Age-related changes in skin barrier integrity increase vulnerability to skin damage and breakdown, often leading to conditions such as xerosis, marked by excessive dryness and itching/pruritus, and chronic wounds like venous leg ulcers (VLUs), which are characterised by compromised periwound skin and delayed healing. Regular use of moisturising creams, especially those containing ceramides as a dominant ingredient can help support and restore skin barrier integrity. While scientific evidence is limited regarding the role of ceramide-dominant moisturisers in supporting an optimal microenvironment for wound healing, a recent case study involving an 88-year-old woman who presented with a VLU on her left lower leg, exhibiting extensive slough, inflamed wound margins, maceration and significant periwound skin breakdown extending beyond the wound edge, demonstrated successful wound healing. Initial wound care further compromised the periwound skin, leaving it dry, fragile and vulnerable. Introduction of a ceramide-dominant moisturising cream applied adjunctively to the periwound area over a four-week period resulted in noticeable improvement in protecting the dry and fragile periwound skin by maintaining a favourable microenvironment for efficient wound healing. However, further research is needed to clarify the benefits of ceramide-dominant moisturisers in wound and periwound skincare.

Aim This scoping review seeks to evaluate the burden of periwound skin maceration in wound care and identify gaps in clinical evidence.

Methods A scoping review was conducted using Medline and manual searches (including in Google Scholar). Keywords related to maceration and acute/hard-to-heal wounds were used. Outcomes focused on identifying periwound maceration and its clinical consequences

Results In all 59 articles were included: eight randomised controlled trials (Oxford Centre of Evidence-Based Medicine (OCEBM) Level 2), 22 non-randomised trials or observational studies (Level 3), and 24 case series/case reports (Level 4). Five articles involved surveys or image-based assessments. Evidence suggests that maceration negatively affects healing time, pain, quality of life and treatment costs. Few studies considered maceration as a primary outcome, and there is a lack of validated assessment tools.

Conclusion Periwound maceration remains a major challenge in managing hard-to-heal wounds. Evidence is limited by methodological and clinical variability, alongside generally low study quality. Inconsistent study designs and outcome measures create further gaps. A key gap is the absence of a validated tool to identify and measure maceration. Developing and adopting such a tool would greatly support clinicians in managing this issue.

Wound debridement is a critical component to advance healing for those at risk of or living with hard to heal wounds. Conservative sharp and sharp wound debridement (CSSWD) methods expediate healing but require advanced knowledge and skills to perform. In 2022, New Zealand (NZ) launched the first national micro-credentialed wound debridement course to provide theoretical knowledge and technical skills, enabling and empowering healthcare providers, organisations and clinicians to improve healing outcomes.

Aim To describe Australian nurses’ attitude toward pressure injury prevention and to examine differences based on age, gender, hospital site, job title and highest qualification.

Methods This multi-site survey was conducted in Queensland, Australia, between April and July 2023 alongside a parent trial. Using the Attitude toward Pressure Ulcer Prevention instrument, we surveyed medical and surgical nurses from the participating wards. Descriptive and inferential statistics were calculated.

Results Seventy-nine nurses, the majority of whom were female (n=63; 79.7%), were recruited and surveyed. Most participants (n=73; 92.4%) reported a positive attitude towards pressure injury prevention (score ≥75%) and rated it as a priority area of care (n=72; 91.7%). There were no statistically significant differences in the median attitude scores based on participant age, gender, hospital site, job title or highest qualification.

Conclusion Australian nurses demonstrated a positive attitude toward pressure injury prevention. Attitude is a complex psychological construct and its influence on pressure injury prevention practices is not fully understood. Further research is needed to better understand how nurses’ attitudes might translate into the implementation of prevention strategies and, ultimately, reductions in pressure injury incidence rates.

Trial registration ACTRESN12619000763145p.

Background Pain at the donor site following Split-Thickness Skin Grafts (STSG) remains a common postoperative complication, often exceeding the pain at the recipient site. Methylene blue (MB), known for its neurolytic and anti-inflammatory effects, has been explored as a potential analgesic adjunct in various surgical settings.

Aim To assess the efficacy and safety of intradermal MB injection for donor site pain relief in patients undergoing STSG compared with standard dressing alone.

Methods This single-center, randomised, parallel-group, active-controlled trial included 60 adult patients undergoing STSG. Participants were randomly allocated to either the intervention group (n=30), receiving intradermal MB injection at the donor site, or the control group (n=30), receiving standard tulle gras dressing. Pain intensity was assessed using the Visual Analog Scale (VAS) at multiple postoperative intervals. Secondary outcomes included duration of analgesic use, need for rescue analgesics, donor site healing and scar quality.

