Hard-to-heal wounds Resources

Aim: To evaluate whether switching to a multilayered, bordered, silicone-coated foam dressing (SFD) alongside structured clinical training reduces dressing changes and costs while maintaining or improving wound management in primary and home care settings. Method: Outpatients with hard-to-heal wounds that had been managed with foam dressings (other than the study dressing) were recruited. Data on foam dressing use in the seven days prior to the baseline assessment was recorded. Clinicians received structured training on SFD use and wear time. Eligible patients’ wounds were then dressed with SFDs for up to four weeks alongside standard care. Patient comfort, satisfaction and pain were recorded and clinicians evaluated dressing performance. Results: Thirty-seven patients completed the evaluation. The median number of SFDs changed within the seven days before the final visit was significantly less than that for previously used dressings (1 vs 3; p<0.001), equating to a 44% cost reduction. Despite poor prior healing, an average reduction in wound size of 68.7% from baseline to final visit was observed, with 32.4% of wounds fully healed. Clinicians rated SFDs highly across all assessed attributes. Patients reported less pain and better comfort. No dressing-related adverse events were reported.
Conclusion: Using SFDs with clinician training reduced dressing frequency and costs while improving wound outcomes and satisfaction of both patients and clinicians. However, due to the small sample size, short follow-up, and lack of a randomised comparator, further investigation using robust methods is needed.

This article explores the integration of a muscle pump activation (MPA) device (the geko® device) into University Hospitals Coventry and Warwickshire community wound healing team’s (CWHT’s) wound care treatment model as an adjunctive intervention for complex and non-healing wounds. The CWHT specialist service temporarily assumes care for patients with wounds which are not healing, focusing on individualised plans to assess healing potential or support quality of life. In 2025, the team introduced the geko device for patients whose wounds were not progressing with standard care. The cases described here highlight its impact, i.e. demonstrating significant healing, reduced pain, and improved mobility and quality of life. This device, which enhances circulation via neuromuscular electrostimulation (NMES), proved eͿective when used alongside advanced wound care. These outcomes support the value of specialist services incorporating adjunctive therapies to optimise care, relieve pressure on community teams, and achieve meaningful outcomes for patients with complex wounds.

Hard-to-heal wounds present a significant challenge in healthcare, requiring a comprehensive understanding of the wound healing process and effective management strategies. A survey was conducted by the Journal of Community Nursing among its registered online members to explore the current opinions and challenges faced by healthcare professionals (HCPs) who are involved in delivering wound care, including opinions on advanced wound therapies. The survey, which consisted of 14 questions, highlighted some interesting findings including several challenges experienced when treating patients with wounds. Results revealed that 69% (n=311) of participants indicated a lack of time and resources as the primary barrier. Patient compliance (67%, n=303), limited access to advanced therapies (47%, n=211), insufficient training (37%), and cost pressures (32%, n=145) were also significant concerns. Despite these challenges, most respondents (63%, n=281) felt ‘somewhat satisfied’ with their ability to manage wounds, but found the process frustrating due to the difficulties that they encountered.

In order to instil confidence in your patients, you yourself need to feel confident in the care you’re providing — including the products you use.

This is why we’re publishing the results of a recent randomised controlled trial (RCT) comparing the efficacy of Exufiber® with the market leading gelling fibre dressing, in exuding venous and mixed aetiology leg ulcers.

IF YOU FEEL CONFIDENT, YOUR PATIENTS FEEL CONFIDENT
In order to instil confidence in your patients, you yourself need to feel confident in the care you’re providing — including the products you use.

Debridement is the removal of non-viable tissue from the wound bed and surrounding skin and is an important part of wound healing and wound bed preparation. Devitalised tissue, such as necrosis, slough and hyperkeratosis, interfere with the process of wound
healing. When a wound fails to progress, there is a need to assess the wound bed and surrounding tissue and promote an optimum environment that encourages the formation of healthy granulation tissue (Young, 2014). Recent advances in debridement techniques
using monofilament fibre technology can be practised by nonspecialist nurses and used safely and effectively in a patient’s home. In a recent audit, a dataset of 486 patients who had been newly prescribed a monofilament fibre debridement pad was obtained to
validate clinical effectiveness and cost efficiency. The total cost of wound care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 after (Burnett et al, 2021). This evidence reinforces the National Institute for Health and Care Excellence (NICE) recommendations for use of monofilament fibre debridement in the community, based on evidence of its effectiveness and estimated cost savings (NICE, 2019).

The problem of delayed wound healing has been highlighted in several publications which has stimulated debate on variance and the need for updated care pathways. This paper demonstrates how adjunctive therapy can be added to the ‘standard care’ model, described in the National Wound Care Strategy Programme’s recommendations for lower limb wounds, to enhance outcomes for patients with ‘hard-to-heal’ lower limb wounds (NWCSP, 2020). A decision-making pathway based on published literature is described,  which uses wound assessment and observed response to treatment to allow the effective and targeted introduction of adjunctive therapies for ‘hard-to-heal’ wounds. This approach will allow the cost-effective introduction of new and evolving therapies, such as WoundExpress™(Huntleigh Healthcare), which addresses the underlying problems associated with resistant lower limb oedema and compromised venous function. The pathway also indicates how other adjunctive or innovative topical wound-based treatments can be integrated to optimise outcomes while providing cost-effective care.

It can be a bit daunting when you are faced with a complex, chronic wound that is failing to progress. What makes a chronic wound hardto- heal and where do you start with its management? It can also be challenging for patients because the wound may be affecting their quality of life, often causing a high volume of exudate, increased pain or discomfort and malodour (Atkins et al, 2019). This article describes what can make a wound become hard-to-heal and offers guidance on assessment and management and how the use of a collagen wound dressing, Cutimed® Epiona (Essity), can help promote wound healing.