Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care.

Orthopaedic trauma care frequently necessitates prompt and precise assessment of musculoskeletal injuries and wound depth. The potential for improved diagnostic accuracy and patient outcomes exists with the integration of sophisticated imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) with focused assessment with sonography for trauma (FAST). The purpose of this research was to examine the benefits and drawbacks of this integrative method in the clinical environment. From June 2022 to September 2023, 250 patients who were admitted to Ningbo University Affiliated People's Hospital, participated in this cross-sectional observational study. Following the administration of FAST, CT and MRI were utilized to evaluate orthopaedic injuries and skin wounds in patients. Analyses of data centred on the precision of diagnoses, the influence of treatment decisions and patient outcomes. Aged and gendered differently, the study participants sustained the variety of injuries and superficial wounds that were predominantly the result of traffic accidents. The FAST assay exhibited sensitivity of 65%, specificity of 80% and 72% overall accuracy. MRI demonstrated the finest diagnostic performance (85% sensitivity, 95% specificity and 89% accuracy), whereas CT scans offered improved diagnostic efficacy (80% sensitivity, 90% specificity and 84% accuracy). Treatment decisions were substantially impacted by integration of these imaging modalities, resulting in modifications in 20%-35% of cases, depending on the specific modality employed. Specifically, MRI played a pivotal role in informing treatment approaches, influencing non-surgical as well as surgical procedures. This study substantiates the significant advantages of integrating FAST with CT and MRI in orthopaedic trauma care, particularly in the accurate assessment of wound depth. The synergistic use of these imaging techniques not only enhances diagnostic precision but also positively impacts treatment strategies and patient outcomes, emphasizing the need for a comprehensive diagnostic approach in trauma care settings.

Three wound types: common challenges with exudate, gaps and anatomical positioning.

Complex wounds require combinations of technologies and regimes to match laboratory tests and address challenges of physiological processes, body contours, movement and ease of use during life-long self-management. Wound management for vascular and lymphatic disorders incorporate wound dressings, skin care and compression to address local wound needs and underlying pathologies, while allowing functionality for movement. In a similar manner, acute inflammatory conditions that become chronic require skin care and local conformable and absorbent wound management, but with simple, atraumatic retention methods without compression. Three types of conditions will be discussed in this article-venous leg ulcers with chronic oedema (VLU), hidradenitis suppurativa (HS) and pilonidal sinuses (PS). It focuses on overcoming challenges associated with excess exudate, compromised skin, dressing awkward areas and contours, while also demonstrating wound care similarities when administered by patients themselves.

Risk factors for amputation in patients with diabetic foot infection: a prospective study.

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well-known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.

Mesenchymal stem cells derivatives as a novel and potential therapeutic approach to treat diabetic foot ulcers.

SUMMARY: Diabetic foot ulcer morbidity and mortality are dramatically increasing worldwide, reinforcing the urgency to propose more effective interventions to treat such a devastating condition. Previously, using a diabetic mouse model, we demonstrated that administration of bone marrow mesenchymal stem cells derivatives is more effective than the use of bone marrow mesenchymal stem cells alone. Here, we used the aforementioned treatments on three patients with grade 2 diabetic foot ulcers and assessed their beneficial effects, relative to the conventional approach. In the present study, two doses of cell derivatives, one dose of mesenchymal stem cells or one dose of vehicle (saline solution with 5% of human albumin), were intradermally injected around wounds. Wound healing process and changes on re-epithelialization were macroscopically evaluated until complete closure of the ulcers. All ulcers were simultaneously treated with conventional treatment (PolyMen® dressing). Patients treated with either cell derivatives or mesenchymal stem cells achieved higher percentages of wound closure in shorter times, relative to the patient treated with the conventional treatment. The cell derivative and mesenchymal stem cells approaches resulted in complete wound closure and enhanced skin regeneration at some point between days 35 and 42, although no differences between these two treatments were observed. Moreover, wounds treated with the conventional treatment healed after 161 days. Intradermal administration of cell derivatives improved wound healing to a similar extent as mesenchymal stem cells. Thus, our results suggest that mesenchymal stem cell derivatives may serve as a novel and potential therapeutic approach to treat diabetic foot ulcers. LEARNING POINTS: In diabetic mouse models, the administration of mesenchymal stem cells derivatives have been demonstrated to be more effective than the use of marrow mesenchymal stem cells alone. Mesenchymal stem cells have been explored as an attractive therapeutic option to treat non-healing ulcers. Mesenchymal stem cells derivatives accelerate the re-epithelialization on diabetic foot ulcers.

Fine-grained diabetic wound depth and granulation tissue amount assessment using bilinear convolutional neural network.

Diabetes mellitus is a serious chronic disease that affects millions of people worldwide. In patients with diabetes, ulcers occur frequently and heal slowly. Grading and staging of diabetic ulcers is the first step of effective treatment and wound depth and granulation tissue amount are two important indicators of wound healing progress. However, wound depths and granulation tissue amount of different severities can visually appear quite similar, making accurate machine learning classification challenging. In this paper, we innovatively adopted the fine-grained classification idea for diabetic wound grading by using a Bilinear CNN (Bi-CNN) architecture to deal with highly similar images of five grades. Wound area extraction, sharpening, resizing and augmentation were used to pre-process images before being input to the Bi-CNN. Innovative modifications of the generic Bi-CNN network architecture are explored to improve its performance. Our research generated a valuable wound dataset. In collaboration with wound experts from University of Massachusetts Medical School, we collected a diabetic wound dataset of 1639 images and annotated them with wound depth and granulation tissue grades as labels for classification. Deep learning experiments were conducted using holdout validation on this diabetic wound dataset. Comparisons with widely used CNN classification architectures demonstrated that our Bi-CNN fine-grained classification approach outperformed prior work for the task of grading diabetic wounds.

Evaluation of haemoglobin in blister fluid as an indicator of paediatric burn wound depth.

The early and accurate assessment of burns is essential to inform patient treatment regimens; however, this first critical step in clinical practice remains a challenge for specialist burns clinicians worldwide. In this regard, protein biomarkers are a potential adjunct diagnostic tool to assist experienced clinical judgement. Free circulating haemoglobin has previously shown some promise as an indicator of burn depth in a murine animal model. Using blister fluid collected from paediatric burn patients, haemoglobin abundance was measured using semi-quantitative Western blot and immunoassays. Although a trend was observed in which haemoglobin abundance increased with burn wound severity, several patient samples deviated significantly from this trend. Further, it was found that haemoglobin concentration decreased significantly when whole cells, cell debris and fibrinous matrix was removed from the blister fluid by centrifugation; although the relationship to depth was still present. Statistical analyses showed that haemoglobin abundance in the fluid was more strongly related to the time between injury and sample collection and the time taken for spontaneous re-epithelialisation. We hypothesise that prolonged exposure to the blister fluid microenvironment may result in an increased haemoglobin abundance due to erythrocyte lysis, and delayed wound healing.