Background Patients with diabetes and stroke have a high risk of injury to the paralysed side of the body, but are incapacitated and unable to maintain their self-care. In stroke units, registered nurses can assist patients through systematic assessments and nursing interventions, including preventive footcare.

Aim To explore the documentation of preventive nursing actions regarding the risk of developing foot ulcers in patients with diabetes and stroke at a neurology clinic’s inpatient ward.

Method A retrospective systematic review of computerised nursing records using the Global Trigger Tool (GTT). All records (n = 101) of patients with diabetes and stroke at the clinic between 1 January and 20 December 2015 were assessed. Descriptive statistics and manifest content analysis were used.

Results Median age: 78 years (41–93). Male/Female: n = 61/40. The records revealed insufficient documentation: Risk for foot ulcers was not documented in any of the records. The GTT showed that three patients had a documented foot ulcer, all with localisation on the same side in which the patient was paralysed. Documented nursing actions for foot ulcer prevention in bed were provided for 12 patients, but none were provided for patients sitting in a chair. Risk factors, according to the International Working Group of the Diabetic Foot, were found in 12 of the patients’ records. The nursing process was not mentioned in the records.

Conclusion Insufficient documentation indicates that the patients’ feet are not assessed and protected.

Implications for clinical practice The patients’ risk factors need to be addressed, and nurses need more education related to the diabetic foot.

Background Wearable sensor technologies for wound management have slowly found their way into healthcare systems worldwide. They aim to produce benefits in the reduction of hospitalisation time, facilitate home healthcare, mitigate loses incurred by human error, reductions in clinician and nursing efforts and the prevention of amputations. They have the ability to capture the diurnal and circadian variations of wound parameters, with patients benefitting from continuous long-term monitoring as a part of either a diagnostic procedure or the maintenance of their wounds.

Aim: This study explored the perceptions of those living with chronic wounds of the foot and lower limb toward the concept of a wearable sensor technology for wound management.

Methods A qualitative description method was employed. Twenty-three semi-structured interviews were conducted in three geographically distinct locations in Ireland. A thematic analysis was also conducted.

Results Four main themes emerged: the element of personal contact, the medical need for wound diagnostics, the practicalities of wearable sensor devices and the trialable nature of wearable sensor devices.

Conclusions Most participants indicated feelings of concern toward accepting wearable sensor technology as a part of wound management and the potential loss of contact with their attending clinician. These findings contribute to understanding technology acceptance in wound patients and aim to open communication channels among users of the technology, researchers and policy and market innovators in wound care.

Key messages

• Wearable sensors have the potential to revolutionise wound management practices, but their acceptance by patients must be considered in advance.
• Researchers and innovators of new sensors should work with patients to develop education tools concerning their use, in order to alleviate fears and increase adoption of the technology.
• Patients value contact with their clinicians and need reassurance that it will be maintained.

Background Martorell hypertensive ischemic leg ulcers are commonly misdiagnosed, and their prevalence may be underestimated. There are still some aspects to be defined about the aetiopathogenesis of Martorell ulcers and the risk factors that may be involved with them.

Methods This is a single-centre retrospective case series study on the demographic characteristics and comorbidities in a series of patients with Martorell ulcer treated at a public university hospital in Madrid.

Results Comparing our results to previous studies, which are few and include small samples, the risk factors that we outline are an average age over 70 years and high blood pressure. Only two (5%) participants had poor control of their high blood pressure.

Conclusions and Implications for Clinical Practice Defining the epidemiological features of this type of leg ulcer may be very useful in differential diagnosis with other disorders, such as pyoderma gangrenosum.

Background Most wound guidelines recommend the measurement of an ankle brachial pressure index (ABPI) prior to the application of compression therapy. However, several studies have shown that this is not happening in reality, and the proper management of venous leg ulcers is delayed. Our study explored the safety of compression therapy for managing venous leg ulcers in the absence of an ABPI where pedal pulses are palpable.

Materials and Methods This study included 149 consecutive new patients referred to a vascular medicine clinic with lower extremity ulceration. Full histories were recorded and a physical examination was performed at the initial visit, and a provisional diagnosis of ulcer aetiology was made. ABPIs were only performed if pedal pulses were not palpable. Patients diagnosed with venous ulceration were treated with compression therapy and followed-up at 12 weekly intervals for up to one year, per our clinic’s protocol.

