Month: March 2026

Hyaluronic Acid-Based Gels and Biomaterial Systems for Oral Wound Healing: Design and Clinical Translation

Summary: Published March 22, 2026 in Gels (MDPI, Special Issue: Designing Gels for Wound Healing and Drug Delivery Systems), this narrative review from Grigore T. Popa University of Medicine and Pharmacy (Iași, Romania), led by Vlad Constantin and Ionut Luchian (corresponding author), with co-authors from multiple clinical and basic science departments, provides a comprehensive synthesis of hyaluronic acid (HA) biology, material design principles, and clinical performance evidence specifically within the oral wound healing context. While focused on oral and periodontal wounds, the biological and biomaterial principles covered are directly relevant to wound care clinicians managing non-healing wounds, skin grafts, and biomaterial-based dressing systems, as HA is one of the most widely investigated biomaterials across all wound healing applications. HA is a non-sulfated glycosaminoglycan and fundamental ECM component that plays critical roles in tissue hydration, cellular signalling, angiogenesis, inflammation modulation, and matrix remodelling throughout the four wound healing phases. Its biological behaviour is strongly molecular weight-dependent: high-molecular-weight HA (>1,000 kDa) exerts anti-inflammatory, anti-edematous, and protective/barrier effects, contributing to tissue homeostasis; low-molecular-weight HA fragments (<20 kDa) act as endogenous danger signals (DAMPs) activating innate immunity via TLR-4, and also promote cell migration, angiogenesis, and tissue remodelling. In oral wounds — complicated by salivary dilution, mechanical stress, microbial exposure, and enzymatic degradation — formulation design is critical. The review systematically covers: topical HA gels (0.1–0.8% concentration range; shear-thinning rheology essential for retention; salivary ionic composition affects gel viscosity and structural integrity); cross-linked HA hydrogels (BDDE, DVS, carbodiimide, and enzymatic cross-linking strategies; enhanced mechanical stability vs. reduced receptor accessibility trade-off; optimal degree of modification balances CD44/RHAMM receptor interaction with degradation resistance); and HA-based membranes and 3D scaffolds (fabricated by freeze-drying, electrospinning, or composite blending with collagen or chitosan; provide guided tissue regeneration, structural support, and bioactive modulation in periodontal and surgical contexts). Clinical evidence covers applications in post-extraction socket healing, periodontal flap surgery, peri-implant soft tissue management, and oral mucosal ulceration — with consistent findings of reduced postoperative pain, accelerated re-epithelialisation, and decreased edema in short-term follow-up. The review is candid about limitations: substantial heterogeneity in formulation parameters across clinical studies makes direct comparison impossible; most trials have small sample sizes and short follow-up; and few studies systematically correlate physicochemical properties with clinical outcomes. The authors call for well-designed multicenter RCTs with standardised HA formulations and harmonised outcome measures.

Key Highlights:

• Molecular weight-dependent biology: high-MW HA (>1,000 kDa) is anti-inflammatory and barrier-protective; low-MW HA fragments (<20 kDa) activate TLR-4 innate immune signalling, promote angiogenesis, and stimulate cell migration — size-dependent effects must inform formulation design for targeted wound healing applications
• Receptor signalling: HA exerts key wound healing effects via CD44 and RHAMM (Receptor for Hyaluronan-Mediated Motility) receptor interactions — regulating cytoskeletal organisation, cell migration, proliferation, and fibroblast-mediated ECM deposition; cross-linking density can mask receptor-interacting domains, reducing biological activity if over-engineered
• Formulation design imperatives for oral wounds: HA gels must exhibit shear-thinning (pseudoplastic) rheology; storage modulus (G′) must exceed loss modulus (G″) for structural retention against salivary washout; ionic composition of saliva (Na, Ca, phosphate) affects intermolecular charge screening and viscosity — requiring formulation-specific rheological optimisation
• Cross-linking strategy comparison: BDDE and DVS cross-linking provide superior mechanical stability but risk cytotoxicity at high concentrations and reduced CD44 accessibility; carbodiimide and enzymatic cross-linking offer improved biocompatibility with moderate stability; physical/self-assembly systems are safest but most susceptible to salivary dilution
• Clinical evidence summary: HA gels consistently reduce postoperative pain, edema, and inflammatory markers, and accelerate re-epithelialisation in periodontal surgery, extraction sockets, peri-implant procedures, and mucosal ulceration — with best evidence in short-term applications; long-term data and standardised RCT evidence remain limited
• Transferability to general wound care: the biological principles and formulation design challenges described — MW-dependent effects, cross-linking optimisation, receptor-mediated signalling, hydrogel rheology — are directly applicable to HA-based dressings used in non-oral chronic wounds including venous ulcers, DFUs, and post-surgical wounds

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Keywords: hyaluronic acid wound healing, HA gel wound dressing design, hyaluronan biomaterial tissue repair, cross-linked hydrogel wound healing, CD44 wound healing ECM, extracellular matrix wound repair

Vlad Constantin, Ionut Luchian, Dragos Ioan Virvescu, Mihaela Scurtu, Nicoleta Tofan, Dan Nicolae Bosinceanu, Elena Raluca Baciu, Carina Balcos, Monica Mihaela Scutariu, Dana Gabriela Budala

Prediction of Diabetes Among Homeless Adults Using Artificial Intelligence: Suggested Recommendations

Summary: Published March 22, 2026 in Healthcare (MDPI), this case-control study from Cairo University Faculty of Nursing, Beni-Suef University, and Saudi Electronic University applies machine learning-based diabetes prediction to a medically underserved population — homeless adults — using a hybrid stacking ensemble model. Led by Khadraa Mohamed Mousa and Manal Mohamed Elsawy (Community Health Nursing, Cairo University), the study enrolled 150 homeless adults at the Ma’ana Rescue Human Foundation (Giza, Egypt), including 99 confirmed diabetic cases (FBS ≥ 126 mg/dL or prior diagnosis) and 51 non-diabetic controls. Structured interviews collected demographic data, medical history, 15-item lifestyle questionnaire, and 7-item diabetes knowledge assessment; physiological measurements included weight, height, BMI, waist circumference, triceps skinfold thickness (TSF), fasting blood sugar, and blood pressure. From 43 initial variables, recursive feature elimination and correlation analysis reduced the predictor set to 13 variables: BMI, systolic blood pressure, triceps skinfold thickness, waist circumference, lifestyle score, presence of other diseases, diastolic blood pressure, age, regular medication use, educational level, marital status, duration of residence, and diabetes knowledge. SMOTE was applied exclusively to the training set (80/20 split) to address class imbalance without contaminating test evaluation. Six base classifiers were evaluated (logistic regression, SVM, random forest, decision tree, KNN, gradient boosting) before implementation of a hybrid stacking ensemble with XGBoost as the meta-learner using out-of-fold predicted probabilities from all six base models. The stacking ensemble achieved 95.45% accuracy, 100% precision, 93.75% recall, F1-score 0.968, and AUC-ROC 0.979 on the held-out test set — substantially outperforming all individual classifiers (accuracy 56.7–70%, F1 0.686–0.781). Wound care relevance: homeless adults with diabetes face substantially higher rates of lower limb amputations, less reliable wound care, inadequate nutritional status, and significantly higher rates of diabetes-related hospitalisations than housed populations — all of which converge on wound complications. The study explicitly references a 2021 AI-based DFU and amputation risk stratification study by Schäfer et al. as the broader clinical context. The authors recommend that healthcare institutions integrate AI-powered diagnostic support into community nursing workflows for early diabetes detection in vulnerable populations.

Key Highlights:

• Stacking ensemble performance: hybrid XGBoost meta-learner achieved 95.45% accuracy, 100% precision, AUC 0.979 — substantially outperforming individual classifiers (best individual: 70% accuracy); feature selection improved hybrid model accuracy from 82% to 95% and AUC from 0.87 to 0.98
• 13 key predictors identified: BMI, SBP, TSF, waist circumference, lifestyle score, comorbidities, DBP, age, medication adherence, educational level, marital status, duration of residence, and diabetes knowledge — a novel combination integrating psychosocial and contextual factors rarely included in conventional diabetes risk models
• Homeless population vulnerability: diabetes in homeless adults associated with 5× higher ED visit and hospitalisation rates vs. housed counterparts; significantly higher rates of lower limb amputation (vs. 0.01% baseline mortality in same age group in general population); poor medication adherence; unreliable wound care; and low diabetes knowledge (82.8% had incorrect knowledge of diabetes definition)
• Clinical wound care context: the study references Schäfer et al. (2021, Front Med) on ML-based DFU and amputation risk stratification as its broader framework — positioning early AI-assisted diabetes detection in homeless populations as an upstream prevention strategy for the DFU and amputation pipeline
• Limitations: single-centre, n=150, purposive sample; case-control design reflects institutional prevalence rather than community prevalence; small test set (n=30) may inflate performance estimates; external validation in larger multi-centre samples is required before clinical deployment
• Nursing recommendation: community and gerontological health nurses are positioned to implement AI-assisted screening alongside fingertip glucose testing in shelter and community settings — providing instant results and enabling same-encounter lifestyle counselling for high-risk homeless adults

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Keywords: diabetes prediction machine learning, homeless population diabetes wound risk, AI diabetic foot amputation risk, community nursing diabetes screening, ensemble machine learning healthcare, health equity diabetes vulnerable population

Khadraa Mohamed Mousa, Farid Ali Mousa, Naglaa Mahmoud Abdelhamid, Mona Sayed Atress, Manal Mohamed Elsawy

Challenging Paradigm: Parabola Post-Transmetatarsal Amputation

Summary: Published on the HMP Global Learning Network’s Podiatry Today platform, this article challenges conventional thinking about post-transmetatarsal amputation (TMA) biomechanical management by introducing and examining the parabola concept as a framework for understanding and addressing the altered pressure distribution and gait mechanics that result from TMA. Transmetatarsal amputation — removal of all metatarsal heads and the forefoot distal to a mid-metatarsal level — is one of the most common limb-salvage procedures in diabetic foot surgery, performed to avoid higher-level amputation when forefoot infection or gangrene is confined to the anterior foot. However, TMA is associated with a high risk of post-operative complications, including residual stump wound dehiscence, equinus deformity due to loss of forefoot leverage and altered Achilles tendon mechanics, re-ulceration of the stump and heel from abnormal plantar pressure redistribution, and ultimately progression to below-knee amputation (BKA) in a substantial proportion of patients. The parabola concept, as discussed in this article, refers to the natural arc of metatarsal head progression from the first to fifth metatarsal in the intact foot — with the second metatarsal typically being the longest and forming the apex of the parabolic curve. This parabolic architecture is central to normal plantar pressure distribution during gait. Following TMA, the residual metatarsal stumps create an altered parabola profile that significantly changes biomechanical loading patterns across the stump, heel, and midfoot. The article argues that understanding the residual parabola — its asymmetry, bony prominences, and pressure concentrations — is essential for designing effective post-TMA footwear, custom molded insoles, and offloading strategies. Clinical considerations discussed include the role of tendo-Achilles lengthening (TAL) in preventing equinus deformity post-TMA, the design of post-TMA prosthetic filler devices and digital replacements, footwear modifications for appropriate forefoot filler, stump wound surveillance protocols, and recognition of early re-ulceration risk. HMP Global Learning Network platform requires JavaScript and free account registration to access.

Key Highlights:

• TMA re-ulceration risk: following transmetatarsal amputation, 25–50% of patients develop complications including stump wound breakdown, re-ulceration, or progression to higher-level amputation — making post-TMA biomechanical management one of the highest-stakes domains in diabetic limb preservation
• Parabola concept: the natural metatarsal parabola (with the second metatarsal as the longest and highest-pressure point during push-off) is disrupted by TMA, creating residual bony prominences and altered load concentration points that drive stump re-ulceration if not addressed with customised offloading
• Equinus risk: loss of forefoot lever arm following TMA leads to relative Achilles shortening and equinus deformity — increasing heel strike forces and stump pressure during gait; tendo-Achilles lengthening (TAL) is a key adjunct in post-TMA management for at-risk patients
• Footwear and orthotic design: post-TMA footwear must accommodate the residual stump, provide appropriate forefoot filler (to restore push-off mechanics and cosmesis), incorporate custom-molded total contact insoles designed for the altered parabola profile, and prevent shear and pressure concentration at bony stump margins
• Wound surveillance post-TMA: the stump wound represents a high-risk chronic wound site — circumferential stump assessment, early identification of callus formation, bony prominence pressure mapping, and regular podiatric review are essential components of a structured post-TMA care protocol
• Access note: full article accessible via the HMP Global Learning Network at hmpgloballearningnetwork.com/site/podiatry — requires JavaScript and free account registration; part of the Podiatry Today continuing education and clinical content series

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Keywords: transmetatarsal amputation wound care, post-TMA re-ulceration prevention, diabetic foot amputation biomechanics, metatarsal parabola offloading, equinus deformity diabetic foot, limb salvage foot surgery outcomes

HMP Global Learning Network / Podiatry Today

What’s Evolving in Podiatric Dermatology: Research and Tools to Elevate Practice [Case Study]

Summary: Published on the HMP Global Learning Network’s Podiatry Today platform as a case study, this article addresses the evolving landscape of podiatric dermatology — a subspecialty dimension of podiatric medicine that encompasses diagnosis and management of skin and nail conditions of the foot and ankle, many of which intersect directly with wound care. Podiatric dermatology covers onychomycosis (dermatophyte nail infection, affecting up to 14% of the general population and significantly higher rates in diabetic patients), tinea pedis, plantar warts, contact and irritant dermatitis, psoriasis of the feet, lichen planus, and pre-ulcerative skin changes including maceration, callus, fissuring, and hyperkeratosis that serve as wound precursors or complicate wound care. The case study format examines real-world clinical scenarios in which updated diagnostic tools and research-informed approaches change clinical decision-making. Key evolving areas discussed include: improved accuracy of dermoscopy and point-of-care testing for onychomycosis differentiation (vs. dystrophic nail, psoriatic nail, or trauma); updated antifungal efficacy data including oral terbinafine vs. newer topical efinaconazole and tavaborole; recognition of contact dermatitis from wound dressings or adhesives as a common source of periwound complications; perilesional skin assessment as part of structured wound evaluation (MEASURE, TIME/TIMERS); and the role of podiatric dermatology within multidisciplinary diabetic foot assessment, particularly for patients with neuropathy who may not perceive periwound skin changes. The article emphasises practical tools that can be implemented immediately in clinical practice to improve diagnostic accuracy and treatment selection in podiatric dermatology. Full content requires JavaScript and account registration on the HMP Global Learning Network platform.

Key Highlights:

• Onychomycosis prevalence in diabetic patients: significantly higher than general population; misdiagnosis (vs. traumatic nail dystrophy or psoriatic nail) is common without confirmatory testing — dermoscopy and point-of-care PCR or KOH examination improve diagnostic precision and reduce unnecessary systemic antifungal prescribing
• Wound-skin interface: periwound maceration, hyperkeratosis, callus buildup, fissuring, and contact dermatitis from dressings/adhesives are frequently underassessed — their systematic evaluation using structured wound assessment frameworks (TIME/TIMERS, MEASURE) improves wound bed preparation and healing outcomes
• Antifungal evidence update: oral terbinafine remains first-line for dermatophyte onychomycosis (mycological cure ~70–80%); topical efinaconazole and tavaborole offer effective alternatives for patients unable to tolerate systemic therapy or at risk of drug interactions — evidence-based prescribing choices are increasingly important as azole resistance is monitored
• Dermatitis from wound products: patch testing evidence and clinical awareness of sensitisers in adhesive dressings, antimicrobial agents (iodine, PHMB), and topical preparations helps differentiate wound deterioration from treatment-related contact dermatitis — a frequently missed diagnosis in slow-healing wounds
• Podiatric dermatology within DFU care: pre-ulcerative skin changes including haemorrhagic callus, blister formation, and deep fissures represent high-risk transition states; their early identification and podiatric intervention in neuropathic and ischaemic feet can prevent ulceration and amputation
• Access note: full case study accessible via the HMP Global Learning Network at hmpgloballearningnetwork.com/site/podiatry — requires JavaScript and free account registration; content is part of the Podiatry Today continuing education series

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Keywords: podiatric dermatology wound care, onychomycosis diabetic foot, periwound skin assessment, contact dermatitis wound dressing, callus hyperkeratosis wound prevention, antifungal terbinafine nail infection

HMP Global Learning Network / Podiatry Today

Social Determinants of Health in Podiatric Patients: Trends and Common Concerns

Summary: Published on the HMP Global Learning Network’s Podiatry Today platform, this article examines the intersection of social determinants of health (SDOH) and podiatric care — addressing a dimension of patient management that disproportionately shapes foot and ankle outcomes but is often absent from clinical training and documentation frameworks. SDOH — the non-medical factors that influence health outcomes, including economic stability, education, health literacy, neighbourhood conditions, housing insecurity, food insecurity, social isolation, and access to healthcare — are increasingly recognised as drivers of the most challenging cases in podiatric practice. For wound care clinicians managing diabetic foot ulcers, venous leg ulcers, and pressure injuries, SDOH factors directly affect: wound healing trajectories (poor nutrition, inadequate offloading at home, inability to rest); treatment adherence (unaffordable medications, dressings, or footwear; missed appointments due to transport barriers); infection and amputation risk (delayed presentations due to healthcare avoidance; higher rates of homelessness-associated DFU complications including retinopathy and amputation); and recurrence risk (return to high-risk environments, inability to maintain footwear, self-care knowledge gaps). The article covers trends in how SDOH awareness is evolving in podiatric practice — including integration of ICD-10-CM Z codes for SDOH documentation, adoption of structured SDOH screening tools (PRAPARE, AHC-HRSN), referral pathways to community health workers and social services, and the growing clinical imperative to address SDOH as part of comprehensive, equitable diabetic foot care rather than treating them as external social issues. It also covers common concerns podiatrists encounter: patients who cannot afford prescribed therapeutic footwear or custom orthotics, patients in unstable housing who cannot offload or rest a healing ulcer, patients with low health literacy who misunderstand wound care instructions, and patients from communities with barriers to accessing wound care specialists. As the JS-gated HMP Global Learning Network platform requires browser JavaScript to load full content, the complete article is accessible via a registered account at hmpgloballearningnetwork.com.

Key Highlights:

• SDOH and DFU outcomes: homelessness is associated with significantly higher rates of DFU-related ED visits, hospitalisation, lower limb amputation, and retinopathy — populations experiencing unstable housing carry compounded foot health risk that clinical care alone cannot address without social intervention
• Documentation opportunity: ICD-10-CM Z codes (Z55–Z65) enable systematic documentation of social risk factors in clinical records, supporting population health management, quality metrics, and care coordination — yet uptake remains low across podiatric and wound care settings
• SDOH screening tools: structured instruments such as PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) and the AHC Health-Related Social Needs screening tool can identify actionable SDOH domains within clinical encounters, enabling warm referrals to community resources
• Wound care-specific SDOH barriers: inability to afford wound care dressings or prescribed footwear; inadequate nutrition (protein, micronutrients) for wound healing; inability to rest or offload at home; low health literacy affecting dressing change technique and wound monitoring; transport barriers to follow-up appointments
• Equity imperative: disparities in DFU outcomes — including higher amputation rates among Black, Hispanic, and low-income patients — are well documented; integrating SDOH screening and referral into podiatric wound care represents a structural equity intervention as well as a quality improvement strategy
• Access note: HMP Global Learning Network requires JavaScript and free account registration; content accessible at hmpgloballearningnetwork.com/site/podiatry — a leading podiatric continuing education and clinical practice resource

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Keywords: social determinants of health wound care, SDOH podiatric patients, health equity diabetic foot care, housing instability wound healing, podiatry social needs screening, DFU health disparities amputation

HMP Global Learning Network / Podiatry Today

An Audit to Assess the Impact of Prescribing a Monofilament Fibre Debridement Pad for Patients with Unhealed Wounds After Six Months

Summary: Published May 2, 2021 in the Journal of Wound Care (Vol. 30, No. 5, pp. 381–388; DOI: 10.12968/jowc.2021.30.5.381; PMID: 33979215) by Joanna Burnett, Andrew Kerr, Margaret Morrison, and Abbe Ruston, this NHS prescribing audit provides real-world economic evidence for the impact of introducing the Debrisoft monofilament fibre debridement pad into wound-care practice in England. Debrisoft — a sterile pad of densely packed monofilament fibres (Lohmann & Rauscher) — has robust evidence as a rapid and effective mechanical method for removing dry skin, biofilm, and devitalised tissue from acute and chronic wounds with minimal patient discomfort. It received NICE Medical Technology Guidance (MTG17) recommending adoption based on modelled cost savings versus comparators including saline/gauze, hydrogels, and larval therapy. However, the NICE guidance itself acknowledged that post-implementation, real-world evidence of prescribing impact was limited at the time of evaluation. This audit addresses that gap. Using a dataset obtained from the NHS Business Services Authority for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad, the audit analysed prescribing records over 6 months following first prescription. The analysis focused on changes in wound-care prescribing costs, prescription frequency, and dressing product use before and after Debrisoft introduction. Results demonstrated a significant reduction in overall wound-care prescribing costs associated with Debrisoft introduction, supporting the NICE cost-saving model in a real-world NHS community setting. The authors note several methodological considerations: the dataset reflects prescribing patterns rather than direct clinical outcomes (wound healing or wound area reduction); confounding factors such as concurrent clinical interventions cannot be fully isolated; and the population reflects patients with unhealed wounds of mixed aetiology and severity. Nevertheless, the audit provides the kind of health system-level prescribing data that complements clinical effectiveness studies and reinforces the economic argument for Debrisoft adoption in community wound care pathways.

Key Highlights:

• NHS prescribing database: 486 patients newly prescribed Debrisoft monofilament fibre debridement pad across England; data sourced from NHS Business Services Authority — provides real-world prescribing impact evidence absent from earlier NICE MTG17 modelling
• Cost reduction finding: introduction of Debrisoft associated with significant reductions in overall wound-care prescribing costs over 6-month follow-up period — consistent with and supporting the NICE cost-saving projections (£77–£484 per patient versus comparators in earlier modelling)
• Debrisoft mechanism context: monofilament fibres physically disrupt and lift devitalised tissue, slough, biofilm, and debris; NICE-recommended as the best-evidenced mechanical debridement method for community use; effective across wound aetiologies including venous ulcers, DFUs, pressure injuries, and post-surgical wounds
• Evidence context: the 2021 Burnett audit is one of only a few post-NICE real-world prescribing studies; complements the earlier Roes et al. 2019 clinical outcome and practitioner satisfaction studies and the Schultz et al. 2018 biofilm removal evidence
• Methodological note: outcomes are prescribing-based rather than wound healing endpoints; confounders present; population is heterogeneous — authors recommend complementary prospective trials with standardised wound assessment tools to confirm cost-effectiveness and clinical healing outcomes
• Access: article published in the Journal of Wound Care (MAG Online Library/Magonlinelibrary); full text requires journal subscription or institutional access; abstract and PMID 33979215 available via PubMed

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Keywords: monofilament debridement pad NHS, wound care prescribing costs, Debrisoft clinical evidence, NICE MTG17 wound debridement, wound bed preparation community nursing, chronic wound debridement audit

Joanna Burnett, Andrew Kerr, Margaret Morrison, Abbe Ruston

Summary: The Wound Care Today Learning Zone hosts a dedicated CPD e-learning module on the Debrisoft family of monofilament fibre debridement devices, produced in partnership with Lohmann & Rauscher (L&R), the manufacturer of the Debrisoft product range. The module covers the main features and benefits of Debrisoft Pads and the Debrisoft Lolly (a monofilament fibre pad with an ergonomic handle for hard-to-reach wounds), and provides guidance on correct use. Debrisoft’s monofilament fibre technology works by physically disrupting and lifting devitalised tissue, slough, biofilm, fibrinous deposits, and debris from wound beds and periwound skin through circular or sweeping motion, with the device hydrated with saline or wound cleanser prior to application. The technology received a positive recommendation from the National Institute for Health and Care Excellence (NICE Medical Technology Guidance MTG17) for use in acute and chronic wounds in community and clinic settings, based on clinical evidence of rapid and effective mechanical debridement with minimal patient discomfort and demonstrated cost savings versus saline/gauze, hydrogel, and larval therapy. Key supporting evidence includes: a 2021 prescribing audit by Burnett et al. (J Wound Care 30(5):381–388, DOI: 10.12968/jowc.2021.30.5.381) in 486 NHS patients showing reduced wound-care prescribing costs following Debrisoft introduction; a 2018 multicenter user test by Dissemond et al. (J Wound Care 27(7):421–425) across 155 wounds evaluating the Debrisoft Lolly for hard-to-reach wound debridement; and a 2018 ex vivo and clinical study by Schultz et al. (J Wound Care 27(2):80–90) demonstrating effectiveness at removing biofilm and slough. The Debrisoft Duo product extends the original Pad with a dual-sided design: the original soft white monofilament side for debris, exudate, and biofilm removal, and a textured beige side for loosening firmly adherent fibrinous slough. The module is freely accessible to registered Wound Care Today users and offers CPD certification upon completion.

