Acute and chronic wounds constitute a considerable care challenge and a financial burden on the health system and wounded individuals, regardless of care setting. The explicit and implicit costs associated with chronic wounds can be monumental, as are the detrimental impacts on a person’s quality of life and wellbeing. A nurse practitioner (NP) coordinated Advanced Wound Assessment Service was established by Silver Chain in Perth, in March 2013. Ongoing successful client outcomes for those with previous non-healing wounds led to an expansion in this service with three clinics and the employment of four NPs. The criteria for referral to a NP is a non-healing or deteriorating wound or an atypical clinical presentation. The NPs work in collaboration with the client, community nursing teams, general practitioners, medical specialists and allied health professionals to develop and implement evidence-based management plans that improve healing outcomes, prevent complications and reduce hospital admissions. They undertake comprehensive assessments and, when clinically indicated, they utilise contact low-frequency ultrasound debridement (LFUD) for the removal of necrotic or infected tissue or biofilm. A three-year retrospective audit found significant reduction in healing times when NPs utilised LFUD in the management of chronic wounds.

Background: To describe the profile of aged care residents and to examine those variables that were associated with skin tears. 

Method: A representative sample of 200 elderly residents were recruited into this cross-sectional study, which was conducted between February and December 2014 from four aged care facilities in Western Australia. The resident’s history of skin tears over the preceding 12-months was compared with their demographics (age, gender, place of birth) and a broad range of clinical characteristics including: body mass index, comorbidities, medications, smoking history, falls, and personal skin characteristics (purpura, ecchymosis, bruising uneven pigmentation, pseudoscars). 

Results: A history of skin tears was documented for 101 (50.5%) residents during the preceding 12-months. Residents with a skin tear history were significantly older, more likely to have a skin tear on initial assessment, had a lower Braden Scale score and a lower Braden sub-score for mobility, were at higher risk of falling, had osteoporosis, used a corticosteroid inhaler, and displayed both skin purpura (≤ 20 mm.) and ecchymosis (≥ 20 mm.). 

Conclusions: Aged care residents are at substantial risk of skin tears. Identification of factors associated with skin tears aids better understanding of risk factors and enables more effective targeted preventive strategies.

Post-caesarean wound infections are difficult to manage, especially when they are caused by multiple antibiotic-resistant Staphylococcus aureus. An attempt was made to treat post-caesarean staphylococcal wound infections with topical application of citric acid. Twenty post-caesarean patients with wound infections caused by multiple antibiotic-resistant S. aureus were treated by application of 3% citric acid once daily. Wound dressing with citric acid ointment in 18 cases resulted in complete healing after 6 to 21 applications. Topical application of citric acid was found highly effective in the treatment of post-caesarean wound infections due to multiple antibiotic-resistant S. aureus.

The management of wounds has evolved over many years and with a greater understanding of the mechanisms of skin repair, a recent approach to treatment is to address the changes in tissue. Complex chronic wounds place a significant challenge on health professionals working with these patients, in accurately identifying the underlying cause of the wound and the tissue factors impacting on wound healing. Many different types of dressings are used with limited success; however, dressings do not address the imbalances in tissue. Once a clear diagnosis has been established, the approach is to try to address this underlying imbalance in the tissues. Calcineurin inhibitors were approved for topical use in 2000–2001 for the treatment of atopic dermatitis. Since that time, their use has expanded to treat a number of chronic wounds, including pyoderma gangrenosum, cutaneous lupus erythematosus and other uncommon chronic wounds, with some success. This approach, in contrast to dressings that only impact on the wound environment, addresses the need to restore tissue balance and thus encourage wound healing.

Complementary medicinal techniques have a wide history, but the recent focus of modern medicine has been on possible effect mechanisms. Chronic wounds are not only a problem to their patients, but also a burden on the healthcare system due to their extensive costs.

Among complementary therapies, maggot debridement therapy (MDT) is by far the most widely studied method in the field of wound prevention and management. MDT is a very effective treatment technique for chronic wounds and, in addition, is a cheap and easy-to-use method, with only minor, rare adverse effects. Many studies have attempted to clarify the actual effect mechanisms of MDT. MDT works in four ways: debridement, antimicrobial effects, wound healing, and biofilm degradation. These actions are mainly achieved by protein substances exhibiting very variable molecular masses and actions.

MDT has a certain positive effect on chronic wounds and is a strong candidate to maintain a bold presence in the multidisciplinary approach to chronic wound care. Its cost, application simplicity, minimal side effects, and easy-accessibility are major superiorities among other wound-care methods.