Journal of Wound Management

This study aimed to evaluate microbiological patterns and their relationship with outcomes in patients hospitalised for diabetic foot infection (DFI). It was a retrospective observational study involving 123 patients, with an average age of 67.8 years; 74.5% were male, and 97.5% had type 2 diabetes. Of these, 22% had osteomyelitis, while 78% had soft tissue infections. The most commonly isolated bacteria were Methicillin-susceptible Staphylococcus aureus (MSSA) (26%), Enterococcus faecalis (12.2%), Pseudomonas aeruginosa (10.6%), and Methicillin-resistant Staphylococcus aureus (MRSA) (7.3%). Polymicrobial infections were present in 37.8% of cases. Minor and major amputation rates were 56.3% and 4.2%, respectively. Amputees were older, had higher rates of ischemic diabetic foot ulcers (91.7% vs 70.6%), and higher white blood cell (WBC) levels (10.9 vs 8.3 x 10³/μL). However, no correlation was found between the type of bacteria, polymicrobial infections, or the type of infection and amputation. Severe infections, defined by WBC>12,000 x 10³/μL, were an independent predictor of amputation. Staphylococcus aureus was the most frequently isolated bacteria, but microbiological characteristics were not independently linked to amputation. Amputation was instead related to the clinical severity of the infection.

Background Wound-related odour has a negative impact on the quality of life of the patient and may be indicative of wound infection or deterioration. Wound assessment should incorporate odour assessment. This scoping review aimed to determine what wound odour assessment methods are incorporated into wound assessment tools.

Methods This review was guided by the Joanna Briggs Institute recommendations for the conduct of scoping reviews and reported according to the PRISMA-ScR checklist.

Results Five methods to assess wound odour used in wound assessment tools were identified: TELER; TSAW-W; WoSSAC; MWAT-C & R; and the National Wound Assessment Form. Each reported on the process of tool development with evidence of validity and reliability testing at the development stage. However, these tools were very poorly represented in research studies that aimed to evaluate the outcomes of interventions to manage odour.

Conclusions Validated methods of wound-related odour assessment do exist but are poorly represented in wound assessment tools or research studies. Numeric rating scales of odour intensity are the most frequently reported but do not take account of the level of interference or ‘bother’ for the patient or their families. We need a call to action for industry and the research community to recognise the significance of this problem and to work together to find solutions that are tested using validated tools.

Telemedicine has been a fundamental component of healthcare for many decades, although its widespread adoption significantly accelerated during the COVID-19 pandemic. This unprecedented global health crisis compelled healthcare institutions to rapidly innovate and shift to remote care options, highlighting the potential of virtual healthcare delivery. This article seeks to look at the emergence of podiatric telemedicine for the management of high-risk feet as an alternate model of care to help reach more high-risk patients in a timely manner. By concentrating on this specific field, we aim to put forward the implementation of podiatric telemedicine as a viable supplementary service for high-risk patients. Researchers and healthcare professionals should work towards implementing such services aimed at preventing complications in the high-risk foot by offering timely care and advice.

Background Chronic wounds pose a major healthcare challenge due to delayed healing, infection risks, and they are associated with chronic conditions, such as diabetes and cardiovascular disease. Smart wound dressings, integrating sensor technologies to monitor biological parameters, offer promising advancements in wound management. However, a comprehensive understanding of the parameters they monitor, and their clinical significance remains limited.

Aim This protocol outlines a planned scoping review to map the existing literature on biological parameters monitored in smart wound dressings.

Methods Following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, a systematic search will be conducted in MEDLINE (via Ovid), Embase, Web of Science, CINAHL (EBSCO), and Google Scholar. The search strategy, developed with librarians, will use controlled vocabulary and keywords. Eligibility criteria will be derived from the Population, Concept, and Context (PCC) framework. Data extraction will be performed using Elicit®, an AI tool, and independently verified. A narrative synthesis will categorise themes.

Discussion and conclusions This review will systematically map available evidence, offering insights into key parameters, their relevance in wound management, and gaps in research. Results will guide future studies, healthcare professionals, and policymakers in integrating smart dressings into clinical practice and optimising wound care technologies.

Implications for clinical practice This review will support evidence-based decision-making, aiding in the adoption of smart wound dressings to enhance patient care and treatment outcomes.

Aims (1) To implement community-based compression bandaging for venous leg ulcer (VLU) patients using the Implementation Research Logic Model (IRLM) and train community nurses. (2) To evaluate patient and nurse perspectives on satisfaction, confidence and outcomes.

Background In Singapore, compression bandaging for VLUs has been limited to tertiary care due to inadequate community nurse training, therefore a structured program was developed to bridge this gap.

Methods This quasi-experimental study evaluated the implementation outcomes of a structured training program on two and four layer compression bandaging in community settings. Patients were given the choice to receive compression bandaging in either community or tertiary care settings. The program included theoretical training, clinical attachments, and competency-based assessments. Guided by the IRLM, facilitators and barriers to community-based care were identified through multiple channels, including intervention characteristics, settings, processes, the referral system and experience by patients and nurses. Patient outcomes, training effectiveness and experiences were assessed after 12 weeks.

