Abstract
The purpose of this study was to gain an insight into the opinions, current clinical practice and knowledge base of registered nurses (RNs) responsible for the care of residents in high care (nursing home) residential aged care (HCRAC) facilities in relation to skin tears. In addition, the awareness and/or use of research findings in their practice, along with the identification of topics to be included in skin tear educational programmes were also explored. This descriptive study used questionnaires to collect data from the target population.
The main findings of the study were that skin tears are perceived by RNs to be a commonly occurring wound in aged residents, and that RNs are directly involved in the reporting, assessment and management of these wounds. There appeared to be no uniform language used by Australian clinicians relating to the description and classification of skin tears. RNs were also often unaware of published skin tear research. A wide range of treatment modalities was being used for skin tears, with little evidence available to support their use in these wounds. Specific skin tear topics identified for inclusion in future educational programmes were aging skin issues, resident risk assessment, skin tear classification skills, local wound management and preventative strategies. The non-response rate was high.
Further research is required to add to the small but growing skin tear knowledge base. National incidence and prevalence rates, along with uniformity in skin tear language, incident reporting, assessment, classification and management are required. Future prospective, randomised, controlled, clinical studies relating to skin tear type (classification) and treatment modality may guide clinicians in the provision of evidence based wound care. There is a need to raise clinicians' awareness and to disseminate both past and future research findings through exposure to the literature and formal educational programmes.

Abstract
Meningococcal septicaemia complicated by purpura fulminans remains a devastating illness with rapid onset, debilitating morbidity and high mortality. The clinical course of management of 68 children (average age 3.4 years) with purpura fulminans seen over a 22 year period is described. All patients received maximum systemic support. Standard surgical techniques were utilised for skin grafting and amputations. Overall mortality was 10 per cent. Demarcation of necrotic areas was evident at 5.5 days and the average area of skin necrosis was 14 per cent body surface area. The lower limbs were predominantly affected. Purpura fulminans resolved in 13 children (19 per cent) without skin necrosis. Skin grafting was required in 39 children. The following factors were associated with a poor outcome for peripheral extremity salvage; progressive irreversible skin changes, early disappearance of distal pulses, tense cold swollen extremities and intense pain on passive movement of the affected extremity. Amputations were performed proximal to the area of necrosis, on average 27 days post injury. Soft tissue releasing incisions were not performed.

Abstract
The wound healing process involves a series of cellular and biochemical events that ultimately lead to tissue repair and regeneration. These events are classically defined as haemostasis, inflammation, proliferation, epithelisation, maturation and remodelling of the scar tissue. Of particular importance to the healing process is the involvement of endogenous growth factors, cytokines and proteases at each of these events. Current knowledge of these at each stage of healing, as well as the biochemical nature of wounds, suggests that there is great potential for analogues of these agents to improve the quality and healing time of a wound, particularly a chronic wound, when they are applied exogenously.
However, many products containing growth factors, cytokines or protease inhibitors are yet to reach market availability. This is mainly due to formulation problems (such as stability), safety concerns, pharmacological aspects (such as effective doses and growth factor combinations) and difficulties with developing well-controlled clinical trials to prove their efficacy.
However, the concept of employing exogenous growth factors, cytokines and protease inhibitors to promote optimal wound healing is only in its infancy. And, while further research into the pharmacology, toxicology and formulation of design and development is still warranted, the American Food and Drug Administration's approval of the growth factor based product, Regranex®, should that indicate that the role of these substances in wound management seems promising.

Abstract
Venous thromboembolism (VTE) continues to be a major cause of morbidity and mortality in hospitalised patients. Its long-term sequelae of post phlebitic syndrome and venous ulceration are significant burdens on the Australian health dollar. Prevention of VTE by appropriate prophylactic measures is unquestioningly the key to reducing acute and long-term consequences of deep venous thrombosis (DVT). Unfortunately, best practice guidelines for VTE prophylaxis are not optimally being followed in our hospitals.
In the first review article in this series, the incidence, prevalence and sequelae of VTE were discussed. The second article discussed the guidelines for prophylaxis and treatment of VTE. However, considerable confusion exists about the role of graduated compression stockings in VTE prophylaxis and the relevance of difference compression levels. Many clinicians are also unfamiliar with intermittent pneumatic compression devices. This final article in the series seeks to clarify the role of compression therapy in VTE prophylaxis.