Journal of Wound Management

Introduction Venous leg ulcers (VLUs) are chronic wounds arising from venous insufficiency and are associated with pain, impaired mobility, reduced quality of life and substantial healthcare costs. Compression therapy (CT) remains the standard of care; however, its effectiveness relies on achieving and maintaining therapeutic sub-bandage pressure. In routine practice, pressure application is highly variable, and target pressures are often not consistently reached.

Objective This service evaluation assessed whether incorporating a multi-sensor pressure monitoring system into CT delivery could improve application accuracy, pressure maintenance and ultimately wound healing outcomes in patients with VLUs.

Methods Six patients with chronic VLUs participated in a service evaluation led by a specialist wound care provider. Each underwent two sequential treatment phases of equal length: (i) unguided standard compression therapy, and (ii) standard therapy guided by real-time feedback from a wireless multi-sensor device. Prospective data were collected on wound healing, sub-bandage pressures, and treatment adherence.

Results Six patients (seven limbs) were treated, with five included in the wound healing analysis. Monitoring adherence was high, averaging 1.78 data transmissions per day. Use of guided compression increased the proportion of applications within the target pressure range (66% versus 39%) and maintained therapeutic pressures more consistently throughout treatment (58.2% versus 26.6%). Sub-target pressures were reduced. Healing rates improved in 80% of patients, with mean daily wound area reduction increasing from 1.31% to 2.3%.

Conclusions Integrating pressure-monitoring technology into compression therapy enhanced consistency in achieving therapeutic pressures and was associated with improved wound healing in this real-world service evaluation. These findings highlight the potential of embedded sensor technologies to optimise compression therapy outcomes in clinical practice.

Aims To evaluate the accuracy of ward nurses’ assessments of DTIs compared to assessment by Wound, Ostomy and Continence (WOC) nurses.

Methodology This was a cross-sectional study conducted between Aug 2022 to Oct 2023. Electronic wound records of patients with deep tissue pressure injuries (DTIs) were reviewed in addition to physical assessment done by wound care nurses. These wound documentations were done by ward nurses. Fitzpatrick skin tone assessment was done. Patients were reviewed within 72 hours of admission by wound care nurses.

Result Among 100 patients, 149 DTIs were documented, with 71% having at least one DTI. Most DTIs occurred at the sacrum (n = 41; 27.5%) and heels (n = 36; 24.2%). WOC nurse reviews were conducted after an average of 3.52 days, including both physical reassessment and review of documentation. Only 58 of 149 DTIs (38.9%) were accurately confirmed by WOC nurses, indicating considerable variability in the identification and staging of DTIs. The remaining 91 DTIs were incorrectly classified as other pressure injury stages, different wound types, or inconsistent anatomical sites. Most patients (70%) had Fitzpatrick Type II skin tones, which range from light to dark brown.

Conclusion Accurate staging and diagnosis of PIs are crucial for distinguishing them from other conditions with similar morphologic characteristics. However, the persistence of DTI misclassification highlights the need for enhanced clinical assessment skills and diagnostic accuracy. Providing nurses with comprehensive education on PIs is essential to improve their knowledge, ensure accurate classification, and facilitate appropriate treatment and management. Strengthening training efforts can help minimise misclassification and improve patient outcomes.

Implications for nursing and/or health policy The high rate of DTI misclassification underscores the need for targeted education and training programs to enhance nurses’ wound assessment skills. Standardised protocols and decision-support tools should be integrated into electronic health records to improve accuracy in pressure injury classification. Health policies should emphasise ongoing competency assessments and the inclusion of wound care education in nursing curricula. Strengthening these initiatives will ensure accurate diagnosis, improve patient outcomes, and reduce the risk of inappropriate treatment due to misclassification.

Background Surgical site infections are frequent and costly, often occurring after discharge when patients manage their wounds. Despite its importance for self-management, discharge education is delivered inconsistently.

Aim To describe patients’ experiences and preferences for surgical wound care discharge education across three countries, and to examine factors associated with their ability to manage their surgical wound following hospital discharge.

