The Observatoire en Ville des Plaies ExSudatives (VIPES) Study: Insight Into the Patient Characteristics, Epidemiology, Previous Management, and Features of Wounds Treated in the French Community Setting

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Hard-to-heal or nonhealing wounds are a burden for health care systems worldwide.^1-6 In France in 2011, for example, care for LUs and PUs cost approximately €1 billion, almost half of which was attributed to nursing expenses.⁷ Furthermore, reimbursement data from the French National Health Insurance database show that in 2022, wound dressings were the second largest expenditure category, totaling €732 million.⁸

Wound age and wound area have been identified as the main factors contributing to poor healing prognosis for chronic wounds⁹; however, whether wound age is a cause or a consequence of poor healing is debatable. A prolonged inflammatory phase and local infection also jeopardize the healing of acute and chronic wounds.^10,11 These are each compounded by lifestyle factors, such as smoking or sedentary behavior, and the occurrence of multiple chronic pathologies associated with increasing age, while not being limited to the elderly population.¹² Therefore, any wound may become chronic and hard to heal, representing a significant global challenge with an aging population.

Although a worldwide consensus on the definition of hard-to-heal or complex wounds has not been established, several national health authorities acknowledge the challenges that these wounds present and include them in their clinical guidelines. For example, in France, the activity of community nurses is coded to define remuneration according to the care performed. Since January 1, 2020, this coding has been updated to include “Pansements lourds et complexes,” that is, difficult and complex dressing protocols.¹³ The coding defines 9 subcategories for difficult and complex dressing protocols for specific wounds: burns; radiotherapy burns; LUs or extensive skin grafts; amputation requiring debridement; digestive fistula; wounds involving traumatic or neoplastic loss of substance, with deep lesions of subaponeurotic tissue, muscle, tendon or bone; wounds requiring packing or irrigation; deep and extensive pressure sores affecting muscles or tendons; and wounds requiring surgical dressing with external osteosynthesis equipment.¹⁴

Furthermore, the French Vulnus expert committee launched an initiative to evaluate the prevalence of open wounds in the community.¹⁵ The committee proposed a more accurate definition of complex wounds based on anatomic characteristics (wound with substantial loss of substance; exposed bone, joint, nerve, or blood vessel structures) and general characteristics, such as wound age. The committee also acknowledged that wound complexity derives from factors inherent to the patient (physical, psychological, and social characteristics); factors related to the wound (eg, wound age, wound area, location, inflammation, and infection); factors related to the available resources and/or treatment; and the skills and knowledge of professionals treating the wounds. In practice, according to the committee's definition, a wound should be considered complex when it requires major excisional surgery (meaning that earlier care has failed); when it requires sophisticated technology (ie, negative pressure wound therapy) or management by a multidisciplinary health care team; or when the wound has a substantial economic impact.¹⁵ The findings of the committee point to a potential major shortcoming in the management of these wounds, which is the limited access to resources to identify at-risk wounds and to implement appropriate care.

The specific skills required to treat complex wounds often do not match the knowledge that nurses acquire during their initial training. Nurses can undertake further specialist training to enhance their knowledge of wound management (in France, for example, a university diploma on wounds and wound healing). However, it may be difficult to identify such professionals, because public records are not always available. Moreover, clinical guidelines on good practice for dressing and treatment of complex wounds (eg, compression therapy) are not regularly updated and vary from country to country.^16-19 In 2014, the French health service published good practice guidelines for community nurses, in which they provided a specific care pathway for chronic wounds to ensure effective management of challenging cases.²⁰ However, the guidelines only cover chronic wounds, with no guidance on complex acute wounds.²⁰ Beyond appropriate care and well-trained health care professionals, the importance of patient engagement with self-care and establishing a partnership between the nurses, the patient, and the patient's caregiver or family (if warranted), as proposed in the McGill model, should not be underestimated.²¹ There is a global need for a holistic approach to wound care to ensure the best clinical outcomes.

