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Objective: To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology., Materials and Methods: This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment., Results: Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0 cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30 d) and 3.4% for SSO (2 reports after 30 d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88)., Conclusions: Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

General Purpose: To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

General Purpose: To present the 2021 update of the Wound Bed Preparation paradigm., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Skin tears (STs) are prevalent wounds found in aging populations and in particular among those living in long-term care (LTC) settings. They are often misunderstood as expected outcomes of aging and as a result are frequently underrecognized and undertreated. Although many factors have been associated with ST development, there is little evidence to corroborate their roles as ST risks., Objective: To examine the risk factors associated with ST development in the Ontario LTC population., Methods: A prospective study design was used to explore the risk factors associated with ST development. A total of 380 individuals 65 years or older from four LTC facilities in Ontario were examined for STs at the beginning of the study and at week 4 to determine if STs had occurred., Results: The study found an ST prevalence of 20.8% and an incidence of 18.9%. History of an ST at baseline (relative ratio [RR], 1.84; 95% confidence interval [CI], 1.25-2.70; P = .002); the presence of skin changes associated with aging, ecchymosis, and hematomas (RR, 1.60; 95% CI, 1.43-1.79; P < .001); chronic disease (RR, 1.17; 95% CI, 1.03-1.32; P = .018); requiring assistance with activities of daily living (RR, 1.13; 95% CI, 1.08-1.18; P < .001); and displaying aggressive behavior (RR, 1.06; 95% CI, 1.02-1.10; P = .001) were key risk factors associated with ST development., Conclusions: These results provide much needed Ontario data on the risk factors associated with ST development and can be used to support prevention programs mitigating ST risk., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian., Methods: In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound images were labeled type 1, 2, or 3 as described by the classification system. The resulting scores were compared with the ISTAP classification, and the reliability of agreement was calculated with Fleiss κ., Results: Complete data were obtained from 209 healthcare professionals. When the image classifications were compared with the original ISTAP indications, 72.5% of all classifications were correct. Data indicated a moderate level of agreement (Fleiss κ = 0.466, range = 0.41-0.60). Data analysis showed similar agreement levels between nurses (n = 197, Fleiss κ = 0.466) and nonnurses (n = 12, Fleiss κ = 0.46)., Conclusions: The study validates the Italian version of the ISTAP skin tear classification system. Further studies are necessary to confirm the system's usability in Italian research and clinical settings.

Background: Pressure injuries (PIs) represent a significant burden on the healthcare system and have a negative impact on the quality of life of those affected by these wounds. Despite best practice guidelines and other protocols to help healthcare facilities prevent PIs, the prevalence of PIs in Canada across all healthcare settings is concerning., Objective: To describe the pattern of PI prevention and identify national priorities and opportunities to address PIs., Methods: A descriptive, cross-sectional, online survey was created between August and December 2017 to explore Canadian healthcare professionals' knowledge, attitudes, and practices related to PIs., Results: In total, 590 surveys were completed. Eighty-five percent of respondents confirmed that PIs occur in their work environments, and 29% claimed PIs are a frequent occurrence. Most of the respondents (91%) confirmed that they were part of a team that treats PIs. Of the 590 participants, 90% confirmed that they are aware of PI prevention devices and technologies. Between 80% and 90% attest to using offloading devices including prophylactic dressings to prevent PIs, but only 20% instituted measures to address moisture-associated skin damage., Conclusions: The findings from this survey have highlighted a disconnect between Canadian healthcare professionals' awareness of PIs and the implementation of best practices for PI prevention. It is evident that, although the majority of respondents were aware of PIs and related treatment protocols, barriers still exist that impede optimized care and treatment.

: Although skin tears are common, particularly among older adults and neonates, they are often inadequately documented and poorly managed, resulting in complications, extended hospital stays, and negative patient outcomes. In this article, the first in a series on wound care in collaboration with the World Council of Enterostomal Therapists (www.wcetn.org), the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.

Purpose: To provide information about product selection for the management of skin tears., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Explain skin tear (ST) risk factors and assessment guidelines.2. Identify best practice treatments for STs, including the appropriate dressings for each ST type., Abstract: To aid healthcare professionals in product selection specific for skin tears, the International Skin Tear Advisory Panel conducted a systematic literature review and 3-phase Delphi consensus with a panel of international reviewers to provide the best available evidence for product selection related to the treatment of skin tears.

Purpose: To enhance the learner's competence with knowledge regarding utilization of a tool kit to aid in the prevention, assessment, and treatment of skin tears., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of skin tear prevention and classification as presented in the International Skin Tear Advisory Panel's tool kit.2. Apply information from the skin tear tool kit to patient care scenarios., Abstract: The International Skin Tear Advisory Panel has created a tool kit for the prevention, identification, and treatment of skin tears. The tool kit is based on extensive literature reviews, international input from healthcare professionals, and on expert opinion. It has undergone a modified Delphi process.

Objective: The aim of this study was to validate and establish reliability of the International Skin Tear classification system., Method: A consensus panel of 12 internationally recognized key opinion leaders convened in 2011 to establish consensus statements on the prevention, prediction, assessment, and treatment of skin tears. Subsequently, a new skin tear classification system was proposed. The system was then tested for interrater and intrarater reliability between the experts before being tested more widely on a sample of 327 individuals from the United States, Canada, and Europe., Results: The results of the study indicated a substantial level of agreement for the expert panel (Fleiss κ = 0.619; 2-month follow-up = 0.653). Intrarater reliability was high (Cohen κ = 0.877). Interrater reliability was moderate (Fleiss κ = 0.555) for healthcare professionals (n = 303) and fair for non-health professionals (Fleiss κ = 0.338; n = 24)., Conclusions: This international study established the reliability and validity of a new classification system for skin tears.

Nonhealing wounds (stalled, healable) challenge affected individuals, wound clinicians, and society. Nonhealing may result despite local factors being corrected. The interplay between tissue degradation, increased inflammatory response, and abundant protease activity is a challenging quandary. A modified Delphi process was utilized to investigate a protease activity test and practice implications.

The appropriate management of patients with skin tears is an ongoing challenge for healthcare professionals. Skins tears are often painful, acute wounds resulting from trauma to the skin and are largely preventable. Healthcare professionals must be able to identify individuals at risk for skin tears and aid in the prevention of these wounds and in their treatment when they occur. Despite preliminary studies that suggest skin tears may be more prevalent than pressure ulcers, there remains a paucity of literature to guide prevention, assessment, and treatment of skin tears. As a result, these wounds are often mismanaged and misdiagnosed, leading to complications, including pain, infection, and delayed wound healing. In addition, skin tears increase caregiver time and facility costs, cause anxiety for patients and families, and may reflect poorly on the quality of care delivered in a facility. In an effort to shift awareness toward this largely unheeded healthcare issue, a consensus panel of 13 internationally recognized key opinion leaders convened to establish consensus statements on the prevention, prediction, assessment, and treatment of skin tears. The initial consensus panel meeting was held in January 2011 and was made possible by an unrestricted educational grant from Hollister Wound Care. This document details the consensus definition and statements, as well as recommendations for future research and steps toward establishing a validated, comprehensive program for managing skin tears.

An alternative approach to the treatment of distal extracranial nonoccluding internal carotid artery penetrating injuries is described in which internal carotid artery ligation is followed expectantly. A warning transient neurologic deficit prompted an unsuccessful attempt at revascularization via a superficial temporal artery to middle cerebral artery anastomosis. The failure of the anastomosis was thought to be secondary to a postinjury hypercoagulable state and a diminished demand for intracranial blood flow secondary to an unexpected, impressive development of collateral blood supply.