Management of a Difficult-to-Treat Diabetic Foot Wound Complicated by Osteomyelitis: A Case Study

A systematic review on the use of transforming powder dressing for wound care

The transforming powder dressing (Altrazeal®, Uluru Inc, Addison, TX, USA) is simple to use, painless to apply and has a wear time of up to 30 days. This study aims to review the current literature to elucidate the impact of transforming powder dressing on healing, pain management and overall patient outcomes. We conducted a systematic review following Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines. Data including study characteristics, patient demographics and wound outcomes were extracted. Our systematic review included 26 articles (n = 175). Of these articles, 13 (50%) were case reports, 10 (38.5%) were case series, 2 (7.7%) were randomised controlled trials and 1 (3.8%) was a cohort study. Wound types included venous ulcer (23.9%), pressure sore (19.7%), burn (15.5%), skin graft (13.4%), diabetic foot ulcer (4.2%), Mohs defect (3.5%) and other (19.6%). Complete re-epithelialization occurred in 90.1% of the wounds. A total of 19 studies (73%) discussed pain, each of which reported reduced pain with the use of transforming powder dressing. The evaluated studies collectively suggest that transforming powder dressing offers a promising re-epithelialization rate and analgesic effect across various wound types.

Clinical characteristics, treatment and efficacy of calcaneal osteomyelitis: A systematic review with synthesis analysis 1118 reported cases

BACKGROUND

Calcaneal osteomyelitis (CO) still poses great challenges to orthopaedic surgeons due to unique anatomic and functional features of the calcaneus. This study summarized the current data regarding clinical characteristics, treatment and efficacy of CO, based on an analysis of literature-reported cases.

MATERIALS AND METHODS

We searched the PubMed, Embase, and Cochrane Library databases to find English and Chinese studies reporting on CO patients between 2000 and 2021, with available data for synthesis analysis. The quality of the included studies was evaluated by the National Institutes of Health (NIH) assessment scale. Effective data were extracted and pooled for analysis.

RESULTS

Altogether 198 studies involving 1118 patients were included, with a male-to-female ratio of 2.3 (724 males and 310 females). The median age at CO diagnosis was 46 years, with a median symptom duration of 3 months. Injury-related infections (524 cases) and diabetic foot infections (336 cases) were the two most common causes, with ulcer (468 cases) and wound sinus or exudation (209 cases) being the predominant symptoms. The overall positive culture rate was 80.2%, with polymicrobial infections accounting for 18.1%. Staphylococcus aureus was the most frequently detected pathogen (42.7%), with fungal-related infections isolated in 17 cases. Although most patients received surgical interventions (96.9%), the recurrence rate was 20.1%. The incidence of infection relapse following partial calcanectomy, total calcanectomy, debridement with implantation of local antibiotics, and debridement with or without flap or skin coverage were 31.7%, 45.0%, 16.8%, and 15.1%, respectively. The overall incidence of limb amputation was 12.4%, with all-cause and CO-related mortalities of 2.8% and 0.2%, separately.

CONCLUSIONS

CO shared similar characteristics with extremity chronic osteomyelitis, primarily affecting young males, with trauma and diabetic foot as the leading causes and Staphylococcus aureus as the most frequently detected pathogen. Despite surgery being the primary treatment modality, clinical outcomes remained unsatisfactory, marked by high rates of infection recurrence and limb amputation.

Evaluation of Altrazeal transforming powder dressing on stage 2-4 pressure ulcers: a clinical case series

OBJECTIVE

Pressure ulcers (PUs) are hard-to-heal, open wounds that affect millions of adults worldwide. Patients experience physical, mental, social and financial impairment. On average, <50% of stage 3 and 4 PUs heal by the sixth month. Treatment of PUs is highly variable due to a patient's comorbidities, demographics and wound characteristics. Because of this, there exists no standard dressing for PUs. Altrazeal transforming powder dressing (TPD, Uluru Inc., US) offers a promising new form of wound treatment; however, little evidence exists for TPD in the treatment of hard-to-heal PUs. This case series sought to examine the effect of TPD in hard-to-heal PUs that have previously undergone unsuccessful standard of care (SoC) wound therapy.

METHODS

This case series used retrospective data from patients with stage 2-4 PUs that failed to heal after SoC therapies. Factors examined were: number of dressing changes; time between dressing changes; time to wound closure; and pain level. While data were assessed for all patients, we focused on the six particular cases that most clearly illustrated the effect of TPD on wound healing.

RESULTS

Each of the 21 patients treated with TPD experienced successful and expedited wound closure. Stage 4 PUs took an average of 87 days with approximately six dressing changes to closure. Stage 3 PUs took an average of 41 days with approximately four dressing changes, and stage 2 PUs an average of 13 days to closure with approximately one dressing change. In the cases presented herein for which pain scores were reported, each showed a reduction in pain from an 8 or 9/10 to a 1 or 2/10 with the first dressing change.

CONCLUSION

In this case series, TPD effectively reduced pain and healed PUs that had previously failed SoC interventions. We suggest future prospective studies in order to more effectively measure the wound healing capability and healthcare utilisation of TPD for treatment of PUs.