Tissue Viability and Wound Care Practice

URGO Medical is proud to announce that its “Tissue Viability & Wound Care Practice” education program has been re-endorsed by the Australian College of Nursing through until 2024.

This Training and Workshop is endorsed by ACN according to the Continuing Professional Development (CPD) Endorsed Course Standards. It has been allocated 14CPD hours according to the Nursing and Midwifery Board of Australia – Continuing Professional Development Standard.

Tissue Viability is explained as preventing insults to the skin and underlying tissues and facilitating healing in wounds where a complication has prevented the normal healing process. It is an umbrella term, which, when used correctly, refers to the prevention and management of tissue damage which may include both acute and chronic wounds, and the provision of the appropriate environment for healing by both direct and indirect methods together with the prevention of skin breakdown.

This 2-day program is intended as a platform where basic to intermediate training is provided for those health care practitioners who are interested in acquiring further knowledge in the area of wound management. Eight modules introduce the participant to the fundamentals of the Integumentary System, the causes and assessment of wounds, how wounds heal and the holistic treatment of alternative wound healing etiologies using an evidence based approach.  The aim of the program is to enhance clinicians practice when dealing with management of and prevention of tissue complications. The workshop includes didactic information via PowerPoint, interactive sessions in the form of group activities, knowledge checks and scenarios or case studies, plus hands-on learning (where applicable).

The URGO Education & Training Alliance has been established with the sole purpose of providing unbiased evidence based education to clinicians. The Chairman and main educational sessions facilitator, Emilio Galea, has a long history in the field of wound management and tissue viability with local individual facilitators Cassandra Hough and Tanya O’Hara – both clinical specialists with URGO Medical Australia.

For a more detailed outline of the modules please do not hesitate to discuss with your local URGO representative. This may be an opportunity to support ongoing education and development of up and coming wound care nurses, assist with the development of wound care champions or up skill team members.  The facilitators can also tailor the program to meet the needs of your team with days and times negotiable.

For more information please contact us or email: enquiries@au.urgo.com

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Venous Leg Ulcer

Despite standard treatment in the community.1


1 %

of world adult population2-4

+11 %

Per year5

Up to 70%

of venous leg ulcers recur after healing


Delayed or inaccurate diagnosis can cause complications and extended treatment durations.

30% of wounds lack differential diagnosis7

Only 22% of patients had an ABPI documented7

42% of wounds remain unhealed after 6 months7


Causes of lower limb ulceration:

Chronic venous hypertension >70%

Poor arterial supply10-15%

Mixed arterial and venous origin 15%


Leg ulcers are becoming increasingly complicated due to a greater number of underlying co-morbidities

(i.e. obesity, malnutrition, diabetes, inflammatory conditions), lifestyle and increased longevity)

35% are now considered to be complex multi-factorial ulcers8


The priority for leg ulcer patients is to reduce healing time to get back to their normal life.


To reverse Venous Hypertension



To remove local factors that impair healing


  • Comorbidities
  • Pain
  • Lifestyle factors


Why do leg ulcers take so long to heal?

Beyond the underlying etiology of leg ulcers, one key local factor significantly impairs wound healing from the beginning:

A prolonged inflammatory phase with increased levels of Matrix Metalloproteinases (MMPs)10 which are present
from the beginning of the wound and destroy essential extracellular matrix (ECM) components.

Interactive dressings that address local barriers to healing can reduce healing time for leg ulcer patients

In addition to the etiologic treatment such as off-loading and compression, a local treatment is needed to act on this factor.

Reduction of excess Matrix Metalloproteinases (MMPs):NOSF has been shown to reduce healing times.10

Since MMPs are the main enzymes implicated in the extracellular matrix (ECM) degradation, their reduction results in a reduction of proteolytic destruction of essential ECM components.

