PICO single use negative pressure wound therapy (sNPWT) is increasinsingly being used in high-risk wounds across many surgical specialities. Their use in orthopaedic arthroplasty surgery is associated with practical challenges limiting mobilisation including tube disconnection and pullouts. We present a description of a novel modification to the PICO sNPWT application using a Granuflex dressing to secure the pump to the patient. Our early patient experience showed 100% (24/24) patients reporting no issues with wound healing and 91.7% (22/24) reporting the dressing and pump staying on for the prescribed amount of time without detachment. This modification allows the dressing to be more conducive to early mobilisation without hindering use of walking aids and crutches. There is a role for the modification to be adopted by other surgical specialties.

The aim of this study was to evaluate the cost-effectiveness of treating patients with Venous Leg Ulcers (VLUs) with the Muscle Pump Activation device (MPA, geko) in Canada. This is a cost-effectiveness analysis of the treatment of patients with VLUs, using MPA for 4 weeks in addition to standard of care compression therapy (SOC), compared to SOC alone using Canadian costs of VLU treatment. The authors determined the Canadian costs for each visit for a patient with a VLU to have their dressings performed at a nursing clinic. The total costs of treatment were determined based on healing rates from a randomized controlled trial from Wales that demonstrated a significant improvement in the healing of VLUs when MPA was used for 4 weeks in addition to SOC, compared to SOC alone. The cost per visit to a nursing clinic for the treatment of a VLU was estimated to be $109.71 CAD and dressing frequency was estimated to be an average of every 2.5 days. Using projected healing rates over a 12-month period based on the UK paper, the model indicated that treatment with MPA resulted in a cost savings of $983.61 CAD per patient. The average increase in ulcer free days was 56.6 days per patient. The Incremental Cost Effectiveness Ratio (ICER) identified a saving of $17.38 per ulcer free day. This model based on Canadian costs resulted in faster healing of VLUs and a reduced average Direct Wound Care Cost of $983.61 per patient for the whole of their ulcer treatment when the MPA is used for 4 weeks in addition to SOC. This treatment has the potential for patient benefit as well as significant cost savings for the Canadian Health Care system.

Delayed wound healing is a major complication of diabetes, with its core pathological process being pathological fibrosis driven by persistent inflammation, metabolic disorders and vascular dysfunction under hyperglycemia. This process involves pathological retention of inflammatory cells, abnormal expression of pro-fibrotic factors, and excessive deposition of extracellular matrix. As a traditional Chinese medicine, leech possesses multiple pharmacological effects including anticoagulation, anti-inflammation and improvement of microcirculation, exerting its therapeutic roles through regulating coagulation, modulating inflammatory responses, and enhancing vascular microcirculation. Simultaneously, leech can reduce epithelial-mesenchymal transition and extracellular matrix deposition by synergistically inhibiting multiple key signalling pathways associated with fibrosis. Future research should focus on elucidating the bioactive components of leech and their synergistic regulatory networks across multiple signalling pathways, providing a theoretical reference for developing leech-based anti-fibrotic drugs.

There are many circumstances where individuals with limited mobility are exposed to prolonged postures increasing the risk of pressure ulcers. Technologies have been developed to monitor posture, mobility and pressure exposure; however, their effectiveness in different clinical settings is unknown. The aim of this scoping review was to assess clinical studies using continuous pressure monitoring for the prevention and/or treatment of pressure ulcers. A scoping review of the literature was conducted using the PRISMA-ScR framework. Clinical-based studies were included which used continuous pressure monitoring for assessment and treatment over a minimum of a 2-h period. The outcomes included quantitative measures such as pressure distribution and mobility data, qualitative insights relating to patient comfort and acceptability, and the perceptions of healthcare staff regarding usability and clinical integration of the technology. Twenty-four studies were identified and included in the scoping review, conducted across eight countries spanning three continents. Most studies were undertaken in a hospital setting (67%, n = 16). Following review of the included papers, five core themes were identified: clinical outcomes, pressure metrics, posture and mobility, nurse feedback and patient experience. There was high heterogeneity in study design, outcome measures and different risk of bias limited the scope to synthesise the outcomes. Collectively, the studies indicate that CPM can enhance awareness of interface pressures, support clinical decision-making and inform repositioning strategies for individuals at risk of tissue damage. Reported benefits include greater staff confidence and patient engagement. However, consistent reductions in ulcer incidence have yet to be demonstrated, with larger trials with standardised outcomes required.