Methods This study used a cross-sectional design, using the Surgical Wounds And Patient Participation Questionnaire with Australian, Dutch, and Swedish surgical patients approximately two weeks post-discharge. Descriptive and univariate analyses summarised patient characteristics and wound self-management, and binary logistic regression identified independent predictors.

Results 520 patients completed the survey. Follow-up instructions (n=439, 84.4%) and contact information for wound concerns (n=443, 85.2%) were the most received discharge information, while 46.9% (n=244) felt excluded from decision-making. Self-reported wound self-management was highest in Australia (90.4%), followed by Sweden (86.5%) and the Netherlands (75.9%). Three significant predictors emerged: care in Australia (OR=4.25, 95% CI [1.82–9.90], p<0.001) and receiving wound closure removal instructions (OR=3.62, 95% CI [1.45–9.05], p=0.006) increased self-management likelihood, while hospital readmission reduced it (OR=0.17, 95% CI [0.04–0.82], p=0.027).

Conclusion Patients’ ability to manage surgical wounds at home depends on discharge education and healthcare context. Clear instructions and supportive systems are vital for safe self-care.

Implications for Clinical Practice Clear verbal and written instructions are essential for confident self-care, particularly after complex procedures.

Background Children are at high risk of developing pressure injuries. Studies have already shown that the implementation of evidence-based guidelines prevents up to 95% of pressure injuries (PI). These demonstrate the high relevance of implementing prevention strategies to achieve a zero incidence of PI in pediatric inpatient care.

Hypothesis/Aim To reduce pressure injuries in hospitalised children through a multi-step quality improvement project

Methods This project was conducted as a single-center study at a mixed neonatal and pediatric intensive care unit in Germany. The implementation process followed the seven steps of evidence-based practice described by Melnyck et al. Patient data were collected retrospectively from medical records before (n=185) and after (n=218) the implementation process. Statistical analyses using SPSS version 29.0 included multiple-response analyses, Pearson chi-square test, and phi coefficient.

Results/findings There was a significant increase in PIs when respiratory support (p<0.001), parenteral nutrition (p<0.001), or inotropic drugs (p<0.001) were necessary. In addition, more PIs were recorded in patients diagnosed with prematurity, and the incidence of PI increased with longer ICU stay. After the education of nurses, a significant increase in risk assessments performed was achieved (p<0.001). After the quality improvement project, grade 2 PIs were completely avoided.

Conclusions Preventing pressure injuries offers numerous benefits. Our study demonstrates that implementing various measures and training nursing staff results in a higher frequency of PI-risk screenings, a zero incidence of grade 2 PIs, and better documentation.

Background Diabetic foot ulcers (DFUs) in people with type 2 diabetes and metabolic syndrome (MetS) carry high cardiovascular risk. Pharmacist-led care may help, but evidence in this combined population is limited.

Objective To assess feasibility and safety, and to explore preliminary impact of pharmacist-led interventions in adults with DFU and MetS.

Methods We conducted a prospective single-arm observational cohort at a tertiary hospital (December 2024–May 2025). Interventions included comprehensive medication review, biweekly counseling, lifestyle education, and adverse drug reaction (ADR) monitoring. Outcomes included feasibility (recruitment, retention, tool reliability), clinical endpoints (HbA1c, blood pressure, LDL-C, DFU healing), and medication adherence (MARS-10). Analyses were within-subject (paired tests); p-values were exploratory.

Results Of 122 screened, 55 were enrolled (recruitment 45.1%); 49 (89.1%) completed 6-month follow-up. MARS-10 improved from 6.8±1.9 to 8.5±1.3; HbA1c from 8.5±1.4% to 8.0±1.3%; systolic BP from 144±21 to 137±20 mmHg; LDL-C from 126±33 to 115±30 mg/dL (all p≤0.003). DFU remained stable in 95.9%, with 51% complete healing; median time-to-healing was 13 weeks (95% CI 10.4–15.6). Twenty-two ADRs were reported (mostly mild/moderate).

