Pressure ulcers and skin tone

Background

Pressure ulcers are a global threat and present a significant health challenge worldwide (Li et al, 2020). Evidence shows that it is difficult to accurately identify the early stages of pressure ulceration in patients with dark skin tones (Black, 2018); for example, patients with dark skin are more likely to be diagnosed with higher-category pressure ulcers than patients with light skin (Bates-Jensen et al, 2021; Cox and Hawkins, 2023). This is the result of a lack of early identification – e.g. redness can be easy to spot among people with light skin tones, but can be difficult to spot in dark skin tones (Chansky et al, 2017). Unrecognised damage arising from pressure ulcers in people with dark skin can lead to worsening stages; prolonged periods of hospital stay; deterioration in patients’ physical and psychological wellbeing; increased risk of sepsis and death; and elevated costs for healthcare services (Andersson et al, 2023). Therefore, there is a need to improve skin assessment skills among clinicians, as well as guidance on integrating pressure ulcer prevention best practice into all care settings where patients present with diverse skin tones.

The application of modified compression to prevent leg ulcer recurrence in the Republic of Ireland

Background: Compression therapy is considered best practice for healing and preventing venous leg ulcer (VLU) recurrence, however, some comorbidities require that modified compression be applied. A range of terminologies, application recommendations and compression amount for modified compression are found in the literature and guidelines. This could implicate how these recommendations are transferred into clinical practice.

Aim: To investigate clinical practice regarding the application of modified compression to prevent recurrence of VLU in the Republic of Ireland.

Methods: Descriptive qualitative design was used, with six experts in compression and wound management recruited from Ireland. Semi-structured interviews were used to gather data, and reflexive thematic analysis was completed.

Results: We identified four themes during data analysis; inconsistent understanding and terminology usage; clinical context influences; issues with standard compression application; and focus on healing (non-routine monitoring) with associated subthemes. 

Conclusions: This research indicates that the application of modified compression to prevent the recurrence of leg ulcers is limited within clinical practice, with inconsistent terminology used, application methods, and non-routine monitoring to prevent recurrence. Reported systemic barriers impact the ability of these services to provide best practice to people with leg ulcers.

Declaration of Interest: No conflict of interest to declare.

KEY WORDS

Clinical practice

Compression

Venous leg ulcers

YVONNE PENNISI

Occupational Science and Occupational Therapy University College Cork, Brookfield Health Science Campus, Cork, Ireland

PROFESSOR NICOLE MÜLLER Head of School, Clinical Therapies, University College Cork, Brookfield Health Science Campus, Cork, Ireland

SIOBHAN MURPHY Lecturer, School of Nursing, University College Cork, Brookfield Health Science Campus, Cork, Ireland

DR CLAIRE M BUCKLEY Senior Lecturer, School of Public Health University College Cork, Western Gateway Building, Cork, Ireland Orcid ID: 0000-0002-3174-7022

PICO™ Single Use Negative Pressure Wound Therapy (sNPWT) non-healing wound clinical practice pathway

In the UK, approximately 4.5 million, or one in fifteen people, are affected by diabetes, including both those who have received a diagnosis and those who have not. In the next 2 to 3 years, it is expected that the prevalence of diabetes will exceed 5 million. This article will discuss a patient with a non-healing diabetic foot ulcer and how the implementation of active treatments, such as PICO single-use negative pressure wound therapy (sNPWT), alongside the PICO sNPWT non-healing wound clinical practice pathway, assisted in achieving wound closure for the patient.

KEY WORDS

Diabetic foot ulcer;

Non-healing wounds;

Patient guidance;

PICO™ sNPWT

ANDREW SHARPE

Advanced Podiatrist, Wound Care, Salford Care Organisation

This article and the best practice statement were sponsored by Smith+Nephew. The views presented in this document are the work of the author and do not necessarily reflect the views of Smith+Nephew.

Management of a fistula in the open abdomen

Abstract: A fistula is an abnormal connection between two body parts. Patients may develop an enterocutaneous fistula following bowel surgery when the abdomen is left open. Managing these patients is complex and requires a multifaceted approach. Some of the issues are discussed and a patient case is presented in the following paper. Difficulties around managing the wound in particular are highlighted. Negative pressure wound therapy (NPWT) options are considered as well as other dressing choices.

KEY WORDS

Fistula

Negative pressure wound therapy

Open abdomen

Wound healing

ALEXANDRA J BISHOP

Lead Tissue Viability Nurse, University Hospitals Plymouth

Interface pressure: what does it mean in clinical practice?

ABSTRACT: Pressure ulcers generally occur at body sites where there are sustained soft tissue stress concentrations associated with either bodyweight or medical devicerelated mechanical forces. These sustained mechanical forces caused by pressure and shear result in localised tissue/cell distortion. This leads to deformation-induced damage, inflammation and ischemia resulting in tissue death and, ultimately, a pressure ulcer (Katz and Gefen, 2023).

      In order to reduce the risk of pressure damage occurring, it is common in clinical practice to select a pressure redistributing support surface (mattress or cushion). It is also important to reposition the patient in order to both change the areas that are load bearing and — as much as possible — increase the surface area of the body that is supporting the load, while avoiding positioning on the most at-risk areas, for example the bony prominences.

KEY WORDS

Interface pressure

Pressure mapping

Pressure ulcer

JACQUI FLETCHER

Independent Nurse Consultant

Implementing an evidence-based pathway to improve outcomes for non-healing wounds

ABSTRACT: In order to provide structured and equitable interventions in relation to identification and management of wound infection, an NHS Trust has implemented an evidence-based pathway for non-healing wounds. Following the introduction of the pathway there were reduced nurse visits for wound assessment, a reduction in wound area, a reduction in necrotic tissue and improved healing rates.

KEY WORDS

Case study

Evidence

Infection

Pathway

Silver dressing

UrgoClean Ag

Wound

ANITA KILROY-FINDLEY, Clinical Lead Tissue Viability, Leicestershire Partnership NHS Trust

KAREN OUSEY, PhD, Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield