Chronic wounds: the challenges of appropriate management

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S26-S32 ◽  
Author(s):  
Leanne Atkin
Keyword(s):  
Wound Healing ◽  
Health Services ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Management ◽  
Product Selection ◽  
Wound Assessment ◽  
Moisture Balance ◽  
Selection For ◽  
Chronic Wound Management

The immense burden imposed by chronic wounds—those persisting over 6 weeks despite active intervention—on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

scholarly journals Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

10.2196/15574 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e15574
Author(s):  
Lihong Chen ◽  
Lihui Cheng ◽  
Wei Gao ◽  
Dawei Chen ◽  
Chun Wang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cohort Studies ◽  
Mobile Phones ◽  
Standard Care ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Meta Analysis ◽  
Wound Management ◽  
Efficacy And Safety ◽  
Chronic Wound Management

Background Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. Objective The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. Methods We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. Results A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. Conclusions Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

scholarly journals Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis (Preprint)

2019 ◽  
Author(s):  
Lihong Chen ◽  
Lihui Cheng ◽  
Wei Gao ◽  
Dawei Chen ◽  
Chun Wang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cohort Studies ◽  
Mobile Phones ◽  
Standard Care ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Meta Analysis ◽  
Wound Management ◽  
Efficacy And Safety ◽  
Chronic Wound Management

BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; <i>P</i>=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; <i>P</i>=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; <i>P</i>=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; <i>P</i>&lt;.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; <i>P</i>=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; <i>P</i>=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

Tools and Components of Wound Healing Assessment

2013 ◽  
Author(s):  
Jessica Chin ◽  
Ibrahim Zeid ◽  
Sagar Kamarthi
Keyword(s):  
Wound Healing ◽  
Healing Rate ◽  
Chronic Wound ◽  
Historical Data ◽  
Wound Management ◽  
Wound Assessment ◽  
Healing Wounds ◽  
Chronic Wound Management ◽  
Healing Assessment ◽  
Wound Healing Rate

Chronic wound assessment and analysis has long been a major healthcare issue. Chronic wound management and treatment cost billions of dollars each year. The research to alleviate the burden of non-healing wounds and predicting when they will heal is progressing at incremental pace. Characteristics of a chronic wound are unique to both the patient and wound itself. Like a fingerprint, each wound has a unique set of properties that tell a story about its health and viability. Although each person’s wound is individual, there are a few underlying pathologies that are common amongst all wounds. For example, all wounds have a definite surface area, depth, and temperature at any given time. By knowing these common characteristics across all wounds, we can use both historical data and collected data to determine wound healing patterns and wound healing rates. The purpose of this study is to develop an algorithm that uses photography and statistical modeling to predict an approximate wound healing rate for lower appendage wounds. We focus on lower appendage wounds with a depth of 1–2 mm because lower appendage wounds account for approximately 70% of wounds seen at wound clinics.

Fluorescent Imaging and Precise Suppression of Bacterial Infection in Chronic Wounds by Porphyrin-Based Metal-Organic Framework Nanorod

2021 ◽  
Author(s):  
zhen zou ◽  
Lihua Zhang ◽  
Minzhi Ouyang ◽  
Yufei Zhang ◽  
Huanxiang Wang ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Antibacterial Agents ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Metal Organic Framework ◽  
Critical Role ◽  
Fluorescent Imaging ◽  
Wound Management ◽  
Metal Organic ◽  
Chronic Wound Management

Nano-antibacterial agents play a critical role in chronic wound management. However, an intelligent nanosystem that can provide both visual warning of infection and precise sterilization remains a hurdle. Herein, a...

scholarly journals Wounds: an overlooked burden (Part 1) – effective wound management starts with proper wound assessment

2020 ◽  
pp. 196-198
Author(s):  
H Parkar ◽  
AD Cromarty
Keyword(s):  
Wound Healing ◽  
General Practice ◽  
Healthcare Professionals ◽  
Chronic Wound ◽  
Treatment Strategies ◽  
Daily Basis ◽  
Wound Management ◽  
Wound Treatment ◽  
Wound Assessment ◽  
Wound Type

Healthcare professionals in general practice are tasked with treatment and management of wounds on a daily basis. The prognoses of these wounds are directly affected by the ability of the clinician to assess these wounds according to several parameters, including the wound type and the features which determine whether a wound is acute or transforming to a chronic wound. This can be achieved by proper and continuous wound assessment, which should guide wound treatment strategies to ensure optimal wound healing and prevent progression to complicated wounds.