Results 27 out of 47 patients opted for community-based bandaging; 15 completed follow-up, with nine achieving complete ulcer healing (median wound area reduction: −2.272 cm squared, p = 0.003). Patients reported consumable cost saving S$339.50 (median)and time savings to commute to the tertiary care centre.  There was mixed confidence in the performance of community nurses. Fifteen community nurses completed the training, with half of them strongly supporting its utility.

Discussion Community-based compression bandaging is feasible and effective in addressing VLU care gaps. It improves access, enhances outcomes and reduces costs through training and collaboration between tertiary and community teams.

Conclusion and implications for nursing and/or health policy This initiative empowers community nurses with advanced skills and offers a scalable, cost-effective model to extend specialised care into the community. Aligning subsidy structures and decentralising healthcare supports equitable, sustainable care delivery and improved patient outcomes.

Summary

Gout is frequently underdiagnosed in patients with diabetes. As a chronic disease characterised by urate deposition, gout can lead to the formation of tophi in the feet, which may ulcerate. However, the prevalence of tophaceous gout in patients with diabetes and foot ulcers has not been previously studied.

This study explored the feasibility of sampling foot ulcer debris for polarised light microscopy to detect birefringent urate crystals and identify cases of gout in patients with diabetes. Among 36 ulcer debris samples examined, urate crystals were identified in five cases (14%) strongly suggesting previously unrecognised gout. Radiographic findings further supported tophaceous gout as the primary cause of these foot ulcers.

These findings indicate that unrecognised tophaceous gout may be relatively common among patients with Type 2 diabetes and foot ulcers. However, selection bias may have led to an overestimation of prevalence, while insufficient or contaminated samples may have resulted in an underestimation. Further refinement of sampling and examination techniques—ideally supplemented by imaging prior to ulcer treatment —is needed to improve the detection of all cases with urate crystals and to ensure that negative findings truly reflect the absence of gout rather than technical limitations.

Background Pain at the donor site of skin grafts remains a significant clinical challenge. Existing pain management approaches include topical agents, oral analgesics, and local anaesthetics, yet optimal strategies remain elusive. Methylene Blue (MB), known for its analgesic potential in various pain types, is being evaluated in this trial for its safety and efficacy when injected intradermally at donor sites following skin grafting

Aim To evaluate the safety and efficacy of intradermal injection of MB for pain relief at the donor site in patients undergoing split-thickness skin grafts (STSG), in comparison to standard dressing without MB.

Methods This single-center, randomised, parallel-group, active-controlled trial will enrol 60 adult patients undergoing STSG. Participants will be randomised into two groups: Intervention group (n=30) which will receive an intradermal MB injection at the donor site, while the control group (n=30) will receive standard tulle gras dressing. The primary outcome of this study is degree of pain relief achieved with the use of MB in split-skin grafting, measured by changes in Visual Analog Scale (VAS) scores at different time points postoperatively at 5th, 7th, 15th and 30th days. Secondary outcomes will include the requirement of analgesia, staining of the donor site, donor site healing (epithelisation) rate, scar quality, and adverse effects reported. Data analysis will include comparisons between the groups postoperatively, using independent statistical tests to assess intervention effects.

Discussion This trial aims to validate MB as a novel, low-cost analgesic intervention in postoperative care. If effective, it could improve patient comfort and recovery with minimal additional risk and may inform the development of more effective pain management strategies for the patient population.

Aim The purpose of this study is to explore the perceptions and experiences of senior nursing students who participate in a real patient simulation designed for the assessment of diabetic foot ulcers.

Background The integration of real patients into standardised patient simulations has the potential to further improve the authenticity and educational impact of the learning experience.

Methods This study used a qualitative design involving eleven senior nursing students. Individual interviews were analysed using Braun and Clarke’s qualitative thematic analysis method.

Results For all students, this was their first experience with both real patient simulation and standardised patient simulation. Thematic analysis identified four main themes reflecting their experiences: emotions experienced, gains achieved, realism of the simulation, and qualities of the simulation application.

Conclusions The study revealed that this simulation created an authentic learning environment as an alternative to clinical teaching, allowing students to experience professional nursing and facilitating learning through experience.

Implications for clinical practice Real patient simulations may enhance nursing students’ clinical readiness and patient-centered care.

Background Medical device-related pressure ulcers (MDRPUs) in the head region are a persistent challenge in healthcare, particularly in patients using non-invasive ventilation masks, high-flow nasal oxygen cannulas, prone positioning supports, or rigid cervical collars.

Aim This study aimed to evaluate the effectiveness of silicone foam dressings in reducing the incidence of MDRPUs in high-risk patients across two major Czech healthcare facilities and to gather feedback from healthcare professionals regarding their usability and effectiveness.

Methods A retrospective study was conducted, analyzing clinical data on MDRPUs in the head region from 2023 to 2024 across two university hospitals in the Czech Republic. The sample included 354 cases of pressure ulcers. Data were analysed to compare MDRPU prevalence before and after the introduction of silicone foam dressings. Informal verbal feedback captured insight from healthcare professionals on the practicality and benefits of silicone foam dressings.

