Abstract
The management of complex mandibular wounds constitutes challenges for clinicians. The challenge is aggravated in cases of wound dehiscence coupled with flap failure and the presence of a buccal fistula. There is often a need to manage high amounts of wound exudate and saliva while endeavouring to achieve wound healing.
We report on a case of a complex mandibular wound in a 51-year-old Chinese male with mandibular neoplasm. The patient underwent tracheostomy, left modified radical neck dissection, en bloc resection of oral cavity tumour with total parotidectomy, infra-temporal resection and partial pharyngectomy. The wound was complicated by heavy exudate and large amounts of draining saliva as a result of a buccal fistula. This paper describes an innovative approach for managing the wound with dental gum and topical negative pressure dressings, which resulted in good outcomes for the patient.

Abstract
The use of negative pressure wound therapy (NPWT) is commonly embraced in the treatment of different types of wounds, in many countries. However, in parts of Asia the use of alternative modified wall suction systems and filler dressings of foam, nonadherent dressings and special sponges are frequently used when commercial products are not available or cost-prohibitive. In Hong Kong, the use of such adapted systems is frequently employed in the management of gastrointestinal fistulae. The case studies discussed in this paper outline the need and use of innovative NPWT applications.

Abstract
The management of complex abdominal dehiscence can be most challenging, especially when the challenge is compounded by a need to manage high fistulae output. This case study outlines the innovative management of a complex abdominal wound in a 56-year-old Chinese female. The patient had multiple surgeries and suffered from a deep abdominal wound dehiscence.
The wound was complicated by heavy exudates and contamination from faecal discharge and urine. This paper describes an innovative approach in managing this complex wound, which resulted in good outcomes for the patient.

Abstract
Complex draining wounds increase the care burden on health providers and reduce patient quality of life. Enterocutaneous fistulae present a challenge to medical and nursing staff and, if not adequately managed, a patient with a high-output fistula can develop fluid and electrolyte imbalances in a relatively short period of time. This case study outlines the management of a patient with faecal fistulae in Thailand.

Abstract
Management of draining wounds can be especially challenging and in Indonesia must be considerate of the patient’s psychological and spiritual needs. In addition, the patient’s financial status and their ability to pay will determine treatment choices. In this article, we will outline the need for some creative and low-cost innovations for management of complex draining wounds in Indonesia. Like other countries, our goals of care focus on identifying wound aetiology, factors which will impact on wound healing as well as optimising containment of the wound drainage and wound bed preparation and interventions for improving the patient's quality of life.

Abstract
The management of an open abdomen may present client and wound care challenges until the abdomen is closed1. This case study describes a client who had a laparostomy and extensive tissue debridement of the abdominal wall on a background of small bowel perforation, peritonitis and life-threatening sepsis. The abdomen remained open for over three weeks from initial emergency surgery prior to commencing repair of the abdominal wall with a biological mesh, Surgisis®. Of interest was the concurrent use of topical negative pressure therapy (TNPT) with the biological mesh until the wound bed was suitable for a skin graft to complete wound closure. At the time, clinical practice guidelines or published literature to guide wound practice, in the context of the exposed biological mesh and TNPT, was not available and is therefore discussed.

Abstract
Introduction: Many patients undergoing radiation treatment experience moist desquamation, a severe acute skin reaction.
The pain, discomfort and dressing applications subsequent to moist desquamation exacerbate the distress associated with the patients’ cancer diagnosis and treatment.
Background: Radiation oncology nurses in a tropical area of Australia believe that moist desquamation occurs more often in patients undergoing radiation treatment in the summer months. It is surmised that this increase is due to a combination of high humidity and the consistency of the preventative cream currently recommended by the clinical staff.
Method: A narrative literature review was undertaken to identify a potential alternative non-prescription topical product, readily available in Australia, to prevent moist desquamation in a tropical environment. Research literature published in a 10-year time frame ending December 2010 was retrieved and reviewed.
Main findings: Seven individual trials met our inclusion criteria. No non-prescription moisturising cream, lotion or gel that was trialled was significantly better than any other at preventing moist desquamation, and none were trialled in a tropical climate.
The literature did indicate possible alternatives to the currently recommended preventative cream.
Conclusion: There is no evidence to support recommending the use of any specific non-prescription topical product to prevent radiation-induced acute skin reactions. This literature review has informed a randomised controlled trial of two non-prescription creams in a tropical setting. It is anticipated that the trial will provide evidence-based preventative skin care recommendations for patients receiving radiation treatment in a tropical climate.

