It is well known that advancing age is a factor that affects the normal course of wound healing. The population over the age of 65 years is increasing globally, and this may be accompanied by an increase in the number of individuals experiencing delayed wound healing. There is a breadth of research to show that age-related changes in the epidermis and dermis change the skin's ability to resist damage and injury. In particular, the dermoepidermal junction becomes flattened, which predisposes the tissue to shear and friction forces. Within the dermis, alterations in the amount and structure of collagen also mean that the tissue is much more rigid. Prompt assessment of the skin to identify existing conditions as well as preventive measures is therefore essential. This article discusses the anatomy of the skin and the effects of ageing on the tissues. It also offers some guidance on skin assessment and the basics of skin care.

PURPOSE: To enhance the learner’s competence with knowledge regarding utilization of a tool kit to aid in the prevention, assessment, and treatment of skin tears. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Demonstrate knowledge of skin tear prevention and classification as presented in the International Skin Tear Advisory Panel’s tool kit. 2. Apply information from the skin tear tool kit to patient care scenarios. The International Skin Tear Advisory Panel has created a tool kit for the prevention, identification, and treatment of skin tears. The tool kit is based on extensive literature reviews, international input from healthcare professionals, and on expert opinion. It has undergone a modified Delphi process.

Home monitoring of skin temperature is effective to prevent diabetic foot ulceration. We explored the validity of various definitions for the >2·2°C left‐to‐right threshold used as a warning signal for impending ulceration. Twenty patients with diabetes and peripheral neuropathy monitored their skin temperature with an infrared thermometer at the plantar hallux, metatarsal heads, midfoot and heel four times a day for 6 consecutive days. Environmental temperature and walking activity were monitored and associated with foot temperature. The average temperature difference between feet was 0·65°C. At single locations, a left‐to‐right temperature difference of >2·2°C was found 245 times (8·5% of measurements). Confirmation of these above‐threshold readings on the following day was found seven times (0·3%). Corrected for individual left‐to‐right mean foot temperature differences, this reduced to four (0·2%). No ulcers developed in the week after monitoring. Left‐to‐right foot temperature differences were not significantly correlated with walking activity, environmental temperature or time of day. The >2·2°C left‐to‐right foot temperature threshold for impending ulceration is not valid as single measurement, but validity improves to acceptable levels when an above‐threshold temperature difference is confirmed the following day and further improves with individual correction. The threshold is independent of time of day, environmental temperature and walking activity.

Background: It is estimated that 2% of the population in developing countries suffer from a chronic wound, making it a hidden phenomenon that is increasing as populations age. The ease of access to maggot therapy has made it increasingly attractive for implementation. This study aimed to explore the effectiveness of maggot therapy as compared to hydrogel dressings in the healing of chronic wounds. Methods: An electronic literature search until October 2019 was performed using Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature. The eligibility criteria were chronic wound patients with an intervention that involved a comparison of any maggot species with hydrogel dressings. Results: The full text of five studies, involving 580 patients with chronic wounds, was retrieved. Four studies used the Lucilia sericata species. The maggot therapy facilitated faster and more effective debridement of non-viable tissue. It enabled faster development of granulation tissue and increased reduction in the wound surface area compared to hydrogel dressings. Maggot therapy had no effect on disinfection or complete healing rate for the wound. Conclusion: Maggot therapy should be considered for faster wound debridement, granulation tissue development, and wound surface area reduction as well as in surgical contraindications. This review can be used as a guide to assist clinicians in identifying patients who may benefit from maggot therapy.

Background Skin tears are acute wounds that are frequently misdiagnosed and underreported. A standardised and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. Objectives To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. Methods A multi‐country study was set up to validate the content of the ISTAP Classification System through expert consultation in a two‐round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter‐rater reliability, and intra‐rater reliability of the instrument. Results A definition for the concept of a “skin flap” in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0.79 (95% CI 0.79‐0.80) and sensitivity ranged from 0.74 (95% CI 0.73‐0.75) to 0.88 (95% CI 0.87‐0.88). The inter‐rater reliability was 0.57 (95% CI 0.57‐0.57). The Cohen's Kappa measuring intra‐rater reliability was 0.74 (95% CI 0.73‐0.75). Conclusions The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for a systematic assessment and reporting of skin tears in clinical practice and research globally.