Daniel A. Rabin

Chronic wounds account for a considerable burden on the overall US healthcare system, affecting an estimated 10.2 million people and costing as much as $148 billion dollars in 2022 alone. Elderly patients suffer disproportionately, as nearly 85% of the chronic wound population is over the age of 65 years old. Despite the burden chronic wounds place on elderly patients and the overall healthcare system, the full mechanism of wound healing changes as one ages has not been fully elucidated. The major deficits in wound healing in the elderly are a function of both skin structural changes and alterations in wound healing kinetics resulting from molecular shifts in gene profiles. Elderly individuals exhibit reduced skin integrity, characterized by a disorganized epidermis, thinned dermis and subcutaneous fat, and a less stable basement membrane, impairing protection from external insults. Simultaneously, wound healing is disrupted across all four stages, as low‐level persistent inflammation from increased fibroblast senescence delays the onset of the proliferative phase and limits overall healing capacity. We hope that this review can bridge the knowledge gap in this field and ultimately lead to future discoveries in aiding the prevention of aging skin and the improvement in wound healing outcomes.

Medical malpractice imposes a substantial clinical and economic burden worldwide. Pressure injuries (PIs) are amongst the most frequently litigated adverse events and represent a major source of preventable patient harm. To characterise the medicolegal landscape of PI‐related malpractice, the Westlaw legal database was queried for cases litigated between 1990 and 2024. A total of 590 cases met inclusion criteria, with data extracted from court documents. The mean patient age was 71 years; 53.4% were female and 46.6% male. Nursing homes were the most commonly named defendants (59.8%), followed by hospitals and outpatient surgical practices (37.3%) and individual physicians (14.1%). The mean settlement was $383 099, compared with a mean jury award of $2 100 787. Adverse legal outcomes were strongly associated with allegations of inadequate care, poor clinical outcomes and gross provider negligence. When prevention and timely management fail, the consequences extend beyond patient harm to substantial legal and financial liability. Targeted interventions such as standardised risk assessment, rigorous documentation, staff education, appropriate staffing ratios and institutional accountability may mitigate both PI incidence and litigation risk. Strengthening these measures represents a critical opportunity to improve patient safety whilst reducing medicolegal exposure.

Chronic wounds, including diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure injuries, remain a major global health burden and contribute substantially to Medicare spending. Because traditional wound dressings fail to address the dynamic microenvironment of chronic wounds, bioactive materials that modulate inflammation and support tissue regeneration are needed. In this study, we evaluated the tissue response to our borate-based bioactive glass fiber matrix (BBGFM) designed to overcome limitations of existing fibrous wound dressings. Two Sus scrofa domesticus underwent creation of twelve 5 × 5 cm subcutaneous pockets each, which were treated with BBGFM at three thicknesses (25%, 50%, and 100%) or left untreated as controls. One animal was euthanized at three weeks and the other at six weeks for gross and histopathological evaluation of all wound sites. BBGFM-treated pockets demonstrated a dose-dependent increase in inflammation at three weeks that diminished by six weeks. Enhanced neovascularization and collagen matrix deposition were also seen at both time points. Collagen maturity increased across all groups by six weeks, and residual BBGFM correlated with initial implant thickness. These findings indicate that BBGFM promotes a controlled inflammatory response and supports neovascularization and matrix remodeling in a dose-dependent manner, suggesting its potential as an effective bioactive wound matrix.