Background The keystone island flap allows quick reconstruction of skin losses in different areas, as an alternative to skin grafts or free flaps.

Hypotesis The described keystone island flap is shaped as two V-to-Y advancing flaps that are supplied by musculocutaneous and fascio-cutaneous perforator vessels.

Methods For the patients enrolled in the present study, keystone island flap was chosen as a surgical strategy after oncologic resections for the reconstruction of defects of the trunk or extremities derived from of tumors. The study involved 20 patients, from 2015 to 2021. After tumor removal, all patients underwent an immediate reconstruction; margins were cleared on the first resection in all cases.

Results There were no flap losses. The complication rate was 10.9%, and there were no major complications. Minor complications included two cases of dehiscence and one of the two cases needed another refinement surgery.

Conclusions This study shows that the keystone island flap can be a useful reconstruction option even in large defects of the trunk and extremities.

Implications for clinical practice The described keystone island flap can be used to easily cover wounds of the trunk or extremities.

Introduction Chronic venous disease (CVD) affects lower extremities and can lead to serious complications, including venous ulcers. Despite its high prevalence, CVD is often underdiagnosed and undertreated. Compression therapy is essential in managing this condition, with the zinc oxide-based Unna boot providing both compression and anti-inflammatory effects. This study evaluates the Unna boot’s effectiveness in reducing lower limb oedema in CVD patients, using advanced non-invasive techniques such as high-frequency ultrasonography (HFUS) and trans epidermal water loss (TEWL).

Materials and Methods We conducted a prospective observational study involving 10 patients with CVD (CEAP classification C3–C6). Participants received treatment with the Unna Boot for four weeks, with assessments at baseline, after treatment, and during follow-up. Key measurements included calf circumference, HFUS for subcutaneous changes, and TEWL to evaluate skin barrier integrity. The Wilcoxon Signed-Ranks Test was used for statistical analysis.

Results Significant reductions were observed in calf circumference (mean decrease of 18.69%, p<0.05) and subepidermal low echogenicity band (SLEB) thickness (mean decrease of 37.95%, p<0.05) after treatment. TEWL measurements showed no significant changes, likely due to external factors affecting the results.

Conclusion The Unna Boot effectively manages the lower limb oedema in CVD. HFUS provides objective assessments, while TEWL may not accurately reflect skin barrier changes. Further research is needed to explore long-term effects and the Unna Boot’s applicability across different CVD stages.

Background Shared decision-making (SDM) can be crucial when making sensitive decisions, such as determining the appropriate level of major lower extremity amputation (MLEA). Despite clinicians aiming for SDM and patients wanting active participation, barriers persist to implementation.

Aim To explore patients’ experiences with pre-amputation communication and shared decision-making and their attitudes towards a decision-support tool for future amputation decisions.

Methods An electronic survey was distributed between November 2023 and January 2024 to individuals with MLEA, identified via social media, healthcare professionals working with MLEA patients, and a non-profit patient organisation. In total, 49 individuals responded (27% female, 47% living alone, mean age 63, SD=15). The questionnaire covered four themes: experiences of the pre-amputation communication, preferences for SDM, discussion of different amputation levels and respondents’ viewpoints on the potential use of a decision-support tool. Descriptive statistics were used to analyse the questionnaire responses.

Results 43% (n=21) of the respondents felt unprepared for a possible amputation, and 80% (n=39) did not know the surgeon beforehand. More than half (59%, n=27) were satisfied with the pre-amputation conversation, while 22% (n=10) were not. Most respondents (73%, n=33) wanted to be involved in the decision about amputation level, and 68% (n=28) believed a decision-support tool would be beneficial.

Conclusions Patients undergoing MLEA generally want to be involved in the complex decision-making process about amputation level and often are, but there is room for improvement. Discussing the risk of amputation earlier allows patients to prepare better and may facilitate easier engagement in SDM.

Background Patients with diabetic foot ulcers (DFUs) experience a significant decrease in their health-related quality of life (HRQoL).

Aim To evaluate the HRQoL of patients with DFUs using the Diabetic Foot Scale-Short Form.

