Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review

Layer-by-layer assembly: advancing skin repair, one layer at a time

Skin wound management remains a critical global healthcare challenge, with annual costs exceeding £30 billion. Traditional treatments like autografts face limitations in cost, availability, and recovery times. This review explores spray-assisted Layer-by-Layer (LbL) technology as a transformative approach for wound healing, emphasising its ability to deposit natural- and synthetic-polyelectrolytes such as chitosan, alginate, hyaluronic acid, and collagen into nanoscale coatings. These biocompatible multilayers integrate therapeutic agents to accelerate healing, reduce infections, and mimic native extracellular matrix structures. The work highlights emerging spray device innovations that optimise spray parameters to enhance cell viability, coverage, and clinical outcomes. While LbL techniques demonstrate versatility across substrates and scalability via immersion, spray, and microfluidic methods, challenges persist in manufacturing uniformity and clinical translation. The review underscores the urgent need for clinical trials to validate Lbl-based coatings in real-world settings and addresses gaps in portable, sustainable device development. By bridging advanced materials science with clinical practice, spray-assisted LbL technology offers a roadmap to overcome current wound care limitations, prioritising biocompatibility, cost-efficiency, and improved patient safety in regenerative medicine.

Modelling the effects of temperature, pH and osmotic shifts on the autofluorescence of Staphylococcus aureus in vitro

AIMS

This study aims to investigate how different wound microenvironmental factors (temperature, pH, and osmotic pressure) influence the autofluorescence of Staphylococcus aureus (S. aureus) and its underlying molecular mechanisms, specifically focusing on the porphobilinogen synthase gene (hemB) gene expression.

METHODS

We measured the average fluorescence intensity of S. aureus colonies under varying conditions of pH (3, 5, 7, 9, 11), temperature (25°C, 31°C, 37°C, 43°C), and osmotic pressure (0.9%, 1.8%, 2.7%, 3.6%) over time. Fluorescence intensity was quantified using ImageJ software. Additionally, RT-qPCR was used to analyze the expression levels of the hemB under these conditions.

RESULTS

Bacterial fluorescence intensity increased as the temperature ranged from 25°C to 43°C, with corresponding upregulation of hemB expression. At pH values between 3 and 11, fluorescence intensity decreased as pH increased, reflecting a similar trend in hemB expression. Fluorescence also diminished with higher osmotic pressures (0.9% to 3.6%), mirroring the downregulation of hemB.

CONCLUSIONS

Our findings indicate that temperature, pH, and osmotic pressure significantly affect the autofluorescence of S. aureus by modulating porphyrin accumulation through hemB gene expression. These environmental factors should be considered when using bacterial fluorescence for wound infection assessment.

Nanomaterial-enabled anti-biofilm strategies: new opportunities for treatment of bacterial infections

Biofilms play a pivotal role in bacterial pathogenicity and antibiotic resistance, representing a major challenge in the treatment of bacterial infections. The limited diffusion and inactivation efficacy of antibiotics within biofilms hinder their clearance, and while increasing dosage may enhance effectiveness, it also promotes antibiotic resistance. Nano-delivery systems that target antimicrobial agents directly to biofilms offer a promising strategy to overcome this challenge. This review summarizes the resistance mechanisms and therapeutic challenges associated with biofilms, with a focus on recent advances in nano-delivery systems such as liposomes, nanoemulsions, cell membrane vesicles (CMVs), polymers, dendrimers, nanogels, inorganic nanoparticles, and metal-organic frameworks (MOFs). Furthermore, the review explores the potential applications and challenges of nano-delivery systems in biofilm treatment and provides recommendations to guide future research and development in this field.

Evaluating the effectiveness of ultrasound-assisted wound debridement in managing diabetic foot ulcers: A systematic review and meta-analysis

BACKGROUND

Diabetic foot ulcers (DFUs) present a significant clinical challenge due to their high prevalence and profound impact on morbidity. Ultrasound-assisted wound debridement (UAWD) has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.

AIM

To evaluate the efficacy of UAWD in treating DFUs on wound closure rates, treatment duration, and quality of life outcomes.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines, systematically searching PubMed, Embase, Web of Science, and the Cochrane Library with no date restrictions. Randomized controlled trials (RCTs) that evaluated the efficacy of UAWD in DFU treatment were included. Data were independently extracted by two reviewers, with discrepancies resolved through consensus or third-party consultation. The risk of bias was assessed using the Cochrane tool. χ 2 and I 2 statistics assessed heterogeneity, informing the use of fixed or random-effects models for meta-analysis, supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.

