Wound treatment is a significant field in healthcare, but one with huge potential and need for advancement. Infection monitoring, in its current state, is a largely primitive affair, relying on visual and olfactory inspection to detect bacteria. As a result, early detection is impossible, and doctors and patients are forced to remove dressings to investigate the wound in a laborious, painful, and unsanitary process. When an infection is detected, the treatment is typically systemic administration of antibiotics. Systemic administration reduces the concentration of antibiotics that can be brought to bear on the infection because it interacts with the entire body and is dissipated by the time it reaches the wound and increases the risk of side effects or antibiotic resistance. Within this thesis, a smart, thread-based wound dressing is presented that addresses these issues by providing a pH-based early detection system accompanied by a topical, on-demand drug delivery system. The device has been tested in vitro and in vivo, on bacterial culture and on an animal model, and demonstrated effectiveness at detecting and eliminating bacteria, and at promoting wound healing. This smart wound dressing has the potential to improve treatment and outcomes for a wide variety of injuries, varying from burns to chronic wounds. / Graduate / 2020-10-10

Antimicrobial peptides are an ancient form of innate defense and is present in all ways of life. In humans they are present as cathelicidins and defensins. Both are important for the immune system and they exhibit activity against viruses, bacteria and fungi. Defensins exhibit less cytotoxicity and are better characterized and are thus more easily developed as therapeutic tools. Defensins are apt at doing a multitude of things, from inhibiting Herpes simplex virus replication and preventing anthrax’ lethality to helping with wound closure and acting as biomarkers for a variety of ailments. Defensins have consistently shown good results in a laboratory setting but have less than exemplary in vivo results. Defensins’ multifunctionality as well as the complex environment in living organisms makes characterizing why defensins are not performing as well in vivo difficult. They can also exhibit negative side-effects such as increasing the infectivity of the HIV and inhibiting anti-viral molecules of the innate immune system. Nevertheless, they exhibit big potential as complementary drugs, adjuvants, biomarkers, wound treatment and much more. Further characterization and development is absolutely necessary in these times of increasing antibiotic resistance.

Att ha ett sår är en belastning och påverkar människors vardag, oavsett om såret är akut efter ett olycksfall eller efter en operation, alternativt svårläkande som vid bensår, diabetesfotsår, trycksår eller maligna tumörsår. Syftet med studien var att undersöka kunskaper hos sjuksköterskor och undersköterskor om sårbehandling inom kirurgisk verksamhet. Metoden utgjordes av en enkätundersökning hos sjuksköterskor (n=56) och undersköterskor (n=38). Resultatet visar att sjuksköterskorna kände sig mer osäkra i sitt val av behandling av svårläkande sår jämfört med undersköterskorna. Kunskaperna om sårbehandling visar att skattade kunskaper inte motsvarar svaren på kunskapsfrågorna. Nitton av 56 sjuksköterskor och 15 av 37 undersköterskor hade genomgått någon form av sårutbildning. Undersköterskorna skattar sina kunskaper om sårbehandling högre än sjuksköterskorna och känner sig mer sällan osäkra i sitt val av behandling av svårläkande sår, jämfört med sjuksköterskorna. Det är också undersköterskorna som oftast utför såromläggningar på avdelningarna. Studien visar att det finns brister i kunskaperna om sårbehandling, hos både sjuksköterskor och undersköterskor och att mer utbildning behövs. / To have a wound is a burden and affect people's everyday lives, whether the wound is acute after an accident or after surgery or difficult healing of the ulcers, diabetic foot ulcers, pressure ulcers or a malignant wound. The purpose of this study was to investigate nurses' and nursing assistant’s knowledge of wound healing in surgical wards. The method was done by using a questionnaire survey among registered Nurses (RNs) (n = 56) and nursing assistants (NAs) (n = 38). The results show that the RNs felt more insecure in their choice of treatment of severe ulcer healing compared with the NAs. Knowledge of wound healing shows that the estimated knowledge does not correspond to the answers to knowledge questions. Of the RNs answered 51 of 56 and of the NAs answered 32 of 37 that they needed more education in wound care/treatment. NAs estimated their knowledge of wound care higher than the RNs and felt less insecure in their choice of treatment of wound healing, compared with the RNs. There are also the NAs who usually perform a change of dressing on the wards. The study shows that there are gaps in knowledge in wound care/treatment, with both RNs and NAs and that more education is needed.

