Search

Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners. [ABSTRACT FROM AUTHOR]

Pressure injuries, also known as pressure ulcers or 'bed sores', are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the use of compression therapy in the assessment and management of the venous and arterial aetiologies underlying leg ulceration as part of a holistic care plan, which was presented in an expert panel discussion held in October 2023.

The Alma Hybrid™ not only bridges the gap between traditional ablative and non-ablative laser treatments but also introduces enhanced transdermal delivery through the Impact Handpiece, utilising ultrasound technology. This integration allows for the effective treatment of a wide range of dermatological concerns, including scar revision, skin rejuvenation, and resurfacing (Arellano-Huacuja, 2023; Arellano et al, 2023b). This article aims to provide an examination of the clinical evidence supporting the Alma Hybrid™ system, with a focus on its integration into treatment plans for aesthetic and dermatological practices. Through an analysis of patient case studies and a review of the literature, this paper will demonstrate how the Alma Hybrid™ can be employed to enhance patient outcomes, particularly in challenging cases such as hypertrophic and atrophic scars. Furthermore, we will explore the system's efficacy across diverse patient demographics, with an emphasis on its safety profile in treating different Fitzpatrick skin types. [ABSTRACT FROM AUTHOR]

Advanced nurse practitioner Michelle McLean delves into the benefits of poly-L-lactic acid filler (PLLA) for skin rejuvenation and restoration as patients demand a 'less is more' approach to facial aesthetics. A recent surge in patients wanting to restore or preserve a youthful appearance has seen a surge in popularity for collagen stimulators due to their association with high levels of patient satisfaction, long-lasting efficiency, minor adverse events and sound safety profile (Christen, 2022). Patients are increasingly opting for a 'less is more' visual aesthetic, hoping to achieve subtle, natural-looking, undetectable results. To meet patient goals, clinicians are utilising combination approaches in facial aesthetics, utilising products with PLLA because of its desirable results. PLLA is a powerful, well-tolerated tool for clinicians to employ for the non-surgical augmentation of the ageing face. [ABSTRACT FROM AUTHOR]

This piece highlights the tremendous potential of Artificial Intelligence (AI) in the field of dermatology and its suitability in revolutionising patient care. The integration of AI technologies into dermatological practices has the power to significantly improve diagnostics, treatment decisions, and overall patient outcomes. AI algorithms have shown remarkable proficiency in analysing dermatological images with impressive accuracy, such as skin lesions, rashes and moles. By leveraging deep learning and computer vision techniques, AI models can recognise patterns, features, and characteristics of various skin conditions, thereby aiding in accurate diagnosis and assists dermatologists in formulating personalised treatment plans tailored to individual patients. [ABSTRACT FROM AUTHOR]

Background: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination. Aims: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management. Methods: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B). Findings: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management. Conclusion: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment. [ABSTRACT FROM AUTHOR]

Topical retinoids continue to be the treatment of choice for healthcare professionals and patients due to their effectiveness in treating several common skincare concerns. In a comprehensive review, Cigdem Kemal Yilmaz discusses the most used topical retinoids: retinyl palmitate, retinol, retinal (retinaldehyde), tretinoin (retinoic acid) and adapalene, and their potential benefits to the skin. This article also addresses the latest EU regulations impacting their use, and the necessity for healthcare professionals to stay informed about advancements and regulatory changes in topical retinoid therapy in order to provide personalised treatment plans for their patients. [ABSTRACT FROM AUTHOR]

Aesthetic medicine extends beyond just correction, evolving into prevention strategies for aging. This case study highlights the revolutionary potential of Neauvia dermal fillers in skin rejuvenation and enhancement. Unlike conventional hyaluronic acid fillers, Neauvia uses PEG (polyethylene glycol), a biocompatible polymer, ensuring exceptional durability and longevity. Moreover, its PEG-based formulation offers thermal stability, enabling synergistic use with energy-based devices like LaserMe. Through the SCT (Smart Combination Therapy) Protocol, combining Neauvia dermal fillers, Hydro Deluxe skin booster, and LaserMe, a comprehensive treatment approach is achieved. Illustrated through a case study of a 74-year-old female, this protocol demonstrates remarkable results in addressing volume loss, fine lines, and skin quality over three sessions. Neauvia's mission to redefine medical aesthetics emphasises synergy between technology and clinical efficacy, creating natural rejuvenation with minimal intervention. This approach signifies a model shift towards holistic aesthetic solutions, optimising outcomes with minimal filler volume and maximal skin regeneration. [ABSTRACT FROM AUTHOR]

