International Journal of Wound Research (IJWR) è una rivista scientifica internazionale, peer-reviewed e ad accesso aperto, dedicata alla prevenzione, valutazione, gestione e guarigione delle lesioni cutanee. La rivista pubblica studi clinici e scientifici sulle lesioni acute e croniche, la vitalità tissutale, l’integrità cutanea e le condizioni correlate. Attraverso una rete editoriale interdisciplinare e internazionale, IJWR promuove una ricerca rigorosa e pratiche basate sulle evidenze, finalizzate a migliorare gli esiti dei pazienti e la qualità del wound care a livello globale.
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Towards Accessible and Circular Wound Care: Integrating Innovation, Education, and Evidence into Clinical Practice
Copyright (c) 2026 Marìa del Rocìo Gonzàlez Garcìa https://creativecommons.org/licenses/by/4.0
Clinical Standardization of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) Treatments in Complex Wounds: A Protocol for Biological Optimization and Evidence-Based Practice
Introduction. Complex wounds represent a critical public health challenge, requiring effective adjuvant therapies to reverse cellular senescence. Autologous platelet derivatives, namely Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF), concentrate essential growth factors to accelerate tissue regeneration. However, the lack of methodological standardization limits clinical reproducibility. Objective. To develop and scientifically validate a structured nursing protocol for the preparation and clinical application of PRP and PRF in complex wounds. Methods. Technical analysis and theoretical validation of institutional protocol EP431, cross-referencing operational parameters (relative centrifugal force, processing times, and handling techniques) with high-impact clinical trials. Results. The protocol establishes a relative centrifugal force of 1500 x g for 9 minutes for PRP (separator gel tubes, inverted 5-8 times) and 700 x g for 15 minutes for PRF. Evidence confirms that these parameters maximize platelet integrity and sustained cytokine release. Intradermal/subcutaneous injection techniques (0.1 mL/cm), an optimal 4-5 day application interval, and advanced perilesional silicone barriers are detailed. Conclusion. Clinical standardization via protocol EP431 mitigates biological variability, ensuring a safe, reproducible, and robust evidence-based intervention.
Copyright (c) 2026 Hugo Miguel Sousa https://creativecommons.org/licenses/by/4.0
Clinical Nursing Management of a Complex Vulvoperineal Wound in a Patient with Hidradenitis Suppurativa and Crohn’s Disease: A Case Report
Introduction. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that may lead to recurrent abscesses, sinus tracts, scarring, and complex wounds in anatomically and functionally challenging areas. Vulvoperineal involvement may be particularly difficult to manage because of severe pain, high exudate, risk of contamination, and major impact on quality of life. Case presentation. We report the case of a 38-year-old woman with hidradenitis suppurativa, Crohn’s disease, insulin-dependent diabetes mellitus, and rheumatoid arthritis, who presented with a complex post-surgical vulvoperineal wound following drainage of purulent fistulas. At initial assessment, the wound was deeply cavitated, highly exudative, fibrinous, painful, and at high risk of local infection. Pain during wound care was severe Visual Analog Scale (VAS 8/10), and the patient showed marked psychological distress. Intervention and Management. A personalized multidisciplinary management plan was established, including multimodal analgesic support, wound cleansing with saline solution and PHMB-based antiseptics, application of an oxygen-enriched oleic matrix dressing, atraumatic secondary dressings, urinary catheter placement to reduce local contamination, and shared hospital-home follow-up. Nursing management focused on pain control, atraumatic local care, infection prevention, patient education, and continuity of care. Results. Progressive wound improvement was observed over time, with reduction in pain, exudate, fibrin burden, and wound size. After 3 weeks, the wound area was significantly reduced, and complete healing was achieved within 3 months. Treatment tolerance progressively improved, allowing regular outpatient and home-based wound care. Conclusion. This case highlights the clinical value of individualized nursing management within a multidisciplinary pathway for complex vulvoperineal wounds in patients with HS and multiple comorbidities. Pain control, atraumatic dressing strategies, and continuity of care were key elements in supporting wound healing and treatment adherence.
Copyright (c) 2026 Elisa Franchini, Daniela Fanfani https://creativecommons.org/licenses/by/4.0
Oxidized Regenerated Cellulose/Collagen Dressings With Silver Rebalance Protease Activity in Venous Ulcer Fibroblasts: Translational Implications for Clinical Practice
Introduction. Chronic venous leg ulcers disproportionately affect older adults and are characterized by delayed healing, high recurrence rates, and substantial impacts on quality of life and healthcare costs. Persistent inflammation and an imbalance between matrix metalloproteinases and their tissue inhibitors contribute to healing failure, maintaining the wound in an inflammatory state. Oxidized regenerated cellulose/collagen dressings, with and without silver, accelerate healing in venous ulcers, but the cellular mechanisms linking these outcomes to changes in the wound microenvironment are not fully understood. This study evaluated how oxidized regenerated cellulose/collagen and oxidized regenerated cellulose/collagen/silver modulate venous ulcer fibroblasts, focusing on proteases, their endogenous inhibitors and key growth factors, to connect in vitro findings to potential clinical applications. Methods. Fibroblasts were isolated from chronic venous leg ulcers and cultured for 72 hours in control medium, oxidized regenerated cellulose/collagen (2.8 mg/mL) or oxidized regenerated cellulose/collagen/silver (4.2 mg/mL). Cell metabolic activity was assessed by MTT assay. MMP 1, MMP 2, MMP 3, MMP 10, MMP 13, TIMP 1, TIMP 2, TIMP 3 and TGF β1, TGF β2, TGF β3 were quantified in conditioned media using bead based multiplex immunoassays. Vimentin, collagen type I and collagen type III expression were evaluated by immunofluorescence. Statistical analysis used the paired Wilcoxon signed rank test (p< 0.05). Results: Both dressings maintained venous leg ulcer fibroblast metabolic activity at levels comparable to, or slightly higher than, control medium, without evidence of overt cytotoxicity. Oxidized regenerated cellulose/collagen alone did not significantly alter MMPs, TIMPs or TGF β isoforms. Oxidized regenerated cellulose/collagen/silver significantly increased MMP 1 (p = 0.0002) and reduced MMP 13 (p = 0.0155) versus control, while decreasing TIMP 2 and TIMP 3 and preserving TIMP 1. TGF β1, TGF β2, TGF β3 and collagen type I and III expression remained unchanged across groups, and vimentin expression was preserved. Discussion. In this in vitro model, oxidized regenerated cellulose/collagen and oxidized regenerated cellulose/collagen/silver preserved fibroblast viability and did not overtly interfere with TGF β signaling or collagen type I and III expression. The silver free matrix did not modify the analyzed protease inhibitor levels, supporting a predominantly extracellular protease sequestering mechanism. The silver containing matrix induced a shift in the fibroblast derived protease inhibitor profile, characterized by increased MMP 1, decreased MMP 13 and reduced TIMP 2 and TIMP 3 with preserved TIMP 1, a pattern that may rebalance protease activity toward matrix remodeling under non cytotoxic conditions. These findings offer a mechanistic, hypothesis generating framework with translational implications for the clinical use of silver-containing oxidized regenerated cellulose/collagen dressings in venous leg ulcers.
