Intensive care unit (ICU) patients are at high risk for pressure injuries (PIs), medical device-related pressure injuries (MDRPIs), and skin tears (STs). Although nurses play a key role in preventing all three conditions, existing research has mainly focused on PIs, with limited evidence addressing nurses' combined knowledge related to MDRPIs and STs. In particular, shared deficiencies across these conditions remain unclear. This study aimed to assess ICU nurses' knowledge of PIs, MDRPIs, and STs together to identify overlapping knowledge gaps that may affect skin integrity management in ICU settings. A cross-sectional online survey was conducted with 283 ICU nurses. Data were collected using three validated tools: the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0), the Medical Device-Related Pressure Injury Knowledge Assessment Tool (MDRPI-KAT), and the Skin Tear Knowledge Assessment Instrument (OASES), enabling construct-specific measurement across related conditions. Knowledge levels varied across domains, with mean total scores of 14.44 ± 3.43 (PUKAT 2.0), 8.73 ± 1.83 (MDRPI-KAT), and 10.17 ± 2.44 (OASES). Across all three tools, prevention consistently emerged as the lowest-scoring domain. Higher knowledge scores were observed among nurses with greater professional experience, postgraduate education, and prior care experience related to STs. The findings provide a comprehensive overview of ICU nurses' knowledge regarding PIs, MDRPIs, and STs, highlighting variability across domains and consistently lower scores in prevention-related areas. These results underscore the need for targeted educational strategies to strengthen knowledge across key aspects of skin integrity management in intensive care settings. However, findings should be interpreted with caution due to potential sampling bias related to social media-based recruitment and the absence of multivariable analysis. Not applicable.

To determine the prevalence of medical adhesive-related skin injury (MARSI) and its association with relevant clinical factors and medical devices in intensive care. An observational, cross-sectional, analytical study was conducted on 84 adult patients admitted to intensive care at the Clinical Hospital of the University of Chile. Data collection included sociodemographic characteristics, MARSI occurrence and types, use of medical devices including adhesive fixation products, medical history, nutritional status, risk factors for skin lesions, biochemical and haematological parameters and skin characteristics. Standardisation training was conducted for data collection, and analysis was performed using STATA v18 (α=0.05). The mean patient age was 63.02±16.0 years, and 53.6% were male. Nine MARSIs were observed in 9.5% (n=8) of patients. Skin stripping (1.2%) occurred in the cervical region, while skin tears (6.0%) affected the cervical region (1.2%), thorax (1.2%) and upper limb (3.6%). Irritant contact dermatitis was found in 3.6% of cases in the upper limb. The most frequently used medical device was the peripheral venous device (76.2%, n=64), and the most common fixation products were acrylic-based adhesives: transparent polyurethane film (88.1%, n=74) and elastic polyester non-woven wide-area fixation (67.9%, n=57). Transparent polyurethane film with acrylic adhesive was the most common adhesive implicated in MARSI, in 4.8% (n=4) of cases. A multiple logistic regression model identified two independent predictors: the chance of MARSI was significantly increased in type 2 diabetes (odds ratio (OR): 8.28; p=0.024; 95% confidence interval (CI): 1.31, 52.14) and reduced with elastic polyester non-woven wide-area fixation (OR: 0.116; p=0.035; 95% CI: 0.01, 0.86). These findings confirm that intensive care patients, particularly those with type 2 diabetes, are at increased risk of developing MARSI. The findings also enhance the understanding of MARSI epidemiology, facilitating evidence-based preventive strategies including the choice of fixation products in intensive care settings. Moreover, they underscore the need for clinical protocols to incorporate education on MARSI identification, standardised documentation and preventive measures.

Prevalence and associated factors of skin tears among hospitalized older adults in a hospital in Türkiye: A point prevalence study.

Effect of a preoperative coating agent on postoperative skin tears in pancreatectomy.

