Wound Practice and Research

Introduction Diabetes-related foot ulcers (DFU) are optimally managed with a team approach to addressing infection, ischaemia, pressure offloading and sharp debridement. Treatment frequency is commonly every 1–2 weeks.

Aim To investigate the actual and preferred frequency of treatment of patients, and potential factors affecting treatment attendance including perceived benefits, mobility and mode of transport.

Method A convenience sample of patients attending urban or regional high risk foot services (HRFS) for treatment were invited to participate in the survey via a QR code, on paper or via phone. The study had ethics approval No X20-0550 2020/ETH03244.

Results A total of 60 participants from three centres completed the survey. Eight (13%) attended weekly, 28 (47%) every 2 weeks, and the remainder (40%) less often; 51 (85%) indicated they would attend weekly if this hastened healing; 33 (45%) had some level of difficulty in mobility impacting their ability to attend, with 11(18%) requiring a carer or family support for them to attend; most (84%) participants drove or were driven.

Conclusions Physical mobility deficits impact patients’ ability to attend for treatment, with the majority relying on private transport to attend appointments. Family support to enable attendance was common. These factors should be considered by providers and commissioners of services.

Foot ulceration continues to persist as a serious health threat among people with diabetes (PWD) due to multiple factors that include poor adherence to recommended foot self-care activities and limited access to self-management support. Given the ongoing adaptation and use of telehealth to improve patient access to health programs, there is a need to explore whether the rapidly growing social media network can engage PWD in self-management strategies to reduce their risk of diabetes-related complications such as diabetes-related foot ulceration (DFU). In this paper, we describe the development and implementation of the Diabetic Foot Care Group (DFCG), a social media-based self-management support intervention for PWD to prevent DFU. Using a co-design approach, we actively engaged both healthcare professionals (HCP) and PWD in the development and implementation activities. The DFCG comprises of four components – patient education, peer support, social interaction and active engagement. The DFCG was implemented through a private Facebook group platform. The posts’ content was patient-centred and structured to enhance self-care confidence and optimise care outcomes among PWD. In summary, social media platforms are feasible alternatives that HCP could utilise to provide continuous self-management education and support (SMES) for PWD to prevent DFU proactively.

Aims To identify the current research on assessment, management and prevention of chronic wounds in Australia and within the global context.

Methods Electronic databases, trial registries and professional organisation websites were searched from 1 January 2010 to 31 May 2022. All original human research studies on chronic wounds conducted in Australia and reviews (systematic reviews (SRs), evidence-based guidelines (EBGs), evidence summaries, consensus documents) conducted worldwide were included. Results were tabulated and synthesised in a narrative review.

Results Overall, 365 Australian studies and 569 worldwide reviews were included. The designs of Australian studies were mostly cohort (31%) or cross-sectional (20%), with a few randomised trials (10%). Australian studies were mostly concentrated on wound management (43%) or assessment (40%), and only 17% on prevention; this profile was similar for worldwide reviews. The chronic wound types focused on in Australian studies were 43% pressure injuries (PIs), 27% diabetes-related foot ulcers (DFUs), 16% venous leg ulcers (VLUs), 8% mixed chronic wounds, 6% mixed leg/foot ulcers, <1% fungating wounds.

Conclusions This review found Australian chronic wound research focused on PIs and DFUs, with few randomised trials (10%), which is likely related to the lack of national competitive funding and difficulties in infrastructure support for adequately powered trials.

Aims To review the progress of a chronic left ankle wound via telehealth. To initiate appropriate wound therapies and review progress towards the achievement of autolytic debridement, management of biofilm and ultimately wound healing.

Methods This is a case study to which the patient provided written consent. Telehealth was predominantly used to assess and treat this chronic wound with wound management strategies and products altered based on wound progress. Wound care was targeted at debridement, exudate management, protection of peri-wound skin, control of bacterial colonisation and treatment of biofilm.

Results Telehealth suited the patient’s lifestyle and work schedule. Telehealth did not allow for mechanical debridement, thus wound products were selected in order to facilitate autolytic wound debridement. The wound made progress with some wound care modalities; however, rapid progress was observed after switching to AQUACEL^® Ag+ Extra^™ and wound closure was achieved.

Conclusion When a chronic wound fails to make positive progress, biofilm should be suspected. Wound debridement should be undertaken, followed by the use of wound products aimed at managing biofilm and preventing its re-accumulation. This case study demonstrates telehealth can be an appropriate medium for treating motivated patients and was incorporated into this patient’s busy schedule.