Copyright (c) 2026 Julia Teixeira Nicolosi, Silvana Cereijido Altran, Liliana Scorzoni, André Oliveira Paggiaro, Viviane Fernandes de Carvalho , Debora Levy, Rolf Gemperli, Cesar Isaac https://creativecommons.org/licenses/by/4.0
Therapeutic Application of hUC-MSC-derived Exosomes in Diabetic Wounds: A Scoping Review
Introduction. Diabetic foot ulcers (DFUs) represent a severe and debilitating complication of diabetes mellitus, often proving refractory to conventional therapies due to a persistent pro-inflammatory state that delays granulation tissue formation and re-epithelialization. While stem cell therapies offer potential, challenges regarding tumorigenicity, cell survival, and regulatory hurdles have spurred interest in cell-free approaches, specifically nanometric vesicles known as exosomes derived from human umbilical cord mesenchymal stem cells (hUC-MSCs). This scoping review aimed to map the extent and nature of evidence regarding the therapeutic application of hUC-MSC-derived exosomes in diabetic wound management across preclinical and clinical settings. Methods. Conducted according to the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, systematic searches were performed in PubMed, Embase, CINAHL, Lilacs, and grey literature (Google Scholar and Research Square) through January 31, 2026. Results. Nineteen studies met the inclusion criteria, primarily comprising preclinical investigations (n=15) alongside two randomized clinical trials. Preclinical evidence consistently demonstrates that hUC-MSC-derived exosomes accelerate wound closure by enhancing angiogenesis (CD31 and VEGF upregulation), modulating macrophage polarization toward the anti-inflammatory M2 phenotype, and promoting extracellular matrix restructuring. Clinical trials involving 130 participants reported favorable outcomes, including complete ulcer closure and a documented safety profile over a 24-month follow-up period. Technological advancements include the use of biomaterial carriers, such as hydrogels and scaffolds, to ensure sustained release and localized retention within the wound bed. Discussion. While evidence is consistent in the preclinical domain, a significant translational gap remains due to mechanistic differences between rodent contraction-based healing and human re-epithelialization. Standardizing dose-response protocols and conducting multicenter randomized trials are essential to bridge the gap toward real-world clinical implementation.
Copyright (c) 2026 Meline Rosseto Kron, André Oliveira Paggiaro, Viviane Fernandes De Carvalho Belizario https://creativecommons.org/licenses/by/4.0
Beyond Survival: Compassion, Complexity and the Long Road to Burn Recovery
In the opening days of 2026, major fire disasters in Crans-Montana, Switzerland, the Biobío and Ñuble regions of Chile, and the Rohingya refugee settlements in Cox’s Bazar, Bangladesh, once again placed burn injuries at the centre of global tragedy. Burns remain the fourth most common form of trauma worldwide and are uniquely complex injuries that disrupt the protective, thermoregulatory and immunological functions of the skin while triggering profound systemic and metabolic consequences. In mass casualty incidents, even relatively small numbers of patients with severe burns can overwhelm healthcare systems, particularly where non-specialist providers must deliver prolonged early care. Beyond the acute phase, survival alone is no longer an adequate measure of success. Advances in critical care and surgery mean that patients with injuries once considered unsurvivable are now living - yet burn injury is increasingly recognised as a chronic condition with lifelong physical, psychological and social sequelae. Pain, scarring, functional impairment, and altered body image can profoundly affect quality of life and reintegration into society. Optimal recovery requires far more than surgical expertise. Burn care has evolved as a multidisciplinary endeavour in which surgeons, nurses, therapists, psychologists, and social care professionals collaborate around the burn survivor as an active team member. Compassion - towards patients, families, colleagues and oneself - emerges as an essential therapeutic resource and a safeguard against burnout in the face of sustained human suffering. As recent disasters remind us, recovery from burn injury is measured not in months but in decades, demanding coordinated systems of care that extend far beyond the moment of survival.
Copyright (c) 2026 Kristina Stiles https://creativecommons.org/licenses/by/4.0
Enzymatic Debridement Based Minimally Invasive Modality versus Standard of Care in Modern Burn Management
Copyright (c) 2026 Lior Rosenberg https://creativecommons.org/licenses/by/4.0
Neonatal Skin Care to Maintain Skin Integrity: A Scoping Review
Introduction. Neonatal skin is essential for maintaining physiological homeostasis; however, its structural and functional immaturity - particularly in preterm infants - makes it highly susceptible to dehydration, infection, thermal instability, and environmental damage. Maintaining skin integrity is therefore a critical component of neonatal and early pediatric care to reduce morbidity and support healthy development. Methods. A scoping review was conducted following the PRISMA-ScR guidelines to synthesize current global evidence on neonatal and pediatric skin care practices. Five electronic databases were systematically searched for studies published between 2014 and 2025 in English, Italian, or Spanish. Eligible studies addressed skin care interventions in neonates and children, including bathing practices, emollient use, perineal care, prevention of atopic dermatitis and management of skin lesions. A total of 38 studies met the inclusion criteria, encompassing randomized controlled trials, observational and quasi-experimental studies, qualitative research, and expert consensus documents. Results. The reviewed evidence indicates that delayed bathing after birth, gentle cleansing routines, and careful selection of skin care products contribute to improved skin barrier function. Early and regular use of emollients containing physiological lipids was associated with enhanced hydration, reduced transepidermal water loss, and a lower incidence of irritant and atopic dermatitis. Structured perineal care protocols were shown to reduce diaper-related skin breakdown. Preterm infants emerged as a particularly vulnerable group, requiring highly cautious and individualized approaches due to their markedly underdeveloped skin barrier. The review also highlights substantial global disparities in skin care practices, especially in low-resource settings, where access to appropriate products and standardized protocols is limited. Discussion. Overall, the findings underscore the importance of evidence-based, standardized, and culturally sensitive skin care guidelines tailored to neonatal and pediatric populations. Implementing consistent practices across diverse clinical settings may improve skin integrity, reduce preventable complications, and support optimal neonatal outcomes, particularly among high-risk neonates.