The role of a warm, moist environment to promote the wound healing process was first established by Winter in 1962.²² The proper management of exudate is important in maintaining this environment. Through its composition, exudate promotes the action of key cells involved in the healing process (neutrophils, macrophages, and fibroblasts). Conversely, pooling of exudate in the wound bed (Figure 1) may delay healing by increasing the risk of infection and skin maceration, potentially widening the wound. Inadequate exudate management can have considerable effects on patients' health-related quality of life, including causing feelings of distress and fear that leakage might soil clothing and bedding, or lead to embarrassing malodor.²³ A thorough knowledge and understanding of the wound is necessary to provide appropriate care, thus avoiding mismanagement of exudate.

The VIPES observational study aimed to describe the use and investigate the performance of 2 wound dressings—a silicone foam (Biatain Silicone; Coloplast A/S) and a gelling fiber (Biatain Fiber; Coloplast A/S)—in the management of chronic and acute wounds in the French community care setting. This article reports the epidemiological outcomes of the VIPES study, which focus on patient characteristics, previous wound management, and descriptions of the wounds reported by nurses at inclusion.

Ethics declaration

The VIPES study was conducted as part of the National Observatory of Wounds and Wound Healing NursTrial study, which provided a framework (study design, primary outcomes, and ethics approval) for other organizations to conduct studies and choose secondary end points. The NursTrial study was approved by the CCTIRS (French committee on health data processing for research purposes) on September 16, 2015, and was authorized by the CNIL (French data protection authority) on December 24, 2015 (DR-2015-699), according to the French regulation and in alignment with the General Data Protection Regulation. The study complied with the Declaration of Helsinki. As part of the nationwide NursTrial study, no additional authorization was required for the VIPES study.

Study design

The VIPES study was a prospective, observational, descriptive, noncomparative research study that was carried out with district nurses throughout the French metropolitan territory. The study aimed to describe the use and investigate the performance of 2 wound dressings—a silicone foam and a gelling fiber—in the management of complex wounds by nurses in real-world, community care in France. This article reports data for the primary epidemiological outcomes of the VIPES study, which focus on patient characteristics, previous wound management, and descriptions of the wounds reported by nurses at inclusion.

Data were collected by 103 district nurses who participated in the study between May 2020 and September 2021 and who provided wound care to patients during home visits. Nurses received financial compensation for their participation in the study. Patients aged 18 years or older with a chronic or acute wound for which nurses independently chose to apply the silicone foam dressing or the gelling fiber, regardless of prior wound management, were eligible for inclusion. In addition to the specific brands of silicone foam dressing and gelling fiber assessed in this study, the nurses had access to the full range of wound dressings available in France (including different silicone foam dressings and gelling fibers). All patients received comprehensive written information about the study from their nurse and provided verbal informed consent to personal data collection and enrollment in the study by their nurse. To reflect daily practice in the community setting, there were no exclusion criteria.

At inclusion, nurses were asked to report baseline data, including patient demographics, clinical data from the patient's file, previous wound care management, and a description of the wound. Nurses were also asked to take photographs, following cleansing and debridement of the wound, from a distance of 20 cm with a 10-cm scale next to the wound. For patients with at least 1 follow-up visit, wound status and care provided were described. Patient follow-up ended at discontinuation of the silicone foam dressing or the gelling fiber as the primary dressing, whatever the reason reported by the nurse. All clinical data and photographs were collected and reported by nurses using the secure smartphone application NursTrial (CEN Biotech Inc.). No other data sources were utilized.