Methods A cross-sectional study was carried out in a general outpatient clinic of a university hospital, from November 2022 to September 2023, among 103 patients. A negative small significant correlation was found between diabetes’ length and the negative emotions domain (r=-0,1991; p=0,0460). Women showed significantly lower scores than men in physical health (p=0.0260), dependence/daily life (p=0.0439), and worried about ulcers/feet (p=0.0310) domains. Patients who smoke had low scores for the leisure domain (p=0.0121). Patients who did not follow a diabetes or diet and physical exercise showed lower scores in dependence/daily life (p=0.0014) and were more bothered by ulcer care (p=0.0117). Scores for the physical health (p=0.0355) and dependence domains (p=0.0195) were lower in patients who did not use oral antidiabetic agents. Patients using insulin had poor HRQoL for the dependence (p=0.0398) and negative emotions domains (p=0.0441).

Conclusion According to the results of this cross-sectional study, patients with diabetic foot ulcers exhibit a low HRQoL.

Background Peripheral intravenous catheters are widely used worldwide. Intravenous catheterisation is one of the most common medical procedures in hospitals. Despite their widespread use, peripheral intravenous catheters exhibit concerning failure rates. Peripheral intravenous catheter dressing and securement devices can be protected against factors that cause the development of peripheral intravenous catheter failures.

Aim The primary objective is to review the evidence of effectiveness and safety of peripheral intravenous catheter dressings and securement devices in terms of post-insertion peripheral intravenous catheter failures; dislodgement, occlusion, extravasation, infiltration, phlebitis, and catheter-related bloodstream infection in hospitalised adult and paediatric patients. The secondary objective is peripheral intravenous catheter dwell time.

Inclusion criteria This review included randomised controlled trials or cluster randomised trials. Cross-over trials are considered for inclusion where data from the initial treatment period was available.

Methods The study performed methodical searches in the following electronic databases: CENTRAL, CINAHL, Ovid EMBASE, and Ovid MEDLINE from 1959 to 2024. The review will use standard methodological procedures expected by Cochrane. Methodological quality will be appraised using the revised version of the Cochrane risk of bias tool for randomised trials (RoB2). A fixed effect models meta-analysis will be conducted where appropriate. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool will be used to determine confidence levels of findings from the studies.

Significant progress has been made in the treatment of wounds, including knowledge of evidence-based wound bed preparation and use of advanced therapies to enhance healing. Yet access to these improved outcomes is not equitably distributed across populations.¹ In early 2022, to tackle this issue, the Board of Directors of the Association for the Advancement of Wound Care (AAWC) created the multidisciplinary Diversity, Equity and Inclusion in Wound Care (DEIWC) task force. The DEIWC task force was charged to address three aims: 1) examine the complex issue of disparities in wound care and provide unified recommendations for wound care clinicians, 2) identify technological approaches and best practices for skin and wound assessment, and 3) investigate disparities in pressure injuries. Three approaches were used by the DEIWC task force: comprehensive literature review (Aim 1 and 2); systematic review (Aim 3); critical review with consensus by experts (all aims). This is the final report of the task force for Aim 1. The purpose of this report is to provide an overview on the etiologic mechanisms of disparities that exist in wound care that impact the complex wounds that clinicians treat and actions for wound care clinicians that may decrease disparities and improve inclusivity in wound care.

Objective This manuscript presents the method which will be used for a scoping review aiming to review the learning theories that have been applied in digital education related to wound care. The proposed review with examine the reported outcomes; the use of technology and identify the challenges and barriers associated with implementing digital learning regarding wound care education for healthcare providers.

Introduction The rising prevalence of wounds results in a necessity for proficient wound care management by healthcare providers. Digital education has potential in knowledge and skill acquisition, accessibility, and scalability. However, regarding wound care education no existing review provides an overview of the learning theories used with digital education or their associated outcomes.

Inclusion criteria This scoping review will consider studies that describe the use of digital education in wound care in all contexts intended for health professionals. The review encompasses quantitative, qualitative, and mixed methods study designs, as well as systematic reviews, text and opinion papers, and conference proceedings.

Methods Following the JBI methodology for scoping reviews and the PRISMA-ScR guidelines, a comprehensive search strategy will be implemented across MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, ERIC, considering both published and unpublished sources. Articles published in English, French, Italian or German, will be included. Screening and data extraction will be performed using Covidence, and the findings will be presented in a table with a narrative summary.

• The review aims to identify learning theories, outcomes, and challenges associated with digital education in wound care for healthcare professionals.
• Existing reviews lack a focus on wound care, learning theories, and implementation strategies, highlighting the need for this scoping review.
• Using JBI and PRISMA-ScR methodologies, the review will map evidence from diverse study designs and contexts to inform future digital education initiatives in wound care.