Background Chronic, complex or hard-to-heal wounds generate substantial clinical burden and wide psychosocial consequences. Understanding patient and family experience is essential to optimise care pathways and continuity of care.

Objective To explore the lived experience of patients and/or family members during treatment and follow-up in specialist wound units within a public health system, and to identify perceived needs, barriers and expectations to inform service improvement.

Methods This was a qualitative study using a phenomenological approach. Purposeful sampling sought maximum heterogeneity (wound type, age, sex, geographical area and care setting). Semi-structured, in-depth interviews were conducted between May and October 2025 with adults and/or family carers under active follow-up in specialist wound units. Interviews were audio and/or video-recorded, transcribed verbatim, and analysed inductively using thematic analysis with investigator triangulation and consensus procedures.

Results Thirty-six interviews were completed. Four overarching themes emerged: (1) a non-linear care pathway marked by delays and challenging transitions between primary and specialist care; (2) the relational and informational dimension, where empathy, clarity and team continuity increased trust and perceived safety; (3) a marked biopsychosocial impact, including functional limitation, emotional distress and identity disruption; and (4) coping sustained by family support and personal strategies, such as patience and normalisation of suffering.

Conclusions Participants described prolonged trajectories in which continuity, coordination and communication were as influential as technical care.

Implications for clinical practice Strengthening inter-level coordination, improving consistent patient information and integrating psychosocial assessment may enhance patient experience and care quality.

Introduction Prolidase deficiency is a rare genetic metabolic disease that leads to an accumulation of dipeptides containing proline. This molecule is involved in the biosynthesis and degradation of collagen. In prolidase deficiency, collagen synthesis is impaired, leading to the main manifestations of the disease, namely skin ulcers, for which current treatments have limited efficacy and are solely supportive.

Methods We describe the case of a 58-year-old woman with prolidase deficiency. The patient benefited from a multimodal treatment including hyperbaric oxygen therapy and the application of resorbable synthetic dermal grafts of biodegradable temporising matrix (BTM) for wound reconstruction.

Discussion Over the course of her life, the patient treated her lower extremity skin ulcers with hyaluronic acid cream and gauze, experiencing a gradual worsening, particularly in the last 10 years. Prior to our evaluation, the patient underwent continuous hyperbaric oxygen therapy for approximately 3 months, which was interrupted so she could undergo surgical intervention. Subsequently, she underwent surgical toilet and application of double-layer, resorbable, synthetic Novosorb BTM dermal matrix grafts, along with oral antibiotic therapy. On the 20th postoperative day, the grafts were removed, revealing a pink, vital and well-perfused underlying tissue with the appearance of granulation tissue at the ulcer base and ulcer reduction. Outpatient follow up was continued, consistent improvements were achieved.

Conclusions Currently, no effective treatments exist for ulcers caused by prolidase deficiency. Our preliminary results suggest that the combination of hyperbaric therapy and synthetic dermal grafts could represent a promising new therapeutic option for these patients.

Introduction Hard-to-heal wounds may be influenced by subtle or occult infections that do not show overt clinical signs. Early identification of these infections is essential to optimise treatment strategies.

Objective To evaluate the ability of a bacterial fluorescence imaging device to detect subclinical infection in hard-to-heal wounds, compared with conventional microbiological swab culture.

Methods A prospective observational study including 20 patients with hard-to-heal wounds (>6 weeks) without evident clinical signs of infection. Wounds were assessed using fluorescence imaging and swab samples were obtained for microbiological culture and semiquantitative Q-index (Q-score) analysis.

Results Positive fluorescence was observed in 60% of wounds, while 55% showed a clinically significant bacterial burden (>10⁵ CFU/mL). A statistically significant association was found between fluorescence signals and pathogenic bacterial load (χ² p=0.002; Fisher’s exact test p=0.005). The device showed a sensitivity of 90.9% and a specificity of 77.8%.

Conclusion Bacterial fluorescence imaging enabled early identification of subclinical infection with high diagnostic performance compared with conventional swab culture in hard-to-heal wounds.