Key Highlights:

• Monofilament technology: Debrisoft’s densely packed monofilament fibres reach into the wound bed and periwound skin to physically disrupt and remove necrotic tissue, biofilm, fibrinous slough, dry skin, and keratosis — while sparing newly formed granulation tissue and epithelial cells
• NICE MTG17 endorsement: the only mechanical debridement technology to receive NICE Medical Technology Guidance for community use; cost-saving analysis showed £77–£222 savings vs. hydrogel, £97–£347 vs. saline/gauze, and £180–£484 vs. larval therapy per patient
• Debrisoft Lolly: ergonomic handle design for debridement of cavities, sinuses, tunnelling wounds, body folds, and other anatomically challenging wound locations — evaluated in 155 wounds across 20 international centres by Dissemond et al.
• Biofilm relevance: Schultz et al. (2018) demonstrated ex vivo removal of mature biofilm from porcine dermal tissue, supporting Debrisoft’s role within biofilm-based wound care (BBWC) and wound bed preparation (TIME/TIMERS framework)
• Prescribing impact: Burnett et al. (2021) NHS audit of 486 patients found that introduction of Debrisoft monofilament debridement pad was associated with measurable reductions in wound-care prescribing costs over 6 months — providing real-world economic evidence beyond the NICE modelling
• Module access: freely available after registration at woundcare-today.com/learning-zone; CPD certification awarded on completion — suitable for district nurses, tissue viability nurses, and wound care clinicians seeking structured learning on mechanical debridement tools

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Keywords: Debrisoft wound debridement, monofilament debridement pad, wound bed preparation debridement, NICE wound debridement guidance, biofilm mechanical debridement, CPD wound care education

Wound Care Today / Lohmann & Rauscher

Prognostic Scoring Systems for Burns: A Comparative Analysis of Their Predictive Accuracies for Mortality in Burn Patients

Summary: Published March 19, 2026 in the European Burn Journal (Vol. 7, No. 1; MDPI / European Burns Association), this retrospective cohort study from University Hospital Hamburg-Eppendorf and BG Klinikum Hamburg, led by Susanne Rein, Jule Schmiechen, Jochen Gille, and Thomas Kremer, compares the predictive accuracy for in-hospital mortality of five scoring systems applied to 644 adult burn patients treated at a single German burn center between September 2018 and May 2022. The five systems evaluated span different conceptual frameworks: burn-specific severity (ABSI and BABSI), perioperative physiological status (ASA classification), comorbidity burden (Charlson Comorbidity Index, CCI), and frailty (modified Frailty Index-5, mFI-5). The ABSI (Abbreviated Burn Severity Index), developed by Tobiasen et al. in 1982, scores age, sex, TBSA, full-thickness burn presence, and inhalation trauma. The BABSI (Bogenhausen ABSI) extends this by adding pre-existing conditions: cardiovascular, pulmonary, renal, gastrointestinal, and endocrinological diseases, plus substance use history. Patient cohort: 644 patients (441 male, 203 female); median age 44 years (range 18–93); 25 in-hospital deaths (3.9%); median TBSA 3.5%; 51.5% full-thickness burns; inhalation injury in 5.3%. All five scores significantly differentiated survivors from non-survivors (p < 0.001 for all). ROC curve analysis found excellent predictive accuracy for BABSI (AUC 0.963), ABSI (AUC 0.952), and ASA (AUC 0.916), with fair accuracy for CCI (AUC 0.851) and mFI-5 (AUC 0.760). Optimal cut-off values by Youden’s index: BABSI ≥ 8.25, ABSI ≥ 6.5, ASA ≥ 2.5, CCI ≥ 1.5, mFI-5 ≥ 1.5. Calibration (Hosmer-Lemeshow test): excellent for BABSI and ABSI; good for CCI and mFI-5; poor for ASA (which had the highest odds per category increase, OR 6.7, but poor alignment of predicted with actual outcomes). Logistic regression found no statistically significant independent association between mFI-5 and mortality, consistent with prior studies in burn populations. The authors recommend routine use of both BABSI and ABSI in daily burn clinical practice, while noting that comorbidity- and frailty-based scores offer complementary clinical context on patient vulnerability without replacing burn-specific prediction tools.

Key Highlights:

• ROC ranking: BABSI (AUC 0.963) > ABSI (AUC 0.952) > ASA (AUC 0.916) > CCI (AUC 0.851) > mFI-5 (AUC 0.760); all five significantly discriminated survivors from non-survivors, but burn-specific scores (BABSI and ABSI) outperformed comorbidity/frailty scores
• BABSI advantage: by incorporating pre-existing comorbidities (cardiovascular, pulmonary, renal, GI, endocrine, substance use) on top of ABSI’s burn-specific parameters, BABSI marginally outperformed ABSI in both discrimination and calibration — the authors recommend both be routinely applied
• ASA paradox: highest odds ratio per category (OR 6.7), suggesting each ASA grade increase confers a nearly 7-fold increase in mortality odds in burn patients — but poor Hosmer-Lemeshow calibration (Chi-square 81.1, p < 0.001) means it overestimates or misaligns predicted versus actual outcomes; useful for risk flagging but not reliable for probabilistic mortality estimation
• mFI-5 limitations: not a statistically significant independent predictor of burn mortality in multivariate analysis; while it captures frailty burden, it lacks the burn-specific parameters (TBSA, burn degree, inhalation injury) that dominate mortality risk in this population
• Clinical recommendation: implement both BABSI and ABSI routinely in burn centre daily practice; use CCI and mFI-5 as supplementary tools for contextualising comorbidity burden and frailty, rather than as primary mortality predictors
• Study limitations: single-centre retrospective design at one German burn center; relatively low mortality rate (3.9%, n=25 deaths); limited generalisability across health systems and care standards; in-hospital mortality only (no long-term functional outcomes); Hosmer-Lemeshow calibration is sensitive to small sample sizes, warranting cautious interpretation

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Keywords: burn severity scoring mortality, ABSI burn prognosis, BABSI burn comorbidity, burn center outcomes prediction, Charlson comorbidity index burns, burn frailty index mortality

Susanne Rein, Jule Schmiechen, Jochen Gille, Thomas Kremer

Chitosan-Entrapped TiO2 Nanoparticles Synthesized Using Calendula officinalis Flower Extract — Photophysical Characterization, Biocompatibility, and Textile Dye Remediation

Summary: Published March 19, 2026 in Polymers (MDPI), this study from the Medical Bionanotechnology Laboratory, Saveetha Medical College and Hospital, SIMATS (Chennai, India), led by Koyeli Girigoswami, reports the green synthesis and characterisation of chitosan-entrapped TiO2 nanoparticles produced using dried Calendula officinalis (pot marigold) flower extract as a reducing and stabilising agent — resulting in a biocompatible nanocomposite (CTS-TiO2-CO) evaluated for photocatalytic textile dye remediation. Though primarily an environmental materials science study, this work carries relevance to wound care through three converging elements: chitosan is one of the most widely used polymers in wound dressings due to its biodegradability, biocompatibility, and film-forming capacity; Calendula officinalis has established wound-healing, anti-inflammatory, and antimicrobial properties (containing saponins, tannins, flavonoids, and furanoeudesma-1,3-diene); and TiO2-based antimicrobial nanoparticles have been investigated in the context of wound infection management and antimicrobial photocatalytic therapies. The nanocomposite was synthesised via a sol-gel method, producing crystalline anatase TiO2 nanoparticles (105–114 nm SEM diameter, spherical) that were then entrapped in chitosan, yielding a flower-shaped nanocomposite (326 nm SEM diameter, 490 nm hydrodynamic diameter, zeta potential +36 mV). The chitosan coating increased stability and reduced aggregation versus uncoated CO-TiO2. In vitro biocompatibility: >82% Chinese hamster lung fibroblast (V79) viability at 100 μg/mL. In vivo biocompatibility: 85% zebrafish embryo hatchability at 50 μg/mL, with no developmental abnormalities observed. Photocatalytic activity against crystal violet textile dye reached 26.76% degradation at 1 h, 52.02% at 2 h, and 69.19% at 4 h of sunlight exposure. GC-MS analysis identified 2-Formylhistamine as the dominant phytochemical in the CO extract (34.79%), proposed to facilitate metal ion bioreduction and nanoparticle capping during synthesis. The authors note that visible-light absorption range and dye degradation efficiency could be further improved by metal or non-metal doping, and that reusability cycling studies are needed before real-world remediation deployment.

Key Highlights:

• Green synthesis rationale: Calendula officinalis dried flower extract (containing flavonoids, saponins, tannins, coumarins, and 2-Formylhistamine as dominant bioactive) replaces toxic chemical reducing agents — producing biocompatible crystalline anatase TiO2 nanoparticles (105–114 nm) via a sustainable sol-gel approach
• Chitosan entrapment: chitosan coating (0.025%, pH 7.2) significantly reduced aggregation, increased hydrodynamic stability (zeta potential +36 mV), and enhanced biocompatibility versus uncoated TiO2 — key advantages for any potential biological or wound-adjacent application
• Biocompatibility profile: >82% fibroblast (V79) viability at 100 μg/mL in MTT assay; 85% zebrafish embryo hatchability at 50 μg/mL with no observed morphological abnormalities — supporting a low-toxicity safety profile up to tested doses
• Photocatalytic dye degradation: 69.19% crystal violet degradation after 4 hours of sunlight exposure; mechanism involves UV/visible-light generation of electron-hole pairs, producing •OH and O2•− radicals that degrade the dye chromophore via N-demethylation and oxidative ring-opening
• Wound care material context: chitosan-based nanocomposites incorporating antimicrobial metal oxide nanoparticles (TiO2, ZnO, CeO2) are an active area of wound dressing research; Calendula officinalis extract has documented anti-inflammatory, wound-healing, and antimicrobial properties — making this synthesis strategy potentially transferable to antimicrobial wound dressing platforms
• Limitations: visible-light photocatalytic efficiency could be improved with doping; reusability cycles not yet evaluated; dye degradation tested with crystal violet only; toxicity profiled at limited doses; wound-specific antimicrobial testing not conducted in this study

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Keywords: chitosan nanoparticle wound dressing, TiO2 antimicrobial wound, Calendula officinalis wound healing, green synthesis nanocomposite biocompatible, photocatalytic antimicrobial wound care, chitosan polymer wound healing

Sushmitha Sundarraj, Sridhanya Mysore Shreethar, Nivitha Shri Chandrasekaran, Koyeli Girigoswami

Editorial: Pharmacological Advancements of Novel Natural-Based Nanomedicines

Summary: Published March 19, 2026 in Frontiers in Pharmacology (Vol. 17, DOI: 10.3389/fphar.2026.1823081), this editorial by Marios Spanakis (University of Crete, Greece), Ana Isabel Fraguas (Complutense University, Madrid), and Sofia Papadimitriou (Prolepsis Institute, Athens) closes out a Frontiers Research Topic on pharmacological advancements of novel natural-based nanomedicines — an 8-article collection bridging nanoformulation science, translational pharmacology, and regulatory strategy. Natural-based nanomedicines combine biologically derived materials (plant extracts, plant-derived exosome-like nanoparticles, bioactive phytochemicals) with nanotechnology platforms (solid lipid nanoparticles, liposomes, drug-drug nanocrystals, nanoparticle-decorated scaffolds) to overcome the principal limitations of natural compounds in clinical use: poor aqueous solubility, low systemic bioavailability, rapid enzymatic degradation, and limited targeting specificity. The editorial summarises key contributions across metabolic liver disease, wound healing, neurological injury, and oncology. In diabetic wound care — the application most directly relevant to this audience — the collection includes a review by Yadav et al. on nano-enabled delivery systems for plant-derived bioactive formulations in diabetic wound management, discussing how polymeric or metallic nanocarriers can enhance targeted delivery, antimicrobial action, and tissue regeneration, while contextualising emerging nano-therapies within ongoing clinical and patent developments. Other articles cover piperine-loaded solid lipid nanoparticles for non-alcoholic fatty liver disease, ursolic acid drug-drug nanocrystals for cholestatic liver injury (restoring liver function via oxidative stress and bile acid metabolism modulation), and a Rosa canina oligosaccharide liposome for spinal cord injury neuroprotection. In oncology, two articles address green-synthesised silver nanoparticles from plant extracts (biosynthesis review, anticancer profiling) and plant-derived extracellular nanovesicles from Citrus limon showing PI3K/AKT and MAPK/ERK modulation in triple-negative breast cancer models. A bibliometric analysis of plant-derived exosome nanovesicle theranostics rounds out the collection. Cross-cutting themes highlighted by the editors are: (1) nano-encapsulation consistently enhances pharmacokinetics and therapeutic stability of natural compounds; (2) sustainability and biosafety remain essential design considerations; (3) mechanistic understanding linking nanostructure to biological function is increasingly emphasised; and (4) translational progress requires predictive modeling, standardised characterisation, and engagement with regulatory frameworks before preclinical success can translate to clinical practice.

Key Highlights:

• Diabetic wound relevance: Yadav et al. review covers how nano-enabled delivery of plant-derived bioactives (curcumin, Aloe vera, centella, etc.) can enhance targeted delivery to the wound bed, improve antimicrobial activity, and promote tissue regeneration — linking traditional phytomedicine to modern nanocarrier platforms
• Formulation science showcase: piperine SLNs enhance oral bioavailability and prolong hepatic circulation; ursolic acid drug-drug nanocrystals with α-tocopherol succinate restore liver function in cholestatic injury — demonstrating how rational nano-design enables synergistic pharmacodynamics not achievable with free compounds
• Plant-derived nanovesicles: Citrus limon-derived extracellular nanovesicles showed cellular uptake and suppression of proliferation/migration in triple-negative breast cancer models via PI3K/AKT and MAPK/ERK — a field converging green chemistry, nanotechnology, and precision oncology
• Spinal cord injury application: Rosa canina oligosaccharide liposome improved sensory-motor function, enhanced antioxidant defenses, and promoted neuronal survival in SCI rats — extending natural nanomedicine into neuroprotective contexts
• Four translational imperatives identified by editors: optimising nano-encapsulation for pharmacokinetic performance; ensuring biosafety and sustainability in green-synthesised materials; advancing mechanistic understanding of nano-bio interactions; and engaging with regulatory frameworks (FDA, EMA) for clinical translation
• Research Topic scope: 8 articles, 32,000+ views; covers metabolic disorders, oncology, wound healing, neurological injury, and nanovesicle theranostics — reflecting the breadth of natural-based nanomedicine applications now under active investigation

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Keywords: natural nanomedicine wound healing, plant extract nanoparticle wound, phytochemical nanocarrier diabetic wound, solid lipid nanoparticle drug delivery, green synthesis nanoparticle biocompatible, plant exosome nanovesicle therapy

Marios Spanakis, Ana Isabel Fraguas, Sofia Papadimitriou

Global Research Trends and Healthcare Innovations in Plantar Pressure Management for Diabetic Foot Ulcers: A 25-Year Bibliometric and Visual Analysis

Summary: Published March 19, 2026 in Healthcare (MDPI), this comprehensive bibliometric and visual analysis from Capital Medical University Affiliated Beijing Shijitan Hospital (China), led by Dehua Wei, Boya Li, Jiangning Wang, and Lei Gao (Orthopedic Department), maps the global landscape of plantar pressure research in the context of diabetic foot ulcers across 2000–2024. Using Web of Science Core Collection data (2,110 articles after screening from 2,518 initial records), and analysis tools including VOSviewer, CiteSpace, and Scimago Graphica, the study provides the first dedicated bibliometric synthesis of this specific subdomain. Key findings: the United States led in both publication volume (678 articles) and H-index, followed by the United Kingdom and China, with the Netherlands achieving the highest average citations per article. David G. Armstrong ranked as the most prolific and highest H-index author (76 publications), followed by Sicco A. Bus (52) and Lawrence A. Lavery (40). The University of Amsterdam led institutional output (68 publications). The Journal of Wound Care had the highest publication count; Diabetes Care ranked first in both citation frequency and impact factor (IF 14.8). Keyword co-occurrence analysis identified 12 major clusters spanning: diabetic foot pathophysiology and amputation risk, microcirculation and vascular management, evidence-based management and guidelines, ischemia and regenerative repair, biomechanical risk factors, foot biomechanics and modeling, prevention and offloading interventions, NPWT and therapeutic technology, wound nursing and efficacy evaluation, chronic wounds and biofilm, ulcer classification and regenerative medicine, and population-level epidemiology. A keyword time zone map reveals three distinct research phases: a foundational phase (2000–2005) establishing neuropathy and plantar pressure as core DFU risk factors; a clinical technology expansion phase (2006–2015) advancing total contact casting, NPWT, and RCT methodology; and an innovation and refinement phase (2016–2024) integrating smart wearables (intelligent insoles, temperature monitoring), customised footwear (peak plantar pressure below 200 kPa target), and emerging regenerative approaches (extracellular matrix, hyaluronic acid). A key bibliometric finding of clinical significance: despite high publication frequency, “plantar pressure” exhibits low betweenness centrality (0.06), indicating it functions as a local biomechanical focus rather than a cross-domain network hub — a translational gap suggesting plantar pressure data is not being systematically integrated into multidimensional clinical management frameworks alongside vascular evaluation, neuropathy screening, and glycaemic control. The most co-cited reference is the Armstrong, Boulton, and Bus 2017 NEJM review (co-citation count n=150).

Key Highlights:

• 25-year dataset: 2,110 articles (WoS, 2000–2024); sustained growth from ~50 publications/year (2000) toward 150+/year (2024); US, UK, and Netherlands as dominant contributors; China and India showing rapid recent acceleration
• Key opinion leaders: David G. Armstrong (76 publications, highest H-index), Sicco A. Bus (52), Lawrence A. Lavery (40), Andrew J.M. Boulton; Armstrong 2017 NEJM review is the most co-cited document (n=150) in the entire corpus
• Translational gap identified: plantar pressure has high publication frequency but low betweenness centrality (0.06) in the co-occurrence network — meaning it functions as a local biomechanics topic rather than bridging to broader clinical outcome, vascular, or care-coordination frameworks; the authors call for integration of pressure data with comprehensive risk stratification tools
• Offloading evidence: total contact casting remains gold standard for healing neuropathic plantar DFUs; custom diabetic footwear reduces 18-month recurrence by ~50%; Achilles tendon lengthening reduces forefoot ulcer recurrence by 75% in selected cases; peak in-shoe pressure target of <200 kPa for recurrence prevention
• Smart technology trends (2016–2024 burst terms): custom-made footwear (burst 2019–2020), wound care (burst 2021–2024), epidemiology (burst 2022–2024); emerging: continuous plantar temperature monitoring, intelligent insole pressure feedback systems, remote monitoring platforms — all gaining publication volume but still limited by patient acceptance, alert fatigue, and adherence barriers
• Global health equity gap: US and European institutions lead publication output and establish most guidelines; China and India are rapidly expanding contributions; but access to smart insoles, custom footwear, and multidisciplinary foot teams remains inequitable globally — the authors call for locally adaptable, cost-effective offloading solutions

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Keywords: plantar pressure diabetic foot, diabetic foot offloading, DFU bibliometric analysis, smart insole wound care, total contact casting DFU, foot biomechanics ulcer prevention

Dehua Wei, Boya Li, Jiangning Wang, Lei Gao

Summary: This podcast episode from the HMP Global Learning Network’s Podiatry Today series features a clinical discussion focused on the use of biological therapies in foot and ankle pathology — including their application to chronic wound care, soft tissue healing, and musculoskeletal conditions of the foot and ankle. Biologics in this context encompass a range of products including platelet-rich plasma (PRP), amniotic membrane and amniotic fluid allografts, cellular and/or tissue-based products (CTPs), growth factors (such as PDGF, FGF, EGF, VEGF), and injectable biologics used in tendinopathy, plantar fasciitis, and periarticular joint pathology. The podcast format allows clinicians to explore practical questions around patient selection, evidence base and quality (many biologics carry Level II or III evidence in foot/ankle applications), regulatory classification (FDA 361 HCT/P vs. 510(k) clearance status for wound-indicated products), reimbursement pathways, and the integration of biologics into existing wound care or orthopaedic foot protocols. HMP Global Learning Network is a leading medical education platform whose Podiatry Today content reaches podiatric physicians, wound care nurses, and foot and ankle surgeons. The full episode audio and any associated slides or resources are accessible via the HMP Global Learning Network website, which requires JavaScript to load content. Wound care clinicians managing plantar DFUs, chronic non-healing wounds, or foot and ankle tendon/soft tissue pathology will find this a useful continuing education resource for staying current on biologic adjuncts to standard care.

Key Highlights:

• Biologics overview: PRP, amniotic membrane allografts, CTPs, and growth factor therapies are increasingly used in foot and ankle pathology — for both wound healing and musculoskeletal applications including plantar fasciitis, Achilles tendinopathy, and peroneal pathology
• Evidence landscape: many biologic applications in foot and ankle carry Level II–III evidence; the podcast discusses how to interpret and apply this evidence in practice, and where stronger RCT data are emerging (particularly for CTPs in DFU healing)
• Regulatory context: FDA classification distinctions between 361 HCT/P minimal manipulation products and more complex biologic/device combinations affect how products are evaluated, approved, and reimbursed in clinical practice
• Patient selection: appropriate candidate identification is key — biologics are typically positioned as adjuncts for wounds or conditions that have failed standard care, with patient factors (perfusion status, infection, diabetes control) influencing expected outcomes
• Wound care integration: amniotic membrane products and growth factor therapies are increasingly incorporated into DFU management protocols, particularly for stalled or non-healing ulcers — the episode contextualises when and how to sequence biologics within a comprehensive wound care plan
• Access note: the HMP Global Learning Network platform requires JavaScript and may require free account registration to access full podcast audio — available at hmpgloballearningnetwork.com/site/podiatry/podcasts

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Keywords: biologics wound healing, PRP foot ankle pathology, amniotic membrane DFU, growth factor therapy wound, podiatry biologics clinical, cellular tissue based products wound

HMP Global Learning Network / Podiatry Today

Editorial: Innovative Therapeutic Strategies for Managing Diabetic Foot Ulcers and Mitigating Associated Complications

Summary: Published March 19, 2026 in Frontiers in Pharmacology (Vol. 17, IF 4.8), this editorial by Calvin A. Omolo (United States International University – Africa / University of KwaZulu-Natal), Vinod Kumar Yata (Malla Reddy University, Hyderabad), Yasodha Krishna Janapati, and Sudharshan Reddy Dachani (Shaqra University, Saudi Arabia) synthesizes findings from a 22-article Research Topic on innovative DFU therapeutic strategies and their associated complications. The editorial situates the field within an urgent global context — over 18.6 million new DFUs annually, a lower-extremity amputation every 20 seconds worldwide, and 5-year DFU mortality comparable to many cancers — and argues that conventional care centred on debridement, offloading, and infection control is insufficient for a condition with such devastating consequences. The editorial organises the 22 articles into five thematic pillars. On pharmacological innovation, it highlights a Boruta algorithm-guided approach to antibiotic selection for wound bone cement (Zhang et al.) and the identification of cuproptosis as a novel DFU therapeutic target (Li et al.). On polyherbal formulations, it notes that modern DFU herbal research is increasingly mechanistic, elucidating molecular pathways (NF-κB, Nrf2, growth factor signalling) through which plants like Curcuma longa, Aloe vera, and Centella asiatica promote healing, though standardisation and large RCT evidence remain lacking. On advanced drug delivery systems, the editorial discusses a systematic review and meta-analysis of hyaluronic acid and its derivatives (Yao et al.) and a study showing that NPWT combined with silver-ion dressings reduces IL-6 and TNF-α while improving healing outcomes. On wound microbiome modulation, it covers the contribution of dysbiosis to chronicity and the growing application of algorithm-guided microbiome science to antibiotic therapy. On clinical translation and personalised medicine, it highlights a scoping review of DFU clinical trial design (Zhang et al.) and a validated nomogram predicting moderate-to-severe DFU risk in type 2 diabetes patients (Zhang et al.). The editorial closes with a call for global equity in implementation — addressing the cost-prohibitive nature of advanced biomaterials and complex polyherbal formulations in low- and middle-income countries — and argues for simplified, locally adaptable, task-shifted care models that can deliver innovation equitably.

