Journal of Wound Management

Aim This study evaluates the impact of postgraduate wound care qualifications on healthcare professionals’ education, clinical practice, and career progression. It examines how advanced training enhances professional confidence, skill integration, and adherence to best-practice guidelines. Additionally, it identifies barriers to education, assesses self-perceived confidence in wound management, and compares career outcomes across countries. Finally, it explores differences between barriers in implementing knowledge in the workplace between geographical regions.

Methods An international cross-sectional survey was conducted in a convenience sample of healthcare professionals who had completed postgraduate wound care education. Participants were recruited through social media, professional networks, peak bodies and associations. The survey included quantitative and qualitative components, assessing career outcomes, barriers and enablers to study, self-perceived confidence, and the application of acquired knowledge. Descriptive statistics and one-way between groups analysis of variance analysis (ANOVA) were performed for quantitative data and thematic analysis was used to analyse qualitative data.

Results A total of 178 health professionals from 27 countries completed the survey. Postgraduate education was found to substantially enhance clinical confidence and decision-making, with 93% (n=166) of participants considering their qualification relevant and 90% (n=160) reporting it met their expectations. Career progression was reported to be enhanced with 33% (n=60) gaining a competitive advantage in obtaining their current role. However, barriers to completing formal study, such as competing work and study demands (68%, n=121), course costs (48%, n=86), and limited study leave (37%, n=66) were frequently reported. Knowledge implementation was reported to be restricted by institutional resistance and restricted access to advanced wound care products.

Conclusion Postgraduate wound care education plays a crucial role in enhancing clinical competency and contributes to career development. However, financial constraints limit accessibility of education and institutional barriers limit implementation of new knowledge. Addressing these challenges through credentialing and benchmarking, increased institutional support, and policy changes could optimise the benefits of postgraduate education and strengthen evidence-based wound care practices globally. Future research should assess its long-term impact on patient outcomes and healthcare efficiency.

Background Patients with delayed wound healing (DWH) experience psychological challenges that can hinder recovery, creating a detrimental cycle. The complex and multifaceted nature of psychological wellbeing, coupled with the heterogeneity of measurement tools used in chronic wound research, highlights the necessity for a more comprehensive understanding of the psychological facets of DWH.

Aim This scoping review aimed to synthesise evidence on psychological wellbeing components and their influencing factors in adults with DWH.

Methods Databases (Scopus, MEDLINE, CINAHL, EMBASE, ProQuest Global, PsycINFO) were searched for studies on adults (18+) with wounds persisting ≥4 weeks. Exclusions included pediatric, burn, malignant, and amputation-related wounds. Data extraction followed a dual-reviewer process, with synthesis guided by Ryff’s psychological wellbeing framework.

Results Of 47 included studies, most were from Asia (31.9%); none were from Africa. Quantitative designs dominated (89.4%), with no psychological interventions identified. Fourteen instruments assessed wellbeing, primarily measuring quality of life (n=43), depression (n=14), and anxiety (n=12). Autonomy was frequently impacted by pain and mobility, while self-acceptance and personal growth were rarely examined.

Conclusions Standardised tools are needed to assess psychological wellbeing in DWH. Future research should prioritise underrepresented dimensions (such as personal growth, purpose) to inform targeted interventions.

Implications for clinical practice Clinicians should manage wound symptoms and adopt holistic assessments that include psychological wellbeing domains, beyond quality of life, such as self-acceptance and personal growth, to improve patient-centered care and healing outcomes. Early screening for depression and anxiety, alongside tailored support, may help break the cycle of psychological distress and delayed healing.

Background Wound infection poses major challenges in clinical practice and can be associated with high morbidity or mortality in some instances.

Hypothesis/aim This study aimed to determine the effects of different corticosteroid-mupirocin cream combinations on wound infection, wound re-epithelialisation and contraction in male Wistar rats.

