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Clinical Management and Outcomes in Wound Healing
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Clinical Management and Outcomes in Wound Healing

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 6900

Special Issue Editor

Dr. Carlotta Scarpa

E-Mail Website
Guest Editor
Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University Hospital of Padova, 35131 Padova, Italy
Interests: skin ulcers; negative pressure wound therapy; advanced dressings; dermal matrices; physical therapies

Special Issue Information

Dear Colleagues,

Although initially focused on burn patients, in recent years, wound healing has become an increasingly pressing challenge due to the increase in cases of so-called ulcerative pathologies, which we could define as a silent epidemic.

Nowadays, in order to achieve the best possible wound healing, we have to overcome many challenges by incorporating new techologies, advanced dressings, surgical therapies, dermal matrices, and regenerative medicine.

In this Special Issue, we aim to present innovative studies in the field of wound healing, in order to create a new strategy for the treatment of acute and chronic wounds both in adults and in children.

Dr. Carlotta Scarpa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute wounds
  • chronic wounds
  • burns
  • pressure ulcers, regenerative medicine

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Published Papers (6 papers)

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Research

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13 pages, 11493 KiB  
Article
Implementation of Aseptically Processed Human Placental Membrane Allografts Within a Comprehensive Sternal Wound Closure Strategy: A Three-Phase Experience
by Zain Khalpey, Ujjawal Aditya Kumar, Pamela Hitscherich, Zacharya Khalpey, Tyler Phillips, Evangelia Chnari and Marc Long
J. Clin. Med. 2025, 14(6), 1877; https://doi.org/10.3390/jcm14061877 - 11 Mar 2025
Viewed by 717
Abstract
Background: Sternal wound complications following median sternotomy result in poor outcomes. Novel approaches such as placental allografts are being explored to optimize wound closure. Methods: This study evaluated consecutive patients undergoing median sternotomy by a single surgeon as sternal closure strategies evolved. Initially, [...] Read more.
Background: Sternal wound complications following median sternotomy result in poor outcomes. Novel approaches such as placental allografts are being explored to optimize wound closure. Methods: This study evaluated consecutive patients undergoing median sternotomy by a single surgeon as sternal closure strategies evolved. Initially, wires with autologous platelet-rich plasma (PRP) were used (Group 1). Subsequently, suture tapes with PRP and an aseptically processed amnion–chorion placental allograft (aACPA) were added (Group 2). Finally, PRP was discontinued (Group 3). Sternal infection, dehiscence, pain outcomes, hospital length of stay, and patient risk factors were analyzed. Results: Compared to Group 1, Groups 2 and 3 demonstrated significantly lower infection (0.7%, 0% vs. 9.3%, p = 0.0001) and dehiscence rates (0%, 0% vs. 8.7%, p < 0.0001). Significant postoperative pain at two weeks decreased from Group 1 to Groups 2 and 3 (18.7%, 4.7%, 3.1%, p < 0.0001), with similar improvements at one month (12.0%, 2.0%, 1.5%, p = 0.0005). Despite higher median risk factors in Group 3 than in Groups 1 and 2 (3 vs. 2, 2, p = 0.0305), a trend toward reduced hospital stay was observed (6 vs. 8, 7 days, p = 0.2298). Conclusions: Adding aACPA to sternal closure significantly reduced infections, dehiscence, and pain in high-risk cardiac surgery patients, with sustained benefits and no increase in operative times. These findings highlight aACPA’s potential to mitigate sternal complications, warranting further study in larger cohorts. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)
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Graphical abstract

