Surgical site infection rates in Sub-Saharan African tertiary hospitals remain high. As primary frontline caregivers, nurses' and midwives' theoretical knowledge and bedside practice directly govern clinical outcomes. However, empirical data evaluating baseline competence and its determinants in Wachemo University Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital remain limited. To evaluate knowledge, attitudes, self-reported practices, and associated determinants regarding wound care among nurses and midwives at Wachemo University Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital. An institutional cross-sectional study was conducted from January 15 to 30, 2026. Systematic random sampling selected 188 participants from a source population of 337 registered nurses and midwives. Data were collected via a validated questionnaire adapted from national guidelines and analysed using SPSS v25. Multivariable logistic regression computed Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Spearman correlation (ρ) and Chi-square tests evaluated domain relationships. Among 178 respondents (94.7% response rate), 33.7% demonstrated good theoretical knowledge (> 6.0), 49.4% held an excellent attitude (> 4.0), and 42.1% reported exemplary practice (> 4.0). Multivariable regression revealed formal in-service training as the sole independent predictor of good knowledge (AOR = 6.12, 95% CI: [2.45, 15.28], p < 0.001). Independent predictors of exemplary practice were clinical experience > 5 years (AOR = 2.68, 95% CI: [1.39, 5.17], p = 0.003) and good knowledge (AOR = 2.14, 95% CI: [1.08, 4.24], p = 0.029). Knowledge and practice scores showed a significant positive correlation (ρ = 0.398, p < 0.001). Although nurses maintain favourable attitudes, theoretical knowledge regarding evidence-based wound care remains suboptimal. This gap is driven primarily by a lack of post-service training rather than basic academic qualifications. Structured continuous professional development programs are urgently required.

This study aims to evaluate nursing staff knowledge of the pressure injury (PI) staging system, assess their accuracy in classifying PIs using a photo-based assessment and explore factors associated with performance outcomes in tertiary hospitals in Saudi Arabia. A cross-sectional design was used. The target population was registered nurses (RNs) who had direct contact with admitted patients with PIs during the previous 2 years in three tertiary hospitals in Saudi Arabia. A total of 330 RNs participated in this study. Data were collected through an online survey using the Pressure Ulcer Prevention Knowledge Test related to PI stages, which included 21 items, and a photo-based PI staging test that included 18 photographs. The survey took approximately 10-15 min to complete. The data were statistically analysed using descriptive and correlational statistics. Among 572 eligible RNs, 330 completed the online survey and were included in the analysis. The findings indicated that the average RN knowledge score was 62.54%, suggesting insufficient knowledge of the PI staging system. This finding was consistent with the average accuracy of 62.04% in classifying the PI photographs according to the staging system. Moreover, no significant associations were observed between RNs' knowledge of the PI staging system or their ability to accurately stage PIs and their sex, age, work experience or education level. Significant gaps were identified in nurses' knowledge and accuracy in staging PIs despite relatively high educational attainment and workshop attendance. Given the importance of accurate PI staging in standardized assessment, communication, documentation, monitoring and healthcare resource allocation, these findings highlight the need for strategies to support and improve the delivery of quality patient care. Targeted competency-based training and emerging technologies, including artificial intelligence-driven image analysis, may help improve staging accuracy. Further research is needed to evaluate the clinical feasibility and impact of these approaches.

To determine whether heel-free compression bandaging is non-inferior to heel-wrapped bandaging for maintaining interface pressure in adults with venous leg ulcers. Randomised, controlled, parallel-group, non-inferiority trial. Adults with open venous leg ulcers (CEAP C6) treated at a French university hospital were randomised to heel-free or heel-wrapped (control) bandaging for 4-6 weeks. The primary outcome was interface pressure 48 h after the final bandage application, analysed in the per-protocol population. Secondary outcomes were ankle oedema, change in interface pressure and patient preference. Of 102 randomised patients, 85 were included in the per-protocol analysis. At V3, mean interface pressure was 30.1 mmHg in the heel-free group and 28.4 mmHg in the control group (difference, 1.7 mmHg; 95% CI, -1.3 to 4.6), meeting the non-inferiority criterion. After adjustment for baseline circumference and sex, ankle circumference was 1.7 cm lower in the heel-free group (95% CI, -3.35 to 0.04). Among 48 patients who had experienced both techniques, 23 (47.9%) preferred heel-free bandaging. Heel-free bandaging was non-inferior to heel-wrapped bandaging for interface pressure at 48 h. The technique may be considered when compatible with ulcer location and patient preference; effects on healing and adherence require further study. Trial Registration: NCT04046120.

