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Chronic wounds can impact the quality of life of working-age individuals. However, the specific challenges and burdens these patients face in the workplace remain understudied. This study aimed to 1) investigate how chronic wounds affect work life and 2) develop a screening tool for identifying highly affected patients. In total, 51 patients with chronic wounds answered a questionnaire on demographics, employment status, wound-related limitations, workplace conditions, social welfare use and subjective burden of disease. To assess the subjective burden, we developed a specific research tool on employment and chronic wounds (REACH Score) to measure and quantify the impact of the chronic wound on working patients. The patients, who answered the questionnaire, were employed (78%), on sick leave (18%) or retired (4%). They spent an average of 5.3 h per week on wound-related activities. Regarding workplace stressors, we found that taking breaks when needed was correlated with less time off sick and better work-related quality of life. Patients reported career concerns and reduced productivity. The REACH score was significantly correlated with sick leave, work difficulties, time consumed by the wound and overall quality of life. According to our pilot-study, the impact of chronic wounds on patients of working age is most evident in the form of sick leave and reduced work performance and in a reduced quality of life. It is crucial to identify the key factors contributing to stress in the work environment in a larger sample in order to improve the working conditions of patients and detrimental socioeconomic effects on the workforce. The REACH score is a novel tool to screen employed patients with chronic wounds for reduced work capacity and quality of life.
Background and aims: Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation. Patients and methods: Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed. Results: A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time. Conclusions: It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate.
Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.
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