Copyright (c) 2026 Francesco Beneforti, Giorgia Locatelli, Alessandra Reddi, Daniele Ciofi, Paola Stillo, Biagio Nicolosi https://creativecommons.org/licenses/by/4.0
The Importance of a Comprehensive Burn Nursing Team Approach: Experience from the Zagreb Burn Unit
The Burn Unit of the Department of Traumatology in Zagreb, established in 1970, is the only specialized burn unit in Croatia and serves patients with severe burn injuries from across the country and neighboring regions. It was the first center in Croatia to integrate surgeons, nurses, and other healthcare professionals into a dedicated multidisciplinary burn care unit. The unit includes an operating theatre, an intensive care unit for critically burned patients, and a surgical ward. In 2007, the Clinical Unit of the Tissue Bank was established within the Department of Traumatology and later integrated into the Sestre milosrdnice University Hospital Center. The introduction of tissue banking and keratinocyte culture significantly improved survival outcomes in patients with extensive burns, while simultaneously increasing the clinical and organizational demands placed on burn nurses, who are actively involved in tissue sampling, application procedures, and post-application care. Burn nurses play a central role in the comprehensive management of burn patients, applying specialized protocols, ensuring continuity of care, and supporting patients throughout acute treatment and recovery. However, the increasing complexity of burn care, combined with workforce reduction and high physical and emotional demands, has made burn nursing progressively more challenging. This commentary highlights the critical importance of a comprehensive burn nursing team approach in sustaining high-quality burn care and supporting both patient outcomes and nursing practice within the Zagreb Burn Unit.
Copyright (c) 2026 Valentina Štrbac https://creativecommons.org/licenses/by/4.0
Early Paediatric Burn Wound Management in Italy: A Cross-Sectional Survey of Protocol-Driven Practices in the First 24 Hours
Introduction. Early management of paediatric burn wounds is a critical determinant of wound progression, healing time, and long-term outcomes. The first 24 hours after injury represent a dynamic phase in which clinical decisions regarding cleansing, antisepsis, dressing selection, and follow-up may influence burn wound conversion and complications. Despite available guidelines, early paediatric burn care remains heterogeneous, and real-world data describing institutional practices are limited. Methods. A cross-sectional observational survey was conducted to describe early paediatric burn wound management practices in Italian burn centres. A structured, evidence-informed questionnaire was distributed electronically to designated clinical referents from 17 centres managing paediatric burns. Respondents were asked to report protocol-driven, centre-level practices regarding first aid, wound cleansing and antisepsis, initial dressing selection according to burn depth, timing of first reassessment, and caregiver education. Data were collected between May and June 2025 and analysed using descriptive statistics. Results. Eleven professionals participated, predominantly nurses (90.9%), most of whom worked in major burn centres. Cooling with running water for 20 minutes was the most frequently reported first-aid measure across burn aetiologies (90.9%). Wound cleansing was performed in all centres, most commonly using normal saline (63.6%). Antisepsis was frequently adopted, particularly for flame burns (100%), with 0.05% sodium hypochlorite being the most commonly reported agent. Paraffin-impregnated gauze was the preferred dressing for first-degree (81.8%) and superficial partial-thickness burns (72.7%). For deep partial-thickness and small full-thickness burns (<5 cm), collagenase, silver alginate, and hydrogel were more frequently selected. First wound reassessment occurred within 24 hours in 63.6% of centres. Most respondents (81.8%) reported providing structured caregiver education focused on home dressing management and pain control. Discussion and Conclusions. Early paediatric burn wound management practices in Italian burn centres appear broadly aligned with current first-aid and early reassessment recommendations. However, variability in antiseptic use and dressing selection persists, particularly for deeper burns, highlighting the need for shared, depth- and objective-driven frameworks to support early clinical decision-making and future multicentre consensus initiatives.
Copyright (c) 2026 Biagio Nicolosi, Ariela Rogai, Benedetta Di Falco, Eleonora Bastarelli, Carlotta Bini, Davide Griffa, Maria Minoia, Stefania Allegri, Luisa Lorenzo, Manuela Stangoni, Flavio Facchini, Guido Ciprandi, Antonio Di Lonardo https://creativecommons.org/licenses/by/4.0
Advanced Dressings for the Management of Pediatric Burns Within the First 24 Hours: A Scoping Review
Introduction. Pediatric burns are a frequent cause of emergency department attendance and hospitalization and may result in acute pain, infection, delayed healing, and long-term sequelae such as hypertrophic scarring and functional impairment. Early management aims to limit burn progression, optimize the wound microenvironment, and reduce the burden of painful dressing changes for children and families. First aid behaviors and the choice of first-line topical agents and dressings vary widely, and traditional treatments such as silver sulfadiazine have been challenged by newer dressings designed to improve comfort and support outpatient care. Methods. We conducted a scoping review in accordance with PRISMA-ScR guidance to map evidence on conservative, non-surgical topical agents and dressings used as first-line treatment for minor-to-moderate pediatric burns (age <18 years). We searched PubMed/MEDLINE, Embase, CINAHL, and the Cochrane Library and screened titles/abstracts and full texts in duplicate. We included comparative and non-comparative studies reporting outcomes related to healing, infection, pain, dressing burden, resource use, and scar endpoints. Findings were synthesized descriptively without meta-analysis or risk-of-bias appraisal. Results. From 2,397 records, 38 studies met eligibility criteria. Designs were heterogeneous (randomized trials, prospective/retrospective cohorts, pilots, observational analyses, and case-based reports) and were conducted across multiple countries. Interventions included first aid and analgesic adjuncts; silver sulfadiazine compared with alternative topical agents and dressings; advanced silver-impregnated systems (eg, hydrofiber/foam dressings); biosynthetic or synthetic membranes and biomaterials (eg, Suprathel®, Biobrane®); hyaluronic acid–based protocols; nanocellulose dressings; gel-based or bioactive treatments; and other innovative dressings. Across comparative studies in superficial-to-partial thickness burns, several advanced dressings were associated with fewer dressing changes and lower procedural pain while achieving comparable or faster re-epithelialization than silver sulfadiazine. Effects on infection, length of stay, and scar outcomes were variable and often limited by inconsistent definitions and follow-up. Discussion. The mapped literature indicates that selected advanced dressings may provide clinically meaningful advantages by reducing dressing-change frequency and procedural pain, potentially facilitating outpatient management in appropriate cases. However, certainty is constrained by heterogeneity in burn depth assessment, variation in debridement and analgesia pathways, and inconsistent outcome reporting, with limited long-term scar and functional data. Future studies should adopt standardized, patient-centered pediatric outcomes (healing, infection definitions, validated pain/itch measures, and scar assessments) and pragmatic comparative designs to inform internationally applicable care pathways.