RESULTS

From 1255 articles, seven RCTs met the inclusion criteria. The studies demonstrated that UAWD significantly reduced DFU healing time (standardized mean difference = -0.78, 95%CI: -0.97 to -0.60, P < 0.001) and increased healing rates (odds ratio = 9.96, 95%CI: 5.99 to 16.56, P < 0.001) compared to standard care. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected.

CONCLUSION

UAWD is a promising adjunctive treatment for DFUs, significantly reducing healing times and increasing healing rates. These findings advocate for the integration of UAWD into standard DFU care protocols.

Biofilm Resilience: Molecular Mechanisms Driving Antibiotic Resistance in Clinical Contexts

Healthcare-associated infections pose a significant global health challenge, negatively impacting patient outcomes and burdening healthcare systems. A major contributing factor to healthcare-associated infections is the formation of biofilms, structured microbial communities encased in a self-produced extracellular polymeric substance matrix. Biofilms are critical in disease etiology and antibiotic resistance, complicating treatment and infection control efforts. Their inherent resistance mechanisms enable them to withstand antibiotic therapies, leading to recurrent infections and increased morbidity. This review explores the development of biofilms and their dual roles in health and disease. It highlights the structural and protective functions of the EPS matrix, which shields microbial populations from immune responses and antimicrobial agents. Key molecular mechanisms of biofilm resistance, including restricted antibiotic penetration, persister cell dormancy, and genetic adaptations, are identified as significant barriers to effective management. Biofilms are implicated in various clinical contexts, including chronic wounds, medical device-associated infections, oral health complications, and surgical site infections. Their prevalence in hospital environments exacerbates infection control challenges and underscores the urgent need for innovative preventive and therapeutic strategies. This review evaluates cutting-edge approaches such as DNase-mediated biofilm disruption, RNAIII-inhibiting peptides, DNABII proteins, bacteriophage therapies, antimicrobial peptides, nanoparticle-based solutions, antimicrobial coatings, and antimicrobial lock therapies. It also examines critical challenges associated with biofilm-related healthcare-associated infections, including diagnostic difficulties, disinfectant resistance, and economic implications. This review emphasizes the need for a multidisciplinary approach and underscores the importance of understanding biofilm dynamics, their role in disease pathogenesis, and the advancements in therapeutic strategies to combat biofilm-associated infections effectively in clinical settings. These insights aim to enhance treatment outcomes and reduce the burden of biofilm-related diseases.

Clinical management of chronic wound infections: The battle against biofilm

Bacteria constitute the most abundant life form on earth, of which the majority exist in a protective biofilm state. Since the 1980s, we have learned much about the role of biofilm in human chronic infections, with associated global healthcare costs recently estimated at ~$386 billion. Chronic wound infection is a prominent biofilm-induced condition that is characterised by persistent inflammation and associated host tissue destruction, and clinical signs that are distinct from signs of acute wound infection. Biofilm also enables greater tolerance to antimicrobial agents in chronic wound infections compared with acute wound infections. Given the difficulty in eliminating wound biofilm, a multi-targeted strategy (namely biofilm-based wound care) involving debridement and antimicrobial therapies were introduced and have been practiced since the early 2000s. More recently, acknowledgement of the speed at which biofilm can develop and hence quickly interfere with wound healing has highlighted the need for an early anti-biofilm strategy to combat biofilm before it takes control and prevents wound healing. This strategy, referred to as wound hygiene, involves multiple tools in combination (debridement, cleansing, and antimicrobial dressings) to maximise success in biofilm removal and encourage wound healing. This review is intended to highlight the issues and challenges associated with biofilm-induced chronic infections, and specifically address the challenges in chronic wound management, and tools required to combat biofilm and encourage wound healing.