Wound care is a field with many treatment methods and products on the market. The healing period varies, some wounds become difficult to heal and chronic, in many cases a connection can be drawn to underlying diseases. Diabetes is a disease that could cause foot ulcers that are difficult to heal. Bioactive materials in wound care have not yet been studied to a greater extent, however it is of interest for development of new products with improved functions. Fibroblasts in the connective tissue have an important role in building and regenerating the tissue. Former studies show that the bio-ceramic calcium silicate (CS) induce tissue regeneration and promote reepithelization. It has also shown improvement of the biological functions of human epidermal stem cells and positive effects on cells in in vitro studies. The purpose of this project is to be a pre-study for further analysis of CS in wound care. The aim is to investigate additive material’s potential role in wound healing, one part will be a literature study to get an overview of the healing process of wounds and wound treatment. The other part of the study is based on three minor experiment to obtain information about how calcium silicate (CS) and CS/ β-tricalcium phosphate (β-TCP) effect human dermal fibroblasts. The method and results of literature study: The litterature study gathers information from literature and studies within the subject using the searchwords: wound, healing, biomaterials, calcium silicate, alamar blue, cell migration, recent trends, skin regeneration and diabetes. The results from the literature study demonstrates that the wound healing process is very complex and many factors must interact for good healing, some factors accelerate and inhibit healing. Furthermore, healing products with additives are already used for treatment of wounds with antibacterial and pain-relieving effects. However, only a little information about bioactive materials can be found which shows that there is lack of studies in this field. The method and results of experiments: Preparation of the two main samples: [1:10] CS in PBS together with pure water and [1:10] CS + β-TCP in PBS and pure water. The first experiment was the Inductively Coupled Plasma Optic Emission Spectroscopy (ICP-OES) made in an Optical Emission Spectrometer which detected the elements Ca 317,933 (mg/L) and Si 251,611 (mg/L) in the main samples. The second experiment was Alamar Blue which produce data about the cell survival in quantitative numbers to determine the toxicity of the diluted samples. One pre-test and two final tests (24 h apart) was made. The pre-test used the dilutions 1:2, 1:10, 1:100, and two Control Media, the pre-test indicated that CS diluted 1:2 is slightly toxic. The first final test used the dilutions 1:2, 1:10, 1:100, 1:1000, 1:10000 and one Control Media. The first final test indicated that CS diluted 1:2 is almost toxic. The second final used the dilutions 1:2, 1:10, 1:100, 1:1000, 1:10000 and one Control Media. The second final test indicated that CS diluted 1:2 is toxic. The third experiment was a Scratch Healing assay. This experiment struggled with learning how to count cells which made the analysis of this experiment difficult. The results of the Scratch healing assay shows cell migration through a before-picture right after the simulated scratch is made and a picture 24 hours after. In conclusion, two important parameters while investigating the direction of further research are toxicity and cell survival. CS as a bioactive material and additive in wound treatment could be possible but should be avoided when diluted 1:2 due to its toxicity shown in the Alamar blue test. The scratch healing assay showed that the fibroblasts migrate to some extent while interacting in solutions of CS.

Hydrogen sulfide (H2S) is a gasotransmitter that is produced endogenously and freely permeates cell membranes. It plays important roles in many physiological pathways, and by regulating these pathways, it provides many therapeutic effects. For example, H2S dilates vascular vessels, promotes angiogenesis, and protects cells from oxidative stress. Due to its therapeutic effects, H2S has been used as a potential treatment for diseases like diabetes, ischemia-reperfusion injuries, lung diseases, ulcers and edemas, among others. To apply H2S for therapeutic applications, two challenges need to be addressed. The first challenge is the H2S donor, which not only provides H2S but must be stable enough to avoid side effects caused by overdose; and the second challenge is the delivery strategies, which transport the H2S to the target sites. A series of S-aroylthiooximes (SATOs), an H2S releasing compound, were synthesized and conjugated to peptide sequences to form H2S-releasing aromatic peptide amphiphile (APA) hydrogels. APAs formed nanofibers, which were stabilized by beta-sheets and aromatic stacking. The self-assembled structures were affected by the substituents on the aromatic rings of SATOs, leading to the formation of twisted nanofibers. After