To evaluate clinical outcomes of autologous follicular unit and scalp-derived grafting techniques in the treatment of chronic cutaneous wounds. A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE and Embase were searched through February 2026. Studies evaluating follicular unit grafts, split-thickness scalp grafts or hair follicle-derived biologic preparations for chronic wounds were included. The primary endpoint was the proportion of wounds achieving complete re-epithelialization during study follow-up. Secondary outcomes included overall closure rates, time to closure, wound area reduction and adverse events. Sixteen studies comprising 239 patients were included. Follicular unit grafts demonstrated high overall closure rates (84% across 80 wounds). Split-thickness scalp grafts achieved 100% complete healing across 54 wounds, with rapid healing times (24-35 days). Biologic follicular preparations showed variable efficacy, with closure rates ranging from 30% to 100% across 70 wounds. Comparative studies consistently demonstrated superior wound healing with hair follicle-containing grafts relative to inter-wound or between-patient controls. Adverse events were limited and mild. Hair follicle-based grafting may be a potential solution for chronic nonhealing wounds, particularly in recalcitrant wounds. However, heterogeneity in study design and outcome reporting highlights the need for standardized, high-quality trials.

Chronic venous diseases (CVD), including venous leg ulcers (VLU), represent a significant health burden. Despite the central role of compression therapy in current treatment guidelines, recent evidence suggests substantial gaps in provision. A retrospective cohort study was conducted using anonymized claims data from 3.35 million insured individuals. Persons with VLU or CVD in 2017 were observed over 5 years. Compression therapy, comorbidities, antibiotic prescriptions, and physician contacts were analysed. The prevalence was 0.50% for VLU (n = 16 615) and 7.27% for CVD (n = 243 681). Across 5 years, 75.85% (VLU) and 53.10% (CVD) received compression therapy. However, 24.15% of persons with VLU were not treated with compression therapy. Persons receiving compression were predominantly female and older (VLU: 74.13 years, 59.56% women; CVD: 68.55 years, 70.86% women), exhibited a higher mean Charlson Comorbidity Index (CCI [95% CI]: VLU 4.09 [4.03-4.15], CVD 2.67 [2.65-2.68] vs. VLU 3.14 [3.05-3.23], CVD 2.12 [2.11-2.14] without compression). In the first year post-diagnosis, 51.43% VLU persons with compression received antibacterials (vs. 36.28%). The data confirm prior estimates of disease prevalence and highlight a substantial gap in the documented use of guideline-compliant compression therapy, especially in VLU. High multimorbidity and care intensity underscore the need for better integration of compression therapy in routine practice.

The Wound-QoL-14 questionnaire has proven to be a valid instrument for assessing patients with chronic wounds. However, cutoff scores are not established, and the smallest detectable change and the minimal important difference have not been defined. We aimed to assess the interpretability, smallest detectable change and the minimal important difference of the Wound-QoL-14 questionnaire in a Spanish population with chronic wounds. At baseline, patients responded to a 5-Likert global anchor question about how much their wounds had been a problem, and bands of severity were calculated. At a re-test phase they responded to a 7-Likert anchor question about the severity of the change in wound status, and smallest detectable change and minimal important difference were calculated using a combination of anchor-based and distribution-based methods. At baseline, stratification of 323 patients according to simplified bands of severity (0-0.25/0.26-1.00/1.01-2.00/2.01-3.00/3.01-4) showed a moderate correlation with the global anchor question (polychoric correlation = 0.653), but the level of agreement (41.5%) was poor (Krippendorff's alfa coefficient = 0.609). For 197 re-test patients, the Wound-QoL-14 individual smallest detectable change was lower than the weighted minimal important difference (0.39 vs. 0.53 points, respectively). These findings support the interpretability of the Spanish version of the Wound-QoL-14 questionnaire for clinical and research use.