Methods A randomised controlled study was carried out to compare the effects of different corticosteroid-mupirocin cream combinations on the healing of infected wounds in male Wistar rats. Forty-two male Wistar rats weighing 150–200g were randomly divided into seven groups, with six rats each. Group 1 (negative control) had no wounds. Wounds were made on the lower backs of the rats and infected with bacteria. During each dressing change, the wounds were assessed for signs of infection via the Southampton wound grading, and the percentage re-epithelialisation was also calculated. On day 24 of the experiment, wound swabs were taken and sent for microscopy and culture. The data were analysed using analysis of variance, and p<0.05 was taken as the accepted level of significant difference.

Results/findings There was no significant difference in the contraction rate across the groups (p=0.502), however, the 2:1 mupirocin-betamethasone group had the highest degree of wound contraction (77.9%) and a lower infection rate (p=0.0001).

Conclusions This study revealed that the combination of mupirocin and betamethasone is more efficacious in promoting wound epithelialisation and wound bacteria.

Implications for clinical practice The use of mupirocin-betamethasone combination is effective in the healing of infected wounds.

Aim To get baseline information on critical aspects on diabetic foot (DF) care in Tuscany, we surveyed the health care professionals (HCPs) working in the public regional health service (RHS), as part of the Diabetic Foot Valley Tuscany project.

Methods A 12-item questionnaire, was delivered, focusing on the amount of their time dedicated to DF care and their interest and sense of adequacy toward DF. They were then asked to indicate the critical aspects of DF care and rank them according to the level of priorities.

Results 61 out of 97 (62.9%) HCPs took part in the survey. DF care represented more than half of the workload of nearly 60% HCPs and their interest was significantly higher (p<0.001) than self-reported professional adequacy/competence, and it was correlated (p<0.001) with years of work for physicians. Lack of technical skills, poor knowledge of guidelines and need for professional upgrade were the most frequently selected criticalities from a clinical point of view, while lack of dedicated beds, spaces and staff were the ones from an organisational perspective. The ranking of the clinical aspects of DF care in need of upgrading assigned urgencies, infection and ischemia management the highest priority, while for the organisational aspects the priorities were revascularisation, local surgery and Charcot’s foot.

Conclusions DF represents a relevant aspect of the activity of the public network of diabetology centres in Tuscany, and the interests of the HCPs is not paralleled by a sense of professional adequacy, especially for practical skills and organisational issues. This is particularly true for the aspects of DFS related to the acute manifestation of the disease, which are considered priorities when HCPs were asked to rank their needs in terms of upgrade and reorganisation.

Implication for clinical practice The information gathered with this survey will be instrumental in planning and realising the amelioration projects that the Diabetic Foot Valley Tuscany project aims to realise for improving the quality of management of DF patients in our region.

Background Gustilo-Anderson type 3A/3B fractures present significant challenges in orthopedic trauma management due to extensive soft tissue damage and high infection risk. While negative pressure wound therapy (NPWT) has shown efficacy, the addition of instillation and dwell time (NPWTi-d) may offer enhanced benefits for complex wound management in these fractures.

Aim This study aimed to compare wound healing outcomes between NPWT and NPWTi-d in patients with Gustilo-Anderson type 3A/3B fractures using the Bates-Jensen Wound Assessment Tool (BWAT).

Methods This retrospective cross-sectional study analysed records of 60 patients with Gustilo-Anderson type 3A/3B fractures treated between November 2023 and October 2024 at R L Jalappa Hospital, India. Patients were equally divided into NPWT (n=30) and NPWTi-d (n=30) groups. Primary outcomes included BWAT scores, while secondary outcomes encompassed complication rates and hospitalisation duration. Patients on immunosuppressive therapy or with diabetes mellitus were excluded. Statistical analysis included independent t-tests, chi-square tests, and multivariate regression analysis.

