EWMA documents have addressed and provided recommendations for the organisation of wound care. However, several challenges are currently creating a need for organisational innovation. An important aspect is the integration of pathways for patient care, implementation of guidelines for managing Diabetic Foot Syndrome, and leveling disparities in DF treatment and outcomes, together with establishment of regional patient registries, where lacking. A pilot project, Diabetic Foot Valley Tuscany, has shown very promising results, which, in addition, led to three new clinical trials being initiated in collaboration with industry. Collaboration between the public and private sectors is vital to deliver better and safer solutions in a difficult and complex environment for health care. In July 2023 EWMA thus established the EWMA Innovation Alliance with the aim of establishing a European Wound Management Innovation Ecosystem. EWMA has for years worked intensely on the qualification of health care professionals within wound management. However, the widespread shortage of personnel in Europe affects the wound management area. EWMA is committed to raising awareness of this issue, to foster discussions on how to tackle it and to explore how organisational innovation can assist health care systems in better utilising resources, particularly human resources. EWMA aims to collaborate more closely with health care authorities and policy makers by joining projects targeting public health care systems and to strengthen advocacy via an EWMA State-Of-Affairs Report to be published in 2025.

Extravasation is a common and potentially severe complication of intravenous drug administration. The COVID-19 pandemic has resulted in a rapid upsurge in the use of remdesivir. Data about complications experienced during use of the drug are limited. The authors describe here the first case report of a patient with remdesivir extravasation in the UK, and a systematic review of all known cases worldwide, as well as their management and long term sequelae. Oedema was reported in all cases, erythema in five cases and pain in four cases. The one case with persistent sequelae had delayed diagnosis which may have caused potential for more severe injury. The two cases which had the fastest resolution of symptoms were those where the extravasation was noticed part-way through the infusion, hinting at a dose-dependent relationship. The acidic pH of remdesivir and high infiltration volumes are the factors which most likely explain the mechanism of tissue injury and should be the targets on which to base a treatment strategy. The clearest recommendation from our review is the importance of awareness to recognise injury early and prevent the most severe sequelae. The authors propose a recommendation for aspiration and hyaluronidase injection to “disperse and dilute” remdesivir.

Aim To evaluate and provide insights on the clinical characteristics and healing outcomes of patients with pressure injuries (PIs) over six months using data from the Chronic Wounds Registry (CWR) database.

Method This was a retrospective database review study where data were extracted from Singapore’s CWR. The patient’s basic demographic, co-morbidities, wound-related clinical data, and wound images were analysed. The study outcomes were on clinical characteristics and healing outcomes over six months.

Results A total of 63 patients with 63 PIs were included in the study; 46.0% of the PIs were community-acquired, and the rest were hospital-acquired. The mean age was 67.3 years, and 56% were males. The most common ethnicity was Chinese (66.7%), followed by Malays (20.6%) and Indians (7.9%). At baseline, 30.2% of patients had deep tissue injury (DTI), 44.8% had stage I/II, and 13.8% had stage III/IV PIs. Twenty-nine (46.0%) of the PIs healed within six months, while 12 (19%) still had ongoing PIs at month 6. Wounds that failed to heal at six months exhibited a higher proportion of wound infection (33.3% vs 6.9%, p=0.02), wound bed slough (46.7% vs 10.3%, p=0.02), maceration of peri-wound skin (46.7% vs 3.5%, p=0.001)), and exudate (75.0% vs 38.0%, p=0.03).

Conclusion While nearly half of the PIs healed within six months, ongoing cases were more likely to exhibit infection, sloughing, skin maceration, and excess exudate, indicating these factors as critical targets for improving healing rates in PIs care.

Background Anal fissure (AF) is the most common cause of severe anorectal pain in adults, with an overall annual incidence of 0.1%. The primary objective of this pilot trial was to evaluate the safety and efficacy of an Olea europaea leaf extract (OELE)-based hydrogel (EHO-85), as a supportive treatment for acute AF episodes.

Methods Prospective, open-label, pilot study (May to October 2022). Adult patients with AF were recruited from three centers in Bulgaria and one in Romania. Patients were allocated 1:1 to each treatment using a computer-generated-based system and received either EHO-85 or customary supportive therapy (CST) for 60 days. The primary endpoint was the time to bleeding disappearance.

Results 42 patients were included by web-based allocation to receive EHO-85 (n=21) or CST (n=21). All patients completed the 60 days’ study. Patients reporting bleeding absence were significantly higher in the EHO-85 group at days 7 (p=0.032) and 15 (p=0.006). From day 29 or 36, no bleeding at defecation was reported in the EHO-85 and CST groups, respectively. On day 60, all subjects were bleeding-free. No adverse events were reported.

Conclusion EHO-85 was feasible to deliver and showed efficacy, safety, and apparent superiority in promoting and speeding up the healing process. In a future definitive trial, the sample size and diversity may be increased, and new objective methods may be considered.

Implications in clinical practice It highlights the combined wound-healing properties of EHO-85 as a promising noninvasive, cost-effective, and easy-to-apply alternative to current CSTs for AF wound repair.