Chronic Wound

Christine Miller's picture

Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

WoundSource Practice Accelerator's picture

Chronic and complex wounds present a formidable challenge in health care. Nonhealing wounds impact approximately 1% of the world's population yet account for more than 2% to 4% of health care expenses. Wounds that require additional clinical efforts often include those that are chronic and resistant to therapy, those with increased risk, and those that reduce the patient's quality of life.

WoundSource Practice Accelerator's picture

The management of wounds, especially complex and chronic wounds, is a daunting clinical challenge. Achieving progress toward wound closure often depends on the right selection of treatment modalities for the wound and acknowledgment of any other underlying clinical considerations that present barriers to healing. However, before treatment selection, a full and accurate wound assessment must be completed. Without analyzing all variables that impact wound healing, clinicians may be unable to identify the proper treatment course.

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By the WoundSource Editors

The process of wound healing ideally progresses from inflammation to epithelialization and, finally, remodeling. If at any point bacterial (or fungal) colonization becomes prominent, the process of wound healing is disrupted. The creation of biofilm is a microbial defense mechanism that stalls the trajectory of healthy wound healing and can contribute to the development of a chronic wound. It is estimated that 90% of chronic wounds and 6% of acute wounds contain biofilms generated by microbes. Epidemiologically, chronic wounds impact 2% of the entire US population. Because of this large impact, knowledge of proper wound healing and use of clinical tools to assist the wound healing process are essential.

WoundSource Practice Accelerator's picture

Chronic and nonhealing wounds are a worldwide issue and are becoming more difficult to treat. In the United States alone, according to Medicare, over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion per year. If standard treatment does not adequately heal a wound, additional methods of wound care treatment may be required, and the underlying disorder must be examined to determine the need for advanced wound care modalities. Advanced wound care therapies are interventions that are used after standard wound care has failed.

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Wound care is complex. Even professionals who have worked as wound care specialists for decades are still learning as researchers discover more about the healing process and barriers that impede healing. Additionally, the medical professionals who may work with a patient with a complex or chronic wound can include clinicians with varying expertise, such as nurses, physical therapists, surgeons, dietitians, and so on. Fortunately, several national organizations are committed to enhancing the quality of wound care for both wound care professionals and patients alike.

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Wound documentation is critical for the delivery of effective wound care, the facilitation of care continuity, and proper health data coding. Inaccurate wound documentation can impact the ability to determine the best wound treatment options and the overall wound healing process. Unfortunately, almost half of all medical record notes on wounds lack key details on assessment and intervention in some settings.

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Frank Aviles Jr's picture

By Frank Aviles Jr, PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, MAPWCA

Wound care has made significant and exciting progress over the years. We have moved from a passive wound bed approach to an active, strategic, individualized wound and periwound approach with the help of technological advancements. Interestingly, some of the technology in use today, such as infrared thermometers and other thermal infrared devices that collect and monitor data, were developed from the National Aeronautics and Space Administration space program. This type of technology is also being used to measure land surface temperatures in two thermal bands to detect heat.

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Liping Tang's picture

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.