To develop a virtual simulation for skin tears (STs) and evaluate the effect of this simulation on wound care nurses' knowledge and skill levels. This study used a pre/post-follow-up design and was conducted in four phases. Researchers developed a virtual simulation on STs (SteVis), the scenario, and the simulation software, and conducted its pilot application within the first 3 stages. In the final stage, researchers evaluated the effect of the SteVis on wound care nurses' knowledge and skill levels. Data were collected using the individual characteristics form, Skin Tear Knowledge Assessment Instrument, skin tear skill assessment form, and SteVis feedback form at 3 time points: before the simulation (T 0 ; n=42), after the simulation (T 1 ; n=42) and at a 2-month follow-up (T 2 ; n=31). Participants' knowledge ( F =7.679; P =.001) and skill scores ( F =20.969; P <.001) regarding STs increased in T 1 and T 2 measurements compared with before the simulation. There was no statistically significant difference in the knowledge scores of the participants between T 1 and T 2 measurements ( P >.05). However, in all measurements, the participants' skill levels increased significantly ( P <.05). The study demonstrated that the use of SteVis increased wound care nurses' knowledge and skill levels regarding STs. Future experimental studies should explore the long-term effects of the SteVis on nurses' knowledge and skill levels.

Collagenase Clostridium histolyticum (CCH; Xiaflex) is an established nonsurgical therapy for Dupuytren contracture. Although adverse effects such as edema, ecchymosis, and skin tears are common, vascular injury is rare and pseudoaneurysm formation has not been previously described. Clinical evaluation and operative management of a patient who developed a digital artery pseudoaneurysm after CCH injection and manipulation were reviewed. A 66-year-old man developed a pulsatile swelling on the volar-radial aspect of the small finger 1 week after manipulation. Duplex ultrasound demonstrated a 1.8 × 1.5 × 1.9 cm partially thrombosed pseudoaneurysm with a 1.2 × 0.5 × 1.0 cm patent lumen arising from the radial digital artery. Surgical exploration revealed the artery entering the pseudoaneurysm with the digital nerve displaced centrally. The diseased arterial segment was excised and clipped proximally and distally. Digital perfusion remained intact and recovery was uneventful. Digital artery pseudoaneurysm is a potential, previously unreported complication of CCH injection for Dupuytren contracture. New or pulsatile swelling after manipulation should prompt vascular imaging to exclude this diagnosis.

PurposeCompare contracture recurrence after limited fasciectomy (LF), collagenase Clostridium histolyticum (CCH), and needle aponeurotomy (NA) for Dupuytren contracture (DC) using prospectively collected studies with ≥2-year follow-up and assess recurrence by joint (metacarpophalangeal [MCP] vs proximal interphalangeal [PIP]).MethodsSystematic review restricted to prospective cohort series or randomized controlled trials treating DC with LF, CCH, and/or NA. Eligibility required ≥2-year, in-person clinical follow-up and explicit definition of contracture recurrence. Exclusions included non-English publications, telephone/questionnaire-only follow-up, no recurrence data at follow-up, and sample size <15 patients. The primary end point was recurrence by treatment. Secondary analyses evaluated recurrence by joint treated and reintervention and complications when reported.ResultsTen studies met criteria, encompassing 1,411 patients and 1,698 treated joints with a mean follow-up of 3.8 years. Across studies, LF demonstrated a lower risk of recurrence than both CCH and NA, and CCH demonstrated a lower risk of recurrence than NA. Recurrence was less likely in the treatment of MCP versus PIP contractures across all treatments. For studies that reported subsequent procedures for recurrence, there was a lower likelihood of reinterventions after LF than after CCH or NA. Commonly reported complications included digital nerve injury, tendon injury, skin tears, swelling, pain, and bleeding.ConclusionsIn prospectively collected cohorts with a mean 3.8 years of follow-up, recurrence after DC treatment was common. LF demonstrated the lowest recurrence (16.5%), CCH had an intermediate recurrence (32.5%), and NA showed the highest recurrence (46.4%). PIP joint contractures were more likely to recur than MCP joint contractures, regardless of treatment.Clinical relevanceLF offers greater durability and a lower likelihood of subsequent procedures than CCH or NA in the treatment of DC at intermediate term follow-up; however, the clinician must also weigh the length of recovery and potential complications between these three treatment options. Patients with PIP contractures should be counseled about a higher recurrence risk and potential need for closer follow-up.

