Aim: To compare the healthcare resource utilization, spending and clinical outcomes associated with porcine placental extracellular matrix (PPECM [InnovaMatrix[®] AC, Convatec Triad Life Sciences, LLC, TN, USA]) versus standard of care (SOC) and other advanced treatments (AT) among Medicare Fee-For-Service beneficiaries with diabetic foot ulcers (DFU) or venous leg ulcers (VLU). Materials & methods: A retrospective cohort study was conducted using 100% Medicare Parts A and B administrative claims from October 2021 through December 2024. Treatment episodes for DFU and VLU were identified and categorized as PPECM plus SOC, SOC alone or AT plus SOC. Patients were followed for 6 months after the end of each treatment episode. Outcomes included post-episode healthcare utilization by site of care, per-patient-per-month spending, wound-related complications and amputations. Results: The final study sample included 109,786 eligible DFU patients (117,633 episodes of care; PPECM 0.2%, SOC 95.0%, AT 4.8%) and 53,624 eligible VLU patients (56,498 episodes of care; PPECM 0.1%, SOC 95.5%, AT 4.4%). In DFU, PPECM was associated with significantly lower post-episode utilization in most sites of care compared with SOC, and fewer wound complications including amputations compared with AT. Although total post-episode costs were higher for PPECM than SOC and AT in DFU, PPECM had lower overall cost at specific types of care sites. In VLU, PPECM was associated with significantly fewer visits across most sites of care compared with AT and SOC. PPECM-treated VLU episodes had significantly lower total costs than both SOC and AT. Rates of wound complications and amputations were similar across treatment groups in VLU. Conclusion: Treatment with PPECM demonstrated lower overall post-episode costs compared with SOC and other AT while maintaining safety outcomes, particularly in VLU, suggesting potential value in chronic wound management.

One of the main consequences of diabetes mellitus is diabetic foot ulcers (DFUs), which often result in amputation and death. Two inflammatory biomarkers, platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), measured in standard blood testing, have become potential indicators of many adverse outcomes in diabetes-related complications. However, evidence regarding their association with complications of DFUs remains limited and inconsistent. This study critically reviewed the prognostic value of both markers in predicting clinical consequences amongst patients with DFU. An inclusive literature search across PubMed, Web of Science, Embase, and ProQuest identified 22 relevant studies. Meta-analysis showed that NLR was associated with amputation (standardized mean difference (SMD) 0.78, p = 0.002) and osteomyelitis (SMD 0.31, p = 0.001). Similarly, PLR was associated with amputation (SMD 0.29, p = 0.005) and osteomyelitis (SMD 0.40, p < 0.001). Pooled diagnostic performance for mortality prediction showed good accuracy for NLR (area under the curve (AUC) 0.83) and moderate accuracy for PLR (AUC 0.75). Overall, both NLR and PLR are promising and readily available biomarkers for risk stratification in DFU patients. The results emphasize the necessity of standardized cut-off values and prospective validation.

This first comprehensive systematic review aimed to summarise evidence on independent prognostic factors for wound healing in people with venous leg ulcers. In June 2025, we searched Ovid MEDLINE, Ovid Embase, CINAHL and additional resources for studies with 100 or more participants that used multivariable analyses and longitudinal data to explore the prognostic value of factors in this area. Two reviewers extracted data and assessed risk of bias using the Quality In Prognosis Studies (QUIPS) tool and certainty of evidence using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach. We synthesised studies narratively and, where applicable, pooled data using meta-analyses. We identified 30 studies with 66,099 participants living with venous leg ulcers. We rated 14 studies at moderate risk of bias, and the remaining 16 studies were at high risk of bias. The included studies explored 116 prognostic factors. The evidence is uncertain or limited for the majority of the 116 prognostic factors. There is moderate-certainty evidence, suggesting no association between complete healing and the factors of age in years (HR 0.99, 95% CI 0.97 to 1.0; OR 1.00, 0.99 to 1.02, for every year increment), and the presence of total deep reflux in the leg veins (HR 0.89, 0.75 to 1.05). Those having the presence of dermatitis likely have lower odds of complete healing (OR 0.51, 0.50 to 0.52). Although a wide range of factors have been investigated as potentially associated with venous leg ulcer healing, the evidence base for most is uncertain or limited.

Inferior vena cava (IVC) agenesis is a rare congenital anomaly (prevalence 0.0005%-1%) often asymptomatic but can be complicated by deep vein thrombosis, particularly in the presence of acquired thrombophilia. There are 2 major presentations reported in literature, infrahepatic IVC agenesis associated mostly with lower-limb thrombosis and intrahepatic IVC agenesis associated frequently with splanchnic thrombosis and pulmonary embolism. We report the case of a 38-year-old man presenting with chronic bilateral leg ulcers evolving for 3 years. Cross-sectional imaging demonstrated partial agenesis of intra-hepatic IVC and complete agenesis of the infra-hepatic IVC up to the iliac bifurcation, a massive compensatory collateral network involving the azygos vein, hemiazygos, lumbar, and abdominal parietal systems, as well as multiple venous thrombosis of the portal vein, mesenteric vein, azygos vein and lower-limbs. The iliac veins drained via ascending lumbar veins to the hypertrophied azygos system. Morphology CT analysis showed a focal right renal infarct, but no atrophy was noted. Laboratory workup revealed a probable antiphospholipid syndrome (APS) and severe antithrombin III deficiency (22%), nephrotic syndrome, and alteration in glomerular filtration. This case illustrates the importance of recognizing radiological signs of IVC agenesis, particularly in the presence of atypical thrombosis or unexplained leg ulcers. The association with probable APS, multiple visceral thrombosis and renal function altered, makes this case exceptionally rare and educationally important.