This study aimed to identify the prognostic markers for Diabetic Foot Ulcer (DFU) healing using routinely collected clinical data. A prospective cohort study of 1075 (M/F: 664/411) patients who attended the foot clinic with a DFU was conducted. At baseline, detailed clinical data were collected and ulcer characteristics were systematically assessed and classified. During 167 ± 408 days follow-up, ulcers of 1039 patients healed and 36 did not. Ulcers with SINBAD classifications 4, 5 and 6 (compared to SINBAD-3) showed 50%, 60% and 70% increase in the risk of not healing and 2.2, 2.8 and 3.3 folds increase in healing duration respectively. Also, deeper ulcer and having previous ulcer history showed 68% and 47% increase in the risk of ulcer not healing and 57% and 20% increase in healing duration respectively. Each day delay in presentation increased the risk of ulcer not healing by 0.5%. The duration of healing was 2.4 times longer for bigger ulcers (> 1 cm2) and 24% longer in patients with peripheral arterial disease. SINBAD score was the strongest predictor of ulcer healing. Among SINBAD constitutive components, ulcer depth (deep-vs-shallow) was the strongest predictor of risk of ulcer not healing, while ulcer size (bigger-vs-smaller than 1 cm2) was the strongest predictor of ulcer healing duration.

Hard-to-heal wounds place a major burden on patients and the Canadian health system, underscoring the need to strengthen workforce capacity in skin health and wound management. This mixed-methods program evaluation examined two education programs implemented in Ontario home and community care: one for regulated interprofessional providers and one for personal care providers. Quantitative data were collected through pre-, mid- and post-program surveys, and qualitative data through open-ended survey responses and focus groups. Between 2022 and 2025, 164 regulated providers and 203 personal care providers graduated. Across both programs, participants reported increased confidence in prevention, assessment, treatment, communication, teamwork and application of best practices. Importantly, confidence was interpreted as a proxy indicator for readiness to change practice rather than a stand-alone endpoint. Survey and focus group findings indicated that participants applied learning in practice through earlier identification of skin concerns, more effective escalation and communication with interprofessional colleagues, increased use of best practices and greater attention to prevention. Confidence gains ranged from 30% to over 50% in the regulated-provider program and 20% to 45% in the personal care provider program. Qualitative findings reinforced the impact of increased confidence in practice and included improved prevention focus, communication and changes in practice. Thus, these programs, by increasing confidence and self-reported changes in practice, enhanced learners' capacity to deliver quality skin health and wound care. Practice capacity was operationalised in this study as a multidimensional construct that includes role-appropriate knowledge, confidence, readiness to apply evidence-informed practices, communication and escalation behaviours and participation. These programs offer a scalable model to enhance wound care capacity and support health-system sustainability in Canada. Economic outcomes, while not formally measured in this work, should be examined in future studies, as the findings reflect a promising approach to cutting the cost curve in skin health and wound care.

Quantitative assessment of the pressure injury size (S) and pocket (P, undermining) is essential for evaluating wound healing. Conventional LabelMe annotations often lead to oversegmentation, whereas object detection with You Only Look Once (YOLO) enables accurate wound localization. Here, we developed a hybrid AI model that combines LabelMe segmentation with YOLO gating. This single-centre retrospective study compared two models: LabelMe-Seeded Auto-Recognition (LSAR) and YOLO-gated LSAR (YGL). Model performance was evaluated by concordance rate and weighted Cohen's κ for DESIGN-R staging and by mean absolute error (MAE) and median (interquartile range) for area error. Overall, 1017 wound images (training: 979; testing: 38) were analysed. For S, the YGL model achieved higher concordance (85.7%, κ = 0.969) and smaller area errors than did the LSAR. For P, the YGL model demonstrated higher concordance and smaller area errors than did the LSAR model. The YOLO-LabelMe hybrid model improved the stage concordance and size accuracy compared with LabelMe alone. Despite the residual outliers in P assessment, this approach represents a promising step towards automated, clinically adaptable wound measurements.

