Chronic Wounds

By the WoundSource Editors

Wound bed preparation is a well-established concept, and the TIME framework is the standard tool used to assist clinicians with the management of patients’ wounds throughout the care cycle. Recent clinical and technological breakthroughs are enhancing our understanding of this care cycle. An overview of the wound bed preparation care cycle and the TIME framework is provided here.

By Heidi Cross, MSN, RN, FNP-BC, CWON

In my recent WoundSource webinar, I discussed the topic of chronic wound etiology and management. The webinar is still available for viewing on WoundSource.com. Chronic wounds are vexing and frustrating to manage; they can be expensive and are a huge source of morbidity and mortality. Infection prevention is a key part of chronic wound management, with recognition of the role that biofilms play.

By PolarityTE®

Salt Lake City – May 10, 2019 – PolarityTE, Inc., a biotechnology company developing and commercializing regenerative tissue products and biomaterials, announced today data from two pilot studies on the use of its SkinTE™ product both showing successful closure of diabetic foot ulcers (DFUs) and venous stasis leg ulcers (VLUs) within a 12-week period. The cases involved patients with lower extremity chronic wounds that were difficult to treat or had failed to heal with standard dressing care and conventional treatments, using a single application of SkinTE.

Christine Miller, DPM, DMM, PhD, FACCWS

One of the most difficult aspects of patient care is dealing with non-compliance. How do we help those who refuse to help themselves? This question is very convoluted indeed! The best treatment protocols in the world will be unsuccessful if the patient does not follow the recommendations. Patients with chronic wounds are usually those with multiple comorbidities such as uncontrolled diabetes, autoimmune disease, and uncontrolled hypertension. This complex medical picture is challenging enough for all of us trying to heal them, but add the patients' lack of concern for their own health and it is quite frankly maddening. I find myself often saying, "Help me help you" or "Healing is a team event," although mostly my genuine pleas for partnership fall on deaf ears.

By the WoundSource Editors

The wound healing cascade is a complex process that follows a strict sequence of molecular events. The complex series of events depend on one another and must take place in a timely and orderly fashion within the body’s natural host processes. The phases of acute wound healing, in order, are hemostasis, inflammatory, proliferative, and maturation. If the cascade of events is interrupted, the acute wound status then develops into a non-healing or chronic status. Wound stalling occurs in the inflammatory and proliferative stages of healing. In chronic wounds, there appears to be an overproduction of matrix molecules resulting from underlying cellular dysfunction and dysregulation. Non-viable or devitalized tissue lengthens the inflammatory phase of healing and increases risk of infection.

By the WoundSource Editors

Wound chronicity is a major concern, and removing barriers with each stage of healing is paramount. Debridement may occur naturally by the body’s own ability to slough off dead tissue; however, often this tissue needs to be removed medically. The goal of wound debridement is to provide consistent wound bed preparation along with good healing outcomes. Removing non-viable tissue and foreign material is the first goal of debridement. Non-viable tissue not only inhibits the development of healthy new tissue but also increases the risk of infection. Non-viable tissue includes slough and eschar, which create the perfect recipe for bacterial growth and infection. Viable tissue is granulation and epithelial tissue, which is beneficial to normal healing. Wounds that present devitalized tissue and/or biofilm warrant one or more of the debridement methods to promote healing. Since 2006, debridement has been found to be advantageous in managing complex wounds.

By the WoundSource Editors

In chronic wounds, debridement can be used to remove dead and necrotic tissue or to remove foreign material. Debridement has repeatedly been shown to expedite healing and is recognized as a critical element in wound care. There are several methods of debridement, some of which may or may not be the best option, depending on the health care setting, so practitioners should follow their individual state licensure boards’ professional scope and practice and the facilities’ policies when considering debridement.

by the WoundSource Editors

Autolytic debridement: A method of debridement that uses the body’s own enzymes and the moisture trapped beneath the dressing to liquefy non-viable tissue. Although it is the safest method, it is also very slow and therefore not the best option for wounds with large amounts of necrotic tissue.

Biofilm: A complex microbial community containing bacteria and fungi. The microorganisms synthesize and secrete a protective matrix that attaches the biofilm firmly to a living or non-living surface. The biofilm contributes to underlying wound infection, chronic inflammation, and delay in healing, and it is present in 60% of chronic wounds and 6% of acute wounds.

by the WoundSource Editors

Chronic wounds affect over 6.5 million people annually in the United States, with a total cost of over $26.8 billion per year. Proper identification of chronic wounds is necessary to develop an effective treatment plan, although many elements—such as intrinsic and extrinsic factors, comorbidities, and mixed etiologies—may complicate this process.

by Karen Bauer , NP-C, CWS

In my recent WoundSource webinar on management strategies of venous leg ulcers (VLU), I discussed the complex pathophysiology of VLUs and procedural interventions that can help them reach closure.