Results NPWTi-d demonstrated superior outcomes with significantly fewer post-intervention complications (10.0% versus 30.0%, p=0.028), shorter hospitalisation (15.80±2.09 versus 18.00±5.46 days, p=0.042), and better BWAT score improvement (19.37±2.86 versus 18.50±4.49, p=0.039). Notably, NPWTi-d showed particularly significant benefits in more severe type 3B fractures (p=0.022). Multivariate analysis identified NPWTi-d as an independent predictor of better wound outcomes (β=-1.85, 95% CI: -3.62 to -0.08, p=0.040) and shorter hospital stay (β=-2.24 days, 95% CI: -4.31 to -0.17, p=0.034).

Conclusion NPWTi-d demonstrated superior efficacy compared to standard NPWT in managing Gustilo-Anderson type 3A/3B fractures, with particular benefits in more severe type 3B injuries, suggesting it as a preferred treatment modality for complex open fractures.

Implications for clinical practice The significant improvements in wound healing metrics and reduced hospitalisation with NPWTi-d indicate potential benefits for both patient outcomes and healthcare resource utilisation in trauma care, especially for severe open fractures requiring specialised wound management.

Aim The study sought to uncover the multifaceted impacts of skin tears resulting from mammography by analysing online discussions and highlighting the importance of addressing this complication.

Design A netnographic approach was employed to analyse online discussions related to skin tears caused by mammography. The study identified four key data sites and utilised the Walkthrough Method to understand the sociotechnical features of these online spaces.

Methods Thematic analysis was conducted on extracted text data from online platforms and immersive journaling. The discussions, spanning 16 years, were analysed to identify recurring themes and concerns related to skin tears in mammography.

Results The analysis revealed low contemporary activity on the topic, with eleven themes emerging, emphasising the reporting and awareness of skin tears, patient concerns, community dynamics, and misinformation. Significant issues such as pain, distrust in medical professionals and potential impacts on future mammography engagement were highlighted.

Conclusion The study underscores the need for greater consideration of skin tears as a complication of mammography. It also points to the role of digital platforms in health-related discussions and the necessity for healthcare professionals to engage in these spaces to provide accurate information and counteract misinformation. The findings suggest the need for post-procedural examinations to identify tears early, robust reporting systems and clear informational materials. Further research is needed to provide more comprehensive data on the prevalence and management of skin tears in mammography.

Background Diabetic foot ulcers (DFU) are a major health concern globally due to their high risk of infection, amputation and associated healthcare burden. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has emerged as a promising adjunctive treatment for infected DFUs, especially when integrated into multidisciplinary care pathways.

Aim This study aimed to evaluate the clinical outcomes of NPWTi-d in the management of infected DFUs within a multidisciplinary team (MDT) setting in a tertiary hospital in Singapore.

Methods A retrospective, descriptive observational study was conducted involving 50 patients with infected DFUs treated with NPWTi-d (V.A.C. Veraflo™) following surgical debridement between January 2021 and June 2022. Patient demographics, wound characteristics, treatment timelines, and outcomes were extracted from a chronic wound registry and electronic medical records. Descriptive statistical analysis was performed using JMP® software.

Results Of the 50 patients included, 90% (n=45) achieved complete wound healing. The majority (88%, n=40) underwent successful closure via reconstructive surgery, while none required major amputation. The median length of stay was 20 days, and the mean number of operative visits was four. More than half of the patients (52%, n=26) underwent minor amputations, primarily ray amputations and toe disarticulations.

Conclusion NPWTi-d, when applied post-debridement and supported by MDT care, appears to be effective in achieving high wound healing rates and facilitating limb preservation in patients with infected DFU.

Implications for clinical practice These findings support the integration of NPWTi-d into MDT pathways for early and effective management of infected DFU. Further prospective comparative trials are warranted.

Background Post-bariatric plastic surgery requires optimal wound closure techniques to enhance healing and aesthetic outcomes. Traditional suturing techniques, while effective, may lead to increased tension and scarring. The introduction of non-invasive mechanical wound closure devices offers a promising alternative to traditional sutures.

Aim This study aims to evaluate the efficacy of a non-invasive mechanical wound closure device compared to traditional sutures in post-bariatric plastic surgery patients, focusing on healing time, scar qualityand patient satisfaction.

