Terri Shih1  · Sarah Park1  · Linnea R. Thorlacius2,3 · Steven Daveluy4  · Amit Garg5  · Susanne D. Goegji6  · Joslyn S. Kirby7  · Barry M. McGrath8  · Peter T. Riis2  · Bente Villumsen9  · Kari Zalik10 · Gregor B. E. Jemec2,11 · Jennifer L. Hsiao12

Received: 16 July 2022 / Revised: 7 December 2022 / Accepted: 6 January 2023 © The Author(s) 2023

Abstract

Drainage from chronic wounds can significantly negatively impact a patient’s quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response.

Keywords Hidradenitis suppurativa · Wound · Drainage · Measure · Tool

Jennifer L. Hsiao

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1 David Gefen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

2 Department of Dermatology, Zealand University Hospital, Roskilde, Denmark

3 Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark

4 Department of Dermatology, Wayne State University, Detroit, MI, USA

5 Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA

6 Amsterdam, The Netherlands

7 Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

8 HS Ireland, County Clare, Ireland

9 Danish HS Patients’ Association, Copenhagen, Denmark

10 Toronto, Canada

11 Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark

12 Department of Dermatology, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174, USA

M. L. V. Sai Krishna1 iD· Santanu Kar1  iD · Raj Kumar1   · Hargovind Singh1  · Ravi Mittal1  iD· Vijay Kumar Digge1 iD

Received: 29 July 2022 / Accepted: 6 January 2023 / Published online: 3 February 2023

© Indian Orthopaedics Association 2023

Abstract

Introduction/Background Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease.

Methodology A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were “femoral head AVN”, “Conservative management”, and “Systematic Reviews”. The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria.

Results The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews.

Conclusion Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1–3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression.

Level of Clinical Evidence Systematic review.

Keywords Femoral head AVN · Conservative management · Bisphosphonates · ESWT · PEMF · HBOT · Systematic review

Vijay Kumar Digge 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

M. L. V. Sai Krishna 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

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1 Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India

Jonathan Johnson1  · Alton R. Johnson Jr.2  · Charles A. Andersen3  · Martha R. Kelso4  · Alisha R. Oropallo5  · Thomas E. Serena6 iD

Received: 4 November 2022 / Revised: 22 March 2023 / Accepted: 31 March 2023

© The Author(s) 2023

Abstract

      Underrepresentation of diverse skin tones in medical education and providers’ implicit racial bias drives inequities in wound care, such as disproportionally poor outcomes for Black patients. Diagnostic indicators (e.g., erythema) can present differently depending on skin pigmentation. This post hoc analysis of 350 chronic wounds from a prospective 14-site clinical trial aimed to determine how the perception of clinical signs and symptoms of infection (CSS) differs by patient skin tone and if fluorescence-imaging can offer a more objective diagnostic solution. Participants were grouped by skin tone (low,

medium, high) as measured by the Fitzpatrick Skin Phototype Classification (FSPC) scale. CSS and total bacterial load

(TBL) were compared across FSPC groups, along with sensitivity to detect TBL >104 CFU/g using CSS alone and combined

with fluorescence-imaging. Erythema was reported less often with increasing FSPC score (p = 0.05), from 13.4% (low),

to 7.2% (medium), to 2.3% (high), despite comparable bacterial loads (median = 1.8 × 106 CFU/g). CSS sensitivity in the

high group (2.9%) was 4.8-fold to 8.4-fold lower than the low (p = 0.003) and medium groups (p = 0.04). Fluorescenceimaging significantly improved the detection of high bacterial load in each group, peaking in the high group at 12-fold

over CSS alone. These findings underscore the threat of pervasive racialized health inequities in wound care, where missed

diagnosis of pathogenic bacteria and infection could delay treatment, increasing the risk of complications and poor outcomes.

Fluorescence-imaging is poised to fill this gap, at least in part, serving as a more objective and equitable indicator of wound bacteria. Clinicaltrials.gov#NCT03540004 registered 16-05-2018.

Keywords Bacterial load · Erythema · Fluorescence imaging · Infection · Medical education · Skin pigmentation

Thomas E. Serena

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1 Comprehensive Wound Care Services and Capital Aesthetic & Laser Center, Washington, DC, USA

2 University of Michigan School of Medicine in the Division of Metabolism, Endocrinology and Diabetes-Podiatry, Ann Arbor, MI, USA

3 Madigan Army Medical Center Joint Base Lewis-McChord, Tacoma, WA, USA

4 Wound Care Plus LLC, Blue Springs, MO, USA

5 Comprehensive Wound Healing Center and Hyperbarics, Northwell Health and Department of Vascular Surgery, Zucker School of Medicine Hofstra/Northwell, Hempstead, NY, USA

6 SerenaGroup Research Foundation, Cambridge, MA, USA