Clinical data collection and description

The primary outcome of the VIPES study was to describe wounds treated with the silicone foam dressing or the gelling fiber, classified by type and etiology at inclusion. Baseline characteristics of the patients included age, sex, body mass index, and presence of general factors that may delay or impair wound healing. The description of the wounds consisted of the anatomic location, wound age, wound surface area (length by width), wound depth, associated fistula, clinical appearance of wound bed, level of exudate, appearance and status of periwound skin and wound edges, and the presence of any local signs of infection and associated antibiotic therapy. As specified in recommendations, additional information was recorded for chronic wounds, if available, including the Braden Scale score for PUs (range, 6–23, with ≤9 representing a very high risk of pressure sore and 19–23 no risk),²⁴ offloading for DFUs, use of preventive support surfaces for PUs, and compression therapy for VLUs. For chronic wounds, the PUSH score was calculated to provide an indication of the improvement or deterioration in ulcer healing over time with respect to wound surface area, exudate, and type of wound bed tissue.²⁵ Total PUSH score can range from 0 to 17 (with 0 representing a healed wound and 17 the most severe)²⁵ and can be calculated for all ulcer types.²⁶ When available, the primary dressings used prior to inclusion in the VIPES study and reasons for dressing change were reported. For the current publication, dressing changes that were attributed to poor exudate management and wounds not progressing toward healing (stagnant wounds) were classified as treatment failure, although in some cases, other reasons for dressing change could also be considered treatment failure. Cleansing and mechanical debridement were specified when performed prior to wound description and application of the silicone foam dressing or the gelling fiber (baseline visit).

Statistical analysis

During data analysis, wounds were categorized as chronic or acute according to their etiology (as reported by nurses at baseline) and in line with the categories shown in Beeckman et al.²⁷ Hard-to-heal or complex wounds were defined as wounds that had not progressed toward healing with standard care in an orderly and timely manner; such wounds occur in patients with multiple comorbidities, and display increases in exudate, infection, devitalized tissue, maceration or pain, or no change in wound size.²⁷

Descriptive analyses were conducted for all patients for whom the data collected were sufficiently complete (baseline characteristics and wound etiology, wound surface area, wound depth, exudate characteristics, wound edge, and wound bed tissue description). Quantitative variables were described by mean and SD or median and 95% CI. Qualitative variables were described by number and percentage. The percentages of wounds included in the epidemiological analysis data set were calculated according to chronic or acute categorization, by etiology within these subgroups, and by treatment group (ie, silicone foam dressing or gelling fiber). Statistical analyses were carried out using SAS software (version 9.4; SAS Institute Inc.).

As shown in Figure 2, the district nurses recorded data for 407 patients, of which 342 had assessable data. After review of the photographs and data collected, an additional 57 patients were excluded due to inconsistent data or erroneous inclusion (ie, the silicone foam dressing or the gelling fiber were not used).

Patient characteristics at baseline

Baseline characteristics of the 285 patients are summarized in Table 1. Patients presenting with a chronic wound were older than patients with an acute wound (median age, 80.0 vs 66.0 years) and displayed a more severe clinical profile (with 96.2% [n = 177] vs 59.4% [n = 60] having at least 1 factor delaying or impairing wound healing).

Wound etiology and characteristics at baseline

Wound etiology is detailed in Table 2. Chronic wounds (64.6% [n = 184] of all 285 wounds) included ulcers (53.8% [n = 99]; venous [n = 63], arterial [n = 9], or mixed [n = 27]), DFUs (13.6% [n = 25]; neuropathic [n = 15], ischemic [n = 7], neuroischemic [n = 2], or unknown [n = 1]), PUs (26.1% [n = 48]; stage 2 [n = 2], stage 3 [n = 34], stage 4 [n = 12]), and malignant wounds (6.5% [n = 12]). Acute wounds (35.4% [n = 101] of all wounds) included surgical wounds (34.7% [n = 35], of which 15 were pilonidal cyst and 8 were wound dehiscence) and traumatic wounds (65.3% [n = 66], of which 6 were burns).

The main wound characteristics at baseline are also reported in Table 2. Mean (SD) wound surface area was larger for chronic wounds (25.6 [62.5] cm²) compared with acute wounds (9.9 [19.0] cm²). However, a similar proportion of patients in the 2 groups presented with wound area greater than or equal to 10 cm² (34.8% of chronic wounds vs 27.7% of acute wounds). Chronic wounds had the greatest average wound age with mean (SD) of 328 (906) days; however, acute wounds also displayed a high mean wound age of 46 (116) days.

A median PUSH score of 12.0 (95% CI, 10.4–11.5; mean [SD]: 10.9 [3.5]) was calculated for 171 chronic wounds during data analysis. A Braden Scale score of 13 was reported for 1 patient with a PU. Additionally, 11.4% of chronic wounds (n = 21) and 14.9% of acute wounds (n = 15) presented with local signs of infection.

