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Kuikko K, Salmi T, Huhtala H, Kimpimäki T. Characteristics of chronic ulcer patients by gender and ulcer aetiology from a multidisciplinary wound centre. Int Wound J 2024; 21:e70012. [PMID: 39107919 PMCID: PMC11303263 DOI: 10.1111/iwj.70012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
Chronic ulcer patients form a heterogenous group of patients with various medical backgrounds. Cost-effective targeted treatment necessitates more knowledge about specific features related to different subgroups of ulcer patients. Hence, this study aimed to characterize ulcer patients according to gender and ulcer aetiology. A total of 946 consecutively recorded chronic ulcer patients in the Tampere Wound Registry (TWR) were included and data were gathered from the TWR and patient medical records. Comparisons were made between males and females and patients with venous-, arterial or mixed-, diabetic foot-, pressure- and atypical ulcers. Male patients were found to have diabetes, hypercholesterolemia and obesity significantly more often than females (59.2% vs. 39.6%; p < 0.001, 46.5% vs. 33.3%; p = 0.001, 42.7% vs. 35.9%; p = 0.017 respectively), whereas autoimmune diseases were more common among females (30.6% vs. 15.6%; p < 0.001). Recurrence of ulcers was most common among patients with venous ulcers (p < 0.001) and multimorbidity among those with diabetic foot ulcers (p < 0.001). To conclude, males with chronic ulcers would benefit particularly from lifestyle advice, multidisciplinary treatment should be targeted specifically at those with diabetic and arterial or mixed ulcers and preventive measures at those with venous ulcers.
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Affiliation(s)
- Katarina Kuikko
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Teea Salmi
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of DermatologyTampere University HospitalTampereFinland
| | - Heini Huhtala
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Teija Kimpimäki
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of DermatologyTampere University HospitalTampereFinland
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Lee YJ, Han HJ, Shim HS. Treatment of hard-to-heal wounds in ischaemic lower extremities with a novel fish skin-derived matrix. J Wound Care 2024; 33:348-356. [PMID: 38683780 DOI: 10.12968/jowc.2024.33.5.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the efficacy of treatment of hard-to-heal wounds of patients with ischaemia of the lower extremities, and compare an omega-3 wound matrix product (Kerecis, Iceland) with a standard dressing. METHOD A single-centre, prospective, randomised, controlled clinical trial of patients with hard-to-heal wounds following three weeks of standard care was undertaken. The ischaemic condition of the wound was confirmed as a decreased transcutaneous oxygen pressure (TcPO2) of <40mmHg. After randomising patients into either a case (omega-3 dressing) or a control group (standard dressing), the weekly decrease in wound area over 12 weeks and the number of patients that achieved complete wound closure were compared between the two groups. Patients with a TcPO2 of ≤32mmHg were taken for further analysis of their wound in a severe ischaemic context. RESULTS A total of 28 patients were assigned to the case group and 22 patients to the control group. Over the course of 12 weeks, the wound area decreased more rapidly in the case group than the control group. Complete wound healing occurred in 82% of patients in the case group and 45% in the control group. Even in patients with a severe ischaemic wound with a TcPO2 value of <32 mmHg, wound area decreased more rapidly in the case group than the control group. The proportions of re-epithelialised area in the case and control groups were 80.24% and 57.44%, respectively. CONCLUSION Considering the more rapid decrease in wound area and complete healing ratio in the case group, application of a fish skin-derived matrix for treating lower-extremity hard-to-heal wounds, especially with impaired vascularity, would appear to be a good treatment option.
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Affiliation(s)
- Yeon Ji Lee
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
| | - Hye Ju Han
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
| | - Hyung Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
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Horvath V, Svobodova A, Cabral JV, Stadler P, Lindner J, Mrstinova MB, Balogh L, Jirsova K. Cryopreserved amniotic membrane in chronic nonhealing wounds: a series of case reports. Cell Tissue Bank 2024; 25:325-337. [PMID: 37945942 PMCID: PMC10901998 DOI: 10.1007/s10561-023-10100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 11/12/2023]
Abstract
A case series of the use of amniotic membrane (AM) for treating chronic nonhealing wounds. It presents five cases of polymorbid patients with a total of nine chronic nonhealing wounds. The patient group consisted of four men and one woman with various comorbidities, aged 45-72 years. The mean initial wound size was 15.8 cm2, and the mean time from the onset of the wound to the first application of AM was 122 weeks. The wounds were caused by chronic venous insufficiency and/or peripheral arterial disease. Wounds were treated in a standardized protocol. AM was applied weekly in the first month and then every two weeks. Photo documentation of the wound and microbiological colonization was carried out at each visit. In three out of five patients, the AM treatment effectively promoted healing up to complete wound closure. In two cases, the wounds stayed unhealed despite numerous AM applications. Pain relief was noted in all patients. The success of the treatment was closely tied to patient factors, such as adherence to the prescribed treatment regimen and individual patient characteristics. In some cases, treatment failure was observed, possibly due to underlying comorbidities, wound parameters, or poor patient compliance. AM treatment has the potential to become a viable treatment option for these nonhealing wounds. However, the effectiveness of the treatment may be influenced by various patient factors and the underlying cause of the wound. Therefore, it is crucial to have an individualized treatment plan that considers these particular factors.