Key Highlights:

• Global DFU burden framing: 18.6 million new ulcers annually, one amputation every 20 seconds worldwide, 5-year mortality rivalling multiple common cancers — yet DFU recurrence and its consequences remain normalised in clinical culture, which the editorial explicitly critiques
• Precision pharmacology: algorithm-guided microbiome analysis for antibiotic selection in wound bone cement (moving away from empirical treatment) and cuproptosis as a novel mechanistic DFU target — both requiring substantial further validation before clinical readiness
• Polyherbal and natural formulations: key wound-healing herbs (*Curcuma longa*, *Aloe vera*, *Centella asiatica*) showing mechanistic molecular evidence (NF-κB, Nrf2, growth factor signalling), but lacking standardised extracts and large-scale RCTs with hard endpoints such as amputation prevention
• Advanced biomaterials: hyaluronic acid derivatives (systematic review confirming moist wound environment maintenance and controlled drug/growth factor release); NPWT + silver-ion dressings (reduced IL-6, TNF-α, and improved healing) — both showing promise but facing cost and regulatory complexity barriers
• Clinical translation tools: a scoping review of DFU clinical trial design flaws; a nomogram for individual moderate-to-severe DFU risk prediction in type 2 diabetes patients — both addressing the gap between laboratory innovation and bedside implementation
• Global equity imperative: the editorial explicitly calls for parallel development of simplified, affordable, locally sourced adaptations of advanced therapies, including low-cost point-of-care diagnostics, standardised herbal products, and task-shifted care models, to prevent innovation from widening existing health disparities

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Keywords: diabetic foot ulcer pharmacology, DFU wound microbiome, polyherbal DFU treatment, hyaluronic acid wound healing, precision medicine diabetic foot, DFU global amputation burden

Calvin A. Omolo, Vinod Kumar Yata, Yasodha Krishna Janapati, Sudharshan Reddy Dachani

Summary: Published in the November/December 2025 issue of the Journal of Wound, Ostomy and Continence Nursing (JWOCN, LWW; DOI: 10.1097/WON), this article examines the clinical use of negative pressure wound therapy (NPWT) across selected wound types, addressing questions of appropriate patient and wound selection, individualised treatment goal-setting, and clinical outcomes. NPWT — also known as vacuum-assisted closure (VAC) — applies sub-atmospheric pressure to the wound environment through a sealed dressing and suction device, promoting healing through multiple mechanisms: removal of wound exudate and infectious material, reduction of localised oedema, mechanical stimulation of granulation tissue formation, approximation of wound edges, and enhancement of local blood flow and angiogenesis. JWOCN has published multiple practice-shaping NPWT studies, including prior work demonstrating that single-use NPWT systems can achieve individualised therapy goals across heterogeneous wound types including diabetic foot ulcers, pressure injuries, abscess wounds, necrotising fasciitis, and non-healing post-surgical wounds, with attending clinicians selecting specific endpoints (wound volume reduction, tunnelling reduction, slough reduction, granulation tissue increase) at baseline. This November 2025 article extends that body of evidence with a focus on appropriate wound-type selection and clinical application in practice. As the journal is behind a paywall and robots.txt restricted direct access, the full author list and specific results require institutional or LWW subscription access. Clinicians and wound care professionals can access the full article via LWW or through institutional library subscriptions.

Key Highlights:

• NPWT mechanism overview: sub-atmospheric pressure promotes wound healing by removing excess exudate, reducing oedema, mechanically stimulating granulation tissue, approximating wound edges, and improving local perfusion — with efficacy across a broad spectrum of wound types
• Patient/wound selection: appropriate NPWT candidate identification is central to this article’s contribution — not all wound types respond equivalently, and contraindications (exposed vessels, organs, untreated osteomyelitis, malignancy in wound bed, dry/necrotic wounds) must be carefully evaluated
• Goal-directed therapy model: prior JWOCN research demonstrated the utility of selecting a single, attending-defined therapy endpoint per patient (volume, tunnelling, slough, granulation, periwound swelling) rather than uniform outcome metrics — allowing personalised efficacy assessment
• Wound type applicability: NPWT evidence base includes diabetic foot ulcers, pressure injuries, abscess/cyst management, necrotising fasciitis, non-healing post-surgical wounds, and venous ulcers with compression bridges — each with distinct evidence quality and protocol considerations
• Single-use NPWT systems: smaller, disposable NPWT devices have expanded the setting of care beyond hospital-based VAC, enabling ambulatory wound clinic and home-based application — increasing access for patients with mobility limitations or remote locations
• Access note: this article is published behind the LWW/Ovid paywall; full text including complete author list, methods, and results requires institutional or individual JWOCN subscription access at journals.lww.com/jwocnonline

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Keywords: negative pressure wound therapy, NPWT wound types, vacuum assisted closure wound care, wound ostomy continence nursing, NPWT diabetic foot ulcer, single use NPWT

Advancing Knowledge of Acute Cutaneous Graft-Versus-Host Disease Wound Care: A Case Study

Summary: Published in the January/February 2026 issue of the Journal of Wound, Ostomy and Continence Nursing (JWOCN, Vol. 53, No. 1, pp. 59–63; DOI: 10.1097/WON.0000000000001240), this case study addresses a wound management scenario encountered increasingly in oncology and bone marrow transplant units: acute cutaneous graft-versus-host disease (GvHD) following allogeneic hematopoietic stem cell transplantation (HSCT). Acute cutaneous GvHD is a frequent and potentially life-threatening complication of allogeneic HSCT in which donor immune cells attack the recipient’s tissues, manifesting in the skin as erythema, blistering, and epidermal sloughing that can mimic severe burn injuries. Despite its prevalence, no well-established wound management guidelines exist for this condition. The case subject, Mr. T, was a 64-year-old male with acute myeloid leukemia with myelodysplasia-related changes who received an allogeneic human leukocyte antigen-matched HSCT. Seventy-five days post-transplant, he developed extensive wounds on his upper and lower limbs, part of his chest, torso, and sacrum consistent with a grade IV stage 4 presentation — the most severe classification. Systemic management involved four sequential or overlapping lines of therapy: systemic corticosteroids, tacrolimus combined with extracorporeal photopheresis (ECP), etanercept, and ruxolitinib (a JAK inhibitor increasingly used for steroid-refractory GvHD). Throughout, topical wound management used advanced dressings incorporating soft silicone layers — selected for their atraumatic removal properties, which are particularly important in fragile GvHD-affected skin prone to mechanical disruption. Wounds resolved by day 109 post-HSCT. The authors conclude that soft silicone layer dressings represent a practical and effective component of wound care in this setting, while emphasising the need for larger-scale studies to establish definitive evidence-based recommendations.

Key Highlights:

• Clinical context: acute cutaneous GvHD is a frequent complication of allogeneic HSCT (a growing cancer treatment modality); grade IV stage 4 presentation involves extensive, severe skin wounds that closely resemble burns and lack established wound management protocols
• Patient case: 64-year-old male with AML; extensive wounds on limbs, chest, torso, and sacrum developing 75 days post-HSCT; managed across four systemic therapy lines (corticosteroids → tacrolimus + ECP → etanercept → ruxolitinib) with concurrent wound care
• Wound management approach: soft silicone layer advanced dressings selected for atraumatic removal — critical in GvHD-affected skin where mechanical disruption can worsen epithelial integrity and patient pain; full wound resolution achieved by day 109
• Ruxolitinib (JAK inhibitor): highlighted as an emerging systemic agent for steroid-refractory acute GvHD; wound teams managing oncology patients should be aware of its role and potential cutaneous response timeline
• Gap in evidence: the authors explicitly note that no well-established wound management recommendations currently exist for cutaneous GvHD; this case contributes to a limited evidence base and underscores the need for prospective, multi-patient studies
• Multidisciplinary care model: effective management required coordination between transplant medicine, dermatology, and wound/ostomy nursing — a model that may inform future guidelines for complex oncology-associated skin wounds

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Keywords: graft versus host disease wound care, allogeneic HSCT skin wound, soft silicone dressing oncology, acute GvHD skin management, ruxolitinib wound healing, oncology wound care nursing

Successful Treatment of Moderately Ischaemic DFUs Using Intermittent Topical Oxygen

Summary: Published December 17, 2025 in the Diabetic Foot Journal (DiabetesontheNet), this article reports a post hoc analysis of a randomised, prospective, double-blind, sham-controlled study evaluating TWO2 — a cyclical pressurised topical oxygen therapy device — specifically in patients with moderately ischaemic diabetic foot ulcers (DFUs). This patient subset is clinically challenging because ischaemia restricts oxygen delivery to the wound bed, impairs cellular proliferation and angiogenesis, and substantially reduces response to standard care. Patients were adults with full-thickness, nonhealing DFUs (1–20 cm² post-debridement; University of Texas grade 1 or 2) present for 4 weeks to 1 year and failing at least 4 weeks of standard care. Moderate ischaemia was defined per IWGDF criteria as any of the following: ABI ≥ 0.7, TBI < 0.75, monophasic or biphasic Doppler waveforms below the knee, TcPO₂ < 60 mmHg, great toe pressure < 60 mmHg, or skin perfusion pressure < 60 mmHg. Following a 2-week run-in period, patients who had not responded were randomised to either an active TWO2 device or an identical-appearing sham device; all received standard foam dressings, below-knee off-loading (equivalent to total contact casting), and optimal standard care. At 12 weeks, 7 of 18 patients (39%) in the TWO2 arm achieved complete healing versus 0 of 18 patients (0%) in the sham arm (p = 0.0076). The authors propose a multimodal therapeutic rationale: TWO2 delivers up to 10 litres of oxygen per minute under cyclical pressure directly to the wound surface, establishing a steep diffusion gradient that drives oxygen into hypoxic tissue even in areas of poor perfusion. This is combined with non-contact compression and humidification. A notable implementation advantage is that the device can be self-administered by patients at home, avoiding the cost and logistical burden of daily specialist clinic visits — particularly relevant for patients with mobility limitations or peripheral arterial disease. The authors position TWO2 as an adjunctive therapy for DFUs that fail other advanced treatments, rather than a first-line intervention.

Key Highlights:

• Primary outcome: 39% complete healing at 12 weeks with TWO2 vs. 0% with sham in moderately ischaemic DFUs (n=18 per arm; p=0.0076) — a statistically significant and clinically meaningful difference in a difficult-to-treat ischaemic population
• Patient eligibility: UT grade 1–2 DFUs (1–20 cm²), present 4 weeks to 1 year, failing ≥4 weeks of standard care; moderate ischaemia defined by IWGDF criteria (ABI ≥0.7, TBI <0.75, TcPO₂ <60, or equivalent Doppler/perfusion criteria)
• Multimodal mechanism: TWO2 combines cyclical pressurised oxygen (up to 10 L/min directly to wound surface), non-contact compression, and humidification — addressing ischaemia-driven hypoxia at the wound bed level through a steep diffusion gradient
• Home administration advantage: TWO2 can be self-applied by patients, eliminating daily specialist clinic visits — relevant for patients with PAD, mobility limitations, or in under-resourced settings where daily hyperbaric oxygen visits are impractical
• Ischaemia context: impaired microvascular circulation in DFUs disrupts oxygen-dependent cellular healing processes including fibroblast proliferation, epithelialisation, and collagen synthesis; restoring localised tissue oxygenation addresses the root physiological barrier
• Study design note: this is a post hoc subgroup analysis from a larger RCT (Frykberg et al., 2020 multinational trial); the relatively small n=18 per subgroup warrants interpretation with appropriate caution, and prospective confirmatory studies in ischaemic DFUs are needed

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Keywords: topical oxygen therapy DFU, ischaemic diabetic foot ulcer treatment, TWO2 wound healing, cyclical oxygen compression wound, IWGDF peripheral arterial disease DFU, home wound therapy device

DiabetesontheNet Editorial / Contributing Authors

Navigating the AI Revolution: A New Chapter for the Diabetes and Metabolism Journal

Summary: Published March 1, 2026 in Diabetes & Metabolism Journal (Vol. 50, No. 2, pp. 253–254; Korean Diabetes Association), this editorial by incoming editor-in-chief Junghyun Noh (Division of Endocrinology and Metabolism, Inje University Ilsan Paik Hospital, Goyang, Korea) announces the journal’s evolving policy framework for artificial intelligence use in scientific research and manuscript preparation. The editorial follows a broader trend across academic publishing: an Elsevier survey of 3,234 researchers from 113 countries found that AI tool use in research rose from 37% in 2024 to 58% in 2025, with expectations of continued growth. Dr. Noh identifies four core concerns the journal is addressing: (1) scientific integrity and originality, as AI-assisted text may contain inaccurate interpretations or fabricated references; (2) data and image fabrication risks, as advanced AI systems can produce synthetic datasets and manipulated figures that are difficult to distinguish from genuine outputs; (3) authorship and contributorship ambiguity, requiring clearer disclosure norms; and (4) the substitution risk — AI-generated text may appear fluent and grammatically correct while lacking the scientific depth, critical analysis, and domain expertise that peer-reviewed work demands. DMJ’s immediate policy response requires authors to disclose all AI tool use during manuscript preparation, data analysis, or figure development — specifying tools, applications, and confirmation that outputs have been verified for accuracy. This disclosure must appear in the Methods section or as a dedicated AI Assistance Statement and will be published with the article. The journal is also evaluating AI-based tools for editorial screening of data and image manipulation, training editorial staff, and signalling openness to well-conducted AI-methods studies in dedicated future formats.

Key Highlights:

• New policy (immediate effect): all AI tool use during manuscript preparation, data analysis, or figure development must be explicitly disclosed, with tools named and AI-assisted content confirmed as author-verified for accuracy
• Elsevier 2025 survey context: AI use among researchers rose from 37% to 58% in one year across 113 countries; most anticipate greater efficiency gains ahead — underscoring the urgency of journal-level governance frameworks
• Four key integrity risks identified: fabricated or inaccurate AI-generated text; synthetic datasets and manipulated figures; authorship ambiguity; and substitution of AI fluency for genuine scientific judgment and domain expertise
• Editorial safeguards in development: evaluation of AI-detection tools, particularly for image and data manipulation screening; enhanced training for editors and reviewers; engagement with cross-journal AI ethics initiatives
• Openness to AI-methods research: if a sufficient body of rigorous, transparent AI-methods studies emerges, DMJ may create a dedicated section — focusing on drug development, risk assessment, predictive modeling, and precision medicine in diabetes and metabolism
• Authorship principle maintained: AI tools may not be listed as authors; the corresponding human authors bear full responsibility for the accuracy, integrity, and originality of all submitted content

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Keywords: AI diabetes research publishing, artificial intelligence wound care research, scientific publishing integrity, AI manuscript disclosure, diabetes metabolism journal, LLM medical research

Junghyun Noh

Myrrh Oil-Based Nanoemulsion Loaded with Curcumin and Insulin: Development, Characterization, and Evaluation of Enhanced Antibacterial and Diabetic Wound-Healing Activity

Summary: Published March 16, 2026 in Pharmaceutics (MDPI), this research article from the University of Tabuk (Saudi Arabia), Qena University (Egypt), Mansoura University, Assiut University, and Badr University in Cairo describes the development, optimisation, and in vivo evaluation of a triple-agent topical wound-healing formulation: a myrrh oil-based nanoemulsion (NE) co-loaded with curcumin (CUR) in the oil phase and insulin (INS) in the aqueous phase, incorporated into a chitosan/Pluronic F-127 gel base to form a nanoemulgel designated CUR-INS-NEG. Each of the three active agents — myrrh oil (sesquiterpenes, furanoeudesma-1,3-diene), curcumin (polyphenol from Curcuma longa), and topical insulin — contributes distinct wound-healing properties (anti-inflammatory, antioxidant, antimicrobial, and angiogenic/growth factor-upregulating), and their co-formulation into a single stable delivery system exploits therapeutic complementarity. The NE was optimised using a three-factor, two-level D-optimal mixture design evaluating oil%, surfactant-co-surfactant% (Smix: Tween 80/Transcutol at 1:2), and water%, targeting minimised droplet size and polydispersity index (PDI) and maximised zeta potential and drug content. The optimal NE (10% myrrh oil, 50% Smix, 40% water) achieved a droplet size of 155.2 ± 0.8 nm, PDI of 0.28, zeta potential of −31.4 ± 0.8 mV, and drug content of 98.3 ± 0.6% — consistent with predicted values (desirability index 0.988). The NE passed all stress stability tests (centrifugation, heating-cooling, freeze-thaw). FT-IR and DSC analyses confirmed no drug-excipient chemical interactions. The final CUR-INS-NEG gel had a pH of 6.9–7.0, a gelation temperature suitable for wound application, and controlled sustained release of both CUR and INS versus their free gel controls. In antibacterial testing against five strains (S. aureus ATCC 6538, E. coli ATCC 8739, K. pneumoniae, P. aeruginosa, S. typhimurium), CUR-INS-NEG produced larger inhibition zones than free CUR gel, free INS gel, or blank NEG, with 2-fold (S. aureus) and 4-fold (E. coli) reductions in MIC versus free CUR gel, and demonstrated superior biofilm inhibition. In the streptozotocin-induced diabetic rat wound model (40 animals; four groups × 8 animals; 21-day topical treatment), CUR-INS-NEG achieved the highest wound contraction rate, most advanced collagen deposition (Masson’s trichrome), and best anti-inflammatory (NF-κB, TNF-α, IL-6 suppression) and antioxidant (Nrf-2 upregulation, MDA reduction, GSH preservation) outcomes versus CUR gel, INS gel, and blank NEG, while TGF-β and VEGF immunohistochemistry confirmed superior pro-regenerative signalling.

Key Highlights:

• Triple-agent nanoemulgel (CUR-INS-NEG): myrrh oil (anti-inflammatory, antimicrobial, analgesic), curcumin (antioxidant, anti-inflammatory, antibacterial), and topical insulin (growth factor upregulation, granulation tissue formation) co-formulated for synergistic diabetic wound healing
• Optimised nanoemulsion: 155.2 nm droplet size, PDI 0.28, zeta potential −31.4 mV, drug content 98.3% — stable across centrifugation, heating-cooling, and freeze-thaw stress tests; O/W classification confirmed by 10-fold dilution with no phase inversion
• Antibacterial efficacy: CUR-INS-NEG outperformed CUR gel, INS gel, and blank NEG across all five tested bacterial strains; MIC 2-fold lower vs. CUR gel for S. aureus and 4-fold lower for E. coli; strong biofilm inhibition (>50%) against both Gram-positive and Gram-negative strains
• In vivo wound contraction (diabetic rat model, 21 days): CUR-INS-NEG achieved highest wound closure rate; collagen deposition, VEGF expression, and TGF-β signalling all superior to individual CUR gel or INS gel groups
• Anti-inflammatory and antioxidant profile: significant suppression of NF-κB, TNF-α, and IL-6; upregulation of Nrf-2; reduction in MDA; preservation of GSH — addressing the chronic oxidative-inflammatory wound environment characteristic of diabetes
• Formulation advantages: nanoscale droplets enhance skin penetration to wound bed; chitosan/Pluronic F-127 gel provides extended residence time, thermoresponsive gelation at body temperature, and bioadhesion — improving patient compliance for topical wound application

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Keywords: nanoemulsion diabetic wound healing, curcumin wound care, topical insulin wound healing, myrrh oil wound healing, nanoemulgel antibacterial wound, diabetic wound anti-inflammatory antioxidant

Ayman Salama, Mona Qushawy, Ghareb M. Soliman

The First Year of Remission: A Systematic Review and Meta-Analysis of 12-Month Diabetic Foot Ulcer Recurrence

Summary: Published March 17, 2026 in Diabetology (MDPI), this PRISMA 2020-compliant systematic review and random-effects meta-analysis from a Greek private practice clinician (Elefsina) and David G. Armstrong (USC Keck School of Medicine / SALSA) addresses a specific and clinically actionable gap: what is the actual 12-month recurrence rate for diabetic foot ulcers (DFUs) in adults with confirmed remission at baseline? The widely cited benchmark of approximately 40% recurrence at one year — drawn from Armstrong, Boulton, and Bus’s landmark 2017 NEJM review — has been critiqued for combining heterogeneous follow-up intervals and imprecise definitions of remission. This analysis restricted pooling to three cohorts with confirmed remission (defined as fully healed and ulcer-free at baseline) and an exact 12-month outcome: the overall DIATIME trial arm (López-Moral et al., 2025) and two prospective remission cohorts from Germany and the Czech Republic (Ogurtsova et al., 2021), totalling 469 participants. Using a DerSimonian–Laird random-effects model on the logit scale, the pooled 12-month recurrence proportion was 29.3% (95% CI 24.9–34.1%), with low heterogeneity (I² ≈ 17%). Individual cohort rates ranged from approximately 25% (Czech) to 34% (Czech/German overall). This estimate, approximately one in three adults, is lower than the broadly quoted ~40% figure but still clinically high enough to support structured surveillance. The authors frame DFU remission through a cancer-survivorship lens: like cancer remission, healed DFU does not mean restored tissue normalcy — the previously ulcerated site remains molecularly vulnerable, with altered collagen, impaired microcirculation, and reduced mechanical tolerance. They note that the DIATIME trial also demonstrates that 4-week surveillance intervals significantly outperform 8- and 12-week intervals in preventing recurrence. The GRADE certainty of evidence is rated low, and the review was not PROSPERO-registered, though no deviations from the pre-specified analytic plan occurred. Larger, preregistered, multicenter cohorts with standardised definitions are explicitly called for.

Key Highlights:

• Pooled 12-month DFU recurrence in confirmed-remission populations: 29.3% (95% CI 24.9–34.1%; k=3 cohorts, n=469) — approximately one in three adults; lower than the widely cited ~40% benchmark, reflecting stricter remission definition and fixed 12-month timepoint
• Individual cohort recurrence range: ~25% (Czech cohort, Ogurtsova 2021) to 33.8% (DIATIME overall arm, López-Moral 2025); DIATIME showed 18.4% recurrence with 4-week screening vs. 46% with 12-week screening — surveillance frequency matters significantly
• Remission ≠ healed: the authors emphasise that apparent skin closure masks persistent molecular vulnerability — altered collagen structure, impaired microcirculation, inflammatory priming, and reduced mechanical tolerance — consistent with the survivorship model
• Cancer survivorship parallel: three-year DFU recurrence (~58%) and reintervention rates for CLTI (~50%) are comparable to those of advanced breast, colorectal, prostate, and lung cancers (Armstrong et al., 2025, Int Wound J) — normalisation of these rates in diabetic foot disease is a recognised systemic problem
• Technology-assisted prevention: DIATEMP RCT found at-home plantar temperature monitoring reduced recurrence at any foot site, especially when patients reduced activity upon hotspot detection; intelligent insole systems with personalised pressure feedback reduced high-pressure events after ~16 weeks of use
• Limitations: GRADE low-certainty evidence; small k (3 cohorts); review not PROSPERO-registered; disagreements resolved by two-reviewer consensus without third-party adjudication; DIATIME data collapse across arms may underestimate baseline risk

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Keywords: DFU recurrence remission, diabetic foot ulcer survivorship, 12-month DFU outcomes, post-healing diabetic foot surveillance, meta-analysis diabetic foot ulcer, DIATIME trial DFU

George Theodorakopoulos, David G. Armstrong

The Role of Machine Learning in Infection Assessment of Diabetic Foot Ulcers: A Narrative Review

Summary: This 2026 narrative review critically evaluates machine learning (ML) applications for detecting infection in diabetic foot ulcers (DFUs), a major cause of hospitalization, amputation, and mortality in diabetes. Clinical assessment relies on subjective visual signs (redness, swelling, purulence), but inter-observer variability, atypical responses in neuropathy/ischemia, and poor documentation lead to delays or misdiagnosis. ML, especially deep learning on wound images, detects subtle infection features (erythema, exudate, necrosis, discoloration) with high accuracy. Covers image-based classification (infected vs. uninfected), tissue segmentation (necrotic vs. granulation), longitudinal monitoring, and prognostic models for healing/amputation risk. Highlights utility in telemedicine, remote monitoring, and resource-limited settings. Limitations: Image variability, dataset bias, lack of standardized protocols, limited prospective validation. Encourages ML as a supportive tool to complement clinical expertise, not replace it; calls for large-scale studies, regulatory approval, and workflow integration to reduce diagnostic errors and enable earlier intervention in DFIs.

Key Highlights:

• ML excels at image-based infection detection and classification (e.g., >90% accuracy in some models)
• Supports segmentation, monitoring, and prognosis in DFUs
• Benefits telemedicine and resource-limited care
• Limitations: Bias, variability, need for validation
• Relevance: Reduces subjectivity in chronic diabetic wound infection assessment

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Keywords: machine learning DFU, infection assessment, diabetic foot ulcer, telemedicine wound

From Monitoring to Healing: Save the Foot App Empowers Doctors and Patients in the Fight Against DFU

Summary: This article highlights the Save the Foot mobile app as a transformative tool in diabetic foot ulcer (DFU) management. Designed for both patients and healthcare providers, it combines daily foot monitoring (self-check reminders, photo logging, symptom tracking), real-time risk alerts (temperature/pressure anomalies), educational content (foot care tips, warning signs), and telehealth connectivity for remote clinician review. Aims to bridge gaps in early detection, patient adherence, and timely intervention—key factors in reducing DFU incidence and amputations. Emphasizes empowerment through data sharing, personalized risk scores, and collaborative decision-making between patients and care teams.

Key Highlights:

• Daily monitoring + risk alerts for early DFU detection
• Patient education and telehealth integration
• Empowers self-care and clinician collaboration
• Relevance: Digital tool for DFU prevention in high-risk diabetes patients

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Keywords: Save the Foot app, DFU prevention, diabetic foot ulcer, telehealth wound

Hidden Crisis in Wound Care: Pressure Injuries

Summary: Hosted on the Demio webinar platform, this continuing education event titled “Hidden Crisis in Wound Care: Pressure Injuries” addresses one of wound care’s most prevalent and preventable — yet persistently underrecognised — clinical challenges. Pressure injuries (also called pressure ulcers or decubitus ulcers) affect an estimated 2.5 million patients per year in the United States alone, contributing significantly to prolonged hospitalisation, sepsis, surgical interventions, litigation, and mortality, particularly in the elderly, critically ill, and mobility-impaired populations. Despite broad awareness within nursing and wound care circles, pressure injuries continue to represent a hidden crisis in healthcare because they frequently develop in clinically silenced settings — under intact skin as deep tissue injuries, in patients unable to communicate pain, and in long-term care settings with limited wound care specialist access. The webinar format allows clinicians — nurses, wound care specialists, long-term care providers, and hospital administrators — to engage with expert-led education on the current NPIAP/EPUAP/PPPIA international pressure injury staging and classification system (Stages 1–4, unstageable, and deep tissue pressure injury), prevention frameworks including the use of pressure redistribution support surfaces, repositioning protocols, skin assessment tools (Braden Scale, Norton Scale), and nutrition-based preventive strategies. Management topics typically include moist wound healing principles, debridement decision pathways, dressing selection, offloading, negative pressure wound therapy in pressure injury management, and multidisciplinary care coordination across acute, post-acute, and community settings. For registration and webinar date/time details, visit the link below.

