Pretibial injuries manifest as lacerations or haematomas. Despite differences in pathogenesis and treatment, these entities have been mixed together in previous classifications. No classification for pretibial haematomas exists, and the Modified Dunkin Classification includes a Type V category that conflates lacerations with haematomas. To present the Sinuhe Classification-a comprehensive system categorising pretibial lacerations and haematomas with evidence-based treatment recommendations-and propose the umbrella term 'dermatoporotic wounds' to encompass the full spectrum of cutaneous injuries arising from chronic skin fragility. A narrative literature review of PubMed, MEDLINE and EMBASE was conducted. Treatment recommendations and clinical findings were synthesised from the available literature, including a doctoral thesis on pretibial injuries. The Sinuhe Classification categorises pretibial lacerations into linear lacerations; flap lacerations (vital, i.e., with adequate perfusion and non-vital, i.e., with flap necrosis); and total skin loss. Pretibial haematomas are classified into open (ruptured), closed and necrotic haematomas. Each subtype is paired with specific treatment guidance. The classification eliminates the Modified Dunkin Type V category and provides a classification framework for pretibial haematomas. The Sinuhe Classification offers a unified yet distinct framework for diagnosing and treating pretibial injuries. Adoption into clinical practice and medical education is recommended.

Chronic non-healing wounds, including diabetic ulcers, venous leg ulcers, and pressure ulcers, represent a significant clinical burden worldwide, associated with major economic costs and impaired quality of life. Although stem cell-based therapies have shown regenerative potential, recent accumulating evidence indicates that their therapeutic effects are primarily mediated by paracrine signaling rather than direct cell engraftment. Stem cell-derived secretome, which consists of soluble bioactive factors and extracellular vesicles, has gained attention as a promising cell-free strategy for wound healing. The secretome modulates inflammation, promotes angiogenesis, supports extracellular matrix remodeling, stabilizes redox homeostasis, and enhances cell survival, proliferation, and migration, thereby creating a pro-regenerative wound microenvironment. Secretome composition is very dynamic and influenced by the stem cell source, donor characteristics, and cell culture conditions, which impacts therapeutic efficacy. Compared with live cell therapies, secretome-based approaches offer improved safety, scalability, and storage potential while avoiding risks associated with cell transplantation. This review provides an overview of the biological processes involved in wound healing, discusses the main stem cell sources used in wound healing, and summarizes current knowledge on stem cell-derived secretome and its mechanisms of action. In addition, emerging delivery strategies, therapeutic advantages, and current challenges associated with secretome-based therapies are discussed, emphasizing their potential in wound regeneration.

Venous leg ulcers (VLUs) are a chronic and often debilitating condition, affecting a significant number of individuals worldwide. One of the most distressing aspects of VLUs is the persistent pain they can cause, which impacts quality of life, mobility and overall wellbeing. Despite advances in wound care, VLU-related pain remains under-recognised and poorly managed. Pain in VLUs is complex and typically includes nociceptive pain from tissue damage, neuropathic pain due to nerve involvement, and probable central sensitisation. Each type requires targeted treatment, yet clinical awareness and tailored strategies are often lacking. This article explores the multifaceted nature of VLU pain and highlights the importance of a multidisciplinary approach. It reviews the evidence on pain mechanisms, patient experiences, and effective management strategies, both pharmacological and non-pharmacological. By enhancing understanding and applying best practices, health professionals can effectively address VLU-related pain, leading to improved outcomes and better quality of life for patients.

Compression therapy is the evidence-based treatment for healing venous leg ulcers. However, it is not routinely applied in many UK hospitals. This paper explores hospital staff's' perspectives of venous leg ulcer care provision where compression therapy is not routinely applied. A semi-structured interview study was conducted with 11 participants, drawn from a larger study, who confirmed that their respective hospitals did not apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Findings indicate that venous leg ulcer care in hospitals was de-prioritised, which, along with structural and organisational constraints, affected clinicians' engagement and focus on it in their hospitals. This de-prioritisation also led to a lack of formal leg ulcer training in hospitals. However, some clinicians showed remarkable empathy for patients derived from their clinical professionalism and deep understanding of their suffering. To help hospital clinicians and senior managers prioritise venous leg ulcer care, it is crucial to first understand their clinical practise priorities. Secondly, understanding how some hospitals implement compression therapy could be beneficial for those where it is not routine practise. Further research should focus on better understanding clinicians and senior managers' clinical priorities and the structural and organisational constraints in real-world settings, ideally in hospitals where compression therapy is a routine practise. Most importantly, the study highlighted key questions for hospital leaders and policymakers: consider fostering the established clinicians' empathy before it is too late.