The Australian Diabetes Foot Registry (ADFR) is a national prospective, longitudinal clinical quality registry established in 2020 to standardise data capture and reporting in Interdisciplinary Diabetes High Risk Foot Services. We describe the ADFR's methodology and early implementation outcomes. Stakeholder consultation informed development of the minimum dataset, governance framework and data-capture workflow. Centrally supported ethics and jurisdictional approvals facilitated site onboarding. Clinical, management and outcome data were collected, de-identified and amalgamated in a national repository. Implementation outcomes included recruitment metrics, case ascertainment, mandatory-field missing data, reporting cycles, conference presentations and inaugural report feedback. Seventy-four sites expressed interest and 49 sites completed implementation. Median time from application to commencement was 7 (IQR 4-12) months under a nationally recognised ethics approval. By mid-2025, 10 919 participants were registered, comprising 13 150 care episodes and 22 383 ulcerations. In 2024-2025, mean service-level case ascertainment was 80%, and the mandatory-field missing data rate was 0%-7%. Four annual reporting cycles have been completed, all services strongly endorsed participation after the inaugural report, and data informed 29 conference presentations. The ADFR demonstrates a feasible, scalable national registry model, enabling timely audit and benchmarking and actionable reporting to support quality improvement, research and collaboration.

Hyperbaric oxygen therapy (HBOT) is an adjunctive treatment for selected chronic wounds with microcirculatory impairment, but treatment response is typically assessed clinically after several weeks. This case series evaluated the feasibility and potential utility of laser speckle contrast imaging (LSCI) for monitoring cutaneous perfusion during HBOT. Six patients with chronic wounds refractory to conventional management underwent HBOT. Cutaneous perfusion was assessed using LSCI before and after HBOT sessions at three predefined regions of interest: referent healthy skin, wound margin and wound bed. Perfusion was quantified in laser speckle perfusion units (LSPUs). Baseline perfusion differed significantly among anatomical regions (Friedman test, p < 0.001). Median perfusion was highest at the wound margin (109 [70-172] LSPU), compared with the wound bed (58 [32-92] LSPU; p = 0.001) and referent healthy skin (45 [36-61] LSPU; p < 0.001). Across monitored HBOT sessions, perfusion increased significantly after treatment in referent skin (+11 [-2 to +18] LSPU; p = 0.022), at the wound margin (+30 [-2 to +64] LSPU; p = 0.005) and in the wound bed (+10 [+1 to +32] LSPU; p = 0.010). Pre-HBOT wound-bed perfusion tended to decrease over the treatment course in most patients, although substantial inter-individual variability was observed. This case series demonstrates the feasibility of repeated, non-invasive LSCI assessment to characterize spatial and acute changes in cutaneous microcirculatory perfusion during HBOT. LSCI appears feasible for monitoring cutaneous perfusion during HBOT. Prospective studies with standardized assessment time points are needed to determine whether LSCI-derived perfusion trajectories or thresholds are associated with wound-healing outcomes and can inform HBOT decision-making.