Dupuytren contracture (DC) is a fibroproliferative disorder characterized by collagen deposition in the palmar fascia. Treatment options include collagenase clostridium histolyticum (CCH) injection and surgery; however, DC frequently recurs after primary therapy. We hypothesized that CCH treatment could be effective and well tolerated for the treatment of contracture recurrence for patients unwilling to undergo reoperation or at high risk for complications. This Phase 4, multicenter, noninterventional, retrospective study analyzed medical records from 10 clinical centers in the US. Patients were treated with CCH for DC recurrence ≥6 months after previously successful surgical correction performed between January 1, 2010, and August 15, 2020. Primary end points were the measured joint contracture change from baseline, at first and last clinical evaluation within 12 months of CCH treatment of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. Secondary end points were "clinical success" (percentage of joints with reduction in contracture to 0° to 5°) and adverse events. Of 113 patients screened, 101 were analyzed (mean age, 64.1 years; 75% men). Median time to DC recurrence was 36.0 months. A total of 144 treated joints were analyzed (MP, n = 64; PIP, n = 75; unspecified, n = 5). Overall mean (SD) baseline contracture was 52° (21°) (MP, 43° [19°]; PIP, 61° [20°]). Mean (SD) improvement of contracture from baseline at last evaluation was 38° (21°) for all joints (MP, 36° [17°]; PIP, 41° [24°]), with 58% of joints having clinical success (MP, 75%; PIP, 43%). All skin tears (20 events in 19% of patients) resolved spontaneously, with 50% resolving in ≤21 days; there was one flexor profundus rupture that did not require secondary reconstruction. This retrospective analysis indicates that CCH treatment is an effective and well tolerated nonsurgical option for recurrent postsurgical contracture, with results comparable to patients without prior surgery. Therapeutic III.

Dupuytren's disease causes progressive flexion contractures and impaired hand function. While percutaneous needle aponeurotomy (PNA) provides rapid correction with low morbidity, the effect on grip strength remains unclear. Grip strength is a key surrogate of hand function and overall health, yet it has been inconsistently evaluated as an outcome in Dupuytren's disease. A prospective study was conducted at a tertiary referral center including 53 patients (80 digits) treated with PNA between February 2024 and March 2025. Standardized assessments included grip strength (Jamar dynamometer, American Society of Hand Therapists protocol), joint extension deficits, patient-reported outcomes (Southampton, Unité Rhumatologique des Affections de la Main [URAM]), and return-to-work data. Grip strength was reassessed at 2 months postprocedure to capture early functional recovery. Statistical analysis used paired t tests and Wilcoxon signed-rank tests, with significance set at P < .05. Mean grip strength improved from 24.9 to 28.7 kg (mean change + 3.8 kg, P < .001). Extension deficits decreased significantly at all levels, with mean correction of 25.5° at the metacarpophalangeal joint (MCPJ) and 29.3° at the proximal interphalangeal joint (PIPJ) (P < .001). At 2 months, the median URAM score was 4 out of 45, and the Southampton score was 3 out of 20, reflecting excellent functional recovery. Forty-four employed patients returned to work within 1 week. Complications were minor (skin tears n = 9, transient hypersensitivity n = 1) with no major adverse events. Percutaneous needle aponeurotomy (PNA) not only corrects digital contracture but also yields clinically significant improvements in grip strength, reinforcing its value as a functional outcome measure. These findings support PNA as a safe, effective first-line treatment for selected patients with Dupuytren's disease.