Wound depth, exudation, periwound skin, and wound edge description at baseline

A total of 269 (94.4%) of all wounds had a depth less than or equal to 20 mm (96.2% of chronic wounds [n = 177] and 91.1% of acute wounds [n = 92]) (Figure 3). Furthermore, the majority of wounds had a depth less than or equal to 5 mm (77.2% of chronic wounds [n = 142] and 65.3% of acute wounds [n = 66]) (Figure 3).

Almost all wounds were classified as exuding (98.2% [n = 280]) (Table 3). A moderate or high exudate level was reported for 64.2% of patients (n = 183), and 77.9% of patients presented with exudate pooling (n = 222). Chronic and acute wounds had similar exudate profiles (64.7% of patients [n = 119] vs 63.4% of patients [n = 64], respectively, presented with moderate or high exudate levels, and 82.1% of patients [n = 151] vs 70.3% of patients [n = 71], respectively, presented with exudate pooling).

Of all wounds, unhealthy wound edges and periwound skin were reported in 57.2% (n = 163) and 35.4% (n = 101), respectively (Table 3). Chronic wounds displayed unhealthy wound edges (66.3% [n = 122]) and periwound skin (41.8% [n = 77]) more frequently than acute wounds (40.6% [n = 41] and 23.8% [n = 24], respectively). In addition, maceration of wound edges was reported in 32.6% of all wounds (n = 93), 38.0% of chronic wounds (n = 70), and 22.8% of acute wounds (n = 23).

Wound bed tissue distribution is illustrated in Figure 4. Of all 283 wounds (data were not available for 2 patients), 24.4% (n = 69) were classified as sloughy (>50% of sloughy tissue) and 56.2% (n = 159) were in the granulation phase (>50% of granulation tissue) (Figure 4A). Chronic wounds displayed a less favorable healing prognosis than acute wounds, with 28.4% of 183 chronic wounds (n = 52) classified as sloughy compared with 17.0% of 100 acute wounds (n = 17) (Figure 4B, C).

Treatment used prior to baseline and reasons for applying the silicone foam dressing and the gelling fiber at enrollment

At enrollment in the VIPES study, 86.0% of all wounds (n = 245) had been previously treated with at least 1 primary dressing (Table 4). In the silicone foam dressing and the gelling fiber subgroups, 24.4% of patients (n = 21) and 9.5% of patients (n = 19), respectively, had no dressing in place at baseline (Table 5). Overall, 78.6% of all patients enrolled (n = 176) had wounds that were in treatment failure (poor exudate management and/or stagnant wound) (Table 4). The change of dressing was reported as due to treatment failure in 81.9% of chronic wounds (n = 122; 65.1% [n = 97] stagnant wound, 16.8% [n = 25] poor exudate management) and in 72.0% of acute wounds (n = 54; 46.7% [n = 35] stagnant wound, 25.3% [n = 19] poor exudate management). Treatment failure was the main reason for switching to the silicone foam dressing in 75.9% of patients (n = 41) and the gelling fiber in 79.4% of patients (n = 135). When the main reason for dressing change was reported as poor exudate management, the gelling fiber was applied more often than the silicone foam dressing (22.9% [n = 39] vs 9.3% [n = 5], respectively) (Table 5).

Wound management at baseline

Treatment by etiology. Nurses reported offloading for 57.1% of patients with a DFU (n = 12 of 21 [4 data points not registered]); use of preventive support surfaces for 63.0% of patients with a PU (n = 29 of 46 [2 data points not registered]); and wearing a compression device for 65.9% of patients with a VLU (n = 54 of 82 [8 data points not registered]), only 1 of whom had an ABPI test to check the adequacy of the compression.

Cleansing and mechanical debridement. Nurses reported cleansing 91.7% of the wounds (n = 254 of 277 [8 data points not registered]). The wounds were mainly cleansed with saline (62.2% [n = 158]) or, to a lesser extent, water and soap (29.1% [n = 74]), and rarely with antiseptics. Mechanical debridement was performed for 16.1% of all wounds (n = 46), 25.6% of necrotic wounds (presence of necrotic tissue; n = 11 of 43 [2 data points not registered]), 21.3% of highly sloughy wounds (>75% sloughy tissue; n = 10 of 47 [2 data points not registered]), and 10.4% of granulating wounds (>75% granulation tissue; n = 14 of 134 [2 data points not registered]).