Optimal management of breast cancer-related lymphoedema (BCRL), a common and debilitating complication of surgery and radiotherapy, depends on early detection, personalised risk assessment and proactive intervention. For instance, a recent review advises healthcare professionals to reframe the narrative about the daily-living skin trauma risks away from 'what to avoid' to 'what to do'. Another review recommends daily, or nearly daily, exercise at home to reduce lymphoedema severity. However, several questions await full answers. There is, for instance, no consensus regarding the most appropriate surgical technique for preventing BCRL. This feature summarises some recent papers updating healthcare professionals about BCRL. [ABSTRACT FROM AUTHOR]

Proposed as a non-invasive alternative to address a variety of patient concerns including cellulite, body sculpting, weight reduction and skin rejuvenation, mesotherapy remains a controversial therapy, with some arguing that it is ineffective at best and potentially dangerous at worst. However, other practitioners and researchers swear by its efficacy. Francesca Ramadan dives into the current evidence base, safety profile and applications of mesotherapy. [ABSTRACT FROM AUTHOR]

Background: An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders. Aim: The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues. Method: Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials. Results: A prospective, three-armed, multi-centre, stratified cluster-randomised controlled trial is proposed. The third arm is recommended as it is expected that patients will need to be moved for the medical device to be used and repositioning is a preventive strategy. A minimum of 16 200 patients in 33 wards would needed to be recruited to achieve statistical significance. Ethical considerations in terms of consent or assent need to be considered. Conclusion: The hypothetical study designed to evaluate the effectiveness of a diagnostic or prognostic medical device in reducing pressure ulcer incidence in secondary care, while accounting for biases, would require large sample sizes and involves risks of inter-operator and inter-device reliability, heterogeneity of users and the vague clinical interpretation of device results. Robust research in this field has the potential to influence or change policy and practice relating to the prevention of pressure ulcers in secondary care. [ABSTRACT FROM AUTHOR]

Aims: Skin breakdown is common in the intensive care unit (ICU). This pilot evaluation aimed to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complications of blistering and other skin breakdowns in a high-risk ICU population with Foley catheters. Design: A prospective, non-randomised performance improvement study using a convenience sample was carried out. Subjects and setting: The study sample consisted of 29 patients with urethral Foley catheters and any degree of thigh oedema in a surgical ICU at an academic quarternary medical center. Methods: Patients were fitted with a standard acrylic-adhesive catheter securement device on one thigh and a nurse-constructed device on the contralateral thigh. At the beginning of each 12-hour shift, the nurse moved the Foley catheter from one securement device to the other; the nurse recorded the assessment findings at the end of the shift. Results: The average age of the 29 patients was 61±16 (range 20–87) years. Visible skin compromise occurred in 21% of the time with the standard acrylic securement device; an equal percentage of men and women developed skin breakdown. Oedema status was a significant factor related to skin breakdown. There was no visible damage to the skin associated with the nurse-constructed silicone-adhesive device. Conclusions: A silicone adhesive urinary catheter securement device causes less skin damage than one with acrylic adhesive. One-step application, pain-free and atraumatic removal, and reliable securement are essential considerations in product development. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England. [ABSTRACT FROM AUTHOR]

Lymphoedema effects approximately 200 000 people in UK. It is a chronic condition without a cure but there is much that can be done to ease and manage these complications. This article looks at the eight most common complications, providing advise on how to manage them, derived from the literature and the author's own experience. It also presents advise on how nurses can promote self-management of these complications, promoting patients' self-care. [ABSTRACT FROM AUTHOR]

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients. [ABSTRACT FROM AUTHOR]

This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision. [ABSTRACT FROM AUTHOR]

Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications. [ABSTRACT FROM AUTHOR]