Copyright (c) 2026 Miriana Landino, Giorgia Locatelli, Alessandra Reddi, Kristina Stiles, Biagio Nicolosi https://creativecommons.org/licenses/by/4.0
Implementing Evidence-Based Burn First Aid in a Low-Resource Community: A Brief Report on Culturally Adapted Education
Introduction. Burn injuries are a common source of preventable morbidity in low- and middle-income countries (LMICs). In many communities, burn first aid is influenced by generational traditions and locally available topical remedies, which can replace or delay effective cooling with water recommended in evidence-based guidance. Programme Approach. This brief report presents Burn Prevention and Treatment Education (BPTE), a culturally adapted burn first aid education programme implemented through a community clinic in a Southeast Asian LMIC. BPTE was intentionally designed as a low-technology intervention for contexts with limited electricity and variable access to running water, using short teaching scripts, visual aids, and repeated reinforcement strategies. Implementation Observations. The programme core message (“Cool, Call, Cover”) was refined through iterative adaptations to improve feasibility and comprehension. Adaptations included using hand water pump imagery to represent water access, practical water collection guidance to address contamination concerns, and continuous clinic-based reinforcement through large printed tarpaulins displayed at the clinic gate. Conclusions. BPTE illustrates how evidence-based burn first aid education can be translated into feasible, culturally acceptable actions in resource-limited settings. While clinical endpoints were not systematically collected, the report provides implementation-focused insights into barriers, adaptation strategies, and sustainable delivery channels. Future evaluation should integrate structured documentation of first aid actions and escalation patterns to support impact measurement.
Copyright (c) 2026 Valerie Smith-Orr, Evelyn T. Reyman https://creativecommons.org/licenses/by/4.0
Reassessment-Driven Dressing Rotation in Chronic Wound Care: A Brief Report
Introduction. Chronic wounds are a major clinical challenge because of delayed healing, recurrence risk, and reduced quality of life Methods. A 90-year-old frail patient presented with a chronic venous-related ulcer of the right lateral malleolus persisting for 10 years. Wound management followed CARE guidelines with repeated assessment using the TIME framework, Triangle of Wound. Assessment, and NERDS/STONEES criteria. Treatment included PHMB cleansing, medical-grade honey, and hydrogel dressings adjusted according to wound progression. Results. Baseline wound size was 5 × 4.5 × 0.8 cm with moderate exudate, partial fibrin coverage, and pain intensity of 6/10 on the VAS scale. Progressive reduction in exudate and inflammation was observed, followed by granulation and epithelialization. Complete wound closure occurred after 15 weeks, with pain reduction to 0/10 and no adverse events. Discussion. Reassessment-guided dressing rotation within an advanced home-care pathway was associated with healing of a long-standing chronic ulcer.
Copyright (c) 2026 Daniela Martino https://creativecommons.org/licenses/by/4.0
Artificial Intelligence in Wound Care: From Experimental Promise to Clinical Reality
Introduction. Wounds represent a substantial and growing global health burden, driven by aging populations, chronic disease, and rising healthcare costs. Artificial intelligence (AI) has emerged as a potential tool to improve wound assessment, monitoring, and management. Aim. To comment on the current state of AI in wound care and identify key requirements for successful clinical translation. Key Content. Recent advances demonstrate that AI can support wound classification, measurement, tissue characterization, healing prediction, and remote monitoring. Increasingly, AI is being positioned within theragnostic frameworks that integrate diagnosis, monitoring, and personalized intervention. Despite this progress, most applications remain investigational, with limited real-world validation, fragmented datasets, and unresolved ethical and regulatory challenges. Implications. AI should be viewed as a clinical decision-support technology rather than an autonomous replacement for expert care. Conclusion. Realizing the clinical value of AI in wound care will require robust evidence, standardized data infrastructures, ethical governance, and meaningful clinician engagement.
Copyright (c) 2025 International Journal of Wound Research
Comparative Evaluation of a DACC-Coated Hydrophobic Dressing versus Silver Sulfadiazine in the Management of Chemical Burns: A Pilot Comparative Study from a Single Center in Pakistan
Introduction. Low- and middle-income countries (LMICs) bear a disproportionate burden of burn injuries, which continue to be a major worldwide health concern. A distinct class of burn injuries known as chemical burns is distinguished by the possibility of profound skin degradation and progressive tissue damage. Although delayed epithelialization and cytotoxic effects on regenerating tissue have been concerns, silver sulfadiazine (SSD) has long been regarded as the standard topical antibacterial therapy in burn care. In order to bind germs without releasing active antimicrobial drugs and perhaps maintain tissue viability, Sorbact® bacteriostatic dressings use hydrophobic interaction technology. The purpose of this pilot comparative study was to evaluate the clinical results of 1% SSD and Sorbact® dressings for patients with partial-thickness chemical burns in a context with limited resources. Methods. This single-center pilot comparative study was conducted at the Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Sixty adult patients who presented within 6 hours of sustaining partial-thickness chemical burns involving ≤30% total body surface area (TBSA) were randomized in a 1:1 ratio in a institutional clinical trial software to receive either Sorbact® dressings or 1% SSD. All patients received standardized supportive management as per institutional protocol including intravenous analgesia, fluid resuscitation, and systemic antibiotics (Piperacillin–Tazobactam) as per institutional protocol. The primary outcome was time to complete epithelialization of the wound. Secondary outcomes included hospital stay duration, need for split-thickness skin grafting (STSG) and dressing frequency. Results. The study included 60 patients (63.3% female) with a mean TBSA of 23.3%, most commonly involving the trunk (n=22) and face (n=16), with comparable baseline characteristics between groups. Mean time to complete epithelialization was significantly shorter in the Sorbact® group. Hospital stay duration was reduced in the Sorbact® group, and fewer patients required STSG. No systemic infections were documented in either group. Discussion. In this pilot single-center study, Sorbact® dressings demonstrated favorable clinical outcomes compared with 1% SSD in partial-thickness chemical burns. Given the unique nature of study and limited sample size, large multicenter trials are required to confirm these findings and evaluate cost-effectiveness in LMIC settings.
