Evidence for many interventions in tissue viability is or has been in short supply, the conclusion of most Cochrane reviews is a woeful chant of insufficient or poor-quality evidence and more research is needed. Very few companies can rebut the “do you have a randomised control trial (RCT) to support your product” and there has been many an argument over the complexity of carrying out RCTs in our world of complex patients in complex environments. The retrospective reviews of the THIN database, e.g. Guest et al, 2015; 2017, and real-world evidence, e.g. Fletcher et al (2016) papers have given us a great start but for many, they cannot replace the rigour of RCTs.