Background Through recent years there has been a shift from inpatient hospital care out to primary care in a home care setting for many patients with different diseases and conditions. This ongoing transition for more primary care-based treatments in general has also been the case for wound treatment with negative pressure wound therapy (NPWT).

Aim To get an overview of the current organisation of NPWT in primary care in different European countries

Method An electronic survey was sent to 53 cooperating organisations of the European Wound Management Association (EWMA) in 35 countries in Europe.

Results In total, representatives from 32 EWMA cooperation organisations in 22 different European countries answered the survey. In 95% of the countries NPWT was used in primary care (n=21); only one country stated that the treatment was not used in primary care at all. The treatment was most commonly initiated from the hospital who prescribes it, and they were also then responsible for the treatment (63%).

Conclusion NPWT in primary care is used, organised, monitored and financed differently in different European countries. The general perception is that treatment with NPWT in primary care is limited and could and should be increased.

Background Wound biofilm is one of the greatest challenges in the local therapy of chronic wounds. In clinical practice, it becomes apparent that there are significant differences in the efficacy of wound therapies, although the corresponding guidelines often classify them – due to lack of evidence and knowledge – as “equivalent”.

Hypothesis Since (almost) no randomised controlled clinical trials (RCT) on antimicrobial local therapies exist, translational research using human biofilm models can further generate information to demonstrate difference and equivalence of topical and physical wound therapies.

Methods This narrative, but also scientific, review addresses several anti-biofilm therapies that have been validated in the translational, human biofilm model based on blood plasma, buffy coat, and various bacterial specimens. Bacterial colonisation patterns of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) of patients and ex vivo biofilm models were compared.

Results Substantial differences in the anti-biofilm efficacy of antimicrobials, which were often evaluated equally in guidelines, are shown. Octenidine dihydrochloride-phenoxyethanol, polyhexanide (PHMB) and cardexomer iodine perform against biofilm with delay but well. Many antimicrobials fail because of the extrapolymeric substance (EPS) of biofilm, a bacterial product of polysaccharides and (lipo)proteins, acting like a protecting shield. Physical therapies also have their limitations here.

Conclusions The persistence of biofilm makes wound healing stagnate. Multiple surgical debridement is not the optimal therapy for aged, critically ill patients. Wound biofilm requires a combined topical therapy because it consists of several ‘components’. Currently, effective anti-biofilm strategies sustainably removing it from chronic wounds are still lacking. Researchers and manufactures are challenged, because the understanding of wound biofilm is already considerable, promising combined therapies are conceivable, only implementation is still missing.

Background Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with systemic inflammatory diseases. Peripheral arterial disease (PAD) is a manifestation of atherosclerosis, which is a chronic inflammatory disease.

Hypothesis Is the presence of PAD a risk factor for the prognosis of PG?

Methods We performed a retrospective medical chart review of seven patients with an overlap of PAD and PG and compared treatment strategies and outcomes.

Results Six out of seven patients had a poor outcome, requiring amputation, even though adequate treatment was initiated.

Conclusions We propose that PAD, whether by reducing the healing potential or by partially contributing to the pathophysiology of the wounds, is a risk factor for the prognosis of PG. Furthermore, the fact that three of the patients developed PAD within a very short period of time after the diagnosis of PG suggests that PG could itself be a risk factor for the development of PAD. However, more clinical data is required to adequately assess this possible relation.

Implications for clinical practice Raise awareness to the possible co-existency of both diagnoses and the importance of early screening.

Background To assess the effects of a local antibiotic delivery system on the incidence of post-surgical infective complications after surgical procedures in patients with diabetic foot osteomyelitis (DFO).

Methods A retrospective study was carried out on patients with forefoot DFO associated with soft tissue infection undergoing minor amputations using local antibiotics in calcium-sulphate granules. Patients were matched with a historical series using propensity-score matching. The principal endpoint was a composite of relapse/recurrence/new onset of DFO, infection/dehiscence at the surgical site, re-intervention for abscesses drainage, and major amputation. Direct costs were analysed as a secondary endpoint.

Results Composite endpoint occurred in 19% and 36.4% (p=0.17) of cases and controls, respectively. Only three patients in the control group had recurrent DFO. After adjusting for ulcer duration, the risk of infective complications and major amputation was significantly lower (Hazard Ratio [HR] 0.20 [0.04;0.95], p=0.047) and the 90-day healing rate was significantly higher (HR 4.44 [1.03;19.07], p=0.045) in cases than in controls. The median direct healthcare costs for cases and controls during the 90-day follow-up were €2,050 [1,829;3,946] and €1,731 [1,028;14,817] per patient, respectively (p=0.072). Median costs for antibiotics were lower for cases than controls (p<0.001).

Conclusions The use of calcium-sulphate granules as an add-on therapy to surgical treatment of DFOs reduces post-surgical infections and complications, without increasing direct costs.

Background Foot ulcers are an important cause of multiple hospitalisation and clinical complications in patients with diabetes. Before hospital discharge, the care transition should be planned across multiple care settings. Many problems occur during care transitions, resulting in negative patient outcomes and unnecessary readmissions.

Aim This paper presents a protocol for a qualitative study exploring the experience of care transitions from both patients’ and clinicians’ perspectives in a regional hospital context in Western Switzerland.

Methods design A qualitative descriptive design will be used to solicit patients‘ and clinicians’ perceptions of care transitions. Semi-structured interviews will be conducted with six patients with a diabetic foot ulcer (DFU) and six community nurses. Data will be analysed according to Braun and Clarke’s thematic analysis.

Discussion Exploring participants’ experiences will afford information about their role within the process, any barriers to effective care transitions, and any strategies to overcome.

Implication for clinical practice The findings of this study will be pivotal to informing and developing new and enhanced transition planning for people with DFU, with the ultimate goal of improving patient outcomes, reducing hospital readmissions and enhancing cost savings. Additionally, this study takes a unique approach as it seeks experiences of both the patient and the clinician and is in alignment with the EWMA project Living with chronic wounds.