Incisional negative pressure wound therapy has expanded from a niche adjunct to a widely adopted strategy for the prevention and management of wound complications in selected surgical settings. However, available systems differ in pressure profile, fluid handling, dressing interface, and suitability for fragile skin or anatomically challenging incisions, while practical guidance for device selection remains limited. Whether iNPWT should be used selectively is an established question; which system characteristics are relevant once its use has been judged appropriate is not. We conducted a structured narrative review of the literature on incisional negative pressure wound therapy published between January 2013 and September 2026, based on a targeted PubMed/MEDLINE search. Clinical studies addressing primarily closed surgical incisions were reviewed across elective, emergency, and reconstructive settings; conventional negative pressure wound therapy for open wounds was considered only in order to define the boundary between the two indications. Device technical characteristics were extracted separately from manufacturers' instructions for use and clinician guidelines. Evidence was synthesised in relation to clinical indication, incision and patient characteristics, device features, reported outcomes, and treatment-related adverse events. On this basis, a clinical-requirement-first decision framework for bedside device selection was developed, with each component labelled as direct clinical evidence, indirect clinical evidence, documented technical characteristic, or expert clinical consideration. The available evidence supports a selective rather than routine use of incisional negative pressure wound therapy. The greatest clinical value appears in high-risk incisions and in settings where oedema, superficial fluid accumulation, or limited soft-tissue protection are likely to contribute to wound morbidity. Reported benefits vary according to procedure type, baseline risk, endpoint definition, and device configuration. Published studies evaluate complete proprietary systems rather than isolated technical variables. The only randomised comparison between two commercial systems identified was small and found no difference between them. Adverse events remain relevant and may limit treatment in fragile skin or when drainage exceeds the fluid-handling capacity declared for the selected dressing. Incisional negative pressure wound therapy should be considered an adjunct to standard preventive measures, not a universal solution. A structured approach integrating anticipated fluid-handling requirements, perilesional skin tolerance, seal feasibility over the relevant anatomy, and intended therapy duration may support more rational and transparent device selection once iNPWT has been judged appropriate. Current evidence does not establish a hierarchy among commercially available incisional systems, and the framework should be regarded as structured decision support rather than as a validated algorithm.

Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis closely associated with immune dysregulation and characterized by painful, treatment-resistant ulcers. Currently, no standardized therapeutic protocol exists; however, topical and systemic immune-modulating therapies have shown positive results. In this article, we evaluate the use of polylactic acid (PLA) matrices as a treatment option, given their immunomodulatory properties and beneficial effects on complex wounds. This case series presents six patients (ages 38-72, five female and one male) with chronic, non-healing ulcers that persisted for 6 months to 3 years previous to the treatment described. PLA matrices were used as the primary wound treatment, requiring a mean of 5.3 applications for healing. Wound closure was achieved in all cases within a mean time of 13.4 weeks with successful outcomes in both scar quality and appearance. PLA matrices may represent a promising local treatment option for PG ulcers; however, these preliminary findings require confirmation in larger, controlled studies.

Haemodialysis patients face a markedly elevated risk of foot lesions because of coexisting diabetes mellitus (DM), peripheral arterial disease (PAD) and uremia-related impairment of wound healing. Structured outpatient strategies and the optimal place of basic fibroblast growth factor (bFGF) within a stepwise algorithm remain poorly defined. To report complete healing and its durability in haemodialysis patients treated with bFGF for foot lesions, and to propose a stepwise limb-salvage algorithm with prespecified escalation criteria in which bFGF precedes dehydrated human amnion/chorion membrane (dHACM) or surgery. Retrospective observational case series of 20 haemodialysis patients receiving bFGF (trafermin; Fiblast Spray) for foot lesions across three outpatient wound-care programmes. Wound status was documented by area, depth, tissue exposure and WIfI classification; perfusion was assessed in every patient by toe-brachial and ankle-brachial indices, duplex ultrasonography and angiography, independently of any pre-existing recorded diagnosis. Complete healing was defined a priori as 100% re-epithelialization confirmed on two consecutive visits at least 2 weeks apart. Tier entry criteria and escalation triggers were prespecified, using a wound-area reduction below 50% at 4 weeks as the principal threshold. The broader haemodialysis population (n = 212) served as contextual comparator. Mean age was 75.0 ± 7.3 years (range, 59-92); there were six men and 14 women. DM was present in 15 patients (75.0%) and registry-recorded PAD in 8 (40.0%), against 56.6% and 17.9% in the broader population; objective testing identified hemodynamically significant PAD in 12 patients (60.0%), all of whom were revascularized. Mean baseline wound area was 5.5 ± 3.4 cm (2), and WIfI stages 1-4 comprised 5, 8, 6 and 1 patients. Twelve patients (60.0%) were managed with bFGF alone, five (25.0%) required dHACM and three (15.0%) required surgery. Complete healing was achieved in 18 of 20 patients (90.0%) at a mean of 8.9 ± 4.4 weeks, with no amputation of any level. Over a median follow-up of 13.0 months (range, 6-28), recurrence at the same site occurred in two patients (10.0%); amputation-free survival at 12 months was 100% and overall survival 95%. The bFGF-treated cohort carried a disproportionate burden of DM and PAD, supporting targeted early biologic intervention in this highest-risk subgroup. Within a stepwise algorithm combining objective perfusion assessment with prespecified escalation criteria, 90% of wounds healed completely without amputation, providing a practical limb-salvage framework for this vulnerable population.