Implications for clinical practice Fluorescence imaging provides a non-invasive, real-time assessment of wound status, allowing clinicians to identify early impairments in healing that are not visible to the naked eye.

Background Artificial intelligence (AI)-enabled wound assessment applications are increasingly developed to support clinical decision-making through automated wound segmentation, measurement and documentation. Although these technologies show promising technical performance, successful implementation in clinical practice depends on clinicians’ trust, perceptions of risk and readiness to adopt AI-supported tools.

Aim The aim of this study was to explore the factors shaping wound care specialist nurses’ and physicians’ trust, perceived risk and readiness to adopt AI-enabled wound assessment applications providing automated wound segmentation and measurement.

Methods A qualitative exploratory study was conducted with ten wound care specialist nurses and physicians working in acute and outpatient settings in French-speaking Switzerland. Semi-structured interviews were conducted in January 2026 to explore clinicians’ wound assessment practices, experiences with digital tools, perceptions of AI-enabled wound measurement, perceived risks and conditions influencing adoption. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis following Braun and Clarke’s framework.

Findings Three themes were identified: objectivity in wound measurement while preserving clinical judgement; perceived risks related to data security and professional responsibility; and workflow integration as a driver of AI adoption. Participants viewed AI as a promising tool for improving measurement objectivity and longitudinal wound monitoring when systems are validated and integrated into clinical workflows.

Conclusions AI-enabled wound assessment tools are perceived as supportive technologies that may enhance wound care practice when implemented in ways that respect clinicians’ expertise, organisational workflows and ethical responsibilities.

Background Diabetic foot ulcers (DFUs) are chronic complications of diabetes mellitus, associated with high morbidity and amputation risk. Objective and standardised evaluations are needed to improve wound monitoring, particularly through the segmentation of red colour intensity that represents granulation tissue.

Aims This study aimed to develop an automated detection model for granulation tissue in DFUs based on red colour index using the YOLOv11 algorithm.

Methods This research employed a descriptive observational design with a cross-sectional approach conducted at two hospitals in Malang City. A total of 226 wound images were collected with ethical approval and informed consent. Image training was performed using Roboflow 3.0 for manual annotation and dataset augmentation. Red colour index was extracted from the RGB channels, and model performance analysis was carried out using You Only Look Once version 11 (YOLOv11). Evaluation metrics included precision, recall and mean Average Precision (mAP@50).

Results The granulation tissue detection model demonstrated satisfactory performance with a mAP@50 of 66.6%, precision of 81.0%, and recall of 60.9%. The mean red channel value of wound images was 155.51, indicating the dominance of red spectrum in granulation areas. Model predictions were consistent with manual and visual validation, confirming that red colour intensity is an effective feature for granulation tissue segmentation.

Conclusion The YOLOv11-based detection model shows strong potential for automated granulation tissue identification in diabetic foot ulcers. This approach can improve objectivity and efficiency in wound healing evaluation and support clinical decision-making through digital technology integration.

Implications for clinical practice The implementation of a YOLOv11-based automated granulation tissue detection model can enhance objectivity and standardisation in diabetic foot ulcer assessment. By utilising red colour index segmentation, this approach supports more accurate wound monitoring, reduces inter-observer variability and assists clinicians in evaluating wound healing progression, thereby facilitating more informed and efficient clinical decision-making.

Background Recurrent diabetic foot ulceration remains a clinical challenge despite preventive care. Plantar fat pad atrophy, neuropathy, and deformities increase plantar pressure and contribute to recurrence. Cross-linked hyaluronic acid (HA) injection for plantar soft-tissue augmentation may restore cushioning; however, evidence remains limited.

Hypothesis/aim To evaluate the safety and effectiveness of subcutaneous cross-linked HA injections in reducing recurrent plantar diabetic foot ulcers and improving ulcer-free survival compared with standard preventive care.