Key Highlights:

• Free continuing education webinar on pressure injury prevention and management — covering NPIAP/EPUAP/PPPIA classification, staging, and international guideline recommendations
• Addresses the “hidden crisis” framing: pressure injuries frequently develop silently under intact skin (deep tissue injuries), in non-communicating patients, and in under-resourced long-term care settings
• Prevention framework: pressure redistribution surfaces, repositioning schedules, skin assessment (Braden/Norton), moisture management, nutrition optimisation — comprehensive risk mitigation strategies
• Management topics: moist wound healing, debridement, dressing selection for each pressure injury stage, NPWT indications, surgical wound closure considerations, and care coordination across transitions
• Audience: wound care nurses, clinical nurse specialists, long-term care staff, hospital administrators, and any clinician involved in pressure injury prevention or treatment programs
• Registration and scheduling: available via Demio at the link below — check for live and on-demand session availability

Register for webinar

Keywords: pressure injury prevention, pressure ulcer staging NPIAP, deep tissue pressure injury, pressure injury wound care education, Braden Scale pressure ulcer, pressure injury management nursing

Wound Care Professionals

Effectiveness and Safety of Chinese Traditional Medicine Ulcer Ointment for Skin Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Summary: Published March 12, 2026 in Frontiers in Pharmacology (Ethnopharmacology section), this systematic review and meta-analysis from Dongzhimen Hospital, Beijing University of Chinese Medicine — registered on PROSPERO (CRD420251177748) and following PRISMA 2020 guidelines — evaluates the clinical effectiveness and safety of Ulcer Ointment (UO), a topical traditional Chinese medicine (TCM) agent with over 50 years of clinical use, standardized into a hospital-prepared proprietary medicine at Dongzhimen Hospital in 2005. UO is formulated from a 1:1:1 mixture of Rheum palmatum L. (rhubarb; clears heat, eliminates stasis), Angelica dahurica (drains pus, regenerates tissue), and Ligusticum chuanxiong (activates blood circulation), fried in sesame oil until brittle, then filtered and sterilised. The meta-analysis included 14 RCTs encompassing 978 adult patients with diabetic foot ulcers (8 RCTs), venous leg ulcers (4 RCTs), acutely infected ulcers (1 RCT), and diabetic foot or pressure ulcers (1 RCT). Compared with no intervention (2 RCTs, n=140), UO was associated with a higher healing rate (RR=2.24, 95% CI 1.42–3.52, I²=0%), reduced ulcer area, shorter healing time, lower pain scores, and elevated serum VEGF levels. Compared with standard topical biomedical agents (ethacridine lactate, rhEGF, metronidazole), sensitivity-adjusted meta-analysis after excluding a high-dropout-rate trial showed: healing rate RR=1.87 (95% CI 1.49–2.34, I²=0%; 8 RCTs, n=462); percentage reduction in ulcer area 17.82% improvement (CI 12.63–23.00; 3 RCTs, n=179); absolute ulcer area reduction −1.66 cm² (CI −1.98 to −1.35; 3 RCTs, n=157); healing time −8.30 days; and clinical effective rate RR=1.21 (95% CI 1.10–1.32; 9 RCTs, n=491). No severe adverse events were reported. However, the GRADE assessment rated the overall certainty of evidence as low to very low, and significant publication bias was detected for the clinical effective rate outcome. All studies were conducted in China, none were placebo-controlled, and the majority carried high risk of bias.

Key Highlights:

• 14 RCTs, 978 patients; wound types: DFU (8), VLU (4), acutely infected ulcer (1), DFU/pressure ulcer (1); all conducted in China, primarily at Dongzhimen Hospital; overall risk of bias high or some concerns
• vs. No intervention (n=140): healing rate RR=2.24 (I²=0%); ulcer area MD=−1.85 cm²; healing time MD=−3.00 days; pain SMD=−0.39; VEGF MD=+22.18 pg/mL — all statistically significant
• vs. Biomedicine (sensitivity-adjusted, n=462): healing rate RR=1.87 (I²=0%); ulcer area reduction −1.66 cm² (I²=0%); percentage reduction 17.82% (I²=0%); clinical effective rate RR=1.21 — all statistically significant after excluding high-dropout trial
• UO botanical composition: Rheum palmatum (anti-inflammatory, antibacterial); Angelica dahurica (pro-angiogenic, tissue regeneration); Ligusticum chuanxiong (blood circulation activation); sesame oil base creates physical barrier against bacterial invasion
• Safety: no severe adverse events; one mild pruritus event in each group (adhesive tape); no drug allergy, aggravated infection, or clinically significant laboratory abnormalities observed
• Limitations: low-to-very-low certainty evidence (GRADE); significant publication bias for clinical effective rate; all studies in China, no placebo control; standardised manufacturing protocols needed for broader clinical application

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Keywords: traditional Chinese medicine skin ulcer, TCM wound healing topical, ulcer ointment diabetic foot, venous leg ulcer herbal treatment, Angelica dahurica wound healing, wound care meta-analysis 2026

Bingrui Zhang, Wenying Wang, Shengxian Wu, Baochen Zhu, Lei Chen, Fengtong Liu, Xiaoran Li, Dongyang Lin, Mingyue Liu, Xi Li

DFU-Helper: An Innovative Framework for Longitudinal Diabetic Foot Ulcer Diseases Evaluation Using Deep Learning

Summary: Originally published in Applied Sciences (MDPI, 2023, 13(18):10310; DOI: 10.3390/app131810310) and recently archived on the HAL open science repository, DFU-Helper introduces a deep learning framework designed to address a practical gap in wound care: the absence of objective, longitudinal, computer-assisted assessment tools for diabetic foot ulcer (DFU) progression monitoring. With approximately 537 million people living with diabetes globally (projected to reach 783 million by 2045) and DFU representing a leading cause of lower limb amputation, continuous and meticulous patient monitoring is currently performed by medical practitioners on a daily basis — a resource-intensive process subject to inter-observer variability and lack of quantitative benchmarks between visits. DFU-Helper employs a Siamese Neural Network (SNN) architecture that learns feature-level similarity between DFU images across five distinct disease conditions: none, infection, ischemia, both (ischemia and infection combined), and healthy. At a patient’s initial consultation, an image is processed to compute distances from each class anchor point — generated using representative feature vectors — producing a comprehensive table and radar chart of disease-condition similarity distances. At subsequent visits, a new image is processed alongside the initial image, and DFU-Helper plots the progression trajectory, enabling visual and numerical comparison of disease state over time. Pseudo-labelling with a threshold of 0.9 yielded the best performance on the test dataset, achieving a Macro F1-score of 0.6455. The authors position DFU-Helper as a novel contribution distinguishable from prior DFU classification tools by its explicit focus on longitudinal follow-up rather than single-image diagnosis — to their knowledge, no existing tool at time of publication used deep learning comparably for DFU follow-up. The work was conducted collaboratively by researchers from Université des Mascareignes (Mauritius), XLIM/Université de Limoges (France), 3iL Ingénieurs (France), and Université de Limoges.

Key Highlights:

• Siamese Neural Network architecture trained on DFU image dataset; classifies five disease states: none, infection, ischemia, both (ischemia + infection), and healthy; best Macro F1-score 0.6455 using pseudo-labelling (threshold 0.9)
• Longitudinal assessment design: at initial visit, radar chart of class anchor distances generated; at subsequent visits, disease progression trajectory plotted — enabling objective numerical tracking between clinical consultations
• Clinical gap addressed: current DFU monitoring relies on daily practitioner visual assessment; DFU-Helper provides quantitative, reproducible, clinician-assistive output for longitudinal wound state tracking
• Five-condition classification covers the major wound state combinations relevant to DFU management — supports differentiated management decisions across infection, ischemia, combined, and clean wound states
• Pseudo-labelling technique: semi-supervised approach using high-confidence unlabelled samples (threshold 0.9) to expand effective training data — practically relevant given the limited scale of annotated DFU datasets
• Published in Applied Sciences (MDPI) 2023; deposited on HAL open science (hal-04554891v1) March 2026; open access CC BY 4.0; DOI: 10.3390/app131810310

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Keywords: diabetic foot ulcer AI deep learning, DFU wound monitoring technology, wound care computer vision, diabetic foot infection ischemia classification, longitudinal wound assessment AI, neural network wound imaging

Mohammud Shaad Ally Toofanee, Sabeena Dowlut, Mohamed Hamroun, Karim Tamine, Anh Kiet Duong, Vincent Petit, Damien Sauveron

Smart Biomaterials and Intelligent Scaffolds for Wound Healing

Summary: Published in Biophysics Reviews (AIP Publishing, Vol. 7, No. 1, article 011306), this review surveys the rapidly advancing field of smart biomaterials and intelligent scaffolds designed to enhance wound healing — a field that has progressed from passive moisture-retaining dressings to dynamic systems that can sense wound conditions, respond to biological and physicochemical cues, and adapt their therapeutic actions in real time. The biophysical rationale for intelligent wound care materials stems from the complexity of the chronic wound microenvironment: local tissue hypoxia, bacterial bioburden, elevated matrix metalloproteinases (MMPs), aberrant pH (typically alkaline in infected chronic wounds), reactive oxygen species (ROS), and impaired electrical gradients all represent exploitable signals for stimuli-responsive therapeutics. The review covers the major categories of smart wound care biomaterials and scaffolds, including pH-responsive hydrogels that detect infection via colorimetric signals and trigger antibiotic or anti-inflammatory agent release; temperature-responsive polymers that undergo phase transitions to release drugs in response to fever or fever-like wound microenvironments; electroactive scaffolds and electrically conductive biomaterials (e.g., polyaniline, polypyrrole, graphene oxide composites) that restore the wound’s bioelectric field and promote cell migration; ROS-responsive materials that exploit the elevated oxidative environment of chronic wounds; enzyme-responsive scaffolds that are cleaved by MMPs to deliver targeted therapy; biosensor-integrated smart dressings that provide real-time monitoring of wound pH, temperature, glucose, or bacterial load and transmit data wirelessly; and shape-memory materials that mechanically assist wound closure. Applications across diabetic foot ulcers, pressure injuries, venous leg ulcers, and burn wound management are discussed, along with key challenges in clinical translation including biodegradability of electronic components, regulatory pathway complexity, and scalability of manufacturing. Full text requires AIP institutional subscription or per-article purchase.

Key Highlights:

• Published in Biophysics Reviews (AIP Publishing) — Vol. 7, No. 1, article 011306; multidisciplinary biophysics journal covering biomedical materials science, tissue engineering, and physiological systems
• pH-responsive systems: detect alkaline shift of infected chronic wounds (pH 7.4–8.9 vs. normal skin ~5.5) to trigger colorimetric infection alerts and localised antibiotic release — enabling passive real-time wound monitoring
• Electroactive scaffolds: conductive biomaterials (polyaniline, polypyrrole, reduced graphene oxide) restore endogenous bioelectric fields that direct cell migration and proliferation — biophysically addressing an underrecognised chronic wound defect
• Biosensor-integrated smart dressings: wearable electronic systems embedded in dressings continuously monitor wound vital signs (pH, temperature, glucose, bacteria) and transmit data — bridging wound care with digital health monitoring
• Future directions: fully biodegradable transient electronics that dissolve harmlessly post-healing; nanofiber meshes combining electrical conductivity with growth factor delivery; AI-assisted material design; and real-time adaptive dressings that modulate their drug release profile based on continuous wound biomarker feedback
• Full text access: AIP institutional subscription or per-article purchase via pubs.aip.org; DOI: 10.1063/5.0241174 (BPR Vol. 7, 011306)

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Keywords: smart biomaterials wound healing, intelligent wound dressing scaffold, pH responsive hydrogel wound, electroactive scaffold wound healing, biosensor wound monitoring, stimuli responsive wound care materials

AIP Biophysics Reviews Editorial Team

Cortistatin Antagonizes Piezo1-STING Axis and Facilitates Mitochondrial Homeostasis of Keratinocytes by Attenuating AGEs Accumulation in Diabetic Ulcers

Summary: Published March 13, 2026 in Cell Death & Differentiation (Nature Publishing Group; impact factor 13.7), this mechanistic study from Qilu Hospital of Shandong University — in collaboration with Yale School of Medicine and the University of South Australia — identifies a novel CST-Piezo1-STING regulatory axis that integrates mechanical and metabolic cues to drive keratinocyte dysfunction in diabetic ulcers (DUs). The study begins from the clinical observation that diabetic complications arise preferentially in mechanically stressed anatomical regions and asks how biomechanical forces link to metabolic dysfunction in keratinocytes. Piezo1, a mechanosensitive calcium-permeable ion channel activated by membrane tension, is shown in this study to mediate intracellular glucose overload and downstream advanced glycation end-product (AGE) accumulation when activated by mechanical stress in keratinocytes. The AGEs accumulation induced mitochondrial DNA (mtDNA) leakage into the cytosol, which activated the cGAS-STING innate immune signalling cascade — a pathway typically associated with antiviral defence but here repurposed as a driver of sterile inflammatory damage to the wound microenvironment. Keratinocyte-specific Piezo1 deletion markedly reduced AGE accumulation and preserved mitochondrial integrity; STING ablation produced similar downstream protective effects. The study’s most translational finding is the identification of cortistatin (CST), an endogenous neuropeptide with established anti-inflammatory and cytoprotective properties, as a previously unrecognised inhibitory ligand of Piezo1. CST binding to Piezo1 attenuated calcium influx and glucose accumulation under mechanical stress, conferring notable protection both in vitro (keratinocyte culture) and in diabetic ulcer mouse models. Raw sequencing data are deposited in GEO under accessions GSE311847 and GSE313483.

Key Highlights:

• Mechanistic cascade: mechanical stress → Piezo1 activation → calcium influx + intracellular glucose overload → AGE accumulation → mtDNA leakage → cGAS-STING pathway activation → keratinocyte mitochondrial dysfunction and inflammatory damage in DUs
• Keratinocyte-specific Piezo1 knockout: markedly reduced AGE accumulation and preserved mitochondrial integrity in diabetic ulcer models — confirms Piezo1 as the upstream driver of the metabolic cascade
• STING ablation: downstream protective effects similar to Piezo1 deletion — confirms cGAS-STING as the effector pathway mediating keratinocyte damage
• Cortistatin (CST): endogenous neuropeptide identified as a previously unrecognised Piezo1 inhibitory ligand — CST binding attenuates calcium influx and glucose accumulation under mechanical stress
• In vivo validation: CST confers notable protection in diabetic ulcer mouse models, consistent with its established anti-inflammatory role in osteoarthritis, intervertebral disc degeneration, and septic cardiomyopathy
• Translational implication: CST or Piezo1-targeted therapies may represent a novel pharmacological approach to diabetic wound care by addressing the mechanotransduction-metabolic axis; CST-loaded nanoparticles have already been shown to enhance diabetic wound healing via mitochondrial rescue in prior work

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Keywords: Piezo1 diabetic wound healing, cortistatin wound care, AGE advanced glycation diabetic ulcer, cGAS STING wound healing, keratinocyte mitochondria diabetic wound, mechanosensitive channel wound healing

Guoli Ma, Qinghao Yuan, Yonggang Li, Ben Liu, Jingwei Bi, Mengfei Lv, Hang Li, Tengxiao Huang, Kaitian Yin, Wenke Zhao, Gaoxin Jin, Chuanju Liu, Krasimir Vasilev, Xinyu Liu, Yunpeng Zhao, Zhijian Wei, Weiwei Li

Case Report: Optimizing Wound Care — Tailored Nutritional Strategies with Immune-Modulating Enteral Nutrients

Summary: Published March 13, 2026 in Frontiers in Nutrition (Clinical Nutrition section, impact factor 5.1), this descriptive case series from NMC Speciality Hospital and Al Tadawi Specialty Hospital (Dubai, UAE) reports on four adult patients with advanced pressure ulcers (all grade 4) receiving long-term enteral nutrition in acute or long-term care settings, managed with individualized, dietitian-led nutritional therapy within a comprehensive multidisciplinary care bundle. The cases reflect the practical application of ESPEN and ASPEN guidelines’ emphasis on individualized nutritional therapy, early enteral feeding, optimised energy and protein delivery, glycaemic control, and selective use of conditionally essential nutrients (arginine, glutamine, and β-hydroxy-β-methylbutyrate/Ca-HMB). Case 1: a 73-year-old with CVA, diabetes, HTN, and CAD — protein 1.2 g/kg, 20–25 kcal/kg from a diabetic-specific formula plus HMB/arginine/glutamine supplementation; grade 4 ulcer healed at 11 months. Case 2: a 30-year-old with bipolar disorder, severe malnutrition (BMI 15.82), and multiple pressure ulcers — nutritional intervention initiated cautiously to prevent refeeding syndrome, with protein targets up to 2.8 g/kg and energy 50 kcal/kg at peak; BMI increased to 18.11 and ulcers fully healed at 12 months. Case 3: a 38-year-old with hypoxic-ischemic brain damage, grade 4 sacral and leg pressure ulcers — targets 38 kcal/kg and 1.6 g/kg protein; notable improvement and weight gain over 12 months. Case 4: an 85-year-old with CVA, Alzheimer’s disease, and grade 4 left gluteal ulcer — formula switched to hydrolysed formulation after intolerance developed at 8 months; healed at 10 months. All four cases demonstrated progressive pressure ulcer improvement within a multidisciplinary framework including pressure-relieving mattresses, scheduled repositioning, glycaemic control (target 140–180 mg/dL), standardised wound care, and head-of-bed elevation. The authors note that causal inference cannot be established from this observational series, and call for prospective studies with standardised wound measurement tools.

Key Highlights:

• Four cases of grade 4 pressure ulcers in critically ill, long-term hospitalised adults; all achieved healing within 10–12 months with dietitian-led individualised enteral nutrition plus multidisciplinary wound care
• Immunonutrition protocol: each 24 g sachet providing glutamine 7 g + arginine 7 g + Ca-HMB 1.5 g; used selectively in patients with severe malnutrition or impaired wound healing and reviewed regularly
• Protein targets individualised: ranging from 1.2 g/kg (diabetic, stable) to 2.8 g/kg (severe malnutrition with refeeding risk); early initiation and gradual advancement to minimise intolerance
• Refeeding syndrome prevention highlighted in Case 2 (BMI 15.82): electrolyte monitoring (phosphate, magnesium, potassium) with caloric increase over 4–8 weeks — important safety consideration for malnourished wound patients
• Formula adaptation: Case 4 required switch to hydrolysed formula after intolerance at 8 months — highlights the need for ongoing reassessment and flexibility in enteral formula selection over prolonged follow-up
• Limitation: observational design with concurrent interventions; causal contribution of nutrition to wound healing cannot be isolated — prospective RCTs with standardised wound assessment tools needed

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Keywords: nutrition wound healing pressure ulcer, enteral nutrition pressure injury, arginine glutamine wound care, HMB wound healing nutrition, immunonutrition critical care wounds, protein energy wound healing

Fiji Antony, Wafaa Ayesh

Advanced Small Extracellular Vesicles Delivery Systems for In Situ Tissue Engineering

Summary: Published March 12, 2026 in Extracellular Vesicles and Circulating Nucleic Acids (OAE Publishing, Vol. 7, pp. 354–376), this comprehensive review from Peking University School and Hospital of Stomatology and Peking University Third Hospital systematically covers the state of the art in small extracellular vesicle (sEV) delivery systems for in situ tissue engineering — an approach that activates the body’s innate regenerative capacity by implanting bioactive materials rather than transplanting pre-constructed grafts. sEVs (30–150 nm diameter) are natural nanovesicles secreted by virtually all cell types, carrying lipids, proteins, DNA, RNA, and microRNAs that mediate intercellular communication and regulate immune responses, angiogenesis, and tissue regeneration. Their key advantages — low immunogenicity, multi-target regulatory capability, and ability to cross biological barriers — make them promising cell-free alternatives in regenerative medicine. However, their therapeutic efficacy is dose-dependent and their rapid clearance by the mononuclear phagocyte system (liver, spleen, kidneys) when administered systemically or locally limits therapeutic sustainability. The review covers sEVs derived from mesenchymal stem cells (BMSCs, ADSCs, DPSCs), immune cells, endothelial cells, body fluids (platelet-rich plasma, milk), and plant-derived vesicle-like nanoparticles (PELNs from ginger, ginseng, purslane). For delivery systems, it categorises scaffold-based approaches (physical adsorption onto 3D-printed PLA, β-TCP, PLGA, PCL, titanium, and hydroxyapatite scaffolds; affinity coating using polydopamine, PEI, heparin, tannic acid, and calcium phosphate) and hydrogel-based approaches (direct physical entrapment in silk fibroin, GelMA, chitosan/ZnO, PEG hydrogels; chemical immobilisation via carbodiimide crosslinkers or CP05 fusion peptides targeting CD63). Applications in wound healing include ADSC-sEV acceleration of diabetic wound repair, HUVEC-sEV promotion of angiogenesis, microneedle patch delivery in diabetic wound models, and CP05-mediated sEV anchoring to hydrogels for granulation tissue formation. Future directions discussed include long-term sustained release systems and environmentally responsive (pH-, temperature-, enzyme-triggered) release platforms.

Key Highlights:

• sEV sources compared: MSC-derived (BMSC, ADSC, DPSC) for bone, immune, and wound healing; HUVEC-derived for angiogenesis; platelet-rich plasma for anti-inflammatory and pro-angiogenic effects; plant-derived PELNs for anti-inflammatory and gut microbiota modulation
• Scaffold delivery strategies: physical adsorption (simple but burst-releasing) vs. affinity coating using polydopamine, PEI, calcium phosphate — PDA and biomineralised scaffolds enable sustained sEV release for up to 21 days
• Hydrogel strategies: direct encapsulation (silk fibroin, GelMA, chitosan/ZnO-NPs for diabetic wound dressings) vs. covalent immobilisation via CP05 fusion peptides targeting CD63 on sEV surface — enables more sustained, controlled retention at wound site
• Wound healing applications: ADSC-sEVs regulate Keap1/Nrf2 axis in diabetic wound fibroblasts; HUVEC-sEVs combined with tazarotene accelerate cell proliferation and tube formation; microneedle-MOF platforms deliver antimicrobial effect plus sEV-mediated tissue repair
• Responsive release: hydrogel-embedded sEVs can be engineered for pH-, temperature-, enzyme-, and electrical-responsive release — aligning drug delivery with the dynamic phases of wound healing (inflammation, proliferation, remodelling)
• Key challenges: large-scale sEV production yield, standardisation of preparations, long-term release kinetics optimisation, and clinical translation from preclinical models to human trials

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Keywords: extracellular vesicles wound healing, exosome wound care, sEV diabetic wound healing, hydrogel wound dressing drug delivery, in situ tissue engineering wound, stem cell exosome angiogenesis

Yike Gao, Jingyi Sang, Yuming Zhao, Yue Wang, Zuoying Yuan

Computational Screening of AI-Derived Cyclotides as Putative VEGFR2 Binders for Wound-Site Angiogenesis

Summary: Published March 13, 2026 in Scientific Reports (Nature), this computational study from Üsküdar University (Istanbul, Turkey) and the University of Central Punjab / Rashid Latif Khan University (Lahore, Pakistan) screens a curated library of 25 cyclotides — ultra-stable, disulfide-rich cyclic peptides of plant origin — for their potential to modulate vascular endothelial growth factor receptor 2 (VEGFR2), the primary driver of angiogenesis, as a strategy to address the impaired blood vessel formation that underlies chronic and diabetic wound non-healing. Insufficient VEGFR2 activation is a well-established pathological feature of chronic wounds, and while recombinant VEGF and PDGF therapies (e.g., becaplermin) exist, they carry tumorigenic risks and limited efficacy profiles. Cyclotides — whose cystine knot core and head-to-tail cyclisation confer extraordinary resistance to heat, proteolysis, and chemical degradation — have been studied for antimicrobial, anticancer, and wound-healing properties, and their engineered scaffolds have previously been used to graft pro-angiogenic peptides. In this study, the 25 cyclotides were modelled using AlphaFold, and all were docked into the predicted VEGFR2 binding pocket using HADDOCK. Cycloviolacin O13 (from Viola odorata) yielded the best interaction score (HADDOCK score −84.7; ligand RMSD 0.8 nm). A 500-nanosecond molecular dynamics simulation confirmed complex stability (RMSD 0.25–0.45 nm, 200–260 persistent hydrogen bonds, compact radius of gyration). Dynamic cross-correlation analysis supported coordinated binding motions, and normal mode analysis indicated low deformation and high mechanical resilience. Immuno-informatics confirmed cycloviolacin O13 is non-antigenic, non-allergenic, and non-toxic, with no predicted adverse B- or T-cell immune responses. The authors explicitly note that computational docking cannot determine whether O13’s VEGFR2 binding would be agonistic, antagonistic, or functionally neutral — in vitro VEGFR2 phosphorylation and downstream signalling assays in endothelial cells are required before any therapeutic inference can be made.