Smart hydrogel-based trends in future tendon injury repair: A review

Despite advances in tissue engineering for tendon repair, rapid functional repair is still challenging due to its specificity and is prone to complications such as postoperative infections and tendon adhesions. Smart responsive hydrogels provide new ideas for tendon therapy with their flexibly designed three-dimensional cross-linked polymer networks that respond to specific stimuli. In recent years, a variety of smart-responsive hydrogels have been developed for the treatment of tendon disorders, showing great research promise and ability to address complex challenges. This article provides a comprehensive review of recent advances in the field of smart-responsive hydrogels for the treatment of tendon disorders, with a special focus on their response properties to different physical, chemical and biological stimuli. The multiple functional properties of these innovative materials are discussed in depth, including excellent biocompatibility and biodegradability, excellent mechanical properties, biomimetic structural design, convenient injectability, and unique self-healing capabilities. These properties enable the smart-responsive hydrogels to demonstrate significant advantages in solving difficult problems in the treatment of tendon disorders, such as precise drug delivery, tendon adhesion prevention and postoperative infection control. In addition, the article looks at the future prospects of smart-responsive hydrogels and analyses the challenges they may face in achieving widespread application.

A Natural deep eutectic solvent as an effective material for dual debridement and antibiofilm effects in chronic wound treatment

In chronic wound treatment, the debridement of devitalized tissue and the eradication of the biofilm must balance aggressiveness with care to protect regenerating tissues. In this study, urea, a potent chaotropic molecule, was modulated through the formation of a Natural Deep Eutectic Solvent (NADES) with betaine to develop a new debriding material (BU) suitable for application into injured dermal tissues. To evaluate BU's debriding capacity, along with its antibiofilm effect and biocompatibility, pre-clinical to clinical methods were employed. In vitro determinations using artificial and clinical slough samples indicate that BU has a high debriding capacity. Additionally, BU's de-structuring effects lead to a strong antibiofilm capability, demonstrated by a reduced bacterial load compared to the antiseptic PHMB-Betaine or medical honey, evaluated in artificial slough and ex vivo human skin. Furthermore, BU's efficacy was evaluated in a murine model of diabetic wound, demonstrating significant effects on debriding and antibiofilm capacity, similar to those observed in PHMB-Betaine and medical honey-treated animals. Finally, BU was clinically evaluated in leg ulcers, showing superiority in reduction of bacterial load and wound area compared to honey, with no adverse effects. Thus, BU represents a simple and non-biocidal option that could contributes to chronic wound care.

Efficacy of EDTA-NS irrigation in eradicating Staphylococcus aureus biofilm-associated infection

Aims

To investigate the efficacy of ethylenediaminetetraacetic acid-normal saline (EDTA-NS) in dispersing biofilms and reducing bacterial infections.

Methods

EDTA-NS solutions were irrigated at different durations (1, 5, 10, and 30 minutes) and concentrations (1, 2, 5, 10, and 50 mM) to disrupt Staphylococcus aureus biofilms on Matrigel-coated glass and two materials widely used in orthopaedic implants (Ti-6Al-4V and highly cross-linked polyethylene (HXLPE)). To assess the efficacy of biofilm dispersion, crystal violet staining biofilm assay and colony counting after sonification and culturing were performed. The results were further confirmed and visualized by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). We then investigated the efficacies of EDTA-NS irrigation in vivo in rat and pig models of biofilm-associated infection.

Results

When 10 mM or higher EDTA-NS concentrations were used for ten minutes, over 99% of S. aureus biofilm formed on all three types of materials was eradicated in terms of absorbance measured at 595 nm and colony-forming units (CFUs) after culturing. Consistently, SEM and CSLM scanning demonstrated that less adherence of S. aureus could be observed on all three types of materials after 10 mM EDTA-NS irrigation for ten minutes. In the rat model, compared with NS irrigation combined with rifampin (Ti-6Al-4V wire-implanted rats: 60% bacteria survived; HXLPE particle-implanted rats: 63.3% bacteria survived), EDTA-NS irrigation combined with rifampin produced the highest removal rate (Ti-6Al-4V wire-implanted rats: 3.33% bacteria survived; HXLPE particle-implanted rats: 6.67% bacteria survived). In the pig model, compared with NS irrigation combined with rifampin (Ti-6Al-4V plates: 75% bacteria survived; HXLPE bearings: 87.5% bacteria survived), we observed a similar level of biofilm disruption on Ti-6Al-4V plates (25% bacteria survived) and HXLPE bearings (37.5% bacteria survived) after EDTA-NS irrigation combined with rifampin. The in vivo study revealed that the biomass of S. aureus biofilm was significantly reduced when treated with rifampin following irrigation and debridement, as indicated by both the biofilm bacterial burden and crystal violet staining. EDTA-NS irrigation (10 mM/10 min) combined with rifampin effectively removes S. aureus biofilm-associated infections both in vitro and in vivo.