Conclusion Pharmacist-led care for adults with DFU and MetS was feasible, acceptable, and deliverable with high fidelity, with encouraging pre–post improvements in adherence, cardiometabolic measures, and wound outcomes. Controlled, multicenter trials are warranted to establish effectiveness and cost-effectiveness.

Regarding systemic analgesic treatment for painful chronic wounds, current guidelines recommend following the WHO analgesic ladder. However, to the best of the author’s knowledge, clinical studies supporting this recommendation are lacking. From a pharmacokinetic perspective, the main problem is the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line analgesics for all types of wounds, including those with poor blood supply.

NSAIDs are primarily local acting agents and must reach the site of inflammation to produce their main clinical effect by inhibiting the cyclooxygenase-2 enzyme. The intensity of the analgesic effect would be compromised in wounds with any degree of ischemia in which blood supply is reduced, as the drugs would be unable to adequately reach their pharmacological target. In contrast, NSAIDs are always able to target and inhibit the cyclooxygenase-1 enzyme, which is responsible for their well-known adverse effects. Therefore, the risk-benefit balance of NSAIDs would be unbalanced in favor of risk in ischemic wounds.

In general, it is clear that clinical trials are needed to determine the role of NSAIDs and other systemic analgesics in the treatment of different types of wounds. In particular, the role of NSAIDs as systemic analgesics in poorly perfused wounds should be addressed. Meanwhile, clinicians should guide analgesic treatment with NSAIDs based on their clinical judgement and, where possible, perhaps with the support of noninvasive new technologies, such as infrared thermography.

Background Care bundles have been widely studied in the general adult population. However, limited research has focused specifically on individuals aged 65 and older on pressure ulcer prevention. Care bundles are sets of evidence-based interventions and when applied consistently, can improve clinical outcomes.

Aim To explore the impact of care bundles on the incidence of pressure ulcers among adults aged 65 and over.

Materials and methods Meta-analysis was conducted for studies with comparable methodologies and highly heterogeneous studies were reported narratively.

Results The search strategy identified 1,482 citations, of which 11 studies met the inclusion criteria. The mean sample size across studies was 1718 participants (SD ± 3130).

Across included studies, care bundles were associated with reductions in pressure ulcer incidence, though findings varied by study design and implementation. Two meta-analyses of randomized controlled trials and quasi experimental studies found no statistically significant differences between care bundles and usual care, with wide confidence intervals and high heterogeneity limiting certainty. In contrast, a third meta-analysis of quasi experimental studies reported that the overall odds ratio for PU development was 0.45 (95% CI: 0.33 to 0.61; p< 0.00001), indicating that patients receiving the care bundle were 55% less likely to develop a PU compared to those receiving usual care. Evidence Based Librarianship (EBL) quality scores ranged from 64% to 96.5%, with the majority (n = 8) scoring ≥75%, reflecting strong methodological quality.

Conclusion This systematic review demonstrates that the implementation of care bundles has the potential to lower pressure ulcer incidence in older adult populations. Given the substantial heterogeneity and variation in study designs, the results should be interpreted with caution. Further research is needed to strengthen the evidence base and optimise implementation in among high risk older adults.

Clinical implications Care bundles should be considered for pressure ulcer prevention in older adults, thorough ongoing evaluation and adaptation are warranted as further evidence emerges.

Background Platelets are the main source of the growth factor complex, which plays a fundamental role in natural wound healing. Platelet-Rich Plasma (PRP), derived from platelets, is a living material that has a positive effect on wound healing.

Aim We aimed to demonstrate the effects of PRP prepared at three different concentrations on the healing process using open wound models created in rats and to evaluate their effects on wound healing rates and histopathological changes during healing.

Methods 55 female Wistar Albino rats weighing 250±25 grams were used. Fifteen of these animals were used as donors only for platelet rich plasma preparation and surgical procedures were performed on the other 40 animals. Group 1(n=10), was the control group. On days 1, 4, 7 and 10 PRP was applied to the wound area of Group 2(n=10) at a concentration of 200,000/mcl; PRP was applied to the wound area of Group 3(n=10) at a concentration of 600,000/mcl; and PRP was applied to the wound area of Group 4(n=10) at a concentration of 1,000,000/mcl.

