Background Medical adhesive-related skin injuries (MARSI) are a relatively new category of skin trauma recognised to occur in postoperative settings. Protecting against MARSI is important since they may impact negatively on patient outcomes and significantly add to the cost of treatment. Despite this, evidence to guide best practice in postoperative wound care dressings is limited. In this study we therefore aim to quantify clinicians’ perceptions of the frequency and severity of postoperative MARSI.

Method Australian clinicians with experience of working with postoperative wounds in the past 12 months completed an anonymous online questionnaire.

Results Over a quarter (27%) of patients with postoperative wounds were estimated to have experienced a MARSI over the past 12 months. Complications were least likely to be associated with silicone adhesives and were most frequently associated with polyurethanes and acrylates. The most frequent complication observed was pain.

Conclusion Whilst it is reassuring that complications are less likely to be associated with silicone, a commonly used dressing adhesive, it is of concern that two other frequently used adhesives – acrylates and polyurethanes – have the highest association of complications. Shifting to using more silicone adhesives could reduce the economic burden of postoperative complications and improve patient outcomes by reducing MARSI-associated pain.

What is already known on this topic

Complications from the effective management of surgical wounds may arise from the dressing itself, particularly the adhesive used to keep the dressing on the skin, although the exact nature and extent of these is still to be investigated. Whilst our understanding of MARSI is emerging, the evidence to preference the use of one wound dressing over another is limited. Given the potential human and economic costs of postoperative complications, it is important that the nature of surgical site healing complications related to different dressing types continues to be investigated.

What this manuscript contributes

This paper reports the observations of Australian clinicians – predominantly nurses – involved in postoperative wound care. Importantly, our findings provide estimates of:

• The extent of MARSI for postoperative wounds in Australia.
• The most common types of MARSI seen in postoperative wound care.
• The type of complication associated with different adhesives.

The purpose of this paper is to provide an overview of the formation of slough on the wound bed. The impact slough has on wound healing will also be explored. There are several wound cleansing products which can be used for the safe removal of slough, and several different methods of debridement – including autolytic, conservative sharp, surgical, ultrasonic, hydrosurgical and mechanical – as well as several therapies which can be used, including osmotic, biological, enzymatic dressings and monofilament fibre pads. These various methods will be described.

Background Although varied interventions are used to prevent venous leg ulcers (VLUs), compression therapy remains the gold standard for VLU prevention and treatment^1–3. However, non-compliance remains an issue. What is it then that makes it difficult for patients to comply? Subsequently, this review paper aims to explain the reasons and contributing factors that attribute to patients’ non-compliance to compression therapy with a view of finding strategies that can increase adherence.

Method A literature search was undertaken using the terms ‘compression therapy’, ‘compliance’ and ‘venous leg ulcers’. Articles that reported reasons for non-compliance or adherence to compression therapy were included. Seventeen articles met the inclusion criteria. The reasons for non-compliance were tabulated and subjected to thematic analysis.

Results Five determinant themes regarding patients’ reasons for non-compliance with compression therapy emerged – pain and discomfort, psychosocial issues, knowledge deficit, physical limitations, and financial issues.

Discussion Compliance with compression is the key to achieving wound healing in patients with VLUs but compliance rate remains low. Consequently, effort needs to be made by healthcare professionals (HCPs) to improve compliance and therapeutic relationships through holistic patient assessment that addresses their experiences and values their individualism, health beliefs, lifestyle and social networks^4,5. Further studies to identify intervention strategies that can increase their compliance are required.

What is known on this topic?

• Evidence-based guidelines for the prevention and management of VLUs recommend compression therapy as the gold standard treatment strategy for VLUs.
• Uptake and compliance with compression therapy promotes VLU healing and can prevent recurrence when compared to no compression.
• Many patients cannot tolerate or comply to compression therapy.

What this paper adds

• Being non-judgemental and supportive allows HCPs to monitor patients’ beliefs and health behaviours about compression therapy, and this also assists them in planning individualised intervention strategies that can increase compliance rates.

Chronic wounds are a serious medical problem both in the hospital and community setting. The healing of chronic wounds is often compromised by colonisation of different bacterial pathogens leading to life-threatening infections. Bacterial infections are a critical contributing factor to chronic wounds and can lead to biofilm formation and inhibition of innate inflammatory responses, including the reduction of acute inflammation.

Concerningly, the overuse of systemic antibiotics and the use of traditional therapeutics, including topical antimicrobials – iodine, chlorhexidine and silver – have both greatly contributed to the development of a global increase in antimicrobial resistance. This has therefore led to a renewed interest in natural and alternative antimicrobial treatment strategies in wound care for the treatment of infected wounds.

This review summarises the pre-clinical and clinical evidence that exists for the use of natural remedies, namely essential and animal oils, as adjunctive therapeutic approaches for the treatment of infected wounds. It also discusses novel approaches in nanotechnology that are being used for the development of natural remedies aimed at improving the healing of infected chronic wounds.

Background Skin and wound care programmes in residential aged care (RAC) facilities are essential to prevent and manage wounds in this complex population.

Method A 6-month pilot research study was conducted in two hospital-level RAC facilities using a mixed method and a continuous quality improvement methodology. The first part of this study aimed to determine professional knowledge about, and reporting of, skin tear and pressure ulcers/injuries (PIs) within this setting – both by nurses and by healthcare assistants (HCA) – in order to determine educational need in this area of practice. Focus groups were held for both nurses and HCAs, and responses to questions asked in the sessions were analysed. In addition, both of these groups completed knowledge questionnaires in order to determine further educational requirements. This was followed up by a programme of education, including educational resources. Nurse and HCA ‘champions’ were also recruited to aid programme implementation. Finally, in order to evaluate the effectiveness of the programme, a post-programme reassessment of knowledge using the same focus group questions and knowledge questionnaires was implemented. The number of facility-reported skin tears and PIs were also recorded periodically over 16 months, from 6 months before the start of the programme to 4 months afterwards.

Results Retrospective and post-programme PI numbers in both facilities were low. During pre-programme knowledge testing, PI numbers increased in one facility, which may be attributed to an increase in reporting. In both facilities, skin tear numbers declined, and this was maintained 3 months post-programme; this was attributed to the implementation of a skin care regime. The champion role, developed throughout the programme, was also seen as aiding both staff leadership and programme ownership.

Conclusion The establishment of an evidence-based skin and wound programme determined from staff-identified practice issues and associated learning needs can improve professionals’ knowledge and practice, and can improve resident care. The two programmes were comparable in both facilities and therefore may be transferable to other RAC facilities.