Copyright (c) 2026 Ali Mujtaba, Samin Khan, Muhammad Hassaan Tariq, Sanila Ayub, Mahvish Aftab Khan, Muhammad Usman Ali, Muhammad Ibrahim, Nimrah Komal, Tariq Iqbal, Muhammad Rehan https://creativecommons.org/licenses/by/4.0
What Really Matters in Paediatric Wound Healing: Sustainability Comes First
High Voltage Electrical Burn Injury of the Upper Extremity: A Prospective Observational Study from Bangladesh
Introduction. Electrical burn injury is one of the most disastrous forms of burn trauma involving the upper extremity. It may lead to devastating complications, including limb loss and even death. This study aimed to characterise the epidemiology of high-voltage electrical burn injury (HVEB), which is critical for developing prevention strategies and evidence-based management guidelines to address this serious public health issue. Methods. This prospective observational study was conducted at the National Institute of Burn and Plastic Surgery (NIBPS), Dhaka, Bangladesh, between January 1, 2022, and June 30, 2022. Based on specific inclusion and exclusion criteria, a total of 112 patients with high voltage electric burn injury involving upper limb were included in the study from total 521 patients with high-voltage electrical burn injuries attended the emergency within this period. Data were collected through a structured data sheet and analysed. Results. A significant male predominance was observed (89.3%), and more than 70% of patients were aged 13-40 years. Ninety-three per cent (93%) of patients came from urban areas. Approximately 56% of accidents occurred while working in unsafe environments without safety protocols, and it was alarming that only 7% of workers used proper protective equipment. Women (2.7%) were primarily affected while drying clothes on rooftops or balconies. Bilateral limb involvement was present in 52% of cases. Seven per cent (7%) of patients presented with charred limbs. The right upper limb was the entry point in 67% of cases. Impending compartment syndrome was evident clinically in 45.5% of patients, necessitating fasciotomy. Finally, 40% of patients underwent limb amputation at different levels within 7-10 post-burn days. Discussion and Conclusions. Electrical burn injury remains a major health problem in developing countries. Most injuries are occupation-related and affect young active males. However, electrical burn injuries are largely preventable. Measures should be taken to create awareness among the population to prevent these devastating injuries.
Copyright (c) 2026 Nurunnahar Begum, Tanveer Ahmed, Ee Xion Tan, Vaikunthan Rajaratnam https://creativecommons.org/licenses/by/4.0
Improving the Quality of Smartphone-Based Medical Photography for Burns Patients: A Quality Improvement Project
Introduction. High-quality clinical photography is essential in burns management, providing an objective record of wound progression, supporting multidisciplinary communication, and fulfilling medico-legal requirements. Smartphone photography is increasingly used for bedside documentation because of its speed and accessibility, but image quality is often inconsistent, and no standardised guidelines currently exist. This quality improvement project aimed to evaluate and improve the quality of smartphone-based burns photography in a busy burns unit. Methods. A retrospective review of 200 patient image sets was undertaken at Wythenshawe Hospital, Manchester. 100 pre-intervention and 100 post-intervention image sets were assessed against eight parameters adapted from best practice guidelines, including clarity, lighting, background, wound coverage, perpendicular angle, distance, inclusion of close-up and distant views, and documentation of wound location. A concise guidance card containing prompts addressing key photography standards was attached to clinical smartphones to support staff during image capture. Statistical analysis was performed using a chi-square test for independent samples. Results. Post-intervention, documentation of wound location improved significantly from 17% to 45% (p < 0.001). Modest, non-significant improvements were observed in adequate lighting (57% to 69%) and perpendicular imaging (77% to 85%). Full wound capture increased from 71% to 79%. However, inclusion of both close-up and distant images declined from 39% to 19% (p = 0.002), while other parameters remained largely unchanged. Discussion and Conclusions. A simple, low-cost intervention produced measurable improvements in the consistency of burns photography, particularly in documentation of wound location. While gains were modest in other domains, the findings suggest that structured visual prompts can improve the consistency of clinical documentation practices. This project highlights the feasibility of low-resource interventions to enhance wound imaging quality. The approach is scalable to other units and healthcare systems, with potential to improve patient safety, communication, and clinical governance. Further studies should assess sustainability and adaptation in wider clinical contexts.
Copyright (c) 2026 Samuel Burgess, Miriam Nyeko-Lacek, Zeeshan Sheikh https://creativecommons.org/licenses/by/4.0
Paediatric Burns – A Single Institution Experience and Suggested Algorithm for School Return
Introduction. Paediatric burns account for almost 40,000 visits to UK emergency departments annually. Following a burn, patients often remain off school – this has educational and social impacts on children, plus financial implications for caregivers. The risk of infection, the commonest cause of morbidity, is highest in the first week post-burn. Currently, there are no formal guidelines regarding school return following a burn, and the recent cost of living crisis in the UK prompted a review into how school return could be facilitated. This study aimed to propose criteria to guide school return if no clear difference in complications was seen between patients returning school before versus after complete wound healing, and to reassess complication rates after implementing a trial in which select patients would return to school early. Methods. A retrospective review of all referrals between January-June 2023 was performed. A set of criteria to guide school return was implemented, and following a 6-month trial period between February-July 2024, another retrospective review was done. Results. 241 children were referred between January-June 2023; after exclusion, 113 cases were reviewed. 8 (7.08%) developed complications; 2/19 (10.53%) of those remaining off school, 2/77 (2.60%) with unclear school return, and 4/17 (23.53%) of those attending school before complete wound healing, with infection developing in all 3 with delayed initial hospital presentation. During the 6-month trial with guided school return, 238 children were referred. 28 children attended school prior to wound healing as per the agreed criteria; patients were followed up until discharge, and none developed complications. Discussion and Conclusions. Delay in presentation, and return to school immediately post-burn, with an associated delay in specialist burn care, appeared to be biggest risk factor for infection in the cohort reviewed. Findings also supported that other risk factors for burn wound complications include burn depth and disturbance to NPWT. Risk of complications did not seem to increase when school return was guided by the proposed criteria, with predictors for uncomplicated early school return appearing to be small burn size (≤1% TBSA), burn location (hands, trunk or limbs), and superficial partial thickness depth. Children remaining off school following a burn can have psychosocial, educational and monetary impacts upon the patient and their caregivers; allowing them to return before complete wound healing may help to diminish these effects, and has been shown to be safe when guided by the proposed criteria.