The aim of this study was to evaluate the cost-effectiveness of treating patients with Venous Leg Ulcers (VLUs) with the Muscle Pump Activation device (MPA, geko) in Canada. This is a cost-effectiveness analysis of the treatment of patients with VLUs, using MPA for 4 weeks in addition to standard of care compression therapy (SOC), compared to SOC alone using Canadian costs of VLU treatment. The authors determined the Canadian costs for each visit for a patient with a VLU to have their dressings performed at a nursing clinic. The total costs of treatment were determined based on healing rates from a randomized controlled trial from Wales that demonstrated a significant improvement in the healing of VLUs when MPA was used for 4 weeks in addition to SOC, compared to SOC alone. The cost per visit to a nursing clinic for the treatment of a VLU was estimated to be $109.71 CAD and dressing frequency was estimated to be an average of every 2.5 days. Using projected healing rates over a 12-month period based on the UK paper, the model indicated that treatment with MPA resulted in a cost savings of $983.61 CAD per patient. The average increase in ulcer free days was 56.6 days per patient. The Incremental Cost Effectiveness Ratio (ICER) identified a saving of $17.38 per ulcer free day. This model based on Canadian costs resulted in faster healing of VLUs and a reduced average Direct Wound Care Cost of $983.61 per patient for the whole of their ulcer treatment when the MPA is used for 4 weeks in addition to SOC. This treatment has the potential for patient benefit as well as significant cost savings for the Canadian Health Care system.

Venous leg ulcers (VLUs) result from a multifactorial interplay of etiological factors, posing significant challenges in clinical management. Effective treatment requires a comprehensive assessment to identify the underlying pathophysiological mechanisms, followed by the implementation of an individualized, multidisciplinary approach that integrates the expertise of vascular surgeons, wound care specialists, and other pertinent healthcare professionals. Although both domestic and international vascular surgery societies, as well as other relevant specialties, have issued consensus statements on the diagnosis and treatment of VLUs or clinical guidelines for managing chronic lower extremity venous diseases, there remains a notable gap in systematic guidance specifically focused on wound repair for VLUs. In particular, standardized protocols for surgical wound repair are either lacking or insufficiently detailed in these documents. With the establishment and advancement of wound repair as a specialized field in China, Chinese experts have accumulated substantial clinical experience in the diagnosis and management of VLU-related wound healing. To standardize the surgical repair of VLUs and improve both therapeutic outcomes and patients' quality of life, the Wound Repair Professional Committee of the Chinese Medical Doctor Association convened a panel of multidisciplinary experts for extensive deliberations. Based on a synthesis of current international and domestic evidence and clinical practice, the committee reached consensus on evidence-based recommendations for key issues in VLU wound management, including debridement techniques, indications, timing, and approaches to wound repair for VLUs. This consensus is intended to serve as a practical reference for clinicians involved in the care of patients with VLUs.

Pathogenic biofilms are a critical barrier to wound healing, driving infection persistence, delayed tissue repair, and antimicrobial resistance (AMR) and tolerance. This recognition has driven a paradigm shift from a traditional planktonic model of infection to a biofilm-mediated framework, where structured microbial communities are encased within a protective extracellular polymeric substance (EPS) matrix. These communities are highly prevalent in chronic wounds, with reported detection rates of 60%-100% across diabetic foot ulcers, venous leg ulcers, and pressure injuries. The establishment of biofilms fundamentally alters host-microbe interactions, promotes antimicrobial tolerance, and triggers therapeutic failure, prolonged inflammation, and wound chronicity. Despite their clinical relevance, management strategies remain limited. Crucially, a lack of rapid point-of-care diagnostics and standardized clinical endpoints hampers timely intervention. Conventional culture based methods frequently fail to detect sessile microbial populations, necessitating advanced techniques such as next-generation sequencing or confocal microscopy, which are largely unavailable in routine practice. A detailed understanding of the molecular and cellular mechanisms underpinning biofilm persistence is essential to translate knowledge into targeted clinical interventions. Effective management requires a biofilm centric, multimodal strategy that prioritizes regular mechanical debridement to disrupt the EPS matrix, supported by proactive exudate control and appropriate topical therapies. Looking forward, advances in diagnostic technologies, artificial intelligence (AI)-assisted analysis, and matrix disrupting or permeating agents offer significant potential. Furthermore, emerging biological therapies, including bacteriophages, promise to help transform wound management, reduce the burden of AMR, and potentially improve patient outcomes globally.