro de Calcio para conseguir propiedades como capacidad bacteriostática, ya que impide crecimiento de S.Aureus y S.Epidermidis, siendo letal contra E.Oralis.

 

EP1217 Radiofrecuencia y regeneración tisular

Elena del Río Ibáñez¹, Ylenia De La Torre Bravo¹, María Bascón Arroyo¹, María de los Ángeles Linares Gallego^1
1Hospital Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain

Objetivo: El objetivo de esta revisión es conocer la utilidad del uso de la radiofrecuencia en tejidos lesionados, la cual promueve la proliferación de células madre al lecho, así como la migración de queratinocitos y fibroblastos, favoreciendo la cicatrización y evitando la cronificación de la herida.

Métodos: Se realizó una revisión bibliográfica en bases de datos y revistas científicas, tanto en inglés como en español, empleando como palabras clave “radiofrecuencia”, “tejido” y “célula madre”, extrayéndose un total de 4 artículos recogidos en los últimos diez años.

Resultados: La terapia con radiofrecuencia estimula la proliferación de células madre humanas implicadas en la regeneración de tejidos lesionados, las cuales participan en las tres fases de regeneración de heridas: inflamatoria, proliferativa y de remodelación. También, favorece la proliferación y migración de queratinocitos y fibroblastos, que permiten la fibroplasia y la síntesis de la matriz extracelular o tejido de granulación. Por tanto, favorece a la correcta cicatrización de las heridas al promover el cierre de capas externas del tejido epidérmico tras la formación del tejido de granulación dérmico, evitándose así la cronificación de la herida.

Conclusiones: Las heridas crónicas son un problema de salud importante, requieren tratamiento prolongado, incrementan los costes sanitarios, así como reducen la calidad de vida de los pacientes. El empleo de radiofrecuencia, técnica no invasiva e indolora, promueve la cicatrización temprana de estas heridas, mejorando la calidad de vida de los pacientes y reduciendo costes y recidivas.

 

EP1218 Beneficios de la lámpara de wood en la unidad de hospitalización a domicilio. Caso clínico

Elena Ubeda De Dios¹, Irene Escribano Santana^2
1SERMAS, Torrejon de Ardoz, Spain, ²SERMAS, Madrid, Spain

Objetivo: Demostrar los beneficios del uso de la lámpara de Wood (LW) aplicado a una unidad de hospitalización a domicilio (UHD).

Métodos: Paciente de 71 años con dependencia leve para actividades básicas de la vida diaria Barthel 90, Bradem 21, Escala FRAIL pre-frágil, EVA 8 en curas controlado con fentanilo intranasal y Resvech 2.0 de 20 puntos en lesión inguinal cara interna en tercio proximal del muslo derecho secundaria a fascitis necrotizante con fistulización a vejiga (Figura 1).

Resultados: Se observa estancamiento en evolución de la herida acompañado de aumento de dolor y exudado, se realiza cultivo, y en cura posterior, se evidencia exudado verdoso (Figura 2). Al utilizar la LW se confirma fluorescencia amarillo-verdosa compatible con Pseudomona aeruginosa (Figura 3a herida-3b gasas). Se realiza curetaje guiado con LW (Figura 4) en zonas donde se aprecia mayor fluorescencia y en el lecho para eliminar biofilm. Se realiza cura con antimicrobiano en solución y apósito de hidrofibra de hidrocoloide plata apreciándose disminución del exudado. A los 15 días mejoría con Resvech 2.0 de 13 puntos (Figura 5).

Conclusiones: La evaluación bacteriológica en heridas de difícil cicatrización mediante el uso de la LW permite identificar la localización de bacterias y microorganismos que emitan fluorescencia. Por otro lado, permite identificar la zona para la toma de muestras, tratar infecciones y preparación del lecho mediante curetaje.

La LW es una prueba segura para el paciente, indolora, rápida, económica y fiable, y su implementación en heridas nos puede ayudar a mejorar su manejo.

 

EP1219 Intervención en heridas quirúrgicas en pediatría: uso de una matriz polimérica bioabsorbible con plata nanoparticulada. Serie de casos

Laura Juliana Suesca Bustacara¹, Liliana Plazas Salamanca^1
1Innovacure S.A, Bogotá, Colombia

Autores: Departamento médico - Innovacure S.A.

Coautores: ¹Plazas-Salamanca, L, – ²Suesca-Bustacara, LJ.

¹Instrumentadora quirúrgica, Miembro del equipo en Campo de Innovacure- ² Enfermera especialista en cuidado a las personas con heridas y ostomías- profesional de enlace científico de Innovacure.

Categoría: Dispositivos e intervención.

Modalidad de participación: Oral o poster.

Descriptores: Neonatos, niños, apósitos de plata, cicatrización de heridas, informe de casos.

Objetivo: Describir los resultados clínicos de la aplicación de una matriz polimérica bioabsorbible con plata nanoparticulada como tratamiento en complicaciones de heridas quirúrgicas en pacientes neonatales y pediátricos.

Métodos: Se trata de serie de casos, según guía de reporte CARE, en el cual se describen criterios de inclusión y exclusión para la aplicación de la matriz polimérica Bioreabsorbible con plata nano particulada en pacientes neonatos pretérmino y pediátricos, basados en la edad, etiología de la herida, las dimensiones de las lesiones, y tejidos en el lecho de la herida. Posterior a la firma del consentimiento informado, se aplicó la Matriz de Superficie de Polielectrolitos 1,33%, Plata iónica y Metálica 0,67%, 2 veces a la semana, y siguiendo el protocolo de cuidado estándar, con los objetivos propuestos como el mantenimiento del lecho de la herida limpio y desbridamiento del tejido necrótico.

Resultados: Se aplicó la matriz polimérica Bioreabsorbible con plata nano particulada a 2 neonatos prematuros (36 semanas) y 2 pacientes pediátricos, con edades comprendidas entre los 25 días y los 9 años. Las causas de las heridas corresponden a dehiscencia en pared abdominal (n=2), dehiscencia corrección de extrofia vesical (n=1) y dehiscencia mucocutánea en colostomía (n=1). El (100%) de los pacientes tuvieron 100% de cicatrización. El tiempo promedio de cicatrización fue de 22 días. Ninguno de los pacientes presento efectos adversos secundarios.

Conclusión: En los pacientes de esta serie de casos, la epitelización completa con la matriz se obtuvo en promedio de 3 semanas. En las recomendaciones internacionales se describe que el tiempo promedio para el uso de dispositivos médicos con plata en pacientes neonatales y pediátricos con el fin de evitar acumulación sistémica es de dos 2 semanas, sin embargo, esto también depende de la concentración de plata en el dispositivo y la superficie de la herida. La matriz aplicada contiene solo 0,16 mg/in2 de plata total, que es de 50 a 100 veces menos que lo contenido en los apósitos de plata tradicionales, y podría considerarse como una opción de tratamiento para las heridas quirúrgicas en este grupo etario. Para futuras investigaciones se recomienda realizar estudios que incluyan heridas de diferente etiología, una muestra etaria más amplia y evaluar la concentración de plata en sangre, durante y posterior al tratamiento.

Conflicto de interés: La instrumentadora quirúrgica Liliana Plazas Salamanca y la enfermera Laura Juliana Suesca Bustacara, laboran en Innovacure S.A.

Rerencias Bibliográficas:

1. O’Donohoe PK, Leon R, Orr DJA, de Blacam C. Safety of silver dressings in infants; a systematic scoping review. J Burn Care Res. 2024 Aug 21: irae159. doi: 10.1093/jbcr/irae159. Epub ahead of print. PMID: 39165069.
2. Amer Y, Bridges C, Marathe K. Epidemiology, Pathophysiology, and Management Strategies of Neonatal Wound Care. Neoreviews. 2021 Jul;22(7):e452-e460. doi: 10.1542/neo.22-7-e452. Epub 2021 Jul 1. PMID: 34210809.
3. Steen EH, Wang X, Boochoon KS, Ewing DC, Strang HE, Kaul A, Masri L, Balaji S, Hollier LH Jr, Keswani S. Wound Healing and Wound Care in Neonates: Current Therapies and Novel Options. Adv Skin Wound Care. 2020 jun;33(6):294-300. doi: 10.1097/01.ASW.0000661804.09496.8c. PMID: 32427785
4. Garcia Molina, P; Bargos Munárriz, M; Ferrera Fernández, MA; Balaguer López, E; Mora Morillo, IM;Áviles Áviles JM; et al. Qué no hacer en lesiones por presión en pediatría / neonatología: Recomendaciones basadas en la evidencia” noviembre de 2021 [Internet]. GNEAUPP. 2021 [citado el 3 de octubre de 2024]. Disponible en: https://gneaupp.info/documento-tecnico-gneaupp-no-xv-que-no-hacer-en-lesiones-por-presion-en-pediatria-neonatologia-recomendaciones-basadas-en-la-evidencia -noviembre-de-2021/

 

EP1220 Uso de la ecografía para la evaluación de la neovascularización en el prendimiento de los injertos en sello

Alvaro Vilela Pajaro¹, Sandra Alexandre Lozano¹, Cristina Lopez Alayeto¹, Maria Carmen Marquilles Bonet¹, Iraida Gimeno Pi¹, Blanca Manuel Marti¹, Laura Martinez Rodriguez^2
1Institut Català de la Salut, Lleida, Spain, ²Universitat de Barcelona, Lleida, Spain

Objetivo: Evaluar la utilidad de la ecografía en el seguimiento de la neovascularización en injertos en sello, para optimizar el monitoreo de su prendimiento y evolución.

Métodos: Se incluyó a 6 pacientes con injertos en sello, realizados mediante previa extracción de dermo-epidermis y colocación posterior en la lesión combinado con un apósito de Ag (plata metálica pura (99.9%). Se realizaron evaluaciones ecográficas seriadas a los 10 días del injerto y, en caso de evolución favorable, se repitió el control a los 20 días. Para ellos se utilizó una almohadilla de gel para evitar dañar la lesión con el gel conductor. La ecografía permitió observar el flujo sanguíneo en las zonas de injerto, o la aparición de signos de degradación del tejido, como irregularidades en la estructura del injerto.

Resultados: De las 6 heridas, 5 fueron úlceras de origen venoso y 1 lesión traumática. De estos, dos necesitaron un nuevo injerto tras la evaluación a los 10 días y un paciente después de la segunda visita a los 20 días. Solo dos pacientes no necesitaron reposición. Se observaron cambios característicos como hiperecogenicidad i degradación, así como la no detección de vascularización en las heridas que posteriormente precisaron reinjerto.

Conclusiones: La ecografía se presenta como una herramienta no invasiva y eficaz para el seguimiento del prendimiento de injertos en sello, permitiendo la detección temprana de neovascularización y posibles signos de fallo en el injerto. Esto redujo significativamente el tiempo de intervención, al no necesitar esperar a la necrosis de alguno de los injertos o la desvitalización visual para detectar su mal pronóstico. Estudios adicionales podrían beneficiarse de un mayor número de pacientes plazo para consolidar los hallazgos.

 

EP1115 Tiempo de aceleración pedal: un método innovador para el análisis de la perfusión periférica

Iria Calvo Ferreiro ¹, Clara Rodríguez Hernández^2
1Institut Català de Salut, Gerona, Spain, ²SSIBE, Palamós, Spain

Objetivo: Sintetizar la evidencia actual sobre el Tiempo de Aceleración Pedal (TAP) como método no invasivo para analizar la perfusión periférica y evaluar su eficacia en la detección de la enfermedad arterial periférica (EAP).

Métodos: Se realizó una revisión de la literatura entre septiembre y octubre de 20i24, utilizando los descriptores “Peripheral Arterial Disease” AND “Acceleration Time” AND (Pedal OR Plantar) en las siguientes bases de datos: PubMed, ClinicalKey, UpToDate, SciELO y Cochrane. La búsqueda se limitó a artículos publicados en los últimos cinco años. La selección de artículos se basó en títulos y resúmenes relevantes, excluyendo aquellos sin acceso al texto completo.

Resultados: La revisión resultó en 13 artículos seleccionados para análisis. Los hallazgos indican que el TAP es una alternativa viable al ITB para evaluar la perfusión en pacientes con vasos incompresibles, aunque se requiere validación prospectiva. El tiempo de aceleración pedal se identifica como una medición clave en la evaluación de la isquemia crónica. Un TAP inferior a 180 ms se asocia a mejores resultados de cicatrización, así como un predictor de salvación de miembro. Existe una correlación inversa significativa entre el TAP y el ITB, sugiriendo que el TAP es una herramienta diagnóstica válida, especialmente en poblaciones con vasos no compresibles.

Conclusiones: Es necesario desarrollar nuevas técnicas para la evaluación de la perfusión periférica en población con vasos no compresibles. El TAP se alza como una herramienta eficaz en estos casos, pero se requieren estudios adicionales para consolidar su uso clínico.

 

EP1221 Vendajes en casa

Monia Della Valle¹, Raffaella Cordelli², Laura Viviani³, Roberto Brambilla⁴, Luca De Gian Battista^1
1Cooperativa Forme, Sondrio, Italy, ²Rete Di Cura Domiciliare Fondazione Villa Del Sorriso, Bormio, Italy, ³Asst Valtellina E Alto Lario, Sondalo, Italy, ⁴Freelancer, Besana Brianza, Italy

El vendaje es una herramienta terapéutica conocida desde los tiempos de Hipócrates. A lo largo de los siglos, la Medicina evolucionó y se enriqueció. La terapia de compresión es un enfoque fundamental en el tratamiento de la insuficiencia venosa y veno-linfática, reduciendo el edema.El conocimiento de las técnicas de compresión, de los materiales y de los dispositivos disponibles nos permite un mejor manejo de los pacientes.

Objetivo: El vendaje es uno de los pilares de la terapia compresiva y es adecuado para su uso en la asistencia domiciliaria. Dado que una aplicación incorrecta puede acarrear graves consecuencias, es esencial que los profesionales estén familiarizados con la teoría y la técnica.

Métodos: Recientes consensos han recomendado dejar de utilizar el término elastocompresión, sustituyéndolo por el de compresión y contención. E introduciendo el nuevo concepto de STIFFNESS. La rigidez es la diferencia entre la presión de reposo y la de trabajo.

Resultados: El vendaje rígido, no compresivo, inelástico, multicapa, multicomponente, en forma de ocho y de alta rigidez es el que más se aproxima al “sistema de compresión inteligente”.Esto supone una mayor comodidad para el paciente. Esta característica también hace que su uso sea seguro en el paciente.

Conclusiones: El vendaje tiene una importancia fundamental en el tratamiento de las lesiones de los miembros inferiores, reduciendo el edema y favoreciendo por tanto la cicatrización de la úlcera.Por tanto, un vendaje correcto puede favorecer un mejor cuidado del paciente ulcerado, favoreciendo la cicatrización y mejorando el cumplimiento. Por lo tanto, es indispensable en el tratamiento domiciliario de los pacientes con úlceras de las extremidades inferiores.

 

EP1222 Eficacia del sistema portátil de irrigación pulsatil en el desbridamiento mecánico y manejo de la biopelícula en heridas crónicas

Ana Paula dos Santos Albuquerque^{1 2 3}, Jeane Carla Fonseca de Jesus⁴, Tatiane Ferreira⁵, Juliana Azevedo Soares⁶, Maria Tereza Silva⁷, Martina de Vasconcelos Oliveira Lemos^8
1Hospital Regional do Agreste, Departamento de Salud del Estado de Pernambuco, Universidad de Pernambuco, Caruaru, Brazil, ²Departamento de Salud del Estado de Pernambuco, Caruaru, Brazil, ³Oficina de Enfermería Dr. Ana Paula Albuquerque, Caruaru, Brazil, ⁴Clipodis, Vitória, Brazil, ⁵Instituto Israelita de Ensino e Pesquisa Albert Einsten, São Paulo, Brazil, ⁶Comitê Paralímpico Brasileiro, São Paulo, Brazil, ⁷Hospital Universitário Antonio Pedro, Rio de Janeiro, Brazil, ⁸CENTRAFE - Consultório de Enfermagem Especializado no Tratamento de Feridas, Maceió - AL, Brazil

Objetivo: Evaluar la eficacia de un sistema portátil de irrigación pulsátil para desbridamiento mecánico y eliminación de biopelícula en heridas crónicas, promoviendo un ambiente favorable para la cicatrización, en conformidad con recomendaciones internacionales sobre la importancia de la irrigación en el tratamiento de heridas.

Métodos: Se realizó un estudio de caso con una paciente de 59 años, con diabetes mellitus e hipertensión, diagnosticada con linfangitis necrotizante. La lesión, en la pierna derecha, presentaba esfacelo, áreas de necrosis y exudado seroso moderado, con un área de 81 cm². Durante una semana, se aplicó el sistema de irrigación pulsátil diariamente, enfocado en eliminar biopelícula y tejido necrótico, preservando el tejido sano. Cada sesión consistió en 3.000 ml de agua destilada a 15 psi por 3 minutos, seguida de secado y cobertura con gasa impregnada con PHMB, siguiendo prácticas recomendadas para control de infecciones y manejo de heridas crónicas.
Resultados: La paciente mostró alta tolerancia al procedimiento, sin dolor y con mejora en la apariencia de la herida, incluyendo reducción del esfacelo, control del exudado y presencia de tejido de granulación y epitelización. El sistema cerrado de irrigación proporcionó contención eficaz de fluidos contaminados, reduciendo el riesgo de contaminación cruzada.

Conclusiones: En alineación con recomendaciones recientes, el sistema de irrigación pulsátil demostró ser seguro y eficaz en la preparación del lecho de heridas crónicas, facilitando el manejo de biopelículas y favoreciendo un ambiente de cicatrización. Se recomiendan estudios adicionales para evaluar su impacto en la tasa de cicatrización.

Imagénes:

 

EP1223 Cuidados postoperatorios tras el alta hospitalaria para pacientes con lesiones en los pies derivadas de la diabetes: una revisión integrativa

Ana Paula dos Santos Albuquerque^{1 2 3}, Alexiane Mendonça da Silva³, Nadjane Santos de Paula Patriota¹, Layane de Lima Góis^{3 3
1}Hospital Regional do Agreste, Caruaru, Brazil, ²Secretaria Estadual de Saúde de Pernambuco, Caruaru, Brazil, ³Comissão de Residência Multiprofissional em Saúde (COREMU), Caruaru, Brazil

Objetivo: Identificar en la literatura los cuidados postoperatorios necesarios para personas con lesiones en los pies derivadas de la diabetes tras el alta hospitalaria.

Métodos: Revisión integrativa desarrollada en seis etapas: (1) formulación de la pregunta de revisión: ¿Cuáles son los cuidados postoperatorios necesarios para personas con lesiones en los pies derivadas de la diabetes tras el alta hospitalaria?; (2) búsqueda y selección de estudios primarios publicados entre 2013 y 2023, en inglés, portugués y español, en las bases de datos BVS, Web of Science, PubMed y Cochrane Library, utilizando los descriptores: Diabetic Foot, Postoperative Care, Self Care, Patient Discharge, Amputation, Surgical y Debridement; (3) extracción de datos; (4) evaluación crítica de los estudios; (5) síntesis de los resultados; y (6) presentación de la revisión.

Resultados: La búsqueda inicial identificó 1.414 artículos. Tras la exclusión de duplicados y de aquellos que no cumplían con los criterios de inclusión y exclusión, quedaron 588 estudios para la selección de títulos y resúmenes, de los cuales 8 fueron seleccionados para lectura completa, resultando en la inclusión de 3 estudios que destacan la importancia de la planificación del alta y de la continuidad del cuidado. Las estrategias de cuidado incluyen prevención de sobrecarga, cuidados de la herida, uso correcto de medicamentos, dieta adecuada, educación en salud y seguimiento multidisciplinario.

Conclusiones: Las estrategias basadas en evidencia son esenciales para minimizar complicaciones y promover la recuperación efectiva de pacientes con lesiones en los pies derivadas de la diabetes en el período postoperatorio.

 

EP1224 Comparación de dos dispositivos de terapia de presion negativa de un solo uso en mastectomia con reconstrucción inmediata con patrón de reducción de weis

Mònica Trillo Garcia¹, Pilar Carrasco Rupérez¹, Ester Morera Morillo¹, Cecilia Valles Quintilla¹, Pilar Biela Ferreiro¹, Carmen Polina Nicolás¹, Carmen María Carmona^1
1Hospital Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Comparar dos dispositivos de Terapia de Presión Negativa (TPN) en mastectomía con reconstrucción inmediata con patrón de reducción.

Métodos: El protocolo utilizado en la Unidad de Mama de nuestro hospital, es instaurar TPN de un solo uso en pacientes que se les realiza mastectomía con cirugía reconstructiva en el mismo acto quirúrgico, para prevenir complicaciones. El dispositivo utilizado actualmente, ejerce una presión negativa de -80mmHg. Cuando se realiza el patrón de reducción de Weiss, da muchos problemas de sellado y mantenimiento de la terapia. Todo esto, hace que el objetivo principal de poner este tipo de terapia, sea infructuoso. Es por ello que hemos decidido probar otro sistema, que nos ofrece, por una parte, el aumento de la presión negativa ejercida (-125mmHg), una forma triangular de los apósitos y la disposición de un depósito para la recogida de exudado. Tres propiedades que no nos da el actual dispositivo.

Seguimiento de casos mediante historia clínica y fotografías.

Resultados: Utilizando el dispositivo actual, se ha obtenido un 75% de fracasos, y en los casos en los que se ha utilizado el nuevo, se ha obtenido un 100% de éxito.

Conclusiones: El volumen mamario, hace que sea una zona de difícil manejo para el sellado y el mantenimiento de la terapia. Los apósitos ergonómicos pensados para esta zona en concreto, nos facilita la colocación y el mantenimiento del dispositivo, así como la mejora del confort de la paciente. Por ello concluimos, que el nuevo dispositivo nos ofrece más garantía de éxito.

 

EP1117 Ampliacion de funcionalidad de la plataforma tecnologica para el diseño de descargas temporales de pacientes con pie diabetico en atencion primaria

Raquel Sarabia Lavin¹, Aroa Delgado Uria², Jesus Javier Lopez Hernandez³, Monica Cueli Arce^4
1Universidad de Cantabria, Facultad de enfermería, Santander, Spain, ²Servicio Cántabro de Salud, Consultorio Santillana del Mar, Santillana del Mar, Spain, ³Servicio Cántabro de Salud, Centro de Salud Pisueña Cayon B/ el ferial s.n, Sarón, Spain, ⁴Servicio Cántabro de Salud, C.S Tanos, Torrelavega, Spain

Objetivo: Creación de un programa informático para el diseño de descargas temporales de pacientes con pie diabético en Atención Primaria (AP).

Métodos: Mapa del pie por fotografía, Escalado horizontal y automático de la aplicación: El enfermero/a realizó fotografías del pie mediante un smartphone, introduciendo las imagenes digitilizadas en el software. Mediante el software y algoritmos de visión artificial se obtuvo el contorno del pie y de las lesiones. Mediante vía bluetooth se enviaron las imagenes digitalizadas al programa software que fueron interpretadas y preprocesadas para mejorar su calidad. Se utlizo las técnicas de segmentación, reconocimiento e interpretación de las imagenes. Tres enfermeros participantes en el estudio pilotaron la aplicación, en pacientes con pie diabetico. Se configuró una base de datos común y sin limite para todos los enfermeros/as que la fueran utilizar. Tras el pilotaje se realizaron las modificaciones necesarias para su posterior implantación

Resultados: La Capa de servidor se dedicó a la administración de la aplicación, usuarios, autenticación, e información de los pacientes. La Capa de cliente se configuró con:

- Pantalla de login con usuario y contraseña.

- Listado de pacientes gestionados por la aplicación.

- Área de edición del paciente con información relativa a un paciente, (básica y generación de la plantilla), galería de imágenes (histórico gráfico del paciente) y lienzo para el diseño de la plantilla sobre la imagen de la planta del pie.

Conclusiones: El programa informatico permite realizar moldes personalizados de descargas temporales para los pacientes con pie diabetico atendidos en AP.

 

EP1226 Terapias de oxígeno en el tratamiento de heridas crónicas: avances y perspectivas

Noelia Rodas Martínez¹, José María Sánchez Abril¹, Maria Eugenia Carrillo Molina², Nieves Garre Baños³, Clara Rodríguez De Gea⁴, Ana Belén Milán Casero^5
1Centro de Salud de Calasparra, Calasparra (Región de Murcia), Spain, ²Hospital Comarcal del Noroeste, Caravaca de la Cruz (Región de Murcia), Spain, ³Centro de Salud de Caravaca de la Cruz, Caravaca de la Cruz (Región de Murcia), Spain, ⁴Centro de Salud de Cehegín, Cehegín (Región de Murcia), Spain, ⁵Centro de Salud de Cehegin, Cehegin (Región de Murcia), Spain

Objetivo: Conocer las diferentes opciones de oxigenoterapia y su eficacia en el tratamiento de heridas crónicas.

Métodos: Se realiza una búsqueda bibliográfica en las bases de datos PubMed, Scielo y Cochrane Library utilizando las palabras clave: “Chronic wound”, “Hyperbaric oxygen therapy”, “Topical oxygen therapy” y “Continuos difusion of oxygen therapy”. Se acota la búsqueda en los últimos 10 años y se encuentran 600 artículos, se eliminan duplicados, revisan títulos y resúmenes y se incluyen en este estudio 16 artículos.

Resultados: Se revisan 4 metaanálisis, 7 revisiones sistemáticas, 3 ECA y 2 estudios observacionales y se concluye que, la cicatrización de las heridas es un proceso complejo que puede verse alterado y provocar que cronifique. Una de las razones para ello es la hipoxia tisular, razón por la que se impulsó la oxigenoterapia en heridas.

Cada vez hay más innovación, evolucionando desde terapias sistémicas como la cámara hiperbárica a terapias de uso local con oxígeno tópico u oxigenoterapia de difusión continua. Actualmente, el uso de estas terapias mejora la angiogénesis, la proliferación celular, la producción de colágeno y reduce el riesgo de infección.

La mayoría de los estudios coinciden que las heridas que se podrían beneficiar de estas terapias son: úlceras de pie diabético, úlceras venosas y lesiones por presión.

Conclusiones: No existe evidencia suficiente para recomendar la oxigenoterapia como tratamiento único, pero si para avalar su uso como una terapia eficaz y de bajo coste con resultados positivos como coadyuvante en terapias de presión negativa y en tratamientos locales convencionales.

 

EP1227 Beneficios de la integración de imágenes en la historia clínica para el seguimiento multidisciplinar de las heridas

Arantza Landa Azaceta¹, Ruth Martinez Valle¹, Maria Arias Rueda¹, Teresa Muga Campo¹, Beatriz Ofelia Diaz Saiz¹, Maider Rojo Alonso¹, Maria Jose Trujillo Hoyo^1
1Osakidetza, Vitoria, Spain

Objetivo: Mostrar la efectividad del uso de imágenes fotográficas para la evaluación el seguimiento y tratamiento de heridas.

Métodos: Se implementó el uso de aplicaciones y dispositivos electrónicos portátiles (tablets) corporativos para realizar un registro regular de la evolución de las heridas. Las fotografías fueron tomadas mediante identificación inequívoca y previo consentimiento verbal del paciente, y almacenadas en su historia clínica sin dejar rastro en el dispositivo para cumplir con la normativa de protección de datos. Las imágenes permitieron analizar cambios en la morfología, tamaño y otras características relevantes de las heridas, permitiendo a los profesionales tomar decisiones en el manejo y tratamiento de cada caso.

Resultados: El uso de las imágenes permite identificar el progreso y detectar complicaciones. Facilita la comunicación entre los miembros del equipo y los distintos niveles asistenciales (atención primaria, atención hospitalaria, consultas externas, hospitalización a domicilio, centros socio-sanitarios…) quienes pueden observar las mismas imágenes y descripción de la cura realizada sin necesidad de interpretaciones subjetivas ni perdidas de información.

Conclusiones: La integración de aplicaciones corporativas para el seguimiento de heridas resulta ser una herramienta eficaz para mejorar el tratamiento y la cicatrización de estas lesiones. Ayudan a los profesionales a obtener datos objetivos siendo vehículo de información entre distintos niveles asistenciales.

La continuidad en los cuidados mejora la toma de decisiones en la cicatrización y permite una intervención oportuna en caso de complicaciones, además de facilitar la comunicación entre los distintos niveles asistenciales respetando la ley de protección de datos.

 

EP1228 Probióticos como coadyuvantes en la cicatrización de las heridas crónicas, una revisión narrativa

Arturo Miravet Gómez¹, Raúl Orozco Irles², Maria Jose Gil Mosteo^3
1Mutua Terrassa, Terrassa, Spain, ²Sangva, Alicante, Spain, ³Servicio Aragonés de Salud, Zaragoza, Spain

Objetivo: El objetivo principal de este trabajo es determinar el papel de los probióticos en la

cicatrización de las heridas y sus mecanismos de acción.

La compresión del microbioma en la cicatrización de heridas abre nuevas posibilidades para estrategias de cuidado de heridas e intervenciones terapéuticas.

Métodos: Se realizó una revisión bibliográfica descriptiva en la base de datos Pubmed usando la ecuación de búsqueda: “probiotics” AND “wound healing”. Los criterios de inclusión fueron artículos que presentasen relevancia sobre el tema de estudio, probióticos y cicatrización de herida; y los filtros fueron “últimos 10 años” y “Full text”. Se seleccionaron estudios tanto in vitro, como en animales y humanos.

Resultados: Se obtuvieron 260 artículos, solo 13 fueron elegibles. En humanos encontramos un estudio aleatorizado a doble ciego, sobre úlceras de pie diabético. Encontrando significancia estadística en las tasas de cicatrización para el grupo con suplementación de probióticos. En otro estudio in vitro sobre quemaduras en modelos de ratón, demostraron la inhibición de la actividad patógena y mayor actividad fagocítica contra P. aureuginosa.

Conclusiones: Estudios recientes han encontrado que ciertas cepas de probióticos pueden ayudar a reducir la inflamación, promover la regeneración de tejidos, mejorar la calidad de la piel, prevenir la infección y formación de biopelículas y acelerar el proceso de cicatrización. La mayoría de los estudios son estudios in vitro, o en animales por ello se requiere más investigación que determine las mejores prácticas para usar estas terapias como coadyuvantes en la mejora de resultados en la cicatrización.

 

EP1229 Tratamiento de un hematoma disecante en la extremidad inferior izquierda con un innovador sistema de compresión multicomponente monocapa

Ane Urrutia Fernández^1
1OSI Barakaldo-Sestao. Osakidetza, Barakaldo, Spain

Objetivo: Los hematomas disecantes aparecen después de un traumatismo y pueden dar lugar a áreas necróticas que requieren desbridamiento quirúrgico. Este estudio de caso tiene como objetivo evaluar la eficacia y la comodidad de un nuevo sistema de compression multicimponente monocapa en el tratamiento de un hematoma disecante en una paciente de 90 años con dermatoporosis.

Métodos: Se realizó un estudio de caso clínico en una paciente que sufrió una contusión que dio lugar a un hematoma disecante en la cara medial de la extremidad inferior izquierda. Se anotaron los antecedentes de dermatoporosis, osteoporosis, osteoartritis, deterioro cognitivo e hipercolesterolemia. También presentó telangiectasias y pulsos distales positivos; por lo que se inició tratamiento con un sistema de compresión monocapa multicomponente aplicando 40 mmHg de presión.

Resultados: Tras la aplicación del sistema de compresión monocapa multicomponente, el hematoma mostró una reducción significativa de tamaño y mejoró el estado de la piel en un período de dos meses. La evaluación continua indicó una mejor cicatrización y una disminución de las molestias.

Conclusiones: Al tratar inmediatamente al paciente con un sistema de compresión monocapa multicomponente, logramos una rápida absorción del hematoma y cicatrización de la herida. Este caso demuestra la eficacia del Sistema de compresión multicomponente monocapa en la promoción de la curación de la lesión, la reducción del edema y la mejora de la calidad de vida. Los hallazgos sugieren que el abordaje personalizado para el cuidado de las heridas pueden mejorar significativamente los resultados de curación y la calidad de vida general.

 

EP1230 Propuesta de desarrollo de una guía educativa para cuidadores no alfabetizados

Cristielle Montenegro¹, Alyne Duarte², Débora Raquel², Vitoria Silva², Herleis Maria², Bárbara Pompeu², Blanck Mara^3
1Emad/Semsa, Rio Branco, Brazil, ²Ufac, Rio Branco, Brazil, ³Sobenfee, Rio de Janeiro, Brazil

Objetivo: El objetivo de este resumen es destacar la propuesta de desarrollo de una cartilla educativa para cuidadores no alfabetizados, atendiendo a la necesidad de capacitarlos en el cuidado de los pacientes. La cartilla, de carácter ilustrativo, enseñará cómo realizar los cuidados de responsabilidad del cuidador, facilitando que se capaciten para el cuidado diario en sus hogares.

Metodología: Se llevó a cabo un estudio de mejora de la calidad del cuidado en cuatro etapas: mapeo de las necesidades de los cuidadores; rediseño del proceso de atención domiciliaria; elaboración de la cartilla ilustrativa; y evaluación de la accesibilidad mediante comentarios directos. Las acciones fueron desarrolladas por equipos multidisciplinarios para aumentar la efectividad.

Resultados: El mapeo inicial evidenció la existencia de barreras para el cuidado debido a la falta de información comprensible. La cartilla, que ofrece información práctica e ilustrada, fue considerada indispensable por los cuidadores para comprender y aplicar los cuidados de manera segura. Los cuidadores manifestaron mayor confianza y claridad en la ejecución de las etapas, además de identificar errores específicos en su práctica.

Conclusión: La implementación de la cartilla para cuidadores no alfabetizados demostró eficacia en la promoción de la inclusión y en la mejora de la atención domiciliaria. Las implicaciones prácticas sugieren la necesidad de integrar la capacitación de cuidadores en las políticas públicas de salud, promoviendo una atención domiciliaria más eficaz. La adopción de recursos educativos ilustrativos amplía el alcance y la calidad del cuidado.
Palabras-clave: Cuidadores, no alfabetizados, cartilla educativa, cuidado domiciliario, inclusión, capacitación.

 

 

PIE DIABÉTICO

EP1535 Impacto de la educación para la salud en el manejo de complicaciones en el pie diabético: reporte de tres casos clínicos

Anna Garcia Morera¹, Jordi Montía Acosta¹, Jaione Echarte¹, Marta Hugas Català^1
1SSIBE, Palamós, Spain

Objetivo: Describir el impacto de la educación para la salud en la evolución de úlceras complicadas en pacientes con pie diabético, destacando la importancia del autocuidado y el uso de calzado adecuado.

Métodos: Se analizan tres casos de pacientes con pie diabético que acudieron a una consulta de curas complejas de atención primaria. El primer caso corresponde a un paciente con neuropatía diabética y una úlcera de 10 meses de evolución en el primer dedo, causada por un objeto extraño en su zapato. Los otros dos casos presentaron úlceras neuroisquémicas en el dorso de los dedos, complicadas por el uso de calzado inadecuado. En dos casos, los pacientes refirieron no haber recibido previamente recomendaciones sobre el cuidado de los pies. Un tercero, había recibido educación sobre autocuidado y derivaciones a podología comunitaria, pero no asistió a las consultas.

Resultados: El paciente con úlcera neuropática mejoró tras la retirada del objeto extraño y el cambio de calzado por la indicación de enfermería. De los casos neuro isquémicos, solo uno mejoró tras la amputación y al cambiar su calzado, mientras que el otro mantuvo el uso inadecuado incluso tras la cirugía.

Conclusiones: La educación para la salud es crucial para prevenir complicaciones en el pie diabético. La adherencia del paciente a las recomendaciones es fundamental El trabajo coordinado e interdisciplinar es clave para la prevención de complicaciones en pacientes con lesiones complejas.

 

EP1536 Efectividad de la termometria infrarroja en la detección precoz de heridas en el pie de personas con diabetes

Maria-Merce Iruela-Sanchez¹, Rafael Medrano-Jimenez², Monica Espelt-Llorens³, Miriam Lara-Rodriguez⁴, Xenia Garcia-Nuñez⁵, Esther Soria-Martin⁶, Rosa-Maria Garcia-Sierra^7
1Enfermera Experta en Heridas de Atención Primaria. Servei Atenció Primaria Vallès Oriental. ICS, Grupo de expertos en heridas Institut Català de la Salut, GEICS, Grupo Multidisciplinario de Investigación en Salud y Social. GREMSAS, Granollers, Spain, ²Grupo de expertos en heridas Institut Català de la Salut, GEICS, Barcelona, Spain, ³Enfermera Experta en Heridas de Atención Primaria.Servei Atenció Primària Vallès Oriental. ICS, Granollers, Spain, ⁴1.Enfermera Experta en Heridas de Atención Primaria. Servei Atenció Primaria Vallès Oriental.ICS, Granollers, Spain, ⁵1. Enfermera Experta en Heridas de Atención Primaria. Servei Atenció Primaria Barcelones Nord. ICS, Badalona, Spain, ⁶Enfermera Experta en Heridas de Atención Primaria. Servei d‘Atenció Primaria Vallès Occidental. ICS, Grupo de expertos en heridas Institut Català de la Salut, GEICS., Sabadell, Spain, ⁷Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Grupo Multidisciplinario de Investigación en Salud y Social. GREMSAS, Mataró, Spain

Objetivo: Evaluar la eficacia de la termometría para la detección de zonas inflamatorias en los pies de pacientes con diabetes antes de la aparición de heridas en Atención Primaria (AP).

Métodos: Estudio aleatorizado, controlado y multicéntrico de dos grupos paralelos durante 18 meses en población ≥18 años. Se estiman necesarios 100 pacientes para cada grupo para detectar un diferencia igual o superior a 2. En el grupo control realizaremos la intervención habitual exploratoria de los pies (neuropatía, arteriopatia, deformidades en los pies) y en el grupo intervención realizaremos intervención habitual y seguimiento con termografía.

Resultados: La termometría permite detectar pequeñas variaciones de temperatura de la piel. Un aumento superior a 2º es un indicador de detección de una zona inflamatoria antes de la aparición de una herida. Teniendo en cuenta este indicador esperamos encontrar que la introducción de la termometría en el seguimiento del PD, reduzca la incidencia de aparición de heridas en el pie diabético.

Conclusiones: Con el aumento de la prevalencia de Diabetes Mellitus y del Pie diabético (PD) con heridas se necesitan intervenciones coste-efectivas en prevención de las ulceras.

Disponer de una técnica objetiva y no invasiva en la prevención de lesiones, permitirá reducir la incidencia de úlceras en el pie en AP. Disponer de datos objetivos reforzaría a las personas diabéticas la necesidad de hacerse el autocuidado de los pies. Las personas con riesgo de PD (diagnosticadas de neuropatía, arteriopatia o las dos) son las que más se pueden beneficiar de la detección precoz de heridas o lesiones en los pies.

 

EP1537 Eficacia de la descarga mecánica en la curación de úlceras neuropáticas plantares: influencia de la reducción de la presión plantar

Anabel Palma¹, Francesc Monés^2
1Hospital Germans Trias i Pujol, Unidad de pie diabético, Miembro de la GEPID. Grupo de trabajo de pie diabético de la SED (Sociedad Española de Diabetes), Barcelona, Spain, ²Hospital Germans Trias i Pujol, Badalona, Spain

Objetivo: Determinar el tiempo de curación de una úlcera neuropática plantar en pacientes diabéticos tratados con descarga biomecánica externa.

Métodos: Diseño: Estudio descriptivo observacional. Criterios de inclusión: Úlceras plantares, diabetes mellitus tipo 1 y 2, pulsos palpables, neuropatía y clasificación PEDIS I-II-III. Criterios de exclusión: Isquemia, infección sistémica o amputación contralateral. Se registran valores de presión máxima (Pmax) e integral presión/tiempo antes y después de la descarga, calculando el porcentaje de reducción de ambos valores. Se registra el tiempo de curación en días. Tipo de descarga: Material fieltro, diseñado bajo principios biomecánicos para compensar las alteraciones dinámicas del pie.

Resultados: El tiempo de curación de las úlceras es de 30 días en 8 pacientes tratados con descarga biomecánica externa, con una media de reducción de la presión máxima del 70%.

Conclusiones: Es importante tener en cuenta sobre todo las alteraciones biomecánicas en dinámica para la aplicación de métodos de descarga. El porcentaje de reducción de la presión en nuestro estudio es del 70%, mientras que en un estudio de Raspovic, A, utilizando fieltro, muestra una reducción del 45%. Otros estudios hablan de descargas con plantillas, pero no diseñados bajo conceptos biomecánicos. El tiempo de curación obtenido es de 30 días, mientras que otros estudios oscilan entre 45 y 70 días. El uso de la descarga biomecánica representa un enfoque prometedor e innovador para reducir el tiempo de curación en úlceras neuropática.

 

EP1003 Eficacia de la descarga quirúrgica mediante tenotomias flexoras digitales en úlceras de pie diabético

Francesc Monés¹, Anabel Palma^2
1Hospital Germans Trias i Pujol, Badalona, Spain, ²Hospital Germans Trias i Pujol, Unidad de Pié Diabético, Badalona, Spain

Objetivo: Evaluar la eficacia de las tenotomias flexoras digitales para la curación de úlceras de pie diabético.

Métodos: Estudio retrospectivo en 17 pacientes reclutados desde Enero a Junio del 2024. Criterios de inclusion: Úlcera neuropática y neuroisquémicas en dedos, infección grados I-II-II (IDSA), DM 1-2 y deformidades de dedos en garra, que no respondieron a tratamientos conservadores. A estos pacientes se les realizó una tenotomía del flexor largo de los dedos, se evaluó el tiempo de cicatrización, la recurrencia de las úlceras y las complicaciones postoperatorias.

Resultados: El 100% (17 de 17) lograron una cicatrización completa de las úlceras en un promedio de 2 semanas tras la tenotomía. Las complicaciones fueron mínimas, con un 11% de transferéncia de presión en otros dedos que presentaban perviamente deformidades en garra, y no se reportaron recurrencias, complicaciones graves ni amputaciones

Conclusiones: La tenotomía flexora es una técnica eficaz y segura para la curación de úlceras en pacientes con pie diabético y deformidades digitales. Favorece una cicatrización rápida, sin apenas recurrencia y pocas complicaciones, lo que la convierte en una opción quirúrgica viable en pacientes que no responden a tratamientos conservadores.

 

EP1538 Experiencia de uso de apósito de cloruro de diaquilcarbamilo en lecho de amputación

Alicia Hernández Aguilera¹, Montse Baixauli Hernández¹, María Isabel Aguirre Fernández^1
1Institut Català de la Salut, Barcelona, Spain

Objetivo: Describir un caso clínico sobre el uso de apósito de cloruro de dialquilcarbamilo en lecho de amputación.

Métodos: Paciente de 82 con antecedentes de arteriopatía periférica, hipertensión, y diabetes mellitus de 20 años de evolución. Julio 2024, alta tras ingreso hospitalario por amputación de 2º dedo pie I. Es dado de alta con herida abierta de aprox 2cm x 1cm para cierre por 2ª intención. Se mantiene el tratamiento pautado al alta con fomento de solución antimicrobiana y apósito de partículas de carboximetilcelulosa c/72h. Septiembre 2024, se ha mantenido la pauta de curas indicada al alta por el servicio de cirugía vascular, pero la evolución, aunque no tórpida, se muestra estancada, motivo por el cuál se decide cambiar a apósito de cloruro de dialquilcarbamilo (DACC) c/72h. Octubre 2024, la lesión presenta una evolución muy favorable, disminuyendo en tamaño y profundidad, aprox 0,2cmx 0,3cm. Se retira el DACC y se pasa a curas c/72h con matriz liofilizada de colágeno y alginato.

Resultados: Tras las medidas instauradas se obtiene una resolución prácticamente completa de la lesión en menos de 3 meses.

Conclusiones: Es imprescindible la reevaluación continua del estado de la lesiones para modificar y adaptar la pauta según las necesidades.

 

EP1539 ¡Yo no quiero una invalidez! Cuidados post amputación por osteomielitis en paciente joven en medio rural

Ana Requena Hernández^1
1Ibsalut, Santanyí, Spain

Objetivo: Analizar las características del proceso de curación en medio rural tras alta hospitalaria de una paciente compleja joven tras una amputación por osteomielitis y que rechazó que se le tramitara una invalidez.

Identificar las repercusiones socio económicas que puede tener una amputación en pie diabético en una persona en edad laboral.

Métodos: Se realizó una plan de curas adaptado a la evolución y características de la paciente al alta. Se trató la herida aplicando la Estrategia de Higiene de la Herida en cuatro pasos en cada cura y se eligió el tratamiento basándonos en el concepto del acrónimo TIME donde T (Tejido no viable), I (Infección), M (exudado), E (bordes). El tratamiento incluía desbridamiento de la biopelícula en cada cura y aplicación de limpiadores y apósitos antibiofilm. La cicatrización estuvo condicionada porque la paciente tuvo que iniciar su actividad laboral precozmente por necesidades económicas. Mantenía inmovilización con zapato ortopédico.

Resultados: La herida cicatrizó completamente, pero sospechamos la evolución hacia una artropatía de Charcot por la que la derivamos al podólogo que recomendó bota Walker. La paciente rechazó colocarse la bota durante el verano por miedo a repercusiones laborales y tampoco acudió a controles con su enfermera que sí mantuvo contacto telefónico.

Conclusiones: El proceso de curación de heridas quirúrgicas por amputación en medio rural a menudo esta condicionado por características inherentes al paciente, a su voluntad o nivel cultural, pero son las económicas las que pueden hacer que rechacen tratamientos que pueden conllevar graves repercusiones.

 

EP1010 Rol de la enfermera de práctica avanzada en heridas crónica complejas en la prevención de amputación en paciente con pié diabético: caso clínico

María Gutiérrez García¹, María Mercedes Carrasco Racero¹, Juan Francisco Jimenez Garcia, Jose Luis Jiménez Láinez², Ana Belén Fernández Ramírez³, Asier Galiano Bolea⁴, Mercedes Muñoz
¹A.G.S. Serranía de Málaga, Ronda, Spain, ²Distrito Sanitario Jaén- Jaén Sur, Jaén, Spain, ³Distrito Sanitario Granada Metropolitano, Granada, Spain, ⁴U.G.C. Jódar, Jaén, Spain

Objetivo: Presentar un caso clínico de una paciente con úlcera de pie diabético de tres años de evolución, analizando comorbilidades y su impacto en la calidad de vida, con el fin de evitar la amputación

Métodos: Se llevó a cabo una evaluación detallada y un plan de cuidados utilizando las taxonomías de la North American Nursing Diagnosis Association (NANDA), Nursing Outcomes Classification (NOC) y Nursing Intervention Classification (NIC). Se implementaron intervenciones como los “cuatro pasos de la higiene de la herida”, uso de fieltros para plantillas de descargas y zapatos postquirúrgicos

Resultados: A lo largo de la fase de evaluación, se observó una progresiva mejora en la condición de la paciente, con un seguimiento a los 8, 23 y 51 días. La lesión presentó una cicatrización completa en este último plazo, evidenciando la efectividad del enfoque multidisciplinario y la intervención rápida. Teniendo en cuenta que cada año, aproximadamente 18.6 millones de personas diabéticas a nivel mundial sufren de úlceras en el pie, con un porcentaje de entre el 30% y el 40% que requiere un tiempo promedio de 12 semanas para cicatrizar.

Conclusiones: La atención temprana y la derivación a un equipo especializado son cruciales en el manejo del pie diabético. Este caso resalta la importancia de un enfoque integral que considere tanto el tratamiento de la herida como las comorbilidades asociadas, mejorando así la calidad de vida del paciente y reduciendo el riesgo de amputaciones.

 

EP1540 Úlceras en paciente con pei diabético de alto riesgo: la importancia de la adherencia al tratamiento

Víctor Cassini Gómez de Cádiz^1
1Servicio Andaluz de Salud, Hospital Universitario San Cecilio, Granada, Spain

Las úlceras del pie diabético neuropático son una de las complicaciones más graves de la diabetes mellitus, con alto riesgo de infección, amputación y mortalidad. Aproximadamente el 80% de las amputaciones de extremidades inferiores en pacientes diabéticos son precedidas por una úlcera. Su manejo adecuado es fundamental para evitar secuelas irreversibles y mejorar la calidad de vida.

Presentamos el caso de un paciente de 54 años con diabetes mellitus tipo 2 y un diagnóstico de pie diabético neuropático de alto riesgo que además recibía tratamiento crónico para psoriasis. El paciente acudió por una extensa úlcera en el lateral externo del pie derecho, caracterizada por bordes irregulares y moderada exudación. Debido al riesgo elevado de complicaciones, se inició tratamiento con curas convencionales en ambiente húmedo, combinadas con el uso de descargas provisionales para aliviar la presión en la zona afectada.

Adicionalmente, se contactó al Servicio de Rehabilitación para valorar un abordaje definitivo con un dispositivo ortopédico adecuado que ayudara a redistribuir las cargas. Sin embargo, la adherencia deficiente del paciente a algunas recomendaciones del tratamiento rehabilitador contribuyó a la aparición de dos nuevas úlceras: una en la región plantar y otra en el pulpejo del segundo dedo.

A pesar de estas complicaciones, ambas lesiones lograron cicatrizar gracias a la implementación estricta de curas convencionales y un reajuste de la estrategia de rehabilitación. Este caso resalta la importancia de la adherencia al tratamiento en pacientes con pie diabético neuropático de alto riesgo y la necesidad de un enfoque interdisciplinario para evitar complicaciones adicionales y preservar la integridad del pie.

 

EP1541 Eficacia de un apósito de cobre en lesiones de pie diabético

Alexandra Moreno Felipe¹, Anna Garcia Morera², Jordi Montía Acosta³, Maria José Sánchez Doblado¹, Irene Cespedes I Feliu¹, Irene Sánchez Sánchez^1
1CAP Torroella de Montgrí, Torroella de Montgrí, Spain, ²CAP Dr. Josep Alsina i Bofill, Palafrugell, Spain, ³CAP Catalina Cargol, Palamós, Spain

Objetivo: Describir la eficacia del uso de un apósito de cobre en la cicatrización en úlceras de pie diabético.

Métodos: Señor de 86 años con lesiones de 14 días de evolución en 1º y 2º dedo de ambos pies por neuropatía diabética, algunas con probe to bone positivo. Índice tobillo-brazo normal. Se descarta osteítis y osteomielitis e iniciamos cura con apósito de cobre favoreciendo así el crecimiento del tejido de granulación, acelerando la cobertura ósea y el tiempo de cicatrización. Señor de 52 años con lesiones neuro-isquémicas de una semana de evolución en pulpejo del 1º dedo del pie izquierdo con alta sospecha de pie de Charcot. Mal control metabólico, enolismo, HTA y mal control lipídico. Mala adherencia a los tratamientos farmacológicos. Se decide abordaje local con desbridamiento de la hiperqueratosis periulceral, limpieza con fomentos de ácido hipocloroso, apósito de cobre y descarga con fieltro resolviéndose en 2 semanas. Paciente de 68 años con arteriopatía severa pendiente de colocación de stent acude con herida traumática en 1º dedo del pie izquierdo. Ante el riesgo de infección y mala evolución se decide iniciar la cura con apósito de cobre, consiguiendo su cierre en 2 semanas.
Resultados: Tras la valoración del riesgo de estas lesiones y afrontar el manejo mediante la elección de un apósito de cobre se consigue su total resolución en un corto periodo de tiempo.
Conclusiones: La elección de un apósito de cobre en úlceras de pie diabético consigue acelerar el proceso de cicatrización evitando consecuencias más graves.

