A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective.

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.

A man in his forties with rapid exacerbation of chronic foot ulcers. / En mann i 40-årene med rask forverring av kronisk fotsår.

BACKGROUND: The development of skin cancer, especially squamous cell carcinoma, is a well-known but rare and often under-recognised complication of chronic wounds and longstanding scar tissue. These skin cancers, known as Marjolin's ulcer, are more aggressive in nature than similar cutaneous cancers of different etiology, with a higher rate of local recurrence and an increased metastatic potential. CASE PRESENTATION: Our patient suffered severe trauma to his left leg and foot in a car accident during childhood and underwent extensive reconstruction. In the years leading up to today the left foot has been lymphedematous, with recurring sinuses and ulcerations. He was now admitted due to a rapidly progressing and debilitating wound. During the first consultation the clinical findings led to suspicion of malignancy and osteomyelitis. The histopathologic examination from our biopsies could not rule out the presence of a highly differentiated squamous cell carcinoma. MRI and bone biopsy revealed osteomyelitis. INTERPRETATION: With few exceptions, the treatment of malignancy in chronic wounds and longstanding scar tissue is surgical. Early diagnostics, including biopsies, and intervention are instrumental to a favourable outcome. We present this case report alongside current literature in order to raise awareness on the topic.

[Diabetic foot ulcers]. / Diabetiske fotsår.

Diabetic foot ulcers result from two specific complications: neuropathy and arteriosclerosis. Prompt and appropriate treatment of these often complicated wounds can help reduce complications that may lead to amputation. The most effective way to prevent these complications is to refer patients to interdisciplinary diabetic foot teams. The most important aspects of treatment are off-loading, treatment of infections, establishment of sufficient circulation, and local wound therapy. A specific examination is the basis for risk assessment. Prophylaxis and appropriate management of patients at risk of developing foot ulcers would contribute to reduce the number of amputations among diabetic patients.