the addition of cysteine, H2S was released from the APAs with half-lives ranging from 13 min to 31 min. The electron-donating groups slowed down the H2S release rate, while the electron-withdrawing groups accelerated the release rate. Therefore, the release rates of H2S were controlled by electronic effects. When self-assembled structures were formed, the H2S release rate was slowed down even more, due to the difficulties in cysteine diffusion into the core of the structures. Antimicrobial effects were also discovered using the H2S releasing APA hydrogels. The H2S-releasing dipeptides S-FE and S-YE formed self-assembled twisted nanoribbons and nanotubes, respectively. The non H2S-releasing control oxime dipeptides C-FE and C-YE were also synthesized. The C-FE formed nanoribbons while the C-YE only showed non-specific aggregates. S-FE and S-YE released H2S with peaking times of about 41 and 39 min. Both the self-assembled structures and the release rates were affected by their packing differences. In vitro and ex vivo experiments with Staphylococcus aureus (Xen29), a commonly found bacterium on burn wounds, showed significant antimicrobial effects. APAs S-FE and C-FE eliminated Xen29 and inhibited the biofilm formation, while S-FE always showed better effects than C-FE. These antimicrobial H2S-releasing APA hydrogels provide a new approach to treat burn wound infections, and provide healing benefits due to the therapeutic effects of H2S. / Doctor of Philosophy / Hydrogen sulfide (H₂S) is a signaling gas that produced in our body. It regulates physiological pathways, and can be a potential treatment for diseases like diabetes, ischemia-reperfusion injuries, lung diseases, ulcers and edemas, among others. However, two issues need to be addressed before applying H₂S for disease treatments. The first issue is to choose an H₂S donor, which is stable enough to avoid side effects caused by overdose. The second issue is the delivery methods, which transport the H₂S to target sites. A series of S-aroylthiooximes (SATOs), an H₂S releasing compound, were synthesized and attached to peptide sequences to form H₂S-releasing self-assembled aromatic peptide amphiphile (APA) hydrogels. The APA hydrogels were found to be affected by the substituents on the SATO structures. For example, the H₂S released from APAs had halflives ranged from 13 min to 31 min, which were controlled by the substituents. When hydrogels were formed, the H₂S release was slowed down even more, due to the difficulties in cysteine diffusion into the SATO structures. The antimicrobial effects were also discovered using the H₂S releasing APA hydrogels. Two H₂S-releasing APA hydrogels, S-FE and S-YE, were formed. At the same time, two non H₂S-releasing oxime dipeptides, C-FE and C-YE, were also synthesized as controls. The H₂S-releasing peptides, S-FE and S-YE, released H₂S with peaking times of about 41 and 39 min, while no H₂S was released from C-FE and C-YE. The self-assembled structures and the release rates were affected by their structural differences. In vitro and ex vivo experiments with Staphylococcus aureus (Xen29), a commonly found bacterium on burn wound, showed significant antimicrobial effects. Both H₂S-releasing S-FE and non H₂S-releasing C-FE eliminated Xen29 and inhibited the biofilm formation, indicating the potential use of the designed peptides as antimicrobial treatment for wounds. The S-FE always showed better effects than C-FE, suggesting the benefit of H₂S during the elimination of bacteria. These antimicrobial H₂S-releasing APA hydrogels provide a new approach to treat burn wound infection and provide healing benefits due to the therapeutic effects of H₂S.

INTRODUÇÃO: Dentre os mecanismos de ação da pressão negativa no tratamento de feridas, que não são totalmente compreendidos até o momento, a melhora do fluxo sanguíneo local pode ser um dos mais importantes. A melhora da circulação sanguínea local promovida pela pressão negativa poderia resultar em maior sobrevida de tecidos submetidos a redução do fluxo sanguíneo. A aplicação clínica deste fenômeno seria um dos mecanismos de ação mais importantes da pressão negativa no tratamento de feridas complexas, e poderia ainda levar à utilização do método em outras situações clínicas, como em ferimentos descolantes de extremidades, e no salvamento de retalhos cutâneos mal perfundidos. OBJETIVO: Baseado na teoria de aumento do fluxo sanguíneo submetido a pressão negativa, este trabalho tem como objetivo avaliar a eficiência da pressão negativa na sobrevivência de retalhos cutâneos ao acaso, em suínos. MATERIAL E MÉTODO: Foram utilizados dez animais, divididos em dois grupos experimentais. No primeiro grupo, foram elevados dois retalhos cutâneos no dorso dos animais, um em cada lado, medindo 3 x 12 cm. Em um dos lados, foi aplicada pressão negativa de 125 mmHg por 48 horas sobre o retalho; no retalho contralateral (controle), o retalho foi apenas elevado e suturado novamente ao leito. No segundo grupo, foram também elevados dois retalhos cutâneos, um em cada