Background: Chronic wounds can be difficult to heal, or sometimes never heal. Current evidence indicates that wound biofilm can interfere with healing. Combining two treatments targeting chronic wound biofilm may improve outcomes when standard care is unsuccessful. The aim of this study was to determine feasibility and acceptability of combining low-frequency ultrasonic debridement (LFUD) and the antiseptic polyhexamethylene biguanide (PHMB) post treatment.

Methods: This was an exploratory case study of four patients with non-healing wounds with suspected microbial involvement, who were subjected to a combination therapy approach. Data collection included retrospective health care record audit, wound observations and structured individual interviews. Interview data captured patient feedback about the acceptability of the therapy and provided information regarding feasibility of conducting larger trials.

Results: Standard care for the four participants had failed to assist with healing. The new combination therapy was acceptable and appeared to accelerate wound healing, with nil adverse effects.

Conclusions: Chronic wounds with suspected biofilm have the potential to heal if treatment is multifactorial. The combination of techniques used in this series was acceptable to patients and shows promise as an effective treatment, as it may have assisted the healing process. Further trials are needed to determine the efficacy.

Preventing wounds is a fundamental goal for all wound professionals and is enshrined within the Australian national wound management standards. The paper presents an overview of the recent evidence in the prevention of venous leg ulcers, pressure injuries, diabetes-related foot ulcers and skin tears. Recent literature searches identified a paucity of high-quality evidence for most wound prevention interventions. The paper presents evidence available to support current best practice. Despite the lack of strong scientific evidence, fundamental care interventions, including promoting healthy skin integrity and off-loading pressure, continue to be mainstay in preventing wounds of all aetiology.

Background: Perioperative pressure injury (PI) remains problematic. Five key pressure injury prevention (PIP) strategies were identified according to literature. However, little is known about current perioperative PIP practice in compliance to international guidelines.

Methods: This study describes perioperative health care practitioners’ implementation of five key PIP strategies in compliance with international PIP guidelines in a tertiary hospital. This was achieved via observation of the implementation of PIP strategies using a structured data collection tool and skin inspection on postoperative day 2.

Results: Seventy-three patients undergoing surgical procedures were recruited. Of these, 36 were identified as at-risk of developing PI based on the Waterlow risk assessment. The number of PIP strategies implemented across the sample ranged from 27 to 49 strategies; and increased according to risk, with high-risk patients receiving more PIP strategies than those patients at moderate-risk, although this finding was statistically non-significant. However, there were significant correlations between the number of PIP strategies used and length of surgery and number of medical devices and/or equipment used, with 4 Stage 1 PIs observed postoperative day 2 on patients’ ears, resulting from oxygen tubing.

Conclusions: These clinical and statistically significant results may inform the development of education regarding improvement of perioperative PIP practice.

Venous leg ulcers (VLU) are a complication of chronic venous insufficiency (CVI). As well as completing a comprehensive wound assessment, practitioners strive to find a dressing that is cost-effective, increases wound healing rates and optimises a patient’s holistic care. This case study depicts a multidisciplinary team approach between a nurse practitioner wound consultant and a plastic reconstructive surgeon, to avoid surgical debridement in a patient with multiple co-morbidities: arterial fibrillation (AF), type 2 diabetes, osteoporosis, anticoagulation therapy and osteoarthritis. The case demonstrated the importance of a thorough wound assessment, as well as a collaborative approach to investigations, incorporating an innovative perspective. This, in turn, allowed the patient, Mrs B, to avoid ceasing anticoagulant therapy, have limited adverse effects in relation to opioids, and therefore remain independent throughout her atypical diagnosis to continue to healing.

In Australia, it is estimated that $2.85 billion is spent annually on wound care. As well as putting a significant strain on the health care system, these wounds decrease patient quality of life, and factors, such as immobility and isolation, can lead to depression. The real impact of these wounds is often masked by co-morbidities such as diabetes and cardiovascular disease. Current treatments available are not a ‘fix all’ solution, and many chronic wounds persist for months, even years, with a major limb amputation required every 30 seconds, amounting to 2500 amputations a day. Understanding how and why these wounds form, and why some heal, and others persist for years is necessary to improve the lives of these patients. Here we discuss, firstly, how co-morbidities alter the wound healing process at a cellular level to promote wound chronicity in patients and how therapies have developed from this information. Then we discuss the impact on the chronicity of wounds that factors, such as wound infection, the patient’s own social context and the health professional may have.