Methods A prospective, non-randomized controlled pilot study included 63 adults with type 2 diabetes and healed neuropathic or Charcot-related plantar ulcers. Thirty-eight participants received subcutaneous cross-linked HA injections beneath high-risk plantar areas, while 25 received standard preventive care. Participants were followed for six months. Outcomes included safety and tolerability, ulcer recurrence, ulcer-free survival, pain, and functional status. Kaplan–Meier analysis and restricted mean survival time (RMST) were used.

Results No HA-related adverse events were observed. During a mean follow-up of 253 days, ulcer recurrence occurred in 7/38 (18.4%) participants in the HA group and 18/25 (72.0%) in the control group (p < 0.0001). The HA group showed significantly longer ulcer-free survival (log-rank p < 0.0001), with an RMST extension of 110.6 days (95% CI 74.4–146.8; p < 0.001). Pain and functional outcomes improved significantly.

Conclusions Plantar soft-tissue augmentation with cross-linked HA was associated with reduced ulcer recurrence, prolonged ulcer-free survival, and improved outcomes. Larger randomized controlled trials are required.

Implications for clinical practice Cross-linked HA augmentation may be promising adjunctive approach for patients with healed diabetic foot ulcers.

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting intertriginous areas and characterised by recurrent nodules, abscesses, draining tunnels and scarring. It is associated with substantial physical and psychological burden and markedly impairs quality of life.

Objective This paper provides a concise overview of the current understanding of HS pathogenesis, clinical phenotypes, severity assessment and therapeutic management.

Methods What is it?: Key concepts explained was developed focusing on the main pathogenic mechanisms, clinical classification systems, severity scoring tools, imaging modalities and currently available medical and surgical treatment strategies for HS.

Results HS is recognised as a multifactorial disease involving follicular occlusion, autoinflammatory and immune dysregulation, microbiome alterations and modifiable risk factors, such as obesity and smoking. Clinical evaluation remains central to diagnosis, while Hurley staging and the International Hidradenitis Suppurativa Severity Score System are widely used in practice. High-frequency ultrasound improves detection of subclinical lesions and may refine staging. Management requires an individualised combination of topical, systemic, biologic and surgical approaches.

Conclusions Early diagnosis, accurate severity assessment and multidisciplinary care are essential to optimise outcomes and improve quality of life in patients with HS.

Background Fournier’s gangrene is a life-threatening necrotising fasciitis that affects the perineal, genital and perianal regions. Its management requires aggressive surgical debridement, antibiotic therapy and complex wound care, especially in patients with comorbidities or immunosuppression.

Aim This study evaluated the effectiveness of an oxygen-enriched oil-based medical device (NovoX^® Fit) in promoting wound healing and avoiding further surgical interventions in patients with Fournier’s gangrene.

Methods We present a retrospective case series involving three patients affected by Fournier’s gangrene and extensive soft tissue loss. All patients underwent multiple surgical debridements and initial wound management. Once the wounds presented a granulating bed, oxygen-enriched oil matrix-impregnated gauze was applied. Dressings were changed every 1–3 days depending on clinical needs. Clinical progress was documented with photographs and monitored through regular outpatient evaluations.

Results All three patients demonstrated progressive granulation tissue formation, improved wound microenvironment and significant reduction in pain and local inflammation. The use of oxygen-enriched oil impregnated gauze avoided the need for further surgical reconstruction. Complete wound healing was achieved in 5 to 12 weeks, even in the presence of severe comorbidities and in anatomically challenging areas, such as the perineum and sacral region.

Conclusions The oxygen-enriched oil impregnated dressing played a critical role in managing complex wounds related to Fournier’s gangrene, offering effective infection control, enhanced patient comfort and faster healing.

Implications for clinical practice The oxygen-enriched oil impregnated gauze represents a promising adjunct in the multidisciplinary management of hard-to-heal wounds, particularly when traditional surgical options are limited or contraindicated.

Background Temperature, pH and moisture are critical biophysical markers in wound healing, yet they cannot be continuously monitored under dressings, creating a significant clinical gap. Sensor-enabled dressings offer promise for early detection of subclinical inflammation, but end-user perspectives — particularly those of frontline nurses — remain largely absent from the literature.