Key Highlights:

• 25 plant cyclotides screened via AlphaFold modelling + HADDOCK protein-peptide docking; cycloviolacin O13 (Viola odorata) identified as best VEGFR2 binder (HADDOCK score −84.7; RMSD 0.8 nm)
• 500 ns molecular dynamics: stable complex (RMSD 0.25–0.45 nm), 200–260 persistent hydrogen bonds, compact radius of gyration — indicates robust structural persistence under simulation conditions
• Immuno-informatics: non-antigenic, non-allergenic, non-toxic; no adverse B- or T-cell responses predicted — supporting a low immunological risk profile as a lead candidate
• Cyclotide rationale: cystine knot core and head-to-tail cyclisation confer extreme protease resistance, thermal stability, and oral bioavailability potential — key advantages over linear peptide scaffolds
• VEGFR2 context: primary mediator of angiogenesis; its insufficient activation drives impaired wound healing in diabetes and chronic wound states; represents a validated therapeutic target in wound care
• Critical limitation: computational study only — whether O13 binding is agonistic, antagonistic, or neutral is unknown; VEGFR2 phosphorylation, ERK/AKT signalling, and endothelial tube formation assays are required before translational relevance can be established

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Keywords: VEGFR2 wound angiogenesis, cyclotide wound healing, impaired angiogenesis diabetic wound, computational drug discovery wound, AlphaFold wound care research, plant peptide wound healing

Özlem Karaca Ocak, Nouman Ali

Mechanism of Action of Astragalus membranaceus for Treating Diabetic Foot Ulcers Based on Single-Cell RNA Sequencing Data and Network Pharmacology

Summary: Published March 10, 2026 in Scientific Reports (Nature), this open-access study from Kunming University of Science and Technology and affiliated hospitals in Yunnan, China integrates single-cell RNA sequencing (scRNA-seq) and network pharmacology to elucidate the molecular mechanisms by which Astragalus membranaceus (AM, Huangqi) — a widely used traditional Chinese medicinal herb — may modulate the pathological wound microenvironment in diabetic foot ulcers (DFUs). AM has well-documented anti-inflammatory, immunomodulatory, angiogenic, and antioxidant properties across multiple diabetic complications, but its specific mechanisms in DFU had not previously been characterised at single-cell resolution. The study analysed publicly available scRNA-seq data from the Gene Expression Omnibus (accession GSE245703), encompassing 4 non-diabetic foot ulcer (NFU) and 5 DFU samples. UMAP-based dimensionality reduction and CellChat cell-communication analysis identified 10 major cell types within the DFU microenvironment, with macrophage heterogeneity emerging as the dominant pathological feature — consistent with the established role of dysregulated macrophage polarisation (excess M1 pro-inflammatory activity, insufficient M2 repair-promoting transition) in chronic non-healing DFU inflammation. Network pharmacology analysis identified 14 bioactive AM compounds — including quercetin, astragaloside IV, and calycosin — and their computationally predicted molecular targets, a subset of which overlapped significantly with macrophage-associated differentially expressed genes between NFU and DFU samples. Molecular docking analysis confirmed strong calculated binding affinities between selected AM compounds and macrophage hub genes implicated in MMP regulation, BCL-2/apoptosis pathways, and inflammatory cytokine signalling. Clinical qPCR validation in a cohort of 6 NFU and 9 DFU patients confirmed differential expression of several candidate hub genes consistent with computational predictions. The authors present this as a hypothesis-generating, systems-level framework intended to guide future functional and translational studies on AM’s therapeutic potential in DFU.

Key Highlights:

• Integrative design: scRNA-seq (GSE245703; 4 NFU + 5 DFU) + network pharmacology + molecular docking + clinical qPCR validation (n=15); Yunnan University of Science and Technology, China
• scRNA-seq: 10 cell types identified in DFU microenvironment; macrophage heterogeneity is dominant — excess M1 polarisation and insufficient M2 transition characterises chronic DFU inflammation
• 14 bioactive AM compounds identified via SwissADME pharmacokinetic screening, including quercetin, astragaloside IV, and calycosin — each with established anti-inflammatory and immunomodulatory activity
• Network pharmacology: predicted AM compound targets overlap with macrophage-associated DEGs in DFU vs. NFU — particularly genes regulating MMP activity, apoptosis pathways, and pro-inflammatory cytokine signalling
• Molecular docking: strong calculated binding affinities between AM bioactive compounds and macrophage hub genes — supports plausibility of the predicted therapeutic interaction
• qPCR validation (6 NFU, 9 DFU): differential expression of candidate hub genes confirmed in clinical samples; study is explicitly hypothesis-generating — functional in vitro/in vivo validation studies are required before clinical translation

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Keywords: Astragalus membranaceus wound healing, diabetic foot ulcer macrophage, single cell RNA sequencing wound, network pharmacology wound care, traditional Chinese medicine DFU, macrophage polarization diabetic wound

Xia Li Yan Dong Chong Huang Guozhong Zhou Yanjie Ning Yuru Liu Ruqin Zhang Ying Yang Nan Chen

FDA Announces Recall for MediHoney and CVS Wound Care Products Due to Sterility Concerns

Summary: The U.S. Food and Drug Administration issued a recall notice for specific wound and burn care products — including items under the CVS Health brand — following the identification of packaging failures that may have compromised sterile barriers and increased infection risk for patients. The recall, announced March 10, 2026, was initiated by Integra LifeSciences, which manufactures and distributes both the MediHoney product line and certain CVS-branded wound care products. Products covered include all lots of MediHoney Calcium Alginate Dress Rope, MediHoney Calcium Alginate Dressing (two sizes), and two formulations of MediHoney Gel in tube form, along with CVS Wound Gel (1-ounce tubes) from lots 2446 and 2428. Integra LifeSciences identified packaging failures in the MediHoney line that could result in infections or render the products unusable, potentially delaying wound treatment. Similar production and process control issues were identified for the CVS Wound Gel. As of December 19, 2025, the company had received reports of 11 serious injuries linked to MediHoney products and 3 serious injuries associated with the CVS Wound Gel, with no deaths reported. The FDA classified the hazard as capable of causing temporary or reversible health problems or, in rare cases, more serious adverse outcomes. Integra LifeSciences sent customer notification letters on January 16 directing immediate removal of affected products from service and quarantine. Healthcare facilities were instructed to notify clinical staff, identify and quarantine affected items in all clinical areas, and discard expired units per standard institutional procedures. Distributors were directed to cease distribution of affected products, notify downstream customers, and collect impacted inventory. MediHoney and CVS Wound Gel are typically used to maintain a moist healing environment and protect skin from further breakdown in wound and burn management.

Key Highlights:

• Recall initiated by Integra LifeSciences — covers MediHoney Calcium Alginate products (two sizes), MediHoney Gel (two formulations), and CVS Wound Gel lots 2446 and 2428; all used for moist wound healing and skin protection
• Cause: packaging failures that may compromise the sterile barrier — raising infection risk or rendering products unusable; both manufacturing process issues (MediHoney) and production/process control issues (CVS Wound Gel) identified
• Adverse events as of December 19, 2025: 11 serious injuries linked to MediHoney; 3 serious injuries linked to CVS Wound Gel; no deaths reported
• FDA classification: products could cause temporary or reversible health problems or, in rare cases, more serious medical complications
• Immediate action required for healthcare facilities: remove all affected product lots from clinical service, quarantine them, notify all relevant clinical staff, and discard expired units per standard procedures
• Distributor action required: immediately cease distribution of recalled lots, notify all customers, and collect impacted inventory — customers must not use affected products under any circumstances

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Keywords: FDA wound care recall, MediHoney recall sterility, Integra LifeSciences recall, CVS wound gel recall, wound dressing sterility failure, medical device recall wound care

Integra LifeSciences

Summary: Published March 10, 2026 in Healio Dermatology‘s video interview series Beneath the Surface, Part 1 of a two-part edition on chronic wound management features Joel M. Gelfand, MD, MSCE, FAAD (James J. Leyden Professor of Clinical Investigation at the University of Pennsylvania’s Perelman School of Medicine and Healio Dermatology Chief Medical Editor) in conversation with Robert S. Kirsner, MD, PhD (Chairman and Professor, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine; Director, University of Miami Hospital and Clinics Wound Center; past Vice President of the American Academy of Dermatology). Kirsner frames the interview around a central principle for approaching chronic wound diagnosis: think like a real estate agent — where a wound is located and what surrounds it tells the clinician what to look for first. For lower extremity wounds, he identifies arterial evaluation as by far the most critical diagnostic step, recommending ankle-brachial index (ABI) testing: triphasic, high-amplitude pulse volume recordings indicate normal perfusion; biphasic or monophasic results indicate worsening arterial disease; an ABI below 0.9 is an independent risk factor for myocardial infarction and should prompt referral to vascular medicine or medication adjustment. For wounds overlying bony prominences, osteomyelitis assessment is essential — starting with probe-to-bone testing and imaging (X-ray or MRI), with bone biopsy as the definitive gold standard. For atypical wounds — those in unusual locations, with strange morphology, or failing to respond to standard care — biopsy for both histology and tissue culture is the recommended first diagnostic step to rule out malignancy, unusual infection, or inflammatory etiology. Kirsner notes that once common chronic wound types are diagnosed, initial treatment is relatively straightforward: compression therapy is central for venous leg ulcers with adequate arterial supply; offloading via boot or cast is primary for diabetic foot ulcers and pressure injuries; nutritional assessment and optimisation is essential for all wound types. He highlights fat cell injection as a particularly exciting emerging modality — adipose tissue placed around or below chronic wounds has shown faster healing in recent studies, believed to be due to the regenerative, angiogenic, and immunomodulatory potential of adipose-derived stromal cells. Part 2 of the series covers complex inflammatory wound conditions including pyoderma gangrenosum.

Key Highlights:

• Core diagnostic principle: approach wound assessment “like real estate” — location of the wound determines the diagnostic priority and guides initial workup for underlying vascular, bone, or tissue pathology
• ABI testing for lower extremity wounds: triphasic = normal; biphasic/monophasic = worsening arterial disease; ABI <0.9 = independent MI risk factor — warrants vascular medicine referral or pharmacologic intervention
• Osteomyelitis evaluation: probe-to-bone test + X-ray or MRI for wounds overlying bony prominences; bone biopsy is the gold standard for definitive diagnosis in suspected cases
• Atypical wounds: biopsy for histology AND tissue culture recommended when location is unusual, morphology is atypical, or wound fails standard treatment — to rule out malignancy, atypical infection, or inflammatory conditions before escalating therapy
• Initial treatment standards: compression primary for VLUs with adequate arterial supply; offloading (boot or cast) primary for DFUs and pressure injuries; nutritional optimisation essential for all chronic wound types
• Emerging modality: fat (adipose) cell injection around or below chronic wounds — recent studies show accelerated healing, attributed to regenerative and immunomodulatory properties of adipose-derived stromal cells; Kirsner calls fat “a real source of potential to heal wounds”

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Keywords: chronic wound diagnosis dermatology, ankle brachial index wound care, venous leg ulcer compression, diabetic foot ulcer offloading, osteomyelitis diabetic foot biopsy, fat injection wound healing

Robert S. Kirsner Joel M. Gelfand

Summary: Published March 11, 2026 in the Guyana Times, this editorial responds to remarks by Guyana’s Health Minister Frank Anthony on World Diabetes Day documenting an increase in diabetes-related amputations in the country. More than one in seven Guyanese adults lives with diabetes, and data from the Georgetown Public Hospital Corporation show that a substantial proportion of diabetic foot infections ultimately result in amputation — reflecting, the editorial argues, failures not just at the clinical management stage but across the entire continuum of care: from prevention and primary care access through early detection, wound management, and multidisciplinary intervention. The piece frames the rising amputation rate as a systemic warning indicator rather than isolated clinical events. It contends that most diabetic amputations are preventable when complications are identified early, and calls for strengthened primary healthcare services capable of detecting warning signs before wounds become limb-threatening; comprehensive public health education campaigns on diabetic foot self-care, routine monitoring, and early symptom reporting; and investment in dedicated foot care clinics, wound management programmes, and vascular assessment tools. The editorial endorses the Health Ministry’s commitment to building multidisciplinary collaboration across surgical, internal medicine, and rehabilitation departments, noting that preserving limbs requires coordinated specialist care. The piece also connects the diabetic foot epidemic to a parallel kidney disease burden, welcoming the expansion of dialysis capacity across regional hospitals and the activation of additional dialysis chairs — and highlighting the continued importance of NGO and civil society partnerships in bridging specialist care gaps in remote communities. The editorial concludes with a call for the rising amputation count to be treated as an urgent prompt for a coordinated national response prioritising prevention, early intervention, and expanded specialised care across all of Guyana’s geographic regions.

Key Highlights:

• Guyana Health Minister Frank Anthony cited rising diabetes-related amputations on World Diabetes Day — Georgetown Public Hospital data show a substantial proportion of diabetic foot infections result in amputation
• More than 1 in 7 Guyanese adults lives with diabetes; diabetic foot infections are increasingly common and often escalate to amputation when detected late or inadequately managed
• Editorial frames amputations as largely preventable through: regular foot examinations, proper wound care, glycaemic control, and timely vascular/wound specialist intervention
• Recommended system-level responses: stronger primary care for early DFI detection; public education campaigns on diabetic self-care and foot symptom recognition; foot care clinics; wound management programmes; expanded vascular assessment
• Multidisciplinary care model advocated: surgery, internal medicine, nursing, and rehabilitation coordination required to maximise limb salvage and support recovery after amputation
• Parallel kidney burden: dialysis infrastructure expansion across regional hospitals and continued NGO partnerships cited as essential alongside foot care improvements to address the full spectrum of diabetes complications

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Keywords: diabetes amputation prevention, diabetic foot infection global, diabetic foot care public health, wound care access developing countries, limb salvage diabetes policy, diabetes complications wound care

Guyana Times Editorial Board

Longevity Medical Institute Physicians and Scientists Publish Peer-Reviewed Research on Stem Cell Therapies for Diabetic Foot Ulcers

Summary: Physicians and scientists from Longevity Medical Institute® (Los Cabos, Baja California Sur, Mexico) announced on March 11, 2026 the publication of a peer-reviewed systematic review and meta-analysis in the Journal of Surgery and Medical Case Reports (DOI: 10.64142/jsmcr.3.1.59) titled “Allogeneic Mesenchymal Stromal Cell-Based Therapies for Diabetic Foot Ulcers: Systematic Review and Meta-Analysis of Controlled Topical and Local Delivery Trials.” The research team, led by Kirk Sanford, DC (Longevity Medical Institute founder), included Félix Porras, MD; Fergie Martínez, MD, MSc; Hugo Ramos, MD; Janine Zamitiz, MD, MSc; Carlos Green, MSc; and Edward Ramsay, MSc. The study reviewed and meta-analysed controlled clinical studies examining allogeneic mesenchymal stem cell (MSC) therapies delivered by topical application or local injection in patients with diabetic foot ulcers — a population for which conventional treatments frequently fail due to diabetes-related impairments in circulation, immune function, and tissue repair signalling. The analysis found that MSC therapies were associated with improved wound closure rates and greater reductions in ulcer size compared with standard wound care alone. Proposed biological mechanisms include immune modulation, promotion of angiogenesis, and activation of regenerative signalling pathways involved in tissue repair. The publication is notable given Mexico’s large stem cell clinic sector, where relatively little peer-reviewed research originates domestically. Longevity Medical Institute recently opened a federally licensed Stem Cell and Regenerative Medicine Biotechnology Laboratory in Los Cabos under COFEPRIS, Mexico’s national regulatory authority, and operates an integrated medical campus offering AI-enhanced full-body MRI imaging, cardiovascular assessment, a clinical laboratory measuring over 120 biomarkers, and surgical services. Readers should note that Longevity Medical Institute is a for-profit regenerative medicine center and this publication should be evaluated alongside the full study methodology and independent literature.

Key Highlights:

• Systematic review and meta-analysis of controlled trials: allogeneic MSC therapies (topical and local injection delivery) for DFUs; Journal of Surgery and Medical Case Reports; DOI: 10.64142/jsmcr.3.1.59; March 2026
• Key finding: MSC therapies associated with improved wound closure rates and greater ulcer size reduction versus standard care alone across controlled clinical studies
• Proposed mechanisms: MSC-mediated immune modulation, angiogenesis promotion, and activation of regenerative tissue repair signalling — addressing the chronic inflammatory and hypoperfused DFU microenvironment
• Institutional context: COFEPRIS-licensed biotechnology laboratory in Los Cabos; integrated medical campus with AI-enhanced MRI, cardiovascular assessment, biomarker laboratory, and surgical services
• Research team: Kirk Sanford, DC (lead); Félix Porras, MD (Medical Director); Fergie Martínez, MD, MSc; Hugo Ramos, MD; Janine Zamitiz, MD, MSc; Carlos Green, MSc; Edward Ramsay, MSc
• Context note: Longevity Medical Institute is a for-profit stem cell and regenerative medicine center; readers are encouraged to review the full publication methodology and evaluate the findings alongside independent systematic reviews in the MSC/DFU literature

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Keywords: mesenchymal stem cell diabetic foot ulcer, stem cell therapy chronic wound, allogeneic MSC wound healing, regenerative medicine diabetic wound, DFU stem cell meta-analysis, wound closure stem cell therapy

Kirk Sanford Félix Porras Fergie Martínez Hugo Ramos Janine Zamitiz Carlos Green Edward Ramsay

Predominance of Multidrug-Resistant Bacteria with High Resistance to Empiric Antibiotics in Diabetic Foot Ulcers: A Cross-Sectional Study

Summary: Published March 11, 2026 in Scientific Reports (Nature), this cross-sectional study from IMU University (Kuala Lumpur, Malaysia) and Universiti Putra Malaysia characterizes the bacterial profile and antibiotic resistance landscape in 153 patients with diabetic foot ulcers (DFUs). Gram-positive bacteria predominated (62% of isolates), led by Staphylococcus aureus and coagulase-negative staphylococci (CoNS), with Gram-negative pathogens Pseudomonas aeruginosa and Klebsiella pneumoniae also prominent. Multidrug resistance (MDR) was observed in approximately 95% of Gram-negative isolates and 60–87% of Gram-positive isolates, with a median resistance profile spanning 9–11 different antibiotics per isolate — the majority of which are included in current empirical DFU treatment regimens. This means standard first-line therapy is likely to be ineffective in the majority of cases without prior culture-guided selection. The authors applied the WHO AWaRe (Access, Watch, Reserve) antibiotic classification framework to identify agents that can be prioritised for DFU treatment while protecting Reserve-category antibiotics (such as carbapenems and last-resort agents) for confirmed MDR cases only. The findings urgently underscore the need for microbiological profiling of DFU infections before initiating antibiotics, periodic updates to institutional empirical treatment protocols, and strengthened antimicrobial stewardship programs. Malaysia has one of Southeast Asia’s highest diabetes prevalence rates, and MDR in diabetic foot infections significantly increases the risk of amputation, prolonged hospitalisation, and mortality. The study was funded by IMU University’s internal research grant and conducted in accordance with national ethics registration requirements (NMRR KKM/NIHSEC/P18-2188).

Key Highlights:

• 153 DFU patients; 62% Gram-positive isolates (dominated by S. aureus and CoNS), 38% Gram-negative (P. aeruginosa, K. pneumoniae) — consistent with the polymicrobial DFI profile observed globally
• MDR prevalence: ~95% of Gram-negative and 60–87% of Gram-positive isolates met MDR criteria; median resistance to 9–11 antibiotics per isolate — most of which appear in standard empirical regimens
• WHO AWaRe framework applied: Access-category antibiotics prioritised where effective; Watch-category used with culture guidance; Reserve-category antibiotics strictly protected for confirmed MDR cases
• Clinical implication: routine wound culture and sensitivity testing is essential before or alongside empirical antibiotic initiation; institutional treatment protocols require periodic evidence-based updates
• Malaysia context: DFU affects approximately 20–25% of people with diabetes at some point; MDR in diabetic foot infections increases amputation risk, hospitalisation duration, and mortality
• Antibiotic stewardship: study supports integration of DFU microbiology profiling into standard wound care protocols as a patient safety and antimicrobial conservation priority

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Keywords: multidrug resistant diabetic foot infection, DFU antibiotic resistance, diabetic foot infection microbiology, antibiotic stewardship wound care, Staphylococcus aureus diabetic foot, AWaRe antibiotic classification

Natasha Nabila Mohammed Shoaib Ebenezer Chitra Jing Rou Ong Willem B. Jay Tan Vasantha Kumari Neela Ashraf Hakim Ab Halim Fabian Davamani

Ultrasonic Cleaning Is Not a Machine; It Is a Quality System: Preventing Hidden Bioburden in Surgical Instruments

Summary: Published in the March 2026 issue of Infection Control Today (Vol. 30, No. 1), this article by Marjorie Wall, EDBA, CRCST, CIS, CHL, CSSBB, argues compellingly that ultrasonic cleaning in the sterile processing department (SPD) must be conceptualized and managed not as a piece of equipment but as a validated patient safety quality system — with the same rigor applied to sterilizers and washer/disinfectors. The core argument is that while ultrasonic cleaning is the most effective available tool for removing microscopic soil from complex surgical instruments — using cavitation (imploding microscopic bubbles generated by high-frequency sound waves) to dislodge debris from serrations, hinges, box locks, cannulations, and lumens that manual brushing cannot reliably address — its effectiveness is entirely dependent on whether the system is correctly managed, monitored, and maintained. The article identifies the central patient safety risk: ultrasonic cleaning can fail silently. Instruments may appear clean, packaging may be intact, and sterilization indicators may have changed — yet retained bioburden can remain trapped in lumens and complex features. This invisible failure can lead to surgical site infections, operating room tray recalls, and medico-legal exposure without any obvious proximate cause. Drawing on Anderson et al. (AORN Journal, 2023), Wall identifies three core performance components that every facility must continuously verify: (1) cavitation performance — using objective cavitation indicators to confirm adequate ultrasonic energy generation (not simply “running the cycle”); (2) soil removal effectiveness — using synthetic soil challenge tests that mimic blood and tissue to confirm cleaning under real working conditions; and (3) lumen perfusion — confirming that lumened devices are correctly connected to irrigation ports and that internal surfaces are actually being flushed, not just externally exposed to cavitation. Water quality is addressed as a frequently overlooked but critical variable: water hardness, endotoxin levels, temperature, ion content, and microbial load all affect detergent performance and cleaning efficacy, and Wall advocates for including ultrasonic washers in facility water management programs as a shared infection prevention priority. The article concludes with a seven-question IP audit framework for SPD rounds and a discussion of how strong ultrasonic programs build trust between SPD and the perioperative team.

Key Highlights:

• Ultrasonic cleaning must be managed as a validated quality system — installation qualification (IQ), operational qualification (OQ), and performance qualification (PQ) testing required, mirroring sterilizer validation standards
• Three verifiable performance components: (1) cavitation — use objective cavitation indicators, not visual inspection; (2) soil removal — use synthetic soil challenge tests simulating blood and tissue; (3) lumen perfusion — confirm irrigation port connection, adapter compatibility, tubing integrity, and flow adequacy
• Most dangerous failure mode is the invisible one: instruments that appear clean may still harbour retained bioburden in lumens, serrations, and box locks — risking SSI, OR delays, and tray recalls without obvious proximate cause
• Water quality as a shared infection-prevention priority: hard water, elevated endotoxins, and microbial contamination reduce cavitation effectiveness and detergent performance — facilities should include ultrasonic washers in water management programs, requiring collaboration across SPD, facilities management, and clinical engineering
• Common operational failures: overloading tanks, instruments closed rather than open, inadequate degassing, improper detergent selection, poor solution change practices, kinked or misconnected lumen tubing, lack of preventive maintenance, inconsistent staff competency validation
• Seven-question IP audit: written IFU-aligned policies; cavitation verification frequency and documentation; consistent lumen port connection; soil indicator use and trend tracking; corrective action process for failed tests; water type and quality monitoring; preventive maintenance schedule documentation

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Keywords: sterile processing wound care, surgical instrument bioburden, ultrasonic cleaning instruments, infection prevention surgical instruments, sterile processing quality system, surgical site infection prevention

Beyond Rejection: Engineering Immune Responses to Redefine Skin Graft Survival

Summary: Published March 10, 2026 in Frontiers in Immunology (Inflammation section), this mini review from Touro College of Osteopathic Medicine and New York Medical College examines the immunologic landscape governing skin graft outcomes — a topic of direct relevance to wound care practitioners managing patients with burns, chronic ulcers, trauma, and post-excisional defects requiring grafting. The global burden is substantial: WHO estimates 180,000 burn deaths annually and approximately 11 million non-fatal burn injuries, with split-thickness skin graft (STSG) take rates of 70–90% under favorable conditions but lower in resource-limited or high-comorbidity settings. The authors systematically map the immune mechanisms underlying graft rejection: hyperacute rejection is driven by preformed recipient antibodies activating the classical complement cascade, triggering thrombosis and ischemia via MAC formation; early acute rejection involves neutrophil and macrophage recruitment, ROS generation, and NK cell cytotoxicity; acute cellular rejection is mediated by direct and indirect T cell allorecognition pathways (CD4+ Th1 activation driving IFN-γ and macrophage activation; CD8+ cytotoxicity); and chronic rejection involves alloantibody production, MMP-driven ECM degradation, and fibrosis. The review contrasts STSG and full-thickness skin grafts (FTSG) immunologically — FTSGs retain dermal Langerhans cells and are significantly more immunogenic. The therapeutic sections evaluate conventional immunosuppression (tacrolimus, corticosteroids, cyclosporine), bioengineered scaffolds incorporating anti-TNFα or anti-IL-6 agents and antioxidant nanoparticles, 3D bioprinted constructs with immune-evasive materials, and MSC-conditioned media for macrophage polarization toward the M2 repair phenotype. The authors candidly address translational barriers: murine skin models poorly replicate human immunogenetics and skin architecture, phase I/II trial data are limited, and regulatory pathways for bioengineered constructs remain demanding. They advocate for humanized models, longitudinal multicenter trials, and personalized immunotherapy approaches.