scholarly journals Ekek anti mikroba terapi larva

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Sunny Wangko
Keyword(s):  
Wound Healing ◽  
Chronic Wound ◽  
Healing Process ◽  
Wound Management ◽  
Wound Healing Process ◽  
Healing Wounds ◽  
Chronic Wound Management ◽  
Very High ◽  
Anti Inflammation ◽  
Larval Therapy

Abstract: Chronic wound is still a world-wide problem that spends a very high cost related to its management and treatment. Although there are a lot of promising studies about wound healing process, the prevalence and incidence of chronic wound and its complications are still high. Conventionally, the management of chronic wound consists of surgical debridement, manual irrigation, dressing, and antimicrobial therapy (topical and/or systemic). It is accepted that microbial biofilm and its complexity play important roles in non-healing wounds. This biofilm consists of polymicrobial colonies embedded in exopolymeric matrix produced by the biofilm itself and has a high tolerance to host defence mechanisme, antibiotics, and antiseptics. Larval therapy has been approved by FDA to be used in chronic wound management. It has antimicrobial effects besides its other effects on wound healing inter alia mechanical debridement, anti-inflammation, angiogenesis, and destabilization of biofilm enzymes. Further studies are needed to explore the effects of larval therapy, especially its excretion/secretion components, so that it can be applicated more aesthetically.Keywords: chronic wound, wound healing process, biofilm, larval therapyAbstrak: Luka kronis merupakan masalah kesehatan di seluruh dunia yang telah memboroskan biaya cukup tinggi. Walaupun telah terjadi kemajuan dan pemahaman mengenai penyembuhan luka, prevalensi dan insidensi luka kronis dan komplikasinya tetap meningkat pesat. Secara konvensional, perawatan luka kronis terdiri dari debrideman, irigasi manual, dressing untuk mempertahankan kelembaban, dan terapi antimikroba (topikal dan atau sistemik). Adanya biofilm mikroba serta kompleksitasnya pada luka kronis telah disepakati sebagai salah satu kunci gagalnya penyembuhan luka. Biofilm mikroba terdiri dari koloni-koloni mikroorganisme polimikrobial terkemas dalam matriks eksopolimerik yang diproduksi olehnya sendiri dan memiliki toleransi tinggi terhadap pertahanan pejamu (host), antibiotik, dan antiseptik. Terapi larva telah diterima oleh FDA dan telah terbukti berefek antimikroba disamping efek lainnya terhadap penyembuhan luka, antara lain: debrideman mekanis, anti-inflamasi, angiogenesis, dan destabilisasi enzim biofilm pada luka. Studi lanjut diperlukan untuk mengeksplorasi efek terapi larva terutama komponen ekskresi/skresi larva terhadap penyembuhan luka agar dapat diaplikasikan secara lebih estetik.Kata kunci: luka kronis, penyembuhan luka, biofilm, terapi larva

Dressing Selection in Chronic Wound Management

2002 ◽  
Vol 92 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Susie Seaman
Keyword(s):  
Wound Healing ◽  
Chronic Wound ◽  
Wound Care ◽  
Wound Management ◽  
Transparent Films ◽  
Chronic Wound Management

The concept of moist wound healing has been examined and gradually accepted by wound care clinicians during the last 40 years, and has led to the development of hundreds of dressings that support a moist wound environment. This article discusses the characteristics of an ideal dressing in an effort to assist clinicians in making appropriate dressing choices from common categories, including transparent films, hydrocolloids, foams, absorptive wound fillers, hydrogels, collagens, and gauzes. Reimbursement issues are also discussed. (J Am Podiatr Med Assoc 92(1): 24-33, 2002)

scholarly journals Povidone Iodine Ointment vs Cadexomer Iodine Ointment in Management of the Chronic Wound: A Study Protocol

2021 ◽  
pp. 33-37
Author(s):  
Shubham Gupta ◽  
Raju Kamalrao Shinde ◽  
Sangita Shinde
Keyword(s):  
Health Care ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Povidone Iodine ◽  
Wound Management ◽  
Tissue Formation ◽  
Granulation Tissue Formation