Aim This study aimed to explore nurses’ knowledge of wound biophysical parameters, their perceptions of sensor-enabled dressing technologies and their views on perceived benefits, barriers and ethical dimensions.

Methods A qualitative descriptive design was used. Fifteen nurses working in public, private and university hospitals in Istanbul were recruited using maximum variation purposive sampling. Face-to-face semi-structured interviews (lasting 25–40 minutes) were audio-recorded, transcribed verbatim and analysed using Braun and Clarke’s thematic analysis. Reporting followed COREQ criteria.

Results Eight main themes emerged. All participants recognised pH, temperature and moisture as healing indicators but expressed frustration over their inability to monitor these under dressings (the “black box” problem). Participants viewed sensor-enabled dressings as transformative, particularly for early infection detection (12/15) and workflow improvement (11/15). Major concerns included high cost (6/15), technical reliability (5/15), data security (5/15) and potential blunting of clinical intuition (2/15).

Conclusions Nurses perceive sensor-enabled dressings as valuable for chronic wound care. Successful clinical integration requires addressing cost barriers, ensuring technical reliability, establishing data governance frameworks and positioning the technology as a tool that supports, rather than replaces clinical judgment.

Implications for clinical practice Sensor-enabled dressings could enable proactive wound management, data-driven decision-making and improved workflow efficiency. Nursing education must evolve to include digital literacy, while preserving traditional assessment skills.

Background Artificial intelligence (AI) simulations are increasingly used in education to provide learners with safe opportunities to practise and develop clinical skills. However, their use in wound care education remains underexplored.

Aim This study evaluated postgraduate wound care students’ satisfaction with, and perceived learning value of AI-supported virtual patient simulations.

Methods Postgraduate students who completed a virtual patient interaction between July 2025 and November 2025 were invited to complete a voluntary, anonymous survey. The survey included 5-point Likert-scale items, binary responses and open-ended questions. Quantitative data were analysed using descriptive statistics with student satisfaction predetermined as ‘good’ when combined agree and strongly agree responses reached 75%. Open-ended responses were thematically analysed.

Results Eight of 32 eligible students completed the survey, a 25% response rate. All respondents agreed that the simulation provided a realistic patient interaction and was engaging (Agree 87.5%, Strongly Agree 12.5%), that it improved their use of patient-friendly language and provided feedback specific enough to identify areas for improvement. Thematic analysis identified psychological safety, authenticity and accessibility as perceived benefits.

Conclusions Preliminary findings suggest that AI-supported virtual patient simulation may provide an engaging, realistic and psychologically safe environment for wound care students to practise non-technical skills. While this study involved a small participant cohort, the findings provide early insights into the potential educational value of AI-enabled simulation within wound care education.

Implications for clinical practice AI-simulations show promise for developing non-technical skills in wound care, but further research is needed to validate skill transfer to practice.

Neoplastic ulcers of the lower limbs are frequently misdiagnosed as vascular ulcers, leading to delayed diagnosis and poor prognosis. They often arise from chronic inflammatory environments or primary skin tumors, most commonly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Ulceration limits the utility of dermoscopy and confocal microscopy, hindering early recognition. Line-field confocal optical coherence tomography (LC-OCT) is a novel, high-resolution, noninvasive imaging technique that provides real-time vertical and horizontal “virtual biopsies” with near-histologic resolution. LC-OCT enables evaluation of lesion margins, allowing identification of characteristic features of BCC and SCC, even in complex ulcers. When combined with artificial intelligence, LC-OCT improves diagnostic accuracy and supports early suspicion, biopsy guidance and monitoring. Despite limitations in cost, availability and operator dependence, LC-OCT is a promising tool for improving the diagnosis and management of neoplastic ulcers.