Conclusion

EDTA-NS irrigation with or without antibiotics is effective in eradicating S. aureus biofilm-associated infection both ex and in vivo.

Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group

OBJECTIVE

Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction.

METHODS

An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds.

RESULTS

Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention.

CONCLUSIONS

The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.

Letter to Editor Regarding "Methylene Blue Staining and Ultrasonic Debridement: A Superior Therapeutic Strategy for Pressure Ulcer Debridement"

The treatment of pressure ulcer is of an extreme clinical and social concern. Effective and thorough debridement lays the foundation for favorable wound healing. Recently, a case report confirmed the efficacy of a combined application of methylene blue staining and ultrasonic debridement for pressure ulcer debridement. A 91-year-old male who suffered from severe pressure ulcers for over 6 years eventually obtained a favorable restoration after receiving surgical debridement optimized with methylene blue staining and ultrasonic debridement. We write to learn more about the details of the case. In this letter, we raised some questions involving the identification capability of methylene blue staining among different tissues, the application of methylene blue staining for various wounds, the arrangement of the debridement liquid, and the management strategy after wound closure. We thank the authors for creating a successful paradigm and hope the discussion can make sense for guiding subsequent clinical practice.

Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review

Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.

[Application and clinical efficacy of ultrasound debridement method in residual burn wounds]

Objective: To investigate the application and clinical efficacy of ultrasound debridement method in residual burn wounds. Methods: A retrospective cohort study was conducted. From August 2017 to August 2021, 64 patients with residual burn wounds who met the inclusion criteria were admitted to the 980th Hospital of the Joint Logistic Support Force of PLA. According to the debridement method adopted for the residual wounds, the patients were divided into ultrasound debridement group (34 cases, 22 males and 12 females, aged (31±13) years) and traditional debridement group (30 cases, 19 males and 11 females, aged (32±13) years). After the corresponding debridement, the wounds of patients in the two groups were selected for stamp skin grafting or large skin grafting according to the wound site and skin donor status. For unhealed wounds after stage Ⅰ surgery, secondary debridement and skin grafting were be performed, with the wound debridement methods in the 2 groups being the same as those of stage Ⅰ, respectively. On postoperative day 3, drug-sensitive test was used to detect the bacteria in the wound and the positive rate of bacteria was calculate. On postoperative day 7, the survival rate of skin slices in wound and the incidence of subcutaneous hematoma were calculated. At discharge, wound healing time and debridement times of patients were counted, and the secondary debridement rate was calculated. Data were statistically analyzed with independent sample t test or chi-square test. Results: On postoperative day 3, the wounds in ultrasound debridement group were infected with Staphylococcus aureus in 2 cases and Pseudomonas aeruginosa in 2 cases, and the wounds in traditional debridement group were infected with Staphylococcus aureus in 5 cases, Pseudomonas aeruginosa in 3 cases, Acinetobacter baumannii in 1 cases, Klebsiella pneumoniae in 1 cases, and Enterobacter cloacae in 1 cases. The positive rate of bacteria of wound in ultrasound debridement group was significantly lower than that in traditional debridement group (χ2=5.51, P<0.05). On postoperative day 7, the survival rate of skin grafts in ultrasound debridement group was (92±5) %, which was significantly higher than (84±10) % in traditional debridement group (χ2=6.78, P<0.01); the incidence of subcutaneous hematoma in ultrasound debridement group was 17.6% (6/34), which was significantly lower than 40.0%( 12/30) in traditional debridement group, χ2=3.94, P<0.05. At discharge, the wound healing time in ultrasound debridement group was (11.0±2.0) d, which was significantly shorter than (13.0±3.1) d in traditional debridement group (t=3.81, P<0.01); the secondary debridement rate of wounds in ultrasound debridement group was 2.9% (1/34), which was significantly lower than 20.0% (6/30) in traditional debridement group (χ2=4.76, P<0.05). Conclusions: Ultrasound debridement method can significantly reduce the bacterial load of residual burn wounds, reduce postoperative hematoma formation, and promote the survival of skin grafts to shorten the course of disease of patients.