This case study series outlines the use of Novosorb biodegradable temporising matrix (BTM, PolyNovo, Australia) in the management of 22 patients, each with a complex wound who attended the vascular department in the University Hospital Limerick between 2021 and 2023. The majority of patients presented with acute conditions (e.g. necrotising fasciitis, crush injuries, compartment syndrome) that initially required high dependency level care. The majority of wounds (21/22, 95%) affected the leg or foot, and one wound was on the chest wall. Each patient had a significant complex wound and, in many cases, was complicated further by the patients' medical condition and comorbidities, which had the potential to cause problematic and delayed healing. The BTM was applied following debridement, as required, and provided a stable base for secondary wound healing or skin grafting, as needed. Of the patients: 12 (54%) healed completely; one (4%) progressed towards complete vascularisation with the BTM in situ; two (9%) underwent major amputations despite successful application of the BTM to lower limb wounds; and one (4%) returned to theatre to have retained clips removed. The remaining six (27%) patients failed to heal completely following BTM application. Ischaemia, infection, vasculitis and underlying osteomyelitis were limiting factors in achieving limb salvage or healing. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

This case study describes the successful management of a patient with primary lymphoedema, who was experiencing lymphorrhoea and epidermolysis, using a multidisciplinary approach. The patient had Klippel–Trenaunay syndrome. The multidisciplinary team, in an outpatient clinic in Japan, included a certified lymphoedema therapist, plastic surgeons, and a wound, ostomy and continence nurse. The team performed complex physical therapy and lymphaticovenular anastomosis, which promoted the resolution of the lymphorrhoea. This resulted in improvements in skin condition, the prevention of recurrent cellulitis, and no increase in limb circumferences during the 1-year follow-up period. This report highlights the importance of a multidisciplinary approach to lymphoedema management, including lymphorrhoea control that fitted in with the patient's daily life. It is hoped that this article will contribute to the improvement of the quality of life of patients with lymphoedema. [ABSTRACT FROM AUTHOR]

There are many benefits of standardised care but often this is not possible due to variations in the availability of healthcare resources in the UK. Within stoma care, there is evidence to guide care but with limited standardisation, particularly for community nurses. Stoma care is provided inconsistently, possibly due to variations in training and experience of the nurse. It is known that patients have greater needs in the first few months after stoma formation and this need for support is compounded if there are stoma complications. Community nurses can provide practical support and information, as well as psychological support and encouragement to help people become independent with stoma care and adapt to life with a stoma. [ABSTRACT FROM AUTHOR]

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment. [ABSTRACT FROM AUTHOR]

For professional use only, the Derma 2.0® product line allows you to achieve goals without having to resort to intricate, complex and expensive procedures from pre-treatment to post-treatment [ABSTRACT FROM AUTHOR]

The use of compression therapy is known to be effective in the management of patients with venous leg ulceration and is commonly recommended as a first-line treatment. A rare but known complication of compression therapy is pressure damage to the limb, also referred to as bandage damage, which should be categorised as a medical device-related pressure injury. Patients should receive a comprehensive, holistic assessment before any compression therapy is applied. Risk factors for compression therapy injury include peripheral arterial disease, older age, fragile skin, pronounced bony prominences or tendons, calf atrophy, foot drop, neuropathy/absent sensation, limited movement, cognitive impairment and receiving end of life care. Risks can be mitigated through a variety of approaches, and practitioners should be aware that these can change depending on the patient's condition. A community improvement initiative, illustrated with a case study, introduced a clinical pathway that can facilitate the identification and management of patients who are at risk of developing pressure injuries as a result of compression therapy. [ABSTRACT FROM AUTHOR]

Skin tears are traumatic wounds caused by mechanical forces, which can be caused by the removal of adhesive dressing. Although they are common – especially in individuals with vulnerable skin, such as older people – their prevalence is underestimated, they are often misdiagnosed and they have a high risk of developing into complex, chronic wounds. However, skin tears are largely preventable. There are a number of intrinsic and extrinsic factors relating to skin tears and preventive strategies that may be undertaken. Health professionals, patients and caregivers/family members should aim to manage modifiable intrinsic and extrinsic factors to promote and maintain skin integrity to prevent skin tears. Where a skin tear does occur, an evidence-based approach should be taken to management, with referral to specialist care if necessary. [ABSTRACT FROM AUTHOR]