Key Highlights:

• STSG take rates 70–90% in ideal conditions; key failure predictors: postoperative infection, hematoma, poor perfusion, diabetes, malnutrition, smoking, immunosuppression
• Rejection mechanisms: hyperacute (preformed antibodies → complement → MAC → thrombosis); acute cellular (T cell allorecognition, CD4+/CD8+ cytotoxicity); chronic (indirect allorecognition → alloantibody, MMP-driven fibrosis); FTSG more immunogenic than STSG due to retained Langerhans cells
• ROS, pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), and MMP-2/MMP-9 amplify tissue injury and interfere with revascularization — but controlled inflammation is also necessary for angiogenesis and M2-driven tissue repair
• Emerging strategies: bioengineered scaffolds with anti-TNFα/anti-IL-6 agents and antioxidant nanoparticles; 3D bioprinted layered constructs using patient-derived keratinocytes and fibroblasts; in-situ portable bioprinting for direct wound deposition; MSC conditioned media for macrophage M2 polarization
• Conventional immunosuppression (tacrolimus, cyclosporine, corticosteroids) reduces rejection but limited by systemic toxicity and impaired wound healing; skin grafts among the most immunogenic tissues, often inadequately controlled by standard systemic regimens
• Translational barriers: murine models diverge from human immunogenetics, skin structure, and microbiome; limited phase I/II human data; regulatory complexity for biomaterial and gene-edited constructs; need for humanized models and stratified multicenter trials

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Keywords: skin graft rejection immunology, skin graft survival wound care, bioengineered skin scaffold, split thickness skin graft, immunomodulation wound healing, 3D bioprinting wound repair

Daniela Grinis Jacob Bouzaglou Anish R. Maskey

Postoperative Buttock Skin Injuries Not Explained by Electrosurgical Burns: Three Cases Suggesting an Ischemia–Reperfusion Mechanism

Summary: Published March 10, 2026 in the Journal of Clinical Medicine (MDPI), this case series from Tenri Hospital (Nara, Japan) presents three perioperative patients who developed painful buttock/sacral skin lesions on postoperative day 1 — a pattern traditionally attributed in the Japanese dermatological literature to stray electrosurgical burns. The authors challenge this attribution on both electrophysical and clinical grounds, arguing instead that these lesions represent ischemia–reperfusion-related deep tissue injury (DTI), consistent with NPIAP/EPUAP pressure injury classification. Case 1 was an 80-year-old woman following 8-hour coronary bypass surgery, in whom the mesh-pattern erythema precisely matched the intraoperative warm-water circulating blanket (a nonconductive device), with CK peaking at 2,448 U/L; histology showed no thermal necrosis, only mild capillary dilation. Case 2 was a 15-year-old girl after anterior cruciate ligament reconstruction using only bipolar electrocautery (not monopolar), who developed diffuse bilateral gluteal swelling with markedly elevated enzymes (CK 6,075 U/L; AST 321; LDH 511) and CT-confirmed bilateral gluteal muscle oedema. Case 3 was an 87-year-old woman after hip fracture fixation in which no electrosurgical device was used at all, yet she developed a 6×7.7 cm sacral erythema with central ulcerative necrosis, and ultrasound confirmed gluteal muscle oedema. The proposed mechanism — surgical mechanical loading → localized deep tissue ischemia → reperfusion-triggered oxidative stress, ROS generation, and inflammatory cascade → delayed subcutaneous and muscle injury — explains the characteristic 12–24 hour delay in lesion appearance that is inconsistent with immediate thermal injury. The authors also note that misattribution to electrosurgical burns has medico-legal and institutional implications, and call for multidisciplinary evaluation (dermatology, anaesthesiology, clinical engineering) of such events.

Key Highlights:

• Three cases: 80-year-old (8-h CABG), 15-year-old (ACL reconstruction with bipolar only), 87-year-old (hip fixation, no electrosurgery) — all developed painful buttock/sacral lesions on postoperative day 1 with intact skin at OR discharge
• Electrosurgical burn hypothesis refuted per case: (1) nonconductive warming device matched lesion morphology; (2) bipolar-only case excludes dispersed monopolar stray current; (3) no electrosurgery used — leaving ischemia-reperfusion as the only plausible mechanism
• Markedly elevated muscle enzymes in Cases 2 and 3 (CK, AST, LDH) and CT/ultrasound evidence of gluteal muscle oedema confirm deep tissue involvement beneath intact or minimally disrupted skin
• Ischemia–reperfusion DTI mechanism: prolonged perioperative pressure → ischemia → reperfusion triggers ROS, endothelial injury, inflammatory cascade → delayed subcutaneous/muscle damage → skin manifestation 12–24 h postoperatively
• Histology (Case 1): intact epidermis and dermis with no necrosis or inflammation — consistent with early DTI, not thermal burn
• Clinical implication: perioperative pressure injury prevention (intraoperative positioning, padding, pressure redistribution) rather than electrosurgical equipment management is the appropriate preventive response; misattribution may misdirect incident investigations and delay correct preventive action

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Keywords: deep tissue injury perioperative, ischemia reperfusion pressure injury, postoperative pressure injury prevention, perioperative wound care, deep tissue pressure injury staging, surgical positioning skin injury

Hiroshi Tanabe Yoshinori Nakamura

Comparison of Tibial Cortex Transverse Transport and Free Anterolateral Thigh Perforator Flap in the Treatment of Severe Diabetic Foot Ulcers: A Retrospective Study

Summary: Published March 9, 2026 in Frontiers in Surgery (Orthopedic Surgery section), this retrospective study from the First Affiliated Hospital of Guangxi Medical University directly compares two surgical strategies for severe diabetic foot ulcers (DFUs) classified as Wagner grade 3 or 4 in 174 patients treated between January 2016 and December 2022. The two approaches are tibial cortex transverse transport (TTT), a minimally invasive technique that uses distraction angiogenesis — whereby a cortical bone window is incrementally transported in a transverse vector, creating a biological stimulus for neovascularization, nerve regeneration, and microcirculatory reconstruction — and free anterolateral thigh perforator flap (ALTPF) reconstruction, a conventional microsurgical approach in which a skin and subcutaneous tissue flap is harvested from the lateral thigh and transferred to the wound. A total of 88 patients underwent TTT and 86 received ALTPF; baseline characteristics including Wagner grade, ulcer area, ABI, peripheral neuropathy prevalence, and osteomyelitis rates were comparable between groups. TTT was dramatically less invasive: mean operative time 59 vs. 274 minutes and blood loss 12 vs. 356 mL, with a transfusion rate of 3.4% vs. 43.0%. At one year or more of follow-up, the TTT group achieved a 97.7% ulcer healing rate versus 88.4% in the ALTPF group (p<0.05), with significantly lower ulcer recurrence (2.3% vs. 10.5%) and major amputation rates (1.1% vs. 7.0%). Three months postoperatively, TTT patients showed superior ankle-brachial index recovery (0.96 vs. 0.84), nerve conduction velocity (51.3 vs. 28.6 m/s), Semmes-Weinstein monofilament test restoration (93.2% vs. 77.9% negative), and Maryland Foot Score (85.2 vs. 80.0). Complications were minimal in the TTT group (two pin-tract infections); ALTPF saw four complete and six partial flap necrosis events, contributing to six major amputations. Authors caution that the retrospective design limits causal inference and that prospective RCTs are needed.

Key Highlights:

• 174 patients with Wagner grade 3–4 DFU; TTT n=88, ALTPF n=86; single-centre retrospective design; minimum 1-year follow-up; First Affiliated Hospital of Guangxi Medical University
• TTT operative time 59 min vs. 274 min (ALTPF); blood loss 12 mL vs. 356 mL; transfusion rate 3.4% vs. 43.0% — all highly significant (p<0.05)
• Healing rate: 97.7% (TTT) vs. 88.4% (ALTPF); recurrence: 2.3% vs. 10.5%; major amputation: 1.1% vs. 7.0% — all p<0.05
• TTT mechanism: transverse tibial cortex distraction stimulates HIF-1α-induced angiogenesis, activates SDF-1/CXCR4 signalling, promotes M2 macrophage polarization, and enhances collagen remodelling in the wound microenvironment
• Superior neurological recovery with TTT: NCV 51.3 vs. 28.6 m/s; SWMT negative rate 93.2% vs. 77.9%; Maryland Foot Score 85.2 vs. 80.0 (all p<0.05) — authors attribute this to TTT’s systemic improvement of limb microcirculation rather than ALTPF’s primarily local tissue coverage
• Limitations: retrospective, single-centre, n=174; prospective multicentre RCTs needed to validate generalizability; TTT complication rate low but includes rare risk of tibial fracture not observed in this cohort

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Keywords: tibial cortex transverse transport, diabetic foot ulcer surgery, anterolateral thigh flap DFU, limb salvage diabetic foot, distraction angiogenesis wound, Wagner grade diabetic foot ulcer

Shunan Dong Jiyong Jiang Sijie Yang Qikai Hua

Innovations in Diagnostics, Treatment and Delivery of Care: Advancing the Wound Care Toolkit

Summary: Editors Peta Tehan and Zlatko Kopecki present the Volume 33, Number 4 (2025) issue of Wound Practice and Research, the official journal of the Australian Wound Management Association (AWMA), published as an open-access diamond publication by Cambridge Media. This editorial introduces five contributions that collectively span the wound care toolkit — from early diagnostics to advanced therapies and care delivery innovation. The first is a case report by Astrada et al. in which point-of-care ultrasonography (POCUS) detected extensive subcutaneous gas gangrene extending to the Achilles tendon and calf in a 61-year-old patient with a closed diabetic foot ulcer — before visible tissue damage had occurred — enabling prompt debridement and antibiotic therapy. The second case by Lauryn and Suryadi describes the successful use of sequential NPWT followed by split-thickness skin graft (STSG) in a 54-year-old man who developed deep wound dehiscence and an enterocutaneous fistula following surgery for abdominal tuberculosis, achieving 95% wound healing within 46 days. The third contribution, a systematic review and meta-analysis by Somboonchokephisal, examines beta-glucan — a natural polysaccharide that promotes immune cell activation and tissue repair — finding a twofold increase in healing rates at 12 weeks for topical beta-glucan applied to chronic wounds. The fourth paper, by Binkanen et al., evaluates patient and caregiver satisfaction with virtual wound care services in Saudi Arabia, finding significantly higher satisfaction among patients than caregivers, with caregivers raising concerns about accessibility and communication. Finally, a WHAM evidence summary addresses silicone gel sheeting for hypertrophic scars, concluding it may reduce pain and scar severity when clinical decisions account for symptom severity, patient preference, and adherence capacity.

Key Highlights:

• POCUS case: subcutaneous gas gangrene detected in a closed DFU before visible tissue damage — early detection enabled debridement and antibiotics, potentially preventing substantial tissue loss
• NPWT + STSG case: sequential negative pressure wound therapy followed by split-thickness skin graft achieved 95% healing within 46 days of treatment initiation in a complex postoperative dehiscence with enterocutaneous fistula
• Beta-glucan meta-analysis: topical beta-glucan application to chronic wounds associated with twofold increase in healing rates at 12 weeks — proposed mechanism is immune cell activation and resolution of persistent inflammation
• Telehealth satisfaction study (Saudi Arabia): patients reported significantly higher satisfaction than caregivers with virtual wound care services — caregiver concerns around accessibility and communication highlight the need for targeted support and training
• WHAM silicone sheeting summary: silicone gel sheeting may reduce pain and scar severity in existing hypertrophic scars — clinical decisions should be individualized based on scar characteristics and patient adherence capacity
• Wound Practice and Research is diamond open access (no APC) and indexed by AWMA; DOI 10.33235/wpr.33.4.155; Vol. 33 No. 4, 2025

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Keywords: wound care diagnostics, POCUS diabetic foot ulcer, beta-glucan wound healing, telehealth wound care, silicone gel sheeting hypertrophic scar, NPWT skin graft

Peta Tehan Zlatko Kopecki

Multimodality Therapy Shows Promise of “Therapeutic Advance” in Lower Extremity Wound Treatment

Summary: Vascular News reported on March 1, 2026 on a special communication published in the January 2026 issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders (JVS-VL) in which lead author Joann M. Lohr (William Jennings Bryan Dorn VA Medical Center, Columbia, USA) and colleagues present a comprehensive review of the mechanistic, translational, and clinical evidence supporting the combined use of pressurised intermittent topical oxygen (TWO2) therapy and non-contact cyclical compression as an integrative multimodality approach to lower extremity wound management. The central argument is that chronic wounds — including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) — persist through a self-reinforcing cycle of tissue hypoxia, oedema, persistent inflammation, lymphatic dysfunction, ischaemia/reperfusion injury, bioburden, and tissue fibrosis. Most current interventions address only one or two of these drivers simultaneously, limiting efficacy. The proposed combination targets three key pathophysiological drivers concurrently: topical oxygen increases tissue oxygen tension, enhances microbial defence, promotes inflammation resolution through redox signalling and specialised pro-resolving mediator (SPM) synthesis, supports angiogenesis, and optimises collagen synthesis and ECM remodelling during tissue repair; while non-contact cyclical compression improves lymphatic clearance of inflammatory mediators, reduces oedema, restores perfusion, mitigates ischaemia/reperfusion injury, and activates mechanotransductive pathways supporting angiogenesis and tissue repair. Together, the authors argue, these modalities exert synergistic effects across multiple wound repair mechanisms, making the combination a potentially significant therapeutic advance. The review draws on a 2020 double-blinded RCT (Frykberg et al., Diabetes Care) showing 41.7% DFU closure at 12 weeks versus 13.5% in controls (p=0.004), with only 6.7% recurrence at 12 months versus 40% in controls; and a 132-patient prospective controlled study (Twafick et al., 2012) showing 76% versus 46% VLU healing (p<0.0001) with median time-to-closure of 57 versus 107 days. The TWO2 technology is marketed by AOTI Inc.; co-author Melodie M. Blakely is a clinical investigator for AOTI.

Key Highlights:

• Combination targets a “trifecta” of chronic wound drivers: tissue hypoxia, persistent inflammation, and lymphatic dysfunction — simultaneously, through two synergistic modalities
• Topical oxygen mechanism: raises wound tissue oxygen tension, enhances antimicrobial defence, drives SPM synthesis for inflammation resolution, supports angiogenesis and durable collagen crosslinking
• Cyclical compression mechanism: clears inflammatory mediators via lymphatic drainage, reduces oedema, restores microvascular perfusion, activates mechanotransductive repair pathways
• DFU RCT (Frykberg, Diabetes Care 2020): 41.7% closure at 12 weeks vs. 13.5% control (p=0.004); 56% vs. 27% at 12 months (p=0.013); 6.7% vs. 40% recurrence (p=0.070)
• VLU study (Twafick, 2012, n=132): 76% vs. 46% healing (p<0.0001); median time-to-closure 57 vs. 107 days; 6% vs. 47% recurrence at 36 months (p<0.0001)
• Authors conclude the integrative approach may “accelerate healing, enhance clinical outcomes, reduce complications, and achieve durable closure in difficult wounds of varied aetiologies” — framing it as adjunctive to current best practice standard wound care

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Keywords: topical oxygen therapy wound, cyclical compression wound healing, multimodality wound treatment, venous leg ulcer treatment, diabetic foot ulcer oxygen, wound hypoxia lymphatic

Joann M. Lohr Melodie M. Blakely

Summary: WoundSource, the HMP Global wound care product and education platform, publishes this foundational reimbursement reference article defining the core billing and coding terminology that wound care clinicians, nurses, and administrators encounter when managing Medicare and commercial payer claims. Given the complexity of wound care billing — where reimbursement rates are high, documentation requirements are stringent, and errors carry significant financial and compliance risk — fluency in reimbursement terminology is increasingly treated as a core clinical competency rather than an administrative function. The glossary covers the principal coding systems used in wound care: Current Procedural Terminology (CPT) codes, which describe procedures performed and in wound care often specify anatomic location and wound size (e.g., debridement codes 97597–97598 for skin, 11042–11047 for deeper tissue); Healthcare Common Procedure Coding System (HCPCS) Level II codes, a standardized CMS-maintained coding system for products, supplies, and durable medical equipment not captured by CPT (e.g., foam dressing code A6209); and ICD-10-CM diagnosis codes, which identify wound etiology and are essential for demonstrating medical necessity. The article also defines the administrative structures that govern reimbursement decisions: Medicare Administrative Contractors (MACs), which are regionally based Medicare insurers that process claims, handle provider enrollment, conduct audits, and establish Local Coverage Determinations (LCDs); and the LCD itself, which is a MAC-issued coverage policy for specific procedure or service categories that dictates covered indications, required documentation, and billing restrictions. Additional terms include the global period (a defined post-procedure window during which related services cannot be separately billed), modifiers (two-character alphanumeric codes appended to CPT or HCPCS codes to provide additional billing context, such as Modifier 25 for same-day E&M and procedure billing, or Modifier 59 for distinct procedural services), and place-of-service (POS) codes, which designate the care setting and directly affect which codes and coverage rules apply.

Key Highlights:

• CPT codes: identify the procedure performed — wound care-specific codes include 97597–97598 (selective debridement, skin), 11042–11047 (subcutaneous/deeper tissue debridement), and 97605–97606 (NPWT); codes often require documentation of wound size and anatomic location
• HCPCS Level II: CMS-maintained coding for durable medical equipment and supplies not covered by CPT — wound dressings, NPWT devices, and compression products are commonly billed using HCPCS A-codes and K-codes
• ICD-10-CM: diagnosis code paired with every CPT/HCPCS code — must accurately reflect wound etiology (e.g., L89.xx pressure injury, E11.621 type 2 DM with foot ulcer) to establish medical necessity
• MAC and LCD: MACs are regional Medicare contractors that administer claims and set LCDs — coverage for a given wound care service may vary by MAC jurisdiction, making local LCD review essential before billing
• Modifiers 25 and 59 are among the most commonly used in wound care: Modifier 25 permits billing a separate E&M service on the same day as a procedure; Modifier 59 identifies a distinct procedural service from another procedure billed that day
• Global period and POS codes: global periods can preclude separate billing of post-procedure wound care visits; POS designation (e.g., POS 11 office, POS 19/22 outpatient hospital, POS 31/32 SNF) affects applicable fee schedules and coverage rules

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Keywords: wound care billing coding, CPT codes wound care, Medicare wound care reimbursement, LCD wound care, HCPCS wound dressings, wound care documentation

WoundSource Editorial Team

How to Talk to Patients About Their Wounds: Tips for Building Trust and Compliance

Summary: Published by Wound Care Professionals on December 2, 2025, this four-minute practice article addresses a frequently underemphasized dimension of wound management: the clinician-patient communication relationship. The piece opens with a striking statistic — research suggests that up to 50% of chronic wound care plans are not followed as prescribed, most commonly because of patient fear, misunderstanding, or insufficient trust in the care team. The author, Nancy Morgan, frames wound care communication not simply as information transfer, but as a two-way dialogue that builds partnership and forms the foundation for long-term compliance. The article outlines five actionable strategies. First, setting a warm and non-judgmental tone early — acknowledging the emotional burden of chronic wounds before diving into clinical details. Second, balancing accessibility with respect: avoiding oversimplification while still translating clinical terminology into plain-language explanations, with visuals of healing stage diagrams recommended where available. Third, involving patients in goal-setting by asking what aspects of the care plan may be difficult to follow in their daily routine — creating shared ownership of the wound care process. Fourth, explaining healing progress honestly and managing expectations around the nonlinear nature of wound repair, including the inflammatory, proliferative, and maturation phases, and using photos or measurements to make progress visible and motivating. Fifth, educating for long-term compliance beyond the immediate wound — including dietary guidance, hygiene, footwear for diabetic patients, and links to community support resources. The article is primarily directed at nurses, therapists, physicians, and home health providers, and is published as part of Wound Care Professionals’ broader educational and certification program portfolio.

Key Highlights:

• Up to 50% of chronic wound care plans are not followed as prescribed — most commonly due to fear, misunderstanding, or low trust in the care team
• Five strategies: (1) non-judgmental tone-setting; (2) plain-language explanation without condescension; (3) patient involvement in goal-setting; (4) transparent healing expectation management; (5) long-term compliance education
• Clinicians advised to validate the emotional impact of wounds before presenting clinical information — particularly important for patients experiencing shame, anxiety, or grief about their wound
• Wound photographs with patient consent recommended as motivational progress-tracking tools — transforming subjective improvement into visible, measurable progress
• Long-term compliance framing: wound care as a lifestyle shift requiring ongoing patient education on prevention, nutrition, hygiene, and footwear
• Applies across all care settings: hospital inpatient, outpatient wound clinic, home health, and long-term care — relevant to any clinician managing chronic or recurring wounds

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Keywords: wound care patient communication, wound care compliance, patient education wound care, chronic wound adherence, wound care trust building, wound care nurse communication

Nancy Morgan

Use of Hypothermically Stored Amniotic Membrane on Diabetic Foot Ulcers: A Multicentre Retrospective Case Series

Summary: Researchers from US-based wound care sites published a multicentre retrospective case series in the Journal of Wound Care (March 2024 supplement) reporting clinical outcomes for diabetic foot ulcers (DFUs) managed with hypothermically stored amniotic membrane (HSAM), a cellular, acellular and matrix-like product (CAMP) classified as a human cellular and tissue-based product (HCT/P) under FDA oversight. HSAM differs from dehydrated and cryopreserved amniotic membrane allografts in that hypothermic storage conditions preserve viable differentiated and stem cell populations, growth factors, cytokines, and extracellular matrix proteins more completely — a distinction the authors argue may enhance clinical effectiveness. The study enrolled 50 patients across multiple US wound care sites; 68% were male with a mean age of 66.7 years. The majority of DFUs (88%) were present for fewer than 6 months at first presentation, and mean wound area at first presentation was 3.5 cm². From first presentation to baseline (the visit at which HSAM was first applied), mean percentage wound area reduction was −68.3%, reflecting the contribution of standard of care (SoC) pre-treatment. HSAM was then applied on top of continued SoC, and patients were followed over 12 weeks. The results suggest positive outcomes in terms of continued wound closure, with reduction in time to complete wound closure (CWC) noted as a key patient benefit — since shortened healing time translates to reduced financial burden and improved quality of life. The case series adds real-world evidence to prior randomized controlled trial data for HSAM in DFUs, including a 14-site RCT (Serena et al., 2020) that demonstrated a 60% closure rate at 12 weeks and a 75% greater probability of weekly wound closure versus standard of care alone.

Key Highlights:

• 50 patients across multiple US wound care sites; 68% male, mean age 66.7 years; 88% of DFUs present <6 months at first presentation
• Mean wound area 3.5 cm²; mean percentage area reduction of −68.3% from first presentation to HSAM baseline (reflecting SoC pre-treatment effect)
• HSAM mechanism: hypothermic storage preserves viable cells, stem cells, growth factors, cytokines, and ECM proteins — a key advantage over dehydrated and cryopreserved amnion products
• Prior RCT (Serena et al., 2020, n=76): HSAM produced 60% closure at 12 weeks vs. 38% SoC (p=0.004) and 75% greater probability of wound closure on a weekly basis over 16 weeks
• Shortened time to CWC cited as having downstream financial and quality-of-life benefits — average DFU cost estimated at $38,000–$54,000 if leading to amputation
• Authors: Anna Sanchez (San Antonio New Step, TX), Alan Hartstein and Hisham Ashry (Palm Beach Foot & Ankle, FL), Maryam Raza; data coordination supported by Organogenesis Inc.

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Keywords: amniotic membrane wound care, hypothermically stored amniotic membrane, diabetic foot ulcer CAMPs, placental allograft wound, HSAM DFU, cellular tissue products wound healing

Anna Sanchez Alan Hartstein Hisham Ashry Maryam Raza

Summary: A new article has been published in the International Journal of Lower Extremity Wounds (IJLEW), a quarterly peer-reviewed SAGE publication and one of the leading interdisciplinary journals dedicated to the science and practice of lower extremity wound management. IJLEW covers original research, literature reviews, case reports, and clinical commentary for a broad audience including vascular surgeons, podiatrists, plastic surgeons, orthopedic specialists, diabetologists, wound care nurses, and allied health professionals. The journal’s scope encompasses burns, stomas, ulcers, fistulas, and traumatic wounds of the lower extremity, as well as evaluations of assessment and monitoring tools, dressings, gels, pressure management systems, footwear and orthotics, casting, and bioengineered skin constructs. With an average time from submission to first editorial decision of approximately 29 days, IJLEW is a rapid-dissemination venue for clinically important lower extremity wound research. The specific article at this DOI (10.1177/15347346251415253) is available to institutional subscribers and individual access purchasers via SAGE Journals. Full-text access is restricted; the link below will direct readers to the article abstract and access options on the SAGE platform.

