Wound chronicity in diabetic foot ulceration (DFU) presents a significant cost to the healthcare system and also increases the likelihood of infection and amputation. Factors such as dietary intake, smoking, vascular status and infection have been proposed as contributory factors for chronicity. However, there is limited quality evidence to demonstrate the contribution of these factors in delayed healing in DFU. The aims of this research protocol are therefore to assess factors contributing to healing outcomes and wound chronicity in people with DFU, and to measure dietary intake in patients with DFU in an Australian setting.

Background Traditionally, the treatment of exposed tendon has required vascularised tissue coverage, usually with complex surgical intervention. The introduction of negative pressure wound therapy (NPWT) has challenged this traditional reconstructive concept. Unfortunately, standard NPWT units are usually bulky, noisy and curtail the mobility and lifestyle of patients. The introduction of small, modern, lightweight, portable, single-use NPWT units have therefore revitalised the use of NPWT and provided a solution to the many problems encountered with the larger devices.

Case series This study highlights three cases of patients with complex lower limb wounds with tendon exposure who were successfully treated with single-use NPWT in an outpatient setting. The median time for complete wound granulation was 5–10 weeks. Minor sharp debridement of wounds was required to encourage granulation tissue formation and this was well tolerated in the outpatient setting.

Conclusion Portable NPWT units provide an alternative to surgical reconstruction in patients with lower limb wounds with exposed tendon. These devices can be utilised in a purely outpatient setting, thus avoid long-term hospitalisation. Older patients with high anaesthesia risk or who lack alternative reconstructive options due to vascular co-morbidities are the most appropriate candidates for this treatment option.

Purpose A chronic wound model provides an opportunity to understand fundamental mechanisms that could possibly provide leads for novel diagnostic molecules. An in vitro chronic wound model was created to evaluate the healing potential of stem cell (SC) secretome obtained from human umbilical cord-derived mesenchymal stem cells (hUCMSCs) and cord blood platelet lysate (CBPL).

Methods hUCMSCs were obtained from explant culture of umbilical cord. SC secretome was collected from cells at passage 2 after appropriate SC characterisation. Platelets were isolated from cord blood and exposed to a repeated freeze–thaw cycle to obtain CBPL. An in vitro chronic wound model was created using dimethyl sulfoxide (DMSO) and hypoxia in HEK293 cells through scratch in a cell monolayer. Wounds were exposed to SC secretome and CBPL and their wound closure efficacy was calculated as relative wound density (RWD%) at defined time points.

Results MSCs with typical spindle-shaped morphology were isolated from explant culture that sustained their stemness and morphology until up to passage 10. DMSO efficiently impeded the movement of cells into the wound area to generate a chronic wound model which was efficiently removed upon addition of SC secretome and CBPL.

Conclusion A transient in vitro chronic wound model was created successfully to determine the healing efficiency of SC secretome and CBPL.

Background Chronic venous leg ulcers (VLUs) are costly to the healthcare system and a burden to patients, significantly reducing quality of life. Nitric oxide (NO) is important to wound healing, with a small study demonstrating a NO donor, topical glyceryl trinitrate (GTN), was effective for VLU healing. The aim of this study is to examine the application of topical GTN in relation to VLU healing.

Methods A pilot double-blinded randomised controlled clinical trial will be undertaken. Participants in the control group (n=20) will receive a placebo ointment (ointment base) and participants in the treatment group (n=20) will receive a NO donor (base ointment with 2% GTN) weekly for 4 weeks. The inclusion criteria will be adults >18 years of age with a chronic VLU. Rate of healing will be determined by planimetry (ulcer tracing) using the Gillman equation.

Significance This clinical trial aims to provide proof of concept of a novel treatment, topical GTN, which may accelerate wound healing through improvements to vasodilation and antimicrobial properties at the wound bed.

What is already known

• Chronic VLUs are a burden to patients and the healthcare system.
• NO is important to wound healing.
• GTN is a NO donor.

What this study aims to contribute

• Pilot a double-blind clinical trial of topical GTN.
• Examine the effect of 2% topical GTN on wound healing in VLUs.

Skin tears are reported to be the most common wound found amongst elderly individuals, yet there is a lack of evidence and consensus on a definition for these age-related traumatic injuries. A consensus on definition is essential for benchmarking prevalence and incidence and informing clinical diagnosis, management and reporting. This paper examines the extent of similarity and heterogeneity between the published definitions of skin tears and the underpinning evidence for the same. Five criteria were used to evaluate and compare the published skin tear definitions – reference to skin pathology; cause of injury; effect of injury; site of injury; and reference to the population group being studied. As a result of the review and recent research findings, which explicitly demonstrate age-related changes to the structural and mechanical properties of skin and associated increased risk of skin tears, the authors present a new skin tear definition based on these findings. Skin tears are defined as trauma-induced partial or full thickness wounds which primarily occur on the extremities of older persons with age-related changes to the skin’s structural and mechanical support properties, and are commonly associated with elastosis and/or ecchymosis.