The prevalence of atypical wounds and malignancies is known to increase with age. Malignancies lead to decreased immune response but may also underlie refractory findings, such as limb oedema caused by physical occlusions. If wounds fail to heal within 2–12 weeks despite proper care, skin biopsies are important diagnostic tools. We report a 91-year-old male who developed an atypical subcutaneous nodule on his thigh following a cutaneous viral infection, most likely varicella zoster, in the same area. The nodule ulcerated, and the wound gradually expanded despite conventional treatment. Simultaneously, the patient developed progressively increasing lower limb oedema. Histological analysis of the wound revealed fungal mycelium, and a fungal culture identified a rare Alternaria alternata fungus. A computed tomography (CT) scan revealed a large malignant metastasising tumor in the liver obstructing the portal vein and the inferior vena cava. This case highlights the importance of considering the possibility of malignancies predisposing to atypical and refractory findings in elderly patients.

Background Burn injuries are among the most challenging wounds to manage due to prolonged healing, high risk of infection and substantial treatment burden. Conventional dressings such as silver sulfadiazine and gauze are commonly used, yet they are associated with limitations including frequent dressing changes, delayed epithelialisation and patient discomfort. Chitosan-based dressings, derived from natural chitin, have demonstrated antimicrobial, haemostatic and wound-healing properties in preclinical research. However, clinical evidence remains scattered, heterogeneous and inconclusive, with no systematic synthesis of human clinical data specifically evaluating the effectiveness of chitosan dressings in burn wound management.

Aim This systematic review aims to evaluate the clinical effectiveness of chitosan-based dressings compared with conventional dressings in burn wound management, focusing on healing outcomes (healing time and healing rate), infection-related outcomes (wound infection rate) and patient-cantered outcomes (dressing frequency, scar quality and pain level).

Methods This protocol follows PRISMA-P guidelines and has been registered in PROSPERO. A comprehensive search will be performed in Ovid MEDLINE, Ovid EMBASE, CINAHL, and CENTRAL from database inception onward. Eligible studies must involve burn patients of any age, treated with chitosan-based dressings (film, hydrogel, nanofiber, composite or chitosan-silver), and compared with conventional dressings such as gauze, silver sulfadiazine, hydro fibre or hydrocolloid. Randomised controlled trials, quasi-experimental studies and comparative observational studies will be included. Two independent reviewers will conduct screening, full-text appraisal, and data extraction. Risk of bias will be assessed using RoB 2 for randomised trials and ROBINS-I for non-randomised studies. Owing to anticipated heterogeneity in interventions and outcome measures, a structured narrative synthesis will be conducted using the SWiM guideline. Effect estimates (RR, MD, SMD, HR) will be reported when available, and GRADE will be used to determine certainty of evidence.

Background Generative artificial intelligence (AI) offers new tools for integration into healthcare provider education. This study explored how newly hired nurses perceived the effectiveness and usability of Generative Patient Simulation (GPSim), which uses AI to create interactive virtual patients using large language models to improve wound care knowledge and skills.

Methods A qualitative descriptive design was used. Nurses hired at a regional healthcare centre participated in a GPSim activity featuring a virtual patient. Upon completion of the simulation activity, participants completed an anonymous survey with open-ended questions. Data were analysed using qualitative content analysis.

Results Sixteen newly hired nurses participated in the survey. Two main themes were present in the findings: impact on learning, and interaction and experience. Nurses described the simulation activity as realistic and engaging. Participants noted improvement in wound assessment, increased confidence and perceived preparedness in wound management. Overly detailed responses and technical challenges were noted as opportunities for improvement.

Conclusions GPSim was perceived as engaging and effective for improving knowledge, confidence and preparedness in wound management.

Implications for Clinical Practice GPSim has demonstrated the potential benefits of AI to enhance experiential learning and bridge the theory and practice gap in nursing education.

Background Keloids are fibroproliferative scars characterised by excessive collagen deposition and persistent growth beyond the original wound margins. Intralesional triamcinolone acetonide (TAC) is widely used; however, therapeutic response may be incomplete. Fractional CO₂ laser has been proposed as an adjunct to enhance corticosteroid delivery and improve clinical outcomes.

Objectives This study aimed to compare the efficacy and safety of fractional CO₂ laser-assisted intralesional TAC with intralesional TAC monotherapy in the management of keloids.