Wound condition at inclusion by treatment group: silicone foam dressing and gelling fiber

The silicone foam dressing was used in the management of 86 wounds, most of which had low (54.7% [n = 47]) or moderate (31.4% [n = 27]) levels of exudate (Table 6). In contrast, the gelling fiber was preferentially used in the management of moderately (46.2% [n = 92]) or highly (28.1% [n = 56]) exuding wounds.

Figure 5 illustrates the wound depth by treatment group. Of the patients with chronic wounds receiving treatment with the silicone foam dressing or the gelling fiber, respectively, a similar proportion had a wound depth of less than or equal to 5 mm (79.6% [n = 39] vs 76.3% [n = 103]), 6–10 mm (18.4% [n = 9] vs 14.8% [n = 20]), or 11–20 mm (2.0% [n = 1] vs 3.7% [n = 5]). All 7 patients with chronic wounds with a depth greater than 20 mm received the gelling fiber. When used to dress acute wounds, the silicone foam dressing was predominantly used for wounds with a depth less than or equal to 5 mm (78.4% [n = 29]). Almost all traumatic wounds were treated with the silicone foam dressing. Notably, 57.8% of acute wounds treated with the gelling fiber were of a depth less than or equal to 5 mm. However, acute wounds with a wound depth greater than or equal to 6 mm were preferentially dressed with the gelling fiber rather than the silicone foam dressing (n = 27 vs n = 8, respectively).

Chronic wounds to which nurses applied the silicone foam dressing displayed less sloughy tissue and more granulation tissue compared with chronic wounds treated with the gelling fiber (Figure 6B, E). In contrast, for acute wounds, wound bed tissue distribution did not seem to have an effect on dressing choice (Figure 6C, F).

The characteristics of chronic and acute wounds and the wound management provided to 285 patients by nurses in a real-world community setting were investigated in this prospective, observational study. The ratio of chronic to acute wounds of 2:1—as well as the respective proportions of ulcers, PUs, and DFUs—reported in the current study were consistent with previous epidemiological data in a community setting^15,28 and data provided by the French health care system database.²⁰ Although health care system databases are a useful source of information regarding the prevalence and incidence of wounds in the general population, they do not capture wounds that are not initially assessed in hospital facilities, or the etiology of acute wounds.

To the knowledge of the authors of the current study, there are no data reporting the frequencies of acute wounds by etiology. However, the annual incidence of burns and pilonidal cysts can be evaluated using health care system databases. The French National Society of Colo-Proctology estimates the incidence of pilonidal cysts to be 26 per 100 000 cases.²⁹ Fifteen patients with pilonidal cysts were included in the current study, suggesting an overrepresentation in the study population. This overrepresentation could be explained by the need for a gelling fiber, such as that used in the current study, for cavity wounds.

There is also a gap in knowledge extending to the proportion of exuding or complex wounds managed by community nurses. Wounds included in the VIPES study were almost all exuding, which is consistent with the intended use of both dressings under investigation. All patients in the current study also presented with a complex profile according to the definition by the Vulnus expert committee¹⁵ and that reported in Beeckman et al,²⁷ which was not anticipated based on available data on complex wound prevalence. The clinical profile of the patients included in the study, particularly age and the presence of factors that may delay or impair wound healing, are important because they are known risk factors for complex wounds. Although typically only reported for chronic wounds, both acute and chronic wounds included in the current study exhibited several prognostic indicators of hard-to-heal wounds, such as older wound age, larger wound surface area, higher levels of exudate and, for some, the presence of necrosis and local signs of infection.¹⁰ Patient clinical profile, wound condition, and the suboptimal wound care identified in this study may have been the main contributors to the finding that all wounds were complex.