 

EP1574 Deficiente control metabólico igual a complicación de la úlcera del pie diabético (UPD), serie de casos

Jose Manuel Rosendo Fernandez¹, Rocío Barral Fernández², María Isabel Campos González³, María Teresa Loureiro Rodríguez⁴, Ana María Bello Jamardo⁵, José Antonio Esperón Güimil⁶, Ana García Fernández^7
1Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Enfermera, Unidad de heridas, Pontevedra, Spain, ³Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ⁴Complejo Hospitalario Pontevedra e O salnés, Hospital Montecelo, Unidad de Cirugía Mayor Ambulatoria, Pontevedra, Spain, ⁵Hospital del Salnés, Supervisora de Unidad, Unidad de heridas, Pontevedra, Spain, ⁶Atención Primaria, Enfermero, Anafans, Poio Pontevedra, Spain, ⁷Complejo Hospitalario Universitario de Pontevedra, Enfermera, Subdirección de enfermería, Pontevedra, Spain

Objetivo: Demostrar y tratar la relación entre el mal control metabólico y la úlcera del pie diabético (UPD). Objetivo específico: Conseguir un buen control metabólico en los pacientes en tratamiento.

Material y método: El tratamiento de las úlceras en el pie diabético ha evolucionado significativamente, con enfoques que son clave como la cura en ambiente húmedo (CAH), las terapias avanzadas y la descarga de las zonas de hiperpresión. El control metabólico en un paciente diabético es crucial para prevenir complicaciones. Se realiza analítica y revisión de controles de salud en los tres pacientes. Se mantiene un buen control metabólico implica con los niveles de glucosa en sangre, lípidos y tensión arterial dentro de los rangos recomendados.

Resultados: Se presenta una serie de 3 casos clínicos con UPD

Conclusiones: La monitorización constante y regular de los niveles metabólicos y la dieta, permite ajustar el tratamiento para mantener la glucosa dentro de los niveles adecuados, con esto se consigue una aproximación a las cifras glucémicas normales. Estos controles deben realizarse en su centro de atención primaria, así como la inspección del pie. El ejercicio mejora la sensibilidad a la insulina y ayuda a mantener un peso saludable y por ello es siempre recomendable. Para el tratamiento de la UPD se puede usar la CAH, así como terapias avanzadas y todo ello en combinación con descarga de la úlcera, que es esencial para la curación.

 

EP1542 La descarga de la úlcera en el pie diabético no se negocia

Jose Manuel Rosendo Fernandez¹, María Isabel Campos González², Rocío Barral Fernández², Ana García Fernández³, José Antonio Esperón Güimil⁴, María Teresa Loureiro Rodríguez, Ana María Bello Jamardo^5
1Complejo Hospitalario Universitario de Pontevedra, Supervisor de procesos y cuidados de enfermería, Unidad de heridas, Pontevedra, Spain, ²Complejo Hospitalario Universitario de Pontevedra, Enfermera Unidad de Heridas, Unidad de heridas, Pontevedra, Spain, ³Complejo Hospitalario Universitario de Pontevedra, Enfermera, Subdirección de enfermería, Pontevedra, Spain, ⁴Atención Primaria, Enfermero, Anafans, Poio Pontevedra, Spain, ⁵Hospital del Salnés, Supervisora de Unidad, Cirugía, Vilagarcía de Arousa (Pontevedra), Spain

Objetivo: Realizar una revisión de la literatura sobre las recomendaciones de uso de descargas locales en la úlcera del pie diabético (UPD).

Métodos: Se desarrolló una pregunta PICO y se realizó una revisión sistemática de estudios publicados en PubMed, CINAHL, EMBASE y Scopus y literatura gris. Realizada en septiembre de 2023. Criterios de inclusión: publicación en los últimos 5 años; escrito en inglés, portugués, o español, y todo tipo de documentación con acceso al texto completo. En la redacción del documento se siguieron las recomendaciones de la declaración PRISMA 2020. Palabras clave: Diabetes mellitus; Úlcera neuropática del pie; Descarga.

Resultados: Se identificaron 184 estudios en total, y 18 fueron considerados elegibles para el análisis.

Conclusiones: La literatura encontrada sugiere que no es difícil realizar una búsqueda bibliográfica específica sobre este tema y existen estudios publicados al respecto. Es necesario promover la estandarización de la práctica de enfermería en la descarga del PDB. El trabajo multidisciplinar en muy importante para la implementación de tratamientos completos y correctos. Sería necesario poder evaluar estas intervenciones para así poder mejorar la salud de las personas UPD. La mejora del cuidado local de la UPD, redundará en la calidad asistencial que se presta y optimizaría la propia la eficiencia del sistema sanitario.

 

EP1017 Efectividad de una intervención formativa avanzada para identificar el pie de riesgo dirigida a enfermeras de atención primaria

Carolina Rodríguez Sardañés¹, Uria Piquer Farrés², Eva Garcia Armengol², Olga Garcia Castillo², Noelia Martínez Martínez², M. Eulàlia Fitó Silvestre², Jofre Bielsa Pascual^2
1Institut català Salut (ICS) Cap la Salut 7B.Badalona, Institut català Salut (ICS) Cap Gran sol 7A. Badalona, Unidad de Soporte a la Investigación, badalona, Spain, ²Institut català Salut (ICS) Cap la Salut Badalona, Institut català Salut (ICS) Cap Gran sol 7A. Badalona, Unidad de Soporte a la Investigación, Badalona, Spain

Objetivo: Observar la efectividad de una intervención formativa avanzada como mejora en la valoración neuropática del pie de riesgo (PR) en pacientes con Diabetes Mellitus (DM), realizada por enfermeras de atención Primaria (AP).Concordancia entre resultado de Electromiograma extremidades inferiores (EMGEI) y valoraciones de neuropatía en población estudiada.

Métodos: Formación avanzada en atención podológica a personas con diabetes desde Atención Primaria realizada por enfermeras de AP (primer semestre 2023).

Estudio descriptivo de concordancia. Participan dos centros de AP. Duración: Octubre del 2023-2024. Población: 183 personas > 18 años con DM atendidos en los centros participantes. Inclusión: Registros EMGEI últimos 5 años, y registros de PR, firmar consentimiento informado. Exclusión: Niega participar, atención domiciliaria, expectativa de vida menor de un año. Muestra: Se necesitan 72 personas para un coeficiente Kappa de 0,8 y precisión de 0,2. Selección: Simple, mediante listado de candidatos. Captación: llamada telefónica Fuentes de información: Historia Clínica: Resultados EMGEI y valoración del PR (2022, 2023). Sensibilidades: presora, vibratoria, dolor, temperatura, reflejo Aquíleo ambos pies.

Variables

Independiente: Resultado EMG alterado SI/NO.

Dependientes: Valoración sensibilidades. (Normal, alterado, no valorado).

Secundarias: Edad, sexo.

Análisis estadístico: Las variables cuantitativas se muestran en frecuencias y las cualitativas en porcentajes. Concordancia mediante Kappa entre registros del PR y EMG. Spss 25.

Resultados: Participan 75 personas (150 pies). Mujeres, 20,6 %; edad 69,8 años DE ± 8,9. En 2023 se incrementaron las valoraciones: Presora, 20%; vibratoria, 21,9%; dolor, 47%; térmica, 54%; reflejos, 29,8%. Concordancia entre valoraciones PR y EMGEI: Kappa, 0,524 p= 0,032; (2022). Kappa, 0,584 p= 0,013 (2023).

Conclusiones: La formación avanzada mejora la identificación neuropática del PR, pero con moderada concordancia a EMGEI.

 

EP1018 Aplicabilidad de la escala neuropathy disability score adaptada a la atención primaria. Resultados del estudio piloto

Carolina Rodríguez Sardañés¹, Mercedes Fernández Almendros¹, Antonia Martin Zafra², Maria Rueda Chiva¹, Yasmin Guzman Liranzo¹, Guillem Marco¹, Laura Sánchez Notario^1
1Institut català Salut (ICS) Cap la Salut Badalona, Institut català Salut (ICS) Cap Gran sol 7A. Badalona, Unidad de Soporte a la Investigación, Badalona, Spain, ²Institut català Salut (ICS) Cap la Salut 7B.Badalona, Institut català Salut (ICS) Cap Gran sol 7A. Badalona, Unidad de Soporte a la Investigación, Badalona, Spain

Objetivo: Observar la aplicabilidad de la escala Neuropathy Disability Score (NDS) original y una adaptación en Atención Primaria (AP) incluyendo sensibilidad presora para identificación de neuropatía diabética (ND) comparando con Electromiograma extremidades inferiores (EMGEI).

Métodos: Estudio observacional descriptivo. Periodo: Octubre 2023-Octubre 2024. Muestra: 78 personas seleccionadas mediante muestreo simple entre un grupo de 183 personas con Diabetes Mellitus (DM) y EMGEI realizado, atendidas en dos centros de AP. Se crean dos subgrupos: Grupo 1(G1): 34 con DM sin ND y Grupo 2(G2): 23 con DM y ND. . Intervenciones: realización de NDS y escala Neuropathy Simptom Score (NSS), dos exploraciones consecutivas y otra a las dos semanas, por examinadores experimentados. Considerando diagnóstico de Neuropatía: NDS 3-5 y NSS > 5 puntos o NDS ≥6 puntos.

Variables

Dependiente: Neuropatía SI/NO. Independiente: Resultado EMGEI alterado SI/NO. Secundarias: Datos del historial clínico: antropométricos, sexo, edad. SPSS 25

Análisis estadístico

Descripción de variables cuantitativas y cualitativas. Homogeneidad (NDS y NSS). Fiabilidad y estabilidad (correlación puntuaciones NDS y NSS). Validez: mediante kappa neuropatía SI/NO por grupos y EMGEI.

Resultados: Incluidos 57 sujetos, 34 con DM y EMGEI normal y 23 con DM y ND. Shapiro-Wilk 000. Mayor presencia de hombres y más edad en G2 (69,6%; 71,9 años DE 7,02). Fiabilidad: G1: 0,912 p= <0,001; G2, 0,927 p=<0,001. Estabilidad: G1, 0,625 p= <0,01; G2, 0,580 p= <0,01. Validez para neuropatía: G1, Kappa 0,752 p= 0,004; G 2, Kappa 0,847 p= -0,012. 

Conclusiones: Ambas escalas NDS concuerdan con los resultados descritos en EMGEI. Podrían aplicarse en estudios de mayor envergadura para determinación de neuropatía diabética en AP.

 

EP1543 Detección de pie diabético con termografía infrarroja

Ana Cortiñas¹, Andrea Roblees¹, Elena Rodríguez², Eva Ruiz¹, María José Caro^1
1GNEAUPP, Córdoba, Spain, ²GNEAUPP, Cordoba, Spain

Objetivo: El pie diabético es una complicación microvascular frecuente de los pacientes con Diabetes. Con una prevalencia mundial entre 1,3%-4,6% se entiende la importancia de esta patología. Aproximadamente el 25% de ellos desarrollará una lesión de Pie diabético y ocurrirá con mayor frecuencia entre los 47 y 65 años. Previo a la lesión se encontrarán alteraciones isquémicas, neuropáticas o neuroisquémicas. Estas alteraciones afectarán a angiosomas del pie, de ahí la importancia de la detección temprana. Detectar precozmente las alteraciones del pie de pacientes con diabetes que pudieran desembocar en lesiones de pie diabético. Establecer la prevalencia de alteraciones en nuestro medio.
Métodos: Fotografiar mediante termografía infrarroja, desde planos diferentes para ubicar el agiosoma afectado, a los pacientes que cumplan los criterios de inclusión. Previamente, se calculará el tamaño muestral necesario de nuestra Área Sanitaria.
Resultados: Actualmente, nuestro estudio se está ejecutando y se analizarán los datos globales mediante medidas de tendencia central y de dispersión en base a las variables introducidas en el estudio, estableciendo el total de alteraciones y específicamente el número de ubicaciones del pie que presenten alteración, al final del estudio en diciembre del año en curso, de forma detallada. Siendo datos preliminares, presentamos un 34% de pacientes detectados con arteriografía periférica mediante termografía.
Conclusiones: Conforme a los resultados obtenidos hasta este momento, el problema tiene suficiente trascendencia como para generalizar el estudio de este tipo de pacientes mediante Termografía infrarroja, para hacer un abordaje global, que permita frenar la progresión de esta alteración y proporcionar calidad de vida.

 

EP1544 Abordaje y tratamiento del dolor del miembro fantasma: una revisión de revisiones

Miriam Berenguer Pérez¹, Daniel Bonet Vélez¹, Sonia Riera Manzano², Gloria Santiago Ocaña³, Veronica Sierra^3
1Universidad Alicante, Alicante, Spain, ²Hospital Clinic, Barcelona, Spain, ³Institut Català de la salud, Barcelona, Spain

Objetivo: Sintetizar la evidencia científica disponible en relación al abordaje y tratamiento del dolor del miembro fantasma.

Métodos: Se ha realizado una revisión de revisiones o Umbrella Review de la literatura a través de una búsqueda en las bases de datos: MEDLINE a través de Pubmed, Cochrane Library, LILACS, SCOPUS, CINAHL y Web of Science. Se siguieron las recomendaciones PRIOR. Además, se evaluó la calidad de las revisiones mediante la lista de comprobación de redacción de artículos del documento PRISMA.

Resultados: De un total de 178 revisiones sistemáticas con o sin metaanálisis, se seleccionaron 14 para su revisión final. Se han identificado distintos tipos de tratamientos para el abordaje del dolor de miembro fantasma, por lo que los hemos clasificado en 3 grupos de tratamientos: terapias farmacológicas, invasivas y no invasivas, siendo todos ellos de calidad alta o muy alta. Los resultados concuerdan en que las terapias no invasivas, son más las más eficaces, y que terapias como la técnica de espejo no son tan efectivas, aun siendo de las más usadas a lo largo de los años. Hoy en día, tratamientos más novedosos de estimulación transcraneal magnética o con corriente continúa, parecen ser más eficaces frente a las más tradicionales.

Conclusiones: Actualmente existen muchos tratamientos sobre cómo reducir el dolor del miembro fantasma, la estimulación transcraneal de corriente continua, la estimulación magnética transcraneal repetitiva, la realidad virtual y aumentada son las más eficaces para la disminución del dolor del miembro fantasma, frente a las demás terapias.

 

EP1545 Opión del paciente sobre el impacto del tratamiento del pié con chacort: estudio de caso

Juliana Lucinda dos Santos¹, Eloisa Malieri^2
1Prime Care, Santo André, Brazil, ²Eloebete, São Paulo, Brazil

Objetivo: Reportar la percepción de los sentimientos del paciente respecto al riesgo de amputación ante un proceso de herida infectada

Métodos: Se trata de un estudio descriptivo y explicativo en forma de relato de experiencia. Se realizó una práctica privada de enfermería en la ciudad de São Paulo – Brasil. Caso de un paciente diabético de 35 años con una úlcera infectada del pie diabético.

Resultados: La realización de una evaluación de una herida compleja requiere experiencia y el uso de herramientas de guía adecuadas. En este caso, se utilizó la herramienta TIMERS para el manejo de heridas, conducta terapéutica.

Conclusiones Las heridas complejas son difíciles de resolver con tratamientos convencionales y apósitos sencillos. Requieren un tratamiento más delicado y con técnicas específicas, ya que están influenciadas por factores que ralentizan el proceso de curación. Si no se tratan adecuadamente, las heridas complejas pueden provocar afecciones graves, como infección, necrosis e incluso amputación de extremidades, lo que corrobora la afirmación de que la falta de un protocolo adecuado conlleva costos financieros e impacto emocional

 

EP1546 Tratamiento de las lesiones profundas de pie diabético con Ozoyl, sulfadiazina argéntica y ácido hialurónico

Christian Baraldi^{1 2 3 4
1}Villa Erbosa SpA, Bologna, Italy, ²Humanitas Gavazzeni, Bergamo, Italy, ³Tirrenia Hospital, Belvedere Marittimo, Italy, ⁴Vein Clinic Dr. Baraldi, Catanzaro, Italy

Objetivo: Numerosos estudios han demostrado la eficacia por separado del Ozoyl y de la sulfadiazina argéntica y del ácido hialurónico. El primero es un inductor biológico que regula las principales vías metabólicas, estimula el sistema de defensa endógeno con acción antiinflamatoria y microbicida; el segundo, tiene una importante actividad antibacteriana sobre muchos gérmenes grampositivos y gramnegativos así como Pseudomonas aeruginosa y Enterobacter pyogenes y muchas especies fúngicas. El objetivo es amplificar y acelerar la cicatrización de las heridas con la combinación de ambos dispositivos médicos.

Método: Se trataron cincuenta cinco casos con pie diabético y lesiones infectadas de distinta naturaleza: de presión, post-amputación y post-traumáticas. La infección estaba presente en todas las lesiones; el tratamiento se combinó utilizando Ozoyl y, tras dos minutos, sulfadiazina argéntica y ácido hialurónico en forma de gaza y crema.

Resultados: En todos los pacientes tratados se observó una cicatrización completa, variable según la extensión de la lesión, pero más rápida que en casos similares tratados individualmente con sulfadiazina argéntica y ácido hialurónico.

Conclusiones: La combinación de Ozoyl y sulfadiazina argéntica con ácido hialurónico parece ser óptima para la curación de lesiones diabéticas infectadas. Se necesitan más estudios prospectivos para corroborar estas primeras impresiones basadas en la evidencia.

 

EP1020 Termografía, temperatura, distribución de la fuerza de presión y actividad física en el pie diabético: una revisión sistemática

Maria Rosell Diago¹, Marta Izquierdo Renau¹, Iván Julián Rochina², Manel Arrebola López³, Manuel Miralles Hernández^4
1Universidad de Valencia, Valencia, Spain, ²Universidad de Valencia, Hospital Universitario y Politécnico La Fe, Valencia, Spain, ³Hospital Universitario y Politécnico La Fe, Valencia, Spain, ⁴Universidad de Valencia, Hospital Politécnico y Universitario La Fe, Valencia, Spain

Objetivo: La actividad física, en concreto caminar, se recomienda ampliamente como medio de control de la Diabetes. Este estudio pretende determinar si la medición de la presión y la temperatura en el pie puede ayudar a recomendar la actividad física que ayude al control de la glucemia sin favorecer la formación de úlceras en el pie.

Métodos: Se realizó una revisión sistemática de acuerdo con el formato PRISMA en las bases de datos PubMed, Scopus y Web of Science, sin restricción temporal para responder a la pregunta: ¿Es la respuesta cutánea plantar termográfica una herramienta pronóstica para la prevención de úlceras en los pies tras la actividad física en pacientes diabéticos?

Resultados: Se identificaron un total de 894 referencias mediante la aplicación de la estrategia de búsqueda. Tras el proceso de cribado, se consideró que un total de 14 estudios eran adecuados para su inclusión en la revisión. De los 14 artículos seleccionados, 12 fueron estudios observacionales descriptivos, y dos fueron ensayos clínicos aleatorizados. De los 12 estudios observacionales descriptivos, ocho fueron estudios de cohortes, un estudio transversal y tres artículos de casos y controles.

Conclusiones: La revisión puso en evidencia que, hasta la fecha, no se han identificado estudios que examinen la relación entre la actividad física y la respuesta inflamatoria de los tejidos plantares en pacientes con diabetes. Las recomendaciones de prevención actuales se basan en limitar o eliminar la actividad física. En consecuencia, es necesario seguir investigando para explorar las posibilidades de un enfoque más personalizado de la prevención de las úlceras en el pie diabético.

 

EP1548 Grado de conocimientos de los profesionales de enfermería en el manejo del pie diabético, en un hospital terciario

Mònica Plans^1
1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Objetivo: Analizar el grado de conocimientos en el manejo de los pacientes con patología activa de pie diabético, en los profesionales de enfermería implicados (hospital terciario).

Métodos: Estudio observacional, descriptivo y transversal. La población de estudio fueron las enfermeras de las unidades dónde se atienden a más pacientes con patología activa de pie diabético. La variable principal fue “conocimientos sobre el manejo del pie diabético”, medido a través de la encuesta “Evaluation of Nurses’ Knowledge Levels of Diabetic Foot Care Management”. También se contemplaron variables sociodemográficas. Para el análisis descriptivo de las variables cualitativas se facilitaron frecuencias absolutas y relativas. Para la comparación entre variables se empleó la T de Student.

Resultados: El grado de conocimiento de las enfermeras en el manejo del pie diabético fue insuficiente. Un 55% las enfermeras confirmaron no haber recibido formación en el manejo del pie diabético, y un 85% declararon que necesitaban más formación.

Conclusiones: El grado de conocimientos en el Pie Diabético de las enfermeras es insuficiente, por lo que se requiere la implementación de intervenciones formativas en su manejo y estudios futuros que evalúen el impacto de éstas en los conocimientos de las enfermeras implicadas.

 

EP1549 Oxigenoterapia complementaria con camara hiperbarica: experiencia desde una unidad multidisciplinar de pie diabetico

Elena María Rozado Gutierrez¹, Aida De la Fuente Prieto¹, Susana Valerdiz Casasola¹, Maria Luz Rodriguez Martinez¹, Nuria Vazquez Garcia^1
1Hospital Universitario Central De Asturias, Oviedo, Spain

La arteriopatía periférica está implicada en más del 50% de las personas afectadas por Pie Diabético: Se produce oxidación de lipoproteinas retenidas en el subendotelio arterial y glicación celular, fenómenos proinflamatorios que ocluyen progresivamente los pequeños vasos y restan llegada de óxigeno y nutrientes a los territorios vulnerables del pie. Ese fenómeno de hipoperfusión es factor perpetuante en el proceso de cicatrización. Por tanto, en situaciones de revascularización complicada, se precisan alternativas terapéuticas destinadas, prioritariamente, a disminuir el riesgo de amputación mayor y el mal pronóstico vital asociado.

Objetivo: Mostrar la efectividad del abordaje integral del Pie Diabético mediante acciones consensuadas desde un equipo multidisciplinary. Mostrar la efectividad del tratamiento complementario de terapia con cámara hiperbárica sobre estas heridas de difícil cicatrización

Métodos: Se describen tres casos de heridas de Pie Diabético con perfusión distal límite, tratadas mediante terapia combinada: control de comorbilidades, cuidados convencionales y ciclos adyuvantes de oxigenoterapia sistémica con cámara hiperbárica.

Resultados: Se confirma la efectividad del manejo global del Pie Diabético, desde una perspectiva interdisciplinar abierta a las innovaciones tecnológicas. En ese sentido, en nuestros casos, demostramos que, sumando la práctica protocolizada y terapias avanzadas se logra la epitelización de las heridas.

Conclusiones: La evidencia disponible sobre la efectividad del uso de la cámara hiperbárica sobre heridas complejas, es escasa en nuestro medio. No obstante, debe contemplarse este tratamiento coadyuvante, por su acción sobre la piel hipóxica, como oportunidad para las lesiones de Pie Diabético en extremidades con revascularización ultradistal subóptima.

 

EP1550 Influencia de la anemia en el desarrollo y pronóstico del pie diabético

Sara Llamedo Martínez¹, Alejandra Diego Arce², Lidia Hernández Crespo^1
1Centro de Salud Circunvalación, Valladolid, Spain, ²CAP BaIx-A-Mar. Consorci Sanitari Alt Penedès- Garraf, Vilanova i la Geltrù, Spain

Objetivo: Evaluar cómo la anemia afecta el desarrollo y pronóstico del pie diabético en pacientes diabéticos.

Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Pubmed, Google Scholar, ENFISPO y CUIDEN, utilizando las palabras clave “Anemia” y “Pie diabético”.

Resultados: En primer lugar, es importante tener en cuenta que existe una variabilidad significativa al definir los valores de hemoglobina que indican anemia.

La asociación entre anemia y diabetes mellitus ha sido muy estudiada con anteriorioridad (hasta un 23% de los pacientes diabéticos padecen anemia).

Existen múltiples comorbilidades y factores de riesgo que influyen en el desarrollo del pie diabético. Entre ellos, se ha observado que los pacientes con úlceras de pie diabético tienen niveles de Hemoglobina significativamente menores comprándolos con otros pacientes diabéticos, pero sin úlceras. Por otro lado, estudios como el realizado por Chuan et al muestran diferencias significativas en el porcentaje de pacientes que consiguieron una resolución positiva de su ulcera del pie diabético (46,2 % de los pacientes con anemia vs 70,9 % en pacientes sin anemia). Además, diversos estudios correlacionan la anemia con tasas mayores de gravedad de las ulceras y amputaciones.

Conclusiones: La anemia está asociada a mayores tasas y mayor gravedad de ulceras de pie diabético. Por lo tanto, resulta crucial considerar los niveles de hemoglobina al tratar a un paciente con pie diabético.

Por último, queda por investigar si la rápida corrección de los niveles bajos de hemoglobina influye en el desarrollo y la evolución de las úlceras de pie diabético.

 

EP1551 Herida traumática en pie diabético. Avanzando en las curas

Susana Blanco Torralba^1
1Centre Integral de salut Cotxeres, Barcelona, Spain

Introducción: Las lesiones en pie diabético tienen una alta incidencia y sus complicaciones son causa de importantes repercusiones sociosanitarias.

Influyen negativamente en la calidad de vida, aumentando la mortalidad de las personas, principalmente en casos de amputación mayor.

Objetivos: Medir la eficacia del apósito con matriz microadherente de tecnología TLC-NOSF. Disminuir la frecuencia de curas y el tiempo de resolución. Mejorar la calidad de vida de los usuarios.

Método: Caso clínico. Sra de 80 años. AP:DMII/IC/HTA/Retinopatía diabética/Insuficiencia venosa. Autónoma para las ABVD y las AIVD. Sin deterioro cognitivo. Presenta herida traumática, ocasionada por objeto cortante. Tres días de evolución. Localizada en pie izquierdo. Tamaño: 4cm x 3,5 cm. EVA 4/10. Flictena inicial que drena de manera espontánea. Bordes regulares en buen estado, igual que la piel perilesional. Lecho de la herida 80% tejido de granulación. Escaso exudado serohemático. Sin signos de infección local. Cura: lavado con suero fisiológico, crema barrera para proteger los bordes, apósito microadherente de tecnología TLC-NOSF y apósito de espuma secundario.

Resultados: En total se realizaron 4 curas. Con una frecuencia inicial de cada 4 días. Aumentando hasta en 7 días. Resolución completa a los 16 días.

Conclusiones: El tratamiento de elección ha permitido disminuir la frecuencia de las curas.

Cicatrización total a los 16 días. Esto hace que la persona afectada pueda mantener su autonomía, interfiriendo lo menos posible en la dinámica habitual diaria.

Disminuye la carga asistencial del profesional. Mejor coste - beneficio.

EP1552 Título: manejo de úlcera diabética plantar complicada con terapia a presión negativa ambulatoria

Brissette Soto^1
1Essalud, Arequipa, Peru

Resumen: Actualmente los estudios enfocan sus objetivos en el manejo de las úlceras de pie diabético con tecnologías avanzadas que permitan salvar la extremidad. Una de éstas es la terapia a presión negativa ambulatoria.

Objetivo: Describir la evolución de una úlcera de pie diabético con exposición de tejidos profundos

Métodos: Paciente mujer de 59 años con diabetes tipo 2 mal controlada de 3 años de evolución, con hipertensión arterial y enfermedad renal crónica, quien había desarrollado una úlcera plantar PEDIS 4, secundaria a exéresis de heloma infectado; siendo hospitalizada y evaluada por traumatología, indicando amputación como única opción de tratamiento. Frente a negativa de la paciente; se abordó la úlcera con tratamiento médico, basado en antibiótico, desbridamiento, educación y terapia a presión negativa ambulatoria durante 2 semanas.

Resultados: Reducción del 58% del tamaño de la úlcera, alcanzando cicatrización en 14 semanas, controlando el exudado, evitando la amputación y manteniendo calidad de vida de la paciente.

Conclusiones: La TPN ambulatoria es una alternativa para los pacientes con UPD con exposición de estructuras profundas, que podrían ser tratados en la comodidad de su hogar para favorecer la cicatrización, manejados por un equipo multidisciplinario.

Palabras Clave: Pie diabético; úlcera de pie; terapia de presión negativa ambulatoria, amputación.

 

EP1553 Evitar amputación, sí se puede

David Belerda Pérez¹, Eva Ginard Cortés¹, Ana Requena Hernández^2
1Ibsalut - Gerencia de Atención Primaria de Mallorca, Palma de Mallorca, Spain, ²Ibsalut - Gerencia de Atención Primaria de Mallorca, Santanyí, Spain

Objetivo: Evaluar la efectividad de intervenciones a nivel multidisciplinar e identificar factores de riesgo de infección para prevenir re-amputaciones de pie en pacientes con diabetes de larga evolución.

Métodos: Se realizó un estudio descriptivo retrospectivo de una serie de casos de pacientes diabéticos previamente amputados. Se incluyeron pacientes mayores de 18 años con diabetes mellitus tipo II y seguimiento mínimo de 12 meses post intervención quirúrgica. Se revisaron las historias clínicas para extraer datos demográficos y clínicos, se analizaron las intervenciones y cuidados post quirúrgicos que habían recibido durante ese periodo de tiempo.

Resultados: Se seleccionaron cuatro casos de pacientes diabéticos sobre los que se realizaron intervenciones post-amputación para reducir factores de riesgo como la infección de herida quirúrgica y la osteomielitis. Dichas intervenciones incluyeron control glucémico intensivo, antibioterapia, desbridamiento y cuidados enfermeros especializados que demostraron ser efectivos para disminuir infecciones y cicatrizar las heridas post quirúrgicas en el menor tiempo posible, evitando nuevas amputaciones y mejorando la calidad de vida de los pacientes.

Conclusiones: Las estrategias terapéuticas personalizadas, el seguimiento continuo y un enfoque multidisciplinar en el paciente post amputado son esenciales para evitar infecciones que deriven en una nueva amputación. Un abordaje adecuado mejora el impacto sobre la salud y la calidad de vida de estos pacientes.

 

EP1554 Seguimiento enfermero proactivo en atención primaria: estrategia clave en la prevención de complicaciones del pie diabético

Beatriz Pinero Jimenez, Daniel de la Cruz Tomé, Alejandra Caballero Jiménez^1
1Consultorio El Escorial, Centro de Salud San Carlos, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain

Objetivo: Analizar el impacto de la captación activa en consulta de enfermería mediante llamadas telefónicas, como estrategia de control y seguimiento en pacientes diabéticos, y evaluar su efectividad en la prevención de complicaciones del pie diabético.

Métodos: Se realizó captación activa de pacientes diabéticos y hemoglobina glicosilada no controlada, mediante contacto telefónico, priorizando aquellos con alto riesgo de complicaciones. Se citó en consulta paciente masculino, 57 años, con antecedentes de diabetes mellitus, hipercolesterolemia e hipertensión arterial, tras evidenciarse manejo ineficaz de su patología, incumplimiento del régimen terapéutico, déficit de autocuidado, consumo excesivo de alcohol y dieta inadecuada, resultando en un control metabólico deficiente. En la evaluación se identificó una úlcera neuropática estadio B grado II en falange distal primer dedo pie derecho, de un año de evolución y signos de infección. La intervención interdisciplinaria incluyó curas locales, mediante preparación del lecho de la herida, apósitos antimicrobianos, antibioterapia oral y descarga de presión, orientadas a optimizar los procesos de cicatrización. Se abordó la deshabituación alcohólica y reinició tratamiento con antidiabéticos orales. El enfoque buscó optimizar la adherencia terapéutica, mitigar la progresión de la lesión y prevenir complicaciones mayores del pie diabético.
Resultados: Epitelización de la lesión, mejora del control metabólico, adherencia terapéutica y reducción significativa del consumo de alcohol.

Conclusiones: Este caso destaca la importancia de un enfoque proactivo y coordinado en la atención integral de pacientes diabéticos, logrando mejoras significativas en su salud física y emocional. La implementación de estrategias de seguimiento activo y educación en autocuidado, en consulta de Enfermería de Atención Primaria, resulta esencial para optimizar resultados clínicos, prevenir complicaciones, y fomentar la adherencia terapéutica en esta población de alto riesgo.

 

EP1025 Monitorización de la úlcera de pie diabético (UPD) mediante inteligencia artificial

Carlos Sánchez Sesma¹, Gabriel Rivera San Martín¹, Amaia Llodio Uribeetxebarria¹, Ibai Ureña Aramendia¹, Egoitz Barrena Lorente¹, María José Bartolomé Dominguez¹, Leire Ganzarain Valiente^1
1OSI Donostialdea, Osakidetza, San Sebastián, Spain

Objetivo: El objetivo ha sido elaborar una herramienta informática basada en inteligencia artificial (IA) que permita la detección temprana de complicaciones en las úlceras de pie diabético (UPD) y el despliegue de medidas correctoras.

Métodos: Se definieron los criterios de complicación basados en la evolución de superficie de la úlcera, la escala Resvech y los signos clínicos de infección. Además, se incluyeron datos referentes a la toma de cultivos, identificación del germen productor de la infección y antibiótico administrado. La IA, programada en lenguaje Python, trabaja sobre datos estructurados de la Organización Sanitaria Integrada en base al algoritmo establecido según los criterios de complicación descritos anteriormente. Este software, a través de un sistema de alertas en tiempo real, informa del retraso en la cicatrización de la úlcera o la presencia de criterios de infección. Todo este proceso automatizado permite a un clínico identificar precozmente la evolución tórpida de esas úlceras y proponer cambios en el manejo y derivación de las mismas.

Resultados: El análisis de los primeros datos ha permitido detectar problemas relacionados con la falta de medición seriada de la úlcera, la no realización de cultivos en presencia de signos de infección, así como la ausencia de tratamiento antibiótico.

Conclusiones: Este proyecto pretende ayudar en la detección temprana de complicaciones de la UPD ya que el retraso en las revisiones y la identificación de problemas se asocia con la falta de curación o la necesidad de amputación.

 

EP1555 Primera valoración del pie diabetico en atención especializada por enfermería

Inmaculada Descalzo Pérez^1
1H.U. La Paz, Madrid, Spain

Objetivo: Mejora en la detección precoz, establecer el tratamiento más adecuado lo antes posible y el seguimiento del Pie Diabético ulcerado de los pacientes que acuden a las consultas de atención especializada y Atención Primaria del área sanitaria.

Como novedad tiene la derivación directa de la enfermera de Atención Primaria que es la que sabe como evoluciona esa ulcera.

Métodos: La atención de esta consulta monográfica se destinará a:

Pacientes con pie ulcerado: Todos 1. Úlcera no infectada, 2. Infección leve: inicio de ATB en AP, 3. Infección moderada/grave: Remitir urgencias de HULP

La cita puede solicitarla médicos/o enfermeras, en primera consulta tanto desde AP como seguimiento de los pacientes ya tratados en Cirugía vascular del hospital.

Resultados: Se han atendido 100 pacientes procedentes de AP y AE de estas se han resuelto 50% . Han disminuido diametro de la lesion 26% y han sido amputados por motivos inevitables14%. Se han derivado de forma preferente a Cirugia vascular 9%, siendo atendidos en la siguiente semana el 100% de los mismos.

Conclusiones: Los resultados obtenidos reflejan el impacto positive de la consulta , destacando la importancia del diagnostico precoz, educación sanitaria y tratamiento integral que se realiza durante la exploración. El rol de la enfermera es vital no solo en la atención sanitaria sino tambien en la promoción de un enfoque emocional y fisico de autonomia del paciente.

 

EP1556 Resultados del tratamiento de úlceras de pie diabético con osteomielitis mediante microinjerto autólogo y terapia láser: serie de tres casos

Susana Zurro González¹, Gemma González Pérez², Cristian Javier Alquezar Larroya³, María Jesús Pardo Diez⁴, Joaquín Fidalgo Perniá⁵, Sara Chiquero Valenzuela⁶, Nuria Benito Goribar^1
1Centro de Salud La Puebla, Palencia, Spain, ²Centro de Salud Torquemada, Torquemada, Spain, ³Centro de Gestión Integrada de Proyectos Corporativos, Zaragoza, Spain, ⁴Hospital Royo Villanova, Zaragoza, Spain, ⁵Hospital General de la Defensa, Zaragoza, Spain, ⁶Hospital Universitario de Jaén, Jaen, Spain

Objetivo: Evaluar el efecto del tratamiento combinado de microinjerto autólogo y terapia láser en la cicatrización de úlceras neuroisquémicas en pacientes diabéticos con osteomielitis, enfocado en reducir el tiempo de cierre de la herida y mejorar la calidad de vida.
Métodos: Se estudiaron tres pacientes con diabetes mellitus tipo 2 y diagnóstico de osteomielitis, quienes presentaban úlceras neuroisquémicas crónicas en el pie (duración de seis meses a dos años). A cada úlcera se le aplicó microinjerto autólogo, precedido de preparación láser, seguido de sesiones continuas de láser junto con los microinjertos, para promover el cierre completo de la herida. Plan de cuidados: Taxonomía NANDA, NOC, NIC. La evolución fue monitorizada con registros de cicatrización, Resvech 2.0 y cuestionario Wound-QoL para evaluar la calidad de vida.
Resultados: Primer paciente, mujer de 65 años, la úlcera cicatrizó completamente en 119 días, 77 de ellos tras iniciar el tratamiento combinado, y su calidad de vida mejoró de 36 a 0 puntos en Wound-QoL. El segundo paciente, un hombre de 66 años, la herida cicatrizó en 29 días, cerrándose totalmente a los 13 días del tratamiento, con una mejora de calidad de vida de 25 a 0 puntos. El tercer paciente, de 83 años, alcanzó el cierre de su úlcera en 18 días, 11 de ellos tras el inicio del tratamiento, mejorando su puntuación de calidad de vida de 28 a 0 puntos.
Conclusiones: El tratamiento de microinjerto y terapia láser resultó en cierres rápidos y mejoras significativas en la calidad de vida de los pacientes, además de reducir el riesgo de complicaciones infecciosas. Estos hallazgos sugieren una alternativa terapéutica eficaz para úlceras neuroisquémicas en pacientes diabéticos con osteomielitis.

 

EP1557 Revisión sistemática: estrategia de cura en úlcera en pie diabético con terapia larval

Candela Martínez Agüero¹, Irene Abad Fernández², María del Carmen Navarro Navarro¹, Gema Sánchez López¹, Rocío Mellado Martín, Carlos Jiménez Zuheros^1
1Servicio Andaluz de Salud, Almería, Spain, ²Servicio Andaluz de Salud, Almeria, Spain

Objetivo: Analizar la eficacia de la terapia larval en la cura de úlcera en pie diabético. Definir el papel de la enfermería en la biocirugía.

Métodos: Se elabora una revisión sistemática siguiendo las recomendaciones de la declaración PRISMA. Las bases de datos empleadas fueron: LILACS, Medline, Cochrane y PubMed, utilizando la siguiente estrategia de búsqueda: ((“Diabetic Foot”[Mesh]) AND (“Larva”[Mesh])) AND (“Maggot Debridement Therapy”[Mesh])

Resultados: Se encontraron 24 artículos de los cuales 6 fueron seleccionados en la revisión sistemática, siendo evaluados mediante los niveles de evidencia y grados de recomendación de Joanna Briggs. Además, se siguió la declaración PRISMA para seleccionar los artículos.

El resultado más relevante de este trabajo es la evidencia encontrada del desbridamiento de la terapia larvaria en las heridas en paciente diabético.

Conclusiones: Elimina tejido no viable. Disminuye la carga biológica en heridas colonizadas.

Ayuda en el proceso de remodelación de la herida. Ayuda a disminuir los costos de tratamiento de las úlceras crónicas de MMII, en especial de origen diabético.

Necesario que la enfermera esté actualizada en la realización de las curas y mantenimiento de las larvas.

 

EP1558 Manejo multiterapéutico de biofilm en la lesión del pie post-amputación de una persona con diabetes: reporte de caso

Ana Paula dos Santos Albuquerque¹, Jeane Carla Fonseca de Jesus², Andressa Albuquerque³, Felipe dos Santos Ramiro da Silva⁴, Jéssica Alexandra Majevski Endlich Alexandra Majevski Endlich⁵, Maria Tereza Silva^6
1Hospital Regional do Agreste, Caruaru, Brazil, ²Clipodis, Vitória, Brazil, ³Cuida Bem - Enfermagem Especializada em Estomaterapia, Vitória, Brazil, ⁴Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), ⁴Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Brazil, ⁵Polícia Militar do Estado do Espírito Santo, Vitória, Brazil, ⁶Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil

Objetivo: Describir el tratamiento multiterapéutico de enfermería en una herida crónica compleja con biopelícula recurrente.

Métodos: Se presenta un caso clínico de herida de difícil cicatrización en un paciente con diabetes no controlada, después de la amputación de un dedo del pie. El seguimiento semanal en una clínica especializada duró 1 año y 5 días hasta la epitelización completa. En cada consulta se evaluaron signos vitales, glucemia capilar y características de la herida (tejido, exudado, bordes, perilesión, dolor, olor y extensión). Se realizaron análisis periódicos de hemoglobina glucosilada y glucemia en ayunas. Se emplearon diferentes terapias antimicrobianas tópicas y terapia láser de baja intensidad para combatir la biopelícula recurrente, con formación continua al cuidador
Resultados: La lesión mantuvo signos clásicos de biopelícula, como hipergranulación pálida y friable, exudado excesivo, esfacelo amarillo y textura viscosa, además de hiperqueratosis de los bordes, dolor con mala respuesta a analgésicos y mal olor. La biopelícula mostró resistencia a varias terapias antimicrobianas, presentando un desafío de manejo. La cicatrización avanzó tras el uso de apósito impregnado con acetato antimicrobiano y una sustancia hidrofóbica para retener la carga microbiana, en combinación con terapia fotodinámica, calzado terapéutico y capacitación del cuidador para el manejo en el hogar.
Conclusiones: Las heridas de difícil cicatrización son un reto complejo, requiriendo conocimientos actualizados de enfermería sobre apósitos y técnicas antimicrobianas coadyuvantes, junto con estrategias de educación en salud para abordar aspectos biopsicosociales que impactan en la adherencia y continuidad del tratamiento.

 

EP1754 El manejo de la herida mediante injerto en sello y terapia de presión negativa en pie diabético con amputación transmetatarsiana

Graziella Claveria Claveria¹, Luisa Hernández Collados¹, Pilar Gener Ferrero¹, Hernan Giordano^1
1Ibsalut, Area de salud de Menorca, MAO, Spain

Objetivo: Objetivo: Reducción significativa en el tiempo de cicatrización, control del dolor y disminución de costes con el uso sincrónico de injerto en sello y terapia de presión negativa (TPN). 

Método: Paciente varón de 80 años, diabético tipo 2, derivado a la unidad de curas tras ser

intervenido de amputación transmetatarsiana (TMT), por exposición ósea de miembro inferior derecho por pie diabético. Se realiza limpieza con cloruro de sodio y desbridamiento del lecho. Se extraen con punch y bisturí los microinjertos cutáneos dermoepidérmicos del muslo izquierdo tras administrar anestésico local, cubriendo la zona donante con apósito de alginato y un secundario de espuma de poliuretano. Se protege la piel perilesional con tiras hidrocoloides. Los injertos en sello se colocan en el lecho de la herida a 5 mm entre ellos, sin fijación, cubriéndolos con una interfase de silicona y espuma de poliuretano poroso y además film de poliuretano para sellar, puerto de succión en zona central y depósito de 300 ml en el dispositivo. Se aplica terapia continua a 125 mmHg dos días y posteriormente intermitente 5/2. Cura cada 4 días.

Resultados: Disminución del tamaño de la herida con un aumento de tejido de granulación. Su eficacia se asocia con una reducción del exudado y mejor inmovilización y sellado de los

injertos. Dolor menor 3.

Conclusiones: El uso de estas dos terapias simultáneas ha reducido el dolor y la TPN ha

favorecido la epitelización de la herida y el éxito de los injertos.

El uso de esta técnica sólo está contraindicada si existe exposición de huesos, tendones o nervios.

 

EP1559 Beneficios del prfg en pacientes con ulceras neuroisquémicas

Maria Isabel Chavarri Fuente¹, María Soledad Gómez Mendoza², Alicia Ibáñez Sáenz², Emma Gonzalez Gonzalez², Consuelo Casco Aguilar², Elena Cenalmor Lopez², Enar Rodríguez González^2
1SERIS, LogroñoSP, Spain, ²SERIS, Logroño, Spain

Objetivo: Valorar la evolución de las lesiones de cuatro pacientes pluripatológicos con diabetes mellitus y diagnosticados de úlcera neuroisquémica.

Favorecer y acortar el tiempo de cicatrización.

Métodos: Se realizan diferentes curas según el estado evolutivo de las lesiones, para favorecer el tiempo de cicatrización decidimos utilizar plasma rico en factores de crecimiento autólogo. La obtención del plasma se realiza mediante extracción de sangre al paciente, centrifugamos la muestra separando la parte hemática de la parte plasmática, con activación de esta última y finalmente procesando en estufa y emulsionador. Obtenemos una sustancia que podremos colocar posteriormente en la herida como líquido, matriz o serum. Realizaremos curas húmedas cada 3-4 días con diferentes apósitos, utilizando tecnología DACC, espumas… según control de exudado.

Resultados: Cada 10 días objetivamos una reducción de aproximadamente un 8% del lecho de la lesión.

Conclusiones: La aplicación del plasma rico en factores de crecimiento autólogo sobre lecho de heridas vaculares en pie diabético es un método eficaz y seguro para la resolución completa de las lesiones.

 

EP1560 Actuación del especialista ante la complejidad del manejo de la úlcera del pie diabético: relato de un caso

Lilian Reis¹, Juliana Lucinda dos Santos², Andrea Dultra^3
1Curali, Santo Estevão Bahia, Brazil, ²Prime Care cuidados integrados a ferida, Santo André, Brazil, ³Clinica CEMI Tratamentos de lesões, Salvador, Brazil

Objetivo: reportar la eficacia del tratamiento con un gel compuesto por cocamidopropil betaína, glicerina y polihexanida como antiséptico y desbridante en el tratamiento de las úlceras del pie diabético.

Métodos: Se trata de un estudio de caso. Seguí el caso a través de la fotografía. Estudio realizado en una clínica privada de cuidado de heridas desde el 06 de marzo de 2022 hasta el 21 de junio de 2022. Respetar los aspectos éticos de la investigación con seres humanos - Resoluciones Nº 466/2012 y 510/2016 del Consejo Nacional de Salud.

Resultados: Paciente masculino de edad avanzada, 65 años, diabético con diagnóstico de úlcera de pie diabético en hallux derecho, amputación previa secundaria a Enfermedad Arterial Obstructiva Periférica. Paciente con indicación de amputación, llevaba dos meses utilizando otras tecnologías, sin éxito. La irrigación se realizó con suero fisiológico y se aplicó un gel compuesto por cocamidopropil betaína, glicerina y polihexanida, y se cambió un protector de bordes con crema barrera con óxido de zinc micronizado cada 48 horas. Asociado al uso de 1 x a la semana de bolsas de ozonoterapia y terapia fotodinámica. Figura A: lesión con tejido inviable e hiperqueratosis en los bordes (06/03/2022), figura B: presencia de tejido de granulación (12/04/2022), figura C: contracción y reepitelización de la lesión (02/05/2022), figura D: tejido remodelado (21/06/2022).

Conclusión: Se puede observar la eficacia del tratamiento con un gel compuesto por cocamidopropil betaína, glicerina y polihexanida como agente antiséptico y desbridante en el tratamiento de las úlceras de pie diabético asociadas a terapias adyuvantes.

 

EP1561 Aplicabilidad de matrices dérmicas acelulares en úlcera de pie diabético

Clara de Cal Revilla¹, Ivan Martínez Moya¹, Javier Mateo Colilla¹, Ana Sanchez Micó¹, Marina Jimenez Liébanas^1
1Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo: Analizar la eficacia en la práctica clínica de apósitos que incluyan Matriz Dérmica Acelular (MDA) en personas con Úlceras de Pie Diabético (UPD), respecto a la seguridad de su uso y el tiempo de cicatrización.

Métodos: Revisión sistemática en bases de datos como PubMed, Wiley Online Library, Google Scholar y ClinicalKey. Se seleccionaron estudios clínicos y revisiones publicadas entre 2019 y 2024, excluyendo aquellos que no se centran específicamente en el tratamiento de UPD.

Resultados: Las complicaciones asociadas al uso de MDA son inferiores al 8%, con reducción notable en infecciones y la mayoría de los eventos adversos considerados leves. La aplicación de matriz dérmica redujo significativamente el riesgo de amputaciones totales, pero no afectó el riesgo de amputaciones menores, en comparación con el uso de apósitos retenedores de humedad (ARH). Se observó que un 70% de los pacientes con UPD no infectadas y no isquémicas lograron una cicatrización completa dentro de las 12 – 16 semanas, en comparación con ARH. La MDA tiene la capacidad de modular la cicatrización y contracción de la herida.

Conclusiones: Las MDA conforman una alternativa segura en el manejo de UPD. No solo disminuyen el tiempo de cicatrización, también brindan mejor calidad de vida en los pacientes. Se requieren más ensayos clínicos que evalúen mejoras en la práctica clínica y su eficacia en los pacientes, optimizando su aplicación respecto al uso de descargas y tratamiento con ARH; así como el control de la infección y abordaje de las limitaciones observadas.

 

EP1562 Trabajando en una piara con una úlcera de pie diabetico

Raül Martín Gargallo¹, Sonia Prada Girbal², Carme Rodriguez Forn², Anna Aguilera Deus², Enriqueta Diaz Pamies³, Marcel Garcia Calafi³, Sara Perera Encinoso^3
1Instituto Catalán de la Salud (ICS), La Sociedad Española de Heridas (SEHER), Associació d‘Infermeria Familiar i Comunitària de Catalunya(AIFIC), Santa Margarida De Montbui, Spain, ²Associació d‘Infermeria Familiar i Comunitària de Catalunya., IGUALADA, Spain, ³Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFiC), IGUALADA, Spain

Objetivo: Evaluar el proceso de curación y manejo de una úlcera de pie diabético con hueso expuesto en un paciente con problemas de salud mental de 50 años que trabaja en una granja de cerdos, considerando el riesgo de infección y las particularidades del entorno laboral.

Métodos: Se seleccionó como sujeto a un paciente masculino con diagnóstico de diabetes mellitus tipo2 con años de mal control, esquizofrenia, fumador y dedos en garra (en seguimiento por la Unidad de Pie Diabético de la zona), quien acude al centro de salud para curación de una úlcera en el tercer dedo del pie derecho con exposición ósea. Se implementó un protocolo de desbridamiento, limpieza de la herida con solución de ácido hipocloroso, hipoclorito sódico i electrólitos, aplicación de apósito hidrófobo con cloruro de diaquilcarbamilo, descarga, cambio de calzado para reducir la presión y antibióticos por vía oral.

Resultados: Durante el seguimiento, el paciente mostró una disminución del tamaño de la úlcera y la exposición ósea, con desarrollo de tejido de granulación en la cuarta semana. No se detectaron signos de infección activa, tras unas semanas, a pesar del entorno laboral.

Conclusiones: Un vínculo adecuado con el equipo referente de atención primaria es primordial en pacientes con factores de riesgo adicionales a sus antecedentes patológicos, como es el ambiente laboral. Es importante reforzar la adecuada adherencia al tratamiento y a las visitas de seguimiento en la evolución de la úlcera de pie diabético, en estos pacientes.

 

EP1563 Abordaje multidisciplinar en el manejo de un caso de pie diabético con debut de diabetes: a propósito de un caso

Maritxu Garate Mendieta¹, Laura Pomposo Ordiales¹, Janire Escalera Lana¹, Gorka Tejado Perez de Albeniz^1
1Hospital de Urduliz, Servicio de Hospitalización a Domicilio, Urduliz, Spain

Objetivo: Presentar el abordaje multidisciplinar en el manejo de un caso de pie diabético en un paciente con reciente debut de diabetes, destacando la importancia de la colaboración entre los distintos servicios de cirugía vascular, endocrinología y hospitalización a domicilio (HaD).

Métodos: Descripción del caso desde HaD, en seguimiento conjunto con los servicios de cirugía vascular y endocrinología. Se realiza en el domicilio curas regulares de la herida y educación diabetológica adaptada al paciente.

Resultados: Gracias a las curas y el seguimiento regular, se consigue estabilidad en las cifras de glucemia y evolución favorable de la herida, evitando cobertura quirúrgica posterior. Además, al ser el seguimiento por HaD, se reduce la estancia hospitalaria siendo beneficioso para la calidad de vida del paciente.

