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The article offers information on how pressure ulcer prevention to be part of end of life care. Topics include the patients who were dying developed pressure damage and termed the ulceration decubitous ominosus, and the rationale came from the fact that over of individuals were dead within six weeks of developing the pressure damage.

'Active' Charcot neuroarthropathy (CN) is characterised by non-infectious inflammation in the presence of peripheral neuropathy (van Netten et al, 2019). The area of the foot most commonly affected is the mid-foot and this is associated with classic 'rocker-bottom foot' deformity (Botek et al, 2010; Mumoli et al, 2012; Dissanayake et al, 2012). While this condition is frequently associated with deformity, this may be prevented if caught early. Without timely recognition and offloading of the affected limb, progressive bone and joint destruction may, however, lead to significant deformity, ulceration, amputation and a vastly reduced quality of life (Caputo et al, 1998; Cates et al, 2019). [ABSTRACT FROM AUTHOR]

Marjolin's ulcers are rare and aggressive malignant transformations seen in scar tissue and chronic wounds. The majority of the malignant transformations are due to squamous cell carcinoma. Here, Trudie Young gives an overview of the condition -- its incidence, pathophysiology, clinical presentation and diagnosis as well as therapeutic management options and treatment plans required to ensure optimal care and good quality of life for patients with Marjolin's ulceration. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is a relatively rare blood disorder that is characterised by the presence of crescent-shaped -- sickled -- red blood cells in the bloodstream. These crescent-shaped cells are stiff and sticky and can block blood flow in the small blood vessels of the peripheral blood system, thus preventing the normal flow of nutrition and oxygen. SCD is inherited in an autosomal recessive manner. In this article, Trudie Young gives a comprehensive overview of this medical condition and its link to lower limb ulceration. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is a systemic condition that is thought to have genetic and environmental components and is more common in females and older people. It causes inflammation of the joints and erosion of the bone. Patients can experience associated problems including vasculitis, ulceration, delayed wound healing, foot deformity, neuropathy, limitations in activities of daily living and impaired quality of life. Treatment with medication can increase patients' functional status but may result in delayed wound healing (disease-modifying anti-rheumatic drugs), an increased risk of skin tears (corticosteroids) or infection (biological therapies). A multidisciplinary approach is needed to educate, screen and manage patients. There is currently no optimal approach to managing patients with rheumatoid arthritis and ulcers, so prevention is key. [ABSTRACT FROM AUTHOR]

Pilonidal sinus disease is a chronic inflammatory condition that consists of cycles of healing and wound breakdown often for many years. It is predominantly found in young males. Clinical presentation can be of an acute abscess formation or a non-healing wound in the natal cleft. The latter, chronic version of the disease significantly impacts on an individual's quality of life due to the extended need for ongoing wound care and recurrent wound infection. There is great variation in the treatment options in the chronic form of the disease such as surgical intervention and subsequent healing by secondary intention or flap formation, with the off-midline surgical closure method is recommended for the prevention of recurrence. This article gives an overview of the condition. [ABSTRACT FROM AUTHOR]

Necrobiosis lipoidica diabeticorum (NLD) is an uncommon inflammatory condition that usually affects people with diabetes mellitus (DM), in which shiny, red-brown or yellowish patches develop in the skin often on the lower limbs. The course of the disease is unpredictable with recurrence and flare-ups common occurrences. In her article, Trudie Young gives an overview of this condition, its aetiology, clinical presentation, complications and treatment options [ABSTRACT FROM AUTHOR]

Background: The greatest burden of community based wound care falls on nurses working within GP Practices. Despite the common treatment of wounds by Practice Nurses little formal guidance is available to this cohort and significant gaps in practice have been reported. Local problem: Objective was to improve wound management and so help reduce the number of patients with wounds seen by the GP Practices. Methods: Interventions: Two complex wound clinics established in GP Practices in South Wales with one-to-one support provided to Practice Nurses by an experienced wound clinician. Results: Within one of the GP Practices data was collected pre- and postimplementation of the wound clinic with healing increased from 33.3% to 67.3% postimplementation. The mix of wounds treated was similar pre- and post-implementation of the complex wound clinic with venous leg ulcers, surgical wounds, traumatic wounds and leg wounds being the common frequently reported aetiologies. The cost of wound treatment was similar pre- and post-implementation of the complex wound clinic. Conclusions: This quality improvement project identified that wound care delivered within GP Practices may result in low healing rates which can be markedly improved through development and introduction of a wound clinic. The approach was successful within the two wound clinics established within the project with healing rates around 70% in both clinics, while the cost of wound treatment did not appear to be markedly changes before or after wound clinic introduction. Expansion of this model may enable GP Practices to successfully treat the wounds of the many thousands of patients who present with wounds in their GP Practice each year. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare immune-related chronic ulcerating skin condition with a predilection for the lower limbs. It is more common in females, with the average age of onset between 20 and 50 years. There are two stages of the disease process: an ulcerative phase and a healing phase. The latter occurs once the heightened and ongoing inflammatory response has subsided, although the exact pathophysiology of PG has yet to be elucidated. Half of the cases of PG are associated with other comorbidities, such as inflammatory bowel disease, arthritis or haematological malignancies. The skin condition pathergy can be a stimulus for the onset of the disease and is due to incidental or healthcare-related trauma. There is no definitive test to diagnose PG and the diagnosis is one of exclusion. The aim of the treatment is to reduce the inflammation and therefore immunosuppression is the basis of any therapy. Nevertheless, the disease can recur following completion of the healing phase. [ABSTRACT FROM AUTHOR]