In vitro cell culture models for ultrasound treatments using collagen-based scaffolds

Applications involving ultrasound treatment as a therapeutic strategy have gained interest due to its enhanced tissue penetration, broad availability, and minimal invasiveness. Recently, ultrasound treatment has been utilized for applications such as controlled drug delivery, enhanced drug penetration, sonodynamic therapy for generating ROS species, and targeted tissue ablation. However, our ability to study and explore applications is limited by the lack of in vitro models that enable efficient and representative screening of ultrasound-based therapeutic strategies. There is a need for cell culture approaches that mimic the mechanical environment of native tissues, which can prevent uncontrolled cell lysis due to ultrasonic energy. We developed two-dimensional and three-dimensional collagen-based materials for culturing cells in vitro that withstand ultrasound treatment. We hypothesized that the collagen matrix mimics the extracellular matrix and absorb most of the energy from ultrasound treatment - similar to in vivo effects - thereby preventing uncontrolled cell lysis. In this study, we developed a strategy for fabricating both the 2D coatings and 3D hydrogels coatings and tested the viability of the cultured cells post different durations of ultrasound treatment.

Potential Utility of Ultrasound-Enhanced Delivery of Antibiotics, Anti-Inflammatory Agents, and Nutraceuticals: A Mini Review

Ultrasound technology has therapeutic properties that can be harnessed to enhance topical drug delivery in a process known as phonophoresis. The literature on this method of drug delivery is currently sparse and scattered. In this review, we explore in vivo and in vitro controlled trials as well as studies detailing the mechanism of action in phonophoresis to gain a clearer picture of the treatment modality and explore its utility in chronic wound management. Upon review, we believe that phonophoresis has the potential to aid in chronic wound management, particularly against complicated bacterial biofilms. This would offer a minimally invasive wound management option for patients in the community.

An Overview of Diabetic Foot Ulcers and Associated Problems with Special Emphasis on Treatments with Antimicrobials

One of the most significant challenges of diabetes health care is diabetic foot ulcers (DFU). DFUs are more challenging to cure, and this is particularly true for people who already have a compromised immune system. Pathogenic bacteria and fungi are becoming more resistant to antibiotics, so they may be unable to fight microbial infections at the wound site with the antibiotics we have now. This article discusses the dressings, topical antibacterial treatment, medications and debridement techniques used for DFU and provides a deep discussion of DFU and its associated problems. English-language publications on DFU were gathered from many different databases, such as Scopus, Web of Science, Science Direct, Springer Nature, and Google Scholar. For the treatment of DFU, a multidisciplinary approach involving the use of diagnostic equipment, skills, and experience is required. Preventing amputations starts with patient education and the implementation of new categorization systems. The microbiota involved in DFU can be better understood using novel diagnostic techniques, such as the 16S-ribosomal DNA sequence in bacteria. This could be achieved by using new biological and molecular treatments that have been shown to help prevent infections, to control local inflammation, and to improve the healing process.

Diabetic foot ulcer, antimicrobial remedies and emerging strategies for the treatment

According to the International Diabetes Federation's 2015 study, diabetes affects over 415 million people globally (5 million of whom die each year), and the incidence of diabetes is expected to climb to over 640 million (1 in 10) by 2040. (IDF 2015). Diabetes foot ulcers (DFU) are one of the most significant diabetic health consequences. Antimicrobial treatments, such as dressings, topical therapies, medicines, drugs, debridement procedures, molecular, cellular, and gene therapies, plant extracts, antimicrobial peptides, growth factors, devices, ozone, and energy-based therapies, would be the focus of this study. Scopus, Web of Science, Bentham Science, Science Direct, and Google Scholar were among the sources used to compile the English-language publications on DFU. DFU treatment requires a multidisciplinary approach that includes the use of proper diagnostic tools, competence, and experience. To prevent amputations, this starts with patient education and the use of new categories to steer treatment. New diagnostic methods, such as the 16S ribosomal DNA sequence in bacteria, should become available to acquire a better knowledge of the microbiota in DFUs. 

Novel Diagnostic Technologies and Therapeutic Approaches Targeting Chronic Wound Biofilms and Microbiota

Purpose of Review

To provide an up-to-date overview of recent developments in diagnostic methods and therapeutic approaches for chronic wound biofilms and pathogenic microbiota.