Inadequate exudate management may result in maceration or dryness; both environments negatively affect wound healing. In this study, pooling of exudate was reported for 78% of patients at enrollment, which suggests that many of these wounds would have a high risk of leakage, maceration, and infection.³⁰ Few wounds presented with local signs of infection. However, unhealthy wound edges and/or periwound skin, which may have resulted from excessive maceration, were frequently observed. Interestingly, the patients enrolled in the current study had comorbidities—such as heart disease, renal or hepatic insufficiency, and endocrine or nutritional diseases—which require medical treatments that may increase the production of exudate. In the current study, nurses reported examining only quantity and consistency of the exudate; however, the findings of a survey of 71 wound care specialists indicated that 80% (n = 57; data not available for 5 specialists) always systematically consider exudate color and odor in addition to consistency and amount.³⁰ Exudate color and smell provide important information when making decisions about appropriate management.

Suboptimal wound management was also observed in the current study. For example, debridement was not systematically performed for all necrotic or sloughy wounds as recommended; on the contrary, it was inappropriately implemented in 10.5% of granulating wounds. Although painful for the patient and aggressive for the wound, mechanical debridement is sometimes essential to clean the wound of debris when autolytic debridement is not sufficient. Nurses are often reluctant to perform mechanical debridement because of lack of practice and training, ignorance of the conditions for which it is required, or the risks inherent with this intervention.³¹

The current study also highlights the inadequate use of available assessment tools. Community nurses should continuously monitor their patients to assess the risk of developing PUs. However, the Braden Scale score was reported only once. A baseline PUSH score, which indicates the healing status of a chronic wound, was reported for most patients with chronic wounds. A chronic wound with a PUSH score of 10 would be expected to heal in 8.8 weeks, whereas for a wound with a PUSH score of 4, healing would be expected at 2.6 weeks.³² The median PUSH score of 12 calculated a posteriori in the current study suggests that healing was not expected within a short time frame, indicating the complexity of the wounds assessed. Overall, 65.9% of patients with a VLU wore a compression device. However, an ABPI value was reported for only a single patient. Adjusting compression therapy to the ABPI is part of the clinical practice guidelines for LU treatment,^18,33 and has been demonstrated as essential to achieve healing.¹⁷ Furthermore, for patients not receiving compression treatment in the current study, the nurses did not report whether this was because the patients had not received a prescription for compression or if they were simply not adhering to treatment. Adherence to compression has been shown to be significantly greater in patients educated by their nurse on the importance of wearing a compression device, compared with patients who did not receive such education.³⁴ There are no specific assessment tools dedicated to acute wounds, even when they present with a complex profile requiring monitoring of healing progression. Global recommendations emphasize the need to assess and/or reassess wounds in order to continuously optimize the treatment plan and achieve healing.^16,18,20,35 Pedagogic and freely available tools, such as the Triangle of Wound Assessment approach,³⁵ exist but seemed to be insufficiently used or not used in the current study to prevent wound stagnation or worsening.

Stagnant wounds or poor exudate management, illustrating previous treatment failure, were the main reasons reported by the nurses for changing to the silicone foam dressing or the gelling fiber. Compared with the silicone foam dressing, the gelling fiber was applied to wounds with a poorer healing prognosis (ie, heavily exuding wounds presenting with exudate pooling and unhealthy periwound skin and/or wound edges). With the exception of specific situations such as undermining, highly exuding, and sloughy wounds, gelling fibers are not usually recommended for shallow wounds (< 20 mm deep). Gelling fiber dressings may induce ischemia or pain at removal, especially if applied incorrectly. Dressings that conform to the wound bed have been shown to be an effective alternative to fillers for shallow wounds.³⁶ Considering wound depth, absence of cavity, or level of exudate, approximately 75% of the wounds treated with the gelling fiber in the VIPES study could, potentially, have been treated with the silicone foam dressing. It is difficult to determine if there is a need for more education in the community setting on the use of different dressing types, if the healing progression called for a switch to a gelling fiber, or if the novelty of the specific brand of gelling fiber assessed in the current study, which was new to market, influenced a relatively high number of nurses to select this type of gelling fiber over the foam dressing.