lado, porém a pressão negativa foi aplicada abaixo dos retalhos no lado experimental; da mesma forma como no primeiro grupo, o outro lado contralateral foi o controle deste grupo (retalho apenas elevado e suturado ao leito). Também neste grupo a pressão negativa foi aplicada por 48 horas. Os animais dos dois grupos experimentais foram mantidos por sete dias, quando foi realizada a observação final. RESULTADOS: Ao final do experimento, foi observada maior quantidade de tecido viável e menor necrose distal dos retalhos no segundo grupo (pressão negativa abaixo dos retalhos), comparativamente ao seu grupo controle, nos dois períodos observacionais, com 48 horas e com sete dias. Não houve diferença estatisticamente significativa no grupo em que a pressão negativa foi aplicada sobre os retalhos. CONCLUSÃO: Este trabalho demonstrou a eficiência da pressão negativa na melhora da sobrevivência de retalhos cutâneos ao acaso, em modelo experimental de suínos, quando aplicada abaixo dos retalhos / INTRODUCTION: Among theories that could explain the mechanisms of action of negative pressure on wound treatment, which are not entirely understood, improvement of blood circulation can be one of the most important ones. The enhancement of blood flow could result in better outcome of tissues submmitted to ischemia. Clinical application of this phenomenom may be one of the most importante mechanisms of action of negative pressure over complex wounds, and could lead to its use in other clinical situations, such as \"degloving\" injuries of limbs and in salvage of poorly irrigated skin flaps. OBJECTIVE: Based on theory of improved blood flow caused by negative pressure, this experiment aimed to evaluate efficiency of negative pressure on survival of random skin flaps, in a swine experimental model. MATERIAL AND METHOD: Ten animals were operated on, and divided in two groups. In the first group, two skin flaps were dissected and elevated, one on each side of dorsum of the animals, measuring 3 x 12 cm. Negative pressure of 125 mmHg was applied over one of the flaps for 48 hours. The opposite flaps were just elevated and sutured to the wound bed, in order to be the control group. In the second group, two flaps were also elevated, one in each side of dorsum, but negative pressure was applied under the flaps in the experimental side; flaps elevated on the other side were the control group, just elevated and sutured to the wound bed. Negative pressure was also applied for 48 hours in the second group. All animals were kept alive for seven days, when final evaluation was done. RESULTS: At the end of the experiment, it was observed greater amount of viable tissue in group submmited to negative pressure under the flaps, compared to control group. There were no significant estatistical differences concerning flap survival in group 1 (negative pressure over flaps). CONCLUSION: This experiment demonstrated the efficiency of negative pressure on improvement of survival of random skin flaps in a swine experimental model, when applied under the flaps

INTRODUÇÃO: Dentre os mecanismos de ação da pressão negativa no tratamento de feridas, que não são totalmente compreendidos até o momento, a melhora do fluxo sanguíneo local pode ser um dos mais importantes. A melhora da circulação sanguínea local promovida pela pressão negativa poderia resultar em maior sobrevida de tecidos submetidos a redução do fluxo sanguíneo. A aplicação clínica deste fenômeno seria um dos mecanismos de ação mais importantes da pressão negativa no tratamento de feridas complexas, e poderia ainda levar à utilização do método em outras situações clínicas, como em ferimentos descolantes de extremidades, e no salvamento de retalhos cutâneos mal perfundidos. OBJETIVO: Baseado na teoria de aumento do fluxo sanguíneo submetido a pressão negativa, este trabalho tem como objetivo avaliar a eficiência da pressão negativa na sobrevivência de retalhos cutâneos ao acaso, em suínos. MATERIAL E MÉTODO: Foram utilizados dez animais, divididos em dois grupos experimentais. No primeiro grupo, foram elevados dois retalhos cutâneos no dorso dos animais, um em cada lado, medindo 3 x 12 cm. Em um dos lados, foi aplicada pressão negativa de 125 mmHg por 48 horas sobre o retalho; no retalho contralateral (controle), o retalho foi apenas elevado e suturado novamente ao leito. No segundo grupo, foram também elevados dois retalhos cutâneos, um em cada lado, porém a pressão negativa foi aplicada abaixo dos retalhos no lado experimental; da mesma forma como no primeiro grupo, o outro lado contralateral foi o controle deste grupo (retalho apenas elevado e suturado ao leito). Também neste grupo a pressão negativa foi aplicada por 48 horas. Os animais dos dois grupos experimentais foram mantidos por sete dias, quando foi realizada a observação final. RESULTADOS: Ao final do experimento, foi observada maior quantidade de tecido viável e menor necrose distal dos retalhos no segundo grupo (pressão negativa abaixo dos retalhos), comparativamente ao seu grupo controle, nos dois