Metamorphosis and the wound

On the cover of this issue is the metamorphosis of the silkworm. The life cycle of the silkworm involves feeding large amounts of leaves from the mulberry tree for around 30-40 days. The silkworms then shed their skin up to four times, as they continue to eat and grow. After the final moulting the worm builds a fine silk-cased cocoon during which time it matures into an ‘adult’. This fits in well with our theme of this special issue of Wound Central which is the challenging topic of transforming hard-to-heal wound beds with skin substitutes. In this issue we have an array of innovative papers from North America. Our colleague Dr Bill Tettelbach writes our guest editorial: Logic, limbs and lives - elevating the standard of care for the lower extremity. He also discusses the impact of skin substitutes in the management of diabetic foot ulcers: lessons from the medicare database (2015–2018). Shane Dowling and colleagues present surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series. Dr John Lantis and colleagues take us through a prospective randomised controlled trial: the fetal bovine acellular dermal matrix for the closure of diabetic foot ulcers. Dr Grace Tsai and colleagues highlight the use of dehydrated amniotic allograft membrane in conjunction with cross-linked bovine tendon collagen and glycosaminoglycan matrix to accelerate healing of chronic diabetic foot ulcers. We see the results of a wound hygiene survey. Dr Kim discusses the development and assessment of a high throughput biofilm and biomass testing platform. Dr Chaffin and team highlight the use of an extracellular matrix graft in different clinical scenarios.