Methods A prospective observational study was conducted over three years, including 64 patients undergoing post-bariatric body contouring surgery. Patients were assigned to one of two groups: traditional sutures (n=32) or a non-invasive mechanical closure device (n=32). Wound healing was assessed at 1, 3, and 6 months postoperatively using clinical evaluations and SCAR-Q scores. Complications and patient satisfaction levels were also recorded.

Results Patients treated with the mechanical device demonstrated significantly faster healing times (p<0.001), superior SCAR-Q scores (p<0.001), and fewer complications compared to those receiving traditional sutures. At one month, the average healing time was 17.3±2.1 days in the mechanical closure group versus 22.5±2.7 days in the suture group (p=0.002). At three months, SCAR-Q scores were significantly higher in the mechanical closure group (76.4±4.3 versus 68.1±3.9, p<0.001). At six months, the device-treated group reported a complication rate of 3.2% compared to 12.5% in the traditional suture group (p=0.005).

Conclusions The study suggests that the non-invasive mechanical closure device is an effective alternative to traditional sutures, offering benefits in wound healing, scar quality and patient satisfaction. Further studies with larger cohorts and longer follow-ups are warranted.

Background Pressure injuries (PIs) remain a major concern in intensive care units (ICUs), where immobility and critical illness increase vulnerability. Despite advances in prevention, gaps in practice persist.

Aim To identify risk factors and characteristics of pressure injuries among adult ICU patients in Jordan and evaluate preventive measures currently in use.

Methods A case-control study was conducted in the ICUs of two tertiary hospitals in Jordan. A total of 300 adult patients were included: 150 with PIs (cases) and 150 without (controls). Data were extracted from medical records using the Braden Scale and a structured risk factor tool.

Results The mean age of cases was 66.0 years compared to 54.9 years among controls. Males predominated in both groups, particularly among cases (61.3%). Preventive practices were inconsistent: none had pressure-relieving mattresses, and repositioning was often reactive. Logistic regression identified significant predictors: male gender (OR=8.6), older age (OR=1.04 per year), prolonged ICU stay (OR=1.52), higher BMI (OR=1.12), mechanical ventilation (OR=22.0), oedema (OR=5.53), reduced consciousness (OR=8.41), and incontinence-associated dermatitis (OR = 9.0). Adequate preventive care reduced PI likelihood substantially (OR=31.0).

Conclusions The findings emphasise the importance of integrating early, targeted interventions into routine ICU practice to minimise patient harm and improve outcomes.

Implications for clinical practice Findings highlight the urgent need for standardised preventive strategies, resource allocation and adherence to evidence-based guidelines to reduce PI incidence and improve ICU patient outcomes.

Partial-thickness burns pose a significant clinical challenge globally. While conventional treatments like silver sulfadiazine (SSD) remain common, polymer-based dressings have emerged as effective alternatives. These dressings aim to relieve pain, speed healing, minimise frequent changes and improve cost-effectiveness. This systematic review and meta-analysis evaluate polymer-based dressings’ efficacy, tolerability, and economic implications in treating acute partial-thickness burns.

Seven electronic databases (PubMed, Scopus, CINAHL, Cochrane Clinical Trials, Medline, Embase, and Web of Science) were searched from 1990 to March 2025, following PRISMA guidelines. Randomised controlled trials (RCTs) and comparative cohort studies evaluating polymer-based dressings versus traditional treatments (such as SSD and paraffin gauze) or other polymer dressings were included. These studies were categorised into silver-based, non-silver-based, and multiple polymer dressings. The risk of bias was assessed using the RoB 2 and ROBINS-I tools. A meta-analysis on pain scores and healing times was performed, using standardised mean differences (SMD) and visualised through forest and funnel plots.

