Introduction: Infection is difficult to detect and diagnose in chronic wounds. Misdiagnosis of wound infection risks inappropriate antibiotic prescribing, antibiotic resistance and unnecessary treatment side effects. Alternatively, waiting for the results of microbiological investigations can delay treatment risking spreading or/and systemic infection. There is a need for simple and objective measures of wound infection that provide real-time indication of infection that is accessible to the majority of clinical settings. 

Methods: A literature review was conducted that explored existing evidence regarding the association between the pH of a wound and wound healing and infection to determine whether a wound pH scale could be used as a marker of infection. 

Results: The literature review found evidence to suggest that wound pH, and specifically an ‘Alkaline pH’, is conducive to bacterial bio-burden and reflective of the specific physiological processes of the healing cascade. 

Conclusions: As such, while pH is not sufficiently understood to be translated into current practice as a metric for infection, the pH scale does have potential as a diagnostic and management indicator and merits exploration.

Background: Chronic wounds affect at least 1.9% of the population, significantly impairing quality of life for sufferers and placing a large financial burden on the health system^1,2. Adequate nutrition is required for wound healing and many patients with chronic wounds are significantly malnourished.

Methods: A systematic search of the literature was conducted utilising the Medline, PubMed, Cochrane Library and CINAHL Plus databases. The terms malnutrition and nutrition in alternate searches were used in various combinations with the Boolean phrase ‘AND’ to find applicable articles: chronic wound, wound healing, ulcer, diabetic, venous, arterial and foot. A total of 20 articles fit the criteria to review.

Results: This review has established that it is likely that malnutrition contributes to wound severity and limb loss; however, this is only level 3 evidence^2-4. This review has identified a paucity of consistent evidence of the influence of nutrition on wound healing.

Conclusions: There are limited good-quality, randomised controlled trials (RCTs) to assess the impact of nutrition or malnutrition on wound healing in patients with vascular wounds. More research is required to evaluate the impact of education and/or supplementation on rates of healing in the different wound types.

Pressure injuries (PIs) are highest amongst the critically ill. The impact of PIs is well reported and includes increased length of stay in acute facilities, increased cost of care, decreased quality of life, and pain and disability for the patient. Over the last decade, a considerable amount of research has been undertaken in the area of PI prevention. We now know that the use of prophylactic silicone dressings can assist in reducing the incidence of PIs in critically ill patients. However, there is currently a gap in the literature in comparing the effectiveness of different silicone products available in Australia. This cluster-controlled clinical trial aims to compare the onset of PIs and cost-effectiveness between two silicone products currently available.

Key points:

• The use of prophylactic silicone dressings is considered a preventative strategy to minimise PI occurrence.
• There is little published comparative clinical evidence or cost-effectiveness data on the various silicone dressings with regard to PI prevention. This study aims to fill this gap.

Definitions: Pressure injury (PI): The result of localised injury to the skin or underlying structures usually over a bony prominence due to one or more contributing factors, such as unrelieved pressure and/or shear forces¹.

Clinical trial end point definitions: Stage 1 PI: Non-blanchable erythema¹.

Background: Chronic wounds are those that fail to move past the inflammatory phase of wound healing in a timely manner. Chronic wounds vary in type and cause and all may present challenges for the clinician, client and the health system. The evidence for current clinical practice needs review without fear or favour to consider how we can improve wound healing.

Aim: To assess the current literature on the management and evaluations of non-healing wounds.

Methods: The electronic databases CINAHL, Medline on Ovid and Cochrane Library were searched for publications from 2005 to 2015, in English on the keywords and MeSH headings including: chronic wound management, debridement and methods, wound pain and comfort, topical analgesics and wound care economics.

Results: Much of the evidence in wound care reports small study sizes, varied methodologies and outcome measures. There is a lack of good-quality evidence to support the most cost-effective method which would minimise psychological effects on the clients. There is insufficient evidence to support which dressing or debridement method should be used. Many of the studies compared different wound types and different treatment options.

Conclusion: There is a critical need for evidence to support efficacy in basic wound care with emphasis in wound bed preparation to promote wound closure with minimal psychological impact on clients.

Invasive aspergillosis is a rare complication of renal transplantation that carries a high mortality rate. We describe the case of a patient with an invasive aspergillus-associated postoperative wound infection. Successful treatment was achieved with a combination of surgical debridement and a novel approach involving the use of topical amphotericin B in addition to intravenous anti-fungal therapy.

This case study documents the treatment interventions and outcomes of a young man with complex pilonidal sinus (PNS) disease. The healing process fluctuated, with periods of improvement and regression. Various wound care products were introduced with the aim of optimising wound bed preparation and healing. Seven general anaesthetics were required to perform surgical interventions, examine wound progress or to apply topical negative pressure wound therapy. The delayed wound healing caused disappointment and frustration for the patient, his family and the team involved in his care. The challenges were exacerbated as treatment took place during his final year of school, while completing the Higher School Certificate (HSC). No pre-existing medical conditions contributed to the delayed healing. Primary wound closure or flap techniques were not recommended due to infection and proximity to the anus. Complete healing was achieved in 343 days.