Methods This prospective comparative interventional study included 60 patients with clinically diagnosed keloids allocated received intralesional TAC alone. Six treatment sessions were performed at four-week intervals. Outcomes were assessed at 24 weeks using scar height measurement, Vancouver Scar Scale (VSS), pain and pruritus scores, vascularity, and pigmentation. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered significant.

Results At 24 weeks, Group A (the laser group) demonstrated significantly greater mean percentage reduction in scar height (69.04% vs 45.51%; p < 0.001) and total VSS score (58.40% vs 39.10%; p<0.001) compared with Group B. Pain and pruritus scores showed greater reduction in the combination group (p<0.001). Normalisation of vascularity (96.67% vs 20.00%; p<0.001) and pigmentation (50.00% vs 13.33%; p=0.005) was significantly higher in Group A. Adverse effects were mild and self-limiting.

Conclusion Fractional CO₂ laser-assisted intralesional triamcinolone provides superior clinical improvement compared with triamcinolone monotherapy in keloid treatment, with acceptable safety.

Malignant fungating wounds (MFWs) are chronic, non healing wounds associated with advanced cancer and often occur in the final months of life. Their complex nature and limited treatment options place significant emotional and physical strain on healthcare professionals (HCPs). This study explored the lived experiences of HCPs caring for individuals with MFW, focusing on emotional impact, perspectives and coping strategies. Drawing on Husserl’s descriptive approach, data were collected through semi-structured interviews with 10 purposively selected participants from a major cancer centre in the UK, all of whom were nurses. The data were analysed using Colaizzi’s seven-step method. Eight themes emerged from the analysis:1) Facing emotional strain while witnessing patients suffering; 2) Acknowledging patients’ concerns and providing compassionate support; 3) Impact of wound odour on HCPs; 4) Complexities in providing MFW care; 5) Supporting patients with kindness, transparency and holistic understanding; 6) Emotional demands and resilience; 7) Harmonising personal feelings with outward positivity; 8) Empowering clinicians through training, skills and guidelines for MFW care.

Findings emphasise the demanding nature of MFW care, the importance of multidisciplinary support, the empathy and optimism HCPs bring to their practice. Persistent challenges, including fragmented care and communication gaps, underscore the need for improved well-being support, specialised training and evidence-based guidelines to strengthen consistency and ensure equitable access to care. Clinical practice should strengthen emotional support, resilience training and specialised MFW education for HCPs, supported by clearer communication, coordinated care and evidence-based guidelines that ensure consistent, patient-centred management across settings.

Introduction Diabetes-related foot ulcers (DFU) are a severe complication of diabetes associated with high morbidity and mortality. Although ulcers are often considered painless, many patients experience debilitating pain that restricts function and quality of life.

Aim This study aimed to explore patients’ experiences of DFU-related pain and their perceptions of how pain and pain relief are assessed and managed in clinical encounters, with a focus on the patient–provider relationship and involvement in care.

Method This qualitative interview study included 13 adults with ongoing painful DFUs recruited from four hospitals in Region Västra Götaland, Sweden. Semi-structured telephone interviews were conducted between October 2024 and June 2025, audio-recorded, transcribed verbatim and analysed using inductive qualitative content analysis.

Results Two main themes were identified: A life ruled by pain and being left alone. Participants described pain that limited daily activities, disrupted sleep and had profound psychological impact including anxiety and isolation. Many participants reported suboptimal pain assessment and management, leading to impaired self-management and reluctance to seek care.

Conclusion DFU-related pain is debilitating and frequently under-recognised in clinical care. It may be considered a chronic pain condition when persisting for >3 months, requiring a biopsychosocial approach, pain neuroscience education (PNE) and systematic pain assessment to guide treatment according to underlying mechanisms and co-morbidities.

Clinical implications Recognising that DFU-related pain may share characteristics with chronic pain highlights the need for systematic assessment, tailored management and education of healthcare professionals to strengthen multidisciplinary care and improve patients’ health-related quality of life.