períodos observacionais, com 48 horas e com sete dias. Não houve diferença estatisticamente significativa no grupo em que a pressão negativa foi aplicada sobre os retalhos. CONCLUSÃO: Este trabalho demonstrou a eficiência da pressão negativa na melhora da sobrevivência de retalhos cutâneos ao acaso, em modelo experimental de suínos, quando aplicada abaixo dos retalhos / INTRODUCTION: Among theories that could explain the mechanisms of action of negative pressure on wound treatment, which are not entirely understood, improvement of blood circulation can be one of the most important ones. The enhancement of blood flow could result in better outcome of tissues submmitted to ischemia. Clinical application of this phenomenom may be one of the most importante mechanisms of action of negative pressure over complex wounds, and could lead to its use in other clinical situations, such as \"degloving\" injuries of limbs and in salvage of poorly irrigated skin flaps. OBJECTIVE: Based on theory of improved blood flow caused by negative pressure, this experiment aimed to evaluate efficiency of negative pressure on survival of random skin flaps, in a swine experimental model. MATERIAL AND METHOD: Ten animals were operated on, and divided in two groups. In the first group, two skin flaps were dissected and elevated, one on each side of dorsum of the animals, measuring 3 x 12 cm. Negative pressure of 125 mmHg was applied over one of the flaps for 48 hours. The opposite flaps were just elevated and sutured to the wound bed, in order to be the control group. In the second group, two flaps were also elevated, one in each side of dorsum, but negative pressure was applied under the flaps in the experimental side; flaps elevated on the other side were the control group, just elevated and sutured to the wound bed. Negative pressure was also applied for 48 hours in the second group. All animals were kept alive for seven days, when final evaluation was done. RESULTS: At the end of the experiment, it was observed greater amount of viable tissue in group submmited to negative pressure under the flaps, compared to control group. There were no significant estatistical differences concerning flap survival in group 1 (negative pressure over flaps). CONCLUSION: This experiment demonstrated the efficiency of negative pressure on improvement of survival of random skin flaps in a swine experimental model, when applied under the flaps

<p>  </p> <p>Infections of dermal wounds is a growing burden for the healthcare industry, with a 2017 market exceeding $17.5 USD. As the number of patients with severe infections continues to increase year after year, there is an alarming downward trend in efficacy for traditional antibiotic treatments. In large part, this is due to the increasing development of antibiotic resistance within common bacteria strains. As microbes evolve to protect themselves from previously effective drugs, there is a growing need for new antimicrobial therapies. While alternatives exist in the market, they are largely impaired by non-selective toxicity which can cause further damage to the cells in the wound bed, as is the case with silver and other strong antiseptics, or the need for high energy, specialized equipment, as with cold atmospheric surface treatments. Gaseous ozone is a promising alternative therapy for treating these wound infections. Because ozone is a strong natural oxidant, it exhibits significant antimicrobial properties, and has also been shown to help stimulate natural wound healing in many cases. Herein is presented the design of a portable system for the topical delivery of gaseous ozone as an antimicrobial treatment for infected dermal wounds. This includes the design and characterization of the portable system and a custom ozone application dressing, the characterization of the safety and efficacy of the system using <em>in vitro</em> and <em>in vivo</em> models, and a disposable system for wound infection monitoring. The system utilizes a portable corona discharge generator to produce gaseous ozone from the ambient environment. The ozone gas is delivered through a dressing engineered to have a hydrophobic interface at the wound bed and disperse the ozone gas across the patch surface for more uniform application. The antimicrobial strength and biocompatibility of the system was optimized at varying ozone output levels. Additionally, an adjunct therapy of topical antibiotics was shown to significantly increase the strength of the treatment without leading to greater cytotoxicity. This synergistic effect between ozone and antibiotics was shown to circumvent natural bacterial resistances to antibiotics, which will have a major impact on the wound care industry. This adjunct treatment was then validated on a porcine animal model for safety and pilot results for efficacy testing. Finally, the pH sensor which can be incorporated with use of the ozone therapy enables objective monitoring of wound condition and is able to signal when appropriate infection therapy should begin. As it stands, this portable ozone wound treatment system shows great promise as an alternative therapy to improve the quality of live for millions of patients.</p>