ABSTRACTSkin tears (ST) are common traumatic wounds, particularly among older adults, that can lead to complications if not accurately assessed and classified. The International Skin Tear Advisory Panel (ISTAP) classification system is widely used internationally; however, no validated Persian version currently exists. To culturally adapt, and evaluate the clinimetric properties of the Persian version of the ISTAP Classification System. This methodological study was conducted from February to May 2025 in multiple phases. After forward–backward translation and expert review, face and content validity were assessed. Criterion validity was assessed by comparing nurses' classifications with expert consensus using weighted Cohen's kappa coefficient. Construct validity was examined using the known‐groups method, comparing skin tear frequency and severity between 30 elderly patients with impaired mobility and 30 younger adults without impaired mobility. Reliability was evaluated using Fleiss' kappa coefficient for multiple raters, and weighted Cohen's kappa coefficient for inter‐rater and intra‐rater agreement. Diagnostic accuracy indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR–), odds ratio (OR) and the area under the receiver operating characteristic curve (AUC), were calculated for each skin tear type. Content validity was excellent (content validity ratio (CVR): 0.82–1.00; item‐level content validity index (I‐CVI): 0.91–1.00; scale‐level content validity index (S‐CVI/Ave): 0.94). Criterion validity showed almost perfect agreement with experts (weighted κ = 0.902, p < 0.001). Construct validity was supported by significant group differences in skin tear frequency (Fisher's exact p = 0.001) and severity (t(58) = 2.12, p = 0.039). Reliability was substantial to almost perfect across analyses (Fleiss' κ = 0.8447; inter‐rater weighted κ = 0.66; intra‐rater weighted κ = 0.86). Diagnostic accuracy was excellent for all types (AUC = 0.99), with sensitivity 97.5%–99.2%, specificity 98.4%–99.6%, PPV 97.5%–99.3%, NPV 98.1%–99.6% and very high OR and LR values. The Persian version of the ISTAP Classification System demonstrated excellent validity, reliability and diagnostic accuracy, supporting its use as a standardised tool for assessing ST in Persian‐speaking healthcare settings.

To translate and validate the content of the Skin Tears Knowledge Assessment Instrument (OASES) into Chilean Spanish. A cultural adaptation was carried out using a simplified methodology. The process began with a forward translation conducted by 2 bilingual translators. Review by an expert panel comprising 10 judges, 8 of whom were wound care specialists. The panel assessed the content validity of the consensually translated version using the content validity ratio (CVR). Subsequently, a back-translation into English was performed and reviewed by one of the original authors of the instrument. Out of 113 items in the consensually translated version, 7 items initially demonstrated low agreement, with CVR values between 0 and 0.4. Following a second round of evaluation by the expert panel, all items achieved a CVR of 1, except for 1 item, which received a CVR of 0.8, still within acceptable limits. The final translated and validated version was approved by one of the original OASES authors. The Chilean Spanish version of the OASES instrument meets local linguistic and cultural requirements while offering a validated, standardized tool for assessing knowledge about skin tears. This adaptation enhances the quality of training and supports prevention efforts across various clinical settings. Future work may include adapting the instrument for use in other Spanish-speaking countries, thereby fostering a more unified and culturally sensitive approach to skin tear prevention and management across Latin America.

Skin tears in older adults people receiving home care

Endoscopy patients ≥65years old who often present with risk factors for skin tears, e.g., advanced age, chronic health issues, limited mobility, and compromised integumentary, were the focus of a skin tear prevention intervention. This evidence-based quality improvement project and feasibility study with a pre/post-timed series survey design had three main goals: to design and implement an evidence-based skin tear prevention protocol for endoscopy, evaluate this protocol for usability and effectiveness, and assess endoscopy nurses' skin tear prevention knowledge. A multidisciplinary approach was taken to identify evidence-based skin tear prevention measures appropriate for the endoscopy setting. A feasibility study was used to measure nursing knowledge on skin tear prevention in endoscopy and nurse satisfaction with the skin tear prevention protocol. A pre/post survey was used to measure nursing knowledge at baseline, one month, and three months post-protocol implementation. Over the 3-month study, 537 endoscopy patients ≥65years old were identified to be at risk for skin tears. Endoscopy nurses implemented 911 skin tear prevention nursing interventions. This project demonstrated an 88% gain in nursing knowledge and a 66% skin tear reduction in endoscopy. The findings provide an optimistic outlook for skin tear prevention in endoscopy settings.

Assessing Knowledge Among Endoscopy Nurses With Implementation of a Skin Tear Prevention Intervention.

veterans to use their personal information in this research paper 1 and broader Veterans' Medicines Advice and Therapeutics Education Services (MATES) program.