Results Baseline demographic and clinical characteristics, including age, sex distribution, indication for grafting and wound size, were comparable between the groups (p>0.05). The intervention group demonstrated significantly lower donor site pain scores at all assessed postoperative time points. Mean VAS scores on postoperative day (POD) 5 were 3.9±1.97 in the intervention group compared to 8.6±1.42 in controls (p<0.00001), decreasing further on POD 7 (1.96±0.92 versus 6.0±1.38; p<0.00001) and POD 15 (0.86±1.27 versus 2.76±1.00; p<0.00001). The overall mean VAS score across time points was significantly lower in the intervention group (2.2±1.06, 95% CI: 1.82–2.58) than in the control group (6.0±0.90, 95% CI: 5.68–6.3) (p<0.00001). Fewer patients in the intervention group required additional analgesia compared to controls (10% versus 26%; p=0.09). Donor site healing, assessed by time to complete epithelialisation, was comparable between groups (12.93±2.75 versus 12.93±2.20 days; p=1.00), with no significant differences in scar quality. No major adverse events were observed; transient donor site staining occurred in all MB recipients and resolved spontaneously.

Conclusion Intradermal MB is a safe, effective and low-cost adjunct for postoperative donor site pain management following STSG, providing substantial pain reduction without affecting wound healing.

Incontinence-associated dermatitis (IAD) is a significant risk factor for the development of hospital-acquired pressure injuries (HAPIs), with inappropriate and delayed management contributing to prolonged patient hospitalisation, increased healthcare costs and decreased quality of life. This study investigates the effectiveness of evidence-based guidelines for preventing and managing IAD applied across three wards at Bankstown-Lidcombe Hospital. Building on a translational research study from 2020–2021, this investigation assesses whether the guidelines reduce IAD occurrence and HAPIs while determining whether the intervention strategies remain effective over 12 months. The study found a significant reduction in both IAD and HAPI rates post-implementation; however, some barriers to sustainability emerged, relating to staffing, resources and leadership turnover rates. This paper discusses the findings and challenges and it offers recommendations for continued improvement in IAD management and prevention practices.

Background Pressure injuries also known as pressure ulcers are a preventable but ongoing challenge in residential aged care. Although guidelines are available, variation in knowledge and practice continues to affect how prevention, assessment and management are performed.

Aim This systematic review set out to identify, appraise and synthesise existing evidence on aged care nurses’ knowledge of pressure injury prevention assessment and management, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.

Methods A systematic search was conducted on 15 April 2025, across CINAHL, Scopus, MEDLINE and the Cochrane Library. Inclusion criteria involved studies published between 2001 and 2025, recruiting registered or enrolled nurses working in residential aged care. Screening and synthesis followed PRISMA guidelines.

Results Only one relevant study was found, revealing both nurses and nursing assistants in Belgian nursing homes had limited knowledge about pressure injury prevention, with little difference between groups. The mean overall knowledge score was 29% (SD 8.8), with highest scores in risk assessment (64%) and lowest in nutrition (4%). In contrast, attitudes toward pressure injury prevention were more positive (mean=78%; SD 7.0).

Conclusions The limited evidence highlights a disconnect between guidelines and everyday practice and points to the need for better education and organisational support. More research is required to build a stronger understanding of nurses’ knowledge and to help improve pressure injury prevention and care for aged care residents.

Introduction Diabetic Foot Ulcers (DFUs) have a prevalence of 6.3% worldwide every year. The ulcers are associated with a five-year mortality rate of more than 70% in the cases of major amputations, driven mainly by infections and cardiovascular diseases (CVDs). Pharmacists can play a vital role in the management of these complications by bridging gaps in care, expanding patient education and optimising therapeutic interventions.

Methodology A narrative review was conducted using PubMed, Scopus and Web of Science databases in order to synthesise evidence on pharmacist-led strategies in DFU management and their cardiovascular impacts. Studies published from 2000 to 2023 were reviewed with a focus on pharmacist-led interventions that included antimicrobial stewardship, glycemic control, patient education and advanced wound care. Data extraction emphasised clinical and cardiovascular outcomes, while methodological rigor was assessed using AMSTAR 2 and Cochrane Risk of Bias tools.

Results and discussion Pharmacist interventions significantly improved DFU management by decreasing ulcer recurrence rates and hospitalisations by 25%. Improved wound healing was attributed to effective antimicrobial stewardship, targeted glycemic control and advanced wound care strategies, such as negative-pressure wound therapy. Pharmacist-led initiatives also lowered cardiovascular risks, showing a 22–27% reduction in mortality and improvement in biomarkers such as HbA1c and LDL-C. These results were supported by regular patient education, adherence counselling and collaboration within multidisciplinary teams. However, systemic barriers, including fragmented care and limited prescribing authority, impede broader implementation.