Conclusiones: Reflejar la importancia del abordaje multidisciplinar en el manejo de heridas complejas, especialmente en pacientes diabéticos con complicaciones macroangiopáticas. Se realiza un primer abordaje por parte del servicio de cirugía vascular, seguido de un control diario del servicio de HaD, quien actúa sobre la herida y sobre los hábitos para el manejo de la diabetes, respaldado por el servicio de Endocrinología. La intervención conjunta de los diferentes equipos optimizó el proceso de cicatrización, redujo el riesgo de complicaciones y mejoró la calidad de vida del paciente.

 

EP1564 Manejo de heridas en pacientes diabéticos: estrategias innovadoras

Carmen Pradas^1
1Osakidetza, Bilbao, Spain

Objetivo: Este resumen tiene como objetivo presentar estrategias innovadoras para la prevención y tratamiento de heridas en pacientes diabéticos, enfatizando la importancia de un enfoque multidisciplinario y el uso de tecnología avanzada.
Métodos: Se llevó a cabo una revisión de literatura y análisis de casos clínicos recientes que incorporan tecnologías como la telemedicina, aplicaciones móviles para el seguimiento del estado de la piel y dispositivos de monitoreo continuo de glucosa. Se involucraron equipos multidisciplinarios que incluyen endocrinólogos, enfermeros especialistas en heridas y nutricionistas.
Resultados: Los hallazgos indican que la implementación de tecnología, como aplicaciones que alertan sobre cambios en la piel y el uso de dispositivos de TPN, ha reducido significativamente las tasas de complicaciones en heridas diabéticas. La educación del paciente sobre el autocuidado y la gestión de la glucosa también mostró una correlación positiva con la mejora en los resultados de cicatrización. Además, los enfoques multidisciplinarios permitieron una atención más integral, abordando no solo el tratamiento de las heridas, sino también factores de riesgo asociados.
Conclusiones: Las estrategias innovadoras en el manejo de heridas en pacientes diabéticos demuestran ser efectivas en la prevención y tratamiento de lesiones. La integración de tecnología y un enfoque colaborativo entre profesionales de la salud son fundamentales para mejorar la calidad de atención y los resultados clínicos. Fomentar la educación y el autocuidado también es clave para empoderar a los pacientes en su proceso de recuperación.

 

EP1565 La aplicación única de matrices de ácido poliláctico promueve el cierre sostenido de úlceras de pie diabético: serie de casos

Virginia Polanco^1
1Regional Hospital Doctor Marcelino Vélez Santana, Santo Domingo, Dominican Republic

Objetivo: Las matrices de ácido poliláctico (PLA) han mostrado eficacia en el manejo de heridas crónicas, especialmente úlceras del pie diabético (UPD), mediante mecanismos como la neoangiogénesis, la deposición de matriz extracelular (MEC) y la modulación del pH, al liberar lactato en la herida y mejorar el microambiente para facilitar la cicatrización.

Métodos: Aplicación única de matrices de cierre de heridas de PLA.

Resultados: Esta serie de casos incluye seis pacientes con DFUs de grado 2 o 3 de Wagner. Tras el desbridamiento de las heridas, se aplicó una sola vez matriz de PLA. Las localizaciones incluyeron un dedo del pie, tres en el lateral del pie, una sobre el tendón de Aquiles y una en el maléolo. Tres heridas lograron el cierre total en 6 semanas, mientras que las restantes sanaron entre 12 y 15 semanas debido a su extension y profundidad. Todos los tratamientos fueron ambulatorios, sin complicaciones registradas.

Las matrices de PLA indujeron una transición notable de tejido necrótico y fibrinoso a granulación y epitelización. Durante las primeras 2-3 semanas, se observó un residuo bioactivo de PLA en la herida como una sustancia amarillenta-verde costrosa o líquida según la cantidad de tejido de granulación. Este residuo libera lactato, promoviendo angiogénesis, proliferación celular y deposición de MEC, lo cual facilita el cierre sostenido de la herida.

Conclusiones: Esta serie de casos demuestra la efectividad de una única aplicación de matriz de PLA en UPDs, facilitando un cierre sostenido y progresivo. La liberación gradual de lactato en el residuo bioactivo apoya la cicatrización en heridas crónicas, posicionando las matrices de PLA como una opción prometedora en el manejo de UPDs en entornos ambulatorios.

 

EP1566 Terapias con luz láser y fototerapia en la estimulación de la cicatrización en heridas de pie diabético

Barbara Gutierrez Royano^1
1Hospital Universitari Mutua Terrassa, Terrassa, Spain

Objetivo: Establecer la utilidad de la aplicación de terapia de luz de baja intensidad Low Level Laser Therapy (LLLT) y fototerapia en el tratamiento de las úlceras de pie diabético mediante revisión bibliográfica de metaanálisis, ensayos controlados aleatorizados, ensayos clínicos y guías clínicas. 

Métodos: Se realiza una revisión sistémica de publicaciones hechas entre 2008-2024 que evaluaban estas técnicas. En inglés, en las bases de datos PubMed, Cochrane Library y ClinicalKey con 54, 25 y 37 resultados respectivamente.

Los criterios de inclusión son los artículos publicados entre 2008 y 2024 en estas bases y en inglés. Los criterios de exclusión son las publicaciones previas a 2008 y con población no europea. 

Palabras clave: diabetic foot, LLLT, low level laser therapy, phototherapy, photobiomodulation, and diabetic foot ulcer. 

Resultados: Los estudios revisados concluyen que la LLLT fomenta la proliferación celular (fibroblastos y queratinocitos) y angiogénesis, aumenta producción de estructuras de soporte (colágeno tipo I, elastina) y microcirculación y activa el factor de crecimiento endotelial vascular (VEGF). La fototerapia con longitud de onda en rango infrarrojo estimula la actividad mitocondrial y producción de ATP en células lesionadas. Además, presentan una reducción de los marcadores proinflamatorios (TNF-alfa, IL-6). Combinado con terapias clásicas presenta una reducción del 30% del tiempo cicatricial. 

Conclusiones: Son técnicas emergentes con alto potencial para mejora de cicatrización de úlceras de pie diabético. Cuando se combinan con tratamientos estándar pueden acelerar la cicatrización reduciendo el riesgo de infección y amputación. Se requieren más estudios clínicos a gran escala para estandarizar los protocolos. 

 

EP1567 Uso del vendaje neuromuscular como terapia adyuvante en la cicatrización de úlcera neuroisquémica en pie diabético: reporte de un caso clínico

Susana Zurro González¹, Cristian Javier Alquezar Larroya², Gemma González Pérez³, María Jesús Pardo Diez⁴, Joaquín Fidalgo Perniá⁵, Sara Chiquero Valenzuela⁶, Nuria Benito Goribar^1
1Centro de Salud La Puebla, Palencia, Spain, ²Centro de Gestión Integrada de Proyectos Corporativos, Zaragoza, Spain, ³Centro de Salud Torquemada, Palencia, Spain, ⁴Hospital Royo Villanova, Zaragoza, Spain, ⁵Hospital General de la Defensa, Zaragoza, Spain, ⁶Hospital Universitario de Jaén, Jaen, Spain

Objetivo: Describir el uso del vendaje neuromuscular como terapia adyuvante en el tratamiento de una úlcera neuroisquémica en pie diabético.

Métodos: Se presenta el caso, mujer, 84 años con antecedentes de diabetes mellitus tipo 2, hipertensión, dislipemia y fibrilación auricular. El 31/01/2024, un roce de zapato provocó una úlcera en hallux valgus del pie izquierdo. La paciente fue tratada inicialmente con espuma de poliuretano plata, compresas y calzado de descarga, además de colagenasa con ácido hialurónico. El 5 de marzo, presento una infección, acudió a urgencias donde prescribieron amoxicilina clavulánico y se programó consulta con Cirugía General para el 10/05/2024. La valoración inicial de enfermera de la unidad de heridas complejas, tras plan de cuidados, taxonomia NANDA, NOC, NIC, mostró fascia hipodérmica expuesta y enrojecimiento perilesional >5 cm. El Wound-QoL-14, obtuvo puntuaciones Cuerpo 6, Psique 4 y Vida cotidiana 5 puntos; en EQ-5D-5L, puntuó 12 en 5D y 10 puntos en 5L. La escala RESVECH 2.0 resultó en 18 puntos. El índice tobillo-brazo fue 0.78 en miembro derecho y 0.75 izquierdo.

Resultados: En unidad de heridas, se inició tratamiento con agua y jabón, corticoide tópico y cloruro de diaquilcarbamilo, logrando escala RESVECH 6 puntos tras 3 días. Del 14 al 21 de mayo, se empleó povidona yodada y vendaje neuromuscular en “U”, curas cada 48 horas. A las 48 horas, la RESVECH fue 3 puntos. En 7 días, la herida estaba epitelizada y se dio el alta en 20 días, con puntuación de 0 en Wound-QoL-14 y mejoría en EQ-5D-5L.

Conclusiones: El vendaje neuromuscular resulta efectivo en la cicatrización de úlceras neuroisquémicas del pie diabético, mejorando los resultados clínicos y la calidad de vida.

EP1568 Salvación de una extremidad en riesgo: efectividad de un apósito de acción capilar rápida en el manejo de úlcera de pie diabético por artropatía de charcot

Érika Fondo Álvarez¹, Silvia Cerame Pérez¹, Emma Santiso Casanova¹, Nerea Fondo Álvarez¹, Elia Novo Fernández^1
1CMUC, Betanzos, Spain

Objetivo: Evaluar la efectividad de un apósito de acción capilar rápida para el tratamiento de úlceras neuropáticas en pie diabético con artropatía de charcot. Prevenir la amputación de la extremidad inferior de mal pronóstico. Evitar ingreso hospitalario. Optimizar la epitelización.

Mejorar la calidad de vida, promoviendo un enfoque conservar y ambulatorio.

Métodos: Varón de 73 años con diabetes mellitus tipo II, con una úlcera cavita plantar córnica (2021) asociada a artropatía de charcot, con exposición ósea, cavitaciones de hasta 3,6 centímetros y desestructuración anatómica significativa. Los cultivos identificaron patógenos multirresistentes. Frente a la recomendación inicial de amputación se aplicó un apósito de acción capilar rápida, con capacidad de presión negativa autóloga de mínimo -68 mmHg, aplicado tres veces por semana.

Resultados: A los seis meses la herida presenta una herida reducción significativa. Se observó la completa eliminación de cavidades y la formación de tejido de granulación. Sin signo de reinfección, lo que evitó el ingreso hospitalario y mejoró la calidad de vida del paciente.

Conclusiones: Este caso resalta la efectividad del apósito de acción capilar rápida como una alternativa innovadora y menos invasiva para úlceras de pie diabético. La preservación de la extremidad, junto con la disminución de la herida y calidad de vida, enfatiza la importancia de enfoques conservadores en estas situaciones, sin correr riego la vida del paciente. Además, es crucial el papel de enfermería en el manejo avanzado de heridas, promoviendo la autonomía y el confort del paciente.

 

EP1569 Manejo del paciente con úlcera de pie diabético

German Ortiz Zafra¹, Mario Sanchez Gonzalez^1
1Servicio Murciano de Salud, Murcia, Spain

Objetivo: El manejo del paciente con UPD pretende mejorar la cicatrización y prevenir complicaciones subyacentes graves, como, infecciones o amputaciones. El objetivo de este estudio es evaluar las estrategias terapéuticas más efectivas en este tipo de úlceras.

Métodos: La metodología empleada para la realización de este resumen se basó en una revisión sistemática de la literatura científica, con búsqueda en bases de datos como PubMed, Cochrane, Elsevier y Google Académico. Se incluyeron estudios publicados en los últimos diez años, utilizando términos clave, y se seleccionaron ensayos clínicos, estudios de cohorte y revisiones sistemáticas.

Resultados: Los resultados de los estudios consultados han demostrado que la combinación desbridamiento regular y apósitos avanzados favoreció la cicatrización con respecto al tratamiento estándar, mientras que la terapia de presión de negativa (TPN) ha reflejado su efectividad en úlceras profundas y con gran exudado, evidenciando una reducción en el tiempo de cicatrización. Además, los pacientes que recibieron educación sobre el control de la glucemia y el cuidado de los pies presentaron una menor recurrecia de UPD. Por otro lado, el empleo de dispositivos de descarga, también ayudó a la cicatrización y previno las recurrencias.

Conclusiones: En la discusión, se recalca la relevancia e importancia de un enfoque integral y multidisciplinario que combine tratamientos clínicos avanzados de manejo de heridas, educación del paciente (como principal medida de prevención) y técnicas de control glucémico para mejorar la calidad de vida. La intervención del equipo multidisciplinario, fue clave para reducir complicaciones en los pacientes diabéticos y acelerar la recuperación.

 

EP1032 Estimación de la prevalencia del pie diabético en una ciudad del nordeste brasileño dentro de la estrategia de salud de la familia

Jabiael Carneiro da Silva Filho¹, Priscila Farias Stratmann¹, Isabel Cristina Santos¹, Marilia Valenca¹, Samara Cecília Silva¹, Bruna Barbosa da Silva¹, Marcela Klyviann Bezerra de Vasconcelos^1
1Universidad de Pernambuco, Recife, Brazil

Objetivo: Estimar la prevalencia del pie diabético en una ciudad del noreste de Brasil y analizar los factores asociados a su aparición en pacientes registrados en la Estrategia de Salud de la Familia.

Métodos: Estudio transversal realizado con 2.022 prontuarios de pacientes diabéticos atendidos por la Estrategia de Salud de la Familia en siete regiones sanitarias del municipio estudiado. Los datos fueron recolectados mediante un instrumento validado y analizados con estadística descriptiva y analítica.

Resultados: La prevalencia estimada de pie diabético fue del 10%. Se observaron asociaciones estadísticamente significativas entre la aparición de pie diabético y las siguientes variables: grupo de edad de 61 a 90 años (RP: 1,56; IC95%: 1,19-2,06), consumo de alcohol (RP: 3,04; IC95%: 2,25-4,09), tabaquismo (RP: 2,91; IC95%: 2,17-3,90), diagnóstico de diabetes mellitus hace más de 10 años (RP: 1,58; IC95%: 1,18-2,11), glucemia ≥ 126 mg/dL (RP: 0,72; IC95%: 0,52-1,00), antecedentes de amputación (RP: 11,60; IC95%: 9,74-13,80), falta de orientación sobre nutrición (RP: 1,62; IC95%: 1,24-2,10), actividad física (RP: 2,02; IC95%: 1,49-2,75), cuidado de los pies (RP: 7,75; IC95%: 6,11-9,85) y falta de examen de los pies (RP: 6,30; IC95%: 4,95-8,01).

Conclusiones: La identificación de factores de riesgo modificables respalda la gestión pública, en particular el rol del enfermero en la atención primaria, para promover la educación del paciente, realizar exámenes de los pies y clasificar el riesgo adecuadamente.

 

EP1570 Tratamiento de úlcera con tendón expuesto en pie diabético

María Elena Teixidó Vallés¹, Ángela González García¹, Laia Lema Berart¹, María Estrella Pérez Vázquez^1
1Aran Salut, Vielha, Spain

Objetivo: Varón de 71 años diagnosticado de diabetes mellitus tipo 2 en 2008. Siempre ha presentado buen control metabólico con hemoglobina-glicosilada sobre 6%.

Métodos: Antecedentes: hipertensión, dislipemia, exfumador y neuropatía sin vasculopatía.

En diciembre 2023 acude a urgencias por aparición de mal perforante plantar en pie derecho con dolor y edema. Ingresa en hospital comarcal para tratamiento antibiótico endovenoso.

Valorado por cirugía vascular de hospital tercer nivel, se traslada para tratamiento específico. Inicialmente valoran amputación 1/3 distal del pie, finalmente proceden a desbridamiento extenso plantar con amputación digital transmetatarsiana de segundo y tercer dedo quedando expuestos los tendones de tercer y cuarto dedo en zona dorsal.

Cirugía vascular indica terapia por presión negativa que suspende al mes por evolución

tórpida. Posteriormente realizan injerto cutáneo que no resulta viable. Finalmente iniciamos curas tópicas desde atención primaria. Cuando comenzamos curas presenta herida de 7x6cm en zona dorsal del pie derecho, lecho con tejido de granulación con tendones expuestos, exudado seroso moderado, bordes difusos y eritematosos, piel perilesional íntegra, sin signos de infección. Iniciamos curas según evidencia con fomento de polihexanida/betaína, matriz de colágeno y espuma siliconada cada 48 horas. Presentó infección local con cultivo positivo a Pseudomonas aeruginosa tratada localmente con polihexanida/betaina gel en combinación con hidrofibra de hidrocoloide con plata según evidencia consiguiendo la cicatrización total en cinco meses.

Resultados: Concluimos que la contraindicación terapéutica en relación con la terapia de presión negativa e injerto cutáneo retrasaron el proceso de cicatrización.

Conclusiones: El empoderamiento y capacitación de enfermería en atención primaria rural favorecieron la resolución del caso.

 

EP1571 Uso de terapia de presión negativa en el abordaje de úlceras de pie diabético

María Alonso Gonzalez¹, Rebeca Sanz Paredes¹, Luis José Maderuelo García¹, Adrián Masa González¹, María Belén Arranz Diez¹, Luis Carlos Merino García^1
1Hospital Clínico Universitario de Valladolid, Valladolid, Spain

Objetivo: Evaluar la efectividad de la Terapia de Presión Negativa en el tratamiento de úlceras en pie diabético, analizando la cicatrización de la herida.

Métodos: Se realizó una revisión bibliográfica en PubMed, CINAHL, SciELO y Web of Science. Se seleccionaron revisiones sistemáticas, ensayos clínicos y estudios observacionales y de casos, donde se evaluaba la eficacia de la Terapia de Presión Negativa en úlceras de pie diabético.

Resultados: Se mostró que sobre la superficie del lecho de la herida, la Terapia de Presión Negativa reduce el área de la úlcera y acelera la formación de tejido de granulación. También se pudo comprobar que la Terapia de Presión Negativa reduce significativamente el tiempo de cicatrización en comparación con los tratamientos convencionales de cura húmeda.

Conclusiones: La Terapia de Presión Negativa resulta efectiva en la reducción del tamaño de las úlceras y en la aceleración de la cicatrización en pie diabético. Esta terapia puede ser una alternativa eficaz y segura en el tratamiento de este tipo de heridas.

 

EP1572 Colaboración interdisciplinar en el tratamiento de heridas cronicas: el rol del podologo como parte del equipo de trabajo

Adrian Montoya Ortega^1
1Hospital Universitario Toledo, Toledo, Spain

Objetivo: El objetivo de esta revisión bibliográfica es analizar la evidencia disponible sobre la colaboración interdisciplinaria en el manejo de heridas crónicas, con especial énfasis en el rol del podólogo. Se busca identificar cómo su participación mejora los resultados clínicos y reduce las complicaciones, especialmente en el tratamiento de las úlceras del pie diabético.

Métodos: Se realizó una revisión de la literatura en bases de datos científicas como PubMed, Scopus y Cochrane Library, utilizando términos clave como “heridas crónicas,” “úlcera del pie diabético,” “colaboración interdisciplinaria” y “podología.” Se seleccionaron estudios publicados entre 2010 y 2024 que evaluaran el impacto de la inclusión del podólogo en equipos interdisciplinarios para el manejo de heridas crónicas. Se analizaron los resultados en términos de tiempos de cicatrización, tasas de amputación y satisfacción del paciente.

Resultados: La revisión de la literatura muestra que la inclusión del podólogo en el equipo interdisciplinario reduce significativamente las tasas de complicaciones, como amputaciones, y acelera el proceso de cicatrización en pacientes con úlceras del pie diabético. Además, varios estudios subrayan un aumento en la satisfacción del paciente y una mejora en la calidad de vida, gracias a una atención más integral y especializada.

Conclusiones: La evidencia sugiere que la colaboración interdisciplinaria, con la participación activa del podólogo, va a ser esencial para mejorar los resultados en el tratamiento de heridas crónicas. La integración del podólogo en el equipo de trabajo debería considerarse una práctica estándar en las unidades de heridas.

 

EP1573 Exposicion osea en el pie diabetico: la importancia del abordaje multidisciplinar

Vanessa Gutiérrez Leon¹, Claudia Terradillos Gonzalez², Javier Varas de la Fuente³, Maria Isabel Blazquez Blanco⁴, Clara Jiménez Andrinal⁵, Ines Ruiz Blazquez^4
1Centro De Salud Ávila Sur-Oeste (Sacyl), Avila, Spain, ²centro De Salud Ávila Sur-Oeste (Sacyl), Avila, Spain, ³Residencia De Tercera Edad (Jcyl), Avila, Spain, ⁴Centro De Salud Cebreros (Sacyl), Avila, Spain, ⁵Centro De Salud De Sotillo De La Adrada (Sacyl), Avila, Spain

Objetivo: Evitar la osteomyelitis. Evitar la amputación. Promover la cicatrización precoz. Mantener un adecuado control glucémico. Favorecer la coordinación entre los diferentes profesionales

Métodos: Varón de 76 años con antecedentes personales de Diabetes Mellitus tipo 2 y artritis reumatoide en tratamiento inmunosupresor.

Acude a consulta presentando infección a nivel del lecho ungueal del primer dedo del pie derecho. Se inicia tratamiento antibiótico empírico con buen resultado y se deriva a Servicio de Podología, el cual procede a retirada de parte de la uña, exponiendo el lecho ungueal con exposicion ósea de la primera falange.

Se realiza exploración de pie diabético, obteniendo leve disminucion de la sensibilidad en dicha zona con Indice Tobillo Brazo en rango de normalidad. La radiografia muestra cambios degenerativos asociados a la edad en primera falange.

Se contacta telefonicamente con Unidad de Heridas Crónicas, que indican continuar con cura seca tal como se estaba realizando y ver evolucion.

Resultados: Tras 1 mes realizando curas en ambiente seco, se consiguió el cierre de la lesion, evitando complicaciones asociadas como osteomielitis y/o pérdida de la función del dedo.

Conclusiones: Un abordaje multidisciplinar asegura un manejo más eficaz y personalizado, mejorando los resultados a largo plazo y reduciendo el riesgo de secuelas graves como la amputación, promoviendo una mejor calidad de vida para el paciente.

 

 

APÓSITOS

EP1067 Estado actual del uso de apósitos que contienen óxido de cobre para el tratamiento de heridas crónicas

José-María Rumbo-Prieto¹, Luis Arantón-Areosa², Antonia Fernández-Vivero², Isabel Turnes-Cordeiro², Maria-Luisa Fraga-Sampedro², Sara Vázquez-Rumbo^2
1Universidad de A Coruña, Área Sanitaria de Ferrol. Servizo Galego de Saúde (Sergas), Ferrol, Spain, ²Área Sanitaria de Ferrol, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain

Objetivo: Revisar la literatura científica para determinar los resultados del uso de apósitos con óxido de cobre en heridas crónicas.

Métodos: Revisión sistemática de alcance. Pregunta de investigación: ¿Cuáles son los resultados del uso apósitos con óxido de cobre en heridas crónicas? Búsqueda en las principales bases de datos de ciencias de la Salud (PubMed, WoS, Scopus, DIALNET y CINAHL). Uso de descriptores MeSH/DeCs, selección y elegibilidad de estudios clínicos en humanos siguiendo las fases del diagrama de flujo PRISMA. Comparativa intraobservador a través de Rayyan. Nivel de evidencia según la escala JBI.

Resultados: Fueron seleccionados 16 estudios de diversa heterogeneidad y calidad metodológica (5 ensayos clínicos, 5 series de cohortes y 6 casos clínicos). La calidad de evidencia global fue de nivel 5 (evidencia baja). Los resultados observados manifiestan el potente efecto antimicrobiano y el rápido efecto cicatrizante de las sales de cobre en comparación con otros productos convencionales, así como su uso efectivo en úlceras tórpidas de diferente etiología y en heridas crónicas sobreinfectadas.

Conclusiones: Los apósitos con óxido cobre estimulan la angiogénesis y la formación de tejido de granulación acelerando la reepitelización; también tiene un efecto biocida y anti-biofilm evidente, posicionándose como alternativa al uso de otros apósitos antimicrobianos (las sales de plata), y como terapia adyuvante en cicatrización de úlceras tórpidas (complementando a la terapia de presión negativa). Aun así, los resultados no son concluyentes dada la escasa bibliografía y la baja calidad de los estudios revisados. Se necesita seguir investigando para obtener una mejor evidencia.

 

EP1071 Evaluacion de los signos biofisicos de la cicatrizacion en el uso protocolizado de un apósito de alata capilaridad

Miguel Ángel Mellado Sanz¹, Carmen Alba Moratilla², MªMercedes Martinez Delgado³, Bibiana Trevissor Redondo⁴, Monserrat del Peso Vidal⁵, Silvia Moran Lorenzo⁶, Remedios Nieto Carrilero^{7 7
1}Sacyl, Palencia, Spain, ²Asesoria profesional CISN, Valencia, Spain, ³Escuela de doctorados Universidad de Valladolid, Soria, Spain, ⁴Universidad de Leon, León, Spain, ⁵Hospital Ruber, Madrid, Spain, ⁶Sacyl, Salamanca, Spain, ⁷Gerencia de Atencion Integral Albacete, Albacete, Spain

Objetivo: Describir la eficacia de un apósito de alta capilaridad en la cicatrización de heridas crónicas, mediante la valoración de los parámetros biofísicos de la cicatrización, medidos mediante lámpara hiperespectral TIVITA.

Métodos: estudio cuasiexperimental analítico de serie de casos sin grupo control. Se aplica apósito de alta capilaridad y limpieza mediante toallitas limpiadoras con ácido hialuronico fosfolípidos y aloe vera. Se valora la evolución durante cuatro semanas. Se procedió a medir parámetros com pH, Tª de la lesión y perilesional, Sat. O2, Índice de perfusion (NIR), índice de agua tisular (TWI), e índice hemoglobina tisular (THI). Se recogieron datos de los signos clinicos de infeccion superficial y profunda, asi como nivel de dolor mediante escala analógica y tamaño de la herida mediante app Imito mesure.

Resultados: Se analizaron 8 pacientes con heridas crónicas, tres pacientes presentaban signos de infeccion superficial y profunda comprobada mediante cultivo microbiológicos positivos. A las cuatro semanas ningún paciente presentaba signos clinicos de infeccion. El dolor presentó una disminución significativa estadísticamente. Se produjo una reducción del área de la herida del 77,4% estadísticamente significativa. El pH disminuyo en 1 punto a lo largo de las cuatro semanas siendo estadísticamente significativa. La Sat.O2 aumento en 5,5 puntos aun sin significación estadística. Los índices NIR, TWI y THI disminuyeron, pero sin significación estadística.

Conclusiones: Los apósitos de alta capilaridad acompañados de una higiene previa de la herida, son efectivos para eliminar carga bacteriana y promover la cicatrización de las heridas crónicas mejorando los marcadores biofisicos de la cicatrización.

 

EP1146 Eficacia de los apósitos superabsorbentes en el control del exudado y la cicatrización de lesiones de difícil manejo

Sònia Gispert¹, Nuria García¹, Gemma Urbizu^1
1Hospital de Atención Intermedia Mutuam Güell, Barcelona, Spain

Objetivo: Demostrar la eficacia del uso de los apósitos superabsorbentes en lesiones complejas de difícil manejo y altamente exudativas.

Métodos: Paciente de 87 años que ingresa el 13/07/2023 en un Hospital de Atención Intermedia con el objetivo de restablecer la integridad cutánea.

Presenta Lesión por Presión IV en talón derecho de 6x5cm con exposición ósea. El lecho de la herida está hipergranulado, tejido friable, mal olor, bordes irregulares, exudado muy abundante y purulento. Zona perilesional macerada. EVA 8/10 durante las curas.

Se inician curas en ambiente húmedo con alginato más espumas de poliuretano, que fueron modificadas por la mala gestión del exudado e infecciones recurrentes. El 10/08/2023 se empiezan curas con cadexómero iodado, alginato, apósito de espuma y crema de óxido de zinc en bordes y zona perilesional c/48 horas, evolucionando desfavorablemente.

El 10/09/2023 se inicia la aplicación de apósitos de polímeros superabsorbentes c/72 horas junto crema de óxido de zinc en zona perilesional.

Resultados: El 13/01/2024 la lesión había reducido su tamaño hasta 2,5x1cm. Presentaba el lecho completamente granulado, leve exudado y sin signos de infección. La EVA se redujo a 2/10.

Los apósitos superabsorbentes gestionaron favorablemente el alto nivel de exudado, el mal olor, la carga bacteriana y el control del dolor.

Conclusiones: La utilización de un apósito superabsorbente es eficaz para la gestión de lesiones exudativas complicadas, acelerando la cicatrización y reduciendo complicaciones asociadas al exudado. Mejoran la calidad de vida del paciente reduciendo la frecuencia de los cambios de apósito y disminuyendo el dolor asociado a las curas.

 

EP1147 Apósitos con piel de pescado: una nueva alternativa

Alba Mira Moltó^1
1Centro de Atención Primaria CAP Les Planes, Barcelona, Spain

Objetivo: Determinar características, beneficios, indicaciones y contraindicaciones de los apósitos de matriz Omega3.

Métodos: Se llevó a cabo una revisión bibliográfica, acotada a los años 2019 y 2024. La búsqueda se realizó a través de las bases de datos “Pubmed” y “Science direct”, utilizando las palabras clave “Fish” AND “Dressings” AND “Wound Healing”. Tras la búsqueda, se incluyeron un total de 19 artículos.

Resultados: Dada la rápida respuesta migratoria del Omega 3 en las células tisulares, se evidencia una veloz respuesta terapéutica del apósito. Su efectividad ha sido demostrada en heridas con un lecho aséptico, sometidas previamente a desbridamientos quirúrgicos, con una perfusión tisular mínimamente adecuada y ubicadas en extremidades inferiores, en pacientes con patologías vasculares, diabetes mellitus y quemaduras. Su elevado contenido en ácidos grasos favorece la síntesis de metabolitos antiinflamatorios, la angiogénesis y disminuye la respuesta al dolor. No obstante, quedan contraindicados en lesiones de zonas poco vascularizadas, como tobillos y pies.

Conclusiones: Se concluye que estos apósitos han demostrado ser una opción de tratamiento ambulatorio viable en heridas complejas y quemaduras, por los beneficios antiinflamatorios, analgésicos y su control semanal.

 

EP1074 Estudio comparativo en pacientes con heridas crónicas con el uso de cura convencional versus sustituto de nanocelulosa (epicite balance)

Enrique Chau Ramos¹, Guillermo Wiegering Cecchi², Crhistian Chau Ramos^3
1Skin Medical, Lima, Lima, Peru, ²Clinica Javier Prado, Lima, Lima, Peru, ³Skin Medical, Javier Prado, Lima, Lima, Peru

Objetivo: Comparar los resultados con respecto a mejoría de la cicatrización; en pacientes con heridas crónicas utilizando cura convencional versus uso de sustituto de nanocelulosa Epicite Balance.

Métodos: Estudio comparativo de tipo analítico, retrospectivo. Se evaluó a 23 pacientes intervenidos con heridas crónicas de ambos sexos, con edades entre 18 a 79 años, cumpliéndose criterios de exclusión e inclusión. Que fueron atendidos en consultorio externo del Centro Especializado “Skin Medical”. Se tomo la medición en milímetros (mm). Con la medición de dimensiones basales (longitud mayor, longitud menor y profundidad); comparándose con mediciones secuenciales semanales desde la segunda a la octava semana.

Resultados:

Conclusiones: Se concluye que el uso de nanocelulosa brinda resultados eficientes y eficaces para la resolución de heridas crónicas complejas.

 

EP1148 Estudio sobre la eficacia del uso de apósitos de cloruro de diaquilcarbamilo combinados con antisépticos

Alejandra María Torrecilla Domínguez^1
1CAP Ramona Via, UDM AFiC Costa Ponent Metropolitana Sud, El Prat de Llobregat, Spain

Objetivo: Los apósitos antimicrobianos con acción hidrófoba mediante el cloruro de diaquilcarbamilo (DACC) han demostrado ser efectivos en la reducción de la carga bacteriana de las heridas. Pero en la práctica se ha extendido la realización de curas utilizando este tipo de apósitos combinados con antisépticos, el más común, la povidona yodada. El objetivo de este estudio es comprobar la eficacia de dicha combinación según la evidencia científica.

Métodos: Se realiza una búsqueda bibliográfica en las bases de datos SCIELO y PUBMED, también se consulta el prospecto de los apósitos con DACC.

Resultados: Según la bibliografía encontrada, los apósitos con DACC no deben emplearse con desinfectantes y antisépticos que se utilizan para limpiar la herida ya que alteran las propiedades hidrófobas de la superficie de los microorganismos. Así mismo tampoco debe usarse con pomadas y cremas grasosas, ya que estos inhiben las propiedades captadoras de bacterias del apósito.

Además, el uso de algunos antisépticos puede retrasar la cicatrización, causar irritación de la piel perilesional y tener posibles efectos citotóxicos en el lecho de la herida, especialmente con el tratamiento a largo plazo. También hay una posibilidad de desarrollar resistencias a los antisépticos haciendo uso generalizado de aquellos de baja concentración, como la povidona yodada entre otros.

Conclusiones: No se recomienda la combinación de apósitos antimicrobianos que utilizan la tecnología DACC junto con antisépticos, como la povidona yodada, ya que reduce el efecto reductor de carga bacteriana del apósito.

 

EP1149 Eficacia del uso de ácidos grasos hiperozonizados en lesiones de etiologías diversas

Agustina Orozco Cuadrado¹, Cristina García Laéz Camacho², Rosa Lopezosa Sánchez², María Piedad Garcia-Ruiz^1
1Servicio Andaluz de Salud, C.S San José, LINARES, Spain, ²Servicio Andaluz de Salud, LINARES, Spain

Objetivo: Demostrar la eficacia del uso tópico de los ácidos grasos hiperozonizados (AGHOZ) en el fortalecimiento de pieles desvitalizadas y la reparación de las lesiones cutáneas de diferente etiología.

Métodos: Presentación de una serie de 5 casos que se encuentran con la piel desvitalizada y/o que presentan daño cutáneo, de diferente etiología para constatar la eficacia de los ácidos grasos hiperozonizados (AGHOZ) a partir de la aplicación de dos productos que los contienen, ya sea de forma individual o conjunta según el criterio clínico: AGHOZ solución tópica con un 90% de AGHOZ y/o AGHOZ barrera protectora con efecto reparador con un 30% de AGHOZ

Resultados: Se obtuvieron tiempos de cicatrización y recuperación de la epidermis dañada más cortos de lo esperado y en comparación con la experiencia previa de las autoras con otros productos. Se redujo significativamente el eritema y los síntomas asociados como prurito, quemazón y ardor.

Conclusiones: Los ácidos grasos hiperozonizados (AGHOZ) corresponden a una matriz hiper concentrada en ozónidos bioactivos de efecto prolongado, su mecanismo de acción se relaciona con un efecto buffer sobre la piel o la mucosa, la producción de ceramidas endógenas , la liberación de factores de crecimiento (PDGF, TGF-β y VEGF) y una potente acción antioxidante exógena con activación del mecanismo antioxidante endógeno. Lo que en conjunto le confieren las propiedades para fortalecer pieles desvitalizadas, y recuperar todo tipo de daño cutáneo.

 

EP1150 El uso de apositos de fibras de alginato de calcio en zonas donantes de injertos de piel

Teresa Hernández Hernández, Laura Moya-Bustamante¹, Maider Lara Zabala¹, Sara Larraz-Giganto¹, Leyre Aldunate-Cia¹, María Agramunt-Renau, Arantxa Sales-Buj^1
1Osakidetza, Vitoria-Gasteiz, Spain

Objetivo: Conocer los beneficios y limitaciones de los apósitos de fibras de alginato cálcico en las zonas donantes de injertos de piel

Métodos: Búsqueda avanzada en PubMed y en Cochrane Library con los descriptores: “calcium alginate”; “wounds”; “graft donor areas”, entre los años 2010-2024, ensayos aleatorios controlados y revisiones sistemáticas a texto completo.

Resultados: Se han realizado unas tablas comparativas de los resultados obtenidos. Observamos que no hay diferencia en la duración del proceso de epitelización y el dolor que le puedan ocasionar las curas con los diferentes apósitos, pero si se observa un aumento de costos con el uso de apósitos de fibras de alginato de calcio frente al uso de otros apósitos.

También, se contemplan divergencias entre los diferentes estudios. En uno de los ensayos de control aleatorio, recoge que los apósitos de fibras de Alginato de Calcio aumentan la comodidad de los pacientes y disminuyen los cambios de apósitos, mientras que otro de los ensayos aleatorios recogidos, metaanálisis y revisiones sistemáticas obtuvieron el resultado contrario.

Conclusiones: El uso de apósitos de fibras de alginato de calcio en las zonas donantes de injertos de piel, tienen diferentes beneficios que pueden aumentar la calidad asistencial de los pacientes, pero debido a sus limitaciones, como es el aumento de costos del tratamiento, para justificar su uso rutinario habría que realizar estudios de análisis de rentabilidad de los mismo, ya que, según los estudios analizados, presentan unas características y beneficios similares a otros apósitos, siendo estos últimos una opción más económica para el tratamiento de zonas donantes de injertos de piel.

 

EP1151 El poder de la miel: avances naturales en el manejo de heridas

Nerea Gómez Almendral¹, Mireia Torres Signes², Luis Marti Santaolaria¹, Susana Castillo March^1
1CSI Alzira II, Valencia, Spain, ²CS Algemesí, Valencia, Spain

Objetivo: Conocer los beneficios terapéuticos de la miel en el tratamiento de las heridas.

Métodos: Se ha realizado una búsqueda bibliográfica de la literatura en bases de datos como Dialnet, Cochrane y PubMed, utilizando los descriptores “honey”, “wound healing”, “ulcer” y los operadores booleanos “and” y “or”, limitando la búsqueda a artículos en inglés y español de los últimos 5 años.

Resultados: La miel presenta propiedades antimicrobianas, siendo efectiva contra diversos patógenos como Staphylococcus aureus y Escherichia coli, lo que ayuda a reducir la carga microbiana en heridas y prevenir infecciones. Acelera la cicatrización mediante la reducción de la inflamación, la estimulación de la angiogénesis y el aumento de la actividad fibroblástica. Gracias a su efecto osmótico, disminuye el edema, favorece el desbridamiento y crea un ambiente óptimo en el lecho de la herida. Además, su alta viscosidad actúa como una barrera contra contaminaciones externas, protegiendo así heridas con alto nivel exudativo. Y, por último, mejora la experiencia del paciente ya que disminuyen el dolor en las curas, eliminan el mal olor y crean menos reacciones alérgicas al apósito.

Conclusiones: La miel representa una alternativa natural y segura para el manejo de heridas, gracias a sus propiedades antimicrobianas y su capacidad de acelerar la cicatrización, además de causar menos efectos secundarios que otros tratamientos.

Aunque los resultados son prometedores, se requiere más estudios controlados y ensayos clínicos para evaluar su eficacia y estandarizar el uso de la miel en la práctica clínica.

 

EP1152 Tratamiento de impétigo con membrana de ácido poliláctico. Prueba de concepto

Mario Aurelio Martínez-Jimenez¹, Ana Lorena Novoa-Moreno¹, Natalia Sanchez-Olivo¹, Víctor Manuel Loza González², Arturo Ortiz-Alvarez², Jose Ramirez-GarciaLuna

¹Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ²Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico

Objetivo: El impétigo es una infección bacteriana superficial de la piel, el tratamiento convencional incluye antibióticos tópicos u orales dependiendo de la gravedad de la infección. En los últimos años, la incorporación de nuevas tecnologías, como las membranas de ácido poliláctico, las membranas de ácido poliláctico, han ganado relevancia por su capacidad de acelerar la curación de heridas de espesor parcial, aunque no se ha demostrado su eficacia en impétigo.

Métodos: El objetivo de este estudio fue evaluar la eficacia del uso de la membrana de ácido poliláctico (Suprathel®) en el tratamiento de impétigo en adultos encontrándose en el cultivo Staphylococccus aureus basándose en una prueba de concepto con tres pacientes, determinando el tiempo de reepitelización y la disminución de la inflamación de la extremidad con la lesión medido por termografía. Se realizó un seguimiento de tres pacientes adultos diagnosticados con impétigo por cultivo, que fueron tratados con la membrana de ácido poliláctico y se les dio seguimiento por un período de 21 días.

Resultados: En los tres pacientes tratados con membrana de ácido poliláctico, las lesiones cicatrizaron completamente en un promedio de 7 días, sin observarse complicaciones significativas ni infecciones secundarias. Se observó regeneración cutánea más homogénea, una menor hiperpigmentación postinflamatoria y la calidad de la cicatrización fue completa. Con respecto a la termografía los tres pacientes disminuyeron la diferencia de temperatura de 1.5°c a 0.5° en un periodo de 3 semanas.

Conclusiones: El uso de la membrana de ácido poliláctico en tres pacientes con impétigo demostró ser una alternativa eficaz y segura al tratamiento convencional. Se requieren estudios adicionales con un mayor número de pacientes para confirmar estos hallazgos.

 

EP1153 Uso de apósito desbridante y antimicrobiano para la cicatrización de lesión talar en un paciente no revascularizable

Alegna Andrea Bártoli González¹, Juan Pedro García Medina¹, Serina Quintero Campos¹, Daniel Díaz Hernández¹, Cristina Rodríguez de Miguel^1
1Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

Objetivo: Describir el uso de un apósito desbridante y antimicrobiano para la cicatrización de lesión talar en un paciente no revascularizable.

Métodos: Estudio observacional descriptivo de un caso único de paciente con lesión isquémica en talón, no revascularizable, en el que se utiliza un apósito desbridante y antimicrobiano.

Se expone el caso de un varón de 87 años con diagnóstico de síndrome isquémico crónico de ambos miembros inferiores. Antecedentes personales: hipertensión, diabetes mellitus tipo 2, fumador, alcohol moderado. Durante su ingreso sufre una amputación mayor del miembro inferior derecho y presenta una lesión en talón izquierdo con tejido esfacelado

Resultados: Se realiza Plan de cuidados enfermero con taxonomía NANDA Internacional-II resultando como diagnósticos: Deterioro de la integridad cutánea, riesgo de infección, deterioro de la movilidad física y desequilibrio nutricional: inferior a las necesidades corporales

La localización en el talón la hace una herida compleja que puede generar una osteomielitis. Debido al proceso isquémico, optamos por realizar un tratamiento conservador, pero a la vez activo, con un apósito desbridante y antimicrobiano, de forma semanal. Logrando cicatrización en 2 meses como se observa en Imagen 1.

Conclusiones: Este apósito nos permite espaciar las curas, su retirada es atraumática y desbrida la herida, favoreciendo la epitelización. Disminuye los costos en material y tiempo, y beneficia al paciente, que suelen tener movilidad reducida y mucho dolor en las curas.

 

EP1154 Uso de apósito de fibras gelificantes en zonas donantes: una serie de casos

Alegna Andrea Bártoli González¹, Juan Pedro García Medina¹, Serina Quintero Campos¹, Daniel Díaz Hernández¹, Cristina Rodríguez de Miguel^1
1Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

Objetivo: Describir el uso de apósito de fibras gelificantes en zonas donantes de varios pacientes.

Métodos: Estudio observacional descriptivo de una serie de casos.

Caso 1: Varón 86 años intervenido de vaciamiento cervical que necesita reconstrucción con colgajo cervical. Antecedentes: hipertensión, dislipemia, carcinoma basocelular pigmentado. Varias cirugías por dermatología y cirugía maxilofacial por lesiones cutáneas.

Caso 2: Varón 62 años, que sufre accidente de tráfico con lesión por avulsión en pie derecho que debido a la pérdida de sustancia necesita reconstrucción con colgajo de piel autóloga. Antecedentes: hipertensión, artritis reumatoide en tratamiento con metrotexato.

Caso 3: Varón 35 años, sin antecedentes de interés con diagnóstico de síndrome cutáneo de patera, que necesita reconstrucción con colgajo autólogo en ambas extremidades inferiores.

Resultados: Se realiza Plan de cuidados enfermero con taxonomía NANDA Internacional-II resultando como diagnósticos: Deterioro de la integridad cutánea (00046), Riesgo de infección (00004), Dolor agudo (00132).

Conclusiones: Es importante optimizar los cuidados de las zonas donantes, ya que son heridas agudas que hemos creado para cerrar otra. Es esencial realizar un buen control del sangrado y exudado, evitar el dolor, y favorecer la cicatrización.

Los apósitos de fibras gelificantes de polivinilo de alcohol, son una buena opción para las zonas donantes porque retienen el exudado o sangrado formando un gel que hace que no se adhiera a la herida, que al retirar no dejen restos y la retirada sea atraumática, manteniendo la humedad óptima para favorecer la cicatrización. No destruimos el tejido neo formado y disminuimos el dolor en la zona.

 

EP1155 Eficacia del apósito hidroactivo en heridas con tejido necrótico

María Amor García Guillén^1
1UDM AFYC Costa Ponent Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain

Objetivo: Evaluar la eficacia del apósito hidroactivo en úlcera con tejido necrótico.

Métodos: Paciente de 75 años con úlcera en maléolo externo derecho provocada por vasculitis de recién aparición. Herida de 8x5cm de extensión con bordes irregulares y piel perilesional íntegra. Lecho de la herida con un 95% de tejido necrótico no fluctuante y resto con tejido esfacelar. Presenta escaso exudado seroso y no se aprecian signos de infección. Como intervención se aplica apósito hidroactivo para aportar humedad y facilitar el desbridamiento osmótico. Se aplica óxido de zinc en piel perilesional y apósito secundario de protección. Se realiza el seguimiento de la úlcera con curas continuadas cada 3 días.

Resultados: Tras 12 días de utilizar el apósito hidroactivo se consigue el desprendimiento del total de tejido necrótico presente en el lecho de la herida, mejora del tejido esfacelar y disminución de la extensión de la herida.

Conclusiones: El uso de apósito hidroactivo en úlcera con tejido necrótico demostró ser efectivo, aportando humedad a la herida al mismo tiempo que retiene exudado, evitando el empeoramiento de la piel perilesional y ayudando a la cicatrización y facilitando una buena evolución de la herida.

 

EP1156 Seguimiento de cura de úlcera venosa con apósito de membrana polimérica multifuncional

Noelia Martín Ruiz¹, Nuria Gordo Serra², Alexandra Simó Llavero^2
1Institut Catalá de la Salut, UD Atención Familiar y Comunitaria en Cataluña Central, Vic, Spain, ²Institut Catalá de la Salut, ABS Vic Nord, Vic, Spain

Objetivo: Mostrar los cambios de la herida aplicándose un apósito de membrana polimérica multifuncional (AMPM) en una paciente con una recidiva de úlcera venosa de tres meses de evolución, en la extremidad inferior izquierda.

Métodos: Mujer de 80 años con úlcera venosa recidivante de larga duración en la extremidad inferior izquierda. Independiente en las actividades básicas de la vida diaria. Valoración el primer día: T: tejido desvitalizado; I: no signos clínicos de infección; M: abundante; E: bordes difusos. Dolor en escala EVA de 8 sobre 10, interfiriendo en el sueño y en su calidad de vida.

Se inicia cura con apósito de membrana polimérica multifuncional y terapia compresiva con un sistema de compresión multicomponente de dos capas, formado por una venda inelástica de corta tracción y otra elástica de larga tracción. Se realizan las curas dos veces a la semana.

Valoración a las 4 semanas: T: granulación; I: no signos de infección; M: moderado; E: difusos con signos de epitelización. Dolor en escala EVA, 2 sobre 10. Reducción importante del área de la herida.

Resultados: Úlcera epitelizada tras 8 semanas con AMPM. Mejoría del dolor con un EVA de 2 tras 3 semanas utilizando AMPM, mejorando la calidad de vida y el descanso nocturno.

Conclusiones: Herida resuelta con apósito de fácil manejo y que reduce el dolor considerablemente. Se observa reducción de la inflamación de la zona afectada por la herida, acelerando así la cicatrización y mejorando la calidad de vida.

 

EP1157 Desbridamiento y granulación con hidrogel de aloe vera, en herida compleja

Graciela Cruz¹, Bibiana Baena^1
1Health & Life IPS, Bogotá, Colombia

Objetivo: Presentar el potencial de desbridamiento y granulación del hidrogel de aloe vera, en combinación con otros apósitos para el manejo de pie diabético de alta complejidad.

Métodos: Manejo observacional de la lesión a través de registro fotográfico semanal, el intervalo de curaciones cada 48 hr a 73 hrs, de acuerdo con la evolución del paciente, se realizaron lavados con solución NaCl al 0.9% y clorhexidina en la etapa inicial para control antimicrobiano, posteriormente, se manejó con solución NaCl al 0.9%, siempre se utilizó hidrogel de aloe vera como apósito principal para el proceso de cicatrización y se combinó inicialmente con apósito de hidropolímeros.

Resultados: En 5 meses se logró el cierre de la herida, aplicando tratamientos de desbridamiento autolítico con hidrogel de aloe vera, el cual aportaría los nutrientes esenciales para avanzar rápidamente en el proceso de granulación y epitelización de una herida de alta complejidad.

Conclusiones: El tratamiento correcto en el momento correcto haciendo uso de la herramienta TIME fue de valor para el éxito obtenido en el caso. La selección del hidrogel de aloe vera, en combinación con otros apósitos fue adecuada, ya que se logró el desbridamiento, granulación y epitelización, acelerando el proceso de cicatrización evitando reingresos a quirófano por desbridamientos de alto costo como los quirúrgicos y/o posibles amputaciones, mejorando así la calidad de vida del paciente que vive con DM 2. Si los pacientes con riesgo moderado a alto de pérdida de la extremidad y con lesiones complejas son tratados de forma adecuada, mejorarán notablemente su probabilidad de cicatrización y se podría disminuir el índice de amputaciones.

 

EP1158 3, 2, 1... Catálogo de apósitos para una consulta rápida

Juana Rituerto Cuerdo¹, Teresa López Nogales¹, Carlos López de Castro¹, Belen Pascual de la Fuente¹, Natalia Gómez¹, Nuria González Acebes¹, Sara Matesanz García^1
1Sacyl, Segovia, Spain

Objetivo: General: Dar a conocer y difundir el catálogo de apósitos entre los profesionales del Área de Salud.

Específico: Ofrecer un formato de información accesible, inmediato y atractivo para maximizar la comprensión (póster en formato papel y digital).

Parámetros Clave: Inmediatez, concreción, accesibilidad y digitalización.

Métodos: A través de una encuesta inicial, se identificó la necesidad formativa sobre apósitos. El catálogo fue definido y categorizado por características, composición e indicaciones clínicas, con códigos de colores para facilitar su uso. Cada apósito tiene un código QR hacia su ficha técnica y presenta iconos clave (duración, posibilidad de recorte, etc.). El material se difundió en formato póster y digital, complementado con sesiones formativas. Finalmente, se evaluó la satisfacción de los profesionales con una encuesta posterior.

Resultados: El 100% de los profesionales consideró el póster fácil de interpretar, y el 90% mostró una alta satisfacción con la información, señalando su utilidad en la práctica asistencial.

Conclusiones: La presentación visual, accesible y actual del catálogo generó un alto nivel de satisfacción. La combinación de elementos digitales y visuales, junto a la formación, podría disminuir la variabilidad en la práctica clínica y mejorar la gestión de productos. Investigaciones futuras pueden evaluar cómo estas estrategias impactan en la eficiencia clínica y la reducción de costos.

 

EP1159 A survey of Iberian healthcare professionals experience on gelling-fiber wound dressings usability and performance for different wound types

Ana Martins¹, Sinead Fahy², Monique Rennie³, Matthew Malone^4
1Mölnlycke Health care, Lisboa, Portugal, ²Mölnlycke Health care, Dublin, Ireland, ³Mölnlycke Health care, Toronto, Canada, ⁴Molnlycke Health care, Western Sydney University, Cardiff University, Gotheburg, Sweden

Aim: A post market survey was conducted of Iberian Health care Professionals (HCPs) user experience on the usability and performance of gelling-fiber wound dressings (Exufiber® and/or Exufiber® Ag+).