Skin tears are a prevalent but often under-recognised type of injury in clinical settings, particularly affecting vulnerable patients in intensive care and surgical environments. The aim of this study was to determine the knowledge levels of nurses working in operating rooms and intensive care units regarding skin tears. This descriptive study was conducted between December 2024 and April 2025 with 81 intensive care and 76 operating room nurses at a training and research hospital. The study data were collected face-to-face using a descriptive characteristics form, the Skin Tear Knowledge Assessment Instrument (OASES). The data were analysed using SPSS software. Descriptive statistics, including frequency, percentage, mean and standard deviation, were calculated. Additionally, independent samples t-tests, one-way ANOVA and regression analysis were performed. The response rate of nurses who responded to the survey was 80.5%. The mean age of intensive care and operating room nurses was 31.2 ± 5.46 and 35.6 ± 8.57 years, respectively. The mean OASES score (range: 0-20, with higher scores indicating greater knowledge) of operating room nurses was 11.15 ± 4.84 out of 20, and that of intensive care nurses was 10.12 ± 6.25. The OASES scores of nurses who worked in the relevant unit for ≥ 7 years or more, who had a master's degree, who considered themselves competent, who had previously cared for patients with skin tears and who had received training were found to be significantly higher (p < 0.05). In addition, the linear regression analysis found that education status and clinical experience had a positive and significant effect on the OASES score (p < 0.001). This study demonstrated that nurses' knowledge of skin tears was suboptimal relative to the maximum possible score. It also revealed that nurses' experience in clinical units and their education levels were important variables affecting their knowledge of skin tears. Determining the knowledge of nurses about skin tears in critical areas such as intensive care and operating rooms helps to identify deficiencies affecting patient care in these areas.

Research Type: Level 4 – Case series Introduction/Purpose: To identify functional outcomes using arthroscopic assisted, minimally invasive contracture tenotomies paired with a tibio-talo-calcaneal (TTC) arthrodesis in the reconstruction of SEF. Methods: Surgeons log retrospective study on patients who underwent arthroscopic assisted, minimally invasive contracture tenotomies paired with tibio-talo-calcaneal (TTC) arthrodesis in reconstruction of SEF deformities. All cases were performed completely arthroscopically, utilizing posterior approach with TTC fusion done in a prone position by a single surgeon at our institution. Patient demographics, SEF pattern, perioperative complications, and radiographs were collected. Paired t-test was applied for FADI and VAS scores to determine improvement. Multivariate logistic regression was used to determine influence that variables have on failure rates. Any correlation between type of procedure, radiographic findings scores and VAS or FADI scores were examined using Pearson’s correlation coefficient at 3 months. Test statistics with p-value less than 0.05 considered significantly different. Analysis was performed with Microsoft Excel. Results: 10 patient cases included. Average 37 years old. 6 male (60%), 4 female (40%). Mean BMI 30.4. 2 tobacco users (20%). No illicit drugs. Preop, 2 patients used AFO or walker (20%), 1 crutches (10%), 7 non-ambulatory 2 years or more (70%). Average time from injury 6.1 years. Mechanisms of injury: drug induced ABI (20%), fall (20%), MVA (30%), CVA (10%), crush (10%), ABI (10%). Average tourniquet time 120.2 minutes. 10 patients underwent tenotomies and TTC nail. All had restoration of alignment. 100% fusion rates 3 months post op. None required bracing. 5 minor complications (50%): 4 skin tears,1 superficial infection. No major complications. FAS Scores - change in pre/post op FAS scores statistically significant (p-value 0.001). VAS Scores - change not statistically significant. Conclusion: Patients who undergo arthroscopic assisted minimally invasive surgical treatment for SEF have improved functionality based on FAS scores and post operative activity levels. Pre and post op assessments of functional ambulatory scale (FAS) scores

