Wound Practice and Research

Aims To compare the efficacy, cost effectiveness and user satisfaction achieved when 4-layer compression bandages (4LCB) and adjustable Velcro^® compression devices (AVCD) are used in the treatment of venous leg ulcers (VLU), in community dwelling adults.

Methods A prospective cross-over study was conducted. A convenience sample of 50 patients with VLUs were recruited. Patients were randomised to receive either 4LCB or AVCD for a period of 6 weeks, then crossed to the alternative treatment for an additional 6 weeks. Baseline and weekly wound assessments were recorded. Patients and nurses completed satisfaction surveys at the end of each arm. A cost analysis was completed.

Results Patients experienced a comparable reduction in ulcer size with both compression modalities.

Nurses and patients reported higher satisfaction with AVCD. The costs associated with a reusable AVCD as compared to single use 4LCB was dependent on the duration of treatment and frequency of changes. Cost benefits were associated with AVCD after 17 episodes of care where a single set of bandages was required and sooner in larger legs.

Conclusions The use of AVCD proved cost-effective and produced comparable healing rates in the community setting. Both nurses and patients expressed higher satisfaction scores when using AVCD.

Background Adequate nutrition is essential for individuals with diabetes and wounds to optimise both wound healing and blood glucose control. Previous systematic reviews have evaluated the effectiveness of nutrition supplementation for wound healing in individuals with diabetes. However, none have reported comprehensively on the range of dietary interventions utilised in this population, despite these being common within clinical practice. Therefore, the aim of this systematic review is firstly to evaluate the effectiveness of dietary interventions for wound prevention and management in people with diabetes, and secondly to describe intervention characteristics.

Methods Using PRISMA-P to guide the review, five databases will be searched for intervention studies (Medline, Embase, CINAHL, Scopus, Cochrane Library) as well as clinical trials registries. The Rob‑2 and ROBINS tools will assess risk of bias. Studies will be described narratively, and a meta-analysis conducted if adequate levels of homogeneity exist between included studies and outcome variables, including study types, and characteristics of the sample including sample size. An appropriate model will be chosen to undertake meta-analysis.

Discussion The systematic review results will inform clinicians on the most effective dietary interventions to optimise wound healing in individuals with diabetes. Study results will inform design and conduct of future nutrition interventions in wound healing.

Aim To explore the comorbidities of community wound patients, and their impacts on healing.

Methods Records of patients treated for a wound in Western Australia by a community healthcare service during 2017/2018 were linked to hospital admissions data for the prior 12 months. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) were calculated using ICD-coded diagnoses from the linked data. Cox proportional hazards regression examined associations between comorbidities and healing.

Results Wound care was provided to 14,479 patients with 25,968 wounds. Most wounds healed (76.11%) and most patients were hospitalised (84.51%) at least once in the 12 months prior to their community wound admission. Two-thirds had one or more ECI comorbidity and over half had one or more CCI comorbidity. There was variation in comorbidity profiles across the wound categories. Patients with pressure injuries had the highest CCI scores (mean 3.26, SD 3.17) and ECI scores (mean 3.32, SD 2.36). For each wound category, the model that best explained the relationship between wound healing and comorbidities was based on the presence of different subsets of comorbidities.

Conclusion Linkage of hospital data to community data improved understanding of the comorbidity burden and differences in wound healing outcomes for different wound categories.

Objective To evaluate the influence of doxycycline on wound healing activity compared to control interventions, such as saline, chitosan, or other pharmacological agents.

Materials and methods The following databases Medline (PubMed), Embase, Scopus, and Web of Science were searched for the relevant studies. A total of 94 records were screened after the removal of duplicates and 16 trials were included. Considering the similarity in outcome measures, data was pooled from nine trials using Comprehensive Meta Analysis (CMA) 3.0 software. The level of significance was p<0.05 and the certainty of the evidence was evaluated using GRADE pro GDT.

Results A pooled analysis of nine trials assessing the wound healing in percentage (SMD 2.952, 95% CI:[0.597 to 5.307], p<0.014) significantly favoured doxycycline over the control agents. In the SYRCLE tool, four out of nine criteria displayed a low risk of bias in more than 50% of the included studies (more than 8 studies). This, along with low/unclear risk of bias, minimised imprecision and indirectness in the included trials, leading to high certainty of evidence.

Conclusion Doxycycline shows notable advantages in wound healing compared to placebos or other agents, but replicability in clinical settings is necessary. Definitive pooled evidence from human trials is crucial to determine its precise clinical implications.

Background Chronicity of wound in vasculopaths or elderly with atrophic skin pose challenges in clinical management. Harvesting skin grafts from non-hairbearing skin in these patients may lead to the formation of a chronic wound itself.

Methods Under local anaesthesia, skin micrografts were harvested from the suprapubic hairbearing area. Subsequently, harvested skin was applied with fibrin glue and post-operative inspections were performed on days 5, 7, 14

Results Chronic wounds re-epithelised within an average of 2 weeks, donor site re-epithelised within an average of 1.7 weeks

Conclusions The suprapubic skin serves as an effective harvest site for chronic wounds.