Results In the statistical analysis of the mean pathological scores of epithelialisation, inflammation and fibrosis, a significant difference was found between Groups 1 and 2; 1 and 3; and 1 and 4 (p<0.05). There was no significant difference between Groups 2 and 3; 2 and 4; and 3 and 4 in terms of epithelialisation, inflammation and fibrosis (p>0.05). When the wound areas measured at the end of the study were compared, it was found that the wound areas in Groups 2, 3 and 4 were significantly smaller than in the control group (p<0.05). The Group 2,3 and 4 wounds were significantly smaller than the control group ‘s (p<0.05), and although there was no difference between Group 3 and 4, the mean area in Group 4 was less than Group 3’s (p>0.05).

Conclusion Double centrifugal PRP doses obtained by different methods are more effective and these PRP forms can be used safely in wound healing.

Implication for clinical practice The highly concentrated liquid form of PRP (1000–1100×10³/ml) obtained by double centrifugation is the most effective form in enhancing wound healing, as proven by wound area measurements.

Background Delayed wound healing is a serious complication of diabetes mellitus, leading to chronic ulcers, infection, and prolonged recovery. Effective therapies are needed to improve both speed and quality of repair in diabetic conditions.

Hypothesis/Aim This study evaluated whether botulinum toxin A (BTX-A) enhances healing of full-thickness skin wounds in diabetic rats.

Methods In this randomised controlled study, 24 male Wistar rats were rendered diabetic with streptozotocin and assigned to two groups (n=12 each). A 20×20 mm dorsal full-thickness skin wound was created in each rat. The treatment group received 5 IU BTX-A injected intradermally around the wound; controls received saline. Wound closure was assessed on days 0, 7, 14, and 21. Histological evaluation of angiogenesis, fibroblast proliferation, collagen deposition and inflammatory infiltration was performed on days 7 and 14. Data were analysed using Prism software with significance set at P<0.05.

Results/Findings By day 7, wound closure was greater in the BTX-A group (40%) compared with controls (25%). Histology showed enhanced angiogenesis, higher fibroblast counts, increased collagen content, and reduced inflammatory infiltration in the treated group. By day 21, wound healing reached 95% in the BTX-A group versus 81% in controls. No adverse effects or toxicity were observed.

Conclusions BTX-A accelerated wound closure and improved tissue repair in diabetic rats.

Implications for clinical practice BTX-A may offer a novel adjunctive therapy for chronic diabetic wounds, but further preclinical and clinical trials are required to confirm safety and efficacy.

Background/introduction Chronic wounds represent an ever-increasing global health crisis, not only exacerbated by a growing, ageing population, but also by the rising prevalence of concomitant morbidity like diabetes. Despite the World Health Organization (WHO) recognising chronic wounds as an epidemic in 2010, statistics show that current curative and strategic health approaches are failing to address the current rapidly increasing unmet wound care medical need of patients.

Methods An online survey, custom-designed questionnaire with 31 items, was conducted among EWMA members and EWMA cooperating wound care organisation members. Descriptive statistical analysis was performed using absolute and relative frequencies with graphical presentation.

Results 176 people participated in this survey. Results show that in 2024, 90% of surveyed European wound care professionals “at the bedside” are strongly concerned about the rapidly increasing number of wound care patients, the corresponding cost and budgetary pressures (93%), and shortage of qualified wound care professionals (87%). Currently, 66% of the participants observe important health inequality and limited access to wound management among patients, while 71% report experiencing moderate to severe economic constraints affecting availability of medical treatment for their patients. Concerning newer, advanced wound therapies, 83% of European HCP observe that reimbursement is either partially (22%), or strongly limited (61%) for their patients. Similar limitations are reported for the coverage for wound care products, whether “new” or “established” (81%), and for wound care therapy as a whole (78%).

Conclusion Urgent action is needed to address the growing unmet needs of European wound care patients and mitigate the associated human and economic burdens of the chronic wound epidemic.