Method: HCPs were provided with a QR code for the Qualtrics platform survey questions between April and July 2024. Only HCPs with a minimum of 3 months clinical experience of using gelling-fiber wound dressings were eligible. HCPs were asked 12 questions for each type of gelling-fiber dressing; 10 questions included the rating of gelling-fiber wound dressings under different clinical scenarios and 2 questions included HCPs rating their overall impression and if they would recommend gelling-fiber wound dressings to colleagues. At the closure date of the survey, data was extracted by a blinded statistician for analysis.

Results / Discussion: 315 HCPs completed the survey. 190 HCP responses were for gelling-fiber dressings and 125 responses for gelling-fiber dressings with Ag+.

• 83% of HCPs in Spain indicated that both gelling-fiber dressings are extremely effective when it comes to one piece removal.
• 74% and 77% of HCPs rated the ability of gelling-fiber wound dressings to meet the clinical objectives of treatment as being extremely effective.
• 71% and 79% indicated that gelling-fiber wound dressings are extremely effective at facilitating patient comfort during wear.
• 68 and 77% of HCPs indicated that it is extremely effective at absorbing, retaining, and transferring exudate.
• 78% of HCPs rated gelling-fiber wound dressings Ag+ as being extremely effective at contributing to an infection management protocol.

Conclusion: The high percentages of extremely effective HCP responses demonstrate the clinical utility and performance of gelling-fiber wound dressings in the management of chronic wounds.

 

EP1160 Comparación de la eficacia de apósitos de alginato e hidrofibra de hidrocoloide en la cicatrización de úlceras exudativas

Amaia Fernández Alonso¹, Celia Aragón Ferrao^2
1Osakidetza, OSI Bilbao Basurto, Bilbao, Spain, ²Hospital Universitario de Basurto, Bilbao, Spain

Objetivo: Evaluar y comparar la efectividad de apósitos de alginato frente a apósitos de hidrofibra de hidrocoloide en términos de tiempo de cicatrización en úlceras, especialmente úlceras por presión y úlceras venosas.

Métodos: Se realizó una revisión de estudios controlados y ensayos clínicos en pacientes con úlceras crónicas tratadas con apósitos de alginato o hidrofibra de hidrocoloide. Se incluyeron estudios que analizaron tiempos de cicatrización, nivel de exudado, manejo del dolor y frecuencia de cambios de apósito. La muestra estuvo compuesta por pacientes adultos con úlceras moderadas a altamente exudativas, un criterio clave para el uso de ambos tipos de apósitos.

Resultados: Los estudios revisados indican que tanto el alginato como la hidrofibra de hidrocoloide son efectivos en la cicatrización de úlceras exudativas, pero el tiempo de cicatrización puede variar según el tipo de herida y las características del exudado. Los apósitos de alginato, que forman un gel al contacto con el exudado, mostraron una ligera ventaja en la velocidad de cicatrización en úlceras con exudado abundante debido a su mayor capacidad de absorción. La hidrofibra de hidrocoloide también mantuvo un ambiente húmedo adecuado y presentó resultados comparables en úlceras con exudado moderado, aunque con una frecuencia de cambio menor y menor adherencia a la herida, lo cual redujo el dolor durante los cambios.

Conclusiones: Ambos apósitos son efectivos para la cicatrización de úlceras exudativas, pero el alginato puede ser más adecuado para úlceras con exudado abundante, mientras que la hidrofibra de hidrocoloide es más conveniente en heridas con exudado moderado, con menos cambios de apósito y mayor comodidad para el paciente.

 

EP1161 El apósito de cobre en pacientes úlceras neuropáticas en pacientes con diabetes mellitus tipo 2

Roser Cabezas Mitjans^1
1ICS, Sant Boi de LLobregat, Spain

Objetivo: Evaluar el apósito de cobre en pacientes con Diabetes Mellitus II y con malos hábitos higiénicos en una úlcera neuropática.

Métodos: Se procede al seguimiento de la herida donde podemos apreciar con imágenes la evolución de la misma con un buen lavado y con el apósito de cobre, se puede ver la diferencia entre la herida al llegar a consulta y como queda después de un buen lavado, con ayuda de fomentos de Prontosan ( Agua purificada al 0,1%, Undecilenamidopropil betaína, 0,1%, Polihexanida), desbridamiento instrumental en alguna de las curas y agua con jabón. A partir de aquí el apósito de Cobre realmente consigue mejorar la herida y disminuir su tamaño.

Resultados: Vemos mejoría notable con el apósito de Cobre y con la limpieza previa que se realiza en cada cura, también hay que tener en cuenta que es un paciente que hay veces que no acude a las citas, y cuando la herida aparece realmente sucia y con poco autocuidado

Conclusiones: El apósito de cobre funciona en este tipo de heridas cuando hay primero una muy buena limpieza y nos permite una granulación/ epitelización de manera correcta y favorable. La limpieza ha de ser muy a consciencia y en nuestro caso el paciente no tienes buenos hábitos higiénicos, con lo cual el proceso se observa con más lentitud. Pudiendo afirmar que con mejores hábitos higiénicos, los resultados serían mucho mejores.

 

EP1162 Caso clínico: tratamiento integral para enfatizar la importancia de un abordaje holístico en el tratamiento de una herida de etiología venosa

María Hernández Cánovas ¹, Rosa Cruañes Mulet², Begoña Moral Vaño², Juliana Loaiza Buitrago^2
1CSI Jávea, Unidad Docente de Alicante, Alicante, Spain, ²CSI Jávea, Alicante, Spain

Objetivo: Evaluar un tratamiento integral de una úlcera venosa en paciente pluripatológica mediante un caso clínico.

Métodos: Mujer, 95 años con Diabetes Mellitus II, hipertensión e hiperuricemia. Acude por un desgarro grado III de origen traumático en región tibial interna derecha de 12cm, suturada con monofilamento 4/0. Presenta un ITB derecho 1,09 y analítica con hemoglobina glicosilada en rango terapéutico.

Se realizó una revisión bibliográfica en PubMed y Science Direct para determinar el tratamiento óptimo. Se inició tratamiento etiológico con un sistema de compresión multicomponente de 40 mmHg. A nivel local, se aplicó un apósito con fibras poliabsorbentes y tecnología lípido-coloide con plata que proporciona un desbridamiento continuo y acción bactericida, tratando los cuatro factores de la infección (exudado, microorganismos, biofilm y detritus). Una vez resuelta la infección, se cambió a un apósito con fibras poliabsorbentes y tecnología lípido-coloide con octasulfato de sacarosa para acelerar la cicatrización al reducir los niveles de metaloproteasas y mantener un desbridamiento continuo. Además, se proporcionó educación al paciente sobre autocuidado y control de la diabetes.

Resultados: El abordaje integral con tratamiento etiológico y local resultó en la cicatrización completa de la lesión en solo 4 meses con curas semanales.

Conclusiones: Los resultados muestran la eficacia de un abordaje terapéutico integral en el manejo de lesiones venosas. La combinación de terapia compresiva multicomponente, manejo local de la infección, la reducción de los niveles de metaloproteasas y educación al paciente demuestra ser una estrategia eficaz para optimizar la cicatrización.

 

EP1163 Creación de un algoritmo de elección de apósitos según el petitorio de la organización sanitaria

Ruth Martinez Valle¹, Arantza Landa Azaceta¹, Maria Arias Rueda¹, Teresa Muga Campo¹, Beatriz Ofelia Diaz Saiz¹, Maider Rojo Alonso¹, Maria Jose Trujillo Hoyo^1
1Osakidetza, Vitoria, Spain

Objetivo: Facilitar al personal con menor formación en heridas a elegir el apósito más adecuado para el abordaje de las lesiones. Evitando así el uso inadecuado de apósitos avanzados, favoreciendo la realización de curas de calidad y mejorando la costo-eficiencia de las curas realizadas. Disminuir la variabilidad entre profesionales a la hora de realizar las curas.

Métodos: Se recopilaron los apósitos más utilizados en la organización y se eligieron las características más relevantes que ayudan a la elección del apósito, en este caso fueron: Signos de infección, exudado, estado del lecho (presencia de fibrina) y profundidad. Además se incorporó la limpieza y tratamiento del biofilm, el cuidado de los bordes de la lesión, así como la importancia del mantenimiento de humedad y temperatura adecuados en la elección del apósito secundario si fuera necesario.

Resultados: Los profesionales mostraron mayor autonomía a la hora de elegir el apósito y menor variabilidad a la hora de realizar las curas. Tuvo muy buena acogida entre los profesionales ya que lo valoraron como una herramienta muy útil para realizar su trabajo.

Conclusiones: Disponer un algoritmo de elección sencillo y de fácil manejo y accesible, permite estandarizar los criterios de cura, así como ayudar al personal más inexperto en la toma de decisiones.

 

EP1086 Efecto cicatrizante del sevoflurano tópico como tratamiento coadyuvante en úlceras tórpidas

José-María Rumbo-Prieto¹, Luis Arantón-Areosa², Javier Sanchez-Galvez^3
1Departamento de Ciencias de la Salud. Universidad de A Coruña, Área Sanitaria de Ferrol, Servicio Gallego de Salud (Sergas), Ferrol, Spain, ²Servizo Galego de Saúde (Sergas), Área Sanitaria de Ferrol, Ferrol, Spain, ³Universidad Católica de Murcia, Facultad de Enfermería, Cartagena, Murcia, Spain

Objetivo: Revisar la literatura científica para determinar los resultados del uso tópico del sevoflurano en úlceras crónicas con retraso en la cicatrización.

Métodos: Revisión sistemática de alcance según la metodología JBI. Pregunta de investigación: ¿El sevoflurano tópico favorece la angiogénesis epitelizante en úlceras tópridas? Búsqueda en las principales bases de datos de ciencias de la Salud a través de Ebsco: PubMed, WoS, Scopus, EMBASE y CINAHL Uso de descriptores MeSH/DeCs, selección y elegibilidad por pares (intraobservadores) de estudios clínicos en humanos, siguiendo las fases del diagrama de flujo PRISMA 2020.

Resultados: De un total de 27 artículos potenciales, se seleccionaron y revisaron 11 de características heterogéneas por tipo de lesión (lesiones por presión y úlceras vasculares) y por estudio clínico (cohortes y serie de casos clínicos). Se observó que el sevoflurano tiene un efecto vasodilatador que mejora la microcirculación, aumentando el proceso epitelizador e inhibe el proceso inflamatorio del lecho ulceral, pero no es concluyente. Así mismo, se determinó que el coste-efectividad del uso del sevoflurano tópico como alternativa terapéutica cicatrizante en úlceras crónicas complejas, sugieren un ahorro y cierta mejoría progresiva en la cicatrización, pero no es significativa.

Conclusiones: No hay una recomendación de evidencia fuerte que avale la eficacia cicatrizante del sevoflurano tópico por la baja calidad de los estudios publicados, debiéndose usar de forma limitada y bajo la premisa de “uso compasivo”. Las líneas de experimentación con nuevas formulaciones farmacológicas del sevoflurano en formato gel y en microesferas resultan prometedoras para su uso rutinario de cara al futuro.

 

EP1164 Evaluación de la eficacia, tolerancia y aceptabilidad del apósito tlc en el tratamiento local de lesiones cutáneas de epidermólisis bullosa

Natividad Romero Haro¹, Macarena Ramirez², Jose Miguel Gallego^3
1DEBRA Spain, Marbella, Spain, ²Laboratorios URGO, Hernani, Spain, ³Laboratios URGO, Barcelona, Spain

Objetivo: Evaluar la eficacia y seguridad de un apósito 100% lípido-coloide extra-flexible, en la cicatrización de lesiones cutáneas en pacientes con Epidermólisis Bullosa (EB). Los objetivos secundarios incluyen la evaluación del dolor al retirar el apósito, la tolerancia al tratamiento, la condición de la piel perilesional y la aceptabilidad del apósito por parte de los profesionales de salud y los pacientes.

Métodos: Este estudio de serie de casos incluyó 15 pacientes con diagnóstico de EB. El tratamiento con un apósito 100% lípido-coloide extra-flexible se aplicó hasta 4 semanas, con 12 visitas de evaluación programadas para documentar el progreso de cicatrización, el dolor y la tolerancia. Se evaluaron parámetros como el estado de la herida y la facilidad de colocación y retirada del apósito.

Resultados: Un alto porcentaje de lesiones presentaron una evolución favorable en 4 semanas, definida como una reducción de al menos el 40% de la superficie inicial. Además, la adherencia al tratamiento fue alta reduciendo el dolor al retirar el apósito.

Conclusión: El apósito 100% lípido-coloide extra-flexible proporcionó un tratamiento seguro y efectivo para las lesiones de EB, favoreciendo la cicatrización y mejorando la calidad de vida de los pacientes al reducir el dolor y el trauma durante el proceso de curación.

 

EP1165 ¿Hay relación entre la variabilidad de tratamiento y la etiología y severidad de las heridas?

Diana Herrera-Valenzuela¹, Jose Manuel Rosendo Fernandez^2
1Gradiant, Vigo, Spain, ²Complejo Hospitalario Universitario de Pontevedra Área sanitaria Pontevedra-Salnés, Pontevedra, Spain

Objetivo: Cuantificar la variabilidad del tratamiento para cada etiología y categoría de herida.

Métodos: Con el registro de heridas de 2023 de un área de salud que atiende aproximadamente a 301.664 habitantes se calculó la frecuencia para cada etiología y categoría de herida, y el número de productos diferentes que se utilizaron para cada una de ellas.

Resultados: Se recuperaron 5323 heridas. Las ubicaciones de las heridas se muestra en la Figura 1. La mayoría de ellas eran heridas por presión (Figura 2). En las figuras 3 y 4 se resume la frecuencia de cada etiología por nivel de clasificación (tamaño de la burbuja) y el número de productos diferentes aplicados a cada subgrupo, para heridas crónicas y agudas respectivamente.

Existe un patrón de mayor variabilidad del tratamiento con respecto a una mayor frecuencia de heridas pero no hay una tendencia al aumento de la variabilidad del tratamiento relacionada con el aumento de la categoría de la herida para ninguna etiología. Sin embargo, para las categorías más altas de todas las etiologías, excluyendo las heridas por presión y quirúrgicas, el número de productos diferentes utilizados es mayor que el número de heridas tratadas. Estas son heridas más complejas con características como infección o exudado abundante que requieren más productos de tratamiento para tratar adecuadamente la herida. El mismo patrón se observa para las heridas arteriales y del pie diabético de las categorías 2º y 3º, y 3º de lesiones cutáneas asociadas a la humedad (LESCAH).

Conclusiones: La estadística descriptiva muestra una mayor variabilidad en el tratamiento de las heridas arteriales, de pie diabético y de LESCAH de categorías superiores a 1º.

                    

EP1166 Tratamiento local de la radiodermitis

Paula Gomez Fauro¹, Alicia Rodríguez Sánchez^1
1Hospital Galdakao-Usansolo, Bilbao, Spain

Objetivo: Evaluar la efectividad de los tratamientos locales en la radiodermitis, una complicación común en pacientes que reciben radioterapia, con el fin de mejorar la calidad de vida y la curación de la piel afectada.

Métodos: Se llevó a cabo una revisión bibliográfica en bases de datos como PubMed y Scielo, buscando artículos publicados en los últimos diez años. Se utilizaron términos de búsqueda como “radiodermitis”, “tratamiento local” y “cuidado de la piel”. Se seleccionaron estudios que evaluaban diferentes enfoques terapéuticos, incluidos cremas tópicas, apósitos hidrocoloides y tratamientos con láser.

Resultados: El tratamiento de la radiodermitis debe ser individualizado y basarse en la severidad de la lesión. Las manifestaciones tempranas pueden requerir cuidados básicos de la piel cremas emolientes y corticosteroides tópicos mostró una disminución significativa de los síntomas como enrojecimiento y dolor. Los apósitos hidrocoloides también se asociaron con una mejora en la hidratación de la piel y la reducción del riesgo de infecciones secundarias

 Las manifestaciones tardías, en cambio, necesitan tratamientos más complejos, incluyendo terapias con láser, desbridamiento de úlceras y, en casos más graves, cirugía reconstructiva.

Conclusiones: El tratamiento local de la radiodermitis es fundamental para el manejo de los efectos adversos de la radioterapia. La combinación de cremas emolientes, corticosteroides y apósitos especializados puede mejorar significativamente los resultados clínicos. Es necesario que el personal sanitario esté capacitado en el manejo de la radiodermitis para optimizar el bienestar de los pacientes. Se requieren más investigaciones para estandarizar protocolos de tratamiento y evaluar la efectividad a largo plazo.

 

EP1087 Etudio retrospectivo y análisis del consumo de apósitos en un área sanitaria

Jose Antonio Esperón Güimil¹, Jose Manuel Rosendo Fernandez², Ana María Bello Jamardo³, Ana García Fernández², María Teresa Loureiro Rodríguez^2
1Área Sanitaria de Pontevedra e O Salnés, C.S. Anafáns-Poio-Pontevedra, Pontevedra, Spain, ²Área Sanitaria de Pontevedra e O Salnés, Pontevedra, Spain, ³Área Sanitaria de Pontevedra e O Salnés, Hospital do Salnés, Pontevedra, Spain

Objetivo: Calcular el consumo de apósitos en una década, así como su montante económico, en el Área Sanitaria, determinando aquel más solicitado por los profesionales.

Métodos: Estudio descriptivo retrospectivo. Se descargó la información recogida en la base de datos de SICAH (Sistema de Información de productos de Cura en Ambiente Húmedo) desde el año 2014 al 2023. Se recogieron los consumos de los apósitos que forman parte de los Catálogos del Servicio de salud de la Comunidad Autónoma. Se tabularon los apósitos solicitados por los profesionales y su montante económico, realizándose un Top ten de los distintos años.

Resultados: El total de apósitos solicitados en ese periodo ascendió a 2.403.317 unidades, de los cuales un 59,4% correspondió a la suma de la totalidad de apósitos que forman el Top ten de cada año. El año 2018 aparece como el de mayor número de apósitos solicitados (276.055) frente al año 2014 que fue el año de menor número de solicitudes (191.000).

Desde el año 2018 el producto más solicitado corresponde a un apósito de 7.5x7.5 cm, adhesivo hidrocelular trilaminar con bordes (7,2% sobre el total de los apósitos solicitados).

El coste total en esta década ascendió a 4.456.200€, siendo el año 2018 el de mayor consumo con 471.703 €.

Conclusiones: Un apósito de pequeño tamaño se destaca como el más solicitado por los profesionales. Eso puede ser debido a que las heridas se detectan en un estadio temprano y por tanto son menor superficie. Esta evolución nos llevará, sin duda, a una nueva estrategia primando productos de menor formato.

 

EP1167 Coste/beneficio de apósito de hidropolímero tras implantación de marcapasos versus apósito simple

Africa González Manzano¹, Beatriz Ollero Pacheco¹, Maria Jose Valle Hidalgo¹, Mercedes Ramon Garcia^1
1Hospital Universitario Virgen del Rocío, Sevilla, Spain

Objetivo: El marcapasos cardíaco artificial es un generador de impulsos eléctricos que ralentiza la actividad eléctrica del corazón y según su mecanismo, desencadenan impulsos eléctricos.

El dispositivo se introduce debajo de la piel, cerca de la clavícula, precisando una incisión quirúrgica para su implantación, que necesitará cuidados enfermeros postoperatorios.

Tras la implantación de forma habitual se recomiendan curas diarias de la herida quirúrgica, aplicando clorhexidina/povidona yodada con apósito de gasa.

Métodos: Realizar CURAS ESPACIADAS en el tiempo, usando un apósito estéril transparente con una almohadilla de hidropolimero delgada y absorbente, que mantendrá la herida limpia y lista para la epitelización, permitiendo un control visual permanente para evaluar el progreso terapéutico de la herida.

Características del apósito:

Indicado en heridas agudas secas y con exudado leve.

Resistentes al agua.

Flexible y elástico, adaptándose a las partes contorneadas del cuerpo y a las articulaciones, ofreciendo una adhesión fiable a pesar de los movimientos y el uso.

Permeable al aire y vapor de agua.

Transparente.

Protege frente a virus y bacterias.

Resultados: Los datos recogidos demuestran que los pacientes tratados con el apósito de hidropolimero tienen una incidencia de infección nula.

Los indicadores subjetivos de satisfacción y confort sugieren una mayor aceptación de los cuidados recibidos por los pacientes valorando las respuestas recibidas en ambos grupos

Conclusiones: Las curas realizadas con apósitos de hidropolímero han demostrado prevenir de una forma más eficaz las infecciones asociadas a manipulación y manejo de las heridas quirúrgicas por inserción de marcapasos.

 

EP1168 ¿Son eficaces los apósitos de sacarosa en el manejo de la úlcera del pie diabético no infectada?

Marina Bernal Ros¹, Alba Díaz Ros^1
1Sistema Murciano de Salud, Murcia, Spain

Objetivo: Evaluar la eficacia de los apósitos impregnados con octasulfato de sacarosa en el tratamiento de úlceras por presión en el pie diabético (UPD) no infectadas

Métodos: Se realizó una revisión bibliográfica de múltiples fuentes, incluyendo una revisión sistemática (RS) del Comité de Evaluación de Tecnologías Sanitarias de Ontario, que evaluó eficacia, seguridad y costo-efectividad de estos apósitos en UPD y úlceras venosas (UV) en adultos con diabetes tipo 1 y 2. Un ensayo controlado aleatorizado (ECA) doble ciego que incluyó 240 pacientes de hospitales europeos con UPD no infectadas, asignados a apósitos con octasulfato de sacarosa o apósitos neutros, con evaluación durante 20 semanas. Además de guías internacionales: del Grupo de Trabajo Internacional sobre el Pie Diabético, del NICE y la Guía de Práctica Clínica australiana).

Resultados: RS: Los apósitos con octasulfato de sacarosa redujeron el tamaño de las úlceras, mejoraron la calidad de vida (reducen dolor y ansiedad) y demostraron seguridad. La evaluación económica sugiere que son rentables debido a una cicatrización más rápida. ECA: Al finalizar 20 semanas, el 48% del grupo tratado alcanzó cierre completo de la úlcera frente al 30% en el grupo control, una diferencia significativa del 18% (p = 0.002). Guías internacionales: Respaldan el uso de estos apósitos en úlceras no infectadas y de difícil cicatrización como tratamiento complementario.

Conclusiones: Los apósitos con octasulfato de sacarosa son una opción efectiva y segura para el tratamiento de UPD no infectadas, mejorando la cicatrización y calidad de vida, y pueden resultar en ahorros de costos si se financian públicamente.

 

EP1169 Efectividad de la cobertura de poliexametilenbiguanida (phmb) en el tratamiento del proceso inflamatorio y/o infeccioso durante la inserción del fijador externo

Kelly Cristina Della Rovere¹, Carolina Barbui de Arruda¹, Julia Silva Del Bello¹, Gabriella Monique Alves dos Santos^1
1AACD, São Paulo, Brazil

Objetivo: Evaluar la efectividad del uso de apósitos PHMB en el tratamiento de signos de inflamación durante la inserción de un fijador externo.

Métodos: Estudio observacional y retrospectivo, recolectado entre abril de 2022 y abril de 2024, mediante un cuestionario desarrollado por los autores, disponible electrónicamente a través del sistema Tasy HTML5®. Las pruebas realizadas consideraron un intervalo de confianza (IC) del 95% de dos vías (valor p) de 0,05. La efectividad de la cobertura del PHMB en el tratamiento de los signos flogísticos se evaluó con base en las descripciones en los registros médicos después de identificada la complicación.

Resultados: La literatura científica ha demostrado una creciente adherencia entre los profesionales de la salud al uso de PHMB para el tratamiento de heridas. En este estudio se evaluaron 125 historias clínicas, observándose que 80 pacientes presentaron signos flogísticos luego del implante del fijador externo, de los cuales 57 (71,25%) utilizaron cobertura PHMB y se encontró que 40 (70,2%) mostraron mejoría y no requirieron antibióticos, mostrando que el uso de un apósito con acción antimicrobiana en la interfaz piel-pin puede ser una opción beneficiosa para prevenir infecciones de la piel.

Conclusiones: Se observó una mejora significativa en los pacientes que utilizaron la cobertura de PHMB en el tratamiento de los signos de inflamación durante la inserción del fijador externo. Sin embargo, es necesario aumentar el número de muestra para alcanzar un valor de significancia (valor p<0,05) que respalde esta evidencia.

 

 

EDUCACIÓN

EP1107 Infografías para la valoración y prevención de LCRD por pacientes y/o cuidadores

María del Carmen Rodriguez Torres¹, Juana Mª Díaz Martínez^1
1Hospital Universitario de Jaén, Jaén, Spain

Objetivo: Desarrollar infografías para ayudar a cuidadores de personas con lesiones cutáneas relacionadas con la dependencia (LCRD) o en riesgo de desarrollarlas basada en la escala de valoración y prevención desarrollada por el GNEAUPP

Métodos: Se analizaron las recomendaciones vertidas en el documento de posicionamiento nº 14 del GNEAUPP titulado Herramientas para cuidadoras de pacientes con heridas crónicas, concretamente en su apartado 6.2 de herramientas formativas. Posteriormente se intentó transcribir las recomendaciones de cada sub-escala a un formato más visual que fuera más atractivo y fácil de seguir por los pacientes y/o sus cuidadores

Resultados: Se han desarrollado seis infografías, una por cada subescala, siguiendo una estructura común. En la parte superior figura el nombre de la sub-escala acompañada de una imagen representativa. En la parte izquierda de la misma figuran los cuatro niveles de riesgo con su definición y una imagen alusiva y en la parte derecha se presentan las recomendaciones de prevención fundamentales que tienen que desarrollar el paciente y/o los cuidadores, jugando con los tonos de color, desde más claros (sin riesgo) a más oscuros (riesgo alto) de forma que puedan valorar y prevenir al mismo tiempo con una sola acción.

Conclusiones: La infografía de la escala de valoración y prevención del riesgo de desarrollar LCRD se presenta como una herramienta formativa, intuitiva, fácil para cualquier cuidador y de rápido acceso, de forma que pueda ser consultada y utilizada por personas con poca experiencia en el cuidado de estas lesiones. Además pueden ser utilizadas para impartir formación.

 

EP1255 Análisis de la comunicación de recomendaciones a pacientes con heridas complejas y diseño de una nueva estrategia

Marta Casals Zorita¹, Clara Masó Albareda², Elisabet Sarri-Plans³, Ariadna Farres Serrat⁴, Joan Espaulella Panicot⁵, Marta Ferrer Solà^6
1Hospital Universitari de la Santa Creu de Vic, Vic, Spain, Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain., Doctoral School. University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain, Vic, Spain, ²Hopsital Universitari de la Santa Creu de Vic, Vic, Spain, Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, Doctoral School. University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain, ³Faculty of Medicine, University of Vic – Central University of Catalonia (UVic-UCC), Vic, Spain, Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, Vic, Spain, ⁴Hospital Universitari de la Santa Creu de Vic, Vic, Spain., Vic, Spain, ⁵Hospital Universitari de la Santa Creu de Vic, Vic, Spain., Hospital Universitari de Vic, Vic, Spain., Central Catalonia Chronicity research Group (C3RG), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, Vic, Spain, ⁶Consorci Hospitalari de Vic - Fundació Hospital de la Santa Creu de Vic, Vic, Spain, Tissue Repair and Regeneration Laboratory (TR2Lab), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IrisCC), Vic, Spain, Vic, Spain

Objetivo: Analizar la estrategia de comunicación de autocuidados utilizada hasta el momento en una Unidad Clínica de Heridas y, si es necesario, mejorarla.

Métodos: Se recabó información de pacientes de nuestra unidad clínica de heridas para conocer cuántas recomendaciones recordaban y cuáles eran.

1) Se priorizaron las recomendaciones de las sociedades científicas mediante una encuesta a un grupo de enfermeras expertas en heridas; 2) Se diseñó un díptico con pictogramas y recomendaciones para cada etiología; 3) Se contrastó el mensaje derivado de los pictogramas con personas de la comunidad.

Resultados: La mitad de los 57 pacientes que recibieron la educación tradicional recordaban entre 2 y 3 recomendaciones de las comunicadas. Las más recordadas fueron: descansar (32%), andar (17%), y llevar calzado adecuado (8%).

Cambiamos la estrategia de comunicación pasando de un formato verbal a un soporte escrito con pictogramas (díptico).

Para priorizar las recomendaciones se encuestaron a 40 enfermeras expertas en el tratamiento de heridas.

Los pictogramas fueron contrastados con 31 personas de la comunidad.

En el díptico se ordenaros las recomendaciones en función de la relevancia que otorgaron las enfermeras y los pictogramas se modificaron si no habían conseguido comunicar la acción de autocura a la comunidad.

Conclusiones: Con la información recibida de pacientes, profesionales que los atienden y personas de la comunidad se diseñó una estrategia comunicativa que añade información escrita y visual a la verbal utilizada hasta el momento.

 

EP1109 Prevención del pie diabético: ¿la formación marca la diferencia? Impacto en la práctica clínica en atención primaria

Lucia Fernandez Ramos¹, David Guillen Rodriguez¹, Cristina González Corral², Isabel Cervan Casanova², Fatima Garcia Briones², Inmaculada Oliva Jimenez^2
1Servicio Andaluz de Salud, Malaga, Spain, ²Servicio Andaluz de Salud, Malaga, Spain

La diabetes mellitus puede causar complicaciones como el pie diabético, aumentando el riesgo de amputaciones. La prevención es crucial, y los profesionales de enfermería en Atención Primaria juegan un papel fundamental. Para ello, es esencial formación continua, para aplicar las mejores prácticas.

Objetivo: Evaluar la relación entre aprendizaje adquirido por las enfermeras en un programa formativo sobre prevención del pie diabético, su intención de transferir esos conocimientos a la práctica clínica, e impacto en resultados de implementación en atención primaria.

Métodos: Estudio cuasiexperimental transversal, para ello, 240 profesionales de enfermería de Atención Primaria recibieron formación presencial impartida por la EPA-HCC durante mayo y junio de 2024, enfocadas en la prevención del pie diabético, implantación de nuevo programa preventivo, exploración clínica y autocuidado de los pacientes.

Para evaluar el aprendizaje y la intención de transferencia de conocimientos, se utilizó el cuestionario basado en el modelo FET (Factores para la Evaluación de la Transferencia), con escalas Likert de 5 puntos. Al finalizar la formación, tras consentimiento, los participantes completaron dicho cuestionario en Google Drive. Estos datos se relacionaron con indicadores de implantación.

Resultados: Los participantes presentaron amplia diversidad en edad y experiencia laboral, con mayoría femenina (76.9%). La satisfacción con el aprendizaje fue alta, (4.2 / 5) y la intención de transferir los conocimientos a la práctica obtuvo puntuación de 4.0. La implementación del programa de prevención del pie diabético mostró aumento de pacientes atendidos y exploraciones realizadas, indicando una efectiva transferencia a la práctica clínica.

Conclusiones: La formación en prevención del pie diabético, evaluada mediante el modelo FET, mostró una alta intención de transferencia, reflejandose en mejoras en los indicadores clinicos.

 

EP1256 Formación digital en el manejo de heridas: resultados de una intervención educativa para enfermería

Cristina Farré Escofet¹, Sílvia Camón Pañella¹, Jéssica Martínez Castillejo¹, Andrea Beltran-Sastre¹, Mercè Piazuelo Pont¹, Adriana San Miguel López¹, Sonia Riera Manzano^1
1Hospital Clínic de Barcelona, Barcelona, Spain

Objetivo: Describir los resultados obtenidos tras la realización de un programa formativo on-line en heridas e identificar el grado de satisfacción de los profesionales. 

Métodos: Se realiza estudio prospectivo cuasi experimental con recolección de datos antes y después de la intervención educativa. La formación se dirigió a todos los profesionales de enfermería de un hospital terciario.

El curso es de modalidad online con una duración lectiva de 4 horas. Consta de 3 bloques teóricos con material audiovisual de soporte. 

Los participantes realizaron un examen previo para evaluar los conocimientos de la materia y otro al finalizar, así como un cuestionario de satisfacción.

Los criterios de evaluación fueron: visualización del 100% del contenido y superación del 80% en la prueba final. 

Resultados: Se inscribieron 420 profesionales, finalizaron el curso 276 (66 %) y fueron aptos 273 (98%).

Los resultados del examen previo obtuvieron un 7’6 de nota promedio y los del examen posterior a la formación un 8’9. 

En el cuestionario de grado de satisfacción un 37’5% se mostró muy satisfecho, un 58’3% satisfecho frente a un 3’9 % que se declaró insatisfecho y 0.4 % muy insatisfecho.

La acción formativa cumplió con las expectativas del 96% de los profesionales.

Conclusiones: La intervención educativa online en heridas ha demostrado ser efectiva incrementado el conocimiento sobre su manejo y logrando un alto grado de satisfacción, lo que sugiere que la formación online puede ser una estrategia efectiva para mejorar las competencias en este ámbito. 

 

EP1110 Simulación clínica y cuidados enfermeros en personas con heridas en el grado de enfermeria. Innovación docente

Elvira Hernández Martínez-Esparza¹, Imma Mundet Riera², Mª Teresa Ricart Basagaña¹, Xènia Sist Viaplana¹, Silvia Vicente Perez¹, Seyla De Francisco Prófumo¹, Rosalia Santesmases Masana^1
1Escuela Universitaria de Enfermeria EUI-Sant Pau, Barcelona, Spain, ²HAD_AI Mutuam, Barcelona, Spain

Objetivo: Diseñar habilidades y/o experiencias basadas en simulación en el área de los cuidados de la piel, de prevención y tratamiento de las personas con heridas, así como analizar el rendimiento académico y la opinión del alumnado al respecto, en el grado de enfermería

Métodos: 1. Creación de la Comisión de trabajo: Coordinación de Simulación y profesorado de las áreas de cuidado relacionadas; 2. Diseño Habilidades en Simulación de zona 1-2, de 3 fases: prebriefing, habilidad en el aula y debriefing/feedback, para estudiantes de 2º (Asignatura Simulación I); 3.Diseño de Experiencias Basadas en la Simulación (EBS) de zona 2, de 3 fases: prebriefing, simulación en el aula y debriefing, para a estudiantes 4º curso (Asignatura Simulación II); 4. Evaluación de la implementación con indicadores de rendimiento académico y opinión de los agentes implicados mediante formulario en línea

Resultados: Habilidades y EBS implementadas sobre el tema: Simulación I: n=85. 10 habilidades; Simulación II: n=85. 3 EBS; Rendimiento académico: tasa de rendimiento y de éxito del 100% en ambas asignaturas; Satisfacción 2º curso: Con asignatura= 7,40 (DE: 0,58), con instructores: 7,94 (DE: 0,20), 65,97% de participación; 4º curso: Con asignatura= 8,95 (DE: 0,42), con instructores: 8,45 (DE: 0,20), 77,77% de participación

Conclusiones: El alumnado muestra satisfacción con la simulación. Esta experiencia proporciona un espacio donde los estudiantes pueden desarrollar habilidades clínicas y de comunicación, mejorar sus resultados de aprendizaje y familiarizarse con la prevención y tratamiento de las personas con heridas agudas y crónicas y los cuidados de la piel.

 

EP1257 Valoración de una formación postgraduada presencial en el cuidado avanzado de personas con heridas crónicas

Elvira Hernández Martínez-Esparza¹, Imma Mundet Riera², Ana M. Torres Corts³, Ruben Molina Carrillo⁴, Rosalia Santesmases Masana¹, Esther Moliner Serra⁵, Antonio Torres Quintana^1
1Escuela Universitaria de Enfermeria EUI-Sant Pau, Barcelona, Spain, ²HAD_AI Mutuam, Barcelona, Spain, ³Hospital Dos de Mayo, Barcelona, Spain, ⁴ICS, Barcelona, Spain, ⁵Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Valorar el rendimiento académico y la satisfacción de las enfermeras de las 7 ediciones de un curso práctico de cuidados avanzados para la prevención y tratamiento de personas con heridas crónicas (HC), en un entorno presencial, y valorar el impacto de las mejoras realizadas.

Métodos: 1-Descripción del curso: De 52 horas presenciales, 19h son en formato talleres: 8h de resolución y discusión de casos prácticos, y 11h de habilidades clínicas en aulas de simulación, con instructores de unidades específicas de HC. 14 h de práctica clínica; 2-Mejoras o cambios introducidos: de 48h presenciales a 52h. Ampliadas la duración de algunos talleres, adaptación de aulas, material didáctico y algunas metodologías docentes. 3-Valoración de la implementación a través de: rendimiento académico y satisfacción de agentes implicados mediante formulario en línea

Resultados: La tasa de rendimiento académico y de éxito fue del 100% (excepto en 2019: 93,3%). En la última edición (2024) (n=40): media de satisfacción global del curso de= 9,85/10 (DE: 0,37), de actuación docente=9,53 (0,41), de talleres=9,49/10 (DE: 0,53) y de prácticas=9,25 (0,76); 97,5% de participación. Media de todas las ediciones >8/10 en todos los ítems evaluados.

Conclusiones: Las valoraciones del alumnado de todas las ediciones del curso han sido muy satisfactorias, con evolución al alza. Afirman que en este curso pueden integrar la teoría en la práctica, resuelven las principales dificultades in situ a través del entrenamiento. La implementación de este tipo de formación permite además generar sinergias entre los centros asistenciales de la zona.

 

EP1258 Proyecto de formación, en cascada, en terapia compresiva terapéutica al equipo de enfermeros de atención primaria

Nayra Díaz Herrera¹, Maylin Bernal¹, María Pilar Perez Hernández¹, Nayra García Rivero¹, Concepción Santiago González¹, Ruyman Brito Brito^2
1Servicio Canario de la Salud, San Cristóbal de la Laguna, Spain, ²Universidad de la Laguna, San Cristóbal de la Laguna, Spain

Objetivo: Describir el proceso formativo llevado a cabo en Atención Primaria, a través de enfermeros tutores (tutores), para instruir a los enfermeros en el diagnóstico de lesiones de extremidades inferiores y su posterior tratamiento con los kits de TC adquiridos por la Gerencia de Atención Primaria.

Métodos: Se diseñó una presentación de contenidos formativos teóricos y prácticos, de dos horas, para ser impartida por los tutores asignados para ello, asegurando unos criterios de calidad y homogeneidad.

Los tutores fueron seleccionados, 26, por contar con: formación en heridas complejas y en TC; experiencia docente y experiencia en la aplicación del kit de vendas de TC adquirido, en pacientes.

Tras la formación, se realizó a los asistentes una encuesta de satisfacción digital, que fueron enviadas y analizadas al departamento de formación de la Gerencia.

Resultados: Los tutores fueron distribuidos por distintas zonas básicas de salud, facilitando la accesibilidad. El número total de sesiones impartidas fue de 32. El total de alumnos fue de 547 enfermeras (siendo la plantilla total de 676 de enfermeros, de consulta de adultos).

Conclusiones: El grado de satisfacción, reflejado en las encuestas por parte de los alumnos, del proceso formativo y la consecución de los objetivos planteados, en general, ha sido elevado.

Se ha logrado una elevada difusión de la formación entre la plantilla de enfermería.

En un futuro se espera:

• Continuar el proceso formativo actualizándolo.
• Medir el impacto que ha supuesto en los pacientes.

 

EP1111 Efectividad de una intervención formativa sobre conocimientos en lesiones cutáneas relacionadas con la dependencia

Mercedes del Cotillo Fuente¹, Montserrat García Vicente¹, Marina Martos Ortega¹, María Pilar Guzmán Muñoz¹, Claudia Díaz Segura¹, Mireya Fernández Rubí¹, Neus Párraga Fernández^1
1Fundació Assistencial Mútua Terrassa, Terrassa, Spain

Objetivo: Evaluar los conocimientos y el grado de satisfacción de los profesionales tras un curso sobre lesiones cutáneas relacionadas con la dependencia (LCRD).

Métodos: Estudio cuasi-experimental pre-post en un hospital concertado en 2023. La intervención consistió en un curso sobre LCRD dirigido a enfermeras y Técnicas en Cuidados Auxiliares de Enfermería (TCAE) de las áreas de hospitalización, críticos, urgencias, atención intermedia y consultas externas. La población diana fueron 762 profesionales, 433 enfermeras y 329 TCAE. Se recogió, antes y después del curso, un cuestionario ad-hoc sobre conocimientos, con un bloque sobre prevención para todo el personal y uno de tratamiento para las enfermeras, además de un cuestionario de satisfacción. Se incluyeron datos socio-demográficos, experiencia profesional y ámbito laboral. Estadística descriptiva con medias, porcentajes y prueba t para muestras relacionadas.

Resultados: Participaron 455 profesionales (59,7%). Se analizaron 684 cuestionarios de 342 profesionales, 218 enfermeras (63,7%) y 124 TCAE (36,3%), con una experiencia profesional de 12,2(DE=7,5). La nota media de las enfermeras pre-formación fue 4,9(DE=1,4) y post-formación 6,8(DE=1,2), p<0,001. En materia de prevención el promedio fue 5,6(DE=1,6) y 6,8(DE=1,5), entre la pre y post formación, p<0,001 y en el bloque de tratamiento 4,4(DE=1,9) y 6,7(DE=1,8), p<0,001. La nota media de las TCAE fue 4,8(DE=2) en la pre-formación y de 5,7(DE=2) en la post-formación. Los profesionales valoraron el curso con 9,2(DE=1,2) puntos.

Conclusiones: La participación fue elevada y el personal valoró muy positivamente el curso. Pese a que la responsabilidad de la piel recae sobre los profesionales de enfermería, existía un déficit de conocimientos importante sobre LCRD. Las enfermeras tenían más conocimientos sobre prevención que tratamiento. Aunque el personal ha mejorado significativamente sus conocimientos, queda margen de mejora.

 

EP1259 Pograma de educación para la salud dirigido a padres de niños con epidermólisis bullosa

Lucía Gómez Tenorio^1
1Escuela Uiversitaria De Enfermeria Cruz Roja, Madrid, Spain

Objetivo: Visibilizar enfermedades raras y dar soporte a padres de niños con Epidérmolisis Bullosa (EB).

Métodos: Se ha creado un proyecto para desarrollar un programa de educación para la salud.

Resultados: Se desarrollarían 5 sesiones metodológicas abordando cuidados y complicaciones de la EB así como repercusiones, ayudas sociales, afrontamiento y manejo del estrés.

Conclusiones: La epidermólisis bullosa es una enfermedad rara con carácter crónico y multisistémico que supone un riesgo para la esperanza de vida. Su baja prevalencia hace que haya un gran desconocimiento tanto en la población general como en el ámbito sanitario.

La noticia de una enfermedad rara congénita en un hijo es una noticia inesperada que supone un choque emocional. Los progenitores asumen el rol doble de padres y cuidadores principales teniendo que adaptarse a las características de la enfermedad, restructurando su vida familiar, social y laboral.

Actualmente no existe cura para la enfermedad consistiendo el tratamiento en mejorar la calidad de vida del niño. Siendo los padres la principal fuente de cuidado es fundamental tener en cuenta su bienestar y calidad de vida para así mejorar la de los niños

Enfermería, dentro del equipo multidisciplinar, es uno de los pilares fundamentales para el apoyo y ayuda el cuidador. Los Programas de Educación para la Salud son una herramienta útil para proporcionar información, aumentar y reforzar la habilidad en el cuidado, así como para brindar apoyo y motivación a los cuidadores.

 

EP1260 Evaluación del conocimiento en prevención de lesiones por presión a cuidadoras: aplicación del test COCU-LCRD 23

Juan Francisco Jiménez García¹, Miguel Zapata López¹, Almudena Amat Bordonado¹, Josefa Arboledas Bellon², María Piedad Garcia-Ruiz³, Mercedes Muñoz Conde⁴, Francisco Pedro García Fernández^5
1Distrito Sanitario Almería, Almería, Spain, ²Distrito Sanitario Jaén Nordeste, Úbeda, Spain, ³Área de Gestión Sanitaria Jaén Norte, Jaén, Spain, ⁴Área de Gestión Sanitaria Este Málaga Axarquía, Vélez Málaga, Spain, ⁵Universidad de Jaén, Jaén, Spain

Objetivo: Las lesiones por presión (LPP) y lesiones cutáneas relacionadas con la dependencia son un problema de salud significativo en España. El 6º Estudio Nacional del GENUAPP reveló una prevalencia de LPP en atención primaria del 0,043% en pacientes de atención domiciliaria. Con el 80% de estas lesiones desarrollándose en el domicilio, es crucial enfocar las estrategias de prevención hacia las cuidadoras.

El objetivo es evaluar los conocimientos sobre prevención de LPP y lesiones cutáneas relacionadas con la dependencia en cuidadoras de pacientes afectados, para diseñar una formación adaptada a sus necesidades.

Métodos: Estudio descriptivo transversal realizado en Unidades de Gestión clínica del Distrito Sanitario, de febrero a junio de 2024. Se analizaron 108 cuestionarios de cuidadoras en septiembre 2024, examinando 23 variables: 10 del cuidador, 9 del paciente y 4 sobre respuestas. Se utilizó SPPSS versión 21 para el análisis descriptivo.

Resultados: Participaron 110 cuidadoras de 12 Unidades de Gestión Clínica, 90% MUJERE, EDAD MEDIA 56,53 Años. El 34,5% tenía estudios primarios. El 25,5% llevaba más de 10 años como cuidadora. El 61,8% tenía experiencia previa. La edad media de los pacientes era 79,75 años, 59% mujeres. El 30,7% de los pacientes padecía alguna LPP. El nivel de conocimientos de las cuidadoras fue del 78,1% según el cuestionario COCU-LCRD23.

Conclusiones: Adaptar la formación el perfil demográfico de las cuidadoras y enfocado a las áreas de mayores debilidades.

Mejorar las estrategias de prevención y cuidado en el domicilio enfocadas a aumentar los conocimientos y habilidades de las cuidadoras.

 

EP1261 Impacto de una acción social multidisciplinar marca la diferencia en la curación en el tratamiento de pacientes con cáncer de mama: reporte de caso

Juliana Lucinda Dos Santos, Juliana Cacilha¹, Jordana Roncon², Luciana Caruso³, Giovanna Lima⁴, Perlla Pollyana Juventino^5
1hospital Lefort, Ribeirão Pires, Brazil, ²jordana Roncon, Ribeirão Pires, Brazil, ³luma Caruso, Ribeirão Pires, Brazil, ⁴flimax Serciços Radiologicos, Ribeirão Pires, Brazil, ⁵livance, Santo André, Brazil

Objetivo: Relatar la experiencia de un especialista en heridas en la recuperación de la autoestima de una paciente con cáncer de mama, en proceso de cicatrización, promoviendo una acción social.

Métodos: Se trata de un estudio descriptivo en forma de relato de experiencia. Este estudio se llevó a cabo en atención domiciliaria en la ciudad de Ribeirão Pires, Brasil. Durante el tratamento, como estrategia terapéutica, la especialista, junto a la paciente, consideró la posibilidad de realizar un evento multidisciplinario con foco en orientar a otras mujeres en la concientización e información especializada, debido al momento de desafío durante el tratamiento oncológico.

Resultados: El paciente fue acogido por un equipo multidisciplinario. Siendo la protagonista de su situación. Contamos con la presencia de 120 mujeres y 10 hombres, quienes asistieron a todas las charlas informativas. Así, reunieron a 8 expertas en el cuidado del tema (2 abogadas hablaron sobre los derechos de las mujeres con cáncer, 1 enfermera especialista en heridas abordó la prevención de la moniliasis oral y la terapia láser, el paciente como protagonista, 1 técnico en mamografía, 1 fisiólogo, 1 enfermera oncóloga, 1 gerente de marketing y 1 psicóloga que abordó el emprendimiento en oficinas inteligentes.

Conclusión: Este evento fue una organización sin fines de lucro pionera en esta región brasileña. Y obtuvimos como resultado positivo el impacto de la orientación y el despertar a nuevos proyectos de política pública. Implicaciones clínicas. Al colocar al paciente como protagonista de una causa real, hubo una mejoría en la condición depresiva, la frustración mejoró. Dejó de centrarse en el problema sobre el terreno y ayudó a otras mujeres a superar y desmitificar el cáncer de mama.

 

EP1262 Evaluación de competencias sobre el manejo de heridas en el grado de medicina mediante el uso de un foro virtual

Carmen Mias Carballal¹, Rafael Villalobos¹, Ramón Ribalta², Fulthon Vela¹, Pablo Muriel¹, Alfredo Escartín^1
1Hospital Universitario Arnau de Vilanova de Lleida, Facultad de medicina de la UdL, IRB LLeida, Lleida, Spain, ²Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Describir que tipo de competencias se pueden evaluar con el uso de un foro virtual sobre el aprendizaje en el manejo de heridas en el grado de Medicina.

Métodos: El uso de un foro de discusión virtual y por grupos permitiría facilitar el aprendizaje teórico y práctico del manejo de heridas en el grado de Medicina, y asimismo aprender a trabajar en un entorno colaborativo y virtual.

Para ello será necesario definir las competencias que consideramos que debería alcanzar un estudiante del grado de Medicina para poder evaluarlas, y realizar el diseño apropiado del foro virtual.

Resultados: El uso de un foro virtual permite evaluar dos tipos de competencias: competencias específicas del grado de medicina (relacionadas con el aprendizaje de heridas) y competencias transversales (relacionadas con el trabajo colaborativo y el uso de un entorno virtual de aprendizaje)

Entre las competencias específicas, deberán poder evaluarse: conocimientos teóricos, habilidades prácticas, y capacidad de juicio clínico.

Entre las transversales deberemos poder evaluar: capacidad de trabajo en equipo (comunicación y colaboración), uso correcto del foro virtual (participacion activa, respuestas justificada, interacción entre alumnos, resolución de problemas).

Para ello debería diseñarse un foro virtual adecuado (temas específicos, casos clinicos) que permitan evaluar los dos tipos de competencias y definir su valor en la evlaución sumativa final del foro.

Conclusiones: Un foro virtual bien diseñado sobre el manejo de heridas permite evaluar no sólo competencias especiífcas sobre el manejo de heridas, sino competencias transversales como el trabajo colaborativo en entorno virtual en alumnos del grado de medicina.

 

EP1263 ¿Como reforzar la formación en heridas de los estudiantes de grado de medicina con un foro de discusión virtual?

Carmen Mias Carballal¹, Rafael Villalobos¹, Fulthon Vela¹, Helena Salvador¹, Alfredo Escartín^1
1Hospital Universitario Arnau de Vilanova de Lleida, Facultad de Medicina de la UdL, IRB LLeida, Lleida, Spain

Objetivo: Describir la estructura de un foro de discusión virtual para reforzar y evaluar el aprendizaje en el manejo de heridas en el grado de Medicina.

Métodos: La asignatura Prácticas Asistenciales III se imparte en el grado de Medicina de nuestra Facultad desde el año 2013. Incluye un seminario teórico-práctico sobre el manejo de heridas.

Actualmente se realiza de manera híbrida, con una parte teórica presencial y una parte práctica mediante un foro de discusión virtual para reforzar y evaluar las competencias que el alumno ha de alcanzar sobre heridas.

Resultados: La herramienta FORO del campus virtual permite diseñar foros específicos con TEMAS.

Se ha elaborado un CUADERNO DE HERIDAS, dividido en cinco partes donde detallan el trabajo que realizará cada grupo. Las partes A, B, C, D trabajarán competencias específicas sobre heridas del grado de medicina, y la parte E competencias transversales.

Se diseñará un foro por grupo. El tutor abrirá el foro con cinco temas: CONOCIMIENTOS TEÓRICOS (A), preguntas para responder y justificar; CASOS CLÍNICOS (B), utiizar el juicio clínico; HABILIDADES PRÁCTICAS (C), conocer curas y materiales; BIBLIOGRAFIA (D), reconocer la evidencia científica; EVALUACIÓN (E), valorar el trabajo realizado (auto y coevaluación)

Para la evaluación se añadirán dos temas: TRABAJO FINAL, para el documento final de grupo; y EVALUACIÓN FINAL, nota final del tutor y comentarios

Conclusiones: En el diseño de un foro virtual para reforzar la formación en heridas es necesario identificar las competencias que se han de trabajar para mejorar los resultados formativos.