Abstract
A community pressure ulcer prevalence study conducted in a health organisation in NSW has revealed patients living at home can experience extended waiting time for equipment to be prescribed by occupational therapists. This can result in delays in accessing pressure-relieving devices in community settings. Therefore, several strategies have been implemented in the Greater Newcastle Cluster (GNC), one of the Primary and Community Health Network in Hunter New England Local Health District (HNELHD), NSW. These various interventions include: systems to improve documentation; an alert notification which has been created in the electronic medical record database; promotion of the HNELHD pressure ulcer prevention and management online education programme; and prompt access to effective pressure redistribution equipment (Repose) in the community setting.
Repose is a compact, lightweight pressure-redistributing device that does not have manual handling limitations. This strategy has enhanced the community nurses’ capacity to prescribe and provide devices immediately for those patients who are identified at risk of pressure injury whilst waiting for further assessment and delivery of further pressure redistributing equipment.
Our preliminary audit results have shown that Repose is effective in preventing wounds and facilitating healing of pressure ulcers while delivering high patient satisfaction. These strategies allow evidence-based best practice to be embedded in daily practice to improve patient safety systems that will permit future monitoring of pressure injury prevention effectiveness.

Abstract

Abstract
This project concentrated on the barriers patients with lymphoedema perceive which prevent them from continuing optimal skin care. Despite receiving education on the importance of skin care in the management of lymphoedema, many patients do not appear to maintain appropriate skin care continually. The project also investigated whether the expectation of skin care as provided in an education programme is acceptable and achievable for these patients. Eight clients diagnosed with lymphoedema attending a clinic were interviewed using semi-structured questions. The transcripts were then analysed to find common themes.
The results found patients reported a need to be vigilant and make a psychological and physical commitment to achieving their lymphoedema care. Similarly the factors affecting a person’s ability to maintain skin care, such as physical limitations, costs and motivational issues were identified in this study. Generally participants found the expectation of skin care was achievable for them but this was likely to be influenced by fear of the consequences of not achieving it. It became clear, during analysis of the responses, that participants were mostly achieving appropriate skin care but were unable to link its relevance in preventing secondary complications or worsening symptoms of lymphoedema. Educators may need to re-evaluate their programmes based on individual skills and need. Despite this, participants rated the education process highly.

Abstract
A man with a history of moderate to severe Crohn’s disease since early childhood contracted leishmaniasis and then underwent further surgery for Crohn’s disease. Postoperatively he developed severe peritonitis and required laparostomy, which was managed using topical negative pressure. The controversial nature of this form of management is discussed together with other issues for nurses’ consideration when caring for a long-term patient.

Abstract
Ruby is a 55-year-old professional lady who has suffered pain and poor wound management of a lower lumbar soft tissue radiation injury following treatment of metastatic disease. Ruby’s primary lesion was a poorly differentiated carcinoma of her left breast. This review of her wound management explores the manner in which patient autonomy and an adjunctive treatment option contributed to an improvement in her skin integrity and personal wellbeing.

Abstract

Abstract
Complex wound management provides many challenges to the clinician, all of which are determined by the presentation of the wound and the aims for healing. How we, as clinicians, approach this may be determined by our individual wound assessment, best practice and also our own clinical experience.
Wound bed preparation maximises the optimal wound healing environment; necrotic tissue is related to bacterial load and can have an adverse effect on wound healing. Necrotic tissue can be managed by debridement in the majority of wounds. However, this should only be considered following full assessment of the ability of the wound to heal and the patient’s pre-existing comorbidities1.
Autolytic debridement uses moisture-retentive dressings to facilitate the breakdown of necrotic tissue. Today there is a diverse range of wound care products designed to promote moist wound healing. Choice of dressing may be determined by availability, ease of use or cost-effectiveness. But how often is a product chosen for its anti-inflammatory activity or antimicrobial action when debridement is the initial goal?
This article reports the management of three case studies taking this early approach using a relatively new product called Woundaid®. The outcomes of this “first line” method of wound debridement and the positive outcome in wound healing can be seen. This is the first publication relating to this therapy according to current literature.