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The Rise of Diagnostics in the Treatment of Chronic Wounds...
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The Rise of Diagnostics in the Treatment of Chronic Wounds 2.0

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 6415

Special Issue Editor

Dr. Thomas E. Serena

E-Mail Website
Guest Editor
SerenaGroup Research Foundation, Cambridge, MA, USA
Interests: chronic wound; diabetic foot ulcer; venous leg ulcer; bacterial burden; pressure ulcer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The specialty of chronic wound care, “woundology”, developed in the absence of diagnostics. The recent rise in diagnostic imaging techniques and biomarker detection will revolutionize the practice of wound care. Point-of-care techniques that identify bacterial virulence factors are under study. In addition, fluorescence imaging can detect bacterial load at the bedside. Devices that rapidly evaluate tissue oxygenation and perfusion will also play a role in evaluating chronic wounds. This issue presents new research and reviews the evidence for diagnostics in the burgeoning field of wound healing. 

Dr. Thomas E. Serena
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. Diagnostics 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.

Related Special Issue

Published Papers (4 papers)

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Research

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11 pages, 287 KiB  
Article
Pressure Ulcers—A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes
by Angelo Alito, Simona Portaro, Giulia Leonardi, Carlotta Ventimiglia, Francesco Bonanno, Domenico Fenga, Cristiano Sconza and Adriana Tisano
Diagnostics 2023, 13(20), 3213; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13203213 - 14 Oct 2023
Viewed by 1036
Abstract
Background: Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. Methods: A retrospective study was [...] Read more.
Background: Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. Methods: A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. Results: Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III–IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. Conclusion: The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01). Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds 2.0)
11 pages, 1397 KiB  
Communication
Antibiotic Misuse in Wound Care: Can Bacterial Localization through Fluorescence Imaging Help?
by Wayne J. Caputo, Patricia Monterosa and Donald Beggs
Diagnostics 2022, 12(12), 3207; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12123207 - 17 Dec 2022
Cited by 7 | Viewed by 1620
Abstract
(1) Background: Systemic antibiotic use in chronic wounds is alarmingly high worldwide. Between 53% to 71% of patients are prescribed at least one course per chronic wound. Systemic antibiotic use should follow antibiotic stewardship guidelines and ought to be reserved for situations where [...] Read more.
(1) Background: Systemic antibiotic use in chronic wounds is alarmingly high worldwide. Between 53% to 71% of patients are prescribed at least one course per chronic wound. Systemic antibiotic use should follow antibiotic stewardship guidelines and ought to be reserved for situations where their use is deemed supported by clinical indications. Unfortunately, in the field of wound care, indiscriminate and often inadequate use of systemic antibiotics is leading to both patient complications and worsening antibiotic resistance rates. Implementing novel tools that help clinicians prevent misuse or objectively determine the true need for systemic antibiotics is essential to reduce prescribing rates. (2) Methods: We present a compendium of available systemic antibiotic prescription rates in chronic wounds. The impact of various strategies used to improve these rates, as well as preliminary data on the impact of implementing fluorescence imaging technology to finesse wound status diagnosis, are presented. (3) Results: Interventions including feedback from wound care surveillance and treatment data registries as well as better diagnostic strategies can ameliorate antibiotic misuse. (4) Conclusions: Interventions that mitigate unnecessary antibiotic use are needed. Effective strategies include those that raise awareness of antibiotic overprescribing and those that enhance diagnosis of infection, such as fluorescence imaging. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds 2.0)
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Review