The efficacy of cryosurgery for skin cancers is believed to depend on thaw time, which may be influenced by the presence of adrenaline in local anaesthetics due to its vasoconstrictive effects. This is the first study to perform detailed, non-invasive temperature measurements using infrared (IR) thermography during cryosurgery for basal cell carcinomas (BCCs), evaluating the impact of adrenaline on thaw time. A total of 15 patients with eyelid BCCs underwent cryosurgery with local anaesthetics both with and without adrenaline. Thawing was continuously monitored using a high-resolution IR camera and compared with the surgeon's visual assessment. No significant difference in thaw time was observed between anaesthetics with and without adrenaline. Thermographic mapping revealed a triphasic thawing curve. The surgeon's visual assessment of thawing corresponded well with the point at which tissue temperatures rose above 0°C, likely indicating the onset of reperfusion, thus providing a clinical margin beyond the actual phase transition. This is the first study to use IR thermography to monitor cryosurgery of BCCs, demonstrating that adrenaline in local anaesthetics does not affect thaw time. The findings suggest that deeper tissue perfusion during BCC treatment may counteract superficial vasoconstriction, supporting the effective use of cryosurgery regardless of adrenaline use.

Inpatient care for venous leg ulcers is often inconsistent, with delays in vascular assessment and compression therapy contributing to prolonged healing and fragmented treatment. This evaluation examined a front-door Tissue Viability Nurse-led service providing specialist assessment at hospital admission. A descriptive service improvement evaluation was conducted. From 2022, patients in the Assessment Ward admitted with leg wounds received Tissue Viability assessment within one working day, including Doppler-based vascular evaluation, wound bed preparation, peri-wound skin optimisation and early initiation of compression therapy. Compression bandaging became a core clinical skill for registered nurses, supported by a rationalised product formulary. This observational evaluation and qualitative review suggested that early specialist involvement supported the timely initiation of compression therapy, reduced variation in inpatient wound care and minimised duplicate referrals through clear Tissue Viability-led care plans. Staff confidence in applying compression was perceived to improve, collaboration with vascular, dermatology and community services strengthened and patients informally reported clearer information and greater continuity of care, supporting a timelier approach to care delivery. Positioning Tissue Viability expertise at the Assessment Ward appeared to support improvements in the consistency and safety of care processes in leg ulcer management. This front-door specialist model, rarely described in acute care literature, enhanced timeliness and coordination and provides a scalable approach to addressing international gaps in acute wound care pathways.

Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in the management of patients with hard-to-heal wounds. To assess this outcome accurately, valid wound-specific patient-reported outcome measures are required. The Wound-QoL was originally developed as a 17-item questionnaire, and a revised 14-item version, consisting of 14 of the original 17 items, was later introduced to improve clarity and reduce respondent burden. Because changes in item composition may affect psychometric properties, the revised version requires separate evaluation. Therefore, this study aimed to assess the psychometric properties of the Swedish Wound-QoL-14 using data from the Swedish validation study of the Wound-QoL-17. This secondary analysis included data from 88 patients with hard-to-heal wounds recruited from an outpatient wound clinic. Responses from the original instrument were recalculated to reflect the Wound-QoL-14 structure. Internal consistency was assessed using Cronbach's alpha, test-retest reliability using intraclass correlation coefficients, criterion validity by comparison with EQ-5D-3L, responsiveness using standardized response mean, and ceiling and floor effects were examined. The Wound-QoL-14 demonstrated good to excellent internal consistency and test-retest reliability. Criterion validity showed moderate correlations with EQ-5D-3L, responsiveness was moderate for Body and Psyche and smaller for Everyday Life and the global score, and no ceiling or floor effects were observed. The Swedish Wound-QoL-14 is a reliable, valid, and practical instrument for assessing HRQoL in patients with hard-to-heal wounds in clinical practice and research.