Copyright (c) 2026 Lydia Hiddema, Liz Nicholls, Jasmine Tang https://creativecommons.org/licenses/by/4.0
Fatal Burn Injury Following Traditional Treatment in a Diabetic Patient from a Rural Area: A Case Report
Background. The skin acts as a vital protective barrier, preventing infection, fluid loss, and heat damage. Burn injuries are among the leading causes of morbidity and mortality, especially in low- and middle-income countries where access to specialized care is limited. Traditional burn treatments, still practiced in some rural areas, often lack scientific evidence and may delay wound healing or exacerbate the injury. This report highlights the complications of such non-scientific approaches and underscores the need for public education and early medical intervention. This case report describes a fatal burn injury resulting from a traditional intervention in a diabetic patient. Case Report. A 74-year-old woman with diabetes mellitus, hypertension, and aortic stenosis from a rural village near Gonbad, Iran, developed swelling and blistering of her right hand after a local healer misdiagnosed an initial lesion as an insect bite and advised washing with hot water and exposure to opium smoke. Her condition progressively worsened, leading to extensive necrosis and infection. She was hospitalized for 13 days at Payambar Azam Hospital in Gonbad and subsequently transferred to 5 Azar Hospital in Gorgan for an additional 5 days of treatment. Despite intravenous antibiotics, wound care, and supportive management, she developed septic shock and died from multiorgan failure shortly after discharge. Conclusion. This case emphasizes the serious risks of unqualified traditional practices and delayed access to professional care in burn injuries, particularly among vulnerable patients with chronic diseases. Promoting public awareness, community education, and timely referral to specialized burn centers are essential steps for reducing preventable complications and mortality.
Copyright (c) 2026 Abolfazl Khamisi, Azin rajaei, Nasrin noori https://creativecommons.org/licenses/by/4.0
Clinical Use of Platelet-Rich Plasma in Neonatal and Pediatric Populations: A Scoping Review
Introduction. Platelet-rich plasma (PRP) is a regenerative therapy that delivers concentrated platelets and growth factors to promote angiogenesis, modulate inflammation, and support tissue repair. While its use is well established in adults, evidence on PRP for neonatal and pediatric wound management remains scarce and heterogeneous. This scoping review aimed to map the existing literature on PRP for cutaneous wound healing in patients aged 0-18 years and to assess the presence of standardized preparation or application protocols. Methods. The review followed Arksey and O’Malley’s methodological framework, enhanced by Levac et al., and was reported according to PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, and Google Scholar (January 2014-April 2025), complemented by backward/forward reference screening and gray literature searches. Eligible studies included neonates, children, or adolescents receiving PRP for any cutaneous wound etiology. Data were extracted on study design, population characteristics, wound type, PRP preparation/application, and clinical outcomes. Results. A total of 1,812 records were identified, with 8 sources meeting inclusion criteria: 4 clinical pediatric wound-care studies, 3 randomized surgical trials, and 1 congress-level protocol. Reported outcomes included rapid healing of neonatal and pediatric surgical dehiscence (mean ~12 days), complete resolution of a chronic neuropathic ulcer within 2 weeks, and >50% ulcer reduction in pediatric chronic graft-versus-host disease. Surgical trials showed reduced fistula formation, postoperative edema, and complications. One transient citrate-related reaction was the only adverse event recorded. Across studies, substantial heterogeneity in PRP preparation techniques and absence of validated pediatric protocols were observed. Discussion and conclusions. Findings suggest that PRP is safe and potentially effective for complex wounds and postoperative recovery in neonates and children, especially when conventional treatments are insufficient. However, methodological variability, small sample sizes, and the lack of standardized pediatric protocols limit comparability and clinical implementation. Pediatric-specific challenges – such as limited blood volume, venipuncture difficulty, and risks of iatrogenic anemia – further underline the need for tailored approaches. High-quality, prospective pediatric studies and validated clinical protocols are required to support evidence-based adoption.
A Corporate Model for the Prevention and Monitoring of Neonatal and Pediatric Skin Injuries: A Four-Year Quality Improvement Study
Introduction. Neonatal and pediatric patients present an increased risk of skin injuries due to their immature skin barrier and frequent exposure to medical devices. To improve prevention, monitoring, and standardization of care, the Azienda USL Toscana Centro (AUTC), one of the largest healthcare organizations in Italy, implemented a corporate pediatric wound care model supported by a multidisciplinary working group. Methods. This descriptive retrospective observational study was conducted within an institutional Quality Improvement framework. Aggregated anonymized data were collected annually from 2021 to 2024 across Neonatal Intensive Care Units (NICUs), Neonatology units, and Pediatric wards. Nurse representatives, coordinated by a pediatric wound care specialist from the corporate Wound Care Team, reviewed medical records to identify pressure injuries (PIs), medical device-related pressure injuries (MDRPIs), and incontinence-associated dermatitis (IAD). Total admissions and injury frequencies were reported for each setting. Results. Over the four-year period, 12,818 admissions were recorded (mean 3,204.5 per year). The mean incidence of PIs was 0.47%, while IAD incidence averaged 5.13%, with higher rates observed in NICUs. Between 2021 and 2024, 149 healthcare professionals (nurses, physicians, and midwives) completed seven editions of a dedicated pediatric wound care training program. The pediatric wound care working group expanded from 6 to 9 nurses and 1 physician, meeting quarterly to review surveillance data, discuss clinical challenges, and update procedures. In 2024, the corporate procedure for the prevention and treatment of neonatal and pediatric skin injuries was revised, and an inter-organizational pathway for the management of minor pediatric burns was jointly developed with Meyer IRCCS Children’s Hospital. Discussion and conclusions. The corporate wound care model supported consistent monitoring, widespread training, and standardized preventive practices across AUTC. The very low incidence of PIs and the stable burden of IAD indicate positive organizational impact, highlighting the value of sustained multidisciplinary engagement in pediatric skin injury prevention.
