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.

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.

Diabetic foot ulcers (DFUs) are serious diabetes complications that may lead to amputation if not properly managed. In West Sulawesi, the Mandar ethnic community continues to use traditional medicine for DFU treatment.

Objective This study explores local knowledge and traditional practices in DFU management among the Mandar ethnic group in West Sulawesi, Indonesia.

Methods A descriptive qualitative design with a phenomenological approach was applied. Eighteen participants with DFU experience who had used traditional treatments were recruited purposively. Data were collected through semi-structured online interviews and analysed thematically using MaxQDA. Relational patterns among ingredients, outcomes, and information sources were visualised using Gephi.

Results Turmeric was the most frequently used ingredient, followed by honey, guava leaves, coconut oil and castor leaves. Most materials were applied in raw, unstandardised forms. Some participants experienced positive early effects, while others reported worsening symptoms. Information was primarily transmitted through families and traditional figures. The network map revealed strong cultural and spiritual influences on treatment decisions.

Conclusion Traditional DFU care displays empirical understanding and cultural values, but its unregulated use poses scientific risks, highlighting the want for evidence-based, culturally-sensitive healthcare integration.

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.

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.

Aboriginal and Torres Strait Islander people face persistent health disparities that arise from structured marginalisation and prejudice as a result of dispossession and genocide promoted by colonisation. The significantly increased prevalence of chronic diseases, particularly diabetes mellitus (DM) and cardiovascular disease (CVD) among Aboriginal and Torres Strait Islander peoples, is a major contributor to the development of chronic wounds and related complications, including amputations and premature mortality. In Australia, Aboriginal and Torres Strait Islander people face a 5–6 times higher risk of developing chronic wounds and a 32.5 times higher risk of suffering an amputation compared to non-Indigenous Australians, revealing a disproportionate burden. Inequalities in social determinants of health, including inadequate nutrition, transgenerational trauma and varied healthcare systemic barriers, contribute to the perpetuation of health disparities. This review highlights recently reported data on the risk of chronic wound development in Aboriginal and Torres Strait Islander peoples and correlated factors, emphasising the critical need for targeted research into chronic wound management, comprehensive data collection, and tailored healthcare to unique social, cultural and geographical contexts, as efforts to mitigate the current disparities in health in relation to wound care.

Aims To compare the effectiveness of distilled water (aquadest) and 0.9% sodium chloride (NaCl) in promoting wound healing, based on wound diameter, re-epithelialisation, granulation formation, neovascularisation and inflammatory response.

Methods An in vivo experimental study was conducted using 27 male Wistar rats (Rattus norvegicus), randomly assigned into three groups (control, aquadest, and NaCl). Full-thickness wounds were created on the dorsum of each rat and treated daily for 14 days. On days 2, 7 and 14, the wounds were assessed macroscopically and histologically, quantitively and semi-qualitatively. Statistical analysis included Friedman and Wilcoxon tests, along with effect size calculations (Cohen’s d and 95% confidence intervals).

Results Aquadest significantly improved reepithelialisation (p=0.018), granulation tissue formation (p=0.022), and reduced inflammation (p= 0.039) compared to baseline. NaCl did not demonstrate statistically significant improvements across any parameter. Although wound diameter reduction in the aquadest group was not statistically significant (p=0.117), it showed a moderate-to-large effect size (d=0.78), with qualitative analysis showing the reduction of inflammatory cells and increase of neovascular count and epithelial thickness (p=0.040).

Conclusions Distilled water showed superior performance to 0.9% NaCl in supporting multiple aspects of wound healing in a rat model.

Summary of aims In the quest for restorative healing and a better quality of life, the ancient wisdom of herbal remedies is emerging as a beacon of hope for effective wound management.This study investigated the wound-healing capabilities of a novel gel combining propolis resin (PR) and green tea (GRT) extract, seeking a natural alternative for wound care. Methods: The PR+GRT gel was formulated and tested for sensory attributes and stability through various methods. Its efficacy was then compared in vivo against a positive control (CICALFATE^™) and negative controls (sodium chloride and base gel). On day 9 post-wounding, histopathological analyses were conducted using Hematoxylin and Eosin (H&E) and trichrome staining to evaluate tissue regeneration and collagen deposition.

Results: The PR+GRT gel possessed favorable sensory characteristics and stability. Significantly, it improved wound healing compared to negative controls and performed comparably to CICALFATE^™. Histopathological examination highlighted significant differences between treatment groups, particularly in membranous nephropathy, where PR+GRT and CICALFATE^™ outperformed the controls.

Conclusions: the PR+GRT gel holds promise as a wound-healing agent, demonstrating effectiveness on par with CICALFATE^™. Further research is recommended to explore its synergistic potential and refine histological evaluations for more quantitative analysis. Study limitations include small sample sizes and qualitative histopathological assessments.

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.

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.

Aboriginal and Torres Straight Islanders are at an increased risk of developing diabetic foot complications including ulceration, infection and amputation with a three-to-six-fold increase when compared with non-Indigenous Australians. With limited health services available in regional areas, this problem is exacerbated. The case reports follow the journey of two Aboriginal patients from remote Western Australia who develop diabetic foot complications requiring transfer from their remote communities to receive treatment in a tertiary metropolitan hospital by the Multidisciplinary Foot Ulcer service. There are many challenges faced by wound management clinicians when caring for this population with diabetic foot complications including late presentation to receive care; lack of resources and staff experienced in the management of the high-risk foot; and obstacles of treating a patient via a telehealth service in rural and remote areas. The aim of the case studies is to highlight the challenges faced by wound management clinicians in the management of rural and remote Aboriginal patients with diabetic foot complications while striving to deliver culturally safe and holistic care.

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.