Despite strong evidence that nutrition is critical for wound healing, its integration into outpatient practice remains inconsistent. This study aimed to explore how nutrition is perceived, communicated, and experienced in outpatient wound care-encompassing healthcare professionals' clinical practice and professional reasoning, and patients' lived experiences. This multicentre qualitative study using Interpretive Description generated data through 156 h of field observations, five focus groups with nurses (n = 19), and interviews with patients with foot ulcers (n = 9) across six outpatient clinics in Denmark. Nutrition was acknowledged as fundamental to wound healing, yet communication remained brief, non-specific, and rarely actionable. Nurses adopted pragmatic, patient-adapted approaches shaped by unclear role responsibility, time constraints, and limited tools, resulting in opportunistic rather than systematic care. Patients had limited understanding of nutrition's role in wound healing, reflecting insufficient explanation rather than disengagement. Relational continuity and communication quality were determinants of whether nutrition became a meaningful component of care. Patients were willing to engage when advice was concrete and tailored to their everyday context. A persistent gap exists between the acknowledged importance of nutrition and its enactment in outpatient wound care, sustained by organisational, communicative, and role-related ambiguities, with implications for nursing education, interdisciplinary roles, and clinical pathways.

Impaired microcirculation contributes to delayed healing in venous, arterial, diabetic and mixed-aetiology ulcers. Activation of the leg muscle pump by intermittent neuromuscular electrostimulation of the common peroneal nerve has been proposed to improve microvascular perfusion. This review examines current evidence for neuromuscular electrostimulation effecting changes in microvascular flux in chronic lower-limb ulcers of all aetiologies, as measured by Laser Speckle Contrast Imaging. Eligible studies were limited to human research evaluating the effects on chronic lower-limb ulcers of any aetiology. Four eligible studies (total n = 44) were identified. In venous ulcers, neuromuscular electrostimulation increased wound bed flux by 28.5% (p < 0.05), and pulsatility by 126% (p < 0.05). In arterial leg ulcers, flux increased by 60.9% (p < 0.02) and pulsatility by 161% (p < 0.02). In mixed aetiology ulcers, wound bed flux increased by 38.2% (p < 0.05) and pulsatility by 214% (p < 0.05). In diabetic foot ulcers, flux increased by 40.2% (p < 0.01) and pulsatility by 406% (p < 0.01). Across all ulcer types combined, wound-bed flux increased by 37.6% (p < 0.001) and pulsatility by 198% (p < 0.001). There is compelling evidence that intermittent neuromuscular stimulation of the common peroneal nerve enhances microcirculatory perfusion in the wound bed of chronic leg and foot ulcers. These consistent physiological improvements support its potential as an adjunctive therapy.

This scoping review examined the literature on the roles of healthcare professionals involved in multidisciplinary team (MDT) management of pressure injuries (PIs), as well as the barriers and facilitators influencing team-based care. Pressure injuries represent a significant global disease burden with physical and psychological impacts on individuals, requiring coordinated management from multiple disciplines. Understanding MDT composition, roles, and care delivery is essential to optimise patient outcomes and team performance across the care continuum. Eligible English-language papers on multidisciplinary PI care in hospital and community settings were identified through searching CINAHL, Cochrane, Embase, MEDLINE, and Scopus. After duplicates were removed, the remaining articles were independently screened by two reviewers, with discrepancies resolved by consensus. Data from 41 eligible papers were extracted and analysed thematically. MDT roles spanned wound care, rehabilitation, education, nutritional support, and care coordination, with substantial interdisciplinary overlap. Key facilitators included dedicated leadership, regular meetings, shared documentation, and ongoing training, while barriers encompassed unclear role definitions, inconsistent guidelines, poor hospital-to-community integration, and patient complexity. Critical gaps remained in psychosocial support, telehealth, and care for diverse populations. Multidisciplinary teams must be adaptable, holistic, and guided by patient experiences to optimise both healing and long-term prevention.