  1. Fund For Employee Insurance of Employed Workers. Report to the minister for security social and parliament on evolution expenses and products of
    health insurance for 2014 (law of august 13, 2004). 2014. https://tinyurl.com/yxe8cq3q (accessed 10 July 2019).
  2. Posnett, J., Gottrup, F., Lundgren, H., & Saal, G. (2009). The resource impact of wounds on health-care providers in Europe. Journal of wound care, 18(4), 154-154.
  3. Bobek K, Cajzl L, Cepelak V, Slaisova V, Opatzny K, Barcal R. Étude de la fréquence des maladies phlébologiques et de l´influence de quelques facteurs étiologiques. Phlebologie. 1966;19:227- 230.
  4. Widmer LK. Peripheral Venous Disorders. Basle Study III. Bern, Switzerland: Hans Huber; 1978
  5. Guest JF, Vowden K. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care 2017; 26(6): 292–303. doi: 10.12968/jowc.2017.26.6.292.
  6. 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 191 1289-1297.
  7. Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J 2017; oi:0.1111/iwj.12814
  8. Moffat, 2001 and Moffat 2014.
  9. Management of patients with venous leg ulcers: Challenges and current best practice. Journal of Wound Care, vol 25 no 6. EWMA document 2016
  10. Lázaro JL, Izzo V, Meaume S, Davies AH, Lobman Rm Uccioli L. Elevated levels or matrix metalloproteinases and chronic wound healing: an updated review of clinical evidence. J Wound Care 2016: 25(5):277-287.

Diabetic Foot Ulcer


Diabetic foot ulcers (DFUs)are one of the major complications of diabetes. Between 19 and 34% of all diabetics will develop a foot ulcer at some point in their lives3 DFUs can lead to complications such as an infection requiring hospitalisation, or in the worst cases, amputation. After amputation, patient life expectancy does not exceed 5 years in almost 70% of cases4.


The prevention of DFUs requires a partnership of those people living with Diabetes and their HCP. This partnership should be underpinned with daily foot checks undertaken by the patient, reinforced by regularly scheduled visits to their HCP for a more detailed check that should, at a minimum include a check for Loss of Protective Sensation (LOPS) due to neuropathy and Peripheral Artery Disease (PAD). Both of these are major risk factors in the development of DFUs.

To assist in the rating of patient’s risk of developing a DFU URGO Medical Australia have provided Fact Sheets for both General Practitioners and their patients, now available in Medical Director and Best Practice, on diagnosis.
This Fact Sheet also provides GPs with a link to the Australian Save Feet/Save Lives website where you can find more information on the prevention of DFUs. A non-HCP version of the site is also available for patients to learn more about Diabetes and preventative care of their feet.



With the best of efforts, a large number of DFUs still occur. This is when closing wounds earlier reduces the risk of amputation 5,6. There are steps that can be taken by front line healthcare practitioners to better managing a DFU.
UNDERSTAND THE STANDARD OF CARE FOR DIABETIC FOOT ULCERATION. DFU treatment is complex and requires a multidisciplinary approach. This is the recommended standard of care that needs to be put in place by a multidisciplinary team in a specialised setting5,6 (also see figure 1)


  1. Whiting, D. R., Guariguata, L., Weil, C., and Shaw, J. 2011. “IDF Diabetes Atlas: Global Estimates of the Prevalence of Diabetes for 2011 and 2030.” Diabetes Res. Clin. Pract. 94 (3): 311-21.
  2. Van Netten JJ, Lazzarini PA, Fitridge R, Kinnear E, Griffiths I, Malone M, Perrin BM, Prentice J, Sethi S, Wraight PR. Australian diabetes-related foot disease strategy 2018-2022: The first step towards ending avoidable amputations within a generation. Brisbane: Diabetic Foot Australia, Wound Management CRC; 2017.
  3. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med 2017; 376: 2367-75
  4. Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med 2016; 33:1493–98.
  5. Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician 2002; 66(9): 1655-62.
  6. Vuorisalo S, Venermo M, Lepantälo M. Treatment of diabetic foot ulcers. J Cardiovasc Surg 2009; 50(3): 275-91.