Integration of Artificial Intelligence in Specialist Nursing Education: Experiences of an Innovative Pedagogical Strategy in Tissue Viability
Introduction. Artificial intelligence (AI) has emerged as a transformative tool in health education, with the potential to enhance scientific literacy, critical thinking, and evidence-informed decision-making. In specialist nursing education, particularly within tissue viability, innovative pedagogical strategies are required to strengthen research competencies. This study aimed to analyse and to compare the integration of AI as an educational support tool through two applied case studies. Methods. Within a specialist/master’s nursing curriculum, students formulated structured research questions, performed systematic database searches, and interacted with AI tools using predefined inclusion and exclusion criteria. Two case studies were developed: (i) caregiver burden in diabetic foot ulcers and (ii) coping strategies in ostomy patients. Traditional narrative and integrative literature reviews (PubMed, Scopus, Web of Science, EBSCO, B-On) were compared with AI-assisted searches (ChatGPT-4.0, SciSpace, Consensus). Data were screened, extracted, and analysed through thematic analysis. Results. In the first case study, both traditional and AI-assisted searches identified the same three eligible studies addressing caregiver burden. Common factors included female gender, low income, low educational level, high caregiving workload, limited social support, and poor communication with health professionals. AI retrieval was faster but required human critical appraisal. In the second case study, three studies on coping strategies in ostomy patients were identified, highlighting active information-seeking, professional guidance, peer support, cognitive reframing, and religious or social support. AI outputs overlapped with these findings and emphasised emotional and cognitive dimensions such as acceptance and self-efficacy. Discussion and conclusions. The integration of AI improved the efficiency of evidence retrieval and supported enriched thematic analysis. Although it did not replace methodological rigour or human critical reasoning, AI functioned as a valuable complementary pedagogical resource, enhancing student autonomy, scientific literacy, and reflective practice.
Nurses’ Knowledge and Practice Gaps in Incontinence-Associated Dermatitis: Findings from a Cross-Sectional Survey
Introduction. Incontinence-Associated Dermatitis (IAD) is an inflammatory condition of the perineal and perianal skin caused by prolonged contact with urine and feces. Despite its clinical impact, recognition and documentation remain inconsistent, with wide variability in diagnosis, prevalence, and treatment across care settings. This study aimed to provide a narrative overview of current evidence on IAD and to assess nurses’ knowledge of its diagnosis, staging, and management across healthcare settings. Methods. A descriptive cross-sectional observational study was conducted using an anonymous online questionnaire (Google Forms) developed from a literature review. The survey included 11 items on demographics, self-assessed competence, and objective knowledge. Data were collected from March to June 2025 via snowball sampling, with 186 nurses completing the questionnaire. Descriptive and comparative analyses were performed across care settings. Results. Participants’ ages ranged from 22 to 62 years (mean 41.7 ± 10.2), with an average of 15.4 ± 8.6 years of professional experience. About half felt inadequately prepared to manage IAD, while only 18% rated themselves as highly competent. Only 44% correctly distinguished IAD from pressure injuries. Barrier products, gentle hygiene, staff training, and proactive incontinence management were the most cited preventive strategies. Knowledge and tool use were higher in surgical and medical/oncology settings, while community, home care, and rehabilitation showed critical gaps. Adoption of standardized tools such as GLOBIAD was limited. Discussion. IAD remains underrecognized and inconsistently managed across care settings. The mismatch between perceived and actual competence, together with low use of standardized assessment tools, may contribute to misdiagnosis, delayed treatment, and suboptimal prevention. Structured, context-specific educational programs and wider implementation of tools such as GLOBIAD are essential to enhance prevention, support accurate documentation, and ultimately improve patient outcomes.
Hyaluronic Acid in Wound Management: An Update on Formulations, Mechanisms, and Clinical Applications
Introduction. HA underpins hydration, immune modulation, and matrix remodeling in wound healing. Its effects vary by molecular weight and formulation, with direct implications for clinical use. This update aims to analyzed and discuss the current knowledge on HA, with the objective of outlining its mechanisms of action and exploring the clinical implications of the various formulations used in wound care. Methods. This update integrates key contributions (2000–2024) from PubMed, Scopus, and authoritative wound-care texts on the cutaneous use of HA in adult and pediatric patients. Evidence was organized to describe mechanisms, formulation characteristics (HA-only, HA+Ag, HA+AA, HYAFF scaffolds, injectable HA+6AA), and practice integration across acute and chronic wounds. No systematic review procedures were applied. Results. High-molecular-weight HA shows protective and anti-inflammatory actions; low- molecular-weight HA promotes angiogenesis and immune activation. Clinically, HA-only topicals aid hydration and epithelialization; HA+Ag addresses bioburden; HA+AA supports stalled/ischemic beds; scaffolded HYAFF provides structure and sustained release for deep/exuding wounds; injectable HA+6AA augments remodeling in complex cases. A TIMERS-aligned framework supports step-up/step-down use and escalation when progression thresholds are unmet. Discussion. HA is a formulation-dependent therapeutic that benefits wound outcomes when matched to phenotype and phase. Heterogeneity of products and outcomes limits cross-study comparability; head-to-head trials and standardized endpoints are priorities to refine indications across hospital and community pathways.
What Kind of Difference Do We Want to Make in Burns?
Burns are some of the most devastating forms of trauma a human body may endure and disproportionately affect the most vulnerable members of our society. Burns cause soft tissue and multi-organ injuries through multiple complex mechanisms and are responsible for life-long physical, functional, social, and psychological impact on burn survivors' quality of lives. While prevention of burns and scalds is the ultimate goal, prevention of further harm once a burn injury has occurred is the next aspiration. Burns first aid consists of application of cool running water for at least 20 minutes within the first three hours of burn injury. Healthcare professionals hold the burden of responsibility to apply this evidence-based early intervention to improve healing and change the trajectory of outcome for patients. Efforts to improve public knowledge and awareness of the impact of early and appropriate burns first aid on burn survivors' quality of life outcomes have to begin close to home.
Copyright (c) 2025 IJWR | International Journal of Wound Research
Physiotherapy Management in Pediatric Burns: A Five-Year Experience Comparing Children and Adolescents at a Tertiary Burn Center
Introduction. Physiotherapy plays a crucial role in the management of pediatric burn patients, requiring early intervention and long-term follow-up to prevent functional limitations and manage scar-related complications. Adolescents represent a particularly challenging group, as developmental, psychological, and social factors may negatively influence engagement and adherence to rehabilitation programs. This study aimed to describe the physiotherapy tools used in pediatric burn patients and to compare physiotherapy modalities and treatment adherence between children and adolescents treated at a tertiary pediatric burn center. Methods. A retrospective observational, monocentric chart review was conducted in accordance with STROBE guidelines. Medical records of pediatric burn patients (≤18 years) admitted to the Burns Center of Meyer Children’s Hospital IRCCS, Florence, between 2017 and 2022 and managed by the Rehabilitation Unit were reviewed. Patients were divided into two groups based on age at admission: children (<11 years) and adolescents (11-18 years). Data collected included demographic characteristics, burn features, physiotherapy modalities used during the acute and scarring phases, and adherence to the prescribed physiotherapy program. Adherence was assessed subjectively by treating physiotherapists during routine clinical practice. Categorical variables were analyzed using Chi-square or Fisher’s exact tests. Results. Thirty-five patients were included: 20 children and 15 adolescents. The adolescent group more frequently presented with burns involving a larger total body surface area. Most physiotherapy tools were used similarly in both groups; however, gait training during the acute phase was more frequently applied in adolescents (p = 0.046), while contact media during the scarring phase were more commonly used in children (p < 0.05). Adherence to physiotherapy during hospitalization was generally good in both groups. During the scarring phase, children showed significantly higher adherence to splints, massage combined with skin hydration, elastic-compressive garments, and contact media (all p < 0.05). Discussion. Physiotherapy management in pediatric burn patients relies on similar tools across age groups; however, adherence appears to be lower in adolescents, particularly during long-term scar management. Developmental factors and family involvement likely play a key role in treatment engagement. These findings highlight the need for age-tailored, patient-centered rehabilitation strategies to improve adherence among adolescents with burn injuries.
