Abstract
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Abstract
Aim: Negative pressure wound therapy (NPWT)-related outcomes have not been systematically reported in Australia. We aimed to evaluate the clinical efficacy of NPWT on post-surgical foot wounds in a consecutive series of patients with diabetes.
Method:Data was extracted from the Diabetes Centre electronic database for all patients treated for post-surgical foot wounds between September 2006 and January 2011. Criteria were diabetes with peripheral neuropathy and an acute post-surgical wound to tendon or bone. A manual audit was conducted on identified cases to determine healing parameters, duration and cost of the NPWT. Adverse events and long-term outcomes were also determined.
Results: From a total of 155 post-surgical patients, 34, each with one wound receiving NPWT, were studied. Amongst the group, 19 were to tendon and 15 were to bone. More than half the wounds resulted from amputation. Complete wound healing was achieved in 79%, with a median healing time of 110 days. One treated ulcer required subsequent partial foot amputation.
Conclusion: NPWT used in diabetic post-surgical wounds was associated with a high rate of wound healing and a low amputation rate. These results accord well with reported international outcomes and support the increasing use of targeted NPWT.

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Abstract
Diabetes remains the most common and important cause of lower limb amputation. Despite evidence that organised, multidisciplinary care can improve outcomes for diabetic foot problems, it is only in the last few years that evidence has started to emerge to suggest that amputation rates for people with diabetes may be starting to improve. Even within those regions that are showing improvements, there remains significant variation in amputation rates, suggesting variability in availability and standards of care. More work is required to make the highest quality of care available to all.

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Abstract
Peripheral arterial disease and associated critical limb ischaemia is a well-respected predictor of wound morbidity and tissue necrosis. With respect to diabetes, patients who present with a threatened lower extremity may carry a broader spectrum of contributing factors including neuroischaemic and infectious aetiologies. The authors of the Society for Vascular Surgery (SVS) Lower Extremity Threatened Limb Classification have refocused an approach to the patient with a threatened limb and not only address ischaemia, but also have taken into account the key factors of tissue loss and the presence and extent of infection. Case examples are presented for practical application of this system which may aid in characterising and stratifying the clinical state and risk of amputation in patients whose disease burden has given way for a limb-atrisk. With this new classification system and risk assessment tool, meaningful clinical trials may be developed to improve current operative and non-operative treatment options for the threatened limb.

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Abstract
Foot wounds are a growing international concern, as the incidence of risk factors such as diabetes, obesity, vascular disease and advancing age rises. This systematic review and meta-analysis was performed to determine the prognostic capabilities of toe blood pressure and the toe brachial index for predicting chronic foot wound healing or progression to amputation. MEDLINE, CINAHL, EMBASE, PubMed Central and the reference lists of retrieved studies were systematically searched in June 2014. Two authors independently reviewed selected studies reporting original research. Methodological quality was assessed using STROBE and CASP appraisal tools. Ten studies were reviewed; six investigated wound healing and four investigated amputation as the outcome. Study quality was inconsistent; most failed to report aspects of their methodology and used different equipment or techniques. Meta-analysis indicated a cut-off toe blood pressure of 30 mmHg was associated with a relative risk of 3.25 (95% CI: 1.96, 5.41) for non-healing, however, significant heterogeneity was found. Additionally, serial assessments or grading of toe blood pressure values may improve accuracy and utility. Toe blood pressure and related indices may be useful in predicting the outcome of chronic foot wounds; however, further high-quality research is required before clinical utility is confirmed.

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Abstract
Diabetes-related foot ulceration is the leading cause of non-traumatic amputation and leading cause of hospitalisation for people with diabetes in Australia. It is associated with depression and high mortality. High-risk foot services (HRFS) in Australia, like the Diabetes Centre at Royal Prince Alfred Hospital, are providing specialised multidisciplinary management for patients and some data on the healing outcomes and improvement in processes has been published. Performance indicators are a key mechanism in the quality improvement process. Excluding national amputation rates, there is no agreed set of performance indicators for monitoring outcomes or processes associated with the management of diabetic foot disease in Australia. This article discusses the processes for selecting and defining indicators that can lead to improving care and outcomes for people with diabetes-related foot ulceration and includes and describes the experiences of measuring outcomes and developing performance indicators for HRFS in the Sydney Local Health District. In time, we anticipate the formulation of national and international consensus performance indicators for diabetes HRFS that can be applied locally to particular patients, ulcer types and models of health care delivery.

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Abstract
The prevalence of leg ulcers of is 0.12%–1.1% and >3,000 lower limb amputations are performed yearly in Australia due to non-healing leg or foot ulcers. Although evidence on leg ulcer management is available, a significant evidence–practice gap exists. To identify current leg ulcer management, a cross-sectional retrospective study was undertaken in Brisbane, Australia. A sample of 104 clients was recruited from a community specialist wound clinic and a tertiary hospital outpatients’ specialist wound clinic. All clients had an ulcer below their knee or on their foot for ≥4 weeks. Data were collected on ulcer care, health service usage and clinical history for the year prior to admission. On admission, participants reported having their ulcer for a median of 25 weeks (range 2–728 weeks); with 51% (53/104) reporting an ulcer duration of ≥24 weeks. Including the wound clinic, participants sought ulcer care from a median of three health care providers (range 2–7). General practitioners (GPs) provided ulcer care to 82% of participants. Nearly half (42%) had self-cared for their ulcer; 29% (30/104) received treatment by a community nurse. A gap was found between the community-based ulcer care experienced by this population and evidence-based guidelines in regard to assessment, management, advice and referrals.

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Question
What is the best available evidence on the effectiveness of pneumatic compression in managing lymphoedema?

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