Risk factors

les facteurs de risque - Urgo Medical

Several factors can cause a wound,  compromise its healing, or even cause an acute wound to become a chronic wound, with all the risks of complications that brings, including the risk of recurrence. Below are some of the risk factors usually present:

Disease-related risk factors
  • Venous insufficiency: Prevents the blood from reaching the upper body (moving towards the heart). It causes blood to stagnate in the veins as a result.
  • Diabetes: Causes a high blood sugar level, damages the arteries and nerves, especially in the feet, rendering certain types of injury (even minor) imperceptible.
  • Arterial insufficiency: Prevents the wound from being sufficiently irrigated with arterial blood which supplies the nutrients required for local healing.
  • Malnutrition: Responsible for essential nutrient deficiency which the wound needs to be able to repair and heal.
Lifestyle-related risk factors
  • Smoking: Can damage the arteries (atheromatous plaque on the wall) and thus reduce the oxygen supply to the wound.
  • Wearing uncomfortable shoes: Can impair blood flow, exert pressure on an existing wound or cause friction which damages the skin.
  • Non-observance of basic hygiene rules: Includes washing daily, drying well between the toes after washing and cutting toenails etc.
  • Sedentary lifestyle: Increases the risk of cardiovascular diseases and diabetes. A minimum level of physical activity is therefore recommended to ensure metabolic balance.
Patient profile-related risk factors 
  • Age: The skin becomes thinner with age, which increases tissue weakness even further. Elderly people are also more subject to skin dryness, as their skin is less well hydrated than young skin. Its lack of elasticity makes it less resistant to even minor shocks, and can slow the healing process.
  • Mental health: Stress and depression are common among patients suffering with a wound, which sometimes takes a long time to heal. Management of these factors, whether related to pain, to the time required for healing, the difficult treatment or a more general feeling of anxiety, is essential for a wound to go on to heal.

Wound healing

There are two categories of wounds:

  • Acute wounds
    They can be described as wounds that appear suddenly; among which are especially burns, and post-operative wounds related to surgery. Or traumatic wounds secondary to an accident; which can look like cuts, lacerations but also bites/scratches, or can result from extreme weather conditions, as in the case of frostbite. For these acute wounds, the physiological healing process takes between two and four weeks.
  • Chronic wounds
    These wounds are most often the result of an underlying disease or change in the patient’s general condition, which delay the healing process. They include leg ulcers, diabetic foot ulcers or even pressure injuries . Their treatment requires local wound care, but also treatment of the incriminated disease which may be venous or arterial insufficiency, diabetes, prolonged immobilisation associated with undernutrition and/or incontinence. These wounds take longer to heal (up to 210 days on average1) and are often recurring, which is why it is important to prevent relapse, especially in the case of venous leg ulcers. Age is also a risk factor for the appearance of wounds (due to the long progression of the incriminated disease) and a less effective healing process.

Regardless of the level of damage to the various skin layers, each wound, acute or chronic, requires appropriate care and management. In effect, the slightest breakage in the skin exposes the human body to bacterial contamination and therefore to a risk of infection.

How to manage a wound?

To help you manage your wound, follow this advice:

  • First clean the wound with water, which should preferably be warm. Remove any foreign bodies at the surface or even in the wound (gravel, soil, pieces of glass, metal splinters etc.)
  • If the tissue is particularly red around the edges of an acute wound, or there is a sensation of heat (sign of local inflammation) or it is yellow/green (sign of the presence of pus), if the wound is weeping considerably, if the wound gives off an unpleasant smell, or if fever is also present, see a doctor immediately, as it is probably infected.
  • You should see your doctor if you have a chronic wound of any type, which occurs or persists.


(1) Report for the Minister of Social Security and the French Parliament on the progression in health insurance expenditure and revenue in 2014 (Law of 13 August 2004) – July 2013.