Abstract
WoundsWest is an innovative Western Australian (WA) project under Ambulatory Care and Chronic Disease Management Reform undertaken in partnership with the Western Australian Department of Health, Curtin University of Technology and Silver Chain Nursing Association.

WoundsWest’s Online Wound Management Education Program is a core component of WoundsWest. It involves the interdisciplinary development of an anticipated 16 online wound management education modules, which are designed to assist health professionals and health services to deliver best practice in wound management and reduce preventable wounds and adverse wound management outcomes. The development of these modules involves an extensive search of the literature to ascertain the evidence for best practice. In preparation for the development of the forthcoming online Leg Ulcer Module a considerable number of atypical leg ulcer presentations and associated comorbidities were identified. This paper outlines some of these presentations and comorbidities and reminds health professionals of the need for further diagnostic investigations when leg ulcer signs and symptoms are atypical, or the ulcer fails to heal in an orderly and timely manner.

Abstract
Diabetic foot ulceration can present a major challenge to healthcare professionals. Even very small lesions have the potential for a disastrous outcome; particularly those overlying joints. This case study discusses the management of a 60-year-old male Maori with type 2 diabetes and a neuro-ischaemic foot ulcer, who underwent a 1st ray and 2nd toe amputation followed by a split skin graft. Friction to the graft site led to the development of verrucous hyperplasia; a hyperkeratotic, papillomatous verrucous lesion. Despite excision and regrafting, the lesion recurred. Structural changes to the foot caused a new foot ulcer to develop. In this paper the impact of the complications of diabetes on the patient’s feet and his mobility as well as the psychosocial factors related to his foot ulceration and foot deformity will be discussed.

Abstract
A number of recent research articles have shown that negative pressure wound therapy (NPWT) is effective in healing a wide range of complex wounds. This form of therapy helps expedite wound healing mainly by the removal of wound exudate, bacterial reduction as well as encouraging wound contraction. A pilot study was conducted to evaluate the clinical efficacy and cost-effectiveness of NPWT using the V1STA® wound vacuum system (Smith & Nephew) across three surgical areas. This technology uses a special gauze-based wound interface instead of the medical grade sponge. This evaluation, which consisted of 20 patients with chronic or surgical wounds, included objective wound measurement at each dressing change to track wound healing rates. The complexity of wounds included compromised graft site (1), diabetic foot ulcers (8), dehisced surgical wounds (5), orthopaedic wounds (5) and necrotising fasciitis (1). This study has demonstrated that positive outcomes were obtained at cost savings of almost 30%, compared with the alternative NPWT. Furthermore, this mode of delivery not only was a lot easier to apply but was relatively pain-free to remove the old dressings.

Abstract
Prediction, prevention and management of pressure injuries are areas that require specific attention from nurses in clinical practice. Moreover, increased awareness that these injuries are preventable is an important precursor to changing nurses’ practice and reducing the incidence of pressure injuries. The language and terminology that we use in daily practice can impact on the understanding and approach that nurses take to care delivery. In this area of wound care practice commonly used terminology that emphasises the nature of the wound, rather than its causation, may be a significant factor that limits the level of concern about prevention and responsibility taken by clinicians. This paper argues that the term ‘pressure injury’ promotes a better understanding of the fact that these wounds are preventable and may refocus the attention of nurses providing care to at-risk patients.

Abstract
Objectives: If wound assessment instruments are to be used in the periodic assessment of wound healing, they must prove to be valid, reliable and sensitive measures of wound healing. Thus, this systematic literature review aims to examine available wound healing instruments in terms of these parameters.

Method: Only instruments able to measure changes in wound healing were included in this review and not those used to predict healing, classify wounds, or measure wound characteristics per se. All wound types were suitable for inclusion.

Results: A total of 20 articles were found, evaluating the validity of 10 instruments used to monitor wound healing. No instrument satisfied all criteria required for instrument validation. Instruments used to assess pressure ulcers, notably the Pressure Ulcer Scale for Healing (PUSH) and Pressure Sore Status Tool (PSST), had been validated to the greatest extent, whilst those describing healing in leg ulcers and general or surgical wounds tended to lack comprehensive and quality evaluation.

Conclusion: This review identified substantial gaps in the literature with regard to validation of existing wound healing instruments. Future studies are needed to comprehensively validate these instruments.