Introduction Tracheostomies are a common adjunct to therapy for critically ill patients in the intensive care unit (ICU). This study sought to identify the incidence of, and demographic, clinical and care process factors related to, tracheostomy-related skin injuries (TRSI) in ICU patients.

Methods Conducted in a 36-bed ICU of an Australian metropolitan tertiary referral acute care health facility, this study employed a retrospective review of patient records between February 2015 and December 2016 for patients who had a tracheostomy inserted during an ICU admission. Records were reviewed for the patient’s admission or a 20-day observation period, whichever was shorter.

Results Of the 102 patients included, 66 were male (64.7%) and their mean age was 50 years (SD=18.3). Of these patients, 23 (22.5%) developed a TRSI. No association was found between patient characteristics, tracheostomy insertion method and the development of a TRSI; however, the use of non-adjustable flange tubes was associated with the development of TRSI (p=0.023). Omissions in nursing documentation of care processes for tracheostomies were observed.

Conclusion This study addressed a specific medical device, the tracheostomy tube, providing evidence of TRSI occurrence in the ICU setting. Although no common demographic, clinical nor care process factors were associated with TRSI development, findings from this study highlight a deficiency in nursing documentation.

Malnutrition is known to contribute to wound development and impair wound healing through reduction in the availability of nutrients to maintain optimal cell maintenance and repair.

This review examines studies from the last decade identified via a search of PubMed^TM and systematic review databases to identify evidence for the effectiveness of nutritional interventions in wound healing. Studies reported identified via the search included 61 primary studies and six systematic reviews.

Generally, single nutrient interventions were found to be less effective than interventions utilising multiple nutrients. Immune modulating supplements containing arginine (Arg) were shown in 13 studies to result in significant improvements in at least one outcome measure for the intervention groups. There was also support for the use of arginine combined with anti-oxidant nutrients in malnourished individuals with pressure injuries (PI), and this intervention was found to be cost effective. The administration of glutamine (Gin) via the enteral nutrition (EN) route appears to convey a beneficial effect, particularly in burns and trauma patients, compared to parenteral nutrition (PN) administration. Omega-3 fatty acids were found to improve healing of diabetic foot ulcers. Encouraging further large-scale, multi-centre, prospective nutritional intervention research in areas of evidence deficiency is recommended.

Objective Our aim was to characterise the chronic wound response to autologous adipose-derived stem cells (ADSCs) sheet transplantation.

Methods A pilot descriptive, longitudinal study was performed at the Wound Healing Center of the Vietnam National Burns Hospital from 1 July 2019 to 30 August 2020. Thirty patients with 38 chronic wounds were enrolled in the study and autologous ADSCs sheets were grafted on the wound beds. Wound edges, wound bed, wound size and structure were assessed using histology with ultrastructural changes visualised by transmission electron microscopy. Wounds were assessed at time of transplantation and at the first, second and third week of follow-up.

Results After ADSCs sheet transplantation, improved extracellular matrix (ECM) with neo-vascular structures was observed, and collagen fibres arranged side by side in the dermal layer. Fibroblast proliferation was observed with increased secretion of collagen. Keratinocytes were also observed proliferating and migrating into the epidermis layer. Neo-vascular cells, fibroblast proliferation and collagen production increased weekly however lymphocytes infiltration decreased. Wound size reduced significantly compared to before treatment commenced and wound beds appeared cleaner and filled with granulation tissue. Re-epithelialisation appeared at the wound edge and throughout the wound. Conclusion: ADSCs  may have a beneficial effect on cutaneous regeneration and chronic wound healing. 

Skin grafting is an intervention used for the closure of many types of wounds and involves removing the epidermis and/or the dermis for transplantation to a prepared wound bed. Patients requiring skin grafts often need anaesthesia and hospitalisation, and complications such as pain, infection and graft failure can result. This review will discuss the use of epidermal grafting (EG) as a skin grafting option, and present population groups that may benefit from its use. 

The development of the CELLUTOME^TM (KCI) epidermal harvesting system makes EG simpler and faster than traditional EG harvesting methods, allowing the procedure to be performed in an outpatient setting without anaesthetic. A discussion of the use of the epidermal device for two outpatient procedures will be presented, highlighting the importance of care of the graft to reduce the risk of failure. Both procedures resulted in a loss of the graft due to inexperience in EG wound management. A review of the evidence surrounding the effectiveness of EG is also discussed in this article; however, there remains limited quality evidence available for this novel approach to wound healing.