Major skin changes are one of the many features occurring with ageing and it is estimated that 70% of older people have skin problems (All-Party Parliamentary Group on Skin (APPGS), 2000). A report into skin diseases in older people highlighted that they were noted to suffer from a lack of sensitivity to their skin care needs and related problems; furthermore, training was lacking for healthcare professionals and service provision was not planned (APPGS, 2000).The aim of this article is to highlight the importance of skin care in the older person and increase the nurse's knowledge of skin changes associated with age. [ABSTRACT FROM AUTHOR]

In this regular feature, aesthetic nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary [ABSTRACT FROM AUTHOR]

The plethora of modalities available to improve skin health and appearance is greater than ever, with one of these options being LED light therapy. Various LED-based devices for dermatological and cosmetic usage have become widely available, but the average consumer or aesthetic practitioner may not be confident in their efficacy or safety. Francesca Ramadan summarises the latest evidence-based applications of LED phototherapy and the research supporting its benefit to the aesthetic practitioner's toolkit. [ABSTRACT FROM AUTHOR]

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications. [ABSTRACT FROM AUTHOR]

Skincare and skin health have risen to ever-increasing prominence in recent years, and there are many products and treatments available on the market that advertise themselves as miracle cure-alls. Hyaluronic acid, a popular skincare ingredient, may indeed live up to the claims, but its efficacy is dependent on its mode of delivery. Skin boosters comprising injectable hyaluronic acid may offer a way to revitalise patients' skin from the inside out. Francesca Ramadan elaborates [ABSTRACT FROM AUTHOR]

Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm. [ABSTRACT FROM AUTHOR]

From dry skin in the newborn to atopic eczema in the infant and child, health professionals in primary care play a crucial role in supporting families in the care of skin, and the treatment and management of skin conditions in children. The evidence base can be conflicting and guidance changes frequently. With so much information to share with new parents, baby skincare is often seen as a lower priority when imparting health promotion advice than other areas such as safe sleep or infant feeding. It has been argued that, with the rising prevalence of atopic eczema in the UK population, advice to parents about what to be concerned about and when to seek medical advice is imperative. This article explores the evidence on general skincare from the newborn period to the treatment and management of common skin conditions, including atopic eczema and seborrheic dermatitis. [ABSTRACT FROM AUTHOR]

The summer slowdown happens every year, but with some pre-planning and creativity, you can provide packages that attract enquiries, deliver results and boost revenue. Post-season, assess what worked, tweak what didn't and make sure that for summer 2024 you start the promotional work in spring to ensure maximum uptake [ABSTRACT FROM AUTHOR]

In this regular feature, aesthetic nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary [ABSTRACT FROM AUTHOR]

The article provides an overview of a selection of published research articles that are of interest to community nurses. Topics discussed include evidence on the most frequent skin conditions affecting older people living in the community, the influence of age on the early stage of vitamin D3 metabolism, and a study which aimed to assess whether chitosan-based gel, known as ChitoCare, may help to treat non-healing diabetic foot ulcers.

With two days of lectures, over 40 speakers, 20 CPD points and an unforgettable networking evening, Rebecca Barnes recaps some of Wigmore Presents' 2024 highlights [ABSTRACT FROM AUTHOR]

Peristomal skin complications (PSCs) are relatively common in ostomy patients, particularly in those with ileostomies. Non-healing irritation presents a clinical challenge and leads to pain and impaired quality of life for patients. Methods: The cases of four ileostomy patients experiencing severe, challenging PSCs refractory to appliance changes, conventional dressings and barrier creams are discussed. Findings: The cases of one male and one female patient with an end ileostomy post-subtotal colectomy for ulcerative colitis, one female with a defunctioning ileostomy post-anterior resection for sigmoid carcinoma and one male with an end ileostomy with a complex Crohn's surgical history are described. Two puffs of a 250 mcg metered dose beclometasone inhaler were applied to the affected skin once or twice daily. Treatment ranged from 6 to 21 days. Complete resolution was seen in all cases. Conclusion: Topical use of a beclometasone inhaler was effective for severe peri-ileostomy PSC secondary to four different aetiologies. Further studies are warranted to determine the effectiveness of this treatment in a larger patient cohort. [ABSTRACT FROM AUTHOR]