Calcinosis cutis is a rare cause of non-healing leg ulceration. There are many factors that can delay the healing of venous leg ulceration and the deposition of calcium in the skin known as calcinosis cutis is one of these factors. There are five distinct forms: dystrophic calcification, metastatic calcification, idiopathic calcification, iatrogenic calcification and calciphylaxis. Warfarin skin necrosis has common clinical features with calciphylaxis and is therefore included in this article, which describes the types of calcinosis cutis, their clinical presentations and limited treatment options. The aim is to highlight these unusual causes and to assist healthcare professionals when faced with a non-healing ulcer. [ABSTRACT FROM AUTHOR]

Hidradinitis Suppurativa (HS) is a chronic recurrent debilitating skin disease of the hair follicle. It is a condition that has been overlooked in wound care publications, with most articles found in dermatological journals. However, the condition affects 1% of the population in Europe and produces painful nodules in one or more of the apocrine-gland bearing aspects of the skin that can ulcerate and produce pain and a foul odour and can multiply and eventually develop sinus tracts and fistulae. HS is often misdiagnosed as alternative skin ulcerating conditions, leaving the individuals with many years of suffering from the physical symptoms and their psychological consequences. The disease often begins in puberty and burns out by middle age, leaving the individual with unsightly scarring. This article examines the pathophysiology, clinical presentations and comorbidities associated with the disease. The treatment options focus on controlling the comorbidities, moderating life-style behaviours and arresting the disease. The medical and surgical options are discussed along with their limitations. [ABSTRACT FROM AUTHOR]

This article discusses the aetiology and clinical presentations of the four conditions collectively known as moisture-associated skin damage (MASD). It explores the normal status of the skin and how this is altered in the presence of excess and prolonged moisture. In all manifestations the barrier property of the skin is impaired, allowing irritants to penetrate the epidermis. Moisture damage disrupts the lipid matrix surrounding the cells in the stratum corneum and effectively dissolves the physical barrier of the skin. The pH of the skin also increases, resulting in an alkaline environment conducive to bacterial proliferation and infection. Urine and faeces are the offending contaminants in incontinence-associated dermatitis, whereas perspiration is the primary cause of intertriginous dermatitis. Effluent from the ostomy causes peristomal damage and wound exudate instigates moisture damage to the periwound skin. The clinical picture of MASD ranges from mild erythema to extensive and painful skin breakdown often complicated by bacterial and fungal infection. A structured skin-care regimen that involves cleansing, protecting and restoring the barrier properties of the skin will assist in the prevention and management of all MASD. [ABSTRACT FROM AUTHOR]

Pressure ulcers remain a worldwide problem. As research techniques have advanced, specifically in the field of finite element computational modelling, the tissue viability community has been able to gain a deeper understanding of the aetiology of pressure ulcers. Historically, the magnitude and duration of pressure was investigated to establish a pressure duration curve, initially for animals and, subsequently, for humans. However, this was restricted in its ability to provide a definitive answer to how long and how much pressure is required for a pressure ulcer to develop. Mechanical loading of the skin gives rise to forces acting either perpendicular to the skin, i.e pressure, or parallel to the skin, i.e. shear. A combination of perpendicular and shear forces changes the shape of soft tissues. Individuals will have a unique pressure-resistant threshold that will depend on the composition of their tissues and general health and lifestyle. Debate continues in relation to the aetiological differences in the formation of superficial and deep pressure damage and into the role of microclimate in pressure ulcer formation as the author highlights in this article. [ABSTRACT FROM AUTHOR]

Venous leg ulceration is caused by chronic venous insufficiency (CVI) as a result of raised ambulatory venous hypertension. Persistent or chronic venous hypertension results in macro- and micro-vascular changes in the limb -- leading to venous ulcers. The failure of venous return -- the flow of blood back to the heart -- is commonly due to valve and calf or foot muscle pump incompetence. Physical, biochemical and radiological examination will establish the underlying pathology and the severity of the CVI. The Comprehensive Classification System for Chronic Venous Disorders (CEAP) is a recognised system for recording the clinical manifestations of the disease and compression therapy remains the most commonly applied treatment for venous leg ulceration, as Trudie Young explains in this article. [ABSTRACT FROM AUTHOR]

Malignant wounds may be due to a primary cancer of the skin, metastasize from a cancer elsewhere in the body or erode the skin from an underlying malignancy; chronic wounds also have the ability to develop malignant cells within the wound bed. Malignant wounds frequently have a low potential for healing and are associated with the accompanying symptoms of malodour, pain and elevated exudate levels -- even death. The burden of suffering with and caring for an individual with a wound at the end of life is remorseless, with the impact of the situation staying with carers for many years. Palliative wound care is often without the aim of complete healing, it is symptomatic care -- not disease-focused -- with the aim to improve quality of life. The individual and their carers require psychological, spiritual and emotional support along with the physical care delivery and clinicians may have to utilise a slightly unorthodox approach to managing patients with these challenging wounds. [ABSTRACT FROM AUTHOR]

The article discusses a Made Easy workshop held at the Wounds UK Annual Conference in Harrogate, England on November 6, 2018 on the role of surfactants in mechanical debridement. Topics include the significance of conducting routine mechanical debridement in chronic wounds, the use of UCS debridement cloth to clean wounds, and its use in practice.