18 pages, 3980 KiB  
Article
Nutritional Status in a Group of Patients with Wounds Due to Diabetic Foot Disease and Chronic Venous Insufficiency
by Mateusz Skórka, Dariusz Bazaliński, Paweł Więch, Stanisław Kłęk, Dorota Kozieł and Regina Sierżantowicz
J. Clin. Med. 2025, 14(1), 43; https://doi.org/10.3390/jcm14010043 - 25 Dec 2024
Viewed by 1193
Abstract
Background: Wound healing is a complex physiological process that begins immediately upon injury. Nutritional status significantly affects the course of regenerative processes. Malnutrition can prolong the inflammatory phase, limit collagen synthesis, and increase the risk of new wound formation. The issue of malnutrition [...] Read more.
Background: Wound healing is a complex physiological process that begins immediately upon injury. Nutritional status significantly affects the course of regenerative processes. Malnutrition can prolong the inflammatory phase, limit collagen synthesis, and increase the risk of new wound formation. The issue of malnutrition is becoming increasingly prevalent and remains a significant concern, particularly among older adults dealing with chronic conditions. Methods: The study was conducted at the Wound Treatment Clinic of the Specialist Hospital at the Podkarpackie Oncology Center in Brzozów, Poland, over 12 months (31 December 2022 to 31 December 2023). A prospective assessment was carried out on 106 patients with chronic wounds. The sample selection was purposeful, based on the following criteria: individuals with hard-to-heal vascular wounds related to diabetic foot disease or venous insufficiency, who provided informed consent to participate after reviewing the study concept. The assessment included a questionnaire and biochemical blood analysis. Further evaluations covered wound characteristics and classification based on clinical scales. The morphotic and biochemical blood parameter assessment included albumin concentration, hemoglobin, C-reactive protein (CRP), and the nutritional risk index (NRI). Results: A larger wound area was associated with lower morphotic values in both groups. Exudate levels and severity in chronic venous insufficiency (CVI) patients and diabetic foot disease (DFD) were associated with lower hemoglobin, albumin, and NRI values. At the same time, the depth of tissue structure damage correlated with the measured biochemical parameters. Conclusions: NRI values and morphotic blood parameters, along with albumin, hemoglobin, and CRP levels, are closely associated with wound characteristics, including surface area, exudate level, and the severity of tissue destruction. The greater the destruction of tissue structures, the higher the risk of malnutrition and wound infection, as indicated by biochemical assessment. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)
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11 pages, 408 KiB  
Article
Characteristics of Helicopter Emergency Medical Services (HEMS) Interventions for Burn Patients—A Four-Year Retrospective Analysis
by Arkadiusz Wejnarski, Piotr Konrad Leszczyński, Maja Biadun, Maria Malm, Kryspin Mitura, Daryna Sholokhova, Patryk Rzońca, Robert Gałązkowski and Leszek Marzec
J. Clin. Med. 2024, 13(24), 7738; https://doi.org/10.3390/jcm13247738 - 18 Dec 2024
Viewed by 871
Abstract
Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to [...] Read more.
Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to outline the profile of the burn patient from the perspective of the Polish Medical Air Rescue (PMAR), as well as to analyze the medical procedures being implemented. Methods: The study includes 2154 interventions by air emergency medical teams (AEMS) which provided aid for burn patients. The analysis covered the period from 2018 to 2022, including nationwide data made available from the IT systems of the PMAR. Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05. Results: Patients’ ages ranged from 1 month to 96 years (mean 35.05; SD ± 26.88). Adult patients (n = 1409; 65.41%) constituted the vast majority. The number of interventions to children below 1-year-old was noticeable (n = 394; 18.29%). Men were the most likely to suffer burns, up to three times more often than women (n = 1574, 73.07% vs. n = 570, 26.46%. T29—burns to multiple body areas (n = 890)—and T21—burns to the trunk (n = 255)—were most frequently reported as diagnoses according to the ICD-10 classification. A statistically significant association was found between age group and ICD-10 diagnosis (p < 0.001). The vast majority of patients were transported from the scene directly to Burn Treatment Centers (n = 1373; 63.74%). Treatment of pain by helicopter emergency medical services (HEMS) crews appeared to be effective (p < 0.001), and other interventions consisted of administering medications—ketamine (23.72%), rocuronium bromide (15.78%), propofol (14.02%)—and procedures such as sedation (30.87%), as well as intubation (13.42%) and mechanical ventilation (13.23%). Conclusions: The burn patient profile indicates men with a mean age of 35 years. Nevertheless, HEMS crews often carry out missions to infants and newborns. The most common diagnosis was extensive body burns. In 63.74% of the missions, patients were transported to the Burn Treatment Center. The HEMS crews implement effective pharmacological analgesia, and handle rescue medications and procedures to stabilize the patient’s condition. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)
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Review