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23 pages, 3518 KiB  
Review
A Host-Directed Approach to the Detection of Infection in Hard-to-Heal Wounds
by Michael Burnet, Daniel G. Metcalf, Scarlet Milo, Clemens Gamerith, Andrea Heinzle, Eva Sigl, Kornelia Eitel, Marieke Haalboom and Philip G. Bowler
Diagnostics 2022, 12(10), 2408; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102408 - 04 Oct 2022
Cited by 1 | Viewed by 1908
Abstract
Wound infection is traditionally defined primarily by visual clinical signs, and secondarily by microbiological analysis of wound samples. However, these approaches have serious limitations in determining wound infection status, particularly in early phases or complex, chronic, hard-to-heal wounds. Early or predictive patient-derived biomarkers [...] Read more.
Wound infection is traditionally defined primarily by visual clinical signs, and secondarily by microbiological analysis of wound samples. However, these approaches have serious limitations in determining wound infection status, particularly in early phases or complex, chronic, hard-to-heal wounds. Early or predictive patient-derived biomarkers of wound infection would enable more timely and appropriate intervention. The observation that immune activation is one of the earliest responses to pathogen activity suggests that immune markers may indicate wound infection earlier and more reliably than by investigating potential pathogens themselves. One of the earliest immune responses is that of the innate immune cells (neutrophils) that are recruited to sites of infection by signals associated with cell damage. During acute infection, the neutrophils produce oxygen radicals and enzymes that either directly or indirectly destroy invading pathogens. These granular enzymes vary with cell type but include elastase, myeloperoxidase, lysozyme, and cathepsin G. Various clinical studies have demonstrated that collectively, these enzymes, are sensitive and reliable markers of both early-onset phases and established infections. The detection of innate immune cell enzymes in hard-to-heal wounds at point of care offers a new, simple, and effective approach to determining wound infection status and may offer significant advantages over uncertainties associated with clinical judgement, and the questionable value of wound microbiology. Additionally, by facilitating the detection of early wound infection, prompt, local wound hygiene interventions will likely enhance infection resolution and wound healing, reduce the requirement for systemic antibiotic therapy, and support antimicrobial stewardship initiatives in wound care. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds 2.0)
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Other

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11 pages, 807 KiB  
Systematic Review
Reference Probe for TcpO2 at Rest: A Systematic Review
by Judith Catella, Guillaume Mahé, Georges Leftheriotis and Anne Long
Diagnostics 2023, 13(1), 77; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13010077 - 27 Dec 2022
Viewed by 1030
Abstract
(1) Background: Transcutaneous oxygen pressure (TcpO2) is used to determine the severity of lower extremity arterial disease (LEAD). Many authors used a ratio of limb to chest TcpO2, also called the regional perfusion index (RPI), which should be independent [...] Read more.
(1) Background: Transcutaneous oxygen pressure (TcpO2) is used to determine the severity of lower extremity arterial disease (LEAD). Many authors used a ratio of limb to chest TcpO2, also called the regional perfusion index (RPI), which should be independent of variations in oxygen delivery and reflective of local limb oxygen supply. The relevance of a reference probe-positioned TcpO2 electrode is debated. We aimed to review the relevance of the reference probe in previous studies using rest TcpO2. (2) Methods: We searched Medline and the Cochrane Central Register of Controlled Trials on 22 September 2022 using keywords related to TcpO2, reference probe and LEAD. (3) Results/Discussion: Fifteen studies were included in the review. Nine studies investigated LEAD severity (n = 9), amputation healing predication (n = 4), surgical outcome prediction (n = 2), therapeutic effect (n = 3) and difference according to diabetic status (n = 1). Four studies investigated more than 1 indication. Among 12 (16.7%) studies using RPI, only two authors found a benefit of using RPI instead of absolute TcpO2. Using only univariate analysis, one author reported that RPI was significantly related to viability at 1 year, while distal TcpO2 was not, on 13 limbs. The following year, the same author published a new study including 118 limbs that reported that RPI and absolute TcPO2 were both prognostic factors for limb viability at 1 year using a multivariate model. (4) Conclusions: Only one study firmly supporting the use of RPI, calculated using a reference probe on the arm, to predict BKA healing. Prospective studies are needed to validate this result; for other indications there is insufficient data supporting the use of a TcpO2 reference probe at rest. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds 2.0)
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