Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

Abstract

Aims To identify the current research on assessment, management and prevention of chronic wounds in Australia and within the global context.Methods Electronic databases, trial registries and professional organisation websites were searched from 1 January 2010 to 31 May 2022. All original human research studies on chronic wounds conducted in Australia and reviews (systematic reviews (SRs), evidence-based guidelines (EBGs), evidence summaries, consensus documents) conducted worldwide were included. Results were tabulated and synthesised in a narrative review. ResultsOverall, 365 Australian studies and 569 worldwide reviews were included. The designs of Australian studies were mostly cohort (31%) or cross-sectional (20%), with a few randomised trials (10%). Australian studies were mostly concentrated on wound management (43%) or assessment (40%), and only 17% on prevention; this profile was similar for worldwide reviews. The chronic wound types focused on in Australian studies were 43% pressure injuries (PIs), 27% diabetes-related foot ulcers (DFUs), 16% venous leg ulcers (VLUs), 8% mixed chronic wounds, 6% mixed leg/foot ulcers, <1% fungating wounds.Conclusions This review found Australian chronic wound research focused on PIs and DFUs, with few randomised trials (10%), which is likely related to the lack of national competitive funding and difficulties in infrastructure support for adequately powered trials.

What is the evidence on skin care for maintaining skin integrity and prevention of wounds? An integrative review

“…• Pressure injuries (PIs): "localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction" 12(p16) • Skin tears: traumatic wounds as a result of shearing or friction forces which separate the epidermis from the dermis, or which separate both the epidermis and dermis from underlying structures 13(p20) • Leg ulcers: an ulcer on the lower extremity that has not healed and may be due to venous, arterial or mixed aetiology 14 • Incontinence-associated dermatitis (IAD): "an inflammation of the skin due to contact with urine or stool" 15(p2) The excessive burden of the breakdown of skin integrity into these common wounds is highlighted internationally, with an estimated pooled prevalence for chronic leg ulcers of 0.32%, 16 incidence of pressure injuries varying across settings 17 and ranging from 3.3% to 12.8% 17 ; and prevalence of IAD ranging from 4.3% to 21.3% within hospitals. 18 In 2023, Wilkie et al 19 highlighted the significant costs of wound care in Australia, and Queen and Harding (2023) 20 provided the estimates of wound care costs internationally being as high as US$126,86 billion.…”