Samantha Holloway

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Background: Pain is among the most problematic aspects of chronic wounds. It adversely affects not only physical function but also social and psychological aspects of life. In concert, these effects can seriously impinge on quality of life. Despite affecting up to 80% of patients with leg ulcers, pain is reported to be under-treated. Methods: A secondary, within-subject controlled study design comparing wound pain intensity using a visual analogue scale of venous leg ulcer patients over 4 weeks receiving different interventions. In total, 29 patients received multi-layer compression over 4 weeks, followed by neuromuscular stimulation (NMES) of the leg muscle pump in addition to compression for a further 4 weeks. Paired comparison was then made of the pain gradient (rate of change in pain) between the two phases. A second cohort of 22 patients received only multi-layer compression throughout both 4-week phases. The trial was reported following the CONSORT guidelines. Results: Introduction of NMES at week 4 was accompanied by a significant increase in the rate of pain reduction over the following 4 weeks. Patients receiving standard care for the second 4-week phase experienced no change in the pain trajectory. Conclusions: 1 Hz NMES of the common peroneal nerve to activate the leg muscle pump is accompanied by an improved pain trajectory in patients with chronic venous leg ulcers. This mirrors the improvement in the rate of reduction in wound size previously reported in the same cohort. Pain is a common feature of chronic wounds and mitigation of pain is likely to have a profound impact on the quality of life of individuals with chronic venous leg ulcers.

: OBJECTIVE: Numerous studies have examined the epidemiology of skin tears; however, inconsistent definitions, classification systems, and data collection methods have highlighted the need for a validated and standardized tool. The primary objective of this study was to validate a data collection tool for skin tears. A secondary aim was to provide a freely accessible tool for health care providers or researchers to collect consistent and reliable data on skin tears. METHODS: The development of the tool was guided by the 2018 International Skin Tear Advisory Panel (ISTAP) Best Practice Recommendations for the prevention, assessment, and management of skin tears in aged skin. Between June and October 2024, a multimethod validation process was undertaken. Content validity ratio and content validity index calculations were used to quantify content validity, supported by qualitative feedback from 15 experts to assess face validity and provide suggestions for refinement. RESULTS: The final tool consists of 22 questions addressing a patient’s demographics, clinical features of the skin tear, associated risk factors, and contextual data. The content validity index was calculated at 0.72, indicating an acceptable level of content validity. International experts reached consensus following a 2-round qualitative review, resulting in subsequent adjustments to the tool. CONCLUSIONS: The ISTAP DC-Tool was developed based on evidence-informed recommendations and validated by an international panel of experts. Its implementation will support health care providers and researchers in gathering standardized epidemiological data contributing to clinical practice improvements, quality initiatives, and further research in skin tear prevention and management.

Surgical site infection is a post‐operative complication, which has a significant clinical impact on the affected individual as well as the healthcare system. They are associated with poor outcomes such as increased length of hospital stay, morbidity, mortality and readmissions. As a result, surgical site infections are used as an indicator of the quality of surgical care and for benchmarking. The aim of the review is to gain insight on the current prevalence/incidence and surveillance of surgical site infection in South Africa. The objective was to determine the surgical site infection rate associated with Maxillo‐facial and Oral Surgery procedures. A literature review was conducted with the search strategy limited to articles published in English with no limitation to the period. Fifteen articles were deemed eligible for the review according to the inclusion criteria. Eleven articles focused on the epidemiology of surgical site infection in South Africa. The surgical site infection rate varies from 0.65‐48% with heterogeneity in the characteristics of the surveillance programmes. The review showed variability in the SSI rates with similar variability in the incidence of surgical site infection as reported on sub‐Saharan and African countries (7.93, 9.3, 19.1, 14.5% respectively). The above information was gleaned from institutional point/period prevalence or incidences due to a lack of an integrated national surveillance programme. Thus, there is an urgent necessity to establish an integrated national surveillance programme to facilitate monitoring as well as prevention of surgical site infection in South Africa.

The clinical outcomes and financial impact of surgical site infection within South Africa is not well known due to the lack of an established national surveillance programme. The aim of this project was to undertake a baseline clinical audit of surgical site infection prevention in a Maxillo‐facial and Oral Surgery unit using the National Institute for Health and Care Excellence clinical guideline (NG125) as the benchmark standard. The primary objective was to establish a baseline incidence of surgical site infection. This was a prospective and observational clinical audit undertaken at the MFOS unit in a University Hospital in South Africa. Thirty‐seven participants who had surgical procedures were recruited and monitored telephonically post‐discharge for a period of 30 days. The composite compliance rate to the process indicators was 39.86% (95% Confidence Interval 37.25–42.46). The incidence rate of surgical site infection was 14.81% (n = 8). The resection of head and neck malignancy contributed majority of the SSI cases (50%, n = 4). Five organ/space SSI cases were detected with a mortality rate of 25% (n = 2). The higher surgical site infection rates may be associated with the lapses in the infection control practices. For example, the lack of an aseptic technique lack or structured approach to wound management. The main recommendation was the development of evidence‐based surgical site infection preventative strategies that are applicable to the Maxillo‐facial and Oral Surgery procedures to reduce surgical site infection.

Skin tears are acute wounds caused by mechanical forces resulting in the separation of the skin’s outer layers. Skin tears are more likely to occur in vulnerable people such as older people and people with neurodegenerative conditions. Rising life expectancy means that the number of patients with skin tears is expected to increase. This article describes the characteristics of skin tears, details the risk factors for skin tears and explains the importance of using a holistic, evidence-based and person-centred approach to skin tear prevention, assessment and treatment. The article outlines the crucial role of nurses as part of the multidisciplinary team in the management of skin tears.

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well‐being. Compression therapy is traditionally the “gold‐standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub‐bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold‐standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.