BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.

Introduction. Negative pressure wound therapy (NPWT) is applied using a foam dressing and an adhesive acrylic drape to create a seal. Removal of this drape can be painful and may play a role in periwound skin breakdown during dressing changes. A novel silicone-acrylic hybrid drape (HA-drape) has been developed for use with NPWT to allow for repositioning after initial placement and easier removal. Objective. This retrospective case series reports on the use of HA-drape in 4 patients who experienced periwound skin breakdown. The goal was to minimize skin breakdown while maintaining a seal on the dressing. Materials and Methods. Four patients with mild to moderate periwound skin breakdown were selected to receive NPWT with HA-drape. Negative pressure wound therapy was applied using a reticulated open cell foam dressing followed by placement of HA-drape to create a seal. Negative pressure wound therapy was initiated at -125 mm Hg with dressing changes occurring every 2 days. Wound healing, periwound healing, and patient-reported pain were assessed at dressing changes. Results. All 4 patients showed significant periwound skin improvement after the first dressing change. All patients reported a decrease in pain with dressing removal. Conclusions. In these 4 patients' wounds, use of NPWT with HA-drape resulted in intact periwound with improved periwound skin healing and reduction in patient-reported pain associated with dressing changes.

Introduction. VLUs are associated with prolonged wound healing, high recurrence rates, and fragile periwound skin. Objective. Skin protectant use with wound dressings and multilayer compression wraps was examined. Methods. Deidentified retrospective patient data were assessed. Patients received endovenous ablation, followed by application of zinc barrier cream to periwound skin before wound dressing and multilayer compression wrap use. Dressings were changed every 7 days, and zinc barrier cream reapplied. After 3 weeks, advanced elastomeric skin protectant use was initiated due to periwound skin injury during zinc barrier cream removal. Topical wound dressing and compression wrap use was continued. Wound healing and periwound skin condition were monitored. Results. Five patients presented for care with medial ankle VLUs. Within 3 weeks of zinc barrier cream use, unwanted product buildup was noted and removal often led to epidermal stripping. Skin protectant use was changed to advanced elastomeric skin protectant. All patients showed periwound skin improvement. Epidermal stripping was not observed with advanced elastomeric skin protectant, and the product did not require removal. Conclusions. In these 5 patients, advanced elastomeric skin protectant use under wound dressings and multilayer compression wraps resulted in improved periwound skin and reduced erythema compared with zinc barrier cream use.

BACKGROUND: Exudate pooling is the collection of wound fluid in the wound bed. Wounds with irregular depth, pockets, or cavities can create a dead space between the dressing and the wound bed where exudate can accumulate. Exudate pooling could lead to increased risk of infection or biofilm formation, maceration of the periwound skin, and delayed wound healing. PURPOSE: This article aims to offer a simplified yet practical summary for the prevention and management of exudate pooling by using advanced wound dressings. METHODS: Following a review of published literature, consensus statements, and best practice guidelines, the authors put their learnings into practice by translating the findings into a practical guide for the prevention and management of exudate pooling. RESULTS: Nearly half (49.6%) of all wounds have depth beyond the epidermis (0.22 cm), a characteristic that increases the risk of exudate pooling. In addition, approximately 12% of chronic wounds are undermined by tunneling or cavities underneath the skin where exudate could pool. Appropriate dressing selection can help manage exudate and prevent exudate pooling. In particular, dressings that provide a moist environment, manage the dead space, and maintain close contact with the wound bed may help reduce the risks associated with exudate pooling. A practical guide is presented that could be used by nurses at all levels to help select appropriate dressings. CONCLUSION: This practical guide could help prevent and manage exudate pooling and associated risk factors.