Abstract
Policy for the treatment of wounds, burns and lymphoedema in a world in which poverty and strife are prominent requires that those who intend to manage them should think globally. The author chooses 12 points for emphasis.

Abstract
Most wound care providers are aware of the principles embodied in the concept of ‘wound bed preparation’, which is an integrated approach that seeks to enhance healing of acute and chronic wounds by optimising four key aspects of a wound bed: 1) tissue debridement; 2) inflammation/infection; 3) moisture levels; and 4) epithelial edge healing. Ideally, treatment strategies should simultaneously address each of these four aspects. This often leads to combining advanced topical and/or systemic therapies that stimulate healing or remove barriers to endogenous healing. While some laboratory data and clinical trial results suggest specific combinations of treatments may synergistically enhance healing, other combinations may destructively interact and reduce the effectiveness of the treatment components. This brief review presents some examples of constructive, destructive and neutral interactions of combinations of wound treatments and emphasises the need for clinicians to carefully consider how combinations of wound treatments may interact in the wound bed.

Abstract

Abstract
Atrophie blanche (AB) is typically described as a variable dimensioned, smooth, ivory-white plaque stippled with telangiectases and is surrounded by hyper-pigmentation. AB commonly occurs in middle-aged women on the lower legs or feet, often associated with ulcerations and chronic venous insufficiency (CVI). The ulcers are slow to heal and painful. Histologically, AB shows superficial and deep dermal vascular occlusion by microthrombi resulting in vascular damage to the skin. However, there is still no consensus on the pathogenesis of AB and a standard protocol of management is lacking.

Abstract
Background: Surgical site infections are one of the most common hospital-acquired infections and are an important cause of morbidity and mortality. These infections are difficult to control and, if not treated in time, increase further morbidity. In the present study, an attempt was made to develop simple and effective treatment modality by using citric acid as a sole antimicrobial agent to control surgical site infections.

Methods: A total of 70 cases of surgical site infections not responding to conventional treatment modalities were included in the present study. Pus from each case was processed for culture and susceptibility. Susceptibility of clinical isolates to citric acid was determined by broth dilution method. Three per cent citric acid ointment was applied to the wound daily once until it healed completely or showed formation of healthy granulation tissue.

Results: Culture and susceptibility results showed P. aeruginosa (34.37%) as the commonest isolate and amikacin (58.33%) as the most effective agent. All the isolates were found to be inhibited by citric acid (MIC – 500 to 2,500 µg/ml). Application of 3% citric acid to wounds resulted in complete healing of postoperative wounds or formation of healthy granulation tissue in 6 to 25 applications in 69 cases (98.57%). In 12 cases (17.14%) wounds were closed by suturing after formation of healthy granulation tissue.

Conclusion: Citric acid treatment was found to be safe and useful in the treatment of surgical site infections. Hence, the topical use of citric acid is recommended, especially when the treatment of surgical site infections is a matter of great concern.

Abstract
The frequency of pressure ulcers in patients living at home is not well-defined. To quantify the extent of this issue, surveillance was conducted in 2009 within 45 community health sites across the Hunter New England Area Health Service of New South Wales (NSW). This is the first community pressure ulcer prevalence study completed in NSW. Seven hundred and ninety-six randomly selected patients cared for by community nurses participated in the study. A pressure ulcer prevalence rate of 8.9% (n=71, 95% CI=7.1–11.1%) was recorded, 6.5% (n=52, 95% CI=5.0–8.5%) if stage I pressure ulcers were excluded. A total of 111 pressure ulcers were identified on 71 clients, with 35.3% of the patients classified as high risk of developing pressure ulcers. Of the patients with pressure ulcers, 40.8% developed the ulcers during their care by community nursing staff. Similar portions of patients acquired their ulcers during hospitalisation or before admitted to the community nursing services. Issues requiring action from the survey include improving documentation of risk, improving speed and access to pressure redistributing devices, which were absent in 50% of the patients with pressure ulcers.

Abstract
In order to reduce the incidence and severity of radiation-induced oral mucositis in patients with head and neck cancers, an oral gel product was added to the mouth care regimen in a regional northern Australian facility. An audit of the medical records of 20 patients who underwent radiation therapy was undertaken to assess the effectiveness of this more comprehensive mouth care regimen. All patients in this sample developed oral mucositis by the end of their radiation treatment: 21% had a low grade, 79% progressed to the higher Grade III. All patients who did not adhere with the full mouth care regimen experienced a Grade III oral mucositis; only half of the patients who adhered with the full mouth care regimen experienced the more severe Grade III mucositis. It is imperative that nurses actively support patients to follow the prescribed mouth care regimens to minimise oral complications associated with radiation therapy.