Twenty-nine studies were included in the qualitative synthesis, with seven suitable for meta-analysis. Findings showed significant pain score reductions for polymer dressings compared to SSD (SMD=-0.61, 95% CI: -0.99 to -0.22), paraffin gauze (SMD=-0.96, 95% CI: -1.21 to -0.70), and other polymers (SMD=-0.71, 95% CI: -0.79 to -0.63). The polymer group also significantly improved healing time over SSD (SMD=-1.05, 95% CI: -1.38 to -0.71). Mepilex Ag consistently demonstrated benefits in pain relief, fewer dressing changes, and cost-effectiveness, followed by Aquacel Ag and Askina Calgitrol Ag. Non-silver dressings, such as bacterial cellulose and chitosan-based materials, had positive results, especially in pain management and patient comfort. Polymer-based dressings like Mepilex Ag and Aquacel Ag yield superior outcomes and economic value for acute partial-thickness burns.

Background Traditional teaching has proven insufficient to provide nurses with the necessary knowledge about pressure injuries. Therefore, alternative educational methods, such as online platforms, are being explored to improve nursing education.

Aim To evaluate the effectiveness of an online website to improve nursing students’ knowledge of pressure injuries and determine their level of satisfaction with this teaching method.

Methods A quasi-experimental design with quantitative analysis of pre- and post-tests and satisfaction scores was used.

Sample Senior undergraduate nursing students (N = 51) from 10 public and private Brazilian universities participated.

Data collection The Pressure Injury Knowledge Test was used, consisting of 41 questions on pressure injury assessment and classification and 12 questions on management. The Student’s Satisfaction with Learning Questionnaire assessed students’ satisfaction. The educational website content was organised into various pressure injury modules, validated by specialists, and offered as a distance course. Students completed pre- and post-tests to compare the effectiveness of learning from the website.

Data analysis The student t-test was used, with statistical significance set at p<0.05.

Results The percentage of correct answers on the post-test (91.53%) was higher than on the pre-test (73.77%) (p<0.01). In the post-test, four questions in the domain ‘Pressure Injury Management’ had success rates between 59% and 66.7%, indicating a lack of knowledge. The average student satisfaction with their knowledge increased (p<0.01).

Conclusion The intervention significantly increased the rate of correct answers, suggesting that online platforms can effectively enhance knowledge and satisfaction in nursing education.

Implications for clinical practice Online educational resources can improve nursing education in critical areas like pressure injuries, contributing to better patient care.

Diabetic foot ulcers (DFUs) have devastating patient and health economic implications, with high infection rates due to unsatisfactory outcomes from current treatment options. A global roundtable of eight DFU experts was held in London in December 2024 to explore pathways for better DFU treatment. This meeting report highlights several key calls to action raised by the panel. Firstly, moving the mindset from passive care of DFUs to proactive treatment, while highlighting new patient-centred metrics. Secondly, early and targeted interventions to reduce infection risk. Thirdly, unification of DFU guidelines for improved practicality. Fourthly, relentless focus on education of patients and healthcare professionals. Finally, global collaboration on key matters, such as clinical research and refinement of guidelines and definitions. A new multimodal, nitric oxide-generating dressing was discussed as a potential option for improving local infection and healing outcomes. The panel is committed to publishing outputs of further roundtables with the goal of improving outcomes for DFU patients.

The EWMA Antimicrobial Stewardship (AMS) Programme aims to promote the responsible and effective use of antimicrobials in wound management. As part of this programme, a series of local infection fact sheets have been developed for clinical practice to better identify early signs and symptoms of local wound infections.

The fact sheets:

• provide key insights into aetiology, including common diagnostic clues and pitfalls;

• highlight “red flags” that indicate when escalation or specialist assessment is required.

The seven fact sheets cover the following topics:

1. Recognising infection in atypical wounds

2. Recognising infection in diabetic foot ulcers

3. Recognising infection pressure ulcers

4. Recognising infection in venous leg ulcers

5. Recognising infection in skin tears

6. Chronic limb-threatening ischaemia

7. Surgical site infections: signs, symptoms and management