Key Highlights:

• Published in International Journal of Lower Extremity Wounds — SAGE’s quarterly peer-reviewed journal covering burns, ulcers, fistulas, stomas, and traumatic lower extremity wounds
• Interdisciplinary scope: vascular surgery, podiatry, reconstructive plastic surgery, orthotics, diabetology, nursing, and allied health professions
• Journal also evaluates dressings, gels, cleansers, pressure management systems, footwear, orthotics, casting, and bioengineered skin — making it a key resource for wound product evidence
• IJLEW is indexed in PubMed/MEDLINE, EMBASE, and multiple international databases; impact factor 1.5 (5-year: 1.9)
• Full-text access requires SAGE subscription or per-article purchase; institutional access available through most major academic medical libraries
• Relevance: Staying current with IJLEW content is essential for lower extremity wound specialists — particularly for DFU, VLU, pressure injury, and post-surgical wound management evidence

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Keywords: lower extremity wounds, diabetic foot ulcer research, venous leg ulcer, wound care journal, podiatry wound care, SAGE wound research

TLC-NOSF Dressings as a First-Line Local Treatment of Chronic Wounds: A Systematic Review of Clinical Evidence

Summary: A landmark systematic review published in the Journal of Wound Care (October 2024) provides the most comprehensive synthesis to date of clinical evidence supporting lipidocolloid technology with nano-oligosaccharide factor (TLC-NOSF) dressings — the UrgoStart dressing range (Laboratoires Urgo, France) — as a first-line local treatment for chronic wounds. Although multiple national and international guidelines already recommend TLC-NOSF dressings, they remain widely prescribed as second-line options in practice, leading to delayed patient benefit and increased payer costs. The review, conducted by an 23-member international panel, searched MEDLINE, Embase, Emcare, and Google Scholar through February 2024 with no language or time restrictions. Seventeen studies meeting eligibility criteria were included, encompassing 10,191 patients and 10,203 wounds across diabetic foot ulcers (DFUs), leg ulcers, pressure injuries, and other chronic wound types — 7,775 treated with TLC-NOSF and 2,428 with comparators. TLC-NOSF dressings function through a unique healing matrix: the TLC component forms a lipidocolloid gel on contact with exudate that prevents dressing adherence and trauma, while the NOSF (sucrose octasulfate) fraction inhibits matrix metalloproteinases (MMPs) that drive wound chronicity and has been shown to improve transcutaneous oxygen pressure, indicating microcirculation enhancement. Three comparative categories were analyzed: TLC-NOSF vs. standard dressings (both first-line, nine studies); first-line vs. second-line TLC-NOSF use (eight studies); and first-line use without a control group (five studies). Across all categories, first-line TLC-NOSF use produced healing rates of 70–80% by weeks 20–24, mean time-to-heal of approximately seven weeks, measurable quality of life improvements, strong patient tolerability and acceptance, and cost savings vs. comparators. Real-world evidence mirrored RCT outcomes across settings and patient populations. The review’s conclusions are aligned with NICE guidance (updated 2023) and French Haute Autorité de Santé recognition, and support the argument that withholding TLC-NOSF as a first-line intervention represents a missed clinical and economic opportunity.

Key Highlights:

• 17 studies, 10,191 patients, 10,203 wounds: TLC-NOSF as first-line treatment consistently outperformed standard dressings on healing rate, time-to-heal, QoL, and cost
• Healing rates 70–80% by weeks 20–24; mean time-to-heal ~7 weeks — with slightly longer times for more severe wound prognosis
• Mechanism: TLC matrix prevents dressing trauma and reduces MMP activity; NOSF (sucrose octasulfate) improves microcirculation and tcpO2 in DFUs
• First-line vs. second-line comparison (8 studies): earlier initiation consistently produced superior outcomes — supporting immediate adoption at first patient presentation
• Real-world evidence confirms RCT results across different healthcare settings, patient demographics, and wound types
• NICE guidance (2023) recommends UrgoStart for VLUs and DFUs; estimated NHS savings of £5.4M/year if universally applied — yet second-line use persists, representing an unresolved implementation gap

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Keywords: TLC-NOSF dressings, UrgoStart, chronic wound dressings, sucrose octasulfate, matrix metalloproteinase wound, wound healing systematic review

Marco Meloni Hester Colboc David G. Armstrong Joachim Dissemond Gerry Rayman José-Luis Lázaro-Martínez Rodrigo Rial Agnès Hartemann Leanne Atkin Terry Swanson Michele Goodeve Ralf Lobmann Martin Storck Knut Kröger Sebastian Borys Harikrishna KR Nair Sanjay Vaidya Thua Nguyen Tran Bao Le Thai Huynh Laetitia Thomassin Serge Bohbot Chris Manu Sylvie Meaume

Skin Sights from Winter Clinical Miami 2026: Key Dermatology Advances with Wound Care Relevance

Summary: Dermatology Times published a LinkedIn roundup of clinical highlights from the 2026 Winter Clinical Miami Dermatology Conference, held February 27–March 1 at the JW Marriott Miami Turnberry in Aventura, Florida. The three-day CME conference convened leading dermatologists for comprehensive updates across medical, surgical, and cosmetic dermatology. Sessions of particular relevance to wound care practitioners included content on inflammatory skin disease — including advances in biologics targeting IL-17, IL-23, and IL-4/13 pathways that intersect with skin barrier dysfunction and chronic wound inflammation — as well as melanoma diagnostics, acne and rosacea management, and emerging AI-driven practice tools. Mark Lebwohl, MD, presented advances in psoriasis including the investigational oral peptide icotrokinra and a new extended-release formulation of apremilast, while multiple sessions addressed atopic dermatitis pipeline progress, including new biologics and JAK inhibitors. The meeting also featured a session on pediatric dermatology, skin of color, and a 20-tips-in-20-minutes rapid-fire clinical pearls panel integrating practice management, off-label treatment considerations, and AI-driven operational strategies. A separate track for early-career dermatologists addressed contract negotiation, ethical industry collaboration, and workflow optimization. The LinkedIn article, produced by Dermatology Times, aggregates key takeaways relevant to dermatology and skin care practice from across the full conference program.

Key Highlights:

• Conference dates: February 27–March 1, 2026 | Location: JW Marriott Miami Turnberry, Aventura, Florida
• Psoriasis advances: icotrokinra (investigational oral peptide) and 75-mg extended-release apremilast — expanding the oral treatment landscape for inflammatory skin disease
• Atopic dermatitis pipeline: new biologics and JAK inhibitors discussed alongside IL-23 inhibition advances with tildrakizumab real-world Medicare durability data
• AI in practice: tools for EMR-based patient recall, aesthetic scheduling, and operational revenue generation — directly applicable to wound care clinic management
• Pediatric focus: Lisa Swanson, MD, shared prior-authorization-free treatment strategies and called for expanded research inclusion for children under 12
• Wound care relevance: advances in skin barrier biology, biologic immunology, and anti-inflammatory pathway targeting have direct implications for chronic wound pathophysiology and management

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Keywords: dermatology conference 2026, skin inflammation wound, biologics skin disease, atopic dermatitis, psoriasis wound care, Winter Clinical Miami

Dermatology Times Editorial Team

Using Patient-Reported Experiences to Inform the Use of Foam Dressings for Hard-to-Heal Wounds: Perspectives from a Wound Care Expert Panel

Summary: An international expert panel convened to address a persistent gap between clinical efficacy outcomes and the lived experience of patients managing hard-to-heal (chronic) wounds — published in the Journal of Wound Care (November 2024). The panel identified five core patient-reported experience (PRE) domains that are underserved by current dressing selection practice: wound-related pain, wound odour, wound-related itch, excessive exudate management, and self-care capacity. While foam dressings are widely selected based on exudate management benchmarks and laboratory performance data, the panel argues this fails to capture what matters most to patients, particularly those managing wounds over extended periods in community and home settings. The review maps specific foam dressing properties — including odour control features, atraumatic removal characteristics, high absorption and retention capacity, and extended wear time — to each PRE domain, providing a practical framework for dressing selection that centres patient experience. The paper also addresses self-management capacity, recognizing that many wound patients change their own dressings and require dressings that are straightforward to apply and remove independently. The panel calls on wound care providers, research scientists, and the healthcare industry to work collaboratively to address these unmet needs, and frames the paper as a call for accountability across all stakeholders involved in wound dressing development and deployment.

Key Highlights:

• Five PRE domains identified as priority targets for foam dressing design and selection: pain, odour, itch, exudate management, and self-care capacity
• Current foam dressing selection largely driven by lab performance data; panel argues clinical and patient-experience gaps remain underaddressed
• Dressing properties mapped to specific PRE outcomes — providing a practical selection framework for clinicians and product developers
• Self-management dimension elevated: dressings must support patients who independently manage their own wound care at home
• International panel spans nursing, podiatry, biomedical engineering, dermatology, and wound care research (11 institutions across 8 countries)
• Relevance: Patient-centred wound care is gaining policy traction; this framework supports both practice and regulatory discussions around real-world dressing performance

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Keywords: foam dressings, patient-reported outcomes wound care, hard-to-heal wounds, wound pain, wound odour, wound self-management

Kevin Woo Nick Santamaria Dimitri Beeckman Paulo Alves Breda Cullen Amit Gefen José Luis Lázaro-Martínez Hadar Lev-Tov Bijan Najafi Andrew Sharpe Terry Swanson

Cold Microwave Plasma Jets for Wound Healing: Antimicrobial Efficacy, Mechanisms and Changes in Microbial Cells

Summary: Researchers at Brno University of Technology (Czech Republic), in collaboration with partners in Prague, Brno, and Lublin (Poland), have published a comprehensive investigation of cold atmospheric plasma (CAP) as a non-thermal antimicrobial strategy for wound care applications, appearing in Scientific Reports on March 6, 2026. The study was motivated by the escalating global burden of antibiotic-resistant microorganisms and the need for effective non-antibiotic decontamination methods. Using a custom-built cold microwave plasma jet, the team demonstrated effective inactivation of four clinically relevant organisms: Staphylococcus epidermidis, Escherichia coli, Cutibacterium acnes, and Nakaseomyces glabratus (formerly Candida glabrata). A critical mechanistic finding was that reactive oxygen and nitrogen species (RONS) — not UV radiation — are primarily responsible for microbial inactivation, established through colorimetric agent experiments and enclosed vs. open-air environment comparisons. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed progressive morphological and intracellular changes in yeast cells following plasma treatment, including localized cell wall thinning and perforation, vacuole enlargement, enhanced vesicle formation, protoplast aggregation, and leakage of intracellular content — consistent with RONS-driven oxidative damage. Optimal treatment parameters balancing antimicrobial efficacy with safety for living tissue were also established, a prerequisite for clinical translation. The study builds on the group’s prior work on plasma sources for biomedical applications and contributes to the growing field of plasma medicine.

Key Highlights:

• Cold microwave plasma jets confirmed effective against S. epidermidis, E. coli, C. acnes, and N. glabratus — organisms spanning bacteria and fungi commonly implicated in wound infection
• RONS — not UV radiation — are the primary inactivation mechanism, confirmed through enclosed/open-air comparisons and colorimetric assays
• TEM analysis reveals progressive yeast cell wall thinning and perforation, vacuole enlargement, vesicle formation, and intracellular content leakage — a detailed ultrastructural map of plasma-induced cell death
• Optimal treatment parameters established balancing antimicrobial efficacy with tissue safety — a critical step toward clinical use
• Dedicated to the memory of co-author František Krčma, who constructed the MW plasma sources and secured funding; he passed away prior to publication
• Relevance: Non-antibiotic wound decontamination technology with growing preclinical evidence base — relevant as antibiotic resistance increasingly complicates chronic wound management

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Keywords: cold atmospheric plasma, plasma medicine, wound infection antimicrobial, antibiotic resistance wound, wound biofilm, RONS wound healing

Kristína Trebulová Veronika Loupová Barbora Chobotská Lukáš Kletzander Přemysl Menčík Zdenka Kozáková Jan Hrudka Joanna Pawlat Pavel Kulich František Krčma (deceased)

Coloplast Appoints Gavin Wood as President and CEO, Effective May 1, 2026

Summary: Coloplast (CSE: COLOB) announced on March 5, 2026 the appointment of Gavin Wood as President and Chief Executive Officer, effective May 1, 2026. The appointment concludes a year-long executive transition that began when former CEO Kristian Villumsen departed in May 2025, with Lars Rasmussen serving as interim CEO through the company’s operational challenges and strategy reset. Wood brings approximately two decades of senior medical technology leadership. Most recently he served as Company Group Chairman of Johnson & Johnson MedTech EMEA, overseeing a multi-billion-dollar business spanning Surgery, Orthopedics, and Cardiovascular and Specialty Solutions. Prior to that he was Worldwide President of J&J’s Ethicon wound closure business — providing direct wound care category expertise — and Executive Vice President Commercial at Mölnlycke, a global wound management manufacturer. He currently serves as Vice Chair of MedTech Europe. A Canadian national based in Switzerland, Wood will relocate to Denmark before assuming the role. He takes over as Coloplast implements its Impact4 strategic plan, announced in September 2025 to reset the company’s growth trajectory.

Key Highlights:

• Effective May 1, 2026: Gavin Wood becomes President and CEO, succeeding interim CEO Lars Rasmussen following Kristian Villumsen’s May 2025 departure
• Most recent role: Company Group Chairman, J&J MedTech EMEA — multi-billion-dollar portfolio across Surgery, Orthopedics, and Cardiovascular and Specialty Solutions
• Direct wound care background: Worldwide President of Ethicon wound closure at J&J; Executive VP Commercial at Mölnlycke
• Currently Vice Chair of MedTech Europe, the continent’s leading medical device trade association
• Takes the helm during execution of Coloplast’s Impact4 strategic plan, introduced September 2025 to drive sustainable growth
• Significant for wound care: Coloplast is a major global supplier of advanced wound dressings, ostomy care, and continence products

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Keywords: Coloplast, wound care industry news, medtech leadership, advanced wound care company, wound care CEO

Wound Care Billing in the USA: A Complete Guide to Accurate Reimbursement and Revenue Growth

Summary: Wound care has become one of the most complex areas of medical billing in the U.S., driven by rising chronic disease burden, a high-value product landscape, and evolving CMS coverage policies. A comprehensive guide published by PicGiraffe covers the full billing landscape — from foundational CPT code selection through the latest 2025–2026 regulatory changes. Wound care services map to CPT codes for debridement (97597–97598 for selective; 11042–11047 for surgical, stratified by tissue depth and wound area), NPWT (97605–97606), skin graft applications, and evaluation and management (E/M) services. ICD-10 codes must be accurately paired to establish medical necessity — especially nuanced for diabetic foot ulcers, venous leg ulcers, and pressure injuries. Modifier accuracy is critical: Modifier 59 prevents inappropriate bundling; the A1–A9 series addresses multiple wound sites. CMS updates effective 2025 tightened prior authorization for skin substitute grafts, required wastage documentation, and restricted same-day Modifier 25 usage. The January 2026 update to LCD L37166 clarified Medicare coverage for medically necessary wound care, and NCD 270.3 was reaffirmed to support platelet-rich plasma for chronic nonhealing diabetic wounds. Documentation and coding errors account for an estimated 30% of claim denials in this specialty.

Key Highlights:

• Core debridement CPT codes: 97597–97598 (selective, per 20 cm²) and 11042–11047 (surgical, by tissue depth) — code selection determined by wound characteristics
• ICD-10 pairing required for medical necessity; diabetic wound claims need the diabetes complication code (e.g., E11.621) plus site-specific ulcer code (e.g., L97.x)
• NPWT: CPT 97605 (≤50 cm²) or 97606 (>50 cm²) — both require supporting medical necessity documentation
• 2025 CMS updates: expanded prior authorization for skin substitute grafts, wastage documentation for graft billing, tightened Modifier 25 for same-day E/M + procedure claims
• LCD L37166 updated January 2026 for skin substitutes; NCD 270.3 reaffirmed supporting PRP for chronic nonhealing diabetic wounds
• ~30% of wound care claims denied due to documentation and coding errors — internal audits, EHR templates, and billing specialist engagement recommended

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Keywords: wound care billing, CPT codes wound care, CMS reimbursement, wound care coding, ICD-10 wound care, prior authorization wound care

New Research in Advances in Wound Care: Emerging Evidence for Clinical Practice

Summary: Advances in Wound Care — the official journal of the Wound Healing Society and the top-ranked wound care publication by impact factor — continues to publish high-impact translational research in 2026. A newly published article (DOI: 10.1177/15347346261428561) adds to its coverage spanning acute and chronic wound management, burns, surgical wounds, and diabetic ulcers. The journal, edited by Chandan K. Sen, PhD, at Indiana University School of Medicine, serves wound care physicians, nurses, advanced practice providers, biomedical engineers, and regenerative medicine researchers. Areas of active inquiry in early 2026 include antimicrobial stewardship in chronic wound infection, skin bioengineering and tissue regeneration, real-world evidence for cellular and acellular matrix products (CAMPs), and AI-assisted wound assessment. The full text of this specific article was not publicly accessible at time of formatting; the link below will direct readers to the full content.

Key Highlights:

• Advances in Wound Care is the Wound Healing Society’s flagship journal — top-ranked by impact factor in the wound care discipline
• 2026 output reflects sustained focus on biofilm management, wound bed preparation, and real-world Medicare data informing clinical practice
• Recent studies link over-reliance on clinical signs of infection to unnecessary antibiotic use — directly relevant to current antimicrobial stewardship initiatives
• Technology coverage includes 3D wound measurement, smart dressings, and AI-assisted assessment — priorities aligned with 2026 CMS policy updates
• WHS members receive discounted access; available via institutional subscription or direct purchase through SAGE Publications
• Note: Full text of DOI 10.1177/15347346261428561 was not retrievable due to access restrictions. Readers should access the full article directly.

Read full article

Keywords: advances in wound care, Wound Healing Society, chronic wound management, wound care research, translational wound research

Antibiotic-Loaded Bone Cement Significantly Improves Diabetic Foot Ulcer Outcomes: Systematic Review and Meta-Analysis

Summary: A systematic review and meta-analysis published in Frontiers in Cellular and Infection Microbiology (March 2026) evaluated antibiotic-loaded bone cement (ALBC) — a polymethylmethacrylate (PMMA)-based sustained-release drug delivery system — for managing diabetic foot ulcers (DFUs). Conducted by Xin Li and Zunhong Liang at Hainan Medical University, China, this is the most comprehensive synthesis to date, incorporating 22 randomized controlled trials (RCTs) and 1,295 patients. ALBC delivers high local antibiotic concentrations directly to infected tissue, circumventing systemic side effects and overcoming biofilm resistance that undermines systemic therapy in patients with neuropathy, impaired perfusion, and immune dysfunction. Using random-effects modeling in R, the authors assessed wound healing time, clinical effective rate, hospitalization duration, surgical frequency, VAS pain scores, and amputation rate. ALBC significantly shortened wound healing time by a mean of 7.10 days, improved clinical effective rate more than fourfold (OR = 4.05), reduced hospital stay by 8.56 days, decreased surgical frequency, lowered pain scores (SMD = −1.29), and reduced amputation risk by 81% (OR = 0.19) — with zero heterogeneity in the amputation outcome. Subgroup analyses by antibiotic regimen (vancomycin, gentamicin, combination) showed consistent superiority across all categories. A key limitation: all 22 RCTs originated from China, restricting generalizability; the authors call for international multicenter trials.

Key Highlights:

• 22 RCTs, 1,295 patients: ALBC shortened wound healing by 7.10 days and improved clinical effective rate fourfold (OR = 4.05) vs. standard care
• Amputation risk reduced 81% (OR = 0.19; I² = 0%) — the most consistent finding across all included studies
• Hospital stay shortened by 8.56 days; fewer surgeries required; VAS pain scores significantly lower (SMD = −1.29)
• Efficacy consistent regardless of antibiotic regimen — vancomycin, gentamicin, and combination therapy all outperformed controls
• Mechanism: high local antibiotic concentrations overcome biofilm-associated infection; Masquelet technique combination promotes vascularized membrane formation
• All studies China-based; authors call for international multicenter RCTs to establish global external validity

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Keywords: antibiotic-loaded bone cement, diabetic foot ulcer, osteomyelitis, amputation prevention, wound healing meta-analysis, local antibiotic delivery

Xin Li, Zunhong Liang — Hainan Medical University / Hainan General Hospital, Haikou, China

Premier Awards Medline New National Agreement for Advanced Wound Care Dressings

Summary: February 2026 announcement: Premier Inc., a leading healthcare improvement company, awards Medline Industries a new national agreement for advanced wound care dressings. Covers foam, hydrocolloid, alginate, silver-impregnated, and other dressings for chronic/acute wounds. Benefits Premier members (hospitals, health systems) with contracted pricing, supply reliability, and access to evidence-based products for pressure injuries, DFUs, VLUs, and surgical wounds. Supports standardized, cost-effective wound management and improved patient outcomes in infection prevention and healing.

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Keywords: Medline, Premier agreement, advanced wound dressings, chronic wound management

Human Keratin Matrix in Addition to Standard of Care Accelerates Healing of Venous Ulcers: A Case Series

Summary: This case series evaluates human keratin matrix (keratin-based advanced dressing) as an adjunct to standard compression therapy in venous leg ulcers (VLUs). Keratin promotes cell migration, proliferation, and moist healing environment. Outcomes: Faster granulation tissue formation, progressive wound area reduction, and higher closure rates compared to standard care alone. Patients showed improved epithelialization and reduced exudate/pain. Supports keratin matrix as safe, effective option for hard-to-heal venous ulcers; highlights potential to shorten treatment time and improve QoL in chronic venous disease.

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Keywords: human keratin matrix, venous ulcers, case series, advanced dressing

Coloplast Names Gavin Wood as New CEO

Summary: February 2026 announcement: Coloplast appoints Gavin Wood as its new CEO, effective date to be confirmed. Wood brings extensive medtech leadership experience, succeeding the previous CEO. Focus: Strengthen Coloplast’s global position in ostomy, continence care, advanced wound care, and skin health products. Highlights commitment to innovation, patient outcomes, and sustainable growth in chronic wound management and related fields.

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Keywords: Coloplast, Gavin Wood, CEO appointment, advanced wound care

Wound Care Billing in the USA: A Complete Guide to Accurate Reimbursement and Revenue Growth

Summary: This 2026 comprehensive guide outlines wound care billing and coding in the United States for accurate reimbursement and revenue optimization. Covers HCPCS codes (e.g., G0465 blood-derived products, A6010-A6248 dressings), modifiers (e.g., -59, -JW), documentation requirements (wound measurements, photos, medical necessity), prior authorization pitfalls, and appeals processes. Discusses common denials (insufficient justification, LCD non-compliance) and solutions (templates, audits, RCM outsourcing). Emphasizes compliance with Medicare, Medicaid, and commercial payers to support advanced therapies (NPWT, biologics, synthetics) and sustain practice growth in chronic wound care.

Key Highlights:

• HCPCS/modifier overview for dressings/debridement
• Documentation best practices to avoid denials
• Revenue strategies: Appeals, audits, outsourcing
• Relevance: Essential for access to advanced wound products

Read full guide

Keywords: wound care billing, HCPCS codes, reimbursement guide, prior authorization

Development and Validation of a Wireless, Low-Cost Device for Dual Measurement of in-Shoe Plantar Pressure and Temperature in High-Risk Diabetic Feet

Summary: This study develops and validates a novel wireless, low-cost in-shoe sensing device that simultaneously measures plantar pressure and skin temperature—critical biomarkers for early detection of diabetic foot ulcer (DFU) risk in high-risk diabetic patients. Pressure performance was tested against the gold-standard F-Scan system across five trials, showing consistently strong correlations with peak pressure readings (r values: 0.801, 0.978, 0.813, 0.887, 0.944). Superimposed peak-pressure plots displayed highly similar waveform patterns, supported by low error metrics (e.g., Root Mean Squared Logarithmic Error). Temperature accuracy was compared to thermal camera measurements; the camera detected an average change of 3.7°C, while the in-shoe sensor recorded 0.67°C, with higher variability in the in-shoe device. Despite this difference, pressure and temperature measurements from the novel device were strongly correlated (r=0.87). The device addresses key limitations of current separate systems (cost, time, lack of real-time dual data) by providing site-specific, gait-based monitoring. Highlights potential for routine clinical use in high-risk foot surveillance to prevent DFUs through early identification of hotspots and temperature rises (pre-ulcer warning up to 1 week prior). Calls for larger-scale validation in real-world diabetic populations.