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Affiliation(s)
- Vojtech Horvath
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Alzbeta Svobodova
- 2nd Department of Surgery-Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Joao Victor Cabral
- Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Stadler
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaroslav Lindner
- 2nd Department of Surgery-Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miluse Berka Mrstinova
- Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lukas Balogh
- Laboratory of Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Albertov 4, 128 01, Prague, Czech Republic
| | - Katerina Jirsova
- Laboratory of Biology and Pathology of the Eye, Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Albertov 4, 128 01, Prague, Czech Republic.
- Department of Transplantation and Tissue Bank, Motol University Hospital, Prague, Czech Republic.
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Ahmajärvi K, Isoherranen K, Venermo M. Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting. BMJ Open 2022; 12:e062673. [PMID: 36410819 PMCID: PMC9680184 DOI: 10.1136/bmjopen-2022-062673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Exact wound diagnosis is essential for successful wound management and a holistic care of the patient suffering from a wound. Wound management has been traditionally seen as a nursing area, but this can lead to considerable delays in wound diagnostics. A diagnostic delay has been recognised as an element of diagnostic error, which, in turn, affects patient safety. The aim of this cohort study was to examine diagnostic delays of chronic wound within primary care. SETTING A specialised diagnostic unit, a wound care team, was established in the primary healthcare with the objective of reducing diagnostic and treatment delays in primary care. PARTICIPANTS The data consists of 197 consecutive patients attending their first appointment with the wound care team in 2016. The collected data included basic demographics, information about the clinical pathway, including doctor's appointments in primary and specialised care, as well as the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes. PRIMARY AND SECONDARY OUTCOME MEASURES The diagnostic delays were calculated in days and divided into three groups: (1) patient-related delay, (2) diagnostic delay and (3) organisational delay. RESULTS The median duration of a patient-related delay was 2 days (IQR 0-14), whereas a physician's first evaluation was performed at a median of 8 (1-32) days from wound appearance and the correct diagnosis by the wound care team was established in a median of 57 (33-100) days. The organisational delay from first contact to diagnosis was a median of 41 (22-80) days. Only one in three patients had a diagnostic delay of less than 4 weeks. CONCLUSIONS According to this study, the diagnostic delay occurs within primary care, as an organisational delay from first contact to correct diagnosis. It is possible to arrange an optimal pathway of care in which a holistic wound care process starts within primary care.
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Affiliation(s)
- Kirsti Ahmajärvi
- Doctoral Programme in Populational Health and Department of General Practice and Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Isoherranen
- Department of Dermatology and allergology, University of Helsinki and Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Vascular Surgery Department, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Soares Dantas J, Silva CCM, Nogueira WP, de Oliveira e Silva AC, de Araújo EMNF, da Silva Araújo P, Freire MEM. Health-related quality of life predictors in people with chronic wounds. J Tissue Viability 2022; 31:741-745. [DOI: 10.1016/j.jtv.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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Lin HC, Fang CL, Hung CC, Fan JY. Potential predictors of quality of life in patients with venous leg ulcers: A cross-sectional study in Taiwan. Int Wound J 2021; 19:1039-1050. [PMID: 34611998 PMCID: PMC9284624 DOI: 10.1111/iwj.13700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross‐sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing.