Introduction Diabetic foot ulcer (DFU) is caused by a combination of hyperglycemia, vascular insufficiency, neuropathy, arthropathy and poor immunity. Regular dressing is important in the management of DFUs after achieving glycemic and infection control. Currently, both conventional and advanced dressing materials are available, with each having its own limitations. Diperoxochloric acid (DPOCL) serves as a new drug in the field of severe wound-healing disorders. It exerts functional effects similar to reactive oxygen species (ROS) by releasing chlorine dioxide (ClO₂) upon decomposition, which provides antibacterial activity.

Objective To compare the percentage and absolute reduction in the wound surface area (WSA) among DPOCL and Normal saline groups.

Method This is a randomised single blinded prospective study. Seventy-four patients were enrolled and divided into two groups by permuted block randomisation. Patients in Group A were managed with DPOCL solution daily dressing and patients in Group B received daily normal saline dressing. The study was carried out for 12 months from 30 June 2022 to 30 June 2023 and the treatment period was equal to follow-up period and lasted 30 days for each patient.

Result The study showed that the percentage reduction in WSA of patients in Group A & Group B was 93.02%±3.39% and 79.64%±6.106% respectively. Reduction in WSA was significantly higher in Group A as compared to Group B after 30 days of treatment with DPOCL. P value=0.001. The healing rate was 16.5mm-sq/day in Group A compared to 14.9mm-sq/day of Group B.

Conclusion The study findings suggest that DPOCL is a safe and effective option and may offer advantages over conventional normal saline dressings.

Background Pressure injuries (PIs) remain a clinical challenge, especially in immobile and elderly patients. EHO-85 is a multifunctional amorphous hydrogel formulated with moisturising agents, a barrier polymer and Olea europaea leaf extract, which provides anti-oxidant and anti-inflammatory effects. This study evaluated the safety and efficacy of EHO-85 compared to a standard hyper-oxygenated fatty acid formulation (HOFA) on Stage 1 PI treatment.

Methods In an open-label, multicenter trial, 50 adults were randomised to receive each treatment for 14 days, with continued use in high-risk patients. Primary endpoints included changes in lesion status using Transparent Disc Technique (TDT) and quality of life (QoL). Secondary endpoints included time to QoL and discomfort improvements, and safety outcomes over a 45-day (D45) follow-up.

Results Both treatments improved TDT scores and QoL, with EHO-85 showing greater QoL improvement at D45 (p=0.038) and reduced discomfort at D14 (p=0.018) among patients who discontinued treatment. Blanchable skin improved in both groups, though without significant differences. No adverse events occurred and compliance was high.

Conclusion EHO-85 demonstrated comparable clinical performance to the HOFA, with additional subjective benefits and sustained improvement after discontinuation.

Implications in clinical practice These findings support EHO-85 use as a safe, patient-friendly option for early-stage PIs, ensuring high compliance and satisfaction, especially useful in older patients, emergency care and hospital settings. Given the similarity in pathophysiological mechanisms to conditions like diabetic foot ulcers (DFU), EHO-85 could be further used in early DFU treatment and broader skin care for diabetic patients.

Aim To evaluate retrospectively the demographics, clinical characteristics and treatment response in patients with an atypical cause for a wound, livedoid vasculopathy (LV).

Method This was a retrospective database review of 24 patients with an ICD-10 code L95.0. Inclusion criteria were clinical and histopathological features typical for LV. Patient demographics, clinical characteristics and treatment response were collected.

Results We found a female predominance in our cohort (62.5%). The median age of the study population at the time of diagnosis was 53.5 years. Mean time between symptom onset and the definitive diagnosis was 8.3 years. Nineteen of our 24 LV patients had one or more comorbidities. Regarding prothrombotic and proinflammatory conditions, 21 patients were screened, and we found positive parameters in 12 of them (57%). Prednisolone and aspirin were most often used as a first-line therapy, and the median healing time was 11 months.

Conclusion According to our retrospective data, livedoid vasculopathy occurs predominantly in middle-aged women. Patients have many comorbidities, and the treatment and treatment responses vary. LV ulcers have a tendency to heal slowly.