Objective: Coverage of upper and lower extremity wounds with exposed vital structures such as tendon and bone is reliant on pedicled and free flaps. However, a population of patients with medical comorbidities or other social issues may not be suitable for flap coverage. We present the first in patient clinical experience in the US with MatriDerm (Billerbeck, Germany) for treatment of difficult extremity wounds, all with exposed bone or tendon. Method: MatriDerm dermal matrix has been popular in Europe for coverage of wounds. However, MatriDerm only received full approval for use by the US Food and Drug Administration (FDA) in 2021. Here we review our clinical experience. Results: Locations (n=11) treated included forearm (n=1), hand (n=4), leg (n=3), and feet (n=3). Vital structures in wounds exposed included bone (n=3), bone and tendon (n=1), and tendon (n=7). Mean area of the wound treated was 59.2cm2 (range: 2 to 230). In our series, eight out of 11 wounds healed, with MatriDerm only (n=6) or following delayed skin grafting (n=2). Mean time to healing in the patients treated only with MatriDerm was 49 days (range 7 to 84). Mean time to split-thickness skin grafting in the remaining two patients was 44.5 days (range 32 to 57). Conclusion: MatriDerm has potential for treatment of complex extremity wounds, which would otherwise require flap coverage, in patients who are not good candidates for flap surgery. [ABSTRACT FROM AUTHOR]

Background: Improper fitting between peristomal body profile and ostomy product(s) is one of the main reasons for leakage among individuals with an ostomy. Aim: To evaluate clinical usability of the Body Assessment Tool developed by Coloplast that is available free of charge. The aim was also to study how changing to product(s) that were best suited to an individual, guided by peristomal body profile, affected the number of leakages and individuals' quality of life. Methods: The study consisted of questionnaires administered before and after the study, which spanned 4–5 weeks. A total of 22 nurses and 68 individuals with an ostomy participated in four Nordic countries. Findings: Of the 22 nurses, 21 recommended use of the tool. A shift to best fitting ostomy product(s) resulted in a significant decrease in the number of leakages (from 5.9 to 1.8 per 7 days) and a substantial improvement in quality of life. Conclusion: The findings support the use of the Body Assessment Tool in clinical practice and the results showed that optimally fitting ostomy product(s) reduced the number of leakages and increased individuals' quality of life. [ABSTRACT FROM AUTHOR]

Background: the potential fire risk of fabrics impregnated with emollients has been described within the health service, including ignition of bandages. The role of emollients in fire fatalities have also been included in coroner reports, as accelerating fires when present. Aims: although changes in burning behaviour is known, no standard tests have been carried out on bandages which are often used in conjunction with emollients. Method: using a standard vertical flammability test, the flammability of viscose bandage was compared to when impregnated with nine dried on emollients with low to high and non-paraffin content. Findings: the time to ignition was significantly reduced with an emollient present and the glowing time was longer. Conclusions: the same safety advice applies to viscose bandages as other fabrics with emollients; do not expose them to naked flames or high heat sources or allow emollients to build up on bandages. [ABSTRACT FROM AUTHOR]

A foreword to the "Journal of Wound Care" is presented.

Background: Choice of ostomy appliances is based on multiple factors including economic considerations, individual patient requirements and lifestyle. A recently launched two-piece ostomy collection device with an extended tape border is expected to provide a long wear time and increase patients' sense of security. Aims and methods: A randomised controlled, non-blinded, cross-over study involving 38 patients (with colostomies and ileostomies) compared the test device to a similar device from the same manufacturer but without the tape border. The main objective was to assess wear time for non-inferiority as a measure of efficacy. Secondary efficacy assessment included peristomal skin condition using the DET (discolouration, erosion and tissue growth) score and patient acceptability, which was assessed through questionnaires using Likert-scale options. Safety was assessed according to the incidence and intensity of device-related adverse events, and the condition of the peristomal skin. Results and conclusion: Analysis of results in the per-protocol population showed an average wear time of 4.5 days for both devices and demonstrated non-inferiority. DET scores were similar in both groups, and both had low rates of device-related adverse events, all of which related to peristomal skin. Patients said the devices were user friendly. While the two devices are similar, some patients may find one with an adhesive tape more suited to their needs. [ABSTRACT FROM AUTHOR]