The choice of dressing should be based on an evaluation of wound etiology, the patient's clinical profile, associated treatments, patient preference, and a detailed assessment of the wound at baseline and on follow-up.^37,38 In France, recommendations for wound care are out of date, do not apply holistic approaches to management, and do not consider the latest dressings.³⁹ Efforts have been made by the French health care system to publish good practice guidelines for wound management, but these are limited to LU, PU, and DFU.²⁰ While the European Wound Management Association offers dedicated study programs for nurses, student nurses, and practitioners, in France, for example, only qualified nurses may have access to specialist wound management training. Furthermore, the health care system does not facilitate identification of specialist wound care nurses able to treat patients at risk of complex wounds.

In addition to the provision of good practice guidelines and specialist education, the quality of wound management is dependent on collaboration between health care professionals. Efforts are needed to improve this collaboration to optimize wound management and reduce the risk of treatment failure. In Canada, for example, a holistic approach to the assessment of patients with complex wounds by a multidisciplinary specialist team using a blended virtual and home-based system has been tested.⁴⁰ The benefits of this collaborative approach were evidenced by favorable clinical outcomes, including complete healing of 29% of the wounds, and improved health care system utilization.⁴⁰

This observational study has some limitations. First, due to the intended uses of the silicone foam dressing and the gelling fiber, most of the wounds captured in the VIPES study were exuding and, therefore, the epidemiology and characteristics of non-exuding wounds was not assessed. Second, the specific gelling fiber assessed in the current study was new to market at the time of data collection, adding to the existing range of gelling fibers available in France. Therefore, the nurses may have been influenced by the novelty of the brand and more inclined to select it over existing gelling fibers and other types of dressing.

The results of the VIPES observational study highlight that both chronic and acute wounds can present complex profiles, and that the current community care practices and clinical guidelines in France warrant improvement. With an aging population and the growing prevalence of chronic diseases, such as diabetes, early and appropriate wound management constitute a real challenge for health care systems. Thus, efforts are needed to provide practical and up-to-date recommendations on wound management for community care nurses in order to obtain the best clinical outcomes for patients.

Authors: Pascal Vasseur, RN¹; Nayla Ayoub, PhD²; Christine Juhel, PhD³; Romain Schueller, B. STAT³; Adoración Pegalajar-Jurado, PhD²; and
Florence Armstrong, PhD⁴

Acknowledgments: Support for revision of the manuscript following peer review was provided by Laura Upstone and colleagues at Cambridge, a division of Prime (Knutsford, UK), funded by Coloplast A/S.

Affiliations: ¹Cabinet Expertise Santé, Lacrau, France; ²Wound and Skin Care, Coloplast A/S, Humlebæk, Denmark; ³CEN SARL, Dijon, France; ⁴Wound and Skin Care, Laboratoires Coloplast SAS, Paris, France

Author Contributions: This observational study was designed by Coloplast, in close collaboration with CEN Biotech Inc., which administered the research as a clinical research organization. Data collected by nurses in their daily practice were analyzed by the CEN biostatistician, independent of the sponsor, after review of the data and photographs. Authors had full access to all data in the study. All authors collaborated to analyze and critically interpret the data, as well as to write the manuscript. All authors approved the manuscript for submission.

Disclosures: This study was funded by Laboratoires Coloplast SAS, Paris, France. Coloplast A/S funded the writing and editing of the article and contributed to its content. Coloplast A/S and Laboratoires Coloplast SAS reviewed the article for scientific accuracy. P.V. is a consultant for Laboratoires Coloplast SAS and received grants for participating in this publication. N.A. and A.P.J. are full-time employees of Coloplast A/S. F.A. is a full-time employee of Laboratoires Coloplast SAS. C.J. and R.S. are full-time employees of CEN SARL. None of these authors received personal payments for their involvement in the study or their contribution to this article.

Correspondence: Florence Armstrong, PhD; Laboratories Coloplast, Wound and Skin Care, 38 rue Roger Salengro, Fontenay sous Bois, Fontenay sous bois 94120 France; frfar@coloplast.com

Manuscript Accepted: January 15, 2024