Nafad Mohammad Elhadidi is Consultant General and Vascular Surgeon, General Surgery Department, Zulekha Hospital Sharjah, Al Zahra Street Al Nasserya, Sharjah, United Arab Emirates;

Ahmed Ramadan Wahdan is General Surgery Specialist, Department of Surgery, Al Hammadi Hospital – Al Olaya, Riyadh, Saudi Arabia; Mohamed Abouzeid

Ahmed Gaballa Ali is General Surgery Consultant, Diabetic Foot and Chronic Wounds care unit, Exir Subspecialities Medical Centre, Jahra, Kuwait

      The Arabian Gulf region has seen an increasing rise in diabetic foot ulcers (DFUs) with prevalence ranging from 4.7% to 19% in Saudi Arabia (Hu et al, 2014; Mairghani et al, 2017). Current practices for standard of care include wound debridement, wound offloading and dressings. The authors successfully managed diabetic foot ulcers with oxygen free-radical binding technology as an adjuvant therapy for our patients. HemaGel® (VH Pharma), a hydrophilic gel, contains sterically hindered amines that bind with reactive oxygen species (ROS) and thereby accelerates wound healing by showing an anti-inflammatory effect. The three case reports in this article discuss the use of targeted oxygen free radicals to promote wound healing by oxidant/antioxidant disequilibrium methodology in the authors’ patients. With supporting diabetes controlling medications and HemaGel, wound healing was achieved successfully in these patients.

Authors (clockwise from top left): Naser Alhumaidi, Mariam Alessa, Abdul Aziz Alshahe and Emilio Galea

Naser Alhumaidi is Senior Specialist in General Surgery, Head of Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Mariam Alessa is Diabetes Specialist Podiatrist, Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Abdul Aziz Alshaheen is General Practitioner Surgery, Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Emilio Galea is International Medical Director, Urgo Medical

Chronic wounds are an international and regional concern affecting many patients, demanding substantial resources from healthcare systems. Managing patients with these wounds is costly in terms of time and resources required, not forgetting the detrimental impact on the quality of life of these individuals. Moreover, diabetic foot problems are very common throughout the world, and their recurrence is high. In 2016, the World Health Organization (WHO, 2022)reported that 14.7% of the population of Kuwait are suffering from diabetes, with very high percentages of overweight, obese and inactive individuals. It is inevitable that many of these individuals suffer and/or will suffer in the future from diabetes-related foot ulcers and complications, and the management of these wounds is complex. The authors reviewed the evidence behind a local treatment indicated for chronic wounds and specific in neuropathic diabetic foot ulcers. In view of the high level of evidence regarding this local treatment, a pilot study was conducted in 2021 to analyse the feasibility of a larger-scale observational study. The article highlights the results of the initial pilot and discusses the feasibility of conducting further research to justify implementation of technology lipido-colloid nano oligosaccharide factor(TLC-NOSF) dressings in the local management of patients with diabetic foot ulcers in Kuwait.

Authors: Rhidian Morgan-Jones (Chair), Amit Gefen and Kylie Sandy-Hodgett

Rhidian Morgan-Jones (Chair) is Consultant Orthopaedic Surgeon, Cardiff Knee Clinic, University Hospital Llandough, Cardiff, UK; Amit Gefen is Professor of Biomedical Engineering and the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Kylie Sandy-Hodgetts is Associate Professor, Centre of Molecular Medicine & Innovative Therapeutics, Murdoch University; Senior Research Fellow, Director Skin Integrity Research Institute, School of Biomedical Sciences, University of Western Australia, Perth, Australia

      This meeting report is based on the Mölnlycke-sponsored workshop held at the sixth World Union of Wound Healing Societies (WUWHS) Congress on March 1–5, 2022, in Abu Dhabi, United Arab Emirates. The workshop, titled ‘Surgical incision care — negative pressure wound therapy and advanced dressings: what to use and when’, included presentations from Kylie SandyHodgetts, Rhidian Morgan-Jones and Amit Gefen. The topics of surgical dressings, risk assessment and requirements of closed-incision negative pressure wound therapy (ciNPWT) were all explored.

Authors: Harikrishna KR Nair, Sylvia SY Chong, Mohd Hasbullah Bin Husain

 Abstact: Negative pressure wound therapy (NPWT), is a wound dressing system that continuously or intermittently applies subatmospheric pressure to the surface of the wound, and provides a positive pressure to the surface of the wound to aid healing. The aim of this study was to assess the healing of chronic wounds treated by single-use NPWT. Study participants were selected by simple random sampling from a pool of patients who were attending their routine follow-up visits in Wound Care Unit in Hospital Kuala Lumpur. During each dressing change, the wound was assessed and cleansed with distilled water. Debridement was performed as necessary. The application of NPWT was a simple 3-steps procedure, removing the release paper from the dressing and positioning it over the wound bed, connecting the tubing from the pump to the dressing and providing negative pressure treatment through the swing. There were five patients with chronic wounds of various size and aetiologies, including a two pressure ulcers/injury (PU), two carbuncles and post-motor-vehicle accident wound, enrolled in the study, all showed complete wound healing. The two abscesses healed on week 6 and 8 with the single use NPWT and the traumatic wound healed in 10 weeks. Both the sacral and gluteal PUs healed on week 28 and week 14. Case 3, the gluteal PU, healed at week 14 due to the good standard of care, 2-hourly repositioning, proper support surface and good nutritional diet. Meanwhile, the sacral PU took double the time i.e. 28 weeks as the wound area is larger and poor adherence to standard of care. NPWT pressure between −75 and −125mmHg would provide moist environment that is suitable for wound healing. It aids healing by improving the rate of angiogenesis, endothelial proliferation, capillary blood flow, reducing oedema and bacterial burden within the wound. The limitation of this study was the small number of patients and might not represent the population at large. A much larger study would be needed to show the significance of these findings.

Key words: ■ Chronic wounds ■ Negative pressure wound therapy (NPWT) ■ Pressure ulcer ■ Wound healing