Conclusion Pharmacist-led interventions provide a transformational approach to DFU care, addressing critical gaps in management and integrating cardiovascular risk reduction. Expanding pharmacists’ roles within standardised care models is a cost-effective solution that could enhance outcomes and reduce the systemic burden of DFUs.

Background Topical antibiotic ointments are commonly used by oculoplastic surgeons to prevent surgical site infections (SSIs). However, their routine use has been questioned due to concerns regarding antimicrobial resistance. This systematic review aimed to evaluate whether topical antibiotic ointments reduce SSIs in oculoplastic surgery compared to non-antibiotic alternatives.

Methods A systematic review was conducted following PRISMA guidelines. Study selection, risk of bias assessment and data extraction were completed by two independent reviewers.

Results Of 603 non-duplicate studies identified in the search, four were included for data extraction. All had some risk of bias. Two studies found no statistically significant difference in SSI rates between antibiotic and non-antibiotic groups, while two showed a statistically significant reduction in SSIs with antibiotic ointment use.

Conclusions Topical antibiotic ointments may offer a modest statistical reduction in SSIs, though the clinical significance remains uncertain. Non-antibiotic options are a reasonable choice in many cases. However, there may still be a role for topical antibiotic ointments for wounds with granulating surfaces, patients at high risk of SSI, or for patients in whom the sequelae of SSI would be unacceptable. Further high-quality, randomised controlled trials are warranted to inform best practices in oculoplastic postoperative care.

Aims Effective compression therapy (CT) is fundamental to venous leg ulcer (VLU) management, yet maintaining therapeutic sub-bandage pressure is difficult in routine practice. Real-time pressure monitoring provides an opportunity to ensure consistent, patient-specific therapeutic pressures.

Methods We conducted a service evaluation integrating a wireless pressure-monitoring system into routine CT for patients with chronic VLUs. Seventeen patients (23 limbs) received digitally guided compression, with target pressures adjusted to individual comfort and tolerance. Wound healing was assessed using percentage area reduction (PAR).

Results Engagement with the system was high, with an average of 1.71 readings per day per patient. Average sub-bandage pressure remained within the therapeutic range (40.3±6.2mmHg). Healing outcomes were favourable: 19 of 23 limbs (82.6%) healed during the evaluation period, with a mean healing time of 58 days. Mean PAR reached 71.8%±24.4% at 4 weeks and 96.1%±8.7% at 12 weeks. The average daily PAR was 1.95%±1.38%, with high variability.

Conclusion Real-time pressure monitoring helps maintain therapeutic compression levels throughout the treatment. Our approach was associated with high healing rates, and patient engagement. Incorporating real-time monitoring into routine practice offers a way to optimise compression delivery and improve outcomes for VLU patients.

Objective To evaluate the efficacy of photodynamic therapy in bacterial control and tissue repair in people with diabetes-related foot ulcers through an umbrella review of systematic reviews.

Methods This umbrella review included systematic reviews identified in PubMed, Web of Science, Scopus, the Cochrane Library, CINAHL, and Embase, following JBI methodological guidelines. Reviews of any year or language evaluating the effects of photodynamic therapy on diabetic foot ulcer healing and bacterial load were eligible. Methodological quality was assessed using the JBI checklist by two independent reviewers. Data were synthesised narratively from included systematic reviews.

Results Four systematic reviews were included, each covering four to 15 randomised controlled trials. Compared to conventional treatment, photodynamic therapy significantly reduced ulcer area and promoted tissue repair. Although, heterogeneity between studies may limit direct comparison. For microbial control, photodynamic therapy effectively reduced bacterial viability, contributing to a more favorable environment for healing.

Conclusion Photodynamic therapy shows promise as an adjunctive therapy for diabetes-related foot ulcers, with evidence of accelerated healing and improved bacterial control. Integration of photodynamic therapy into clinical practice may enhance healing outcomes and infection control in diabetes-related foot ulcers.

Aim Venous leg ulcers have a high recurrence rate impacting patients’ health and the health care system. This study aimed to identify factors associated with recurrence within 12 months post-healing.

Methods A convenience sample of 50 participants was recruited for a prospective longitudinal study with three monthly data collection until 12 months or recurrence. Mean time to recurrence was calculated using Kaplan-Meier survival curve analysis and a Cox proportional hazards regression model to adjust for possible confounders and establish factors associated with recurrence.

Results By 12 months, 27 of the 39 participants reaching that time point experienced a recurrence. Topical steroid usage (p=0.039) and oedema in the study leg at (p=0.022) were significantly associated with increased risk of recurrence in the Cox regression model. The Venous Leg Ulcer Self-efficacy Tool daily self-care tasks subscale score was associated with decreased risk of recurrence (p=0.015). The overall model was significant to predict ulcer recurrence (χ2=24.24, p<0.001).