Introduction: Chronic wound and its care has always been a health burden for patient, health care professionals and the entire health care system. There have been certain topical preparations available in market today for application in chronic wound management. In our study, we are comparing effects of cadexomer and povidone iodine ointment in context of reduction in bacterial overload, slough reduction, facilitations of granulation tissue formation, reduction in size of the wound and ultimately in percentage of wound healing and its cost of management. Aim: Comparison of outcome of Povidone Iodine Ointment and Cadexomer iodine Ointment in management of the wound. Methodology: This cross section observational study has been conducted among 40 patients diagnosed as chronic wound with 20 patients in each group. Student’s paired t-test and Pearson’s Correlation Coefficient is being used as statistical analysis. Results: The percentage of patient treated with cadexomer iodine ointment shows significantly (p<0.05) higher rate of wound healing along with significant reduction in bacterial overload and promotion of granulation tissue formation. Conclusion: Cadexomer as a vector with iodine ointment shows higher rate of reduction of biofilm, slough and debris with better rate of promotion of granulation tissue formation, thus leading to increased and effective rate of healing of wound as well as cost effective management of chronic wounds.

scholarly journals A Systematic Overview of Recent Methods for Non-Contact Chronic Wound Analysis

2020 ◽  
Vol 10 (21) ◽  
pp. 7613
Author(s):  
Domagoj Marijanović ◽  
Damir Filko
Keyword(s):  
Wound Healing ◽  
Global Economy ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Healing Process ◽  
Significant Rise ◽  
Wound Healing Process ◽  
Obesity And Diabetes ◽  
Wound Assessment ◽  
Analysis System

Chronic wounds or wounds that are not healing properly are a worldwide health problem that affect the global economy and population. Alongside with aging of the population, increasing obesity and diabetes patients, we can assume that costs of chronic wound healing will be even higher. Wound assessment should be fast and accurate in order to reduce the possible complications, and therefore shorten the wound healing process. Contact methods often used by medical experts have drawbacks that are easily overcome by non-contact methods like image analysis, where wound analysis is fully or partially automated. Two major tasks in wound analysis on images are segmentation of the wound from the healthy skin and background, and classification of the most important wound tissues like granulation, fibrin, and necrosis. These tasks are necessary for further assessment like wound measurement or healing evaluation based on tissue representation. Researchers use various methods and algorithms for image wound analysis with the aim to outperform accuracy rates and show the robustness of the proposed methods. Recently, neural networks and deep learning algorithms have driven considerable performance improvement across various fields, which has a led to a significant rise of research papers in the field of wound analysis as well. The aim of this paper is to provide an overview of recent methods for non-contact wound analysis which could be used for developing an end-to-end solution for a fully automated wound analysis system which would incorporate all stages from data acquisition, to segmentation and classification, ending with measurement and healing evaluation.

scholarly journals The use of wound dressings as a means to alter the composition of biofilms in a chronic wound model

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Gabriela Nedelea ◽  
Sarah Maddocks
Keyword(s):  
Chronic Wounds ◽  
Chronic Wound ◽  
Low Ph ◽  
Wound Dressings ◽  
Wound Management ◽  
Chronic Infections ◽  
Gram Negative ◽  
Negative Shift ◽  
Wound Model ◽  
Chronic Wound Management

It is estimated that £5 billion are invested yearly into chronic wound management by the NHS. Whilst the demand for treatment rises every year, it has become harder to treat wounds given the burden of antimicrobial resistance. Chronic wounds can easily become harbouring grounds for polymicrobial biofilms in which species interact in specific ways. This study assessed the interactions between two commonly co-isolated chronic wound pathogens: Pseudomonas aeruginosa (ATCC 9027) and Staphylococcus aureus (EMRSA 15), whose biofilm relation initiates a Gram-negative shift. During this phenomenon, P. aeruginosa takes over the majority of the bacterial community, at the detriment of S. aureus. The Gram-negative shift marks the turning point from an acute to a chronic wound. The pH of a chronic wound is typically alkaline, and it was hypothesised that topical dressings with an acidic pH could disrupt the onset of the Gram negative shift, and therefore chronicity. Six different topical dressings with low pH were used in achronic wound model to assess their ability to reverse or delay the Gram-negative shift. It was found that they did not have an impact on the onset of the Gram-negative shift, despite their low pH values. However, the lower the pH of the dressings, the more frequently small colony variant (SCV) bacteria were observed in the biofilm. SCVs are known for causing persistent or chronic infections. It was therefore concluded that low pH dressings alone may not be favourable for managing chronic wound infection.

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