Results The study included 60 males and 89 females (mean age 71 years, range: 24–100 years). The mean ulcer history was nine months (1 week–10 years); 101 ulcers (68%) were venous in aetiology. ABPIs were only performed on four patients (4%), when pedal pulses were not palpable. The remaining 97 patients were treated with full compression (ankle pressure 30–40 mmHg) in the absence of ABPIs. No adverse events occurred during follow-up, and 65 patients had fully healed at four months.

Conclusion In our patient cohort, it was safe to compress venous ulcers in the absence of ABPIs when pedal pulses were palpable.

Background Ischaemic wounds are notoriously difficult to treat, as poor perfusion often leads to chronic, non-healing wounds.

Aim This case study describes the successful treatment of an ischemic ulceration in a neonate using topical oxygen therapy (TOT).

Methods A large necrotic ulceration quickly developed over the left gluteal area in a 2-week-old child and enlarged to cover the entire gluteal area in one week. The aetiology of the wound was ischaemic, due to internal iliac artery thrombosis after an umbilical vein catheterisation. The wound was initially managed using the standard of care and surgical debridement of the necrotic tissue with saline dressing; however, the condition worsened with the development of a new necrotic patch.

Topical oxygen therapy (TOT) was applied using the M.O.I.S.T. concept. After the second surgical debridement, TOT in the form of haemoglobin spray was administered on alternate days and a moist dressing was applied.

Results / Findings The wound healed progressively, with granulation tissue formation and epithelisation after 6 weeks.

Conclusions Wound management in neonates is extremely challenging, due to their relatively small physical size and the preference for less invasive management strategies.

Implications for clinical practice TOT has proven to be an easily accessible, efficacious, non-invasive and cost-effective method for treating ischaemic wounds in neonates.

Background There is a paucity of research investigating the experiences of nurses using a standardised skin tears programme and the influence that such a programme has on their clinical practice. The available literature is primarily in English, and there is a lack of validated instruments for use in other languages, including French.

Aim The aim of this study is to translate and cross-culturally adapt an original English language survey conducted among Australian nurses into Swiss French.

Method/results A structured methodological approach was used to translate, adapt and validate the survey based on Sousa and Rojjanasrirat’s translating process: (1) two independent bilingual experts were involved in the translation from English to Swiss French, and a synthesis version from both translations in Swiss French was obtained; (2) a blind back-translation of the synthesis version in English by two experts was completed, and consensus attained by a committee, to generate a pre-final version of the survey in Swiss French; (3) validation of the translated version was provided by postgraduate wound care students.

Conclusion The translated Swiss French 2020 survey is now ready to be used to assess the clinical reasoning of wound care specialists on the prevention and management of skin tears in Switzerland.

Implications for clinical practice Given the lack of research in this area, it is important for policymaking and improving patient outcomes that we understand the situation in Switzerland. Using an existing survey, updating it and doing a translation and cultural adaptation of it will allow an understanding of nurses’ clinical reasoning on skin tears in Switzerland, enabling comparisons with other countries.

Background Long-standing wounds are at risk of developing malignant degeneration, including leiomyosarcomas. These exceedingly rare malignant tumours originate from smooth muscle cells and are considered superficial if they affect the dermis and/or subcutis.

Hypothesis To exclude malignancy, a biopsy should be performed on chronic skin ulcers with atypical features or evolutions.

Methods We report the case of a 62-year-old male with a history of a two-year old chronic venous ulcer who presented with a tumour developing over three months, progressively increasing in size on the surface of the wound. As the clinical aspect strongly suggested a malignant tumour arising within a chronic venous ulcer (the initial suspicion was of squamous cell carcinoma), a biopsy from the edge of the lesion was performed.

Results Histopathological and immunohistochemical examinations revealed a diagnosis of leiomyosarcoma. The patient refused further medical care. The tumour arose in the context of severe cutaneous changes of venous insufficiency and had aggressive clinical behaviour. Histopathological and immunohistochemical analysis of the tissue sample is essential for establishing the final diagnosis, as no pathognomonic clinical features of leiomyosarcoma exist.

Conclusions Our case emphasises the importance of considering malignancy in chronic ulcers with atypical features or evolution. Biopsy of atypical skin ulcers is crucial for establishing a diagnosis and initiating therapy at the rightful moment.

Implications for clinical practice The findings from this case highlight the importance of an early diagnosis of atypical, non-healing wounds, based on tissue samples, to decide the optimal approach. Patient denial may interfere with the proper management of this particular clinical context.

Written by a group of international experts in the field, the Textbook on Scar Management allows readers to gain a detailed understanding of scar and wound treatment – a topic still dispersed among various disciplines.