Background Venous leg ulcers (VLU) are chronic wounds that cause significant socioeconomic burdens on individuals and healthcare systems, yet data on this in the Singapore setting is sparse. Thus, this study aimed to describe the frequency of outpatient and inpatient visits for patients with VLU and the costs of compression therapy.

Method A retrospective review of patients at Singapore General Hospital (SGH) diagnosed with VLU between 2016 and 2018 (primary and secondary) was conducted.

Results A total of 4214 unique patients’ data were extracted; 238 patients (5.6%) received compression therapy. A patient on compression therapy in Singapore was estimated to spend a median of S$451.20 (US$333.26) for VLU. Patients on compression therapy had more visits to the outpatient clinics (Mean=3.26, SD=2.92) than patients who were not (M=1.57, SD=1.16). At outpatient clinics, patients on compression therapy spent more – M=S$309.88 (US$228.88), SD=S$379.90 (US$280.60) – than patients who were not –M=S$173.31 (US$128.01), SD=S$230.88 (US$170.53).

Conclusion Compression therapy was received by minimal patients. As it is only offered at outpatient clinics, patients on compression therapy were found to spend more than their counterparts.

Aims/hypothesis To identify hospital admissions and length of stay (LOS) and to investigate readmissions, cumulative LOS and associated factors for diabetes-related foot ulceration (DFU).

Methods Routinely-collected hospital admission data were used to identify DFU-related hospital admissions in two public hospitals between 2012–17. Readmission and cumulative LOS were investigated using negative binomial regression.

Results DFU-related admission was required by 749 patients. Median LOS was 8–10 days (stable across 2012–17). Readmission within 28 days was required by 62 patients (8%) and was significantly more likely with increasing comorbidities (incidence rate ratio [IRR] 1.38, 95% confidence intervals [95% CI] 1.02–1.88). Readmission within 1 year was required by 206 patients (28%), and was significantly more likely for males, unplanned admissions and increasing revascularisation requirements (IRR 1.34–1.70), and significantly less likely for those requiring minor and major amputation (IRR 0.33–0.64). The median cumulative LOS was 13 days (IQR 7–29), and was significantly longer for males, older age, unplanned admissions, those requiring dialysis, and those with increasing revascularisation requirements, comorbidities and mental health or behavioural disorders (IRR 1.02–2.30), and significantly shorter for those with more podiatry attendance (IRR 0.96, 95% CI 0.95–0.97).

Conclusions/interpretation Results provide an important benchmark for DFU outcomes. Predictors for patients at risk of readmission and prolonged cumulative LOS were identified which may be used to guide intervention.

Aim This study was conducted as a randomised controlled study to determine the effect of tea tree oil on acute wound healing.

Methods Rats were divided randomly into two groups, non‑diabetic and ‘diabetic’; rats in the diabetic group were made diabetic by intraperitoneal streptozotocin induction at 50 mg/kg. Each group was then subdivided into sunflower oil, tea tree oil and saline (0.9% NaCl) groups. After incisional wound formation, rats were wound-dressed according to their treatment group every day for 15 days. On day 3, 7 and 15 following the wound formation, 0.5cmx0.5cm full thickness tissue samples were taken and examined histopathologically.

Results On day 3, the epithelisation and inflammatory cell density of the non‑diabetic tea tree oil group was found to be statistically significantly higher than the diabetic saline group. There was a statistical difference in favour of the non‑diabetic tea tree oil group in terms of procollagen and mature collagen density. In addition, the non‑diabetic tea tree oil group had a statistically higher angiogenesis amount than the diabetic and non‑diabetic saline and the diabetic sunflower oil groups on day 15 (p<0.05).

Conclusions It has been determined that tea tree oil has an accelerating effect on wound healing and is an alternative method that can be used in wound dressing.

Epidermal grafting (EG) using a novel epidermal harvesting system (the CELLUTOME^TM System) offers an alternative method to classic surgical approaches of assisted wound closure. Use of this device requires minimal training, leaves a nominal donor site injury, and may be employed in non-operating theatre environments, lending to consideration for use in a high-risk vascular surgical cohort.

This single centre series observed the application of EG to lower limb wounds in vascular surgical patients with aetiological barriers to wound healing, including peripheral arterial disease (PAD), venous insufficiency and diabetic neuro-ischaemia. Complete wound healing was established as the primary outcome measure, with time to 100% epithelialisation as a secondary outcome measure.

Ten consecutive patients underwent EG via the CELLUTOME^TM Epidermal Harvesting System for treatment of wounds related to a variety of vascular surgical aetiologies. Complete wound healing was observed in seven out of ten patients, significant wound surface area reduction was seen in one patient, with the remaining two patients failing to respond, requiring further surgery to facilitate wound healing. These results suggest that EG via the CELLUTOME^TM System offers a viable option for assisted wound closure of wounded vascular surgical patients in whom avoidance of general anaesthesia may be desirable.

Aims Negative pressure wound therapy (NPWT) was introduced to assist closure in hard-to-heal wounds. The benefits of NPWT include enhanced exudate management, increased blood flow to the skin, reduced interstitial oedema, stimulation of granulation tissue formation, and reduction of pro-inflammatory cytokines. NPWT has been successfully used on wounds of various aetiologies, largely in hospital settings. The aim of this case series is to explore the use of a NPWT system with a unique Hydrofiber^® wound contact layer in community settings.

Methods We present three case studies where the Avelle^TM NPWT System has been used to treat hard-to-heal wounds in primary care settings.

Results Complete healing was achieved in three wounds that were complex, ‘hard-to-heal’ wounds

Conclusions This NPWT system provides a feasible, effective and well-tolerated solution for the management of complex wounds in the community Clinicians reported that the Hydrofiber^® wound contact layer facilitated autolytic wound debridement, was conformable to a variety of wound locations (including wounds prone to contamination due to incontinence), and provided appropriate exudate management even in limbs subject to dependent oedema.

Background Wound care forms a significant component of nurses’ roles across acute, long-term, community and primary healthcare settings. This scoping review aimed to examine and analyse key concepts and factors that inform nurses’ decision-making and the use of evidence-based practice (EBP) in wound management.

Methods A literature scoping review was undertaken, searching original research articles from academic databases and grey literature. Papers were screened for relevant topics and inclusion criteria included wounds, decision-making and nursing. The quality of evidence was evaluated using a validated quality assessment tool. Thematic analysis was used to analyse results through dominant and meaningful themes.

Results A total of 14 relevant peer-reviewed articles were identified. Five decision-making contributors were identified: patient factors – patient factors, education and information, expert opinion, peer guidance, and economics and logistics. These results identify evidence gaps to inform future research opportunities on nurses’ decision-making in wound management.

Conclusion The review identified factors nurses use in decision-making in wound care. Recommendations include the need for high-quality research on the area, the uptake of standardised wound assessment, improved pathways for collaboration with experts in the field, and increased training for nurses on evidence appraisal to address economic burden and optimising patient outcomes.

Background Chronic leg ulcers affect 1–3% of the population and are costly to treat and health service resource intensive. Venous aetiology contributes to about 70% of all chronic leg ulcers; these ulcers are often associated with prolonged ill health, pain and decreased physical functioning, and have a substantial impact on health-related quality of life.

Aim The primary aim of this systematic review is to identify literature on the risk factors for delayed healing or non-healing of venous leg ulcers (VLUs) in adults.

Methods This systematic review will be guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Studies will be identified from PubMed, ScienceDirect, Web of Science, ProQuest, CINAHL Complete, MEDLINE, APA PsychINFO, Academic Search Elite, Cochrane Library, JBI EPD (evidence-based practice database), ProQuest (Dissertations and Theses Global) and Global ETD (electronic theses and dissertations) Search Engine up to August 2021. Methodological quality will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018. A narrative synthesis of risk factors will be categorised as physiological (general/medical), clinical, demographics or psychosocial.