Bakgrund   Allmänsjuksköterskor kommer ofta i kontakt med personer med venösa bensår. Behandling och vård av dessa personer sker ofta inom primärvård, öppenvård eller hemsjukvård, men även på vårdavdelningar och andra sjukvårdsinstanser. Venösa bensår är en följd av underliggande kronisk venös insufficiens. Det är därför stor risk att såren återkommer efter läkning och behandlingen måste därför i många fall bli livslång. Trots detta finns få studier som fokuserar på personers upplevelser av behandling och vård vid venösa bensår.   Syfte  Syftet är att beskriva personers upplevelser av behandling och vård vid venösa bensår. Metod  För att sammanfatta den forskning som i dagsläget finns kring ämnet har en litteraturöversikt gjorts. Sökningar har utförts i de vetenskapliga databaserna Pub Med och CINAHL och 16 artiklar identifierades. Dessa har kvalitetsgranskats genom Sophiahemmet Högskolas bedömningsinstrument. Resultat Litteraturöversiktens tre huvudkategorier, förhoppning och uppgivenhet, att leva ett begränsat liv och att inte bli sedd som person berättar om upplevelser som många personer med venösa bensår har av behandling och vård. Personer upplever att behandling och vård på något sätt begränsar eller påverkar dem. Vårdens kontinuitet, god kommunikation, och relationen till sjuksköterskan är av betydelse för upplevelsen av behandling och vård. Det finns brister i individanpassningen av behandling och vård som påverkar personer med venösa bensårs förtroende för vården. Många personer uppger en ovisshet som gör det svårt att hantera behandlingen psykologiskt. En stark önskan om läkning av de venösa bensåren är gemensamt för många studiedeltagare. Slutsats Det fattas specifik forskning om personers upplevelser. Sjuksköterskor som behandlar personer med venösa bensår saknar kunskaper om deras tillstånd och rekommenderad behandling. I denna litteraturöversikt framkommer ett behov av att skifta fokus från läkning av det venösa bensåret till personens livskvalitet. Sjuksköterskor behöver mer kunskaper om venösa bensår och en större förståelse för den livssituation som många personer med venösa bensår befinner sig i. Ökad nivå av personcentrering i behandling och vård av personer med venösa bensår bör därför eftersträvas, och förutsättningar måste skapas för sjuksköterskor att kunna erbjuda den specialiserade och kvalitativa vård som krävs. / Background Registered nurses frequently come into contact with persons living with venous leg ulcers, as these wounds are primarily treated and cared for by nurses. Persons with venous leg ulcers often experience underlying chronic venous insufficiency, which is the main cause of venous leg ulcers. This means that even once healed venous leg ulcers are likely to reoccur, and treatment is often life-long. In spite of this, very few studies and research projects focus on the person’s experiences of their ailment in relation to the treatment they receive. Aim To highlight persons’ experiences related to the treatment and care of venous ulcers.  Method To summarize the research knowledge of this subject, a review of current literature was undertaken. Searches have been conducted in several online-based databases. Through the databases PubMed and CINAHL 16 articles were identified and then analyzed. Results Many persons with venous leg ulcers feel that treatment and care affects or impedes them in some way. Three core categories were identified as signifying for the result: hopefulness and uncertainty, an impaired life, and not being viewed as a person. Continuity of care, quality of communication, and the nurse-patient relationship are all key contributors to the experiences of treatment and care that persons with venous leg ulcers describe. The result implies that treatment and care of persons with venous leg ulcers is not satisfyingly individualized, which reduces the level of confidence that these persons feel for their healthcare providers. Persons with venous leg ulcers report that experiences of uncertainty make the treatment hard to handle psychologically. A strong desire for permanent healing is shared by persons with venous leg ulcers.  Conclusions There is a shortage of specific research aimed at the experiences of persons with venous leg ulcers of aspects relating to their treatment and care. Many nurses lack vital knowledge regarding the treatment and care of these individuals. In this review a need for a shift of focus is perceived, from simply the healing of the venous leg ulcer, into also considering the quality of life of persons with venous leg ulcers. Nurses are in need of more knowledge of the condition, and more insight into the lives of persons with venous leg ulcers. A person-centred approach should therefore be sought, and conditions must be provided for nurses to expand their knowledge and be able to offer a more specialized and qualitative level of treatment and care.