Diabetic foot ulcers (DFUs) are a devastating complication of diabetes that markedly affects quality of life and generates significant socioeconomic and healthcare burdens. When DFUs fail to respond to standard of care (SOC), advanced therapies including Cellular, Acellular and Matrix-like Products (CAMPs) are often employed. A novel composite CAMP comprising ovine forestomach matrix and high molecular weight hyaluronic acid, termed 'OFM-HA' has been developed for the treatment of chronic wounds and evaluated in a prospective multi-centre controlled trial. For this trial, 143 subjects were randomized to receive OFM-HA plus SOC or SOC alone for the treatment of chronic full thickness wounds of the foot in people with diabetes meeting prespecified eligibility criteria. The primary endpoint was the proportion of wounds healed by 12 weeks. Secondary endpoints included healing time, percentage area reduction, adverse events and changes in pain and quality of life. For the modified intent-to-treat population, 46% (31/68) of the OFM-HA plus SOC group healed by 12 weeks compared to 24% (17/72) in the SOC alone group (p = 0.008). Kaplan-Meier analysis favoured OFM-HA plus SOC over 12 weeks (log-rank p = 0.023). No unexpected safety-related occurrences were observed. OFM-HA plus SOC increased 12-week closure in this selected population. Interpretation is limited by post-randomization exclusions, differential withdrawal and an adjusted comparison close to the significance threshold (p = 0.045).

Placental-derived cellular, acellular, and matrix-like products (CAMPs) are widely used as adjuncts to standard care for diabetic foot ulcers (DFUs), but trials differ in product class, comparator, and healing window. We estimated the effect of adjunctive placental-derived CAMPs on complete wound closure at a single, clinically meaningful 12-week endpoint. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261399700) and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, with search reporting guided by PRISMA-S. PubMed/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 21 June 2026 for randomised or quasi-randomised trials comparing a placental, amniotic, chorionic, amnion-chorion, placental membrane, or umbilical cord-derived product plus standard care against standard care or a non-placental control in adults with active DFUs. The primary outcome was complete wound closure at 12 weeks. Risk ratios (RRs) were pooled in a random-effects model (inverse-variance, restricted maximum likelihood [REML], Hartung-Knapp). Risk of bias was assessed with the Cochrane Risk of Bias 2 tool (RoB 2) for the 12-week outcome and certainty with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Prespecified sensitivity analyses included odds ratios, leave-one-out, product-class subgroups, and exclusion of high-risk-of-bias studies. Of 474 records, 14 randomised articles were retained; 9 standard-care-controlled comparisons (944 participants) provided extractable 12-week complete-closure data for the primary analysis. Complete closure occurred in 298 of 505 product-treated participants (59.0%) versus 157 of 439 controls (35.8%). Adjunctive CAMPs increased the likelihood of closure (RR 1.70, 95% confidence interval [CI] 1.31-2.20). Heterogeneity was moderate (I[2] = 51.9%) and the prediction interval crossed the null (0.93-3.11). The effect was robust to leave-one-out analysis (RR 1.59-1.81), an odds-ratio model (odds ratio [OR] 3.36, 95% CI 1.68-6.71), and exclusion of the single high-risk-of-bias trial (RR 1.73, 95% CI 1.29-2.33). Certainty was moderate, downgraded once for inconsistency. Adjunctive placental-derived CAMPs improve 12-week complete closure of DFUs compared with standard care, with moderate certainty. The wide prediction interval indicates that the average benefit may not be reproduced by every product, population, or setting, underscoring the need for product-specific, standard-care-anchored trials and for coverage policy grounded in endpoint-specific randomised evidence. Trial Registration: Registration number: CRD420261399700.