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.

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

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

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