Pressure Injuries in Dependent Individuals within Primary Care: A Descriptive Study
Introduction. Pressure injuries represent a prevalent and serious health issue among dependent individuals, especially within the primary care context. These injuries contribute to increased morbidity, diminished quality of life, and greater healthcare resource utilization. Accurate and comprehensive clinical records are essential not only for guiding individual patient care but also for supporting scientific research. They enable the identification of risk factors, monitoring of outcomes, and development of evidence-based interventions. The Aim of this study is to analyse the informatic nursing records of dependent persons in a Portuguese Primary Health Care Unit (PHCU), within the scope of the prevention and treatment of pressure ulcers/injuries (PU/PI). Methods. Retrospective analysis of electronic health record database from 112 patients registered in the “Dependents Program” of the Informatic System SClínico® of a Portuguese Primary Health Care Unit during 2019. Beyond sociodemographic characterization, the data analysis included the following variables: self-care level; PU/PI risk; co-morbidities; nutritional risk; PU/PI classification, anatomical location, assessment, and type of treatments performed; pain and the family caregiver’s “ability” and “knowledge” to prevent PU/PI. Results. During 2019, 80.4% of the participants had the self-care level recorded and 83.0% had the PU/PI risk assessment recorded. The nutritional risk assessment was not recorded in 90.2% of the participants. The PU/PI assessment through RESVECH 2.0 was registered in 72.2% of the participants. The treatment implemented and the pain assessment were documented in a residual way. Discussion and Conclusions. The findings reveal notable strengths and gaps in the documentation practices related to pressure injury prevention and management in primary care. While a majority of participants had their self-care level and PU/PI risk assessments recorded, critical areas such as nutritional risk assessment were largely neglected. Given the well-established link between nutrition and skin integrity, this represents a significant oversight. The use of the RESVECH 2.0 tool for PU/PI assessment was observed in great percentage of participants, indicating moderate integration of standardized assessment tools into clinical practice. However, the documentation of both treatment interventions and pain assessment was minimal, suggesting these essential aspects of care are not being systematically recorded. These findings underscore the need to strengthen comprehensive and consistent record-keeping, as incomplete documentation can hinder both the continuity of care and the generation of robust scientific evidence.
Effective Preventive Strategies for Pressure Injuries in Neonatal and Pediatric Intensive Care: Analysis of an Implemented Pathway
Introduction. This descriptive observational study aimed to assess the impact of a structured pressure injury (PI) prevention program on the incidence of PIs in critically ill neonatal and pediatric patients implemented in the Neonatal and Pediatric Intensive Care Unit of the IRCCS Istituto Giannina Gaslini. The program, coordinated by a nurse specialized in wound care, included the use of pediatric risk assessment tools (Braden, Braden Q, and Glamorgan scales), evidence-based protocols, frequent repositioning, support surfaces, and targeted staff training. Methods. The primary objective was to assess the impact of these interventions on the incidence of PIs. Prospective data collection was carried out to document the implementation of the measures and the progression of PIs. Results. A direct comparison between data collected prior to the systematic introduction of preventive strategies (incidence rate: 5.6%) and data collected after program implementation (average incidence rate: 1.6%) revealed an overall 71% reduction in PI cases. Discussion. The program’s success appears to be linked to a multifactorial approach: systematic risk assessment, continuous staff training, and the use of appropriate support devices and dressings. The role of the wound care nurse proved essential for clinical supervision and team engagement. However, fluctuations in incidence rates during staff turnover periods highlight the need for sustained education and a strong culture of prevention. The variable application of risk assessment tools also suggests that standardized use and interpretation should be promoted to improve consistency. Conclusions. The adoption of a structured, multidisciplinary program—with the involvement of a wound care specialist nurse and the use of pediatric-specific assessment tools—appears promising in reducing the incidence of pressure injuries in critically ill neonatal and pediatric patients. Further prospective studies are needed to confirm these results and to identify specific risk predictors.
Prevention Decalogue for Dependency-Related Skin Lesions in Neonates: A Consensus-Based Delphi Study
Introduction. The extreme fragility of neonatal skin, particularly in extremely preterm infants, underscores the need for effective preventive measures. This study aims to validate and design a decalogue for the prevention of dependency-related skin lesions (DRSL) in the neonatal population, based on existing consensus documents. Methods. The Delphi method was employed to validate the content of the decalogue through expert consultation across Spain. Key criteria—including relevance, clarity, ambiguity, simplicity, satisfaction, and applicability—were assessed using a 4-point Likert scale and a 10-point scale, with a 75% agreement threshold for validation. Descriptive statistics were used to analyze responses. Items not meeting the threshold were revised based on qualitative feedback and re-evaluated. The final list of interventions was established through consensus in the second round. Results. A total of 23 experts participated in the first round, and 20 in the second. Across both rounds, all items were validated with a high level of agreement. In the second round, all items exceeded 85% agreement for relevance, clarity, ambiguity, and simplicity. The average satisfaction (9.36–9.47) and applicability (9.09–9.42) revealed a high level of agreement concerning the clinical applicability of the Decalogue. The decalogue outlines essential measures for preventing DRSL in neonates, including risk assessment, postural changes, the use of specialized pressure-relieving surfaces, and monitoring of device-related pressure points. It also highlights the importance of tailored skin care based on neonatal maturity and the need for thorough documentation of preventive interventions. Discussion. Consensus achieved via the Delphi process substantiates the Decalogue’s capacity to effectively articulate key preventive strategies with clarity and brevity. Moreover, its implementation will foster evidence-based care practices, ultimately enhancing the quality of care in neonatal units. However, ongoing efforts are required to further improve DRSL prevention and continuously update strategies in light of emerging evidence.