Conclusion Incidence of recurrence was high. The significant relationship between self-efficacy and decreased risk of recurrence in self-care activities indicates a need for interventions to boost self-efficacy in management of chronic venous insufficiency. Topical steroid usage and oedema could signal inadequate control of venous hypertension and flag the need for intervention.

Background Negative pressure wound therapy is widely used in the management of complex acute and chronic wounds. Although its benefits are well established, technical deviations in routine practice may compromise effectiveness and lead to preventable complications.

Cases Four cases encountered in routine clinical care are presented to illustrate common and avoidable technical errors during negative pressure wound therapy application.

Findings Identified errors included inadequate wound bed preparation, omission of a wound contact layer, inappropriate interface material placement and delayed management of dressing leakage. These deviations were associated with tissue trauma, periwound maceration, delayed granulation and impaired negative pressure transmission. Recognition of these issues and timely corrective interventions allowed safe continuation of therapy and improved wound progression.

Clinical implications These cases highlight that successful negative pressure wound therapy depends not only on appropriate indication but also on meticulous application and consistent monitoring. Structured clinical oversight and adherence to standardised principles may reduce avoidable complications and improve patient safety.

Aim Incisional negative pressure wound therapy (iNPWT) is increasingly used prophylactically to prevent surgical wound complications in women with obesity after caesarean birth. However, few studies have explored women’s perceptions of this dressing. Understanding their experience is essential to inform product design and support sustainable use. This study aimed to explore women’s perceptions and experiences of using iNPWT after caesarean delivery.

Methods This qualitative study used semi-structured interviews in an Australian maternity hospital. A purposive subsample of women who received iNPWT participated in telephone interviews 14 days following discharge. Content analysis was used to synthesise the interview findings. Twenty women participated. The interviews were transcribed and thematically analysed. Four main categories were identified: 1) wearing the iNPWT dressing, 2) managing iNPWT dressing accessories, 3) removing the iNPWT dressing, and 4) receiving iNPWT information.

Conclusion Women perceived iNPWT as an acceptable option after caesarean birth. Clear information and straightforward device management supported home-based wound care. While some practical challenges and disruption to daily routines were reported, most participants found the dressing comfortable and wearable. Overall satisfaction with wound healing and scar appearance was high. The findings highlight the importance of structured patient education to facilitate effective self-management at home.

Introduction Platelet-rich plasma (PRP) is an autologous blood product containing higher than usual concentration of platelets beneficial for wound healing. The objective of this study is to review the economic outcomes of PRP in the management of chronic wounds compared with standard of care (SoC).

Methods A systematic search for studies published between 1 October 2015 and 1 October 2025 was conducted across PubMed/MEDLINE, Scopus, and ProQuest, supplemented by reference searching. Full and partial economic evaluations were eligible. Studies screening and quality appraisal were performed by two independent reviewers. Quality assessments used Drummond and Philips checklists. Data on costs, outcomes and incremental cost-effectiveness ratios (ICERs) were extracted, adjusted for country-specific inflation to 2025 values, and converted to euros (€).

Results Five studies were included in this review. PRP costed more in one cost-minimisation analysis (CMA), while another was a partial economic analysis without comparator. Among three cost-effectiveness analyses (CEA), one study found PRP to be more cost-effective than when prepared in a laboratory, and another found PRP to be more cost-effective than over SoC, whereas the rest reported PRP to remain below the willingness-to-pay (WTP) threshold. Quality appraisal revealed higher methodological rigor in the model-based studies.

Conclusion Findings indicate PRP is generally cost-effective in some settings.

Aims To identify scientific evidence related to therapeutic parameters for the use of ozone therapy in people with diabetes mellitus and foot ulcers.

Methods This integrative review was conducted using searches in BDENF, LILACS, PubMed, Scopus, EMBASE, Web of Science, and ScienceDirect. Randomised controlled trials describing therapeutic parameters for ozone therapy were included, screened using the Rayyan platform. Methodological quality was assessed using the JBI checklist.

Results A total of 474 articles were identified, of which six met the eligibility criteria. The most frequently reported parameters involved a daily, 30-minute topical application using an ozone bag, for a total of 20 sessions, with concentrations ranging from 35mg/L to 60mg/L. Observed benefits included reduced lesions, analgesic and antimicrobial effects, and reduced fasting blood glucose and insulin resistance when administered systemically. The included studies suggest potential benefits of ozone therapy in treating foot ulcers in people with diabetes. However, proper definition of the parameters is essential to avoid harming patients. The low methodological quality of the studies limited the accuracy of the findings.

Conclusions The findings of this review allowed the identification of therapeutic parameters most frequently reported in ozone therapy protocols for diabetic foot ulcers.