Background: Leakage is the number one concern for people with an ostomy. The 2019 Ostomy Life Study, a global study of more than 5000 ostomates, showed that 92% of people living with a stoma worry about leakage. Getting the right stoma appliance for each patient is key to increasing patient quality of life. Aim: The study was designed to assess the use of the Peristomal Body Profile Assessment Tool in helping choose the most appropriate stoma products for a given patient, decreasing incidents of leakage and peristomal skin complications. Methods: A multi-centre (33 sites, 147 patients) low-interventional clinical investigation was conducted in which the use of the Peristomal Body Profile Assessment Tool was evaluated as a tool to reduce incidents of leakage, increase peristomal skin health and increase patient quality of life. A focus group of randomised participating clinicians (n=16) was held to explore the audit results. Results: The assessment tool most often took between 2 and 5 minutes to complete. It supported clinicians in selecting the right appliance for each patient, avoiding leakages and preventing associated peristomal skin complications. The assessment tool helped improve the accuracy and quality of documentation in the patients' medical/nursing notes, increasing the quality and continuity of care. Participants reported that using the assessment tool helped reduce care costs by reducing the need for product changes, supporting product usage and return patient visits. Conclusion: Use of the Peristomal Body Profile Assessment Tool helped clinicians choose the most appropriate stoma appliance the first time, resulting in patients having healthier peristomal skin, fewer leakages, more confidence in their stoma appliance and a higher quality of life. [ABSTRACT FROM AUTHOR]

Complex wounds require combinations of technologies and regimes to match laboratory tests and address challenges of physiological processes, body contours, movement and ease of use during life-long self-management. Wound management for vascular and lymphatic disorders incorporate wound dressings, skin care and compression to address local wound needs and underlying pathologies, while allowing functionality for movement. In a similar manner, acute inflammatory conditions that become chronic require skin care and local conformable and absorbent wound management, but with simple, atraumatic retention methods without compression. Three types of conditions will be discussed in this article—venous leg ulcers with chronic oedema (VLU), hidradenitis suppurativa (HS) and pilonidal sinuses (PS). It focuses on overcoming challenges associated with excess exudate, compromised skin, dressing awkward areas and contours, while also demonstrating wound care similarities when administered by patients themselves. [ABSTRACT FROM AUTHOR]

This case report discusses the role of a practitioner managing a patient with secondary lymphoedema as part of a self-management regime. The patient was diagnosed with multiple sclerosis and lumbar spinal stenosis. The focus is on compression therapy, which is used as part of complete decongestive therapy to reduce and control lymphoedema. The case report illustrates how a patient-centred plan can help people with lymphoedema and co-morbidities to achieve their personal goals. The evidence behind treatment decisions is considered, and modifications made to the care plan to accommodate the needs of the individual are described. The teaching and rehabilitation role of the practitioner is explored, including strategies used to support patients with long-term conditions. This report also identifies a lack of research-based evidence supporting the management of oedema as a symptom of multiple sclerosis. Further research is needed to inform clinical guidelines which would promote the management of secondary lymphoedema. [ABSTRACT FROM AUTHOR]

Often, the neck and décolletage are forgotten treatment areas, as most people concentrate on the face's appearance. Photodamage is the primary cause of ageing, leading to loss of skin elasticity and dyschromia. Fat loss and redistribution also occurs, which leads to the familiar pattern of ageing. Treatment of the neck and décolletage differ, as the later has minimal fat to act as a buttress for deeper treatments. Effective intervention relies on a good history, examination, management of expectations and sensible treatment choice. The options are extensive, and it is usually a combination of treatments that provide the best outcomes. [ABSTRACT FROM AUTHOR]