Recent Findings

Biofilm infections are one of the major contributors to impaired wound healing in chronic wounds, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, and nonhealing surgical wounds. As an organized microenvironment commonly including multiple microbial species, biofilms develop and persist through methods that allow evasion from host immune response and antimicrobial treatments. Suppression and reduction of biofilm infection have been demonstrated to improve wound healing outcomes. However, chronic wound biofilms are a challenge to treat due to limited methods for accurate, accessible clinical identification and the biofilm's protective properties against therapeutic agents. Here we review recent approaches towards visual markers for less invasive, enhanced biofilm detection in the clinical setting. We outline progress in wound care treatments including investigation of their antibiofilm effects, such as with hydrosurgical and ultrasound debridement, negative pressure wound therapy with instillation, antimicrobial peptides, nanoparticles and nanocarriers, electroceutical dressings, and phage therapy.

Summary

Current evidence for biofilm-targeted treatments has been primarily conducted in preclinical studies, with limited clinical investigation for many therapies. Improved identification, monitoring, and treatment of biofilms require expansion of point-of-care visualization methods and increased evaluation of antibiofilm therapies in robust clinical trials.

Custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas

RESUMO Objetivo: Analisar os custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso, realizada numa Unidade de Tratamento Integral de Ferida. Obtiveram-se os custos multiplicando-se o tempo despendido pelos profissionais pelo custo unitário da mão de obra da respectiva categoria, somando-se aos custos dos materiais e terapias tópicas. Resultados: Os custos da assistência ambulatorial corresponderam a US$4,25 (DP ± 7,60), da hospitalar a US$3,87 (DP ± 17,27) e da domiciliar a US$3,47 (DP ± 5,73). Nessas três modalidades, os custos diretos com os curativos e consultas médicas foram os mais representativos: US$7,76 (DP ± 9,46) e US$6,61 (DP ± 6,54); US$7,06 (DP ± 24,16) e US$15,60 (DP ± 0,00); US$4,09 (DP ± 5,28) e US$15,60 (DP ± 0,00), respectivamente. Conclusão Considerando a assistência integral aos pacientes com feridas crônicas, o custo direto médio total foi de US$10,28 (DP ± 17,21), sendo a modalidade ambulatorial a mais representativa na sua composição. Constatou-se diferença estatística significante (valor p = 0,000) entre os custos da assistência domiciliar e ambulatorial, domiciliar e hospitalar e ambulatorial e hospitalar.

Average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds

ABSTRACT Objective: To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds. Method: Quantitative, exploratory-descriptive case study, carried out in a Comprehensive Wound Care Unit. Costs were obtained by multiplying the time spent by professionals by the unit cost of labor in the respective category, adding to the costs of materials and topical therapies. Results: Outpatient care costs corresponded to US$4.25 (SD ± 7.60), hospital care to US$3.87 (SD ± 17.27), and home care to US$3.47 (SD ± 5.73). In these three modalities, direct costs with dressings and medical consultations were the most representative: US$7.76 (SD ± 9.46) and US$6.61 (SD ± 6.54); US$7.06 (SD ± 24.16) and US$15.60 (SD ± 0.00); US$4.09 (SD ± 5.28) and US$15.60 (SD ± 0.00), respectively. Conclusion: Considering comprehensive care for patients with chronic wounds, the mean total direct cost was US$10.28 (SD ± 17.21), with the outpatient modality being the most representative in its composition. There was a statistically significant difference (p value = 0.000) between the costs of home and outpatient, home and hospital, and outpatient and hospital care.

Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review

Chronic wounds are defined as "hard-to-heal" wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form biofilms, leading to the release of planktonic bacteria, which causes persistent infections locally or remotely. Therefore, infection control and removal of the biofilm in chronic wounds are essential. Recently, ultrasonic debridement was introduced as a new method to reduce infection and promote the healing of chronic wounds. This scoping review aimed to evaluate the effectiveness of ultrasonic debridement on the changes in bacteria and biofilms, and consequently the wound healing rate of chronic wounds. A total of 1021 articles were identified through the database search, and nine papers were eligible for inclusion. Findings suggest that non-contact devices are useful for wound healing as they reduce the inflammatory response, although the bacterial load is not significantly changed. Ultrasonic debridement devices that require direct contact with the wound promote wound healing through reduction of biofilm or bacterial load. The optimum settings for ultrasonic debridement using a non-contact device are relatively consistent, but the settings for devices that require direct contact are diverse. Further studies on ultrasonic debridement in chronic wounds are required.