Son necesarios mecanismos de evaluación para que el alumnado aprenda a valorar el conocimiento adquirido.

 

EP1264 Cicatriza la brecha: homogeneizando los cuidados en heridas para una recuperación óptima

Esther Ortega Ojeda¹, María Pilar Mombiela Romeo^2
1Asepeyo, Madrid, Spain, ²Asepeyo, Zaragoza, Spain

Objetivo: En este documento presentamos dos cursos modalidad on-line elaborados en la entidad en la que trabajamos relacionados con el abordaje de las heridas.

El fin de esta formación es estandarizar la valoración de las personas con heridas agudas y crónicas que tratamos en consulta y orientar en la elección del tratamiento.

El curso se divide en dos fases:

Los objetivos de la primera fase tematizada en valoración son: 

• Valorar al paciente con heridas traumáticas.
• Conocer cómo describir su estado actual.
• Relacionar casos prácticos con la valoración adecuada.

Los objetivos de la segunda fase tematizada en administración de cuidados son: 

• Relacionar situación clínica con cuidados óptimos.
• Relacionar casos prácticos con los cuidados adecuados.

Métodos: Trabajo descriptivo donde explicamos en qué consiste la herramienta formativa dirigida a todo el personal sanitario de la mutua de accidentes de trabajo.

Resultados: Este trabajo pretende presentar y divulgar una herramienta formativa.

Tras la implantación y desarrollo de la herramienta, en el futuro nos planteamos elaborar una línea de estudio comparando los datos previos y posteriores a la implantación relacionado con percepción de la calidad de los servicios prestados por parte de los pacientes, eficiencia en la utilización de los recursos tanto materiales como humanos destinados al tratamiento de las heridas, influencia en los tiempos de cicatrización.

Conclusiones: El presente trabajo pretende divulgar una herramienta formativa en línea, diseñada para unificar criterios de valoración y tratamiento de heridas. Los resultados esperados son estandarización de cuidados y mayor calidad asistencial para nuestros pacientes.

 

EP1265 IImpacto de la educación y el rol del cuidador en la prevención de úlceras por presión en pacientes geriátricos con fracturas traumáticas

Laura Garcia Llamas¹, Elena Lancha Fernández¹, Marta Gonzalez Corrochano¹, Esmeralda Vega Fernández¹, Maria Teresa Celestino-Cruz, Celestino-Cruz¹, Adrian Montoya Ortega¹, Ana Albiol Esteller^1
1Hospital Universitario de Toledo, Toledo, Spain

Las úlceras por presión (UPP) son comunes en pacientes hospitalizados, especialmente con fracturas de miembros inferiores. (1)(2)La prevención es posible en más del 95% mediante dispositivos de alivio de presión y educación (3), siendo clave la participación activa de los cuidadores.( 4)(5)(6)(7)

Objetivo:

1. Proporcionar educación a pacientes geriátricos y cuidadores e involucrarlos en la prevención de UPP.
2. Evaluar el riesgo de UPP en pacientes sin cuidador.
3. Registrar la evolución de la piel y satisfacción del paciente o cuidador.

Métodos: Se realizó un estudio longitudinal prospectivo en 50 pacientes mayores de 70 años con fractura de miembros inferiores, hospitalizados en la Unidad de Traumatología. Se dividieron en dos grupos: con y sin cuidador. Se utilizó un cuestionario adaptado CUPD-35 para medir el conocimiento sobre la prevención de UPP al ingreso y antes del alta. Las variables evaluadas incluyeron factores de riesgo quirúrgicos, la Escala de Braden y satisfacción. Los datos se analizaron utilizando programa SPSS.

Resultados: Hubo una mejora significativa en el conocimiento del paciente y cuidador principal sobre la prevención de UPP, mayor en pacientes con cuidadores. Ningún paciente desarrolló UPP al alta.El 97% de los encuestados se mostró satisfecho.

Conclusiones: El cuestionario adaptado CUPD- 35 (8) y la intervención educativa mejoraron el conocimiento sobre UPP en pacientes geriátricos traumatológicos (9). La participación del cuidador y la educación fueron clave para el éxito del programa.

 

EP1266 Centro especializado en heridas, estomas y quemaduras de la universidad autónoma de querétaro

Miguel Aguilar Álvarez¹, Juana Martínez Botello¹, Arianna De Coss Gómez¹, Cecilia Cervantes Arias^1
1Universidad Autónoma de Querétaro, Querétaro, Mexico

Objetivo: Brindar atención integral a las personas con factores de riesgo para desarrollar una herida; atención a personas que padecen heridas dificíl cicatrización y estomas mediante cura avanzada, reduciendo el tiempo de recuperación para una mejor calidad de vida, Querétaro, México.

Métodos: Sociedad del Estado de Querétaro de bajos recursos que no puedan costear un tratamiento de heridas crónicas. 
La Universidad Autónoma de Querétaro (UAQ), lanza convocatoria de proyectos denominados “FONDEC 2022” (Fondos para el Desarrollo de conocimientos), aportación UAQ $100,000.00 M.N. México, equivalente 4607 EUR, productos entregables.

Resultados: 25 pacientes atendidos, 285 curaciones. Un centro de Atención Consolidado.

 

Conclusiones: Un Centro Especializado en Manejo de Heridas, Estomas y Quemaduras dentro de un proyecto universitario en Querétaro ofrece a los estudiantes formación práctica supervisada y mejoraría la calidad de vida de los pacientes al brindar atención accesible y especializada. Este centro podría reducir complicaciones y la carga en hospitales, fortaleciendo el sistema de salud local. Además, posicionaría a la universidad como líder en estas áreas, fomentando colaboraciones y avances en investigación y tratamiento innovador.

 

 

EP1267 Feria del Cuidado: Intervención educativa para mejorar los cuidados de la piel y prevenir caídas en usuarios del Hospital Guillermo Grant Benavente Concepción

Geyssi Gutiérrez Riquelme¹, Pía Molina Chailán^2
1RNAO-SDGC, Hospital Guillermo Grant Benavente Concepción Chile, Concepción, Chile, ²UCIM Hospital Guillermo Grant Benavente Concepción Chile, Concepción, Chile

Objetivo: Implementación actividad educativa “Feria del Cuidado” para divulgar y motivar a funcionarios en los cuidados de la piel, manejo avanzado de heridas y prevención de caídas.

Métodos: Relato de experiencia actividad educativa, descriptiva, con análisis de campo. Implementación de “la feria del cuidado” durante los años 2022 y 2023 en el Hospital Guillermo Grant Benavente, Concepción-Chile.

Resultados: Durante la “Feria del Cuidado” se desplegaron 10 stands educativos en puntos estratégicos del hospital, cada participante conoció insumos disponibles para el cuidado de la piel, y prevención de lesiones. Se realizaron foros de planificación de los cuidados de la piel, categorización del riesgo de lesión, tipos de lesiones por dependencia. La feria también incluyó concursos de conocimiento y juegos de reforzamiento del aprendizaje. Todos los interesados respondieron una encuesta voluntaria donde se exploran los cuidados de la piel y prevención de caídas aprendidos. Se estimó una convocatoria de 150 funcionarios por año, de los cuales 100 aportaron con sus respuestas, de ellos, el 82% manifestó que realiza diariamente valoración de la piel de su paciente, el 68% registra el estado de la piel, el 81% utiliza insumos de protección de la piel para el cuidado diario y el 49% indica que es necesario mantener los pisos secos y libres de obstáculos para evitar caídas.

Conclusiones: Esta actividad es una instancia estratégica para divulgar y enseñar las buenas prácticas en el cuidado, con calidad y seguridad, incluyendo la provisión de estos y de una mejor relación terapéutica.

 

EP1112 Uso de maquillaje de heridas realista para enseñar apósitos a estudiantes de enfermería

Jabiael Carneiro da Silva Filho¹, Marcela Klyviann Bezerra de Vasconcelos¹, Joel Menezes Neto², Isabel Cristina Santos¹, Marilia Valenca¹, Maria Mariana Barros Melo da Silveira¹, Thaisa Remigio Figueiredo^1
1Universidad de Pernambuco, Recife, Brazil, ²Hospital Dom Moura, Garanhuns - PE, Brazil

Objetivo: Describir la experiencia de un docente en la enseñanza de vendajes mediante el uso de maquillaje realista para simular heridas.

Métodos: Se trata de un estudio descriptivo, basado en el relato de una experiencia docente en 2024 en una institución de educación superior de enfermería en Pernambuco, Brasil, a cargo de un profesor especializado en el cuidado de la piel.

Resultados: Con el fin de implementar una metodología activa, se utilizó maquillaje realista de heridas para ofrecer a los estudiantes una forma interactiva de evaluar heridas y prescribir apósitos. Primero, se presentó una breve explicación del tema, seguida del uso de un kit de efectos especiales, que incluía masilla para crear textura y apariencia de la herida y pintura para simular la pigmentación del tejido. Se seleccionaron voluntarios para simular a los pacientes; a estos se les crearon lesiones en el antebrazo, simulando una herida traumática, y en los miembros inferiores, representando úlceras vasculares. Tras aplicar el maquillaje, los estudiantes evaluaron las heridas usando la herramienta TIMERS (Tejido, Infección, Exudado, Regeneración y Aspectos Sociales), además de realizar mediciones y prescribir productos adecuados.

Conclusiones: El proceso de enseñanza-aprendizaje ha experimentado cambios significativos. Las metodologías activas se han convertido en aliadas de estos avances, facilitando el aprendizaje. El uso de simulaciones realistas con maquillaje permite a los estudiantes involucrarse en una evaluación y prescripción más cercanas a la realidad, contribuyendo a brindar cuidados de enfermería más seguros para los pacientes.

 

EP1268 Importancia de la educación para la salud en la adherencia al uso de medidas de compresión para el tratamiento de úlceras venosas

Iria Calvo Ferreiro ¹, Lucia De Urraza Palomares^1
1Institut català de salut, Gerona, Spain

Objetivo: Abordar la úlcera venosa mediante educación para la salud (EpS) fomentando la adherencia a la compresión.

Métodos: Hombre de 79 años con antecedentes de insuficiencia venosa crónica, neuropatía y arteriopatía de arteriolas periféricas. Intervenido de safenectomía y portador de stent en vena femoral izquierda.

Presenta úlceras recidivantes (CEAP C2r-C4b-C6r), predominantemente venosas en contexto de arteriopatía, de 1 año de evolución en miembro inferior izquierdo.

A la exploración, se observan dos úlceras contiguas en zona tibial media externa de forma irregular y bordes delimitados. El lecho presenta tejido de granulación, biofilm y esfacelos, con exudado moderado de tipo serohemático. En piel perilesional: dermatitis ocre, atrofia blanca y lipodermatoesclerosis. Pulsos distales conservados con índice tobillo-brazo en miembro inferior izquierdo de 1,2.

Se pautan curas cada 72 horas. En el lecho, desinfección con jabón de clorhexidina; apósito primario absorbente modulador de metaloproteasas y, de apósito secundario, espuma de alta absorción. En piel perilesional, óxido de zinc tópico. Medidas de compresión con media corta de 30-40 mmHg.

Se incide en la importancia de hábitos higiénicos y de reposo para mejorar el retorno venoso por falta de adherencia terapéutica del paciente.

Resultados: Evolución favorable tras control del exudado y mejora de la adherencia a medidas higiénicas. Se observa una disminución progresiva del tamaño de las lesiones y del edema, con mejoría franca de la sintomatología concomitante.

Conclusiones: La mejora de la adherencia, sumada a la correcta gestión de la etiología de las lesiones mediante el uso de compresión, son clave para la curación de las úlceras venosas.

 

EP1114 Efectividad de una intervención formativa para prevenir úlceras por presión en pacientes hospitalizados

Dolors Pons¹, Anna Illamola¹, Cristina Macedo^1
1Institut d‘Assistència Sanitària, Girona, Spain

Objetivo: Valorar la eficacia de un programa educacional para auxiliares de enfermería y celadores como herramienta para disminuir la incidencia de Úlceras por Presión (UPP) de nueva aparición durante el ingreso hospitalario.

Métodos: Estudio experimental antes-después con medición mensual durante 15 meses llevado a cabo en un hospital de nivel 1. Se incluyeron todos los episodios hospitalarios superiores a 24h (EH>24h) excluyendo los de menores de 14 años. Se impartieron sesiones teoricoprácticas a partir del mes de enero de 2024 con el fin de aportar conocimientos sobre las causas etiológicas de las UPP y las actividades preventivas basadas en el sistema GRADE. Se utilizó la prueba Z para determinar si había diferencias significativas entre los grupos preintervención y postintervención. Se consideraron diferencias estadísticamente significativas valores de p < 0,05.

Resultados: La muestra incluyó un total de 8.341 EH>24h. En el grupo preintervención (n = 3.809) EH>24h de julio de 2023 a octubre de 2024, la proporción de UPP de nueva aparición fue de 0.0121. En el grupo postintervención (n = 4.532) EH>24h de 1 de febrero a 15 de octubre de 2024, la proporción fue de 0.0073. La prueba Z mostró un valor de 2.25, con una p=0.024. Se calculó un intervalo de confianza del 95% para la diferencia de proporciones, que fue de (0.0006, 0.009).

Conclusiones: La intervención formativa está asociada con una reducción en la incidencia de úlceras por presión. Para augmentar la robustez de los resultados es conveniente un período de recolección de datos más prolongado.

 

EP1269 Compresion en heridas venosas: clave para prevenir recidivas

Ainara Rodriguez Vicario¹, Naiara Eizaguirre Jauregui¹, Cristina Archeli Mesonero¹, Leire Barrutia Feijoo¹, Xabier Barquero Garate¹, Nagore Arza Alonso^1
1Osakidetza, Mendaro, Spain

Objetivo: Se trata de un caso clínico de un paciente que ingresó con una celulitis extensa en la extremidad inferior. Se administró tratamiento antibiótico y se realizaron curas locales y compresión, dado que no se identificaron arteriopatías. La herida mostró una evolución favorable, logrando una cicatrización completa en tres semanas con curas semanales.

Métodos: Se presenta un seguimiento riguroso del paciente, tratando la celulitis con antibiótico y tratamientos de cura locales, además de compresión como parte integral del manejo. Se evaluaron regularmente el estado de la piel y la respuesta al tratamiento.

Resultados: La respuesta al tratamiento fue exitosa, con una completa resolución de la celulitis en tres semanas. Sin embargo, un mes después, el paciente presentó una recidiva de la herida, atribuida a la falta de uso de medias de compresión.

Conclusiones: Este caso subraya la efectividad de la cura local y la importancia de las medidas de compresión en el manejo de heridas en las extremidades inferiores. La educación del paciente sobre la necesidad de mantener el uso de media de compresión es crucial para prevenir recidivas y asegurar resultados positivos en el tratamiento de celulitis y heridas asociadas.

 

EP1116 Uso de tecnologías cuidado-educativas para la promoción de la salud en el tratamiento de lesiones cutáneas

Marilia Valenca¹, Maria Augusta de Souza¹, Isabel Cristina Santos¹, Jabiael Carneiro da Silva Filho¹, Emanuela Batista Ferreira e Pereira¹, Marcela Klyviann Bezerra de Vasconcelos¹, Alice Fonseca Pontes^1
1University of Pernambuco, Recife, Brazil

Objetivo: Desarrollar y aplicar una tecnología cuidado-educativa para promover la salud en una clínica de lesiones de un hospital universitario de Recife.

Métodos: Se trata de un estudio metodológico, con un enfoque cuantitativo y cualitativo. Datos recolectados de noviembre de 2021 a agosto de 2022. Se realizaron entrevistas recogiendo datos sociodemográficos, una intervención educativa con información sobre el tratamiento y el procedimiento que se realizó y una escala de valoración del modelo hedónico sobre la intervención realizada.

Resultados: Se desarrollaron tres modelos anatómicos de piel para aplicación práctica en la promoción de la salud durante las consultas de enfermería. La edad promedio de los participantes fue de 59,5 años, con predominio de personas mayores (53,85%), del sexo masculino (53,85%), de etnia blanca (61,53%), con ingreso familiar de hasta 2 salarios mínimos (84,62%), prevaleciendo al menos una comorbilidad (76,93%), siendo prevalentes las heridas quirúrgicas (69,24%) y las lesiones cutáneas contaminadas (46,16%). Todos los pacientes consideraron positiva la contribución del uso de la tecnología a su tratamiento.

Conclusiones: El uso de una tecnología cuidado-educativa permitió el desarrollo y aplicación de una nueva metodología estratégica que contribuye al cuidado integral, incentivando el autocuidado del paciente, el fortalecimiento de los vínculos familiares y la sistematización del cuidado de enfermería como herramienta y reconocimiento profesional.

 

EP1270 Prácticas educativas para la prevención de úlceras en el pie diabético en atención primaria: una revisión narrativa

Ana Paula dos Santos Albuquerque¹, Mateo López Moral², Aroa Tardáguila García³, Vanessa Azevedo⁴, Débora Taynã Gomes Queiróz⁵, Alini Dantas Custódio⁶, Guilherme Mortari Belaver^7
1Universidad Complutense de Madrid, Madrid, Spain, ²Diabetic Foot Unit. Universidad Complutense de Madrid. 28040. Madrid. España, Madrid, Spain, ³Complutense University of Madrid, Madrid, Spain, ⁴Urgo Medical, São José dos Campos, Brazil, ⁵Instituto Doutor José Frota - IJF, Fortaleza, Brazil, ⁶Clínica Petúnia - Ciência, Saúde e Reabilitação, Mossoró, Brazil, ⁷Secretaria Municipal de Saúde de Florianópolis, Florianópolis, Brazil

Objetivo: Mapear las prácticas educativas desarrolladas por el equipo de salud para la prevención de úlceras del pie diabético (UPD) en Atención Primaria de Salud.

Métodos: Revisión narrativa de la literatura en las bases MEDLINE, LILACS e IBECS, considerando artículos publicados entre 2017 y 2024. Se incluyeron 26 estudios, enfocados en estrategias educativas para el autocuidado y la prevención de UPD en pacientes diabéticos.

Resultados: La educación en salud es un pilar fundamental para el manejo del pie diabético, con intervenciones educativas en diversos formatos: orientación individual y grupal, materiales impresos (cartillas y folletos) y tecnologías digitales (aplicaciones móviles, videos y películas educativas). Estrategias interactivas como grupos operativos y círculos de conversación promueven la concientización y el autocuidado, esenciales para reducir la incidencia de UPD y, consecuentemente, el riesgo de amputación. La evidencia muestra que las prácticas educativas pueden disminuir la incidencia de úlceras en hasta un 85%, y el uso de tecnologías digitales facilita el seguimiento continuo y la adherencia al tratamiento.

Conclusiones: Las prácticas educativas dirigidas por profesionales de salud desempeñan un papel esencial en la prevención de complicaciones del pie diabético, promoviendo la autonomía y la adherencia de los pacientes al autocuidado. Estas intervenciones contribuyen a reducir la morbimortalidad asociada al pie diabético, mejorando la calidad de vida de los pacientes y mitigando el impacto socioeconómico del diabetes en la salud pública.

 

EP1271 El conocimiento: la mejor herramienta para curar. Actualizacion continua en el manejo de las lesiones cutáneas

Susana Merino Perera¹, Cecilia Movilla Jiménez², Marta Rodriguez Camblor³, Leticia Muñoz García⁴, Rebeca Garrido García^5
1Consejeria de Salud del Principado de Asturias, Oviedo, Spain, ²Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain, ³C.P.R. Santa Bárbara, Sotrondio, Spain, ⁴Smith+Nephew, Madrid, Spain, ⁵Centro de Salud Joaquin Elizalde, Logroño, Spain

Objetivo: Proporcionar a los diferentes profesionales de la salud un espacio divulgativo referente en el cuidado y prevención de las lesiones cutáneas, aportando información relevante, breve, rigurosa y actualizada, para facilitar la identificación de problemas, toma de decisiones, asignación de recursos y evaluación de resultados.

Métodos: Rigurosa revisión de la literatura científica más reciente para la elección de contenido.
Para garantizar la calidad y objetividad, se realiza una revisión por pares del contenido a publicar.
Para facilitar su comprensión y accesibilidad, el contenido (siempre en relación con el mundo de las heridas) se presenta en diferentes formatos (monografías, videos, infografías).

Resultados: La plataforma ofrece a los profesionales de la salud una herramienta útil para:

• Adquirir nuevos conocimientos o actualizar los existentes: Accediendo a información rigurosa, con contenidos actualizados, documentados, de calidad contrastada, basados en la evidencia científica.
• Tomar decisiones clínicas basadas en la evidencia: proporcionando así el mejor cuidado posible.

Conclusiones: Esta plataforma se presenta como una herramienta valiosa para los profesionales de la salud que día a día se enfrentan a las heridas. El acceso a información actualizada y de calidad, facilita la toma de decisiones clínicas y contribuye a mejorar la atención al paciente.

 

EP1272 Evaluación de conocimientos teóricos y habilidades en el manejo de lesiones de etiología venosa en enfermería de atención primaria antes de una intervención formativa

Anna Garcia Morera¹, Joan Blanco-Blanco², Erica Homs Romero³, José Mª Inoriza Belzunce¹, Angel Romero-Collado
¹SSIBE, Palamós, Spain, ²Universitat de Lleida, Lleida, Spain, ³ICS, Girona, Spain

Objetivo: Describir los conocimientos teóricos y competencias de las enfermeras de atención primaria en el manejo de lesiones de etiología venosa, antes de una intervención formativa.

Métodos: Participaron 40 enfermeras/os de Atención Primaria(AP) y residentes de Enfermería Familiar y Comunitaria. Se evaluaron conocimientos mediante un cuestionario y un caso clínico, evaluando la valoración y el tratamiento. Se emplearon estadísticas descriptivos de tendencia central y proporciones.

Resultados: El 69,4% de los participantes eran mujeres con una media de 15± años de experiencia. Dos enfermeras tenían más de 30 horas de formación formal específica. Se consideró que un 60% de respuestas correctas era el mínimo aceptable, que no alcanzaron el 28,5%. En el caso simulado, el dato más valorado sobre la úlcera fue el tejido (74%) y el menos la localización y los bordes (12,8%). El dolor se valoró en un 51,3% de los casos. Un 71,8% no pidió ITB. Un 48,7% la identificó cómo venosa. En la compresión un 12,8% valora la movilidad. Un 15,4% aplica emolientes y un 17,9% coloca en 90º el tobillo. El 75% inicia el vendaje en la base de los dedos y un 71,8% llega a la zona poplítea. Un 20,5% pregunta sobre el confort y explica signos de alarma; dolor(28,2%), cianosis(20,5%), hormigueo(10,3%).

Conclusiones: Se detectaron carencias en los conocimientos teóricos y la formación del personal en el manejo de lesiones venosas, destacando áreas para la mejora principalmente en la aplicación del vendaje. Estos subrayan la necesidad de desarrollar una intervención formativa para mejorar el conocimiento teórico-práctico de las enfermeras de AP.

 

EP1273 Evaluación del conocimiento de los profesionales sanitarios sobre el lipedema. Prueba piloto

Júlia Roigé Chesa¹, Blanca Mascarell Albà¹, Blanca Manuel Marti¹, Alvaro Vilela Pajaro¹, Maria Carmen Marquilles Bonet¹, Mercè Portè Llotge^1
1Institut Català de la Salut, Lleida, Spain

Objetivo: Averiguar el conocimiento de los profesionales sanitarios de un Centro de Atención Primaria (CAP) urbano sobre el diagnóstico del lipedema.

Métodos: Estudio cuantitativo descriptivo transversal. Encuesta anónima realizada en plataforma Google Forms al colectivo de enfermería y medicina de un CAP.

Estudio preliminar sobre conocimiento del lipedema. Este estudio se va a llevar a cabo a los profesionales sanitarios de Atención Primaria de toda la provincia.

Resultados: Se obtuvieron un total de 28 respuestas.

El 88,9% sabían qué era el lipedema mientras que el 11,1% no.

Solo el 57,1% de los profesionales encuestados sabrían diferenciar un lipedema de un linfedema. El 60,7% no sabrían diagnosticarlo, junto con un 39,9% que sí que lo harían de los cuales 4 son médicos y los restantes personal de enfermería.

El 81,4% no conocían el signo de Stemmer.

El 96,4% manifestó que una formación adicional sobre el lipedema sería beneficiosa para su práctica clínica, y un 100% que había un infradiagnóstico del lipedema.

En el centro constan diagnosticados de lipedema 3 usuarios de 17.203, de obesidad 253, y obesidad mórbida 195.

Conclusiones: Se observa la falta de conocimientos sobre el lipedema a los profesionales encuestados, ello provoca un infradiagnostico de la enfermedad, como sugieren diferentes estudios consultados, acarreando problemas futuros a los pacientes. Un aumento en la formación y conocimiento podría mejorar estos datos, lo que ayudaría al aumento del diagnóstico y seguimiento de la enfermedad. Se requieren estudios con mayor muestra para poder extrapolar los datos.

 

EP1274 Inicio de enfermera referente en heridas. Compartiendo conocimientos

Montserrat Sánchez González^1
1Servicio Murciano de Salud, Universidad de Murcia. Facultad de Enfermería, Murcia, Spain

Objetivos:

Mejorar la calidad de vida de los pacientes con heridas

Cambiar conceptualización y actuación en el abordaje de heridas de los profesionales del Área de Salud VIII del Servicio Murciano de Salud.

Métodos:

1. SESIONES CLINICAS

a. Directas en los distintos servicios del hospital. FEED-BACK

2. aSISTEMATIZACIÓN DE TRABAJO CON:

a. Marcos teóricos referenciales

b. Práctica Clínica basada en evidencia científica

c. Atención a las IC

d. Atención directa en servicios de C. externas y hospitalización

e. Atención directa en Consulta de Heridas del Área VIII

Resultados:

• Enfermeras formadas en sesiones clínicas: 250
• TCAE formadas en sesiones clínicas: 350
• Personal facultativo formado en sesiones clínicas: 40
• IC de otros profesionales: 1029
• Realización, autoria y ejecución del nuevo formulario para heridas crónicas y complejas. Siendo el hospital piloto en aplicación del mismo.

Conclusiones:

• Mejora la eficacia y la eficiencia del abordaje de pacientes HCC
• Mejora en la formación de los profesionales
• Se ha garantizado la equidad y profesionalidad (Área VIII)
• Se han optimizado recursos técnicos, materiales y humanos
• Se ha reducido la estancia hospitalaria y las consultas a urg.

 

EP1275 Formación en línea sobre el deterioro de la integridad cutánea y tisular a través de gamificación

Ana Isabel Calvo Pérez¹, Yolanda Moares Castiñeiras¹, Josefa Fernández Segade¹, Ana Garrote Recarey¹, Marta Álvarez Vázquez¹, Alicia Piñeiro Redondo^1
1Servizo Galego de Saúde, Santiago de Compostela (A Coruña), Spain

Objetivo:

• Introducir la gamificación como metodología de aprendizaje en el deterioro de la integridad cutánea y tisular (DITC)
• Aumentar el conocimiento de los profesionales sobre (DITC)
• Reforzar el conocimiento de los profesionales sobre el catálogo de productos para cura en ambiente húmedo de nuestra organización.

Métodos: Implementación de dos “serius games” alojados en nuestro portal web, con contenidos basados en la evidencia,cuyos algoritmos se sustentan en diferentes tomas de decisiones del participante:

• Triviheridas basado en el conocimiento del jugador sobre heridas de diferente etiologías sobre cuestiones acerca de definiciones, fisiopatología, tratamiento y prevención.
• Quizpósito sobre el correcto uso de los apósitos incluídos en el catálogo de productos para cura en ambiente húmedo de nuestra organización, basado en la relación entre cada uno de los productos y clasificación, características, indicaciones de uso y contraindicaciones

La interfaz de los juegos emplea la imagen de una enfermera que cambia su expresión según la toma de decisiones del usuario sean adecuadas o no. Se presentan en partidas con preguntas aleatorias. Finalmente, el usuario tiene un reporte de puntuación y un ranking según el nivel de aciertos /errores conseguidos.

Resultados:

• Nº de visitas al portal web en el apartado de juegos

Conclusiones: La introducción de la gamificación en la gestión de la formación denota la intención de nuestra organización de adaptación a novedosas técnicas de demostrado potencial didáctico por sus implicaciones en el ámbito motivacional y de diversión.

 

EP1276 Título: Autonomía para el paciente en el abordaje de la dehiscencia total de la colostomía

Gemma Serra Sastre¹, Assumpció Mundet Juliol^2
1Hospital de Girona Dr Josep Trueta, Girona, Spain, ²Hospital de Girona Josep Trueta, Girona, Spain

Objetivo: Describir el abordaje de una dehiscencia total de colostomía mediante cuidados adaptados para su realización por parte del cuidador principal, en este caso la esposa del paciente, y analizar la eficacia de este método en la cicatrización por segunda intención y en la mejora de la autonomía del paciente y su entorno familiar.

Métodos: Se diseñó un plan de cuidados personalizado para el paciente con el objetivo de que su esposa pudiera llevarlos a cabo en el domicilio. Este plan incluyó la formación específica de la cuidadora en técnicas de limpieza de la herida, cambios de colostomía y medidas de higiene para prevenir infecciones. Se realizó un seguimiento periódico de la evolución de la cicatrización, así como del nivel de autonomía y confianza de la cuidadora. La cicatrización se planteó por segunda intención, permitiendo una recuperación gradual de los tejidos

Resultados: Tras varias semanas de cuidados por parte de la cuidadora principal, se logró una cicatrización completa de la dehiscencia de la colostomía por segunda intención, sin complicaciones infecciosas. La adaptación de los cuidados al entorno familiar favoreció la autonomía del paciente y la confianza de su esposa en la gestión de la colostomía, mejorando la calidad de vida y reduciendo el estrés emocional.

Conclusiones: Destacar la formación e implicación del cuidador principal, en este caso la esposa del paciente, fueron esenciales para lograr una cicatrización exitosa y mejorar la autonomía del paciente. Concluimos que, en situaciones similares, proporcionar herramientas y conocimientos al cuidador principal puede ser una estrategia eficaz para optimizar los resultados y favorecer la recuperación en el entorno domiciliario.

 

EP1278 La importancia de implantar las 3hs de la piel en el tratamiento de las heridas

Érika Fondo Álvarez¹, Silvia Cerame Pérez¹, Emma Santiso Casanova¹, Nerea Fondo Álvarez¹, Elia Novo Fernández^1
1CMUC, Betanzos, Spain

Objetivo: Implantar el protocolo de las 3HS de la piel (higiene, hidratación, humedad) en la práctica clínica diaria de los profesionales de enfermería, con el propósito de mantener la salud de la zona anatómica donde se encuentra la heridas, de la piel perilesional y optimizar el proceso de cicatrización de las heridas.

Métodos: Las extremidades que ingresan a nuestra consulta a menudo presentan condiciones desfavorables, como suciedad, costras, xerosis cutánea y heridas agrandadas, debido a un manejo inadecuado del exudado y a la falta de protección de la piel perilesional. Durante la primera consulta, se lleva a cabo una limpieza exhaustiva de la zona anatómica y de la piel perilesional, seguida de una adecuada hidratación y protegiendo la piel perilesional de la humedad de exudado de las heridas. Se emplean productos a base de aceites ozonizados por sus propiedades calmantes, higienizantes, antiinflmatorios y antioxidantes, que respetan la barrera cutánea y son apropiados para pieles sensibles. Presentamos diferentes casos clínicos donde se puede observar los cambios en la condición de las lesiones tras la implementación del protocolo.

Resultados: Tras la primera sesión de tratamiento, se observa una mejoría significativa en el estado de las extremidades afectadas. La higiene reduce la carga bacteriana, mientras que la hidratación favorece un microambiente propicio para la cicatrización.

Conclusiones: La 3HS de la piel son esenciales para lograr resultados clínicos óptimos y preservar la salud de la piel perilesional, subrayando la importancia de un manejo integral de los tejidos circundantes.

 

EP1119 Implementación de escenarios de simulación clínica en el área de viabilidad tisular

Pedro Sardo¹, Alexandre Rodrigues², Nuno Correia³, João Simões^2
1Universidade Aveiro, Aveiro, Portugal, ²Universidade de Aveiro, Aveiro, Portugal, ³ULS S. João, Porto, Portugal

Objetivo: Describir el proceso de creación e implementación de escenarios de simulación clínica para el desarrollo de competencias específicas en viabilidad tisular.

Métodos: Estudio exploratório. Integrados 4 expertos en el cuidado de heridas, 5 «pacientes actores» (estudiantes de Enfermería) y 20 Enfermeras de un postgrado en Heridas. Se crearon cuatro escenarios de simulación de acuerdo com la metodologia de Fonseca, A. et al (2023) para proporcionar el desarrollo de habilidades técnicas y no técnicas para el cuidado de personas con (riesgo de) heridas de diferentes etiologías en diferentes entornos asistenciales. Las enfermeras fueron expuestas a todos los escenarios. Para cada escenario, hubo una sesión informativa (5 minutos), un período de «escenario dinámico» (10 minutos) y un «debriefing estructurado» (45 minutos).

Resultados: El «Escenario 1» permitió desarrollar las habilidades de evaluación del riesgo de úlceras por presión en una persona dependiente. El «Escenario 2» habilidades específicas relacionadas con la evaluación del riesgo nutricional en un contexto de atención domiciliaria. «Escenario 3» proporcionó un abordaje integral a una persona con una lesión de pie diabético. El «Escenario 4» permitió la evaluación de la carga del cuidador. Todos los escenarios tenían como objetivo el desarrollo de habilidades para la toma de decisiones, la articulación del juicio clínico y la aplicación de instrumentos de evaluación. El uso de «pacientes actores» proporcionó un entorno asistencial realista.

Conclusiones: Esta práctica pedagógica permitió a las enfermeras enfrentarse a problemas reales, creando entornos inmersivos e implicando a todos los participantes en el proceso de desarollo de competências.

 

EP1279 Estratégias essenciais para a prevenção e manejo do pé diabético na atenção primária de saúde

Ana Paula dos Santos Albuquerque¹, José Luis Lázaro-Martínez², Mariana Santo³, Aroa Tardáguila García⁴, Vanessa Azevedo⁵, Rosa Amália Barbosa⁵, Wanessa Karla Regis da Silva^6
1Hospital Regional do Agreste, Caruaru, Brazil, ²Complutense University, Madrid, Spain, ³Urgo Medical, São Paulo, Brazil, ⁴Complutense University of Madrid, Madrid, Spain, ⁵Urgo Medical, São José dos Campos, Brazil, ⁶Curamed, Recife, Brazil

Objetivo: Capacitar a los profesionales de la Atención Primaria de Salud (APS) en el manejo preventivo y terapéutico del pie diabético, una de las complicaciones más graves de la Diabetes Mellitus (DM), que afecta al 10,5% de la población mundial adulta y presenta altas tasas de morbilidad.

Métodos: Manual técnico desarrollado como conclusión del Máster en Pie Diabético de la Universidad Complutense de Madrid, basado en las directrices más recientes del Grupo Internacional de Trabajo sobre Pie Diabético (IWGDF). Su estructura cubre la definición, epidemiología y manejo clínico y educativo de las lesiones del pie, con prácticas basadas en evidencia para su uso en APS. Incluye QRCode con videos e imágenes para demostrar todo seguimiento del pie en riesgo, según guías internacionales.

Resultados: El manual enfatiza la detección de riesgos, el control riguroso de la glucemia y la educación del paciente sobre cuidados diarios de los pies. Entre las estrategias destacadas se encuentran el uso de protocolos prácticos y la capacitación continua del equipo de salud para reducir el riesgo de amputaciones y mejorar la calidad de vida de los pacientes. La experiencia clínica indica que los cuidados preventivos pueden reducir hasta en un 70% las complicaciones graves en los pies.

Conclusiones: Este manual es una herramienta esencial para los profesionales de la APS, promoviendo un enfoque multidisciplinario e integrado. Al priorizar las intervenciones preventivas y educativas, el objetivo es reducir la morbilidad y mejorar los resultados de salud, transformando la atención al paciente y la calidad de vida.

 

SALUD EN LÍNEA

EP1606 Promoción de la salud en línea: abordando los desgarros cutáneos a través de @skinsintears

Carmen Prieto Hernandez^{1 2}, Beatriz Perez Sepulcre², Esther Ferrández Iborra², Alejandra Ballester Verdú², Eva Kasiyanchuk Dyachenko^2
1Serveix de Salut Integrats Del Baix Empordà, Palamos, Girona, Spain, ²Universidad de Alicante, Alicante, Spain

Objetivo: El objetivo de este proyecto es utilizar la plataforma de Instagram (@skinsintears) para educar y concienciar sobre el manejo adecuado de los desgarros cutáneos, promoviendo prácticas de cuidado y prevención entre profesionales de la salud y la comunidad.

Métodos: Se desarrolló una estrategia de contenido que incluye publicaciones informativas, infografías y vídeos educativos sobre el cuidado de las heridas. Tras un período de 6 meses, se analizó el alcance de las publicaciones, evaluando el impacto en la audiencia mediante métricas de participación (comentarios, likes, visualizaciones…).

Resultados: Desde su creación, @skinsintears ha alcanzado a más de 500 seguidores, con un promedio de 60 interacciones por publicación. Los vídeos educativos sobre prevención y clasificación de los desgarros cutáneos han sido los más populares, con un número de visualizaciones entorno a 3300. Los posts informativos acerca de técnicas para la mejora de la práctica clínica diaria han logrado las 100 interacciones. Además, a través de los mensajes directos se han recibido críticas positivas sobre la claridad y utilidad de la información compartida de cuentas con reconocimiento relacionadas con heridas.

Conclusiones: La experiencia con @skinsintears demuestra que las redes sociales pueden ser una herramienta efectiva para la educación en salud, facilitando el acceso a información relevante sobre el manejo de heridas. Este enfoque no solo empodera a los profesionales de la salud, sino que también fomenta la participación activa de la comunidad en el cuidado de su salud. Se recomienda continuar explorando el potencial de las plataformas digitales para la educación en salud.

 

EP1607 Innovando en el cuidado de las heridas

Laura Pérez Rodríguez¹, Ana Belén Lozano Lozano¹, Mª Lorena Folgado Temprano¹, María del Consuelo Ortiz Martín¹, Cristina García López¹, Patricia Miguel Gómez¹, Julia Domínguez Rodrigo^1
1Complejo Asistencial de Zamora, Zamora, Spain

El proyecto de digitalización de técnicas y procedimientos en las Unidades de Enfermería del Complejo Hospitalario incluye la realización de videos explicativos de la Terapia de Presión Negativa (TPN).

Objetivo: Estandarizar procedimientos relacionados con el cuidado de heridas.

Disminuir variabilidad de la práctica clínica.

Mejorar conocimientos de profesionales.

Métodos: Realización de videos explicativos sobre el modo de uso de la TPN (VAC y un solo uso) subidos al canal de youtube de la Dirección de Enfermería.

Creación de codigos QR y difusión entre los profesionales y los estudiantes de enfermería.

Resultados: Agosto 2024 se escribe guión y se realizan videos con maniquí de heridas y materiales necesarios. Videos con indicaciones y contraindicaciones, material necesario, procedimiento y alarmas frecuentes.

Septiembre de 2024 se crean códigos QR, se imprimen y plastifican. Se colocan en máquinas de TPN que se encuentran en las Unidades, se difunden intranet, mandos intermedios y en portal de la Universidad.

En septiembre-Octubre de 2024: 116 visualizaciónes del video de terapia de un solo uso y 180 de la terapia tipo VAC.

Conclusiones: La rotación de personal obliga a mantener conocimientos actualizados.

Se observa satisfacción entre profesionales por facilidad de acceso a videos recordando técnicas no habituales.

Utilidad para pacientes dados de alta hospitalaria con TPN, pueden reconocer las alarmas y manejo.

Unificar criterios de actuación y procedimientos a seguir disminuye la variabilidad en los cuidados y aumenta la calidad y seguridad de la asistencia sanitaria.

 

EP1608 Telepresencia: un enfoque innovador para el cuidado de los pacientes con heridas complejas entre los diferentes niveles asistenciales

María del Mar Izquierdo Muñoz¹, Maria Cristina Perez Benito^{2 3}, Cristina Ruiz Nuñez^{4 5
1}Enfermera Gestora de la Unidad De Continuidad Asistencial del Complejo Hospitalario de la Gerencia de Soria, Presidenta de la Subcomision de Heridas de Gasso, Soria, Spain, ²Secretaria de la Subcomision de Heridas de la Gasso, Soria, Spain, ³Centro de Salud De Almazán de la Gerencia de Asistencia Sanitaria de Soria, Soria, Spain, ⁴Miembro de la Subcomision De Heridas de la Gasso, Soria, Spain, ⁵Centro de Salud Soria- Norte De La Gerencia De Asistencia Sanitaria de Soria, Soria, Spain

Objetivo:

• Implementar la telepresencia como método de comunicación entre diferentes niveles asistenciales en el cuidado de pacientes con heridas complejas.
• Determinar la efectividad de la asistencia a distancia a través de tecnología digitales a pacientes con heridas complejas.

Métodos: Analizaremos el impacto de esta tecnología en el manejo de heridas complejas, mediante escalas de cicatrización específicas, así como encuestas de satisfacción validadas de los pacientes y profesionales que han demandado este tipo de asistencia durante el primer trimestre de 2025. Determinando al final del estudio los beneficios e inconvenientes que puedan surgir durante su implementación.

Resultados: La calidad de imagen y sonido en circuito cerrado hacen de la telepresencia un recurso tecnológico asistencial que facilitará la mejoría y/o resolución de heridas complejas.

El poder compartir información exploratoria y diagnóstica relevante, de forma bidireccional en tiempo real entre profesionales sanitarios y pacientes, complementará la atención sanitaria presencial y mejorará la asistencia a estos pacientes, en lugares donde existe una compleja situación asistencial por dispersión geográfica, población envejecida dependiente y una alta incidencia de heridas complejas con tendencia a cronificarse.

Conclusiones: Se pretende mejorar la comunicación y la calidad asistencial en pacientes con heridas complejas, optimizando el tiempo y los recursos, así como la satisfacción de pacientes y profesionales, evitando los desplazamientos de profesionales y pacientes, las visitas presenciales innecesarias y disminuyendo los costes.

 

EP1609 Impacto de las tecnologías en las curas de heridas en atención primaria

María Sebastián Rodriguez¹, Isabel Solís Calderón², Noemí Sánchez Ferreño¹, Noelia León Carretero¹, Ana Reyes Tapia³, Anna Oliver Olius¹, Zara Doctama Ayong^1
1Parc Sanitari Pere Virgili, Barcelona, Spain, ²EAP Poble SEC SLP, Barcelona, Spain, ³Institut Català de Salut, Barcelona, Spain

Objetivo: Evaluar el impacto del uso de una aplicación móvil (APP) gratuita en la consulta de enfermería, centrada en la reducción del tiempo de atención y la mejora en la curación de heridas.

Métodos: Se implementó una APP del mercado para el seguimiento de heridas en una consulta de AP, empleando un enfoque empírico basado en el método inductivo y técnica de muestreo de conveniencia.

Resultados: Beneficios:

1. Clasificación de pacientes con archivos fotográficos ajenos al directorio raíz del dispositivo.

2. Valoración sistémica y registro de características de la herida, incluyendo área, tamaño, localización y otros aspectos relevantes, con la opción de añadir notas.

3. Acceso a un catálogo de productos de curación, orientando a los profesionales en decisiones de tratamiento.

4. Facilita la comunicación entre profesionales mediante canales de mensajería directa y elaborando informes que pueden ser compartidos.

Limitaciones:

1. No integra la información en la historia clínica electrónica del paciente.

2. Requiere un tiempo de aprendizaje para su uso.

3. Necesidad de inversión en dispositivos

4. No se observa una reducción significativa en el tiempo de atención.

Conclusiones: Las APPs emergen rápidamente. Cada APP tiene sus propias características que las hacen útiles dependiendo del objetivo. Su uso puede implicar riesgos de privacidad si no cuentan con las medidas de seguridad adecuadas.

A pesar de sus limitaciones, son una herramienta valiosa como apoyo a los profesionales ya que buscan la eficiencia en salud. Sin embargo, optimizar la curación aún depende de factores humanos como el conocimiento y la experiencia.

 

EP1610 Las nuevas tecnoligias se cuelan en las consultas.

Pilar Palomares Diaz¹, Mª Teresa Pingarrón^2
1Conselleria de Sanidad, Departamento de Salud de Gandía, Consultorio Aux Palma de Gandía, Palma de Gandia, Spain, ²Conselleria de Sanidad, Departamento de Salud de Gandía, Centro de Atención Primária Oliva, Oliva, Spain

Las investigaciones han demostrado que la falta de comunicación y colaboración puede ser responsable de hasta el 70% de los eventos adversos notificados actualmente. El trabajo en equipo interprofesional y las prácticas colaborativas eficaces entre los profesionales de la salud son garantías importantes para brindar a los pacientes una atención segura y de alta calidad. La atención médica y las aplicaciones se unen, creando un espacio innovador que está revolucionando la atención y el compromiso de los pacientes.⁽²⁾ Las aplicaciones móviles de salud lideran la revolución de la salud digital, haciendo que la atención médica sea más accesible y personalizada.
Objetivo: Evaluar el impacto de una aplicación móvil en la coordinación y comunicación durante el cuidado de heridas, específicamente en mejorar la calidad del seguimiento y la toma de decisiones cuando el paciente recibe atención en varios centros.

Métodos: Utilización de una aplicación móvil para realizar la comunicación interprofesional durante el seguimiento de la paciente, que, por motivos de logística familiar, asistía a dos centros de salud diferentes. Por ende, era atendida por más de un profesional, lo que hacía necesaria una buena comunicación durante el proceso y toma de decisiones de este.

Resultados: La aplicación contribuyó a reducir el tiempo de respuesta y permitió una toma de decisiones rápida y precisa, al posibilitar el intercambio seguro de datos clínicos, fotografías del proceso de curación.

Conclusiones: Este estudio sugiere que la implementación de estas tecnologías es una estrategia escalable y aplicable en contextos de salud con atención compartida.

 

EP1106 Uso de una aplicación móvil para optimizar el seguimiento de una lesión por presión secundaria a tratamiento ortoprotésico

Francisco Barragán Navarro^1
1Residencia de Mayores La Molineta, Alicante, Spain

Objetivo: Evaluar la eficacia de una aplicación móvil innovadora para mejorar la gestión de heridas cutáneas.

Métodos: Se hizo el seguimiento de una lesión con una aplicación móvil. Esta aplicación permite el registro detallado de datos de la herida, un control fotográfico y la organización del tratamiento.

Se evaluó una paciente de 92 años con hipertensión arterial, epilepsia, Alzheimer y linfedemas crónicos. La paciente desarrolló una lesión por presión secundaria al uso de una férula de escayola tras fracturarse el pilón tibial y peroné derecho. La herida presenta tejido desvitalizado, bordes eritematosos y deterioro de la piel perilesional. Se inició tratamiento con un apósito con fibras poliabsorbentes y tecnología lípido-coloide que proporciona un desbridamiento continuo. Tras una semana, se cambió el tratamiento para acelerar la cicatrización a un apósito con fibras poliabsorbentes y tecnología lípido-coloide con octasulfato de sacarosa(TLC-NOSF) y óxido de zinc en la piel perilesional. Tras observarse una evolución favorable, una mejora de la piel perilesional y reducción del exudado, se cambia la pauta a una malla con TLC-NOSF que favorece la epitelización.

Resultados: Tras 5 meses de tratamiento, se consigue el cierre de la herida. Además, la aplicación permitió un seguimiento exhaustivo de la lesión, facilitando la toma de decisiones clínicas basada en datos objetivos.

Conclusiones: La aplicación demostró ser una herramienta eficaz en la gestión de heridas, facilitando el seguimiento exhaustivo y la toma de decisiones clínicas. Consecuentemente, esta herramienta podría facilitar la práctica clínica diaria de los profesionales sanitarios, mejorando la atención al paciente

 

EP1611 La e-consulta (consulta electrónica) como desarrollo de mejora asistencial

Marta García Nuñez-Garcia¹, Guillermo Servera Negre¹, Casto Barbero^1
1Hospital Universitario La Paz, Madrid, Spain

Objetivo: Abordar las deficiencias en continuidad asistencial entre los ámbitos de Atención Primaria (AP) y Especializada (AE) dermatológica en un contexto de demanda creciente.

Métodos: Se evalúa la incorporación de un sistema de consulta electrónica en dermatología (teledermatología) en su modalidad asíncrona (no se desarrolla en tiempo real sino en diferido) e indirecta (el equipo de AP actúa como interlocutor entre el paciente y el equipo de AE); implementado con el fin de cubrir las deficiencias de continuidad y aumento de la demanda derivados de la irrupción de la pandemia por SARS-CoV2.

Realizada mediante tecnologías de la información y comunicación seleccionadas al efecto por la organización, este sistema de teledermatología permite a los equipos multidisciplinares (medicina y enfermería) compartir y abordar aspectos relacionados con el problema de salud de un paciente (que debe siempre ser conocedor de la intervención realizada) con los respectivos compañeros del otro ámbito asistencial (AP o AE).

Resultados: La implementación de las consultas electrónicas permite una comunicación ágil y efectiva entre los profesionales sanitarios de diferentes niveles asistenciales. Su uso, especialmente con el intercambio de iconografía, mejora notablemente la calidad asistencial, fomentando la coordinación y el seguimiento conjunto en las pautas de tratamiento y evolutivos, agilizando la toma conjunta de decisiones y evitando a los pacientes desplazamientos innecesarios tanto a su Centro de Salud como a su Hospital de Referencia.

Conclusiones: Estos procesos, que tienen como principales beneficiarios a los pacientes crónicos, son posibles gracias a la coordinación real y efectiva entre ámbitos asistenciales.

 

 

ECONOMÍA SANITARIA Y RESULTADOS

EP1248 Sin financiacion no hay compresion

Miren Castilla Toribio¹, Iraia Echeverz Elizalde¹, Elixabet Isasi Agirre¹, Idurre Arregui Arregui¹, Maria Garza Larreta^1
1Centro De Salud Andoain, Andoain, Spain

Objetivo:

General: Empoderar a los pacientes sobre el uso de los dispositivos de compresión autoajustables de tipo velcro para reducir la prevalencia y recidiva de las úlceras venosas.

Específicos: Concienciar al personal sanitario de la importancia de la promoción de dicha terapia.

Comparar los gastos que supone la prevención primaria con el gasto de la curación de una úlcera venosa.

Demostrar la efectividad de dichos dispositivos pese a su elevado coste debido a la mayor tolerancia frente al fracaso del uso de las medias de compresión financiadas por el Servicio Nacional de Salud.

Métodos: Revisión bibliográfica a partir de los programas asistenciales junto con la ayuda de la coordinadora de integración asistencial.

Resultados: La terapia de compresión autoajustable permite asegurar una excelente adherencia en pacientes con dificultad para utilizar las medias de compresión gracias a su fácil manejo. De esta manera, garantizamos una mejora en la circulación venosa y protección de la piel.

Tras comparar los gastos ocasionados hasta la curación de una úlcera venosa en pacientes sin compresión con el precio de la terapia compresiva mejor tolerada (autoajustable tipo velcro), objetivamos la necesidad de priorizar dicha terapia en el SNS debido a la reducción de carga financiera: 3000€ vs 300€.

Conclusiones: Pese a promover la proactividad entre los sanitarios en cuanto al uso de los dispositivos autoajustables tipo velcro, actualmente nos encontramos ante el problema de que dicha terapia resulta inalcanzable debido a la no financiación de las mismas.

