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Our celebratory 35th publication year continues with our fourth annual themed issue on pressure injuries (PIs), an important global concern.


This issue provides recent PI research in print and online from the US and around the world. Some of the international authors' contributions include the following:


* Finnish data on PI prevention


* A study from Turkey on managing PIs in home care


* Brazilian research on PIs in ICU patients.



The continuing education article from Nie et al outlines how underdeveloped neonatal skin structure can lead to a high incidence of device-related PIs, especially from commonly used respiratory devices. This premature skin thinness and lack of development of some layers seen in adults lead to a variable clinical skin appearance that creates unique PI staging challenges. There is a need for research to outline refined criteria or a revised staging system for premature infants.


Urquhart and her interprofessional team also discuss device-related PIs. The investigators reduced their hospital tracheotomy-related PIs by 50%. The authors increased device-related PI awareness and implemented a standardized prevention bundle for tracheostomy insertion and care.


Healing PIs requires dermal granulation tissue to fill the space between the epithelial edges of the ulcer. Granulation tissue is protein, and accordingly, the body requires adequate nutrition to generate healthy granulation tissue. Munoz and colleagues provide an important overview of frequently asked questions regarding malnutrition and PI risk. The authors provide important assistance to apply the recommendations from the 2019 international clinical guideline.


Wound care specialists are still discussing the right term to describe these wounds, which have been called bedsores, decubitus ulcers, pressure ulcers, and now PIs. Dr Abruzzese1 brought forward the idea that until we can accurately assess the relative role of pressure, vascular occlusion, or other contributing factors, the current name may not reflect the true pathophysiologic basis of and best treatment for PIs. As with the wound bed preparation model, the current PI treatment paradigm emphasizes the importance of assessing the cause and determining the correct etiology.


Think about leprosy and the many misconceptions about the etiology of this variable skin disorder. Historically, although there were several causal theories, all of them were physiologically wrong. These factors resulted in misguided treatment, including isolation. Once the correct cause, Mycobacterium leprae, was identified and the appropriate antibacterial treatment/control of inflammatory sequelae was implemented, it resulted in a more successful standard of care.2 The history of leprosy underscores why scientific investigation and accurate pathophysiologic understanding are so vital.


The topic of PIs in patients at end of life and if they should be included in the concept of skin failure also continues to be of great interest. In this issue, you will find an article on this "hot topic" that was published online ahead of print. Levine and colleagues review the concept of skin failure and propose a model that relies on physiologic principles that are common to other organ systems.


Since the journal's inception, defining terms has played an important role in its scholarship. In March 2020, we invited the skin and wound care community to complete a 10-question survey on skin condition terminology in persons at the end of life. We published the results in March 2021.3 However, the discussion continues. Therefore, once again, we invite you to participate in an anonymous survey to advance knowledge on this critical topic. Please go to for more information. The survey will be available until June 30, 2022. Your opinion is important, and we hope you will be part of the conversation. Please watch for the results in a future issue!


Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN


R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM




1. Abruzzese R. Editorial. Decubitus1988;1(1):7. [Context Link]


2. Centers for Disease Control and Prevention. Hansen's disease (leprosy). 2017. Last accessed January 5, 2022. [Context Link]


3. Sibbald RG, Ayello EA. Terminal ulcers, SCALE, skin failure, and unavoidable pressure injuries: results of the 2019 Terminology Survey. Adv Skin Wound Care2021;33(3):137-45. [Context Link]