Wound healing

Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention (2025)

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Type of publication:

Journal article

Author(s):

Macefield R.; Mandefield L.; Blazeby J.M.; Fairhurst C.; Baird K.; Arundel C.; Chetter I.; Martin B.C.; Hewitt C.; Gkekas A.; Mott A.; Saramago Goncalves D.P.; Swan S.; Torgerson D.; Wilkinson J.; Zahra S.; Dixon S.; Hatfield J.; Oswald A.; Dumville J.; Lee M.M.; Pinkney T.; Stubbs N.; Wilson L.; Clothier A.; Bosanquet D.; Blow M.; Price C.; Todd J.; Munro T.; Pillay W.; Pradhan A.; Garnham A.; Wall M.; Powezka K.; Gerrard D.; Croucher A.; Hadjievangelou N.; Firth A.; Roe T.; Smith G.; Bicknell C.; Carr C.; Negbenose E.; Tarusan L.; Vesey A.; Wilson D.; Bell D.; Fletcher J.; Greenwood C.; Wallace T.; Vallabhaneni S.; Holder S.; Williams J.; Sim S.; Tambyraja A.L.; Kerray F.; Ng A.; Sylvester M.; Slater L.; Rashid S.T.; Palacios A.; Feld K.; Nandhra S.; Stansby G.; Parr N.; Jones L.; Milne J.; Stubbs C.; Hinchliffe R.; Twine C.; Antoniou G.A.; Corbett C.; Munt S.; Warran S.; Fletcher R.; Al-Jundi W.; Burrows M.; Stather P.; Barnes R.; Woodrow T.; Adams B.; Agu O.; Gleeson Y.; D'Souza R.; Erete L.; *Jones S.; *Checketts C.; *Bajic D.; *Matravers R.; Loftus I.; Budge J.; Azhar B.; Juszczak M.; Syed A.; Hancox R.; Pearce C.; Suggett N.; Whitehouse A.; Kuhan G.; Premnath S.; Dattani N.; Hollings V.; Khasawneh F.; AlShakarchi J.; Packer E.

Citation:

Journal of Tissue Viability. 34(3) (no pagination), 2025. Article Number: 100889. Date of Publication: 01 Aug 2025.

Abstract:

Background: Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim(s): To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention. Method(s): The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)). Result(s): Baseline in-person questionnaire return rates were highest (672/686; 98 %), with postal return rates of 428/615 (68.5 %), 274/416 (65.9 %) and 186/296 (62.8 %) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC = 0.796). Conclusion(s): The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.

DOI: 10.1016/j.jtv.2025.100889

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A Case Report of the Management of a Severe Scalp Wound with Combination Treatment including Negative Pressure Therapy with Skin Cell Spray (2016)

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Type of publication:
Conference abstract

Author(s):
*Sandhu B.; *Messahel A.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)

Abstract:
Facial injuries can lead to extensive scarring, causing physical discomfort, anxiety and social isolation for patients. The optimum method of wound healing would be primary closure, however in cases where this is not possible other options must be explored. This case report involves a 40 year old female who sustained a severe scalp wound following a road traffic accident, causing partial ejection from the vehicle. The patient was transferred to our care seven days after receiving treatment to the affected area by an emergency department. Examination revealed an 8 cm right frontal scalp region wound present, which was clearly acutely infected with areas of full thickness skin necrosis and generalised overlying slough across the defect. The lower region of the wound involved an area of 2.5 cm exposed bone. There was also weakness noted of the temporal branch of the right facial nerve with reduced brow movement. Following thorough debridement and lavage, combination treatment consisting of negative pressure vacuum therapy and allogenic skin spray application was instigated. Negative pressure allowed for contraction of the wound edges for granulation, and reduced dehiscence risk. It also increased vascularisation of the exposed bone region inferiorly and significant reduction in wound size. Fresh allogenic human keratinocyte suspension allowed for complete healing of the defect. This involved epithelisation of the superficial layer of the wound, with no remaining exudate and complete bone coverage.This successful result is exemplary of a non-surgical therapy for extensive wounds in aesthetically challenging areas.