 

EP1249 Diagnóstico y propuesta de tratamiento de heridas a través de canales informales : redes sociales

Emilia Mateo Marin¹, Nuria Solanas, Irma Fornell Boixader², Marta Torrebadella³, Teresa Carbó Casanova⁴, Maria Josep Rodriguez Moran⁵, Saida Rodriguez Serra^6
1Institut Català de la Salut, Equipo de Atención Primaria de Súria, Enfermera referente de Heridas de la Cataluña Central, Socia y Miembro Consultivo del GNEAUPP, Socia de la SEHER, Callús, Spain, ²Institut Català de la Salut, Equipo de Atención Primaria de Gironella, Socia del GNEAUPP, Miembro de la Comisión de Heridas de la Catalunya Central, Gironella, Spain, ³Institut Català de la Salut, Equipo de Atención Primaria de Berga, Socia del GNEAUPP, Miembro de la Comisión de Heridas de la Catalunya Central, Berga, Spain, ⁴Institut Català de la Salut, PADES Manresa, Socia del GNEAUPP, Miembro de la Comisión de Heridas de la Catalunya Central, Manresa, Spain, ⁵ICS CAP CArdona, Socia del GNEAUPP, Miembro de la Comisión de Heridas de la Catalunya Central, Cardona, Spain, ⁶ICS CAP Cardona, Cardona, Spain

Objetivo: Dar a conocer los canales comunicativos utilizados para identificar el diagnostico y sugerir tratamiento de las heridas consultadas a la enfermera referente territorial de heridas en una zona sanitaria sin una agenda específica de heridas.

Método: Se contabilizaron los mensajes recibidos a través de una red social conocida, a través de mensajes de correo electrónico incluyendo la fotografia de las heridas y resúmenes de la etiologia, así como las llamadas telefònicas realizadas por las enfermeras referentes de los equipos sanitarios durante un período de 18 meses.

Resultados: Se registraron un total de 112 heridas consultadas a través de la red social, 25 mensajes de correo electrónico y 54 llamadas telefónicas (se contabilizaron solo las realizadas al teléfono móvil, ya que las llamadas al teléfono fijo no quedan registradas).

Hay 16 enfermeras referentes de heridas de equipo, con lo que resultó un promedio de 7 consultas anuales por red social, 1,5 consultas por correo electrónico y 3,3 llamadas telefònicas.

Conclusión: Los resultados indican que estos canales de comunicación para la consulta de heridas no son efectivos para su desarrollo ni evaluación, por falta de confidencialidad, pérdida de datos, etc.

Aunque la red social se presenta como un recurso para la atención a distancia, el sistema teleheridas asociado al sistema informático del territorio, es el más adecuado.

Este enfoque no debería servir de modelo para la implementación de sistemas de consulta, ya que tan solo se mejora con la inmediatez, característica de dicha red social, sin tenir en cuenta el horario laboral.

 

EP1113 Unidad de heridas crónicas complejas: proceso de cuidados de enfermería

Ana Belén Sánchez de la Ventana¹, Ana García^{2 2
1}Hospital Clínico San Carlos, Madrid, Spain, ²Hospital Clínico San Carlos, Madrid, Spain

Objetivo: Describir la actividad del proceso de Cuidados de Heridas Crónicas Complejas (HCC) en una unidad de HCC de un hospital de tercer nivel de la Comunidad de Madrid.

Métodos: Estudio descriptivo retrospectivo realizado en la Unidad de HCC del Hospital Clínico San Carlos de Madrid, analizando datos recopilados en 2022, 2023 y primer semestre de 2024. Variables estudiadas: Número de interconsultas (ITC), Etiología de las lesiones, Actividad docente, Superficies Especiales Manejo de Presión (SEMP).

Resultados: En 2022 se realizaron 204 ITC (28,9% de pacientes con HCC) de las cuales un 84,8% (173) fueron lesiones por presión (LPP). En 2023 fueron 287 las ITC (46,14%), siendo un 73,2% (210) LPP. Durante el primer semestre de 2024 se realizaron 280 ITC (58,9%), de las cuales un 34,6% (97) fueron lesiones de otra etiología.

En 2022, la distribución de la actividad docente fue del 39,7% para enfermeras residentes (EIR), 19,2% de formación a profesionales y 41,1% educación sanitaria (EPS). En 2023, la formación EIR representó el 26%, frente al 27,8% a profesionales y un 46,2% EPS. En el primer semestre de 2024, la formación EIR fue el 28,6%, el 27,8% a profesionales y un 36,4% EPS.

En febrero de 2024 inició un sistema de renting de SEMP. Hasta agosto de 2024 se han usado una media de 48,3 superficies.

Conclusiones: Las unidades de HCC son esenciales para la atención del paciente, garantizando una asistencia de calidad basada en la evidencia, con un abordaje integral y haciendo uso eficiente de los recursos disponibles.

 

EP1753 Impacto de la implementación de una herramienta digital en la gestión de heridas en un entorno geriátrico

Julio Alberto Matíz Bolivar¹, Julio Alberto Matiz Bolivar^2
1Hogar Santa Rita, Tenerife, Spain, ²Fundación Hogar Santa Rita, Puerto de la Cruz, Spain

Objetivo: Este estudio evalúa los beneficios obtenidos tras la implementación de una herramienta digital para la gestión de heridas en una residencia geriátrica. Se analiza su impacto en la eficiencia clínica y organizativa, resaltando mejoras en la calidad asistencial y la optimización de recursos.

Métodos: Estudio retrospectivo donde se comparan datos clínicos y operativos de 2024, tras la implementación de la herramienta, respecto a 2023, previo a su uso. Los indicadores clave incluyen el número de heridas tratadas y cerradas, el tiempo promedio de cierre y la precisión en los registros. También se evalúan aspectos económicos, como la reducción de personal y el tiempo de gestión por herida, junto con mejoras en la comunicación y organización del equipo.

Resultados: Los resultados evidencian una mejora significativa en la gestión de las heridas. Mientras que en 2023 no se contaba con datos tan detallados, la nueva herramienta ha permitido un control más riguroso y preciso. Se observa un aumento en el porcentaje de heridas cerradas, una reducción en el tiempo medio de cierre y una mejora en la precisión de los registros. Además, se registran mejoras en la coordinación y comunicación del equipo traducido en un mejor aprovechamiento del tiempo y una disminución del personal sanitario dedicado a la cura de lesiones.

Conclusiones: La implementación de la herramienta digital ha mejorado los resultados clínicos y optimizado los recursos económicos, contribuyendo a una mayor calidad asistencial en el cuidado de los pacientes geriátricos. Este modelo es aplicable a otros centros que busquen mejorar la gestión de heridas mediante el uso fácil y rápido de tecnología.

 

EP1250 Importancia de la implementacion de algoritmos de derivacion en el tratamiento de heridas complejas

Cristina Archeli Mesonero¹, Leire Barrutia Feijoo¹, Ainara Rodriguez Vicario¹, Naiara Eizaguirre Jauregui¹, Xabier Barquero Garate¹, Nagore Arza Alonso¹, Ainhoa Bolinaga Gullon^1
1Osakidetza, Mendaro, Spain

Objetivo: Analizar la importancia de implementar algoritmos de actuación y circuitos de derivación interprofesionales en el tratamiento de heridas de difícil cicatrización, mediante el estudio y análisis de un caso de insuficiencia venosa que ha estado en atención primaria durante siete meses con una evolución desfavorable.

Métodos: Se presenta el caso de un paciente con úlcera venosa mal tratada durante siete meses, donde tras derivación se realizó un diagnóstico exhaustivo y se estableció un circuito interprofesional adecuado. Se aplicaron protocolos estandarizados para evaluar la condición del paciente y determinar el tratamiento más eficaz. Ante ello, se realiza una comparativa de las curas previas a la derivación y las actuales.

Resultados: Tras la implementación del circuito de derivación, el paciente mostró una notable mejoría en un corto período de tiempo. La úlcera venosa, que había presentado una evolución deficiente durante meses en atención primaria, comenzó a cicatrizar adecuadamente. En un lapso de semanas, la herida fue cerrada, evidenciando la efectividad del enfoque multidisciplinario.

Conclusiones: Algoritmos de actuación claros y circuitos de derivación interprofesionales en el manejo de heridas crónicas. La rápida mejoría del paciente tras establecer el circuito adecuado demuestra que un enfoque colaborativo y organizado puede optimizar la atención, reducción del gasto sanitario, mejorar los resultados clínicos y garantizar una adecuada calidad de vida para los pacientes con heridas complicadas. Se recomienda adoptar estos protocolos en la práctica clínica habitual.

 

EP1251 Cicatrización sin interrupciones: eficacia de un apósito de 5 capas de silicona suave

Ana Carolina Mendes¹, Ana Martins², Pedro Garcia², Ainhoa Muñoz^2
1Mölnlycke, Matosinhos, Portugal, ²Mölnlycke, Madrid, Spain

Objetivo: Evaluar el rendimiento de una espuma de poliuretano de cinco capas de silicona suave en enfermería, identificando las razones de su uso en el cuidado de heridas.

Métodos: Entre abril y junio de 2021, se aplicó una encuesta de satisfacción a enfermeros de varias regiones de España implicados en el cuidado de heridas. El cuestionario recogía el tipo de heridas tratadas, las razones para optar por el nuevo apósito, las limitaciones de los tratamientos previos y la satisfacción global. También se realizó un estudio clínico de una úlcera por presión (UPP) para evaluar la eficacia del apósito con el concepto de «cicatrización sin interrupciones».

Resultados: Participaron 23 enfermeros, que informaron de que trataban heridas diferentes. Antes de utilizar el nuevo apósito, 17 enfermeros utilizaban apósitos de espuma de 3-5 capas, que se consideraban ineficaces para la cicatrización. El cambio al nuevo apósito se produjo debido a la mala gestión del exudado (n=14) y a la maceración de la piel (n=6). El nuevo apósito fue evaluado como «muy bueno» en términos de absorción (78%) y retención (83%) y fue recomendado por el 100% de los participantes debido a su buen rendimiento y comodidad. El estudio clínico demostró que, en condiciones ideales de cicatrización, es posible prolongar los intervalos entre tratamientos, promoviendo la «cicatrización sin interrupción».

Conclusiones: La elección de tratamientos adecuados es esencial para evitar el dolor, la infección y los cambios frecuentes de apósito, creando un ambiente ideal para la cicatrización. Los apósitos deben sellar bien los bordes y controlar el exudado, evitando cambios innecesarios.

*Mepilex® Border Flex

 

EP1252 Impacto de los referentes en el cuidado de la integridad cutánea en una organización sanitaria

Paula Urones Cuesta¹, Ana Calvo Pérez¹, Yolanda Moares Castiñeiras¹, Josefa Fernández Segade¹, Marta Álvarez Vázquez¹, Alicia Piñeiro Redondo^1
1Servizo Galego de Saúde, Santiago de Compostela, Spain

Objetivo: Analizar el rol clave de los referentes en el manejo del deterioro de la integridad cutánea y tisular dentro de nuestro servicio sanitario.

Métodos: Hemos realizado una descripción de las funciones y aportes de los referentes, destacando sus principales contribuciones en docencia, elaboración de guías, y participación en proyectos técnicos.

Resultados: Desde 2010, un total de 150 profesionales sanitarios han sido formados por profesionales a nivel nacional e internacional como expertos en el cuidado del deterioro de la integridad cutánea y tisular, consolidándose así una red de referentes en nuestra comunidad autónoma. Estos referentes han impartido 102 cursos de capacitación a otros profesionales, elaborado 9 guías clínicas especializadas en el cuidado de la piel y colaborado en la creación de 4 catálogos de productos para cura en ambiente húmedo como parte del comité técnico de evaluación. También han desarrollado contenidos educativos para la plataforma del programa y participado activamente en congresos y simposios científicos, difundiendo prácticas basadas en la evidencia.

Conclusiones: La creación de referentes en el cuidado de la piel ha fortalecido el sistema sanitario mediante la mejora de la calidad asistencial y educativa en esta área. Su dedicación a la formación, desarrollo de recursos formativos y participación en eventos científicos garantiza una atención de alta calidad, promoviendo conocimientos actualizados y buenas prácticas entre los profesionales sanitarios y la comunidad en general, contribuyendo así a la sostenibilidad y avance del cuidado integral de la piel.

 

EP1253 Unidades de heridas complejas: Jornada de consenso

Marta Ferrer Solà¹, Joan Enric Torra i Bou^2
1Consorci Hospitalari de Vic - Fundació Hospital de la Santa Creu de Vic, Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Ctra. de Roda, 70 08500 Vic, Barcelona, Spain., Vic, Spain, ²Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Ctra. de Roda, 70 08500 Vic, Barcelona, Spain, Vic, Spain

Objetivo: Las unidades de heridas complejas (UHC) son una estructura funcional para el cuidado de heridas que se va introduciendo progresivamente en el Sistema Sanitario de España.

Métodos: Con motivo del XX aniversario de la Unitat de Ferides Complexes del Hopsital de la Santa Creu-Consorci Hopsitalari de Vic, se organizó una sesión de discusión entre representantes de XXX Unidades de Heridas acreditadas por el GNEAUPP para consensuar, de acuerdo con la experiencia de dichas unidades, los aspectos más importantes a tener en cuenta en estas unidades y generar un documento que sirva para actualizar los criterios de acreditación de unidades de heridas del GNEAUPP.

Resultados: En la reunión participaron 7 de las unidades acreditadas por el GNEAUPP en Junio de 2024. Los participantes consensuaron una serie de conclusiones en base a las siguientes dimensiones de las UH, las cuales se describen sintéticamente en la comunicación:

• Conceptualización y modelos, objetivos, requisitos, composición, dependencia y relaciones dentro de las organizaciones asistenciales, docencia e investigación, documentación y registros, evaluación de resultados, valoración psicosocial, escalabilidad y continuidad de las UHC.

Conclusiones: Tras la compilación de las conclusiones se está elaborando un documento que será publicado en una revista científica de heridas.

• Los autores son representantes de las 7/9 de las unidades acreditadas i de los 19 participantes en la reunión de consenso.

 

 

ASISTENCIA A DOMICILIO

EP1170 Funciones de la enfermera gestora de residencias geriátricas en el abordaje de lesiones complejas en un Área Básica de Salud: importancia de la coordinación entre niveles asistenciales

Jordi Montía Acosta¹, Anna Garcia Morera, Marta Hugas Català, Alexandra Moreno Felipe, Daniel Moreno Garcia

¹SSIBE, Palamós, Spain

Objetivo: Describir las principales funciones de la enfermera gestora de residencias geriátricas en el abordaje de lesiones complejas en un Área Básica de Salud.

Métodos: Desde el año 2021 se introdujo en nuestra Área Básica de Salud la figura de la enfermera gestora de residencias geriátricas con el objetivo principal de mejorar la coordinación entre Atención Primaria y las residencias geriátricas de gestión privada de la zona. Se detallarán las principales funciones y actividades relacionadas con el abordaje de las lesiones tanto a nivel formativo como asistencial. Se expondrán una serie de casos clínicos sobre los principales tipos de lesiones cutáneas atendidas (úlceras por presión, úlceras vasculares, lesiones por humedad, laceraciones) y el procedimiento para introducir la terapia compresiva (vendas de corta tracción, sistemas de velcros, medias de compresión médica) en los centros residenciales.

Resultados: La implementación de la figura gestora de residencias ha conseguido mejorar la comunicación entre las residencias geriátricas y Atención Primaria de Salud, ha contribuido a facilitar la coordinación con otros niveles y recursos asistenciales implicados en el abordaje de lesiones de nuestro sistema integral de salud (cirugía vascular, servicio de rehabilitación, centro sociosanitario de atención intermedia), ha favorecido una racionalización de los recursos materiales de cura y ha mejorado la atención en las lesiones de difícil cicatrización.

Conclusiones: La figura de la enfermera gestora de residencias permite mejorar el abordaje de las principales lesiones cutáneas atendidas en las residencias geriátricas de un Área Básica de Salud.

 

EP1171 Circuito asistencial del paciente programado para tac que precisa nefroprotección en la
Unidad de hospitalización a domicilio del hospital universitario fundación de alcorcón

Gema Reviejo¹, Raquel Diaz Diaz^1
1Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain

Objetivo: Disminuir la presión asistencial en los servicios de hospitalización convencional.

Disminuir infecciones cruzadas, ya que un alto porcentaje de pacientes provienen de las consultas de Oncología.

Aumentar la satisfacción del paciente/familia.

Métodos: La prestación se inició el 20 de diciembre del 2022, atendiendo a un total de 60 pacientes hasta el 23 de noviembre 2023. Estancia media de 2 días. No se han evidenciado infecciones cruzadas. Las visitas domiciliarias las realizó el equipo de enfermería, ninguno precisó visita médica. Cuando el médico especialista responsable del paciente que precisa un TAC detecta el riesgo de nefropatía según el protocolo, realiza una interconsulta a nuestro servicio. Si cumple criterios de inclusión, el paciente se incluye en el listado de citados de nuestra unidad.

Resultados: La Hospitalización a Domicilio es la alternativa de elección para aquellos pacientes que precisen una prevención de la nefropatía inducida por contraste. Los pacientes atendidos en ésta modalidad experimentan un alto nivel de satisfacción como se recogen en las encuestas de la unidad. El volumen de pacientes atendidos en nuestra unidad sirve de descarga asistencial a la hospitalización convencional.

Conclusiones: La enfermería de la unidad de Hospitalización a Domicilio realiza un amplio abanico de actividades que se engloban en los siguientes ámbitos: Gestión integral y coordinación de citas del paciente. Coordinación de los traslados si necesita ambulancia. Coordinación con la familia de la hora de la asistencia en domicilio. Valoración integral. Del paciente, entorno y cuidadores. Educación Sanitaria. Al paciente y cuidadores.

 

EP1172 Impacto del Déficit de autocuidado en el tratamiento de úlceras de pie diabético

Claudia Martinez Menendez¹, Carmen Prieto Hernández¹, Cristina Cama Capellas¹, Mar Gainza Sancha¹, Paula Barnés Anglada^1
1SSIBE, Palamos, Spain

Objetivo: El objetivo principal es valorar el impacto de la atención domiciliaria interdisciplinaria en la evolución de las heridas y la calidad de vida de nuestros pacientes. Sobre todo en aquellos más complejos y en casos de aislamiento social. 

Métodos: Durante 2 años se atiende al paciente en el programa ATDOM (atención domiciliaria) tras descubrir una úlcera necrótica en el pie izquierdo, que se fue complicando hasta requerir la amputación del 2º y 3º dedo del pie, y actualmente se está tratando la infección de la herida postquirúrgica. Se realizaron curas avanzadas, terapia compresiva y tratamiento antibiótico, con escasa mejoría, exceptuando durante los ingresos hospitalarios, cuando recibía atención diaria integral. Servicios sociales es el encargado de su alimentación, medicación e higiene personal debido a su carencia de autocuidado.

Resultados: La herida ha mostrado una evolución lenta, con episodios recurrentes de necrosis e infección por Pseudomonas multirresistente. El paciente continúa con dolor durante las curas, abundante exudado y mal olor, lo que repercute negativamente en su calidad de vida.

Conclusiones: El déficit de autocuidado ha sido el factor principal del empeoramiento de las heridas y del deterioro general del paciente. Sin embargo la coordinación entre servicios sociales y la atención domiciliaria proporcionada desde el ABS, ha supuesto la única manera efectiva de resolver las úlceras de este paciente, al proporcionarle una continuidad en sus cuidados.

 

EP1173 Descripción y análisis de una unidad de curas de heridas complejas a domicilio, en un hospital comarcal

Ana Belén Blázquez Fernández¹, Vicente Villalba Munera¹, M. Ángeles Fernández Labrada^1
1Fundación Hospital Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain

Objetivo: Mejorar la calidad de vida de pacientes con heridas complejas, que presenten limitación de movilidad, dificultad de transporte autónomo y/o problemática social, acercando el hospital al domicilio habitual (particular y/o residencia).

Métodos: Valoración integral del paciente por un equipo multidisciplinar (cirujano vascular y enfermera experta en curas) durante la hospitalización o en las visitas ambulatorias. La unidad dispone de criterios de inclusión. Los pacientes candidatos a recibir curas en domicilio deberán dar el consentimiento y aceptarán un registro fotográfico de la evolución. La enfermera experta efectuará las curas domiciliarias y las fotografías. Ante cualquier incidencia, se contactará con el cirujano vascular para dar respuesta prioritaria.

Resultados: Análisis de los primeros 6 meses de funcionamiento de la unidad (marzo-septiembre 2024). Heridas atendidas: isquémicas 40%, venosas 23% y LPP 18%; el 19% restante incluye post-traumatismos, hipertensivas y neuropáticas. El 60% de los pacientes han sido dados de alta, destacando un 70% por cicatrización completa y un 8% por mejoría en la movilidad. El 100% de los candidatos a los que se les ha propuesto entrar en el circuito ha dado su consentimiento.

Conclusiones:

• El trabajo multidisciplinar permite una optimización de los recursos sanitarios, posicionando al paciente en el centro de la atención integral.
• Se promueve el autocuidado y la colaboración de la familia/entorno mediante responsabilidad compartida y educación sanitaria.
• La unidad atiende a las necesidades reales y cambiantes de la comunidad, teniendo en cuenta los factores bio-psico-sociales que intervienen en el proceso de cicatrización.

 

EP1174 Circuito de continuidad asistencial para pacientes con heridas complejas en hospitalización a domicilio (HAD)

Carmen Mias Carballal¹, Noemí Martin², Esther Guiu², Pilar Gómez², Bárbara Lambea², Ramón Ribalta², Natividad Ocaña^2
1Hospital Universitario Arnau de Vilanova de Lleida, Facultad de Medicina de la UdL, IRB LLeida, Lleida, Spain, ²Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain

Objetivo: Compartir el protocolo de continuidad asistencial para pacientes con heridas complejas en el domicilio de nuestra unidad de HAD.

Métodos: Se describe el circuito de ingreso y alta de la unidad de HAD quirurgíca (HADQ) de nuestro hospital, para pacientes que presentan heridas complejas, considerando la procedencia del paciente (hospitalización, otros), lugar de residencia (zona de cobertura o no), estabilidad clínica, voluntariedad, tipo de curas a realizar y necesidad de otras actuaciones asistenciales (drenajes, antibioterapia, nutrición, pruebas, analíticas)

Resultados: El protocolo está dirigido a pacientes quirúrgicos con heridas complejas que también puedan necesitar de la realización de otros procedimientos en el domicilio.

Se describe el circuito de ingreso, identificando el lugar de residencia, para identificar si reside fuera de la zona de cobertura de la HAD

Es necesaria una ORDEN DE INGRESO en HAD en la historia clínica electrónica (HCC), para realizar la valoración social y clínica del paciente por el equipo de HaD, y proceder al INGRESO REAL en HAD.

Los pacientes reciben información escrita sobre el funcionamiento de la HAD, y firman el consentimiento informado. Se les facilita material para las primeras 24h, y un número de teléfono de contacto. En el caso de que se necesite la colaboración de Atención Primaria (AP), se facilitará material especializado necesario, y las gestoras de casos hospitalarias (GCH) coordinarán con AP la atención conjunta de estos pacientes.

Tambien se describe el circuito de alta de HaD, distinguiendo si es programada o urgente.

Conclusiones: El protocolo de continuidad asistencial para el ingreso y alta de HaD de los pacientes con heridas complejas, garantiza la calidad y la seguridad en la atención al paciente.

 

EP1175 Papel del especialista enfretamento el manejo del cáncer de mama: reporte de un caso

Juliana Lucinda dos Santos¹, Juliana Cacilha², Lys Santos^3
1Prime Care Cuidados Integrados a Feridas, Santo André, Brazil, ²Hospital Lefort, São Paulo, Brazil, ³aliiance, Rio de Janeiro, Brazil

Objetivo: El cáncer de mama es un carcinoma causado por la multiplicación desordenada de células anormales de las glándulas mamarias que invaden otros tejidos, dando lugar a tumores malignos. En su epidemiología, el cáncer de mama es la primera causa de mortalidad por cáncer en la población femenina en Brasil.

Métodos: Se trata de un estudio descriptivo y explicativo en forma de relato de experiencia. Realizado en atención domiciliaria en São Paulo- Brasil. Paciente de 43 años con antecedente de cirugía bariátrica. Diagnosticada de cáncer de mama derecha en enero/2025. Después de la cirugía, el paciente evolucionó con vendajes oclusivos durante 7 días, acompañados de dolor intenso en el sitio. Después de este período, se retiraron los vendajes y se observó isquemia parcial en la mama, y necrosis .Uso de rifampicina

Resultados: Após una evaluación estomaterapeuta, utilizó la herramienta de gestión TIMERS para apoyar la nueva planificación, se llevó a cabo el protocolo de limpieza con espuma impregnada con polihexametileno biguanida, para la eliminación de tejido no viable, protección de los bordes e hidrofibra con plata asociada al recubrimiento de espuma de silicona. Terapia láser de baja intensidad, de 2 J de 660 nm. Período de cambio cada 3 días.

Conclusiones: Durante el tratamiento se pudo observar acción autolítica, debido al uso de espuma con phmb, siendo fundamental una disminución del tejido desvitalizado asociado a su poder antimicrobiano. Enfatizo la importancia de los protocolos asertivos en los pacientes en tratamiento oncológico .Implicaciones clínicas: Falta de seguimiento interdisciplinario durante el proceso de curación. Impacta en la planificación para un mejor resultado de la clínica, proporcionando un retraso para la radioterapia.

 

EP1176 Implementación de modelo de atención intercultural en el manejo domiciliario de heridas complejas en comunidad mapuche: serie de casos

Pedro Alberto Arévalo Catalán^1
1Departamento de Salud Rural, Lautaro, Chile

Objetivo: Evaluar el impacto de la implementación de un modelo de atención intercultural en la cicatrización y adherencia al tratamiento de úlceras venosas (UV) en pacientes mapuches de una zona rural de Chile.

Métodos: Se realizó un estudio de caso descriptivo y prospectivo con tres pacientes mapuches diagnosticados con UV. El modelo integró tanto las recomendaciones internacionales para el manejo de UV como las prácticas tradicionales y la cosmovisión de los pacientes. Se contó con la participación de una facilitadora intercultural y un enfermero, quienes implementaron los tratamientos en domicilio. Los pacientes fueron evaluados dos veces por semana durante un total de cuatro semanas.

Resultados: En los tres casos se observó una cicatrización completa en menos de 28 días. La adherencia al tratamiento mejoró notablemente al integrar las prácticas tradicionales y respetar la cosmovisión de los pacientes, lo que también contribuyó a una reducción en los costos de manejo de estas heridas.

Conclusiones: El manejo de heridas complejas en comunidades indígenas requiere un enfoque integral que respete las prácticas y cosmovisión de los pacientes, lo cual no representa una limitante para implementar un tratamiento basado en evidencia científica y el uso de tecnologías avanzadas. Esta serie de casos demuestra que la integración de un modelo de atención intercultural puede no solo mejorar los resultados clínicos y la adherencia al tratamiento en pacientes mapuches, sino también combinar eficazmente la medicina tradicional con terapias modernas, superando las barreras culturales y geográficas en zonas rurales.

 

EP1177 Aplicación de crema compuesta con aceite de equipo, extracto glicólico fermentado de papaya y aloe vera en el tratamiento de la lesión oncológica

Andrea Dultra, Carine Almeida^1
1Lifecoop, Salvador, Brazil

Objetivo: Reportar la eficiencia de un tratamiento alternativo utilizando una crema con propiedades antisépticas y cicatrizantes, compuesta por aceite de Melaleuca, extracto glicólico fermentado de papaya y Aloe Vera, aplicada sobre una lesión oncológica con el objetivo de evaluar su efectividad en el proceso de cicatrización.

Métodos: Se trata de un relato de experiencia con seguimiento fotográfico a lo largo del tiempo. Realizado en atención domiciliaria, el estudio tuvo lugar del 1 de diciembre de 2023 al 5 de mayo de 2024, respetando los principios éticos de las Resoluciones nº 466/2012 y 510/2016 del Consejo Nacional de Salud.

Resultados: El paciente M.D.S.V., de 84 años, con lesión oncológica facial que no respondía a tratamientos anteriores, recibió irrigación con solución salina, seguida de aplicación de la crema cada 48 horas. La evolución de la lesión se registró en diferentes etapas. Inicialmente (Figura A, 01/12/23), la lesión mostraba biopelícula y tejido granulado. En la fase intermedia (Figura B, 24/01/24), hubo aumento del área y presencia de tejido hipergranulado. En una tercera etapa (Figura C, 07/03/24) se observó contracción de la lesión y reepitelización. En la última fase (Figura D, 24/05/05) se encontró tejido remodelado, lo que indica la efectividad del tratamiento.

Conclusiones: El tratamiento con la crema a base de aceite de Melaleuca, extracto glicólico fermentado de papaya y Aloe Vera demostró ser eficaz como agente antiséptico y cicatrizante, favoreciendo la recuperación de la lesión oncológica, siendo una alternativa viable para lesiones complejas resistentes a otras terapias.

 

EP1095 Abordaje transdiciplinar de la persona con heridas crónicas en una unidad de convalescencia domiciliaria

Imma Mundet¹, Raquel Segala Castañeda², Nuria Lopez Matons², Nerea Sala Ponce², Maria Perez Romero², Sara Zauner Lopez^2
1Convalescència Grup Mutuam, Barcelona, Spain, ²Convalescencia Grup Mutuam, Barcelona, Spain

Objetivo: Describir el perfil del paciente con heridas crónicas atendido en una unidad de atención a domicilio de convalecencia.

Describir el manejo transdisciplinar de la unidad y las técnicas básicas aplicadas.

Métodos: Estudio descriptivo retrospectivo de abril a octubre del 2024.

Revisión de historias clínicas de personas atendidas por un equipo multidisciplinar de atención intermedia de hospitalización a domicilio. Se registraron variables sociodemográficas, procedencia, ubicación, días de ingreso, número de visitas, escalas ingreso/alta, localización, estadío, epitelización de heridas, y medidas de manejo/prevención.

Resultados: N:45 personas visitadas, 14 presentaban herida crónica. Edad media:83.59(SD:5.25), 78.6% mujeres. El 57.1% derivadas de atención primaria y el 64.3% vivían en residencia geriátrica. Media de Braden: 13.21(2.9). El 35.7% herida en sacro, 21.4% talones, 7.1% trocánter, 7.1% pierna y el 28.6% poliulcerados. El 14.3% categoría II-III, 71.4% IV y el 14.3% no estadiables. Al 85.7% se aplicó cura avanzada y al 14.3% cura seca. Las puntuaciones medias (SD) de las escalas en ingreso/alta fueron: Barthel 15.4(24.2)/18.2(28.1), Lawton 0.2(0.8)/0.4(1.3), Katz 1(1.3)/1.1(1.5), Tinetti 2.8(5.8)/3.6(7.5), Aschworth 0.2(0.8)/0.2(0.8) y Pfeiffer 6.4(4)/5.4(4). Porcentaje de ayudas técnicas ingreso/alta fueron: Sistema dinámico manejo presión 42.9%/92.8%, cojín 92.9%/100%, ácidos grasos hiperoxigenados 57.1%/100%. El 100% tomaron suplementos, el 14% con arginina. El 8.69% epitelizaron. La estancia media de las personas con heridas fue de 37.8(15.9) y el número total de visitas de 33.1(16.5) frente al 23.2(14.1) y 20.4(19.3).

Conclusiones: Los pacientes institucionalizados ingresan con lesiones más severas y muchos, sin medidas preventivas. La resolución de los casos está limitada por el tiempo de estancia en la unidad.

 

EP1178 Importancia de la coordinacion entre niveles asistenciales para mejorar la atencion de una persona con heridas complejas

Sara Gutiérrez Aguilera¹, María Sebastián Rodriguez², Anna Carrasco Álvarez², Marta Escriu de Gracia², Marta Florensa Rex², Marta Serrate Casado², Anna Santoyo Medina^2
1PArc Sanitari Pere Virgili, Barcelona, Spain, ²Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Destacar la necesidad de un enfoque interdisciplinario y de colaboración entre diversos profesionales de la salud y servicios sociales para mejorar el abordaje de casos complejos.

Métodos: Mujer, 67 años. Cardiopatía isquémica, lesiones varicosas infectadas, estenosis de canal, trastorno depresivo y trastorno por acumulación. Reside en su hogar junto a su marido vulnerable (en tratamiento de hemodiálisis), su hija y sus mascotas.

Es una familia multiproblemática que requiere colaboración e implicación de todos los profesionales.

Resultados:

1. Seguimiento Inicial de Lesiones (2018): Curas cada 7-10 días en Centro de Atención Primaria (CAP) de lesiones varicosas.
2. Intervención de Servicios Sociales (2019): Trabajadora social (TS) del CAP y Servicios Sociales (SS) proponen una limpieza de choque y apoyo en el hogar, a lo que la familia responde con negativas reiteradas.
3. Pandemia de SARS-CoV-2 (2020): La paciente recurre a autocuras tres veces por semana debido a las restricciones de movilidad.
4. Empeoramiento y Atención Domiciliaria (2024): En julio, se integra en el programa de atención domiciliaria y se realizan curas tres veces por semana.
5. Ingreso Hospitalario y Traslado a Sociosanitario (Octubre de 2024): Sufre una posible fractura de cadera e isquiopubiana tras dos caídas. TS y SS gestionan su traslado a un centro sociosanitario, decisión aceptada por la paciente y su família por claudicación.

Conclusiones: La negativa familiar resalta la necesidad de un enfoque adaptativo, holístico y colaborativo, de manera precoz, integrando motivación y apoyo interdisciplinario para abordar eficazmente casos complejos, respetando sus dinámicas y entornos personales.

 

EP1179 Técnicas avanzadas en el cuidado de heridas en entorno domiciliario. Cuidados compartidos y monitorización de las heridas

Adolfo Suarez Rodriguez¹, Ana Otero¹, Marina Cordoba¹, Irene Ocete¹, Sonia Riera Manzano^1
1Hospital Clinic de Barcelona, Barcelona, Spain

Objetivo: Describir el manejo de una herida de difícil cicatrización mediante el uso de técnicas avanzadas y la monitorización de la herida en entorno domiciliario

Métodos: Paciente de 54 años con paraplejia secundaria a lesión medular completa que presenta lesión por presión (LPP) en trocánter izquierdo tras ingreso prolongado por shock séptico. Al alta se inicia seguimiento ambulatorio por enfermera de práctica avanzada en heridas complejas (EPA HC) que valora LPP de categoría IV, cavitada, con tejido esfacelado abundante, bordes inflamados, mal olor y exudado abundante. Se plantea ingreso en hospitalización domiciliaria (HDOM) para iniciar terapia de desbridamiento larval (TDL), con el objetivo de viabilizar el lecho de la herida y poder realizar terapia de presión negativa (TPN). El paciente es visitado a diario por el equipo de HDOM monitorizando escala RESVECH 2.0 y registro fotográfico en historia clínica. 

Resultados: La valoración inicial de la LPP por parte de la EPA HC puntuaba 21 en la escala Resvech 2.0. A la semana de inicio de TDL se consigue un lecho viable y ausencia de signos clínicos de infección, con disminución en la escala Resvech de 8 puntos. La TPN se mantiene durante 4 semanas con mejoría evidente y puntuación en la Escala Resvech de 6 puntos

Conclusiones: Las técnicas avanzadas son una opción cada vez más establecida ante heridas de difícil cicatrización. Monitorizar heridas usando escalas validadas, registro fotográfico y colaboración con la EPA HC aumenta la seguridad y confianza del profesional de Hospitalización a domicilio. 

 

EP1181 Implementación de la guía práctica para el tratamiento de heridas en la atención domiciliaria de una capital de la amazonia occidental

Cristielle Montenegro¹, Alyne Duarte², Anne Caroline³, Gabriel Araujo³, Herleis Maria³, Bárbara Pompeu^3
1EMAD/SEMSA, Rio Branco, Brazil, ²UFAC, Rio Branco, Brazil, ³UFAC, Rio Branco, Brazil

Objetivos: La Guía Práctica para el Tratamiento de Heridas fue creada para orientar las decisiones de los profesionales de la salud en cuanto a los utensilios necesarios para el cuidado de heridas, además de establecer un proceso estandarizado para la solicitud de insumos al Servicio de Atención Domiciliaria (SAD).

Métodos: La redacción de la guía comenzó con la organización de ideas y la consulta de directrices nacionales. La estructura se delimitó en temas que abarcan la evaluación de la morfología de la herida y las opciones de tratamiento, tales como vendajes y coberturas. Tras su elaboración, el contenido fue revisado por profesionales de la salud, con énfasis en accesibilidad y aplicabilidad, integrando imágenes y un diseño práctico. Finalmente, la guía se puso a disposición en formato impreso y digital, y los profesionales recibieron capacitación para su uso.

Resultados: La implementación de la guía facilitó la elección de los insumos por parte de los profesionales, estandarizó el cuidado y el flujo de solicitud. Sin embargo, se identificaron algunos problemas de interpretación en relación con la interfaz del documento. La actualización periódica, basada en la opinión de los usuarios, permite la adaptación, mejorando la atención.

Conclusiones: La Guía Práctica para el Tratamiento de Heridas es fundamental para estandarizar la atención y mejorar el cuidado domiciliario. Su diseño simple y las instrucciones contribuyeron a optimizar el flujo asistencial. La actualización regular asegura la funcionalidad del manual, destacando la importancia de un enfoque colaborativo y flexible en las herramientas de cuidado en salud.

 

EP1182 Gestión del cuidado en lesiones por presión en la atención domiciliaria

Cristielle Montenegro¹, Alyne Duarte², Ana Carolina Melo², Herleis Maria², Blanck Mara^3
1EMD/SEMSA, Rio Branco, Brazil, ²UFAC, Rio Branco, Brazil, ³Sobenfee, Rio de Janeiro, Brazil

Objetivo: Este estudio tuvo como objetivo identificar el protocolo, las prácticas facilitadoras y dificultadoras asociadas al manejo y prevención de la lesión por presión (LP) en la gestión del equipo multiprofesional en el cuidado del paciente en atención domiciliaria.

Métodos: Se realizó un estudio exploratorio-descriptivo, de naturaleza cuantitativa y cualitativa, con profesionales de un equipo multiprofesional. Se utilizó un cuestionario semiestructurado con preguntas de opción múltiple sobre el protocolo de prevención, necesidades de conocimiento, percepción sobre prevención y sugerencias para reducir la ocurrencia de LP. Los datos permitieron realizar análisis descriptivos mediante frecuencias absolutas y relativas, y el análisis cualitativo se llevó a cabo mediante análisis de contenido.

Resultados: Entre los resultados más destacados, una parte significativa de los profesionales informó conocer el protocolo de intervención de LP. Se mencionaron documentos como la cartilla del cuidador como prácticas facilitadoras; sin embargo, se reportaron dificultades de compromiso de otros miembros del equipo y la falta de tiempo debido a múltiples demandas de cuidado.

Conclusiones: Se concluye que la prevención y tratamiento de LP requieren gestión compartida con acciones integradas entre quienes brindan asistencia, superando las dificultades mencionadas. La asistencia del equipo multiprofesional domiciliario a pacientes con LP es crucial para prevenir y tratar daños, así como para crear un plan de cuidados integral.

 

EP1183 Elaboración de la cartilla del cuidador: información y orientaciones para instituir las buenas prácticas en la atención domiciliaria

Alyne Duarte ¹, Julia Perreira², Cristielle Montenegro^{2 2}, Herleis Maria², Bárbara Pompeu², Blanck Mara^3
1UFAC, Rio Branco, Brazil, ²UFAC, Rio Branco, Brazil, ³Sobenfee, Rio de Janeiro, Brazil

Objetivos: La “Cartilla del Cuidador: Información y Orientaciones para Instituir las Buenas Prácticas en la Atención Domiciliaria” tiene como objetivo proporcionar información práctica y accesible a los cuidadores domiciliarios, con el objetivo de mejorar la calidad de la atención prestada y un mayor bienestar a los pacientes en el hogar. Presenta información y orientaciones multidisciplinarias para una atención integral.

Metodología: Para la elaboración se realizó una revisión de la literatura, entrevista con cuidadores y profesionales de la salud.

Resultados: Los resultados destacan que la cartilla no solo contribuye a la mejora de la calidad de la atención prestada, sino también a la promoción de la autonomía de los cuidadores con respecto a la atención diaria. En el análisis del material producido se identifica que la cartilla aumenta la confianza y, al mismo tiempo, la eficacia de las prácticas de prestación de cuidados, haciendo así que el cuidador sea autosuficiente en el manejo y en el proceso de rehabilitación de quien está siendo atendido.

Conclusiones: La cartilla es una herramienta eficaz para la capacitación de los cuidadores domiciliarios, promoviendo prácticas seguras en diversas áreas y mejorando la calidad de vida de los pacientes. La cartilla refuerza la importancia de la educación en salud multidisciplinar para los cuidadores, mostrando que un material informativo bien elaborado puede ser un recurso valioso para la atención domiciliaria. Además, la cartilla debe ser ampliamente difundida en varias comunidades, así como un estímulo para el desarrollo profesional de los cuidadores.

 

EP1184 Costo efectividad de los ácidos grasos hiperozonizados en el manejo de lesiones de pacientes domiciliados

José Alfredo Gallardo Velásquez ²^,³, Vanessa Edith Gallardo Velásquez¹^,³
¹ Clínica Indisa, Santiago, Chile, ² Clínica Dávila, Santiago, Chile, ³ PUQ HOME, Santiago, Chile.

Objetivo: Demostrar la costo-efectividad y beneficios de los ácidos grasos hiperozonizados (AGHOZ) en la restauración de pieles desvitalizadas y reparación de lesiones de diferentes etiologías en una serie de casos de atención domiciliaria.

Método: Presentación de una serie de 6 casos con lesiones cutáneas de diferente etiología y piel desvitalizada de pacientes atendido en domicilio para evaluar los beneficios y costo-efectividad de los ácidos grasos hiperozonizados (AGHOZ) utilizando una solución tópica* con un 90% de AGHOZ y un protector barrera con efecto reparador**con un 30% de AGHOZ, los cuales fueron aplicados de forma concomitante o por separado según requerimiento clínico.

Resultado: En todos los casos se constataron los beneficios de los ácidos grasos hiperozonizados (AGHOZ), los que permitieron restaurar la calidad e integridad de la piel desvitalizada y reparar las lesiones cutáneas en un tiempo menor a lo esperado, destacando que además se utilizan menos recursos en el manejo de cada caso.

Conclusión: La serie de casos presentados nos permite concluir que los productos que contienen ácidos grasos hiperozonizados (AGHOZ) constituyen una clase de productos costo-efectivos para tratar pacientes en domicilio, cuyos beneficios permiten restaurar de forma rápida y segura todo tipo de pieles desvitalizadas y de igual forma reparar lesiones cutánea de diferente etiología.

Abzolem oil®*

Abzolem barrier®**

 

EP1185 Perfil epidemiológico de heridas crónicas atendidas por una ips a nivel domiciliario en la costa caribe colombiana desde el año 2020 hasta del año 2024

Oswaldo De Jesús Cantillo Padilla^1
1IPS Cuidado Seguro en Casa, Cartagena, Colombia

Objetivo: Determinar la prevalencia de las heridas crónicas en pacientes atendidos en atención domiciliaria en el periodo de 2022 y 2024.

Métodos: Se realizó un estudio descriptivo, retrospectivo, cuantitativo, observacional, analítico de cohorte donde se tuvo en cuenta un maestreo poblacional que corresponde al 98% de los pacientes atendidos por el servicio de clínica de heridas durante el periodo comprendido de enero del 2022 a septiembre del 2024 con heridas crónicas.

Resultados: Se realizó seguimiento a un total de 12258 pacientes, de los cuales el 43.4% corresponde a hombres y el 56,60% fueron mujeres. Se realizó un análisis de promedio de estancia de acuerdo al tipo de herida crónica encontrando que el mayor número de estancias se presentó en las úlceras atípicas (274 días) seguido de úlceras de etiología venosa (200.8), neoplásicas (148,56), seguido de las lesiones cutáneas relacionadas con la dependencia (96.49), seguido úlceras por síndrome de pie diabético (81.39 días), heridas posquirúrgicas (79.5), y en último lugar las quemaduras (32.43 días).

Conclusiones: Las heridas crónicas constituyen uno de los problemas más importantes en el ámbito asistencial que afecta al sistema de salud debido a los elevados promedios de días de estancia que generan tanto en el ámbito intrahospitalario como en el ámbito domiciliario (1). Dentro de estas las heridas crónicas con mayores promedios de estancia las lesiones cutáneas relacionadas con la dependencia y las úlceras de etiología venosa, es importante que estas representan una disminución de la calidad de vida de quienes las padecen y de sus cuidadores, debido a su elevado costo económico y por la dedicación de tiempo de los profesionales de la salud como personal médico, enfermería, nutricionistas entre otros.

 

EP1186 Menos presion, mas recuperacion

Maria Isabel Blazquez Blanco¹, Vanessa Gutiérrez Leon¹, Claudia Terradillos Gonzalez¹, Clara Jiménez Andrinal¹, Javier Varas de la Fuente^2
1sacyl, Avila, Spain, ²Residencia tercera edad (JCYL), Avila, Spain

Objetivo:

- Control de la infección

- Control del dolor

- Cicatrización de la lesión

- Lograr movilizacion del paciente

Métodos: Varón de 86 años, Diabetes Mellitus tipo II, en tratamiento con insulina y antidiabeticos orales, Hipertension Arterial, fumador de 20 cigarrillos al día, cirrosis crónica, insuficiencia renal crónica, deterioro cognitivo, incontinencia urinaria, precisa ayuda para actividades de la vida diaria, se niega a realizar cualquier actividad, permaneciendo en cama casi todo el día. Presenta una protuberancia en esternón, que se ha ulcerado e infectado.

Se realizan curas domiciliarias cada 72 horas concarboximetilcelulosa sódica con plata ionica y apósito secundario de espuma adhesivo.

Se libera presiones mediante cambios posturales frecuentes, fomentando la movilidad, logrando que el paciente se levanter al sillon y permanezca varias horas al dia levantado

Realiza ejercicios isometricos para mejorar la movilidad y la fuerza muscular

Resultados:

- Cicatrización de la lesión.

- Mejora de su relación con el entorno.

- Mejor control de la diabetes.

- Mayor movilidad

- Mejora de la calidad de vida.

Conclusiones: El Alivio y disminución de presiones, cambios posturales y el aumento de la movilidad junto a un adecuado control de la diabetes son fundamentales para lograr cicatrización de lesiones en pacientes inmovilizados producidas por presión y friccion.

La colaboracion de los cuidadores mediante educacion sanitaria de los mismos es fundamental.

 

 

INFECCIÓN

EP1522 Productos sanitarios con evidencia controvertida : povidona yodada y sulfadiazina argéntica. Una revisión de la bibliografía

Ana Isabel Guerrero Troyano¹, José Manuel Sánchez Vicente¹, Claudia Martínez Martín^1
1Consorci Sanitari de Terrassa, Terrassa, Spain

Objetivo: Las curas con povidona yodada y sulfadiazina argéntica resultan muy polémicas debido a la variabilidad que hay en la práctica clínica a la hora de emplear estos productos sanitarios. Por este motivo, el objetivo del estudio es conocer si la última evidencia avala su uso.

Métodos: Se han realizado 3 búsquedas bibliográficas en Cochrane y Pubmed, tomando como criterios de inclusión artículos del 2017 hasta la actualidad y estudios que incluyesen las palabras “sulfadiazina argéntica” OR “sulfadiazina de plata”; “povidona yodada” y “povidona yodada” AND “materia orgánica” en el título y/o resumen, seleccionado un total de 12 artículos.

Resultados: La povidona yodada presenta una efectividad antibacteriana muy alta, produce una neovascularización muy rápida y es muy efectivo para combatir los biofilms, estudiado en ratas y en condiciones in vitro respectivamente. Además, resulta más efectivo en presencia de materia orgánica que el gluconato de clorhexidina, polihexanida y la octenidina.

En quemaduras, el uso de la sulfadiazina argéntica para prevenir infecciones está contraindicado. La última evidencia avala otros productos con tiempo de curación menor y menos efectos adversos, como la miel entre otros. Se apoya su uso sólo en quemaduras de tercer grado; en las ya infectadas; o con alta carga microbiana.

Conclusiones: Los resultados orientan a que la povidona yodada puede resultar un antiséptico efectivo en la cura de heridas en la práctica clínica, aunque habría que realizar más ensayos clínicos in vivo. En lo que respecta a la sulfadiazina argéntica, está contraindicado su uso de manera sistemática.

 

EP1523 Cómo actuar ante una miasis cutánea en herida humana

Jéssica Martínez Castillejo¹, Cristina Farré Escofet¹, Mercè Piazuelo Pont^1
1Hospital Clínic de Barcelona, Barcelona, Spain

Objetivo: Dar a conocer las pautas de actuación con más consenso ante una miasis en herida humana dado que es una etiología poco común y con escasa evidencia científica sobre su abordaje. 

Métodos: Paciente de 86 años que acude a la consulta de curas de cirugía ortopédica derivado de atención primaria con úlcera en base de 5to dedo del pie derecho con exposición completa de cabeza del 5to metatarsiano. Tras valoración se decide iniciar tratamiento con terapia de presión negativa de un solo uso a la espera tratamiento quirúrgico. 

Una semana después la lesión presenta larvas en diferentes estadios y orificios de respiración interdigitales. 

Por indicación de facultativa con conocimientos en miasis, se procedió a la extracción de las larvas utilizando vaselina para ocluir lesiones. Tras cinco minutos se retiró la vaselina y las larvas que salieron a respirar. Este proceso se realizó en dos ocasiones y se derivó a urgencias para tratamiento quirúrgico. Tras 24h se realizó amputación transmetatarsiana y se inició tratamiento antibiótico endovenoso. 

Tras un mes de ingreso hospitalario fue dado de alta a centro socio sanitario. 

Resultados: La experiencia previa de un miembro del equipo en este tipo de lesiones propició una actuación precoz. La extracción de las larvas previa a la intervención fue importante para su correcta preparación.

Conclusiones: Este caso resalta la necesidad de educar a los profesionales de la salud sobre la miasis en heridas, sus métodos de tratamiento y la importancia de un enfoque multidisciplinario en el manejo de pacientes con heridas complejas. 

 

EP1524 Evolución de las Infecciones de localización quirúrgica (ILQ) en cirugía cardiaca (CC), tras la implementación del Programa de Prevención de la infección quirúrgica en Cataluña (PrevinQCat) en el Hospital Clínico de Barcelona (HCB)

Isabel Fortes Bazaga¹, Veronica Peinado Garcia², Yael Haimovich Katz³, Silvia Poyatos Manrubia¹, Gemina Santana Aparici¹, Judith Prats Barrera^1
1Hospital Clínico de Barcelona, Barcelona, Spain, ²Hospital Clíco de Barcelona, Barcelona, Spain, ³Hospital Clinico de Barcelona, Barcelona, Spain

Objetivo: Evaluar la evolución de las Infecciones de Localización Quirúrgica (ILQ) en pacientes intervenidos de cirugía cardíaca (CC), identificando tendencias y efectividad de las medidas preventivas implementadas, generales y específicas del PrevinQCat.

Métodos: Estudio retrospectivo, descriptivo y observacional donde se analiza la evolución de las ILQ en pacientes sometidos a CC los años 2022 (n539) y 2023 (n478). Los datos se han obtenido mediante revisión de historias clínicas. Se analizaron variables demográficas, tipo de cirugía, uso de antibióticos profilácticos, incidencia y tipo de ILQ.

Resultados: En 2022 se realizaron un 7,4% de CC urgente diferida, en 2023 fue un 10,5%. La derivación coronaria fue la CC más realizada. En ambos años el cumplimiento de la profilaxis antibiótica fue del 79%, no se prolongó más de 48h después de la CC en el 95%. El control estricto de la glicemia ≤150mg/dl disminuyo en el 2023. Hubo una ligera mejoría en el 2023 respecto a las ILQ en los pacientes intervenidos de CC valvular, en el resto de las cirugías no hubo cambios significativos. La ILQ con injerto safena son similares en los dos años, siendo la Infección superficial la más recurrente. La ILQ sin injerto > 2023 (3) en comparación al 2022 (1).