Pyomyositis is a serious bacterial infection of the skeletal muscles, usually treated with antibiotics and surgical drainage. The success of medical or surgical treatment is often delayed or less effective when tissue hypoxia is present. Hyperbaric oxygen therapy (HBOT) is currently being studied as a helpful additional treatment for various conditions, especially those involving complications of tissue hypoxia. In this case report, we describe a 29-year-old male who developed chronic pyomyositis and a right lower leg ulcer after failure of multiple surgeries, including fasciotomy, debridements, skin grafts and antibiotics to treat compartment syndrome and tuberculosis of the right knee. HBOT was administered for 80 sessions at 243 kPa (2.4 atmospheres absolute) for 90 minutes. The patient showed significant clinical improvement, as evidenced by the development of healthy granulation tissue, reduction in swelling and discharge, and better mobility. This case highlights the potential of HBOT as an additional treatment option for complex soft tissue infections such as pyomyositis caused by tuberculosis, especially in cases where traditional treatments have been ineffective.

Scalp follicular unit (FU) transplantation is a highly effective yet underutilised minimally invasive technique for promoting healing in chronic and recalcitrant cutaneous wounds. In this case series, five patients with long-standing nonhealing leg ulcers of mixed etiologies were treated exclusively with single FU grafts harvested from the scalp with a 0.9-1-mm punch. Complete re-epithelialization occurred in three cases by 6, 3 and 1 month, respectively, while the remaining two cases showed marked partial improvement at 6 months, with reduction in ulcer area and pain. Overall, all five patients experienced a favourable clinical outcome. Case reports suggest that the transplantation of a minimum of 4 FU grafts/cm[2] is required to promote effective wound closure, with higher graft densities being associated with faster healing. However, the optimal graft density and placement, whether uniform distribution or targeting the wound edge to exploit an 'edge effect', require further investigation. Considered alongside prior reports, these results suggest that 1-mm single-FU grafting achieves wound healing comparable to, and often faster than, 2-3-mm punch grafts. Additionally, the technique is less invasive and causes less bleeding, overall supporting wider use as an adjunct in multidisciplinary wound care. Level of Evidence: IV.

This case series describes six patients with large, highly exuding lower-limb ulcers of varying aetiologies, including venous disease, lymphoedema and atypical ulceration. Across all cases, use of extra-large superabsorbent dressings within a comprehensive management approach was associated with improved exudate control, reduced dressing frequency and decreased pain. These changes were accompanied by reductions in wound size, infection burden and malodour, alongside improvements in patient quality of life and, in some cases, return to daily activities or work. The findings suggest that optimised exudate management using large superabsorbent dressings may enhance clinical and service outcomes in complex wound care.

Accurate chronic wound classification is essential for appropriate management, yet diagnostic variability persists in routine practice. Transparent, rule-based decision-support tools may improve standardisation but require validation against expert judgement under clearly defined conditions. To evaluate inter-expert agreement, agreement between a rule-based algorithm and an expert-consensus reference standard, diagnostic accuracy as a complementary measure, exploratory comparison with a non-expert nurse, and expert agreement with algorithm-generated therapeutic recommendations. Thirty anonymised standardised clinical cases were classified by the algorithm and one non-expert nurse. Thirty wound-care experts, including 26 nurses, three physicians, and one researcher, were organised into six independent panels of five and classified case subsets, yielding 150 ratings. A consensus reference diagnosis was defined a priori as agreement by at least 3/5 experts. The primary outcome was algorithm-consensus agreement using Cohen's κ. Expert reliability was assessed using Krippendorff's α and Fleiss' κ. Recommendation agreement was dichotomised and analysed exploratorily. Expert agreement was low to moderate (Krippendorff's α = 0.26-0.60), highest for pressure ulcers/injuries and venous leg ulcers, and lowest for mixed or unknown leg ulcers and diabetic foot ulcers. Consensus was reached in 29 of 30 cases. The algorithm achieved 86.2% accuracy (25/29) and substantial agreement (κ = 0.70, 95% CI 0.46-0.94). Nurse accuracy was 72.4% (21/29, p = 0.219). Experts endorsed 85.2% of therapeutic recommendations. The algorithm showed promising agreement under controlled conditions, supporting further prospective validation in larger, balanced real-world datasets.

Dear Editor, Pancreatic panniculitis (PP) is a rare form of lobular panniculitis associated with pancreatic disorders, including acute and chronic pancreatitis and pancreatic neoplasms. It develops in a small percentage of patients with pancreatic disease and may represent the first manifestation of an occult malignancy. Clinically, PP usually presents with painful erythematous-to-violaceous nodules on the lower extremities, which may ulcerate and discharge oily brown material secondary to liquefactive fat necrosis induced by circulating pancreatic enzymes. Because of its rarity and heterogeneous presentation, diagnosis is frequently delayed or initially misdirected toward more common inflammatory or vascular conditions. [...].