Key Highlights:

• Pressure validation: Strong correlation (r=0.801–0.978) and waveform similarity vs. F-Scan
• Temperature: Lower sensitivity than thermal camera but strong internal correlation with pressure (r=0.87)
• Advantages: Wireless, low-cost, simultaneous dual measurement during gait
• Clinical value: Enables proactive DFU risk stratification in high-risk diabetic feet
• Next steps: Further real-world testing for routine monitoring and prevention

Read full article (open access)

Keywords: in-shoe pressure temperature, DFU risk assessment, plantar pressure, diabetic foot ulcer, prevention monitoring

The Role of Gut Microbiota in Diabetic Foot Ulcer Healing: A Comprehensive Review

Summary: This 2026 comprehensive review explores the gut microbiota’s influence on diabetic foot ulcer (DFU) healing. Dysbiosis in type 2 diabetes patients alters short-chain fatty acid production, increases systemic inflammation (via LPS/endotoxemia), impairs immune response, and disrupts angiogenesis/collagen remodeling—key factors in chronic non-healing DFUs. Evidence from animal models and human studies links low microbial diversity to higher infection rates, prolonged inflammation, and amputation risk. Therapeutic modulation strategies: probiotics (Lactobacillus/Bifidobacterium), prebiotics, fecal microbiota transplantation (FMT), and diet interventions show promise in restoring balance, reducing oxidative stress, and accelerating healing. Calls for clinical trials to validate gut-targeted therapies as adjuncts in DFU management. Highlights the gut-skin axis as a novel target in diabetic wound care.

Key Highlights:

• Gut dysbiosis → systemic inflammation and delayed DFU repair
• Mechanisms: Reduced SCFAs, LPS translocation, immune dysregulation
• Potential therapies: Probiotics, FMT, dietary modulation
• Relevance: Gut microbiome as emerging target for chronic diabetic wounds

Read full review (open access)

Keywords: gut microbiota, diabetic foot ulcer, dysbiosis, probiotics, FMT

Dynarex Launches Dürma+ Negative Pressure Wound Therapy System for Homecare and Post-Acute Settings

Summary: Dynarex Corporation has launched the Dürma+ Negative Pressure Wound Therapy Pump, a portable NPWT system engineered for use across acute, post-acute, and homecare environments. The pump weighs 11.3 ounces, offers up to 72 hours of battery operation, and includes disposable canisters, foam dressing kits, suction tubing, wound drapes, and a carrying case for patient mobility during therapy. Multiple dressing sizes and accessory configurations allow integration into a variety of wound care protocols. Alongside the NPWT pump, Dynarex has expanded its wound care portfolio to include collagen-based wound care products, calcium alginate dressings, silicone bordered foam dressings, petrolatum and impregnated gauze dressings, transparent film and island dressings, wound gels, and measurement tools — supporting continuity of care from hospital to home. The product line is available through Dynarex’s national distribution network.

Key Highlights:

• Dürma+ NPWT pump: 11.3 oz, up to 72-hour battery — designed for patient mobility and homecare use
• Full system includes canisters, foam kits, tubing, drapes, and carrying case
• Expanded portfolio: collagen, alginate, silicone foam, impregnated gauze, film dressings, wound gels, and measurement tools
• Designed to support care continuity across acute, post-acute, and home settings
• Available through Dynarex’s national distribution network
• Relevance: Addresses the growing shift of complex wound management beyond the hospital setting

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Keywords: negative pressure wound therapy, NPWT homecare, Dynarex, portable wound care, wound care products

Shauna Winston, Dynarex Corporation

Development of a Film-Forming Wound Dressing from Periplaneta americana Grease: Formulation, Characterization, and Bioevaluation

Summary: Researchers at Dali University (Yunnan, China) have developed and characterized PAP, a novel film-forming topical wound agent derived from Periplaneta americana grease (PAG) — the lipid-rich fraction of a traditional Chinese medicine source with documented wound-repair properties. PAG was formulated into a PVA-124/PVP-based film-forming system using orthogonal experimental design, producing a transparent, flexible, adherent film that conforms to wound surfaces, maintains a moist environment, and localizes bioactive compounds at the wound site. GC-MS characterization revealed PAG’s complex composition, rich in heterocyclic compounds, terpenoids, sterols, and alkanolamines. In vitro, PAP demonstrated potent free radical scavenging activity comparable to vitamin C and selective antibacterial activity against Staphylococcus aureus. In a murine full-thickness wound model, PAP achieved a 98.2% healing rate by day 10 — comparable to bFGF and the established wound treatment Kangfuxin solution — with vehicle controls confirming that all bioactivity was attributable to the PAG fraction. Histological analysis demonstrated enhanced re-epithelialization, reduced inflammation, and superior collagen organization. Authors note further validation in chronic wound models (diabetic, ischemic) and comprehensive safety assessment are needed before clinical translation.

Key Highlights:

• 98.2% wound closure rate at day 10, matching bFGF and Kangfuxin liquid positive controls
• Multifunctional: antioxidant (DPPH/ABTS), antibacterial (S. aureus-selective), and pro-regenerative
• Vehicle control confirms healing effects are attributable to PAG, not the film matrix
• Shear-thinning rheology supports easy application; superior mechanical properties vs. vehicle film
• GC-MS profiling identifies terpenoids, sterols, and heterocyclic compounds as key bioactive classes
• Relevance: Novel insect-derived biomaterial approach to multifunctional, patient-friendly topical wound management

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Keywords: film-forming wound dressing, wound healing natural products, antioxidant wound care, Staphylococcus aureus wound, traditional Chinese medicine wound

Qian Wang
Zhuohui He
Siyu Ji
Jie Zhao
Pengfei Gao
Yunchuan Yang
Lijuan Li
Hairong Zhao
Chenggui Zhang

BD Unveils Surgiphor™ 1000mL: First Antimicrobial Irrigation System Optimized for Powered Lavage

Summary: BD (Becton, Dickinson and Company) has received FDA 510(k) clearance for the Surgiphor™ 1000mL, the first antimicrobial irrigation system specifically engineered for powered lavage in surgical settings. The device mechanically detaches and removes debris and microorganisms during surgery, arriving terminally sterile and ready-to-use — eliminating the need for manual mixing by OR staff. The 1000mL expands BD’s existing Surgiphor™ portfolio and is equipped with a powered-device adapter and Y-connector for seamless switching between saline and Surgiphor™ solution mid-procedure. A collapsible bottle design and vented flow system support ergonomic handling. According to Rian Seger, BD Surgery’s worldwide president, this clearance reinforces BD’s position as the global leader in surgical irrigation innovation. The system is designed to integrate into existing powered lavage device workflows across a range of surgical procedures.

Key Highlights:

• FDA 510(k) cleared — first antimicrobial irrigation system optimized for powered lavage
• Terminally sterile PVP-I solution; no manual mixing required
• Compatible with existing powered lavage devices via included adapter and Y-connector
• Collapsible bottle with venting for smooth flow and ergonomic use
• Expands BD’s Surgiphor™ portfolio (manual and powered options now available)
• Relevance: Addresses surgical site infection prevention at the irrigation step, supporting OR efficiency and standardization

Note: Surgiphor™ 1000mL is not indicated for use as an antimicrobial at or within the wound site.

Read full press release

Keywords: surgical irrigation, powered lavage, surgical site infection, PVP-I, BD medical

Too Much or Too Little? A Molecular Switch That Decides How Wounds Heal

Summary: Researchers from the Chinese PLA General Hospital have identified the NLRP3 inflammasome as a dual, time-dependent regulator of acute wound healing, published in Burns & Trauma. NLRP3 is a core component of innate immunity, and its activation during the early inflammatory phase was found to be necessary — facilitating macrophage and fibroblast migration, supporting pro-inflammatory macrophage polarization, and accelerating initial wound closure. However, when NLRP3 was genetically deleted (Nlrp3-deficient models), early closure was delayed but later-stage healing was markedly superior: fibrosis was reduced, collagen overaccumulation decreased, and regeneration of hair follicles and nerves was enhanced. The mechanism involves early activation of regenerative pathways (Wnt and Notch signaling) when inflammatory signaling is attenuated. The study also uncovered an inflammasome-independent role for NLRP3 in fibroblasts — associating with mitochondria to regulate reactive oxygen species production and modulate TGF-β/Smad signaling. Together, these findings frame NLRP3 as a molecular switch linking inflammation intensity to repair quality, and suggest that phase-specific NLRP3 modulation — rather than broad anti-inflammatory suppression — is key to improving chronic and acute wound outcomes.

Key Highlights:

• NLRP3 is required early to initiate repair, but must be restrained later to prevent excessive scarring
• Nlrp3 deletion delays early closure but dramatically improves tissue quality, reducing fibrosis and enabling nerve/follicle regeneration
• Mechanistic link: NLRP3 controls ROS production via mitochondrial association, modulating TGF-β/Smad and fibroblast phenotype
• Explains why broad anti-inflammatory therapies often underperform in wound care
• Relevance: Translational framework for developing phase-specific NLRP3-targeted therapies in diabetic ulcers, surgical wounds, and burns

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Keywords: NLRP3 inflammasome, wound healing inflammation, fibrosis wound, TGF-beta, molecular wound healing

Chinese PLA General Hospital Research Team

WCCC Driving Innovation in Wound Care Summit — April 10, 2026 | Charlotte, NC

Summary: The third annual Wound Care Collaborative Community (WCCC) Driving Innovation in Wound Care Summit takes place April 10, 2026, co-located with SAWC Spring | Wound Healing Society in Charlotte, North Carolina. This invitation-only, full-day FDA-recognized working meeting is designed to move the wound care field from discussion to concrete, measurable action. The 2026 program is structured across three progressive phases: vision and policy (featuring perspectives from FDA and CMS, including a keynote from Anitra Graves, MD, CMS Medical Director, Novitas), implementation (WCCC and industry initiatives), and community activation (audience-driven collaboration with structured outputs). This year’s agenda spotlights modernizing evidence standards, strengthening FDA–CMS alignment, elevating patient-reported outcomes, and preparing the field for meaningful integration of AI and digital tools. Sessions include high-impact panels, real-time polling, and an open-mic community forum. Steering Committee Chair: Vickie R. Driver, DPM, MS. Principal Partner: Organogenesis Inc.

Key Highlights:

• Date: April 10, 2026 | Location: Charlotte, North Carolina (co-located with SAWC Spring | WHS, April 8–12)
• FDA-recognized, non-accredited, invitation-only working meeting — applications subject to review
• Keynote from CMS MAC Medical Director on regulatory and payer perspectives
• Focus areas: evidence modernization, FDA–CMS alignment, patient-reported outcomes, AI/digital tool integration
• Supporters include Organogenesis, MiMedx, MTF Biologics, MediWound, MIMOSA Diagnostics, and others
• Relevance: Premier annual policy-action forum for wound care stakeholders invested in regulatory science and access to innovation

Learn more & apply for invitation

Keywords: WCCC Summit, SAWC Spring, wound care innovation, FDA wound care, CMS wound care

Preserving Limbs and Lives: The Role of Cellular, Acellular, and Matrix-like Products in Diabetic Foot Ulcer Care

Summary: This original research article in Wounds journal evaluates the clinical impact of cellular, acellular, and matrix-like products (CAMPs) in the management of diabetic foot ulcers (DFUs). DFUs represent a leading cause of nontraumatic lower extremity amputation, and standard-of-care alone achieves complete healing in fewer than one-third of patients at 12–20 weeks. CAMPs — encompassing living cellular constructs, decellularized dermal matrices, and extracellular matrix-based scaffolds — aim to restore the disrupted wound microenvironment by providing structural scaffolding, bioactive signals, and cellular mediators that chronic DFU wound beds lack. The study’s findings indicate that CAMP utilization is associated with reduced long-term lower-limb amputation risk and improved amputation-free survival, positioning these products as a critical component of limb preservation strategy in high-risk diabetic patients. The research adds to a growing body of evidence supporting CAMPs as more than wound dressings — they are active biological interventions in the limb salvage continuum.

Key Highlights:

• CAMPs associated with reduced long-term lower-limb amputation risk in DFU patients
• Improved amputation-free survival compared to standard care alone
• Encompasses full CAMP spectrum: cellular constructs, acellular matrices, ECM-based scaffolds
• Frames CAMPs as integral to limb preservation rather than adjunctive wound dressing
• Relevance: Timely given new 2026 CMS coverage and payment policies for cellular and tissue-based products (CTPs)

Read full study

Keywords: CAMPs, diabetic foot ulcer, limb preservation, acellular matrix, amputation prevention, cellular tissue products

Celebrating Pressure Injury Milestones: The Eighth Annual Themed Issue

Summary: This editorial marks the eighth consecutive annual pressure injury (PI) themed issue of Advances in Skin & Wound Care, underscoring the enduring global significance of pressure injury prevention and treatment. The issue brings together research from contributors across multiple continents, reflecting the international scope of the PI challenge. A central milestone highlighted is the staged rollout of the 4th edition of the EPUAP/NPIAP/PPPIA International Pressure Injury Clinical Practice Guideline — the field’s most authoritative evidence-based resource — developed using GRADE methodology for the first time, with prevention recommendations released in early 2025 and treatment recommendations to follow. The editorial also situates this work within broader healthcare policy shifts, including forthcoming CMS regulatory changes that will exempt certain unavoidable pressure injuries from adverse event reporting beginning January 2027.

Key Highlights:

• Eighth annual PI-dedicated themed issue reflecting sustained global research attention
• 4th edition EPUAP/NPIAP/PPPIA International PI Guideline now rolling out with GRADE methodology
• Prevention recommendations live at internationalguideline.com; treatment chapter to follow
• CMS regulatory change: select unavoidable PIs to be exempt from adverse reporting starting January 2027
• Relevance: Comprehensive orientation to the current state of PI science, policy, and evidence-based practice

Read full editorial

Keywords: pressure injury, pressure ulcer prevention, NPIAP, clinical practice guideline, wound care policy

Autologous Skin Cell Suspension Grafting: A Fundamentally Different Approach to Skin Restoration

Summary: This editorial in Wounds journal addresses autologous skin cell suspension (ASCS) technology as a meaningfully distinct advance beyond conventional split-thickness skin grafting (STSG). Traditional STSG — long the gold standard for coverage of burns and complex wounds — requires large donor sites, creates significant donor site morbidity, and is associated with delayed healing, hypertrophic scarring, and prolonged hospital stays. ASCS, prepared at the point of care using devices such as the RECELL® System, produces a spray suspension of keratinocytes, fibroblasts, and melanocytes from a small biopsy specimen, achieving an 80:1 expansion ratio that dramatically reduces donor skin requirements. Clinical evidence supports its use in partial- and full-thickness burns, nonthermal traumatic wounds, necrotizing infections, and chronic nonhealing wounds. The editorial contextualizes the growing body of evidence — including RCTs and real-world cohort studies — demonstrating ASCS achieves wound closure rates comparable or superior to STSG while reducing donor site burden, shortening length of stay, and lowering hypertrophic scarring rates.

Key Highlights:

• ASCS produces 80:1 expansion from minimal donor skin vs. traditional meshed STSG
• Point-of-care preparation with no specialist lab infrastructure required
• Demonstrated efficacy in burns, traumatic full-thickness wounds, and chronic nonhealing wounds
• Reduces donor site morbidity, operative time, and hypertrophic scarring incidence
• Relevance: Reframes ASCS not as an adjunct but as a fundamentally different wound closure strategy

Read full editorial

Keywords: autologous skin cell suspension, RECELL, skin grafting, burn wound, donor site morbidity

Nursing Practices for a Patient With ALK-Negative Anaplastic Large Cell Lymphoma With a Cancerous Wound: A Case Report

Summary: This case report from the Oncology Department at Tongji Hospital (Huazhong University of Science and Technology) documents the comprehensive specialist nursing management of a 59-year-old female with stage IIIB ALK-negative anaplastic large cell lymphoma (ALCL) who developed a severe cancerous wound. Cancerous wounds — malignant cutaneous infiltrations that ulcerate and break through the skin — present complex challenges including malodor, exudate, bleeding, pain, and profound psychosocial distress. Across two inpatient chemotherapy sessions, specialist wound care nurses designed and executed a holistic wound care plan encompassing local wound management, multimodal pain control, targeted nutritional support, psychosocial intervention, and structured transitional care protocols following discharge. The wound progressively decreased in size and ultimately healed, underscoring the critical role of nurse-led, multidisciplinary care planning in oncologic wound management.

Key Highlights:

• Rare case of severe cancerous wound complicating stage IIIB ALK-negative ALCL in a 59-year-old female
• Specialist nurses led wound care across two inpatient chemotherapy admissions
• Holistic plan integrated wound care, pain management, nutrition support, and psychosocial care
• Structured transitional/discharge care maintained continuity after inpatient stays
• Wound resolved completely — demonstrating the impact of evidence-based nursing on oncologic wound outcomes
• Relevance: Practical framework for wound care nurses managing malignant/cancerous wounds in oncology settings

Read full case report

Keywords: cancerous wound, malignant wound, oncology wound care, wound nursing, anaplastic large cell lymphoma, transitional care

Mei Liu, RN
Nina Cai, RN
Meichen Du, RN
Juan Guo, RN

Observational Study of Venous Leg Ulcer Treated With a Native Collagen-Alginate Dressing and the Impact on Wound-Related Quality of Life

Summary: This observational study evaluates native collagen alginate dressing in real-world management of venous leg ulcers (VLUs). Patients with recalcitrant VLUs received standard compression therapy plus the advanced dressing. Key outcomes: accelerated granulation tissue formation, progressive wound area reduction, decreased pain and exudate levels, fewer dressing changes required, and favorable cost-per-healing metrics compared to traditional alginates or gauze. The dressing modulates matrix metalloproteinases (MMPs), supports ECM remodeling, and maintains optimal moisture balance. Emphasizes ease of application, patient tolerance, and effectiveness in outpatient/clinic settings for hard-to-heal venous wounds.

Key Highlights:

• Faster granulation and closure rates
• Reduced pain, exudate, and dressing change frequency
• Cost-effective adjunct to compression therapy
• Relevance: Evidence-based support for collagen-based advanced dressings in chronic venous ulcers

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Keywords: native collagen alginate, venous leg ulcer, observational study, advanced dressing

Alisha Oropallo, MD
Amit S. Rao, MD
Sally Kaplan, RN
Farisha Baksh, BS
Christina Del Pin, MD

Carbon Dot Nanotherapeutics Modulating the Polyol Pathway and Targeting Infection Pathogens Associated with Diabetic Complications

Summary: This study synthesizes nitrogen-doped carbon dots (N-HCD from hexamethylenediamine, N-ECD from ethylenediamine) via hydrothermal method and evaluates their dual role in modulating diabetic complications. The dots significantly inhibit aldose reductase (AR) and sorbitol dehydrogenase (SDH) activities in ex vivo kidney tissue from STZ-induced diabetic rats in a dose-dependent manner, reducing polyol pathway flux and associated oxidative stress that contributes to delayed wound healing in diabetes. They also exhibit selective bacteriostatic activity against Enterococcus faecalis (common in diabetic foot infections), with inhibition zones of 11.5–13 mm at 50 µg/mL and no effect on other tested bacteria (S. aureus, E. coli, K. pneumoniae). In silico docking shows strong binding to AR active site residues. Biocompatible and low-toxicity profile. Suggests potential as a multifunctional nanotherapeutic for managing hyperglycemia-driven metabolic stress and polymicrobial infections in diabetic foot ulcers and chronic wounds.

Key Highlights:

• Dose-dependent inhibition of AR and SDH in diabetic tissue
• Selective bacteriostatic effect against E. faecalis (11.5–13 mm zones)
• Favorable in silico binding to AR residues
• Biocompatible; no activity against other common pathogens
• Dual metabolic + antimicrobial potential for DFU management

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Keywords: carbon dots, polyol pathway, diabetic foot ulcer, Imane Nait Irahal, Noureddine Bourhim

Important Terms to Know: Wound Biofilm

Summary: This educational blog defines and explains critical terms related to wound biofilm, a major barrier in chronic wounds (present in 60–90% of non-healing cases). Covers: Biofilm formation (bacterial attachment, EPS matrix), quorum sensing (communication), tolerance (reduced susceptibility to antimicrobials), and resistance. Discusses clinical impact: Persistent inflammation, delayed granulation, recurrent infection. Management: Aggressive debridement (sharp, mechanical, enzymatic), topical/systemic antimicrobials, anti-biofilm dressings (e.g., silver, DACC, honey), and prevention (wound hygiene). Emphasizes multimodal approaches and early intervention to disrupt biofilm and accelerate healing in hard-to-heal wounds (DFUs, VLUs, pressure injuries).

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Keywords: wound biofilm, EPS matrix, quorum sensing, anti-biofilm dressing

Hydrosurgical Debridement System Combined with Negative Pressure Wound Therapy

Summary: Case report demonstrates the combined use of hydrosurgical debridement (Versajet or similar) with negative pressure wound therapy (NPWT) for a complex wound. Hydrosurgery provides precise, high-pressure saline removal of necrotic tissue, biofilm, and contaminants with minimal damage to viable structures. NPWT follows to promote granulation, reduce edema, and prepare the bed for closure or grafting. Outcomes: Clean wound bed, infection resolution, accelerated healing. Emphasizes synergy: debridement for bed prep, NPWT for sustained healing environment. Relevant for chronic, infected, or traumatic wounds where traditional sharp debridement is limited.

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Keywords: hydrosurgical debridement, NPWT, Versajet, complex wound

The Courage to Do the Right Thing

Summary: June 22, 2018 blog post by Dr. Caroline Fife reflects on the ethical dilemmas wound care providers face amid reimbursement pressures, documentation demands, and payer audits. Discusses the courage required to prioritize patient-centered, evidence-based care (e.g., appropriate debridement, advanced therapies) despite risk of denials or scrutiny. Emphasizes integrity, advocacy for fair coverage, and balancing clinical judgment with compliance. Highlights real-world examples of systemic challenges and the need for providers to “do the right thing” for patients even when it’s difficult.

Key Highlights:

• Ethical tension: Patient care vs. payer requirements
• Call for integrity and advocacy
• Relevance: Timeless message for chronic wound practice amid policy changes

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Keywords: ethical wound care, reimbursement challenges, Caroline Fife

Observational Study: Venous Leg Ulcer Treated with Native Collagen Alginate

Summary: Published observational study evaluates native collagen alginate dressing (e.g., Promogran Prisma or similar) in real-world treatment of venous leg ulcers. Tracks outcomes in patients with recalcitrant VLUs under standard compression therapy + advanced dressing. Key findings include accelerated granulation, reduced wound area over time, decreased pain and exudate levels, fewer dressing changes, and favorable cost-per-healing metrics compared to traditional alginates or gauze. Supports use of collagen-based products to modulate MMPs, promote ECM remodeling, and enhance healing in chronic venous wounds. Emphasizes ease of application and patient tolerance in outpatient/clinic settings.

Key Highlights:

• Outcomes: Faster closure rates, pain/exudate reduction
• Mechanism: Native collagen binds excess MMPs; alginate manages moisture
• Real-world: Effective adjunct to compression in hard-to-heal VLUs
• Relevance: Adds evidence for advanced dressings in venous/chronic care

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Keywords: native collagen alginate, venous leg ulcer, observational study, advanced dressing

Why Are Prior Authorization Denials Spiking in Wound Care?

Summary: February 2026 blog post examines the sharp rise in prior authorization (PA) denials for wound care treatments (advanced dressings, NPWT, biologics, debridement). Causes: Payer scrutiny (Medicare Advantage, commercial plans), incomplete documentation (medical necessity, failed conservative care proof), evolving LCDs, and administrative burden. Impacts: Delayed treatment, revenue loss, patient outcomes affected. Solutions: Proactive PA submission checklists, detailed clinical notes/photos, appeals training, payer-specific templates, and outsourcing to specialized RCM services. Urges providers to stay updated on policy shifts and advocate for streamlined processes in chronic wound care.

Key Highlights:

• Rising denials driven by payer policies and documentation gaps
• High-impact areas: Biologics, NPWT, cellular products
• Strategies: Checklists, appeals, RCM support
• Relevance: Critical for access to advanced wound therapies

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Keywords: prior authorization, wound care denials, reimbursement challenges, advanced wound therapy

The Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Reducing Pathologic Scar Formation After Median Sternotomy

Summary: This cross-sectional observational study (n=100 patients ≥6 months post-median sternotomy on continuous antihypertensives) investigated whether ACE inhibitors (ACEIs, n=33) or angiotensin II receptor blockers (ARBs, n=35) influence pathologic scar formation compared to other antihypertensives (n=32). Scar quality was assessed using POSAS v2.0 (Patient and Observer Scar Assessment Scale). Results showed significantly lower keloid formation in ACEI (24.2%) and ARB (25.7%) groups vs. controls (53.1%, p=0.021). Both patient (PSAS) and observer (OSAS) total scores were significantly better in ACEI/ARB groups (p=0.042 and p=0.036). Key subparameters improved: vascularization, pigmentation, thickness, surface appearance (OSAS); pain, stiffness, thickness, irregularity (PSAS). Suggests RAS inhibition (via ACEIs/ARBs) may modulate tissue remodeling and reduce hypertrophic/keloid scarring in hypertensive patients post-sternotomy. Exploratory due to cross-sectional design and variable postoperative times; calls for prospective RCTs to confirm causality and explore mechanisms.

Key Highlights:

• Keloid rate: ~50% lower in ACEI/ARB groups (p=0.021)
• POSAS improvement: Multiple subscores (vascularity, pigmentation, thickness, pain, stiffness) significantly better
• Implication: Common antihypertensives may offer dual benefit for scar quality in cardiac surgery patients
• Limitations: Observational; needs RCTs for causality and dosing

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Keywords: ACEI scarring, ARB keloid, POSAS scale, pathologic scar, Cansu Altınöz Güney, Huriye Aybüke Koç