Abstract
The purpose of this study was to establish the costs of conventional management of neuropathic foot ulcers in people with diabetes and evaluate the cost effectiveness of Dermagraft®, a living human dermal replacement, as an adjunct therapy. The cost of conventional management of foot ulcers was established by surveying specialist clinics for typical resource use and applying published unit costs. A Markov model was used to estimate expected cost per ulcer healed, with and without Dermagraft, drawing on effectiveness data from the pivotal clinical trial. The expected use of Dermagraft in Australian specialist clinics was based on an observational case study of 27 hard to heal ulcers. The data from this study was also used to establish an alternative cost-effectiveness estimate, using a pre-post own control study design.
Using the Markov model, the mean cost per ulcer healed is estimated at $10,906 using conventional management and $12,128 using Dermagraft as an adjunct or $9,393 if Dermagraft is cut and used to treat two ulcers. In the case studies, a mean 7.6 applications of Dermagraft were used per ulcer, with healing achieved in 85 per cent of ulcers. Based on the case studies, the mean cost of managing an ulcer after commencement with Dermagraft -until healing was achieved or to 24 weeks -was $4,682, compared with an estimated $12,500 incurred under conventional management prior to Dermagraft use.
The use of Dermagraft as an adjunct to conventional management in the specialist clinic setting for hard to heal ulcers results in a similar average cost per ulcer healed and a lower cost per week in a healed state to conventional management alone. A shorter treatment period, fewer complications and fewer inpatient episodes will, in some cases, offset the cost of Dermagraft making the treatment cost saving.

Abstract
This article describes the quality improvement and audit processes used by one hospital to: examine pressure prevention practices and rates of pressure ulcer development; develop and implement an organisational pressure prevention framework in response to the audit results found; and evaluate the outcomes. The developed framework supports the principle:" of clinical governance. The early identification of risk is then communicated to all subsequent health care workers, resulting in the implementation of appropriate preventative interventions.
Point prevalence monitoring is the main organisational evaluation mechanism used and, whilst methodological differences existed between the first and subsequent audits, there still remains enough evidence to support the notion that the framework has been successful in achieving its goal. The hospital has seen an increase in the identification of the patient at risk on admission and the implementation of appropriate preventative interventions; this has led to a reduction in the incidence and severity of pressure ulcers. However, the brief of the working party is not complete. The working party plans to undertake a piece of research in 2002 to validate the risk assessment tool developed and also to develop a mechanism to link the identified risk with the casemix profile of the patient.

Abstract
As the population ages, wound management increasingly requires the expertise and resources of specialists in aged care. This paper presents a survey of the wound management practices and knowledge of Australian geriatricians. Seventy five per cent felt they had sufficient knowledge to manage a lower limb ulcer, but only 41 per cent were comfortable advising on the management of more complex ulcers. Twenty four per cent were unaware of any specialist wound clinic available to see their patients. For 39 per cent of the doctors, more than 10 per cent of their patients had lower limb ulcers although it was not usually the patients’ primary problem. These aged care doctors used a range of wound management products but 6.5 per cent indicated that they used gauze dressings and only 42 per cent always, or nearly always, recommended compression for an uncomplicated venous ulcer. Some 65 per cent always or nearly always had access to a nurse to assist them with dressings. Fifty six per cent never or almost never used a written protocol when managing wounds and only 22 per cent always or nearly always used a risk assessment tool to estimate pressure ulcer risk. Thus, it is important that geriatricians and other aged care specialists have adequate knowledge of wound management, and that there are sufficient specialists in aged care with It is concluded that comprehensive wound management education would be valuable for these aged care specialists, and that there is a need for more wound clinics staffed by geriatricians.

Abstract
Vasculitic leg ulcers, although forming a small proportion of all leg ulcers seen at the specialised wound clinics, pose a significant challenge in terms of diagnosis and treatment. Cutaneous vasculitis may be associated with systemic involvement and occur as a result of hypersensitivity reaction with formation of immune complexes.
Obtaining a deep biopsy from the margin of the ulcer assists with making a definitive diagnosis of a vasculitic leg ulcer. The essential elements of treatment of vasculitic leg ulcers include treatment of the primary cause, providing moist occlusive dressings, protection from further trauma and, most importantly, relieving pain.

Abstract
This article is the second part of the practice review of modern wound dressings. The abstract at the beginning of part one covers both articles. Part one described the nature of the article as well as the objectives of the workshops from which the article was derived. It also discussed some broader wound management concepts that facilitate the selection of a particular dressing.
This second part will consider dressings that fall in to the classes of hydroactive, alginate, hydrocolloid, hydrofibre, cadexomer iodine and zinc paste bandages.