Wound Practice and Research

Aim To achieve consensus on priorities for chronic wound research in Australia.

Methods A three-round modified online Delphi survey using RAND/UCLA methods was undertaken to seek consensus from a random sample of Australian multidisciplinary expert chronic wound practitioners and researchers. Participants rated their agreement/disagreement on a nine-point Likert scale for each potential research topic. Customised software calculated median scale scores and 30–70% inter-percentile range for each item.

Results A sample of 20 practitioners and researchers were invited and 12 agreed to participate. After three rounds, 102 topics achieved consensus as national priorities, including 26 items on diabetes-related foot ulcers, 25 on pressure injuries, 17 on mixed chronic wounds, and 16 on venous leg ulcers. The highest rated topics included pain management, compression therapy to prevent venous leg ulcers, pressure injury management for heels and wheelchair users, and compression therapy adherence.    

Conclusion This study found that while diabetes-related foot ulcers and pressure injury topics had the greatest number of consensus national priority topics for chronic wound research in Australia, pain management, compression therapy for venous leg ulcers and pressure injury management were the highest rated priorities. These findings could be used to target funding for national grant schemes.

Aims To assess the evidence from the literature and characteristics of self-management strategies for preventing venous leg ulcer (VLU) recurrence after healing.

Methods JBI Scoping Review guidelines were used to conduct a systematic database search of CINAHL, MEDLINE; PubMed; and Scopus (May 2023 updated March 2024). Two reviewers independently reviewed the data using Covidence.

Results 22 articles were identified as meeting the inclusion criteria. The data extraction identified a prevalence of expert opinions, with limited systematic reviews, quantitative, mixed and qualitative research designs. The research was predominantly located in the UK and Australia, within metropolitan hospitals and community-based services. Limited demographic information was gathered. Most of the research was patient-based, with only one study including families and carers. Self-management interventions included compression; however, other interventions were less consistent.

Conclusions Self-management to prevent VLU recurrence post-healing is a lifelong commitment, similar to any other chronic illness. Expanding self-management research to include contextual factors, such as family, economic impact and education, with a multidisciplinary lens may improve understanding of VLU and prevent reoccurrences

Older people are at risk of chronic oedema that increases morbidity and reduces quality of life. This retrospective study aimed to explore the prevalence, characteristics, and risk factors for chronic oedema in older community-dwelling people.

Methods Non-health professionals completed routine screening of older people receiving community-age care between 2020 and 2022, including a 10-second pitting test to detect foot and ankle oedema, age, gender, comorbidities, mobility and care levels. Participant characteristics were described, and unadjusted analyses and logistic regression were completed to explore factors associated with oedema.

Results There were 459 older adults receiving community care with a mean age of 80.3 years (SD 7.4), and 68.6% were female. Prevalence of chronic oedema was 38.1% (n=175) and 85.4% (n=147) had bilateral oedema. An increased risk of oedema was associated with having chronic heart failure (OR:3.73, CI 2.41, 5.79) and using a mobility aid (OR: 2.38, CI 1.51, 3.75).

Conclusion Older people are at risk of chronic oedema and early detection may prevent complications. Non-health professionals can perform screening, boosting workforce capacity.

Background Subcutaneous fibrosis is a recognised complication following wound healing, mainly caused by persistent edema. It causes irreversible changes to the anatomical structure of the foot risking recurrent foot ulceration and lowering the quality of life. However, its identification may be challenging due to it having similar features to edema. This case report highlights the ultrasonographic characteristics of phlebolymphedema-related subcutaneous fibrosis following the healing of an infected diabetic foot ulcer.

Case Presentation A 50-year-old male patient with diabetes presented with persistent swelling on the dorsal aspect of his right foot after healing of an infected ulcer, complicated by non-compliance with edema management. Ultrasonography revealed extended adipose globules with low echogenicity in the interstitial spaces and foci of pooled fluid, suggesting subcutaneous fibrosis. In contrast, a comparative case of edema without fibrosis showed diffusely distributed anechoic interstitial fluid.

Conclusion This case underscores the utility of ultrasonography in detecting subcutaneous fibrosis, a potential long-term consequence of persistent edema during wound healing. Early recognition through imaging can guide timely intervention and appropriate management strategies to mitigate functional impairments associated with this complication.