Abstract
Cigarette smoking is one of the leading and most preventable health problems of Western society. Unfortunately, smokers provide a challenge for wound care practitioners as smoking is associated with impaired tissue restoration, increased risk of surgical wound infections and pressure ulcers and is a deleterious factor in the repair of post-surgical flaps and grafts.
Smoking inhibits healing through the effects of anoxia, hypoxia, impaired epithelialisation, vasoconstriction and enzymatic system toxicity. Individuals undergoing elective surgery may require additional assistance involving a multidisciplinary approach to cease smoking preoperatively. Managing patients’ wounds that include an arterial component necessitates a holistic approach involving client education, regular dressing changes and liaison with the physician.

Abstract
Pressure ulcer prevalence is frequently cited as a factor used to determine the quality of nursing care and is used as a proxy measure for nursing home quality. This paper reports the results of the organisational study conducted as a subcomponent of the PRIME trial. The PRIME trial was a multi-dimensional clinical trial designed to investigate the effectiveness of an integrated pressure ulcer management system in reducing the pressure ulcer prevalence and incidence in a cohort of Australian nursing homes. A stratified random sample of staff were interviewed from 17 consenting nursing homes (n=120). The interviews used a 10 question, semi-structured questionnaire covering four organisational quality factors and six PRIME trial implementation factors. Responses to questions were ranked on a scale of 1-5,1 representing no evidence and 5 representing embedded practice. Data were aggregated by nursing home and the mean scores were calculated. Data were correlated with baseline pressure ulcer prevalence and the post PRIME pressure ulcer prevalence.
The results of this study show that there was no relationship between baseline pressure ulcer prevalence and the context of care as measured by a range of organisational factors, including staff development planning, equipment and resource management, communication management and effectiveness of staff and resident feedback. The PRIME trial was able to significantly reduce prevalence of pressure ulcers regardless of the context of care. Paired sample t-tests showed a significant difference between the mean baseline prevalence (25.8%) and the mean post PRIME pressure ulcer prevalence (16.6%) (p=0.008) in nursing homes participating in the organisational component of the PRIME trial.

Abstract
Mr L, a 43 year old male with Type 2 diabetes, developed an infection in the right groin after a fall. He was diagnosed with Fournier’s gangrene and underwent surgery four times for debridement of infected, necrotic tissue. An extensive wound extending from the right groin around to the right buttock with a 2cm margin from the anus was created. After 10 days of normal saline gauze packs, use of a topical negative pressure dressing was suggested. Problems with the irregularity of the wound margins, the location of the wound in the groin, and its proximity to the anus were overcome by an innovative approach to wound management.

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