BACKGROUND: Skin tears (STs) are traumatic wounds that can result from shear and/or friction forces, inappropriate handling, falls or removal of adherent dressings. Nurse education plays a key role in the prevention and management of ST. The aim of this paper was to determine nurses’ knowledge level about STs.METHODS: A total of 123 acute hospital nurses participated to this cross-sectional study. A data collection tool developed according to the Skin Tear Knowledge Assessment Instrument (OASES) model was used. Participants completed the survey online during the period from September to October 2024. Data were analyzed using descriptive and multivariate statistics.RESULTS: Nurses’ mean number of correct answers on modified OASES instrument was 6.3 (SD, 1.85) out of 10. Nurses with a postgraduate degree (P<0.005), those with previous experience in nursing care of people with STs (P<0.001) and those with previous STs’ training (P<0.001) had a higher level of knowledge than their nurse colleagues, with a statistically significant difference.CONCLUSIONS: Overall, nurses’ knowledge level about ST’s etiology, classification, risk assessment, prevention and treatment was low. The results of this study are in line with data from the existing literature. Based on these findings, an education program will be developed by the study authors to address the identified nurses STs’ knowledge.

Each year the NSWOCC President has the privilege of recognizing an NSWOC who has exemplified leadership in the wound, ostomy and continence specialty. The President's Award goes beyond job titles. The award goes to someone who has worked tirelessly, often behind the scenes, to advance our mission, support our community and elevate our specialty in meaningful and lasting ways. This year the recipient is truly a champion of evidence informed practice. With over twenty years of research and dozens of publications from peer reviewed articles to textbook chapters, to textbooks, this individual is leading change and knowledge development throughout our specialty and profession. This year's Awardee has been an ambassador for the association at an international level. He has led our association’s Research Practice Core Program and assisted with the literature searches for all best practice recommendation documents over the past five years. He has served on the International Skin Tear Advisory Panel and helped found the Canadian Pressure Injury Advisory Panel. This individual has consistently demonstrated the NSWOCC values of excellence, leadership and collaboration. I am proud to say that I have personally experienced the mentorship that this individual provides first as a PhD supervisor and now as a colleague. I now have the honour of awarding Dr. Kevin Woo with the 2025 NSWOCC President's Award.

Preventing skin tears (STs) in older adults is an urgent public health concern, especially in long-term care (LTC) facilities. However, limited research on ST prevention among care workers exists due to a lack of suitable assessment tools. This study aims to develop and psychometrically evaluate the Knowledge, Attitude and Practice instrument for care workers in preventing Skin Tears (KAP-ST) in older adults. The KAP-ST was developed and validated in four phases during May-October 2024. First, an item pool was generated through a comprehensive literature review. Second, a preliminary instrument was developed through a Delphi expert consultation and pilot testing. Third, the items and the final instrument were optimised through a cross-sectional survey involving 317 care workers from 29 LTC facilities in China. Finally, a psychometric evaluation was conducted in another cross-sectional survey involving 373 care workers from 18 LTC facilities. The final KAP-ST contains 35 items across knowledge, attitude and practice dimensions. Exploratory factor analysis (EFA) revealed a nine-factor structure (factor loadings ranging from 0.451 to 0.799, accounting for 61.35% of total variance). The Item-Level Content Validity Index (I-CVI) values ranged from 0.926 to 1.000, and the Scale-Level Content Validity Index (S-CVI/Ave) was 0.991. The instrument's Cronbach's α, split-half, and test-retest reliability coefficients were 0.887, 0.744, and 0.934, respectively. The CFA analysis revealed an ideal absolute fit validity (RMSEA = 0.068; RMR = 0.029) and parsimony fit validity (PGFI = 0.684). The KAP-ST demonstrates strong reliability, structural validity and content validity. It is well-suited for assessing care workers' knowledge, attitudes and practices in preventing STs among older adults. Further research is required to enhance and confirm its validity. STs in the spotlight recently necessitate the use of appropriate investigative tools to facilitate in-depth research, especially for care workers, who should prioritise access to specialised knowledge. Introducing professional guidance in LTC facilities is recommended to enhance the knowledge, attitude and practice of care workers. Standardised Guidelines for Scale Construction and COSMIN checklist. No patient or public contributions.