Results The implementation of silicone foam dressings was associated with a noteworthy reduction in MDRPU prevalence, with MDRPU cases decreasing from 61% to 30% at one facility and from 41% to 33% at the other between 2023 and 2024. Healthcare professionals highlighted the dressings’ ease of application, adaptability and effectiveness in preventing skin damage.

Conclusions Silicone foam dressings are an effective intervention for reducing MDRPUs in the head region. Their integration into care protocols has demonstrated improved patient outcomes and increased healthcare provider satisfaction. Routine use of silicone foam dressings in high-risk settings is recommended to enhance prevention efforts, and ongoing education and research are needed to optimise their application and explore cost-effectiveness in diverse healthcare environments.

Background Martorell’s ulcer, also known as hypertensive leg ulcer (Martorell hypertensive ischemic leg ulcer /HYTILU/) is a challenging chronic ulcer form and often underdiagnosed.

Aim To highlight the role of interprofessional teamwork in treating Martorell HYTILU ulcers.

Method Case study of a 69-year-old woman with chronic ulcers in the left ankle, identified as ischemic and Martorell HYTILU ulcers. The interprofessional team included vascular surgeons, dermatologists, plastic surgeons, a geriatrician, an infectious disease specialist, tissue viability nurses and a physiotherapist.

Discussion At first visit, ER evaluation showed palpable ADP and ATP. Cefuroxime was started, and surgical revision was assigned. After second revision, the ulcers necrotized again and became extremely painful. On second evaluation, peripheral pulses were not palpable, and the patient was referred to university hospital, where she received interprofessional care.  In CTA, multilevel atherosclerotic stenoses were seen on the left limb. After revascularization, intravenous sodium thiosulfate treatment was initiated due to clinical suspicion of Martorell HYTILU ulcer and the reappearance of necrotic tissue declined. Negative pressure wound therapy (NPWT) was started, but technical challenges prevented compression therapy threatening the skin graft’s success due to leg oedema. After skin grafting, NPWT was replaced by compression therapy. After 3 months, the ulcer was healed.

Conclusion Interprofessional teamwork is essential for treating Martorell HYTILU ulcers. Regular clinical evaluations and education on leg oedema treatment are also crucial.

Implications for clinical practice Clear, concise, and concrete instructions aid the work of the receiving care unit.

Background Hansen’s disease, commonly known as leprosy, is an infectious disease caused by Mycobacterium leprae, an acid-fast intracellular bacillus (affecting macrophages and Schwann cells), primarily involving the skin and nerves. It is a rare disease in Portugal, with a higher prevalence in developing countries, where it remains a significant public health issue.

Aim To share the difficulties of establishing the correct diagnosis of Hansen´s disease and to raise awareness of this condition, especially in European countries where clinicians are not familiarised with the disease.

Methods/description of the case The case study presented is of a 65-year-old female who visited the emergency department due to sudden onset of purpuric lesions dispersed across her body, accompanied by fever and generalised oedema. A skin biopsy revealed the presence of multiple thrombi and signs of vasculitis in the adipose tissue lobules along with a neutrophilic infiltrate. Bacilloscopy identified numerous acid-fast bacilli, often arranged in ‘globi’. A diagnosis of multibacillary Hansen’s disease with type II immunological reaction (erythema nodosum leprosum) and a possible Lucio phenomenon was established.

Conclusion/implications for clinical practice The importance of obtaining an accurate diagnosis for proper treatment plan implementation is cardinal. In the process of providing care for this population of patients, it is crucial to address wellbeing and promote quality of life, by providing proper pain management, along with odour and exudate control.

Background Pressure injuries (PIs) are a significant public health concern in the USA, contributing to patient morbidity, mortality and healthcare costs. Epidemiological and health economic research relies on robust estimates of PI prevalence and incidence to inform resource allocation and preventive strategies.

Aim This systematic review aimed to assess the feasibility of a meta-meta-analysis (meta-MA) to estimate the prevalence or incidence of PIs in the USA.

Methods The umbrella review of systematic reviews (SRs) with meta-analyses (MAs) published between January 2010 and September 2024 was conducted. Searches were performed in four databases. Two reviewers independently screened articles, one extracted data, and another verified data points. Quality was assessed using AMSTAR-2, and feasibility of a meta-MA was evaluated based on SR quality, study overlap, population and outcome similarities, and inclusion of US-specific studies or subgroup analyses.

Results Twenty SRs with MAs were identified. Overall quality was poor, with two high-quality and one moderate-quality study. Overlap was minimal. Population characteristics and outcome definitions were poorly reported; only four SRs properly defined outcomes. Three SRs focused on the general hospitalised population, nine on subgroups, five on device-related PIs, and 13 on specific settings. Sixteen SRs included ≥2 US studies, but only six performed country subgroup analyses.

Conclusions A robust meta-MA to support US health economic modeling was not feasible.

Implications for clinical practice PI point prevalence remains high, but the low quality of SRs limits the ability to delineate a clear epidemiological picture, underscoring the need for higher-quality reviews.