Conclusiones: Hay una disminución del total de infecciones, pero se mantienen el número en profunda y órgano espacio. Aplicar los paquetes de medidas, conocer la tasa de ILQ y establecer un feedback con los profesionales es la estrategia más importante para implementar las actuaciones y mejorar resultados. 

 

EP1093 Describir la efectividad de un apósito de cobre en el abordaje de lesiones con elevada carga bacteriana

Laura Baltà Domínguez, Eduardo González Álvarez, Sofia Megino Escobar¹, Ruben Molina Carrillo¹, Amalur Mateo^1
1Instituto Catalan de la Salud, Barcelona, Spain

Objetivo: Describir la efectividad de un apósito de cobre en el abordaje de lesiones con elevada carga bacteriana.

Métodos: Estudio observacional de serie de casos retrospectivo, sobre pacientes con lesiones de difícil cicatrización de diferentes etiologías atendidos en las consultas de heridas complejas de las Gerencias de la Atención Primaria y comunitaria de Barcelona ciudad (GAPIC). 

Las variables de recogida son: 

1. Evaluación Inicial: Datos del paciente y estado de la lesión (Resvech 2.0: Dimensión, Profundidad, Bordes, Tipo tejido en el lecho, Exudado, Infección).

2. Tratamiento local: Aplicar el apósito de cobre siguiendo el procedimiento que indica su ficha técnica.

3. Seguimiento: Monitorizar semanalmente hasta la cicatrización, documentando parámetros Resvech 2.0. 

Resultados: En el estudio se incluyeron 11 casos clínicos de pacientes con lesiones de difícil cicatrización con elevada carga microbiana, tratados con apósitos de cobre. Se documentó una mejora significativa en los parámetros evaluados mediante la escala Resvech 2.0. En particular, se registró una disminución notable en el exudado y en los signos sutiles de infección, así como una mejora en la calidad del tejido en el lecho de la herida. Los bordes de las lesiones mostraron una disminución del proceso inflamatorio y una tendencia a su aproximación y cierre. 

Conclusiones: Los apósitos de cobre contribuyen a acelerar el proceso de cicatrización al eliminar los microorganismos que pueden impedir o retrasar la curación y, también, promueve la angiogénesis, incrementa la producción de colágeno y mejora la estabilización de la matriz extracelular.

Estos hallazgos sugieren que los apósitos de cobre son una opción eficaz para el manejo de lesiones complejas, mejorando significativamente los resultados clínicos en pacientes con heridas de difícil cicatrización. 

 

EP1525 Manejo del biofilm

Francisca Ramirez San Lorenzo^1
1fundació Hospital De L´Esperit Sant, Santa Coloma De Gramanet, Spain

Objetivo:

• Describir el proceso de formación del biofilm y su tratamiento.
• Conocer que influencia tiene el biofilm en la cicatrización de las heridas crónicas.
• Identificar sus métodos de diagnóstico y los tratamientos que existen.
• Mostrar que el biofilm es un factor clave en la cronicidad de las heridas porque retrasa y dificulta enormemente la cicatrización.

Métodos:

• Revisión bibliográfica, se han consultado diversos protocolos, guías de actuación, libros y artículos de revistas científicas.
• Se ha consultado la biblioteca virtual biomédica (SCIELO), se ha recurrido también a los siguientes, fuentes bibliográficas: Dialnet,Cuiden,Pubmed, Cuiden Plus,CINHAL.
• Los criterios de inclusión por los que se han aplicados son los siguientes:
• Documentos con acceso a texto completo, en español e inglés y con una antigüedad máxima de 15 años.

Resultados:

• El biofilm está formado por varias especies de bacterias que resultan más patógenos que aquellos que están formados por una única especie; tolerante a antimicrobianos.
• La presencia de biofilm en heridas retrasa el proceso de cicatrización.
• No existe una prueba diagnóstica de referencia que nos permita identificar la presencia de biofilm en las heridas.

Conclusiones:

• La presencia de los biofilms es un reto para los profesionales de la salud, nos compromete a una ralentización del proceso de la curación de las heridas, ocasionando que con mayor frecuencia se cronifiquen.
• Necesidad de disponer de un detector de biofilms en forma de análisis de diagnóstico rápido” in situ”.
• El método de extracción por biopsia de la herida se presenta como el más riguroso, en la actualidad.

 

EP1526 Complicaciones Infecciosas Asociadas a Inyecciones Intramusculares:Revisión bibliográfica

Sandra Patricia Bravo¹, Nerea Herrero Arnedo², Paula Suarez Cabrera^2
1Consorci Sanitari de Terrassa (CST), GNEAUPP, Terrassa, Spain, ²Consorci Sanitari de Terrassa (CST), Terrassa, Spain

Objetivo: Identificar la prevalencia, patrones comunes, etiología y tratamiento por inyecciones IM mediante una revisión sistemática de la literatura.

Métodos: Se realizó una revisión en la PUBMED y Cochrane Library con los términos: Abscess y Injections Intramuscular, incluyendo estudios publicados en humanos entre 2014-2024. La calidad de los artículos se evaluó según las directrices de la red EQUATOR

Resultados: Se identificaron 77 artículos evaluados por pares; tras la lectura del título y resumen, se seleccionaron 6documentos para lectura a texto completo, de estos, 5 repostes de casos cumplieron con los criterios de calidad, ver Anexo 1 y 2. Los casos presentaron inflamación, dolor y fiebre, algunos desarrollaron piomiositis y bacteriemia. Entre los agentes causales más comunes se identificó M. Fortuitum, M. Smegmatis y S. Dysgalactiae subespecie equisimilis (SDSE), sobre todo en inyecciones no estériles. La mayoría de los casos requirió drenaje quirúrgico y antibióticos de amplio espectro.

Conclusiones: La falta de técnica aséptica en las inyecciones IM incrementa el riesgo de complicaciones graves, y se recomienda considerar vías orales como alternativa. Aunque los estudios presentan buena calidad según la red EQUATOR, el nivel de evidencia y recomendación es limitado debido a la naturaleza de reporte de casos. Es necesario realizar investigaciones con mayor nivel de evidencia para determinar mejor la prevalencia y riesgos asociados a las inyecciones IM.

 

 

ÚLCERA DE PIERNA

EP1670 La importancia de la terapia compresiva: resolución de una úlcera venosa por incumplimiento terapeútico

Ana Varela Pardo¹, Eva Boix^1
1Consultorio Médico Local de Pals, SSIBE, Palafrugell, Spain

Objetivo: Dar a conocer, a través de una caso clínico, la importancia de la terapia compresiva en el manejo y resolución de úlceras venosas en pacientes con un linfedema primario crónico.

Métodos: Hombre de 60 años con antecedentes de linfedema primario crónico unilateral grado III (elefantiasis verrucosa nostra) en miembro inferior derecho que nos remiten a la consulta de enfermería de atención primaria para el control y curación de una lesión ulcerosa, exudativa, de tres semanas de evolución.

A primera instancia realizamos curas cada 48 horas con un apósito de cadexómero yodado, más alginato, gasa y doble vendaje tubular compresivo a 40 mmHg; con previa limpieza con agua y jabón y desbridamiento instrumental con cureta.

Al cabo de 3 semanas y debido a la mejoría visible de la úlcera decidimos cambiar la pauta a un apósito antimicrobiano de espuma junto con el vendaje compresivo.

Resultados: Epitelización completa a los 72 días del comienzo de las curas, conservando independencia funcional y visualizando mejoría del linfedema.

Conclusiones: El vendaje compresivo supone un elemento fundamental para el manejo y la recuperación de las úlceras venosas. Resultando especialmente efectivo en los pacientes con linfedema ya que no solo proporciona una mejor curación de las lesiones, al favorecer la circulación, sino que también disminuye el grado de inflamación de la extremidad.

Además, en el caso de nuestro paciente la alta eficacia del vendaje compresivo ha reforzado la importancia del cumplimiento terapeútico para evitar futuras complicaciones potenciales derivadas de su enfermedad.

 

EP1671 A propósito de un caso clínico: úlceras por estasis venosa

Irene Escribano Santana^1
1Centro de Salud Rascafría, Rascafría (Madrid), Spain

Objetivo: Describir la evolución de úlceras por estasis venosa con terapia compresiva multicomponente.

Métodos: Paciente 79 años dependiente parcial para actividades básicas vida diaria con Barthel 70, Norton 14, valoración nutricional MNA 25, Pfeiffer 1, dolor EVA 0.

Antecedentes personales: insuficiencia cardiaca congestiva, hipertensión arterial pulmonar, fibrilación auricular y exfumadora.

Tratamiento: Furosemida, Lixiana, Bisoprolol, Crestor, Trixeo Aerosphere, Omeprazol.

Resultados: Presenta múltiples lesiones ampollosas secundarias a edema por insuficiencia venosa con signos de infección manifiesta por celulitis en miembro inferior derecho. Se estadía según clasificación CEAP C6 úlcera activa.

Índice tobillo-brazo resultado: miembro inferior derecho 1,0 e izquierdo 1,15.

Para ver evolución de la úlcera se utilizó APP Healico (Figura 1).

Día 0, Resvech 2.0 de 15, se realiza drenaje y limpieza de piel desvitalizada con gluconato clorhexidina 40mg/ml y cloruro sodio 0,9gr/ml de lesión principal y satélites. Presenta lecho con esfacelos secos 50% y tejido de granulación friable 50%, exudado leve-moderado, bordes ligeramente engrosados y piel perilesional íntegra. Cura en ambiente húmedo con hidrofibra de hidrocoloide y sistema de compresión multicomponente.

Día 30, Resvech 2.0 de 11, lecho con tejido granulación 90%, se cambia tratamiento con apósito con factor nano-oligosacárido.

Día 63, Resvech 2.0 de 4, en proceso de cicatrización, cambio a malla de poliéster hidrocoloide.

Día 85 alta a la paciente con cuidados de heridas, higiene, hidratación y medidas antiedema.

Conclusiones: La valoración holística en primera consulta, permite abordar la etiología de la úlcera, reduciendo tiempos de epitelización, cicatrización y mejorando la calidad de vida.

Figura 1. Evolución días

 

EP1672 Uso de apósito con tecnología de matriz extracelular de oveja asociada a estiramiento corto y alta compresión en el tratamiento de úlceras venosas de difícil manejo: reporte de experiencia

Danielly Anjos^1
1Instituto Stay Care, São Paulo, Brazil

Objetivo: Demostrar los efectos de la matriz extracelular de oveja asociada a la compresión en el tratamiento de pacientes con heridas vasculares.

Métodos: Métodos: Se trata de un estudio de caso, con enfoque cualitativo, realizado en una clínica privada de enfermería de la ciudad de São Paulo, durante el período de octubre de 2023 a febrero de 2024.

Resultados: Resultado y Discusión: Paciente T.M.D, mujer, 32 años, lesión venosa en EMI, comorbilidades vasculopatía congénita de miembros inferiores con indicación quirúrgica. Previamente fue tratado con vendajes diarios realizados por el paciente, oxigenoterapia hiperbárica, este periodo duró 1 año. En septiembre de 2023 se inició compresión de estiramiento corto, asociada a cobertura de membrana extracelular primaria y apósito antiadherente, realizándose cambios sucesivamente cada 48h, 72h, 7 días hasta finalizar el tratamiento. lesión abierta hace 10 años, luego de iniciar tratamiento se logró controlar el exudado, mejorar el retorno venoso y completar la cicatrización en 90 días.

Conclusiones: El uso de terapia adyuvante con matriz extracelular y vendajes de corta elasticidad en el tratamiento de heridas vasculares demostró ser eficaz para el proceso de cicatrización. Es necesario realizar estudios más amplios con esta población.

 

EP1001 Tratamiento de úlceras venosas en miembros inferiores con láser de CO2 en personas adultas

Victor Gadea Lopez¹, Miguel Ángel Parada Sanchis^1
1IIS LA FE: Grupo de Investigación de Dermatología y Regeneración Tisular, Hospital Universitario y Politécnico de La Fe, Valencia, Spain

Introducción: Las úlceras venosas representan el 75-80% de las úlceras de miembro inferior, su aparición disminuye la calidad de vida de los pacientes generando una carga sustancial en los sistemas de salud. Cada vez surgen más métodos para su abordaje, entre ellos la aplicación del láser de CO2 puede presentar beneficios en el proceso de cicatrización.

Objetivo: Describir el uso del láser de CO2 como tratamiento de úlceras venosas en miembros inferiores de personas adultas.

Métodos: Estudio descriptivo, observacional y longitudinal realizado en el departamento de Dermatología. Se incluyó a pacientes mayores de 18 años, con una evolución superior a 6 semanas, que participaran de forma voluntaria, firmaran el consentimiento informado y que tuvieran capacidad de seguimiento. La potencia utilizada en todos los pacientes fue de 50 mJ y 5% de densidad, cada 3 semanas.

Resultados: Se incluyó un total de 7 úlceras venosas en las que el 84,5% eran mujeres. Se consiguió una reepitelización total en 6 de los 7 casos. Todos los pacientes reportaron menor dolor asociado al tratamiento (p=0,01). No hubo relaciones significativas con las variables sexo, edad, complicaciones, infección, antecedentes de úlceras previas (p>0.05). La media del estudio fue de 3 sesiones.

Conclusiones: Se consiguió una reepitelización mayor al 85% en todos los casos. El tiempo medio de curación fue menor que el tiempo promedio en úlceras venosas. Se reportó una disminución del dolor asociada al tratamiento. No hubo ningún caso de infección ni complicaciones secundarias al tratamiento.

 

EP1673 Terapia de compresión en heridas crónicas venosas: ¿la solución definitiva? Un estudio en atención primaria

Lucia Fernandez Ramos¹, David Guillen Rodriguez², María Francisca Morente Bernal², Isabel Cervan Casanova², Fatima Garcia Briones¹, Maria Francisca Rios Gil^2
1Servicio Andaluz De Salud, Malaga, Spain, ²Servicio Andaluz De Salud, Malaga, Spain

Las heridas crónicas, especialmente las úlceras venosas, son un desafío creciente. El tratamiento de estas lesiones es complejo y multifactorial, siendo la compresión el gold standard.

Objetivo: Evaluar la efectividad de la terapia de compresión, con vendas de corta tracción, en el tratamiento de heridas crónicas de etiología venosa, en un distrito de atención primaria, tras su reciente implantación.

Métodos: Se realizó un análisis retrospectivo de 29 pacientes tratados entre julio de 2023 y julio de 2024, tras la implantación de esta terapia en un distrito de atención primaria. Se evaluó la tasa de cicatrización, el tiempo de tratamiento y la atención especializada recibida.

Resultados: El 79,3% de las heridas cicatrizaron, con un tiempo medio de tratamiento de 49,65 días. La participación de especialistas en el manejo de estas heridas fue significativa, lo que refuerza la importancia de un enfoque multidisciplinario.

Conclusiones: La implementación de la terapia de compresión como estándar de cuidados según las guías de práctica clínica, utilizando vendas de corta tracción en un distrito de atención primaria, demostró ser efectiva, con una tasa de resolución del 79,3%. La duración del tratamiento fue adecuada, y la intervención de especialistas jugó un papel crucial en el manejo de los pacientes. Estos resultados subrayan la eficacia de esta terapia y la necesidad de un abordaje multidisciplinario. Se recomienda la formación continua de los profesionales en estas técnicas, evaluaciones periódicas de los protocolos de tratamiento e incorporar estudios sobre la calidad de vida de los pacientes tratados para optimizar los resultados clínicos

 

EP1004 Abordaje de úlcera venosa con terapia compresiva; la importancia de la adherencia. A propósito de un caso

Laia Esteve Caritg¹, Silvia Alvarez Vega^1
1Cap Dr.Joan Vilaplana - Girona 4 ICS, Girona, Spain

Objetivo: Identificar la eficacia de la terapia compresiva en el abordaje de úlceras venosas.

Métodos: Hombre de 53 años, antecedentes: Diabetes TII, Obesidad, Ex.fumador, Insuficiencia venosa. Ortostatismo laboral.

Úlcera venosa (CEAP:C2r, C3, C4b, C6a) de tres semanas de evolución de 12,1 cm x 6,4 cm. Presenta venas tronculares, edema, cambios tróficos en la piel. Pulsos pedios y tibiales presentes, ITB normal. 

Resultados: Abordaje inicial con terapia compresiva con vendas de tracción corta, 20 mmHg, con reticencias por parte del paciente. Se aplican fomentos con solución de ácido hipocloroso y apósito de fibra hidrodetersiva; previa higiene e hidratación de la extremidad. 

Las primeras dos semanas, presenta infección de la lesión por exceso de exudado debido a incumplimiento y manipulación de la terapia compresiva. Precisa tratamiento antibiótico. 

Evolución con curas cada 48h, donde el paciente toma conciencia sobre la eficacia de la compresión. Pasadas tres semanas con cumplimiento de la terapia compresiva, mejoría con reducción tamaño y cambio a apósito de alginato cálcico.

Se progresa a una terapia compresiva de 40 mmHg, que el paciente no tolera, y acordamos continuar con 20 mmHg. 

Evoluciona con buena tolerancia, cumplimiento y poco exudado, se cambia a vendaje multicapa de 20 mmHg semanal.

A los 21 días, epitelización completa; se prescriben medias compresivas de calidad médica para evitar recidivas. 

Conclusiones: Determinar la etiología es importante para aplicar el tratamiento adecuado. 

El seguimiento por el mismo equipo, favorece la concienciación y empoderamiento del paciente para el cumplimiento de la terapia compresiva.

 

EP1005 La escleroterapia ecoguiada en el tratamiento de úlceras venosas: una revisión de la literatura

Sara Pacheco Riquelme¹, Amparo González Cal², Guillermo Vera Vicioso³, Aida Orrit González¹, Paula Moreno Padollers⁴, Pamela Tatá Quijada¹, Carme Valldaura^1
1Institut Català de la Salut, Berga, Spain, ²Servizo Galego de Saúde, Ferrol, Spain, ³Universidad de Málaga, Málaga, Spain, ⁴Institut Català de la Salut, Puig Reig, Spain

Objetivo: Conocer el estado de la literatura actual sobre la eficacia del uso de la escleroterapia ecoguiada de vasos hiperafluentes (EEG) en el tratamiento de las úlceras venosas (VU).

Métodos: Se realizó una búsqueda bibliográfica en Pubmed en septiembre de 2024. Fueron incluidos ensayos clínicos y estudios observacionales que presentaran resultados sobre el uso de la EEG para la curación de las UV. Se utilizaron las palabras clave sclerotherpy, ultrasound-guided, ulcer y wound para la estrategia de búsqueda. Dos revisores independientes, de acuerdo con previos criterios de inclusión y exclusión, seleccionaron la muestra de artículos en un primer cribado por título y resumen, y en un segundo por texto completo. Un tercer revisor decidió sobre los desacuerdos.

Resultados: Se incluyeron 10 estudios, entre los que 5 eran ensayos clínicos cuasiexperimentales, 4 de cohorte retrospectiva y 1 cohorte prospectiva. Ninguno contaba con un grupo de control. La muestra media fue n=42. El 80% de los estudios utilizaron la espuma de polidocanol como esclerosante. Si bien el rango de tiempos de seguimiento es muy grande (entre 84 y 1276 días), todos mostraron una tasa de curación entre un 52 y un 95,6%, excepto uno. Esta excepción mostró mejoría estadísticamente significativa de los diámetros en una semana.

Conclusiones: La EEG parece mostrar beneficios en el tratamiento de la insuficiencia venosa, también en la curación de las VU. Es clara la falta de ensayos clínicos aleatorizados con una técnica de EEG menos heterogénea que muestren evidencia suficiente para la implementación de esta terapia.

 

EP1674 Impacto de la compresión en la evolución de úlceras vasculares en un centro de salud de atención primaria

María Francisca Morente Bernal ^1
1Encarna Ayala Castaño, Lucía Fernández Ramos, Paula María Ramos Martín, Málaga, Spain

Objetivo: El objetivo es evaluar la efectividad clínica de pacientes con úlceras vasculares tratados mediante la combinación de curas personalizadas y terapia compresiva en un centro de salud de atención primaria durante el periodo de 2023 a 2024.

Métodos: Estudio retrospectivo realizado en un centro de salud de atención primaria, entre los años 2023 y 2024. Tras una evaluación integral, con análisis de aspectos funcionales, sociales y vasculares, se incluyó a los pacientes en un tratamiento combinado de curas y terapia de compresión. Los factores determinantes de inclusión fueron: presencia de comorbilidades, nivel de movilidad, grado de dependencia y disponibilidad de apoyo social. Una vez seleccionados para el tratamiento, se presentaron en sesión clínica con el equipo, compuesto por enfermeras y EPA del distrito Costa del Sol, se estableció un plan terapéutico personalizado para cada paciente y se definió la fecha de inicio de la terapia compresiva y la gestión del material necesario. Cada paciente fue informado sobre el tratamiento, para garantizar una correcta adherencia.

Resultados: Fueron tratados 5 pacientes, logrando la cicatrización completa de las úlceras vasculares.

Conclusiones: La terapia compresiva combinada con curas personalizadas ha demostrado ser una herramienta fundamental en el tratamiento de las úlceras vasculares de difícil cicatrización, logrando acelerar el proceso de evolución, reducir los costes asociados al tratamiento y, mejorar significativamente la calidad de vida de los pacientes verbalizada por ellos mismos.

 

EP1675 Eficacia de las enfermeras de práctica avanzada en atención primaria en la gestión integral de úlceras venosas

Daniel de la Cruz Tomé, Beatriz Pinero Jimenez, Alejandra Caballero Jiménez^1
1Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain

Objetivo: Implementar estrategias preventivas y terapéuticas, dirigidas a la cicatrización de la lesión, y optimización de la calidad de vida del paciente.

Evaluar la relación coste/eficacia y coste-efectividad de la Enfermera de Práctica Avanzada, (EPA), garantizar continuidad asistencial, y optimizar el uso de recursos disponibles.

Métodos: Paciente femenina de 91 años con úlcera venosa en miembro inferior izquierdo, secundaria a traumatismo (30/03/2024), remitida a consulta de la EPA, derivada de otro centro del Área Básica de Salud, tras manejo subóptimo de seis semanas con antibioterapia oral, cuidados locales no basados en evidencia, y ausencia de compresión terapéutica por resistencia conductual.

Presenta herida de 5x3.5 cm con tejido desvitalizado, bordes macerados, exudado moderado-alto, sobreinfección (celulitis perilesional) y edema por éstasis venoso. Dolor según escala visual analógica EVA: 9. Índice tobillo-brazo (ITB: 1.1).

Intervención: Evaluacion integral e implementación de protocolo de higiene de la herida, terapia compresiva multicomponente personalizada, profilaxis en miembro contralateral y educación sanitaria estructurada para adherencia terapéutica.

Resultados:

Cicatrización completa en 8 semanas.

Evolución favorable sin retrasos en la cicatrización.

Ausencia de complicaciones asociadas.

Reducción del dolor EVA de 9 a 0.

Mejora significativa de la calidad de vida.

Conclusiones:

La intervención de la EPA resultó en una mejora en la relación coste-eficacia, garantizando continuidad asistencial y minimizando la variabilidad clínica.

El rol de la EPA en Atención Primaria fortalece la autonomía enfermera, facilitando un abordaje costo-efectivo y basado en evidencia para patologías crónicas complejas como las úlceras venosas.

 

EP1676 Pioderma gangrenoso: abordaje desde una consulta de atención primaria

Paula Rodríguez Casabán^1
1Centro de Atención Primaria Ramona Via i Pros, El Prat de Llobregat, Spain

Objetivo: Favorecer la cicatrización y proteger la piel perilesional de una lesión muy exudativa de 50 x 30 cm zona tibial del miembro inferior derecho (MID) que está asociada al diagnóstico de pioderma gangrenoso ulcerativo establecido en 2021 en una consulta de dermatología.

Métodos: Ante una lesión que presenta tejido de epitelización en un 75 % y tejido esfacelado en el resto de la superficie (25 %) se inician curas sobre el lecho con apósito bioactivo con iones, el cual estimula la actividad celular acelerando así el proceso de epitelización de la lesión y a su vez favorece una buena gestión del exudado. Para proteger la piel y reducir la inflamación perilesión se aplica crema de óxido de zinc mezclada al 50 % con corticoides tópicos. Por último, se realiza terapia compresiva con doble vendaje de tracción corta al 50 % para reducir el edema del miembro afectado.

Resultados: El cambio de apósito se realiza cada 48 horas para evitar la maceración de la lesión. Tras 1 mes de curas, la lesión presenta una superficie menor (actualmente de 30 x 20 cm) y tejido de epitelización en la totalidad del lecho. A su vez, con la terapia compresiva hemos conseguido reducir el edema del MID.

Conclusiones: Establecer una cura con apósito bioactivo con iones en este tipo de lesión es fundamental ya que acelera la epitelización y gestiona de manera adecuada el exudado.

 

EP1677 ¿Es la adherencia a la terapia compresiva un objetivo inalcanzable? Estudio de un caso.

Fátima María Dios Quiroga¹, David Fernández Díaz¹, Daniel Domínguez Alonso¹, Almudena Rivas Raña^1
1Sergas, Vigo, Spain

Objetivo: Valorar la importancia de favorecer la adherencia a la terapia compresiva, para resolución de las úlceras de etiología venosa.

Métodos: Búsqueda bibliográfica para determinar los factores que influyen en la adherencia al tratamiento.

Valoración integral y entrevista motivacional a la paciente con el objetivo de identificar que factores están influyendo negativamente en la adherencia a la terapia compresiva. De los factores encontrados destacan:

Relacionados con el paciente:

• Alteración de su imagen corporal.
• Desconocimiento sobre su enfermedad.

Relacionados con los profesionales sanitarios:

• Falta de conocimiento y habilidades.

Una vez detectados se desarrollan intervenciones para favorecer la adherencia.

• Explicar al paciente: qué es lo que tiene, por qué se produce y la importancia de la terapia compresiva en el tratamiento.
• Negociar con el paciente: objetivos a alcanzar y plan de cuidados.

Resultados:

• Resolución de la úlcera en 15 días.
• Mejora de la relación con el paciente, aumentando la confianza.
• Buena adherencia a la terapia compresiva. Medias de compresión tras la resolución de la lesión.
• Mejora de la calidad de vida.

Conclusiones: La falta de adherencia al tratamiento es un problema inquietante y muy presente en nuestro día a día. Conseguir una adherencia al tratamiento es complejo pero crucial ya que sin ella el riesgo de complicaciones, costes e insatisfacción aumenta.

Cuando el paciente entiende y colabora es más fácil observar resultados que invitan a que esta adherencia tenga lugar, creando una relación de confianza con el profesional sanitario.

 

EP1006 Influencia de un sistema de compresión con velcros yuxtapuestos en la calidad de vida de los pacientes con úlcera venosa activa.

Ana Belén Fernández Ramírez¹, Antonio Juan Pérez Fernández¹, David Alcaide^1
1Distrito sanitario de Atención Primaria Granada-Metropolitano, Granada, Spain

Objetivo: Determinar el impacto de los sistemas de velcros yuxtapuestos en la calidad de vida, la adherencia al tratamiento del paciente y el tamaño de la úlcera venosa.

Métodos: se diseñó un estudio descriptivo en base a 16 casos clínicos durante el año 2023. Se utilizó el cuestionario de calidad de vida Wound-QoL-17 al inicio del tratamiento con el sistema de velcros yuxtapuestos (T0) y a los 3 meses del comienzo (T3). Se utilizó la herramienta Imito Measure® para medir las variaciones en el tamaño de la herida en esos 2 tiempos. La adherencia al tratamiento se determinó durante las curas por la enfermera de familia de cada paciente.

Resultados: En un 75% de los pacientes se observó una mejora clínicamente relevante respecto a la calidad de vida. Además, en los pacientes con dificultades para adherirse al tratamiento, se consiguió mantener la terapia compresiva durante más tiempo al usar el sistema de velcros. En un 87% de los pacientes se redujo el tamaño de la herida y en un 37,4% se consiguió la cicatrización completa.

Conclusiones: El sistema de velcros yuxtapuestos podría ser un tratamiento que consiga mejorar la calidad de vida de los pacientes, potenciando su autonomía con respecto a la terapia de compresión y de esta manera mejorar la adherencia terapéutica.

 

EP1678 Injerto en sello parcial para la resolución de una úlcera venosa de larga evolución

Adrián García Montero¹, Elisa Gloria Bolívar Gilpérez^1
1Enfermera de Práctica Avanzada Para el Abordaje de Personas Con Heridas Crónicas Complejas (EPA-HCC). Distrito Sanitario Sevilla. Servicio Andaluz de Salud, Sevilla, Spain

Objetivo: La úlcera de etiología venosa es el tipo de herida más común en las extremidades inferiores, con una prevalencia del 70%, siendo además de la que más recursos consume. Su pilar de tratamiento, la terapia compresiva, presenta dificultades en su aplicación por la falta de adherencia de los pacientes y por la inexperiencia de las enfermeras en su manejo. Los injertos en sello son una opción cada vez más utilizada en nuestra práctica habitual para favorecer el cierre de úlceras de larga evolución, reduciendo el dolor y los tiempos de cicatrización.

Métodos: Se presenta el caso de una mujer de 68 años con una úlcera venosa en pierna izquierda de unos 8 años de evolución. Durante ese tiempo ha estado probando múltiples terapias y apósitos, sin el resultado del cierre epitelial. Es derivada a la enfermera de práctica avanzada en heridas crónicas complejas (EPA-HCC), que realiza valoración integral. Se inicia abordaje local de la herida, junto a terapia compresiva adaptada a la persona, para conseguir un lecho limpio de tejido de granulación. Se plantea realización de injertos en sello para conseguir un cierre en el menor tiempo posible. Se realizó injertos en la mitad superior de la lesión por las dimensiones de la herida

Resultados: El resultado fue prendimiento total de los injertos y una cicatrización en menos de 60 días.

Conclusiones: Esto demuestra que el injerto en sello en la mitad de la dimensión total de la herida promueve la cicatrización incluso en zonas no injertadas.

 

EP1007 Disminución de los signos clínicos de infección - inflamación con el uso de vendaje compresivo y almohadillado con calamina

Carmen Alba Moratilla¹, Ana Falcon Bonardy², Eduardo González Álvarez³, Jose Garcia Reig⁴, Maria Eugenia Diez Esteban⁵, Mªmercedes Martinez Delgado⁶, Silvia Romero Moreno^7
1Udima, Valencia, Spain, ²Hospital Virgen Del Castillo, Yecla (Murcia), Spain, ³Ics, Barcelona, Spain, ⁴Conselleria De Sanitat C. Valenciana, Valencia, Spain, ⁵Sacyl, Burgos, Spain, ⁶Escuela De Doctorados Universidad De Valladolid, Soria, Spain, ⁷Centro Sociosanitario Los Royales - Servicios Sociales Junta De Castilla Y Leon, Soria, Spain

Objetivo: Evaluar los signos clínicos de inflamación e infección en los pacientes con insuficiencia venosa crónica, asi como el índice de Calidad de Vida Dermatologica antes y después del tratamiento con terapia compresiva y almohadillado con vendas de calamina.

Métodos: Se realizó un estudio cuasiexperimental sin grupo control de medidas repetidas, durante cinco semanas en 24 pacientes con signos clinicos de insuficiencia venosa con o sin úlceras. Se utilizaron las escalas Venous Clinical Severity Score (VCSS) y el Índice de Calidad de Vida Dermatológica (DLQI) así como los acrónimos NEDRS y STONES. Se midió el nivel de dolor asi como la modificación de perímetros de tobillo y pantorrilla.

Resultados: Al início veinte pacientes presentaban signos clínico de infección, pasando a dos en la observación final. No se utilizó antibiótico sistémico en ningún caso solo antimicrobianos tópicos si había presencia de úlceras.

En las escalas VCSS y DLQI se observaron unos valores medios iniciales de 15,67 para VCSS pasando en el último control a 7,38. Para la escala DLQI se observa al inicio una media de 9,33 pasando a 1,69. La diferencia de medias presenta una alta significación estadística para ambas escalas.

Los perímetros de tobillo disminuyen de media 3 cm sin significación estadística

El dolor disminuye de media en 3 puntos en la escala analógica, con alta significación estadística.

Conclusiones: El vendaje compresivo con vendas impregnadas con calamina es efectivo para disminuir el edema y los signos clinicos de infeccion; mejora la calidad de vida dermatologica y disminuye los signos clinicos de la enfermedad venosa.

 

EP1679 Comprimir sí, pero con criterio

Laura Martínez Martínez¹, Jennifer Otero Páez¹, Beatriz Montero Arias¹, María Elena González Fernández^1
1Sacyl, Ponferrada, Spain

Objetivo: Establecer la relación entre una buena elección de un dispositivo de compresión y la curación de una úlcera venosa, optimizando los recursos disponibles.

Métodos: Caso clínico de una mujer de 80 años con antecedentes de hipertensión, fibrilación auricular, insuficiencia venosa crónica con linfedema, insuficiencia cardiaca e hiperuricemia. En abril de 2024, presenta úlcera en miembro inferior izquierdo de años de evolución, afectando la zona infrapatelar hasta tobillo, con hipergranulación, biofilm, exudado hemático abundante y eritema perilesional. Anteriormente utilizaba venda de crepé y posteriormente media de compresión de tricotado circular que no toleraba siendo reticente a la compresión. Tras explicarle la etiología de su úlcera y llegar a un consenso, realizamos biopsia para descartar malignidad, y cura en ambiente húmedo con fomentos de polihexanida/biguanida, corticoide tópico y fibra de hidrocoloide más apósito superabsorbente hasta reducción de la inflamación, junto con vendaje de tracción corta. Posteriormente continuamos con malla DACC, fibras de hidrocoloide y ácidos grasos hiperozonizados en piel perilesional. Solicitada interconsulta a rehabilitación para establecer la mejor opción de compresión tras la remisión de la herida.

Resultados: Tras doce semanas, la lesión se redujo más del 50%. A los seis meses más del 75% ha cicatrizado y el eritema perilesional ha desaparecido. La paciente refiere una mejoría notable.

Conclusiones: Establecer una correcta etiología de las heridas y monitorizarlas nos permite establecer el tratamiento óptimo. Elegir una terapia compresiva que se adapte a las necesidades del paciente facilita la adherencia al tratamiento y con ello la cura de la lesión.

 

EP1680 UlcerAPP^®. El sistema de ayuda a la decisión para el diagnóstico, tratamiento y seguimiento de las ulceras de etiología vascular mediante una aplicación móvil ¿Lo implantamos en atención primaria?

Javier Rodríguez Padilla¹, Lourdes Del Río Solá², Guillermo Moñux Ducajú³, Alvaro García Álvarez⁴, Álvaro Ramón Dominguez⁴, Isabel De la Torre Díez^4
1Hospital Universitario HM Torrelodones/ Hospital Universitario Severo Ochoa, Torrelodones/Leganés, Spain, ²Hospital Universitario de Valladolid, Valladolid, Spain, ³Hospital Universitario HM Torrelodones/ HM Madrid, Torrelodones/Madrid, Spain, ⁴Universidad de Valladolid, Valladolid, Spain

Objetivo: Las úlceras de etiología vascular representan un importante problema de salud y suponen un gran consumo de recursos. Los sistemas de ayuda a la decisión pueden mejorar la calidad de los diagnósticos y de los tratamientos de los pacientes, mejorando la eficacia y la eficiencia de la asistencia sanitaria. El objetivo es desarrollar una aplicación móvil que facilite el manejo de las úlceras de etiología vascular en el entorno de atención primaria y en hospitales sin facultativos o enfermería experta.

Métodos: Se elaboraron algoritmos de decisión capaces de generar una respuesta correcta, guiando al usuario hacia un diagnóstico más probable y/o a la aplicación del tratamiento específico. Se desarrolló una app móvil, UlcerAPP®, para Android e iOS.

Resultados: Tras estar disponible en las tiendas virtuales, la app incluyó una encuesta de experiencia del usuario (QoE) basada en una escala Likert, ideal para medir reacciones, actitudes y comportamientos de una persona. Se obtuvieron 209 respuestas. Los resultados obtenidos fueron excelentes de forma global y en el análisis por subgrupos con unas medias muy satisfactorias en ambas aplicaciones y en todos los bloques de preguntas: calidad del contenido, facilidad de uso, disponibilidad, funcionamiento, apariencia y precisión del método diagnóstico.

Conclusiones: UlcerAPP® es una herramienta útil para los usuarios, porque facilita el manejo de estas úlceras paciente, mejorando la atención en estos pacientes.

Dado los resultados obtenidos mediante la QoE en las primeras versiones, UlcerAPP® podría tener gran potencial de uso en personal no entrenado, sobretodo en primaria o en hospitales sin facultativos expertos en úlceras.

 

EP1681 Abordaje de úlcera venosa mediante terapia compresiva con sistema dual

Jaime Rodríguez Báez¹, Susana Casaus Carmona^2
1Institut Català de la Salut, Barcelona, Spain, ²Institut Català de la Salut, Sant Boi de Llobregat, Spain

Objetivo: Abordar lesión venosa en extremidad inferior con vendaje dual

Métodos: Se trata de un caso clínico de una paciente con CEAP 6 que no quiere que el personal de enfermería le realice la cura de la úlcera venosa, realizándola por ella misma en su casa. Tras empeoramiento del estado de la úlcera, acude a consulta. Pulsos pedio y tibial presentes, candidata a realizar terapia compresiva. Se trata de una lesión que rodea la parte anterior y posterior de la pierna. Presenta en el lecho de la herida tejido con fibrina y con bordes difusos.

Resultados: Tras la aplicación de terapia compresiva semanal mediante un vendaje dual, la herida presenta una notable reducción de la extensión de la úlcera en menos de un mes de evolución, convirtiendo una úlcera de grandes dimensiones a dos pequeñas úlceras. Se realiza la limpieza con solución acuosa de polihexanida 0,1% i undecilenamidopropil betaina, desbridamiento con gel de alantoina bisabolol y proteasas y apósito bioactivo absorbente modulador de proteasas.

Conclusiones: La terapia compresiva en pacientes con pulsos presentes consigue un aumento de la efectividad de la cura de las úlceras venosas. La pronta instauración de una terapia compresiva dual en pacientes que son candidatos reduce el tiempo de evolución de la úlcera y reduce los costes en el sistema sanitario.

 

EP1682 Caso clínico: ulcera venosa

Laura Codina¹, Iria Labara¹, Rosa Maria Ibars¹, Elisabet Comino¹, Ester Castellano^1
1ICS Girona Sud, Sils, Spain

Objetivo:

- Describir la evolución de una ulcera venosa.

- Remarcar la importancia de un buen diagnóstico de la lesión con el fin de proporcionar el tratamiento más adecuado.

Métodos: Paciente de 68 años con antecedentes personales de Hipertensión arterial acude en consulta por herida de 2 meses de evolución con empeoramiento. Se le han realizado curas con antisépticos, pomadas antibióticas varias y apósitos de plata.

3 de agosto: Se le realiza ITB, con resultados dentro de la normalidad (itb derecho 1,30; itb izquierdo 1,27) por lo que etiquetamos a la lesión de origen venoso y se le indica a la paciente poner terapia compresiva de 40mmHg.

- Se van realizando curas c/48h con apósito de hidrofibra con plata y apósitos de espuma con adhesivo. Se realiza desbridamiento quirúrgico del biofilm mediante bisturí y previa asepsia.

- A los 15 días se retira la plata y se siguen hacienda curas con apósitos de hidrofibra y apósitos secundarios de espuma. Seguimos con el desbridamiento con bisturí.

- 23 de setiembre: Lesión resuelta.

Resultados: En dos meses con la aplicación de la terapia compresiva y una buena limpieza del lecho de la herida se ha resuelto una lesión por traumatismo que llevaba varios tratamientos sin mejoría.

Conclusiones: Identificar el tipo de lesión y aplicar las medidas correctas, así como unas curas adecuadas es clave para la resolución de las heridas

 

EP1683 La importancia de un buen diagnostico para el correcto tratamiento

Irma Fornell Boixader¹, Laia Pascual Coma², Teresa Carbó Casanova³, Emilia Mateo Marin⁴, Meritxell Almà Garcia², Montserrat Nieto Martinez², Nuria Solanas

¹Socia GNEAUPP, Miembro Comisión Heridas Gtcc, Coib, Gironella, Spain, ²Coib, Gironella, Spain, ³Socia GNEAUPP, Miembro Comisión Heridas Gtcc, Coib, Manresa, Spain, ⁴Socia Y Miembro Consultor GNEAUPP, Socia Seher, Referente Heridas Gtcc, Callus, Spain

Objetivo: Dar a conocer la cicatrización de úlcera de 30 años de evolución mediante terapia compresiva

Mejorar el tratamiento de la herida 

Ayudar a la cicatrización de la herida 

Métodos: Paciente de 85 años con 2 ulceras en pierna derecha de años de larga evolución que es derivada a enfermera referente de heridas por involución de las lesiones. La paciente explica recidivas de más de 30 años pero que ahora hace ya 2 años que no curan. Auto curas con mupirocina c/24h (prescripción vascular)

En la primera visita en atención primaria (AP):

- Anamnesis de antecedentes patológicos de la paciente, curas previas, medicación y tratamiento actual

- Exploración: úlceras: proximal 2x2 cm y distal:4x7cm diámetro. Lechos de las heridas esfacelado. Pierna edematosa y eritematosa.

Se realiza Índice tobillo brazo (ITB): derecho: 1,25, Izquierdo: 1,01. Diagnóstico úlceras venosas

Iniciamos curas con:

Fomentos de solución de ácido hipocloroso, hipoclorito sódico y electrolitos (solución antimicrobiana) + apósito de poliacrilato con hidrocoloide, vaselina y plata+ espuma de poliuretano+ protección perilesional + vendaje multicapa

Curas 2 vez por semana, la primera semana, luego pasamos a curas semanales. A las 6 semanas lechos de las heridas limpios, disminución del tamaño. Cambio de cura a apósito absorbente modulador de proteasas y terapia compresiva

Resultados: A los 6 meses cicatrización total de las heridas. 

Se prescribe dispositivo de compresión autoajustable tipo velcro para evitar recidivas. 

Conclusiones: Un buen diagnóstico diferencial agiliza el tiempo de curación 

La compresión es el principal tratamiento para las úlceras venosas 

La buena coordinación entre los diferentes agentes sanitarios favorece el proceso de curación 

 

EP1684 Identificación de las dificultades en la práctica de la Terapia Compresiva a través de una Jornada Formativa. ¿Por qué no comprimimos?

Sonia Riera Manzano¹, Judith Prats Barrera¹, Amparo Sanchez Buitrago², Dan Breton Garbelota², Gloria Santiago Ocaña³, Elena Gomez Fàbregas⁴, Maria Luisa Martí Aguasca^5
1Hospital Clínic Barcelona, Barcelona, Spain, ²Clínica Sant Antoni, Barcelona, Spain, ³Centro de Atención Primaria Sarrià, Vallvidrera, Les Planes., Barcelona, Spain, ⁴Consorci d‘Atenció Primària de l‘Eixample. CAPSBE Casanova, Barcelona, Spain, ⁵Centro de Atención Primaria Adrià. Institut Català de la Salut, Barcelona, Spain

Objetivo: Identificar las barreras que dificultan la implementación de la Terapia Compresiva (TC) en el tratamiento de las úlceras de extremidad inferior (UEI) en los diferentes centros del Área Integral de Salud de Barcelona Izquierda (AISBE).

Métodos: Se realizó un análisis estadístico utilizando el programa SPSS sobre los datos obtenidos de una encuesta elaborada por el Grupo de Trabajo de Heridas del AISBE. Esta encuesta evaluó la aplicabilidad de la TC por parte del personal de enfermería en centros de atención primaria, hospitalaria e intermedia. Los resultados se presentaron en una sesión formativa teórico-práctica sobre TC, donde se debatieron casos clínicos y se analizaron las barreras en la aplicación de la TC identificadas por los asistentes.

Resultados: Un total de 60 profesionales respondieron la encuesta, con una edad media de 40 años. El 50% provenía de atención primaria y el 17% de atención intermedia. Un 80% de los asistentes consideró que la TC no se integra adecuadamente en la práctica diaria. De este grupo, el 48% atribuyó la falta de integración a un déficit de conocimiento del personal sanitario, mientras que el 17% mencionó la escasez de material. Solo el 23% de los profesionales conocía la existencia de un protocolo sobre TC en su centro.

Conclusiones: El Grupo de Trabajo de Heridas del AISBE tiene como objetivo mejorar circuitos asistenciales, elaborar y actualizar protocolos, y fomentar el desarrollo de competencias en el manejo de heridas. Es fundamental conocer y comprender las dificultades y necesidades del profesional para implementar acciones más efectivas que optimicen la práctica asistencial.

 

EP1011 Desbridamiento hidromecánico: preparación de un lecho óptimo en úlcera de extremidad inferior

Sonia Villajos García¹, Maria Gloria Lorente Granados¹, Antonia Gonzalez Gomez¹, Francisco Javier Castellanos Cencerrado^1
1Hospita Lmancha Centro, Alcazar de San Juan, Spain

Objetivo: Demostrar que el desbridamiento hidromecánico mediante kit de irrigación de pulso es una alternativa no invasiva y efectiva para preparar el lecho de una lesión con infección bacteriana y tejido no viable.

Métodos:

Presentación del caso: Mujer de 86 años con lesión traumática de 3 meses de evolución en miembro inferior izquierdo con insuficiencia venosa, MNA 13, IMC 23, Braden 15, Barthel 45.

Ingreso hospitalario por infección en lesión (S.aureus, Pseudomona aeruginosa, Enterobacter cloacae-c, Proteus mirabilis, Enterococcus faecalis), con tratamiento antibiótico y analgesia intravenosa

Valoración inicial: Índice Tobillo Brazo: 1.1, Resvech: 29, EVA: 9, dimensiones:12x8 cm en cara posterior y 10x3 cm en anterior, 99% necrosis.

Se aplicaron tres sesiones en una semana, con kit de irrigación de pulso desechable (presión 8-15 psi ,3000ml de solución salina).

Se continúan curas con desbridamiento cortante, cadexómero yodado y vendaje inelástico de corta tracción.

Resultados: Valoración en 1 semana: Resvech 19, EVA 5, dimensiones: 12x8 cm cara posterior y 10x3 cm anterior, 10% necrosis.

Pasadas tres semanas: Resvech 15, EVA 5, dimensiones: 11x7 cm y 7x2 cm anterior, 0% necrosis.

5 meses: cicatrizada.

Conclusiones: El desbridamiento hidromecánico con irrigación pulsada ha demostrado ser una opción eficaz, para limpiar y desbridar el lecho de una lesión dejando unas condiciones óptimas para continuar con las curas.

Es bien tolerado por el paciente ya que es una técnica indolora, el tiempo de tratamiento es corto y la presión se puede ajustar según tolere el paciente.

 

EP1012 Evolucion de una úlcera crónica en extremidad inferior con apósito impregnado de cobre y terápia compresiva. Caso clínico

Elena Samper Saldes¹, Marta Oña¹, Montse Villanueva Villanueva^2
1Consorci Sanitari Integral, Sant Joan Despí, Spain, ²Institut Català de la Salut, L‘Hospitalet de Llobregat, Spain

Objetivo:

- Realizar control de la carga bacteriana i disminuir el edema promoviendo el cierre de la herida.

- Coordinar las curas entre la enfermera de práctica avanzada (EPA) de atención primaria (AP) y la enfermera clínica (EC) hospitalaria.

Métodos:

- Hombre, 60 años, factores de riesgo cardiovascular, glicohemoglobina 9%, posible vasculopatía periférica con amputación del 1r y 5º dedo del pie derecho.

- Valoración de la herida: úlcera cara externa tibia pierna derecha, 2 años evolución.

Mide 13 cm de largo, lecho de la herida con biofilm y tacto leñoso, exudación profusa. Piel periulceral con dermatitis y edema.

- Cultivo positivo polimicrobiano

Arteriografia muestra permeabilidad femoro-poplítea.

- Plan de tratamiento: limpieza de la herida, aplicación de apósito impregnado en cobre y vendaje bicapa a 20mmHg.

Las curas se realizan de forma coordinada entre ambos dispositivos cada 48 horas

Resultados:

- El apósito de cobre redujo el biofilm

- El vendaje bicapa disminuyó el edema y el exudado

- La herida mostró signos de epitelización a los 3 meses de tratamiento

- El paciente se mostró satisfecho destacando la coordinación entre ambos equipos.

Conclusiones: El apósito impregnado en cobre redujo la carga bacteriana y el biofilm. Las propiedades antimicrobianas del cobre lo convierten en una solución para el tratamiento de las infecciones asociadas con la cicatrización de heridas.

El vendaje compresivo bicapa contribuyó a controlar el edema y el exudado.

La coordinación entre atención primaria y hospitalaria fue clave para garantizar el tratamiento, mejorando tanto el estado de la herida como la calidad de vida del paciente.

 

EP1014 Papel de las metaloproteasas de matriz extracelular (mmps) en la evolución y respuesta al tratamiento local standard de las úlceras cutáneas venosas crónicas. Resultados preliminares

Javier Díaz Arias¹, Victor Asensi Álvarez², María Luz Rodríguez Martínez², Nuria Vázquez García², Susana Valerdiz^2
1ISPA/FINBA, Oviedo, Spain, ²HUCA, Oviedo, Spain

Objetivo:

1.- Determinar que genotipos de polimorfismos MMPs (-9,-8,-2,-12) y TIMPs (-2) favorecen/dificultan la curación de las úlceras cutáneas crónicas (UCC) de miembros inferiores tras 12 semanas de seguimiento con un tratamiento local standard

2.- Analizar la tasa de curación de dichas úlceras a las 12 semanas

Métodos: Estudio observacional, descriptivo, prospectivo de 103 pacientes adultos reclutados en la Unidad de Heridas Crónicas (UHC) entre mayo 2020-novimebre 2023 con UCC en miembros inferiores.

Se genotiparon diferentes polimorfismos de MMP-2 (rs2285053, rs243865), MMP-8 (rs11225395, rs 2155052, rs2012390), MMP-9 (rs17576, rs17577, MMP-12 (rs2276109), TIMP-1 (rs5953060, y TIMP-2 (rs4789936) en muestras de sangre de los pacientes

Se consideró como curación parcial de la UCC una reducción de su superficie de ≥50% a las 12 semanas, y como curación total de ≥ 90%

Resultados: Basados en el criterio de superficie, en 75,4% se consiguió una curación parcial y en 12,3% una curación total a las 12 semanas. La curación de las UCC era menos frecuente en los portadores de los genotipos CC del polimorfismo rs2285053 de MMP-2 y GG del polimorfismo rs17576 de MMP-9 al compararlos con otros genotipos de estos polimorfismos.

Conclusiones: Aunque preliminarmente, consideramos que los pacientes adultos con UCC de miembros inferiores portadores del genotipo CC del polimorfismo rs2285053 de MMP-2, y GG del polimorfismo rs17576 de MMP-9 deben ser seguidos más tiempo y más individualizadamente en la UHC. Su sustrato genético podría condicionar una curación más difícil de sus UCC lo que debería considerarse al planificar sus cuidados.

 

EP1015 Abordaje úlcera venosa en miembro inferior de larga evolución con sistema de compresión autoajustable

María López Zapata¹, Isabel López Algaba¹, Juana Illanes Valenzuela^1
1Servicio Andaluz de Salud, Andalucía, Spain

Objetivo: Demostrar que la terapia compresiva autoajustable es el método de elección para la resolución de las úlceras venosas en miembros inferiores.

Métodos: Paciente con insuficencia venosa crónica que presenta úlcera venosa de varios años de evolución con mala adherencia al tratamiento, obesidad y sedentarismo.

Enfermería le propone al paciente un nuevo tipo de abordaje haciendo ver las posibles consecuencias a largo plazo de una mala adherencia y el beneficio de un buen control.

Presentaba úlcera venosa extensa categoría 2 en cara anterior y lateral interna de miembro inferior izquierdo con Resvech 2.0:21.

Tras la explicación del método, aceptación y compromiso del paciente se comienza el siguiente abordaje: analítica, cultivo de exudado, índice tobillo-brazo y curas.

