Wound Practice and Research

Aim To evaluate an evidence-based pathway of care for people with venous leg ulcers (VLUs) which covered assessment, management and referrals incorporating a venous leg ulcer risk assessment (VLURA) tool for early detection of those at risk of delayed venous leg ulcer healing in general practice.

Method A pilot quasi-experimental design with pre- and post-intervention measures. This included pre and post health professional surveys along with pre and post lower limb surveys of people with VLUs attending two general practice clinics.

Results The trend was that at both the intervention and non-intervention sites, staff reported increases in levels of confidence in identifying, assessing, managing, and implementing evidence based VLU prevention strategies, management and use of clinical pathways for assessment of VLUs. Documentation improved at both sites although client education, peri-wound care and pain management showed little improvement.

Conclusion Results from this pilot study concluded that a pathway of care, incorporating a risk assessment tool for early detection of those at risk of delayed healing, could provide benefits to the health organisation, health care professional staff and people with VLUs, although no significant results could be determined due to a small sample size. A larger study is warranted to further explore the impact of this pathway of care.

Aim Hypertrophic scars occur due to overactivity of fibroblasts, leading to increased collagen deposition and the formation of new blood vessels. Existing therapies have limitations, underscoring the need for alternative options. Pimecrolimus, a calcineurin inhibitor, exhibits immunomodulatory effects; however, its influence on hypertrophic scars remains unclear.

Methods This study explored the impact of pimecrolimus on scar development in vivo. We used 10 female New Zealand rabbits. Round full-thickness dermal wounds were created on each ear. Pimecrolimus 1% cream was applied to the wounds on the left ear, while the right ear received a placebo (Vaseline), applied daily for six weeks. Scar diameter (mm) was measured weekly using calipers. At the conclusion of the study, histopathological assessment was conducted to evaluate fibroblast density, vascularisation and collagen deposition.

Results Scar diameter decreased progressively in both groups, with a significantly greater reduction observed in the Pimecrolimus-treated group by week 6 (p<0.05). Histological analysis also indicated significant reductions in fibroblast density (p<0.01), vascularisation (p<0.001), and collagen deposition (p<0.05) in the pimecrolimus group relative to controls.

Conclusion Pimecrolimus reduced hypertrophic scar formation, presumably by influencing fibroblast proliferation, angiogenesis and collagen remodeling. Further trials are necessary to validate its therapeutic potential as a non-invasive treatment for hypertrophic scars.

Verrucous squamous cell carcinoma is a variant of a cutaneous squamous cell carcinoma. The most common anatomical location for the lesion is the soles of the feet, particularly over previous amputated sites, oropharynx and genitalia. The lesions slowly increase in size taking on a wart-like appearance. There is local invasion of the soft tissue, bony involvement is rare and the lesions rarely metastases. The reported incidence is most commonly in Caucasian males, in their sixth to seventh decade. Human papilloma virus and abnormal expression of the p53 tumor suppressor protein are a potential cause for the pathogenesis. It is often diagnosed as verrucous hyperplasia resulting in a delay in appropriate treatment. Our case report highlights the complexity of managing patients with a high-risk foot. This gentleman had previous minor amputations, life-threatening infections including a disseminated multisite methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia requiring intensive care support, and five burrhole procedures for drainage of an intercranial abscess. The verrucous carcinoma developed over a previous amputation site. There was a delay in appropriate biopsy and treatment. This case was unique in our clinical setting, as it was the first time we have seen a case of a verrucous squamous cell carcinoma. This case may increase awareness of usual pathogenies for non-healing wounds within the high-risk foot setting.

Wound management is an integral component of healthcare professionals’ practice. Incorporating artificial intelligence into healthcare professionals’ bedside practice will revolutionise wound care management approaches. Artificial intelligence is rapidly being tested and integrated inconsistently across health services globally, with healthcare professionals and policymakers struggling to keep pace with the evolving clinical environment in wound care. This protocol outlines the steps of a scoping review that aims to synthesise available data on healthcare professionals’ experiences of the barriers and enablers to artificial intelligence-assisted wound management. Data charting will focus on wound assessment, diagnosis, and management plans in various care settings, and healthcare professionals’ awareness of clinical practice guidelines and policies. Searches will be conducted in Scopus, Ovid MEDLINE, Embase, CINAHL Complete, PubMed, Web of Science, ProQuest, Connected Papers, Google Scholar, and Google Advanced for relevant studies. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist will be referred to throughout the review’s development. Selected articles matching the inclusion criteria will be evaluated using the appropriate quality and critical appraisal tools. This scoping review will be informed by the Theoretical Domains Framework. The identified barriers and enablers will be mapped to the framework’s constructs and domains.

Aim To investigate the impact of nutritional factors on chronic wound care and explore the challenges and potential benefits of integrating nutritional interventions into wound management.

Methods This review investigates the influence of macronutrients, micronutrients, and hydration on chronic wound care, evaluating the impact of malnutrition on wound healing and the efficacy of nutritional interventions. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science using keywords pertinent to nutrition and chronic wound care. Studies published in English from 2010 onwards were prioritised, with earlier landmark studies considered when relevant.

Results Nutritional assessment tools are crucial for identifying deficiencies in patients with chronic wounds. Multi-nutrient oral formulations enriched with protein, arginine, zinc, and antioxidants, along with vitamin C and D supplements, have demonstrated efficacy in enhancing wound healing outcomes. The benefits include reduced healing times, decreased ulcer size, and increased closure rates. However, implementation faces challenges related to systemic barriers, resource constraints and patient adherence.

Conclusion Addressing implementation challenges requires strategies. Future research should focus on developing personalised nutritional strategies for individuals with chronic wounds. Integrating evidence-based nutritional interventions into wound care protocols can significantly improve healing outcomes, reduce healthcare costs and enhance patients’ quality of life.