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Affiliation(s)
- Hsiao-Ching Lin
- Department of Surgery, Division of Plastic Surgery, Wound Care Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chien-Liang Fang
- Department of Surgery, Division of Plastic Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Tai-Chung City, Taiwan
| | - Chang-Chiao Hung
- Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chia-Yi, Taiwan
| | - Jun-Yu Fan
- Division of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan, Taiwan
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Díaz-Herrera MÁ, Martínez-Riera JR, Verdú-Soriano J, Capillas-Pérez RM, Pont-García C, Tenllado-Pérez S, Cunillera-Puértolas O, Berenguer-Pérez M, Gea-Caballero V. Multicentre Study of Chronic Wounds Point Prevalence in Primary Health Care in the Southern Metropolitan Area of Barcelona. J Clin Med 2021; 10:jcm10040797. [PMID: 33669397 PMCID: PMC7920417 DOI: 10.3390/jcm10040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Chronic wounds give rise to major costs and resource consumption in health care systems, due to their protracted healing time. Incidence and prevalence data are scarce or nonexistent in community settings. Objective: The aim of the present epidemiological study was to analyse and determine the prevalence of chronic wounds in the community in the south of the province of Barcelona (Spain). Design: A cross-sectional, multicentre secondary data analysis study was conducted in the community (excluding nursing homes) in Barcelona between 16 April and 13 June 2013. It included 52 primary care centres that serve a total population of 1,217,564 inhabitants. Results: The observed prevalence was 0.11%. Venous ulcers presented the highest prevalence, at 0.04%, followed by pressure injuries, at 0.03%. The >74 age group presented the highest frequency of chronic wounds, accounting for 69.4% of cases. Conclusion: The results obtained are consistent with those reported in previous similar studies conducted in Spain and elsewhere. As with most studies that adjusted their variables for age and sex, we found that the prevalence of ulcers increased with age and was higher in women, except in the case of diabetic foot ulcers and ischaemic ulcers, which were more frequent in men.
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Affiliation(s)
- Miguel Ángel Díaz-Herrera
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
- Teaching Committee, Hospital Universitari General de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940 Cornellà de Llobregat, Spain;
| | - José Ramón Martínez-Riera
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (J.R.M.-R.); (J.V.-S.)
| | - José Verdú-Soriano
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (J.R.M.-R.); (J.V.-S.)
| | - Raúl Miguel Capillas-Pérez
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Carme Pont-García
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Silvia Tenllado-Pérez
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Oriol Cunillera-Puértolas
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940 Cornellà de Llobregat, Spain;
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Miriam Berenguer-Pérez
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
| | - Vicente Gea-Caballero
- Nursing School La Fe, Adscript Center of University of Valencia, Research Group GREIACC, Health Research Institute La Fe, Avinguda Fernando Abril Martorell nº 106, Torre H. CP, 46006 Valencia, Spain;
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Prevalence of Chronic Skin Wounds and Their Risk Factors in an Inpatient Hospital Setting in Northern China. Adv Skin Wound Care 2020; 33:1-10. [DOI: 10.1097/01.asw.0000694164.34068.82] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ahmajärvi KM, Isoherranen KM, Mäkelä A, Venermo M. A change in the prevalence and the etiological factors of chronic wounds in Helsinki metropolitan area during 2008-2016. Int Wound J 2019; 16:522-526. [PMID: 30672095 DOI: 10.1111/iwj.13077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022] Open
Abstract
The prevalence of chronic wounds in the Helsinki metropolitan area in 2008 was investigated. Thereafter, a specialised wound care team was founded as part of the City of Helsinki Health Services, aiming for early diagnoses of chronic wounds. In the current study, we have repeated the prevalence study to analyse the changes in the prevalence of chronic wounds. A questionnaire on wound patients was sent to all units of social and health care in the Helsinki metropolitan area. We asked about the number of patients with wounds treated during a 24-hour period, as well the aetiology and location of the wounds. A total of 911 patients had, altogether, 1021 wounds. Thus, prevalence was 0.08%. Pressure and multifactorial ulcers were the most common aetiological groups, whereas wound without defined aetiology had diminished greatly (61%) The prevalence of chronic wound decreased when compared with 2008 (0.08% vs 0.1%). The number of elderly people aged over 65 years had increased 35%, and the age-adjusted prevalence had decreased. Wounds are treated mostly in primary care units and as outpatients. Therefore, the following conclusion may be reached: diagnostic process and implementation of treatment paths are strengthened within primary care units, yet prevalence of wounds has decreased.
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Affiliation(s)
- Kirsti M Ahmajärvi
- Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland.,City of Helsinki Social and Health Services, Helsinki, Finland
| | - Kirsi M Isoherranen
- Department of Dermatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anita Mäkelä
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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