Chronic wounds are a significant burden in orthopedic patients, often complicating recovery and prolonging hospitalization. ^[1] These wounds, defined as those that fail to progress through the normal stages of healing in an orderly and timely manner, are frequently associated with underlying conditions such as diabetes, vascular insufficiency, and immobility. ^[2] The intersection of orthopedic and dermatological care is crucial in addressing these complex wounds, as orthopedic injuries often compromise skin integrity, while dermatological interventions can optimize wound healing. ^[3]

Orthopedic patients, particularly those with fractures, joint replacements, or spinal injuries, are prone to developing chronic wounds due to prolonged immobility, pressure ulcers, and surgical site infections. ^[4] The management of these wounds requires a multidisciplinary approach, integrating orthopedic stabilization with dermatological therapies. ^[5] Dermatological interventions, such as topical antimicrobials, bioengineered skin substitutes, and negative pressure wound therapy, have shown promise in accelerating wound healing and reducing infection rates. ^[6]

The pathophysiology of chronic wounds involves a dysregulated inflammatory response, impaired angiogenesis, and microbial colonization. ^[7] In orthopedic patients, these processes are further exacerbated by mechanical stress, poor perfusion, and underlying comorbidities. ^[8] A dermatological approach addresses these factors by promoting a moist wound environment, facilitating debridement of necrotic tissue, and enhancing epithelialization. ^[9]

This study aims to evaluate the efficacy of a dermatological approach in managing chronic wounds in orthopedic patients. By integrating dermatological principles into orthopedic care, we hypothesize that wound healing outcomes can be significantly improved, reducing the risk of complications such as osteomyelitis and sepsis. The findings of this study have the potential to inform clinical practice and improve patient outcomes in this vulnerable population.

A prospective cohort study was conducted over 18 months, involving 150 orthopedic patients with chronic wounds. Patients were recruited from a tertiary care hospital specializing in orthopedic and dermatological care.

Inclusion Criteria

1. Patients aged 18 years and above.
2. Chronic wounds persisting for more than 6 weeks.
3. Wounds associated with orthopedic conditions such as fractures, joint replacements, or pressure ulcers.
4. Willingness to participate in the study and provide informed consent.

Exclusion Criteria

1. Wounds of malignant origin.
2. Systemic infections requiring intensive care.
3. Patients with uncontrolled diabetes or vascular diseases.
4. Immunocompromised patients (e.g., HIV, chemotherapy).

Interventions

1. Topical Therapies:Application of antimicrobial creams, growth factors, and collagen-based dressings.
2. Debridement:Surgical and enzymatic debridement to remove necrotic tissue.
3. Advanced Dressings:Use of hydrocolloids, hydrogels, and negative pressure wound therapy.
4. Patient Education:Guidance on wound care, nutrition, and mobility.

Data Collection and Analysis

Data on wound healing rates, infection control, patient satisfaction, and cost-effectiveness were collected at baseline, 4 weeks, and 12 weeks. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant.a

Table 1: Demographic Characteristics of Patients

In table 1, the majority of patients were male (60%), with a mean age of 58.4 years. Half of the patients had diabetes mellitus, a known risk factor for chronic wounds.

Table 2: Wound Healing Rates at 4 and 12 Weeks

In table 2, by 12 weeks, 75% of the wounds had healed, demonstrating the effectiveness of the dermatological approach.

Table 3: Infection Rates Before and After Intervention

In table 3, Infection rates decreased significantly from 30% at baseline to 6.7% at 12 weeks, highlighting the role of antimicrobial therapies and debridement.

Table 4: Patient Satisfaction Scores

In table 4, 90% of patients reported being either "very satisfied" or "satisfied" with the wound care provided, indicating high patient acceptance of the dermatological approach.

Table 5: Comparison of Healing Rates by Wound Type

In table 5, Surgical site infections had the highest healing rate (80%), while diabetic foot ulcers had the lowest (65%), likely due to underlying vascular and metabolic issues.

The findings of this study underscore the efficacy of a dermatological approach in managing chronic wounds among orthopedic patients. The integration of dermatological principles, such as advanced wound dressings, topical therapies, and debridement, resulted in a 75% wound healing rate at 12 weeks, a significant improvement compared to baseline. This aligns with previous studies that have demonstrated the benefits of multidisciplinary wound care in complex cases. For instance, Singer and Clark (1999) emphasized the importance of maintaining a moist wound environment to promote epithelialization and reduce healing time, a principle central to our intervention strategy. ^[10] Similarly, the reduction in infection rates from 30% to 6.7% highlights the critical role of antimicrobial therapies and regular debridement in preventing microbial colonization, as supported by Falanga (2004), who noted that biofilm formation is a major barrier to wound healing in chronic wounds. ^[11]

The high patient satisfaction scores (90% satisfied or very satisfied) further validate the acceptability and effectiveness of the dermatological approach. This is consistent with findings by Gupta et al. (2018), who reported that patient-centered wound care, including education and advanced therapies, significantly improves adherence and outcomes. ^[12] The cost-effectiveness analysis also revealed net savings of $300 per patient, primarily due to reduced hospitalization and fewer complications. ^[13] This echoes the work of Sen et al. (2009), who highlighted the economic burden of chronic wounds and the potential for cost savings through evidence-based interventions. ^[14]

The variation in healing rates by wound type, with surgical site infections showing the highest healing rate (80%) and diabetic foot ulcers the lowest (65%), reflects the influence of underlying comorbidities on wound healing. Diabetic patients often experience impaired angiogenesis and neuropathy, which delay healing, as noted by Brem and Tomic-Canic (2007). ^[15] This underscores the need for tailored interventions in high-risk populations, such as the use of growth factors and bioengineered skin substitutes, which have shown promise in diabetic wound care.

The study also highlights the importance of debridement in wound management. Regular removal of necrotic tissue not only reduces infection risk but also stimulates the formation of granulation tissue, a finding supported by Steed et al. (1996), who demonstrated that aggressive debridement significantly improves healing rates in chronic wounds. ^[16] Additionally, the use of negative pressure wound therapy (NPWT) in our study aligns with the work of Armstrong and Lavery (2005), who found that NPWT enhances wound contraction and reduces edema, further accelerating healing. ^[17]

Despite these positive outcomes, the study has limitations. The single-center design may limit the generalizability of the findings, and the lack of a control group makes it difficult to isolate the effects of the dermatological interventions. Future studies should employ randomized controlled designs to establish causality and explore the long-term outcomes of these interventions.

A dermatological approach significantly improves the management of chronic wounds in orthopedic patients, enhancing healing outcomes and reducing complications. This study demonstrates that a dermatological approach significantly improves wound healing outcomes in orthopedic patients, reducing infection rates and enhancing patient satisfaction. The findings align with previous research and highlight the importance of multidisciplinary care in managing chronic wounds. By integrating dermatological principles into orthopedic practice, clinicians can address the complex needs of these patients, ultimately improving their quality of life and reducing healthcare costs.

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