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17 pages, 285 KiB  
Review
Maggots in Medicine: A Narrative Review Discussing the Barriers to Maggot Debridement Therapy and Its Utilisation in the Treatment of Chronic Wounds
by Zoe Mumford and Yamni Nigam
J. Clin. Med. 2024, 13(22), 6746; https://doi.org/10.3390/jcm13226746 - 9 Nov 2024
Cited by 1 | Viewed by 2571
Abstract
Background: There is currently no standardised guidance that supports any particular method of debridement. Maggot debridement therapy (MDT) is often used as a last-resort therapy over more conventional treatments, despite mounting evidence of its benefits. Objectives: This review aimed to critically [...] Read more.
Background: There is currently no standardised guidance that supports any particular method of debridement. Maggot debridement therapy (MDT) is often used as a last-resort therapy over more conventional treatments, despite mounting evidence of its benefits. Objectives: This review aimed to critically analyse the systemic and individual barriers to MDT implementation and utilisation. As the primary providers of wound care, discussions are primarily focused on nursing care. Search strategy: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct a literature search of the studies published between 2012 and 2022 across four databases: CINAHL, Cochrane, British Nursing Index and PubMed. The keywords used for this search were based on the PICO (Population, Intervention, Comparison, Outcome) framework. Twenty-three main articles met the inclusion criteria. All the studies were quality appraised using a risk of bias tool and data were extracted using a predesigned form. The evidence base of the four main themes were discussed: (1) effectiveness of MDT compared to conventional treatments, (2) perceptions and stigma, (3) cost, training and accessibility and (4) side-effects. Conclusions: The findings of this review suggest that MDT is an underused and potentially very effective method of debridement compared to conventional treatments. The identified barriers could be mitigated with relatively low-cost solutions. More high-quality research is needed across all the barriers. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)

Other

Jump to: Research, Review

13 pages, 1788 KiB  
Systematic Review
Reducing Infections and Improving Healing in Complex Wounds: A Systematic Review and Meta-Analysis
by María Juana Millán-Reyes, Diego Fernando Afanador-Restrepo, María del Carmen Carcelén-Fraile, Agustín Aibar-Almazán, Marcelina Sánchez-Alcalá, Javier Cano-Sánchez, María Aurora Mesas-Aróstegui and Yolanda Castellote-Caballero
J. Clin. Med. 2025, 14(9), 3237; https://doi.org/10.3390/jcm14093237 - 7 May 2025
Viewed by 481
Abstract
Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative [...] Read more.
Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)
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18 pages, 3588 KiB  
Systematic Review
The Use of Integra Dermal Regeneration Template in Exposed Bone Reconstruction: A Case Report with Systematic Literature Review
by Marko S. Jović, Branko J. Suđecki, Ivan Ljubiša Radosavljević, Milan D. Jovanović, Milan T. Stojičić, Jelena D. Isaković Subotić, Nataša D. Nejković, Zorka M. Inić, Marina M. Stojanović and Jelena V. Jeremić
J. Clin. Med. 2025, 14(9), 2971; https://doi.org/10.3390/jcm14092971 - 25 Apr 2025
Viewed by 537
Abstract
Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well [...] Read more.
Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well as the surgical methods involved. Methods: A systematic review was conducted to identify studies using IDRT in the reconstruction of defects with exposed bone devoid of periosteum. Primary outcomes of interest were IDRT and skin graft success rates, followed by patient and wound characteristics, and different surgical methods used. The results were accompanied by an illustrative case report of IDRT-based hand reconstruction after a deep burn injury. Results: The review included 40 studies, with a total of 202 individual defects. The primary indication for IDRT-based reconstruction was post-oncologic defects in the elderly population. Although surgeons mostly used burring/fenestration as a bone preparation method prior to IDRT placement, decorticated bones showed faster grafting time (23.8 vs. 27.9 days). The average success rate of IDRT was 87.54% (±25.9), with an excellent IDRT take rate (100%) observed in more than 50% of cases. In the majority of cases (95.5%), the skin graft acceptance rate was deemed to be higher than 95%, with an average graft take of 98.8%. Conclusions: The results of this review support the use of IDRT in managing complex defects involving exposed bone, offering fast coverage with good functional restoration, without any donor site morbidity. Additionally, bone preparation methods also play an important role in IDRT-based reconstruction by shortening the grafting time. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)
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