One of the defining features of chronic wounds is their high levels of inflammation. Patients present with high levels of inflammation, around 80%, of cells at the wound margin being macrophages and with wound fluid laden with pro-inflammatory cytokines. The latter is in part responsible for preventing wound closure, along with the low levels of growth factors. In healthy acute wounds, two types of macrophages can be found: pro-inflammatory M1 macrophages and anti-inflammatory M2 macrophages, with more M1 cells present early post-injury and M2 appearing later to regulate repair and wound closure. This pro-repair M2 phenotype, that secrete a range of mediators including growth factors that regulate re-vascularisation and closure of a wound, is lacking in chronic wounds, leading to excessive inflammation, enhanced degradation within the wound, reduced matrix deposition and lack of closure. This review will discuss the alterations seen in chronic wound macrophages, how this might affect the repair process and some potential reasons for their dysregulation.

Objective: The present study investigated subjective wellbeing amongst informal caregivers of people with wounds. Although under-investigated in the wound care literature, prior research indicates that informal caregiving results in a series of poorer outcomes for the caregiver.

Methods: A convenience sample of 57 caregivers (16 male, 41 female, 19–84 years old), was recruited from public outpatient facilities. Participants completed measures of caregiving satisfaction, and subjective wellbeing, in addition to characteristics about themselves and the care provided.

Results: The informal caregivers of people with wounds scored significantly lower on a measure of subjective wellbeing than the Australian population to a large effect (d = 1.11). Negative associations were identified between sleep and subjective wellbeing, while positive associations were found between caregiving satisfaction, and relationship quality with subjective wellbeing.

Discussion: Caregivers displayed lower subjective wellbeing than the general population. Subjective wellbeing was related to sleep, satisfaction, and relationship quality. Future research should compare outcomes of the caregivers of people with different forms of wounds, and should determine if correlating stressors and mediators are causal to wellbeing.

Background: Pressure Injuries are a relatively common but largely avoidable result of hospitalisation and care for frail clients in their own homes. These injuries are costly, painful and debilitating. Current research and intervention guidelines have focused on clients who are either in bedded facilities or chair/wheelchair-dependent. The majority of existing pressure redistribution surfaces have been designed and tested for these populations. Method: This paper describes a small pilot study designed to explore the effectiveness of these prevention devices at reducing interface pressure when utilised on a non-standard surface (an armchair), utilising each subject as their own case control to compare against the device on a “control” surface. Results: It was found there was a statistically significant difference in cushion performance dependent upon which surface was used. It was also found that devices that are most effective at interface pressure reduction on the “control” surface were not necessarily the most effective on the non-ideal armchair. Conclusions: These findings have clinical implications for the prescription of effective pressure redistribution surfaces for use in a client’s own home.

Therapeutic antibodies present numerous opportunities for the treatment of wounds and cutaneous conditions; however, they have not been widely adopted due to the difficulty of administering antibodies through the skin. Local antibody administration to the skin may result in fewer side effects, reduce cost of therapy and be less invasive than systemic methods and recent advances in antibody engineering have addressed many stability and formulation challenges. Penetration of the epidermal barrier is crucial to effective delivery of antibodies and other protein drugs and can be achieved through chemical or physical methods. Chemical penetration enhancement is poorly suited for delivery of large hydrophilic molecules such as antibodies; however, enhancers based on surfactants or terpenes may improve antibody delivery to the dermis and novel cell-penetrating peptides provide opportunities for well-tolerated local antibody delivery. Physical penetration enhancement methods (including electroporation, iontophoresis, microneedles and ultrasound) address many formulation challenges common to chemical penetration enhancers; however, more studies are required to demonstrate effective antibody delivery for clinical translation. While topical antibody administration to the skin remains challenging, advances in antibody engineering and skin penetration enhancement may render antibodies more viable treatment options for improving wound outcomes.

Pressure wounds are not uncommon in persons with spinal cord injury. This study of an ischial tuberosity pressure wound featured an unexpected finding in the wound bed — calcified material. Following internal imaging and histopathology of the material, "Fat necrosis with dystrophic calcification" was reported. The wound was then deemed not to be a pressure wound, but due to its anatomical position it was conservatively managed as such, when surgical intervention was declined by the patient. This time-line case study depicts holistic management of a patient with tetraplegia at home with a slow healing wound. Strategies to reduce external pressure forces on his wound are discussed; the healing was most likely impeded by internal forces from a calcifying disorder. With regular monitoring and care, the wound appeared healed a year after first sighting the calcified material. With no medical therapy prescribed and no confirmation that the calcification disorder is no longer an issue, the question arises as to how long the skin will remain intact.

Aim: The trial aimed to identify the most effective dressing for haemodialysis central venous catheter exit sites in a tropical region.

Background: Central venous catheters, often used to deliver haemodialysis, require meticulous exit site care. Staff in a tropical renal service were concerned a transparent dressing could increase the likelihood of dressings not remaining intact or of infection of the exit site.

Design/Methods: Patients (n=26) with central venous catheter access attending this Australian renal service for haemodialysis consented to participate in this population-based, prospective, randomised crossover trial. Participants were randomly assigned to a specific sequence of transparent (IV3000) and non-transparent (Primapore™) dressings. The primary outcome measure of effectiveness was intactness of dressings between haemodialysis episodes.

Results: The majority of participants were Aboriginal and Torres Strait Islander people (n=21). There were no statistical differences between intactness of the IV3000 and Primapore™ dressing types. No laboratory-confirmed catheter-related infections occurred while patients were wearing the non-transparent dressing.

Conclusions: Nurses in tropical settings can safely select either a non-transparent or transparent dressing until the study is replicated in other geographical locations with a larger sample size.