Se inician curas cada 48 horas con lavado de suero fisiólogico, fomento con polihexanida, cadexomero yodado junto con alginato, oclusión con compresas y vendaje compresivo a 40 mmHg durante un mes. Tras la escasa mejoría y problemas laborales para asistir a curas, se le propone el sistema de compresión autoajustable. Se le instruye al manejo de la lesión así como a la colocacion de la nueva terapia compresiva, acordando con el paciente acudir a control semanal.

Resultados: Tras 4 meses de tratamiento la evolución ha sido favorable con Resvech 2.0:0.

Conclusiones: La terapia compresiva autoajustable es el método de elección en el tratamiento de úlceras venosas. Se evidencia la buena adherencia y fácil manejo por parte del paciente, coste-beneficio, mayor movilidad, posibilidad de llevar calzado normal, estética y disminución de sobrecarga asistencial para enfermería.

Autoras:

Juana Illanes Valenzuela

Isabel López Algaba

María López Zapata

 

EP1685 Cierre de herida crónica isquémica infectada tratada con alginogel enzimático

Esther Vílchez García¹, Neus Sarobé Carreño^2
1Centro Médico Teknon. Grupo Quironsalud., Barcelona, Spain, ²Quironsalud, Barcelona, Spain

Objetivo: Este estudio tiene como finalidad describir el manejo y la evolución de las heridas en un paciente de 73 años con celulitis derivada de úlceras vasculares isquémicas de larga duración (más de un año), usando un complejo enzimático antibacteriano con alginato llamado Alginogel® enzimático. El paciente presenta múltiples comorbilidades, incluyendo trombocitemia esencial, EPOC, ictus isquémico, hipertensión arterial, dislipemia y es portador de un stent femoral. Además, es alérgico a la plata.

Métodos: Se realizó un cultivo del exudado de las úlceras, que resultó positivo para Pseudomona aeruginosa multirresistente y Enterococcus faecalis. Se realizó tratamiento con antibiótico endovenoso ceftolozano/abivactam durante 10 días. El 06/02/2024 se iniciaron curas diarias que incluyeron el uso de solución de polihexanida betaína, crema barrera para proteger los bordes perilesionales, Alginogel® enzimático y apósitos de silicona.

Resultados: Se observó una mejora significativa en el aspecto del lecho de las heridas y en el tamaño de las lesiones, lo que sugiere la efectividad del tratamiento implementado. El paciente fue dado de alta con curas ambulatorias el 19/02/2024. La epitelización completa se produjo el 04/04/2024.

Conclusiones: El uso de Alginogel® enzimático se presenta como una alternativa valiosa en la práctica clínica para el tratamiento de heridas crónicas isquémicas infectadas. Este enfoque es especialmente relevante para pacientes que presentan alergia o intolerancia a la plata, quienes a menudo enfrentan limitaciones en las opciones de tratamiento disponibles. La aplicación de Alginogel® enzimático no solo promueve un manejo efectivo del lecho de la herida, sino que también favorece una epitelización temprana.

 

EP1686 Tratamiento de úlcera venosa en extremidad inferior con cura húmeda en paciente con leucemia mieloide. Caso clínico

Cristina Sarmiento Rodríguez, Sandra García Ballesteros¹, Esther Ayala Casado¹, Héctor Lorenzo Ruiz^1
1BSA, Badalona, Spain

Objetivo: Paciente de 81 años que acude a consulta para control de tensión arterial se refiere que desde hace 3 meses presenta múltiples heridas en extremidad inferior izquierda. Durante este tiempo ha estado realizando autocuras con povidona yodada. Paciente diagnosticado de leucemia mieloide y neoplasia maligna de próstata. Actualmente solo en tratamiento con antihipertensivos.

Métodos: Desde el día 17 de septiembre de 2024 se realizaron curas en consulta cada 72 horas con un apósito de carbón activado contenido en una malla de nailón no adherente, para el control de la infección y del mal olor y un apósito de fibras de polivilino de alcohol no tejido para el control del exudado. Se realizó cultivo de la herida, siendo positivo a Streptococcus agalactiae grupo B, Enterobacter cloacae complex y al Staphylococcus aureus. Tras obtener el resultado del cultivo, se inició tratamiento antibiótico.

Resultados: Epitelización completa en 90 días.

Conclusiones: La cura de úlceras venosas en un ambiente húmedo ha demostrado una mejoría clínica y ha iniciado el proceso de epitelización.

Es muy importante usar el tratamiento adecuado para cada tipo de úlcera, con un control del proceso inflamatorio y de la infección, ya que la presencia de microorganismos resistentes puede dificultar el proceso de curación.

Además, es fundamental la gestión adecuada del exudado en el tratamiento de úlceras venosas.

 

EP1687 Manejo integral de heridas en extremidades inferiores por estasis venoso en insuficiencia venosa crónica

Sandra García Ballesteros¹, Cristina Sarmiento Rodríguez, Esther Ayala Casado^1
1BSA, Badalona, Spain

Objetivo: Evaluar el manejo integral de heridas en extremidades inferiores (EEII) secundarias a edema en un paciente con insuficiencia venosa crónica.

Métodos: Caso clínico de una paciente de 82 años, sin hábitos tóxicos, independiente para las actividades básicas de la vida diaria. Antecedentes patológicos de insuficiencia venosa crónica e hipertensión; que desarrolló úlceras y celulitis en las piernas debido a estasis venoso.

Se describen las características clínicas de las heridas, el enfoque multidisciplinario en su manejo, incluyendo el control del edema, la aplicación de apósitos adecuados y la implementación de terapia compresiva. Además, se discuten las complicaciones asociadas y los resultados obtenidos a lo largo del tratamiento, destacando la importancia de un abordaje integral.

Resultados: Reducción del tamaño de las úlceras y disminución de edema en EEII.

Mejora significativa en el dolor. 

Alta adherencia al uso de terapia de compresión.

Conclusiones: Subrayar la efectividad de un enfoque multidisciplinario y personalizado en el manejo de heridas venosas. La combinación de terapia compresiva, uso de apósitos adecuados y educación sanitaria al paciente son fundamentales para optimizar la cicatrización y prevenir recurrencias. 

Se recomienda la implementación de protocolos estandarizados en la atención de heridas venosas para mejorar los resultados clínicos y la calidad de vida de los pacientes. La experiencia adquirida a través de este caso puede servir de base para futuros estudios y prácticas clínicas en el tratamiento de heridas por estasis venoso.

 

EP1688 La importancia de la adherencia terapéutica para evitar las recidivas

Lucia Aragón Rodríguez¹, Maria Francisca Delgado López^1
1Centro de Salud Úbeda Este, Úbeda, Spain

Objetivo:

- Conseguir la epitelización de la lesión a través del correcto tratamiento etiológico, evitando complicaciones.

- Fomentar los autocuidados en el domicilio.

Métodos: Hombre de 66 años con antecedentes de hiperuricemia, insuficiencia venosa, cor pulmonare, obesidad, DM, asma, HTA. Barthel: 90. Incumplimiento terapéutico.

Atendido en consulta tras presentar úlceras de etiología venosa en MMII de 2 semanas de evolución.

- MID: Celulitis, maceración, tejido compatible con biofilm en el lecho. RESVECH 2.0: 20.

- MII: Celulitis, maceración, edema, prurito y vesículas. 10 x 15 cm. RESVECH 2.0: 23.

Limpieza con esponja jabonosa y suero fisiológico. Fomento de PHBM durante 10 minutos. Desbridamiento cortante con bisturí, recogida de muestra para cultivo. Apósito primario: Alginato Plata. Protección de bordes con óxido de zinc.

El paciente consultó en cardiovascular prescribiéndole dispositivo de terapia compresiva con velcros. No lo usa por falta de adiestramiento.

Índice Tobillo Brazo = 1.

Tras 3 días: eritema y rubor. Se realiza misma limpieza, desbridamiento cortante. Pauta de cura: Óxido de zinc en pomada en bordes, óxido de zinc en loción en el lecho. Apósito primario: Alginato plata. Aplicamos AGHO en extremidad para hidratación. Se aplica sistema de velcros a 20 mmhg para fomentar tolerancia. Se instruye para aplicación en domicilio.

Cultivo: Proteus Mirabilis. Tratamiento: Ciprofloxacino, cada 12h, 14 días.

Resultados: Tras 7 días con terapia compresiva, epitelización completa. El paciente tolera la compresión y tanto él como su esposa han comprendido la importancia de su uso diario.

Conclusiones:

- El uso correcto de la terapia compresiva evitará recidivas de lesiones venosas.

- Una buena educación terapéutica favorecerá la adherencia de nuestros pacientes.

 

EP1689 Úlcera arterioesclerótica; importancia del diagnóstico precoz y el tratamiento etiológico

Maria Pascual Pol^1
1Coloplast, Barcelona, Spain

Objetivo: Diagnosticar la etiología arteriosclerótica en úlceras de pierna a través de signos y síntomas, realizando un tratamiento efectivo y resolutivo.

Métodos: Desde la consulta de heridas complejas se ha realizado la observación e identificación de lesiones de pierna con una serie de características arterioscleróticas en común; dolor intenso, contorno eritematoso-violáceo, tejido desvitalizado, pulso distales presentes, no respuesta al tratamiento convencional.

Reduciendo la hipertensión tisular perilesional se ha mejorado el retorno venoso y la microcirculación en el lecho de la herida.

Descartamos lesiones de etiología arterial con afectación de grandes vasos.

Resultados: Identificación de 8heridasconcaracterísticas arterioscleróticas.

Iniciamos el tratamiento local de las lesiones, inicialmente sin desbridamiento cortante por dolor, posteriormente se ha utilizado anestésico local. Fomentos de solución antibacteriana, apósito hidrofibra de hidrocoloide, corticoides perilesionales en zonas eritematosas, apósito secundario para una correcta gestión del exudado.

Utilizamos terapia de compresión, inicialmente tracción corta o multicapa y posteriormente con material ortopédico.

En los casos con mayor afectación y/o dolor agudo, realizamos la técnica de microinjertos en sello para conseguir unos resultados más rápidos y una disminución del dolor más efectiva.

La evolución de los casos estudiados y tratados ha sido favorable, obteniendo resultados positivos en menos de 2 semanas.

Conclusiones: El diagnóstico acertado permite una correcta actuación de tratamiento, siempre con evidencia científica y siguiendo las guías clínicas oportunas. En los casos más tempranos evita una evolución tórpida y en los casos más prolongados da solución a heridas consideradas crónicas y que solo se ha podido tratar la sintomatología.

 

EP1690 Plasma rico en plaquetas una opción eficaz, versátil y económica para tratar úlceras y/o heridas crónicas

Miguela López^1
1Policlinico PAMI 1 y 2, Centro Médico Brown, COMLHEI, Rosario, Argentina

Objetivo: Exponer la eficacia y la accesibilidad del Plasma Rico en Plaquetas (PRP) para tratamientos de úlceras crónicas aún en centros de salud con bajo presupuesto

Métodos: Se ha utilizado el PRP en gel para el tratamiento de úlceras y heridas crónicas con pérdida de substancia y con tendones expuestos consiguiendo cicatrizaciones de buena calidad, sin usar injertos o apósitos de alta tecnología. Para obtención solo se requirió una centrifugadora y un médico hemoterapista. Los materiales para todo el proceso no exceden 1,39 dólares.

Resultados: Desde hace 10 años venimos utilizando el PRP en gel, para el tratamiento de úlceras crónicas en pacientes añosos con variadas patologías agregadas sin que ello haya sido obstáculo para los resultados positivos del mismo.

Logrando preservar tendones expuestos, rellenar grandes pérdidas de substancia, disminuir el dolor y conseguir mayor confort en los pacientes

Mujer 85 años. Antecedentes: Insuficiencia venosa periférica Insuficiencia cardíaca derecha

19/07/21                                           29/12/21

Hombre, 75 años. Antecedentes: Insuficiencia arterial periférica LPP post internación por

Insuficiencia cardíaca descompensada en Aquiles derecho

  

01/12/21                   18/01/22                      16/05/22

Hombre 61 años. Antecedentes: tabaquismo. Accidente motociclista. Fractura expuesta. Gran pérdida de substancia. No requirió injertos.

06/05/2019                     28/08/2019                07/01/2022

Conclusiones: Recurso válido en tratamiento de heridas con pérdida de substancia como lo atestiguan trabajos y medicina basada en la evidencia

El bajo costo, para su producción, lo hace accesible para centros de salud con muy bajo presupuesto y de baja complejidad o ubicados en zonas aisladas con difícil acceso a insumos de alta tecnología

 

EP1691 Cuando la compresión está contraindicada - dehiscencia en paciente con isquemia crítica

Mireia Cuella Serres¹, Matilde Garrido Luque¹, Patricia Romero Lopez¹, Elena Langarita Llorente¹, Inmaculada Concepción Hernandez Cebrian¹, Laura Ibañez Canal¹, Ana Rios Baile^1
1Institut Català de la Salut, Barcelona, Spain

Objetivo: La terapia compresiva es esencial en el tratamiento de úlceras venosas, con solo dos contraindicaciones absolutas: enfermedad arterial oclusiva con isquemia crítica (índice tobillo-brazo <0,5) e insuficiencia cardíaca descompensada. El objetivo principal en estos casos es el cierre de la úlcera en 6 a 12 meses, disminuir el dolor y mejorar el bienestar emocional del paciente.

Métodos: Se presenta el caso de un hombre de 73 años con una dehiscencia de 5 cm tras una safenectomía interna. El paciente, con isquemia crónica grado III y antecedentes de revascularización percutánea y quirúrgica, acude a consulta un mes después de la cirugía.

Resultados: Se inician curas cada 48 horas con fomentos con descontaminante bactericida, apósito bactericida en pasta con alginato y plata iónica, apósito de fibra de alginato, oxido de zinc perilesional y apósito secundario de espuma de poliuretano con bordes de silicona. En las primeras visitas, se aplica la Escala de Ansiedad y Depresión de Goldberg, detectando ansiedad (7) y dolor (EVA 5/10 antes y 9/10 durante la cura). La ansiedad se relaciona con la incertidumbre sobre la herida y su salud. Se coordina con el médico de familia para el manejo del dolor, insomnio y ansiedad. Se realizan técnicas de relajación, anticipación de eventos (continuidad asistencial, transporte sanitario, etc.) y ajustamos expectativas de curación. A los dos meses, la lesión mejora lentamente, la ansiedad disminuye a 4 puntos y el dolor se controla mejor (2/10 y 5/10 durante la cura).

Conclusiones: El manejo de lesiones arteriales en pacientes con isquemia crítica debe ser holístico y multidisciplinario, manteniendo la continuidad asistencial y fomentando la expresión emocional del paciente.

 

EP1692 Enfoque terapéutico holístico para la curación de una úlcera infectada en un paciente anciano con insuficiencia venosa crónica

Alicia Ibáñez Saenz¹, Maria Isabel Chavarri Fuente¹, Maria Soledad Gomez Mendoza^1
1Seris, Logroño-La Rioja, Spain

Objetivo: Evaluar el manejo de una úlcera infectada en la extremidad inferior derecha en un paciente con signos evidentes de insuficiencia venosa crónica (IVC) utilizando un enfoque combinado de manejo local de la herida y tratamiento etiológico.

Métodos: Paciente de 84 años que presentó una herida dolorosa y exudativa de 15 días de evolución. El tratamiento inicial incluyó antibióticos orales, aposito antimicrobiano y vendaje de soporte. 4 días después, se reevaluó al paciente, identificando signos de IVC como dermatitis por estasis, deshidratación de la piel e infección local, se aplicó un apósito de plata con tecnología lipido -coloide, y terapia compresiva con vendaje multicomponente bicapa de 20 mmHg de presión. 2 semanas después, con la infección resuelta, el tratamiento cambió al uso de apósito con tecnología lipido -coloide y factor nano-oligosacárido. El día 13, se introdujo un sistema de compresión multicomponente bicapa de 40 mmHg, hasta que se logró el cierre de la herida.

Resultados: Tras 23 días de aplicar un enfoque terapéutico holístico, incluyendo manejo local de la infección, reducción de niveles elevados de metaloproteinasas y tratamiento con sistemas de compresión multicomponentes, se consiguió el cierre de la úlcera.

Conclusiones: Este caso pone de relieve la importancia de adaptar los tratamientos a las características específicas del lecho de la herida y a las condiciones etiológicas de los pacientes. Así como tanto la selección adecuada de los apósitos para controlar eficazmente la infección y el exceso de metaloproteinasas, como la aplicación temprana de la terapia de compresión para promover una cicatrización óptima.

 

EP1693 Perspectivas combinadas en el tratamiento de úlceras de pierna: más allá de lo físico

Nuria Piquer Farrés¹, Carolina Rodríguez Sardañés¹, Eva Garcia Armengol¹, Mercedes Fernández Almendros¹, Antonia Martin Zafra¹, Maria Rueda Chiva¹, M. Eulàlia Fitó Silvestre^1
1Institut Català Salut (ICS) Cap la Salut Badalona, Badalona, Spain

Objetivo: Realizar un abordaje biopsicosocial y multidisciplinar de una lesión de evolución tórpida en extremidad inferior favoreciendo el cierre de la misma.

Métodos: Valoración integral de la persona:

Antecedentes principales, varón 70 años con HTA, diabetes mellitus 2, EPOC CF III (portador oxigenoterapia), SAHS, obesidad mórbida, insuficiencia venosa (C6 según clasificación CEAP), dermatofibrosis. 

Análisis etiológico: úlcera varicosa EII maléolo externo (ITB: 1)

Tratamientos previos: recidivas anteriores de úlceras varicosas.

Situación psicosocial: vive en habitación de alquiler, no tiene soporte familiar ni cuidador de referencia, se deriva a trabajadora social. Higiene e hidratación de la piel deficientes.

Exploración EEII: edema importante, xerosis cutánea y piel liquenificada, pulsos presentes, dermatoesclerosis y atrofia blanca.

Tras valoración lesión: cura en ambiente húmedo utilizando para limpieza una solución acuosa (agua purificada, polihexanida 0,1% y undecilenamidopropil betaína 0,1%), un apósito absorbente modulador de proteasas y un sistema de compresión multicapa multicomponente. Cura semanal.

Seguimiento compartido con unidad de pacientes crónicos complejos y Cirugía Vascular.

Resultados: Tras 60 días se consigue la epitelización de la úlcera, se retira vendaje multicapa y se aconsejan medias de compresión. A los 15 días presenta de nuevo una recidiva que coincide con disminución de la adherencia terapéutica y la ausencia de medidas de compresión en EID. 

Conclusiones: El abordaje biopsicosocial y multidisciplinar favorece el cierre de la úlcera varicosa, así como disminuye el riesgo de recidivas. En este caso toma especial relevancia la problemática social y la ausencia de un cuidador de referencia que contribuya a favorecer la adherencia terapéutica.

 

EP1019 Revisión bibliográfica: Control del dolor irruptivo en úlceras venosas

Laia Vallejos Díaz^{1 2}, Judit Fabregat Polo^{1 2}, Elia Reyes Tena^{1 2}, Mónica Morcillo Gris^{2 3}, Maria Atienza Rodriguez^{2 3}, Marta Benítez Madir^{2 4
1}Consorci d‘Atenció Primaria de Salut Barcelona Esquerre (CAPSBE), CAP Casanova, Barcelona, Spain, ²Hospital Clinic de Barcelona, Barcelona, Spain, ³Consorci d‘Atenció Primaria de Salut Barcelona Esquerre (CAPSBE), CAP Borrell, Barcelona, Spain, ⁴Consorci d‘Atenció Primaria de Salut Barcelona Esquerre (CAPSBE), CAP Les Corts, Barcelona, Spain

Objetivo: Actualizar los conocimientos basados en la evidencia científica sobre el control del dolor irruptivo en úlceras de origen venoso 

Métodos: Revisión bibliográfica de estudios que evalúan los diferentes tratamientos de las úlceras venosas y tratamientos utilizados para el control del dolor irruptivo. Los artículos se buscaron entre los meses de junio a octubre. Se incluyeron estudios que comprueban distintos tratamientos excluyendo aquellos con limitaciones metodológicas.

Bases de datos utilizadas: PubMed, Cochrane y Scielo.

Palabras clave: úlceras venosas, tratamiento, dolor irruptivo, compresión, metamizol, lidocaína, sevoflurano, calidad de vida, autocuidado, enfermería, atención primaria.

Resultados: El manejo del dolor irruptivo en pacientes con úlceras venosas ha mostrado beneficios con un enfoque multimodal. La terapia compresiva acelera la cicatrización y reduce el dolor, especialmente con vendajes multicapa, logrando mejoras del 30-40%. Para el control del dolor, la lidocaína tópica y el sevoflurano tópico ofrecen analgesia con buen perfil de seguridad. El metamizol también es útil para el dolor irruptivo, mientras que los opioides de acción rápida, alivian el dolor agudo. Un enfoque integral y personalizado es clave, incluyendo educación sanitaria y atención a factores psicosociales. 

Conclusiones: Los artículos revisados ofrecen una visión detallada sobre el manejo del dolor y el tratamiento de úlceras venosas. Se destaca la alta prevalencia, su fisiopatología, y la importancia del diagnóstico temprano. La terapia compresiva el tratamiento por mejorar el retorno venoso y reducir la inflamación. Para el control del dolor, se resalta la eficacia de la lidocaína al 2% y el uso innovador de sevoflurano o metamizol tópicos, que ofrecen alivio rápido y seguro. Se destaca la necesidad de enfoques personalizados que mejoren los resultados y la satisfacción del paciente. 

 

EP1694 Abordaje y evolución de una ulcera vascular de etiologia arterial compleja

Sebastian Arias Millan^1
1hospital Sociosanitario Mutuam Girona, Girona, Spain

Objetivo: Describir el abordaje y evolución de una ulcera vascular, pasando por una amputación, cronificación y cicatrización de la herida.

Evidenciar la importancia de la valoración y revaloración de la herida hasta su resolución.

Métodos: A propósito de un caso. Varón de 91 años con antecedentes de diabetes tipo II mal controlada, arterioesclerosis y hipertensión arterial ingresa en marzo del 2023 en hospital de atención intermedia (HAI) con ulcera vascular de etiología arterial.

Se realizó una valoración al ingreso, que incluía: riesgos, herida y valoración geriátrica integral: Barthel 50/ Emina 4/ Charlson 8/ Eva 0/ Pfeiffer 2 / Yesavage 1. Buen estado nutricional y preservado cognitivamente. Se realizaron revaloraciones programadas cada 4 semanas por HAI y cirujano hospital referencia, revaloraciones no programadas según evolución e intermedias en cada cambio de apósito.

Resultados: Al ingreso presenta ulcera de etiología arterial en 1er metatarsiano pie derecho, pulsos débiles, aspecto necrótico y extendiéndose, cura tópica. Tratamiento conservador por indicación del vascular.

Octubre: amputación distal presentando herida quirúrgica con sutura tensa, bordes mal aproximados, necrosis, exudado hemático abundante y profunda cavidad. De acuerdo con la evolución y las indicaciones del vascular, con poca base científica concluyente, los referentes de curas prescriben cura mechada con plata, hidrocelular y film barrera.

Noviembre: terapia de presión negativa.

Enero: cura con colágeno.

Febrero: cura hidrogel y apósito plata.

Marzo a setiembre: fase de granulación y epitelización.

Conclusiones: La valoración holística y las revaloraciones han favorecido un buen resultado en un caso de lesión compleja y de lenta evolución.

 

EP1695 Implementación de los injertos en sello un centro de atención intermedia para el abordaje de lesiones complejas

Marta Hugas¹, Daniel Moreno Garcia^1
1SSIBE, Palamós, Spain

Objetivo: Describir el proceso de elaboración y posterior implementación de un protocolo de injertos en sello en un centro de Atención Intermedia integrado en un Sistema Integral de Salud.

Métodos: Se detallará el proceso de redacción y elaboración de un protocolo de injertos en sello liderado por profesionales de enfermería. 

Resultados: El protocolo de injertos en sello fue aprobado en septiembre de 2023. Durante el último año se han llevado a cabo 19 injertos en sello en el centro de Atención Intermedia, mejorando tanto la tasa de cicatrización como la calidad de vida de las personas con lesiones complejas y un mejor abordaje del dolor.

Conclusiones: Los injertos en sello son costo efectivos, reducen la frecuencia de cura, el consumo de apósitos y los días de ingreso en un centro de atención intermedia de las personas con lesiones complejas. Mejoran el dolor y reducen los tiempos de cicatrización propiciando una mejora significativa en la calidad de vida de los pacientes.

 

EP1696 De simple fricción a posible complicación pie diabético: a propósito de un caso

Meritxell Torà Rey¹, Elisabet Mateos Navarro¹, Mar Novis Berenguel², Elena Saba³, Anna Carbonell Perez^4
1Servei Andorrà Atenció Sanitària, Escaldes Engordany, Andorra, ²SErvei Andorra Atenció Sanitària, Escaldes Engordany, Andorra, ³Servei Andorra Atencio Sanitaria, Escaldes Engordany, Andorra, ⁴SErvei Andorra Atencio Sanitaria, Escaldes Engordany, Andorra

Objetivo:

• Evitar complicaciones y riesgo infección de la herida mediante medidas estériles durante todo su proceso de curación.

Métodos: Acude al servicio de Urgencias por presentar herida con esfacelos en zona pulpejo y eritema en dorso del 3er.dedo del pie derecho de más de 1 semana de evolución. Valorada por la enfermera referente de cura compleja que deriva el caso a Atención Primaria para continuar plan de curas y educación sanitaria.

A las 24h inicia curas en el centro de salud. Se mantiene el plan de curas con hidrocoloide en malla de Ag cada 72h y se coloca descarga de fieltro para evitar presión en la zona. Palpación de pulso pedio y tibial posterior presentes.

A los 6 días, la zona superior está epitelizada, cura con hidrocoloide en placa. La zona pulpejo, está más reducida y el lecho con tejido sano.

A los 12 días, se cambia curas a Alginato por sangrado al realizar desbridamiento cortante de las hiperqueratosis en zona pulpejo.

EL paciente se manipula la herida y aparece nueva lesión con eritema y edema en el lateral del dedo, cura con Alginato y control evolución, favorable a las 48h.

Al mes, la piel está integra aunque presenta hiperqueratosis.

Resultados: Durante todas las curas se han seguido medidas asépticas para evitar complicaciones con resultados favorables.

Conclusiones: La coordinación entre la atención especializada y la atención primaria ha evitado las complicaciones de una herida de pie diabético al recibir una rápida e individualizada atención.

A su vez, se ha reforzado con educación sanitaria un cambio en los estilos de vida para favorecer un mayor control metabólico de su enfermedad

 

EP1697 Terapia compresiva en úlceras traumáticas

Malen Irusta¹, Maria Garza Larrea², Miren Castilla Toribio², Iraia Echeverz Elizalde², Idurre Arregui Arregui^2
1Osakidetza, San Sebastian, Spain, ²Osakidetza, San Sebastian, Spain

Objetivo:

GENERAL

Fomentar la terapia compresiva en úlceras traumáticas cuando presentan componentes de insuficiencia venosa y no existe contraindicación.

ESPECÍFICOS

- Demostrar que la aplicación de un vendaje compresivo precoz en una úlcera de origen traumático acelera el proceso de curación cuando existe insuficiencia venosa.

- Determinar el coste terapéutico cuando se utiliza la compresión en este tipo de heridas.

- Identificar los criterios que determinen la necesidad de un vendaje compresivo en heridas traumáticas.

Métodos: Descripción de un caso clínico apoyado en el registro de enfermería de Osakidetza, Osanaia. Se han utilizado fotografías como material complementario.

Resultados: Transcurrieron 15 días desde que el traumatismo produjo la úlcera en la paciente estudiada. En ese tiempo se realizaron 5 curas en el centro de salud en las que se utilizó una malla antiadherente con plata y un vendaje de sujeción. Esto supuso un coste de 200 euros aproximadamente y ninguna mejoría clínica. Tras la identificación de la conveniencia del uso de la terapia compresiva, se utilizó un alginato y un vendaje de compresión de 20mmHg durante las siguientes 10 curas en el botiquín. Su coste total fueron 800 euros y la úlcera se cerró por completo en 36 días sin presentar complicaciones.

Conclusiones: El caso clínico que se presenta corrobora que con el uso de la terapia compresiva precoz en ulceras traumáticas con signos de insuficiencia venosa, se consigue una evolución rápida, favorable y eficiente.

 

EP1698 Visión holística desde un abordaje transdisciplinar de un hematoma disecante postquirúrgico de extremidad inferior en geriatría: estudio de caso

José Antonio García García¹, Montse Pérez Baena², Miriam Eslava Suárez³, Estrella Mesa⁴, Anna Roig Panisello^5
1Xarxa Sanitària, Social i Docent de Santa Tecla, Tarragona, Spain, ²Hospital de Sant Pau i Santa Tecla. Xarxa Sanitària, Social i Docent de Santa Tecla., Tarragona, Spain, ³Hospital del Vendrell. Xarxa Sanitària, Social i Docent de Santa Tecla, El Vendrell. Tarragona, Spain, ⁴Pius Hospital de Valls, Valls. Tarragona, Spain, ⁵Institut Català de la Salut. Terres de l‘Ebre, Tortosa. Tarragona, Spain

Objetivo: Analizar la aplicación de un diagnóstico terapéutico integral y transdisciplinar, basado en el modelo TIMERS, para el manejo de hematoma disecante en un persona geriátrica con múltiples comorbilidades y alta labilidad emocional, evaluando su impacto en la calidad de vida.

Métodos: El enfoque terapéutico siguió el modelo TIMERS para optimizar el manejo de la lesión. Se utilizó el índice RESVECH 2.0 para monitorizar el avance de la cicatrización y el cuestionario Wound-QoL para evaluar el impacto en la calidad de vida. Se realizó un desbridamiento quirúrgico y cuidados transdisciplinares para controlar el riesgo de complicaciones y ajustar los tratamientos a su perfil emocional, social, espiritual y físico.

Resultados: El uso del índice RESVECH 2.0 permitió un seguimiento sistemático del progreso de la lesión, mostrando una mejora gradual en los parámetros de cicatrización hasta la epitelización completa. Paralelamente, el cuestionario Wound-QoL reflejó una leve mejora en la calidad de vida percibida; sin embargo, el impacto positivo fue limitado por la labilidad emocional y la presencia de comorbilidades. EL modelo TIMERS ayudó a estandarizar el tratamiento y optimizar el entorno de cicatrización, consiguiendo un enfoque terapéutico integral adaptado a las necesidades específicas de la persona.

Conclusiones: El abordaje transdisciplinar desde una visión holística permite un manejo integral y personalizado de un hematoma disecante en geriatría, facilitando la cicatrización y manteniendo la calidad de vida de la persona, a pesar de sus comorbilidades y labilidad emocional.

 

EP1699 Uso de láser como terapia coadyuvante para promover la cicatrización de una úlcera compleja en miembro inferior en paciente pluripatológico con compromiso arterial

Mercedes Muñoz Conde¹, Rafael Cabello-Jaime¹, María Gutiérrez García², Ana Belén Fernández Ramírez³, Jose Luis Jiménez Láinez⁴, Melania Pérez Rivas^5
1AGS Éste de Málaga-Axarquía, Vélez-Málaga, Spain, ²AGS Serranía de Málaga., Ronda, Spain, ³Distrito Sanitario Granada Metropolitano, Granada, Spain, ⁴Distrito Sanitario Jaén-Jaén Sur, Jaen, Spain, ⁵Hospital Regional Universitario de Málaga. UGC Endocrinología-Nutrición, Málaga, Spain

Objetivo:

• Evitar amputación
• Promover cicatrización
• Mejorar calidad de vida
• Valorar eficacia de terapia láser como complemento en proceso de curación.

Métodos: Hombre de 71 años. DMT2. Urostomía por carcinoma urotelial. Neuropatía sensitivo-motora severa con denervación de MID, atrofia muscular. IVC C6 y arteriopatía moderada sin posibilidad de revascularización de tibial anterior. Dependiente moderado para actividades de la vida diaria.

Úlcera en pierna derecha, 16 meses de evolución (209 cm2). Lecho con biofilm, exudado que fuga, bordes inflamados.

RESVECH 2.0=22. EVA en curas 7/10, entre curas 4/10_. Tratamientos previos con apósitos antimicrobiano, injerto de espesor parcial que no prende proponiéndose amputación.

Derivado a Enfermera de Práctica Avanzada en Heridas Complejas (EPA HCC) por úlcera de evolución tórpida.

Se emplea durante 20 semanas terapia complementaria en la cura, Láser infrarrojo a longitudes de ondas de 660nm, 800 nm, 905 nm y 970 nm en modo superpulsado con una fluencia de 4 J/cm² junto a cura en ambiente húmedo con apósitos en función de la fase de cicatrización

Resultados:

Conclusiones: La aplicación de Láser ha sido segura y eficaz logrando importante reducción del área de la lesión, desaparición de dolor y mejora en la calidad de vida percibida evitando la amputación del miembro.

 

EP1700 Tratamiento de úlceras venosas con matriz polimérica bioabsorbible con plata nanoparticulada: serie de casos

Laura Juliana Suesca Bustacara ¹, Liliana del Pilar Pérez Parra^1
1Innovacure S.A, Bogotá, Colombia

Descriptores: Heridas, úlceras venosas, cicatrización, matriz polimérica bio absorbible, plata nano particulada, informes de caso.

Objetivo: Describir los resultados clínicos de la aplicación de una matriz polimérica bioabsorbible con plata nanoparticulada en el tratamiento de pacientes con úlceras venosas.

Métodos: Se trata de serie de casos, según guía de reporte CARE, en el cual se describen criterios de inclusión y exclusión para la aplicación de la matriz polimérica Bioreabsorbible con plata nano particulada en pacientes con úlcera en miembros inferiores, basados en la etiología, tiempo de evolución, tipo de tejido en el lecho. Posterior a la firma del consentimiento informado, se aplicó la Matriz de Superficie de Polielectrolitos 1,33%, Plata iónica y Metálica 0,67%, 2 veces a la semana, y siguiendo el protocolo de cuidado estándar incluida la terapia de compresión, con los objetivos propuestos como el mantenimiento del lecho de la herida limpio y desbridamiento del tejido necrótico.

Resultados: Se aplicó la matriz polimérica Bioreabsorbible con plata nano particulada a 6 mujeres, que presentaban un total de (n= 7) heridas, (una paciente presentaba 2 úlceras en miembros inferiores). En los casos de estudio la edad cronológica de las pacientes en promedio fue de 69,6 años, tiempo promedio sin cicatrización de las lesiones: 6 meses. El (100%) de los pacientes tuvieron 100% de cicatrización. El menor tiempo de cicatrización fue de 67 días y el mayor de 140 días; el tiempo promedio de cierre fue de 3 meses (90 días). Ninguno de los pacientes presento efectos adversos secundarios.

Conclusiones: Con base a los hallazgos clínicos presentados, se puede concluir que el uso de la matriz polimérica bioabsorbible con plata nano particulada en conjunto con el tratamiento estándar de oro para las úlceras venosas, funciona para reducir los tiempos de cicatrización de estas lesiones a 12 semanas como se reporta en la literatura.

Conflicto de interés: Las Enfermeras María del Pilar Pérez Parra y Laura Juliana Suesca Bustacara, laboran en Innovacure S.A.

Referencias bibliográficas:

1. Beltrán V, Bulla A, Espitia N, Vargas D, Vargas L. Caracterización clínica de pacientes con recurrencia de úlcera por enfermedad venosa crónica. Ciencia e Innovación en Salud. 2021
2. Benalcazar JF, Tipanxi S. úlcera Venosa. Estrategias terapéuticas. SECAV.2023. Cap. 1. Pag 15-16.
3. Manning SW, Humphrey DA, Shillinglaw WR, Crawford E, Pranami G, Agarwal A, Schurr MJ. Efficacy of a Bioresorbable Matrix in Healing Complex Chronic Wounds: An Open-Label Prospective Pilot Study. Wounds. 2020 nov;32(11):309-318. PMID: 33465043
4. Atkin L, Bućko Z, Conde Montero E, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019

 

EP1701 Aplicación de un apósito en polvo transformador en heridas de díficil cicatrización: serie de casos

Laura Juliana Suesca Bustacara ¹, María Fernanda Cote¹, Ricardo Neira^1
1Innovacure S.A, Bogotá, Colombia

Descriptores: Heridas, difícil cicatrización, apósito en polvo trasformador, informe de casos.

Objetivo: Describir los resultados clínicos de la aplicación de un apósito en polvo transformador (APT) para el tratamiento de heridas de difícil cicatrización y altamente exudativas.

Métodos: Se trata de serie de casos, según guía de reporte CARE, en el cual se describen criterios de inclusión y exclusión para la aplicación de un apósito en polvo transformador compuesto por polímeros biocompatibles en pacientes con heridas de difícil cicatrización y altamente exudativas, basados en comorbilidades de base, etiología, tiempo de evolución y tipo de tejido en el tejido en el lecho de la herida. Posterior a la firma del consentimiento informado, se realizó aplicación de (APT) cada 7 días y este permaneció hasta 30 días en el lecho, siguiendo el protocolo de cuidado estándar, con los objetivos propuestos como la gestión del exceso de exudado, protección de bordes, piel perilesional y reepitelización.

Resultados: Se aplicó el ATP a 2 mujeres y 1 hombre, con edades comprendidas entre los 67 y 87 años. Las causas de las heridas corresponden a úlceras de origen venoso (n=3), úlcera de origen arterial revascularizada (n=1), la de menor evolución de 2 meses y la de mayor evolución de 20 años, el 100% de los pacientes tuvieron 100% de cicatrización, el tiempo promedio de cicatrización fue de 52 días. Ningún paciente presento efectos adversos secundarios.

Conclusiones: Los resultados de los pacientes de esta serie de casos a los que se aplicó apósito en polvo transformador (APT), concuerdan con los reportes de otros estudios similares en la literatura, específicamente, en cuanto a la etiología de las heridas como úlceras de origen venoso y el tiempo promedio de cicatrización reportado de 64 días, con lo cual se infiere que el ATP podría ser considerado como una alternativa eficaz en el tratamiento de heridas de difícil cicatrización particularmente en aquellas con altos niveles de exudado.

Conflicto de interés: La instrumentadora quirúrgica María Fernanda Cote, Ricardo Neira y la enfermera Laura Juliana Suesca Bustacara, laboran en Innovacure S.A.

Referencias Bibliográficas:

1. O’Connor MJ, Ho KC, Sriram N, Fine KS, Melnick BA, Bartler AV, Huffman KN, Marzouk SM, Galiano RD. A systematic review on the use of transforming powder dressing for wound care. Int Wound J. 2024 Sep;21(9):e70046. doi: 10.1111/iwj.70046. PMID: 39278842; PMCID: PMC11402518.
2. Mahmood BA, ElSayed EH, Abd Elghany SM, Elnaggar DF, Youssef HAA, Abdelmaksoud SM. A New Powder Dressing for Management of Chronic Venous Ulcers. Dermatol Surg. 2023 Jul 1;49(7):664-668. doi: 10.1097/DSS.0000000000003812. Epub 2023 Apr 25. PMID: 37134230.
3. Yu SY, Ullrich PJ, Weissman JP, Joshi CJ, Taylor R, Patel A, El Hoseny S, Galiano RD. Evaluation of Altrazeal transforming powder dressing on stage 2-4 pressure ulcers: a clinical case series. J Wound Care. 2022 May 1;31(Sup5):S6-S12. doi: 10.12968/jowc.2022.31.Sup5.S6. PMID: 35576198.
4. World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound exudate: effective assessment and management Wounds International, 2019. www.woundsinternational.com

 

EP1021 Estrategia terapeutica en herida compleja sobre piel injertada

Naiara Eizaguirre Jauregui¹, Ainara Rodriguez Vicario¹, Leire Barrutia Feijoo¹, Cristina Archeli Mesonero¹, Nagore Arza Alonso¹, Xabier Barquero Garate¹, Ainhoa Bolinaga Gullon^1
1Osakidetza, Mendaro, Spain

Objetivo: El objeto de este trabajo es enseñar la curación de una herida que se desarrolla sobre un injerto cutáneo previo, presentando desafíos adicionales en comparación con las heridas primarias. Además, el cierre de heridas sobre un injerto previo puede requerir más recursos y esfuerzos, y se asocia con una mayor incidencia de complicaciones como la dehiscencia de la herida.

Métodos: Se describe el caso clínico de una mujer de 69 años, con una herida que se desarrolla sobre un injerto cutáneo previo, presentando desafíos adicionales en comparación con las heridas primarias. La presencia del injerto puede afectar la vascularización local y la calidad de la piel circundante, lo que dificulta la cicatrización adecuada. Se presenta de manera visual la evolución de la herida, tras realizar un diagnóstico de una insuficiencia venosa. Se combina la terapia de compresión con la dificultad previa de injerto, con lo que añadimos a la cura, la terapia de presión negativa.

Resultados: Tras un buen diagnóstico de la herida, se decide combinar el vendaje compresivo con terapia de presión negativa. Se trata de una extremidad con insuficiencia venosa y con un antecedente previo que preciso un injerto en la misma. La combinación de ambas terapias resulta beneficiosa en la cicatrización.

Conclusiones: La introducción de la terapia de presión negativa junto con un vendaje compresivo en el tratamiento de la herida estancada representa un enfoque terapéutico prometedor. La combinación de estas técnicas ayuda a mejorar la cicatrización y promover una recuperación más efectiva. Este podría ser otra área de estudio para próximos trabajos.

 

EP1702 Uso de plasma rico en plaquetas (PRP) en el tratamiento de úlceras crónicas

Candela Alemán Ruiz^1
1ICS, L´Hospitalet de Llobregat, Spain

Objetivo: Conocer los beneficios y evaluar la eficacia del PRP en la cicatrización de úlceras crónicas. Determinar, si el PRP acelera la cicatrización y mejora la calidad del tejido reparado en comparación con otros tratamientos convencionales.

Métodos: Tras realizar una revision sistemática en las bases de datos Pubmed y Cochrane, utilizando operadores booleanos ‘AND’, ‘OR’ y ‘NOT’, y los términos MeSH “Platelet-Rich Plasma”, “Wound Healing”, “Chronic Wounds” y “Treatment Outcome”. Se han incluido estudios realizados en los últimos cinco años.

Resultados: Se presentan hallazgos en la eficacia de la cicatrización, reducción del dolor y la inflamación, y en la evaluación de la seguridad.

Conclusiones: Los resultados generales sugieren que el PRP es una opción prometedora para el tratamiento de úlceras crónicas, mejorando tanto la velocidad como la calidad de la cicatrización, y es bien tolerado por los pacientes. Es una terapia efectiva y segura para úlceras crónicas. Sin embargo, se requiere de más investigación, para optimizar su aplicación y asegurar su efectividad en diferentes tipos de úlceras.

 

EP1022 Resolución de heridas crónicas en paciente con linfedema sin anitibioticoterápia: abordaje multidisciplinar con vendaje multicapa

Ester Moliner Serra¹, Maria Belen Sendra Criado¹, Melissa Fuentes Zambrano¹, Melina Nsoni Zoyo¹, Lizeth Johanna Botero Cartagena¹, Estíbaliz Fernandez Egea¹, Ana Gabriela Rosales Garcia^1
1Parc Sanitari Pere Virgili, Barcelona, Spain

Objetivo: Este estudio describe el abordaje multidisciplinar de un paciente con linfedema de un año de evolución demostrando el beneficio de la aplicación temprana de la compresión a través de un vendaje multicapa.

Métodos: Paciente de 79 años multimórbido con dependencia funcional moderada, cuyos antecedentes cabe destacar vasculopatía periférica, ingresa en centro de atención intermedia con el objetivo de antibioticoterapia sistémica y cura de heridas de ambas extremidades inferiores de un año de evolución.

Tras una valoración integral y una atención multidisciplinar se decide seguir el concepto “TIMERS”: realizando limpieza del lecho de las heridas, tratando con apósitos de plata para reducir la carga bacteriana y aplicando un vendaje multicapa para favorecer retorno venoso, reducir el edema y gestionar el exudado.

Además de ser monitorizado por enfermería y medicina, se pudo beneficiar de un plan de rehabilitación con fisioterapia, terapia ocupacional y también fue asesorado por trabajo social.

Resultados: Tras la aplicación del abordaje descrito, las heridas se resolvieron durante su estancia en la unidad de convalecencia, evitando la administración de antibióticos sistémicos.

Durante su estancia se pudieron gestionar recursos sociales para el retorno a domicilio tal y como medias de compresión específicas para el linfedema y ayudas sociales para el domicilio.

Conclusiones: La intervención personalizada y el diagnóstico precoz hacen que realice el mejor tratamiento para el paciente, en este caso la aplicación temprana de la compresión con vendaje multicapa ha sido clave para la disminución del tiempo de ingreso en el centro hospitalario.

 

EP1703 Tratamiento de eritema y descamación en extremidad inferior en paciente diabético con aceites hiperozonizados

Mª Elena Saba^{1 2 3 4 5 6
1}Elisabet Mateos Navarro. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ²Mª del Mar Novis Berenguel. Hospital Nostra Senyora de Meritxell, Escaldes- Engordany, Andorra, ³Meritxell Torà Rey. Hospital Nostra Senyora de Meritxell., Escaldes-Engordany, Andorra, ⁴Susset Maria Figueiredo Pereira. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ⁵Ana Rita Gonçalves Zeferino. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra, ⁶Anna Carbonell Pérez. Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra

Objetivo: Reducir y mejorar la lesión eritematosa y de descamación de la extremidad inferior.

Métodos: Desde abril hasta setiembre que acude a nuestra consulta se ha realizado diferentes consultas con diferentes especialistas: médico de cabecera, dermatólogo, alergólogo, cirujano vascular, y se han realizado diferentes planes de cuidados: aplicación de alginato Ag+foam, hidrofibras de hidrocoloide+foam Ibu®, foam, vaselina, crema hidratante, talquistina® polvo y talquistina® crema.

El 4 de octubre acude a Consultas explicando la situación, se le realiza una exploración y se le recomienda aplicación de aceite hiperozonizado dos veces al día. A los 15 días se le hace una revisión y presenta mejoría del eritema de la pierna y solo queda una pequeña zona de descamación en la zona maleolar.

En nuestra consulta se le realiza, también, una exploración por parte de podología con resultados de MESI D: 1,39 e I: 1,36 con onda bifásica. Se constata una disminución de la sensibilidad en zonas digitales y metatarsos.

Resultados: Mejoría de la lesión de la extremidad inferior en 3 semanas de aplicación de aceites hiperozonizados.

Conclusiones: Los aceites hiperozonizados nos ayudan a cicatrizar y tratar una dermatitis por estasis venoso en paciente con problemas de circulación. Ha sido el único tratamiento que ha proporcionado una mejoría del estado de la pierna y en general del paciente ya que refiere reducción del prurito.

 

EP1704 A veces las curas no acaban como nos gustaría

Irma Fornell Boixader¹, Meritxell Almà Garcia², Teresa Carbó Casanova³, Montserrat Nieto Martinez², Gloria Serradell Vidal², Emilia Mateo Marin⁴, Adriana Pérez Justicia^2
1Socia GNEAUPP, Referente Heridas ABS Baix Berguedà, Miembro Comisión Heridas GTCC, Gironella, Spain, ²ICS CAP Gironella, Gironella, Spain, ³Socio GNEAUPP, Miembro Comisión Heridas GTCC, PUIG-REIG, Spain, ⁴Socia y Miembro Consultor GNEAUPP, Referente Heridas GTCC, Socia SEHER, Callús, Spain

Objetivo: Dar a conocer el abordaje de la úlcera arterial y el control del dolor en paciente pluripatológica

Métodos: Paciente de 90 años con antecedentes patológicos de AVC, Artropatía periférica, Bypass aorta-femoral pierna izquierda, IRC, Diabetes tipos II, HTA, Hiperlipidemia. 

En enero la hija nos alerta de un punto de presión en el tobillo D, pautamos hidratación y descarga. A la semana ingresa en hospital por isquemia pierna derecha (EID), dónde se aconseja bypass que la paciente no acepta. Se da alta con curas a domicilio y visitas mensuales a consulta de vascular.

Primera valoración en Atención Primaria (AP). Úlcera por presión de 3x1 cm diámetro, lecho esfacelado, edema y eritema. Resvech:10. Dolor EVA 7/10. ITB pie derecho: 0,78

Tratamiento oral: Clindamicina 300 c/6h, furosemida 40 mg 2 c/24h + paracetamol 1000mg c/8h y metamizol c/8h.

Cura: Fomentos de solución de ácido hipocloroso, hipoclorito sódico y electrolitos (solución antimicrobiana) + apósito de poliacrilato con solución Ringer+ espuma de poliuretano. Curas 3 veces por semana.

En marzo presenta afectación 1r dedo pie derecho. Cura seca con povidona iodada diaria

Cura úlcera: Igual pauta. EVA: 8/10 se pautan parches de fentanilo
En abril la herida presenta signo “pintalabios rojo” con los bordes enrojecidos, augmento del dolor. Se decide en comité amputación de manera urgente.

Resultados:

Amputación supracondílea de EID.

Control de dolor.

Conclusiones: Visualizar y mostrar que por mucho que hagamos una buena cura, con el material adecuado y con el seguimiento de los mejores profesionales el desenlace no es siempre es el esperado.

 

EP1705 Abordaje de lesiones isquémicas tras una revascularización en paciente con isquemia crónica

Sara Parrilla Binue¹, David Aguilo Lopez^1
1Hospital San Juan de Dios, Zaragoza, Spain

Objetivo: Describir la evolución de los cuidados de enfermería en lesiones de un paciente con úlceras en extremidad inferior izquierda.

Métodos: Se presenta un caso de un paciente con unas lesiones de gran extensión con diagnóstico de isquemia crónica grado IV en extremidad inferior izquierda por obstrucción femoropoplítea con componente isquémico e infeccioso. Se plantea cura de las lesiones por enfermería ante una posible propuesta de amputación.

Resultados: Caso clínico: varón de 77 años. Antecedentes personales: fumador desde hace 60 años (1,5 paquetes al día). Bebedor diario, hipertensión, diabetes mellitus tipo 2 insulinodependiente, dislipemia, obesidad, adenocarcinoma de próstata en 2011, accidente isquémico transitorio en 2021.

Remitido en febrero de 2024 para continuidad de curas en lesiones de gran extensión con pronóstico reservado tras realización de una revascularización. Al ingreso presenta lesiones de 30-35 centimetros de extensión desde el talón hasta zona tibial media, que prácticamente afectan a todo el contorno de la pierna con tejido necrótico y de granulación. Se inicia tratamiento con apósitos con efecto antimicrobiano (DACC), y aplicación de apósitos con colágeno bovino en zonas de granulación. Se consigue un desbridamiento total del tejido necrótico (salvo zona del talón) y las zonas con tejido de granulación terminan de cicatrizar casi en su totalidad.

Conclusiones: El abordaje del equipo de enfermería en las curas de las lesiones es la piedra angular del éxito de la cicatrización de las heridas, para ello es muy importante reforzar los conocimientos de la enfermería en el manejo de heridas. Se ha logrado una epitelización casi total de las lesiones.

 

EP1706 Abordaje de una herida traumática mediante terapia compresiva

Desiree Garcia Laguna¹, Gemma Ruiz Martinez¹, Sandra Gallardo Lopez¹, Aina Lluch Rossell¹, Elisabeth Navarro Rodriguez¹, Judit Vilaro Viladoms¹, Africa Cebada Ferrer^1
1Gestió i Prestació de Serveis de Salut, Tarragona, Spain

Objetivo: Compartir el plan de cuidados del manejo de una herida traumática de evolución tórpida tras varios meses de tratamiento fallido en atención primaria.

Métodos: El caso clínico presentado es de una paciente con herida crónica de origen traumático de 3 meses de evolución. Para la resolución de esta, se intentaron varios tratamientos no siendo exitosos lo que condujo la llegada de esta paciente a nuestra unidad hospitalaria.

Resultados: Valoramos el estado inicial de la herida y reajustamos la pauta de cura en ambiente húmedo haciendo hincapié en los principales factores del manejo de la herida