An advisory panel of academicians, private practice physicians, nurse clinicians, and research nurses was chosen to develop guidelines (minimum standards) for the treatment of arterial insufficiency ulcers of the lower extremities. METHODSPrevious guidelines, meta-analyses, PubMed, MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, recent review articles of arterial ulcer treatment, and the Medicare/CMS consensus of usual treatment of chronic wounds were all searched and reviewed for evidence. Guidelines were formulated, the underlying principle(s) enumerated, and evidence references listed and coded. The code abbreviations for the evidence citations were as follows: There were major differences between our approach to evidence citations and past approaches to evidence-based guidelines. Most past approaches relied only on publications regarding clinical human studies. Laboratory or animal studies were not cited. We have used well-controlled animal studies that present proof of principle, especially when a clinical series corroborated the laboratory results.
Twenty-six patients with chronic leg wounds had transcutaneous oxygen measurements taken from the peri-wound area and a chest reference site before undergoing hyperbaric oxygen therapy in order to evaluate the utility of transcutaneous oxygen measurements in predicting the response of wounds to hyperbaric therapy. Wound scores and wound areas were determined before treatment and after 10 hyperbaric exposures. Patients whose wounds averaged a 5% or greater reduction in wound score per treatment were designated "responders." Nine patients' wounds exhibited at least a 5% reduction in wound score per treatment. There were no differences observed between responders and the 17 nonresponders in age, duration of the wound, initial wound area, initial wound score, or in wound or reference transcutaneous oxygen measurements. Responders required significantly fewer treatments to achieve wound closure than did nonresponders. Peri-wound transcutaneous oxygen pressure when the patient was exposed to 2.4 atmospheres absolute correlated directly with the improvement in wound score per treatment (r = 0.64, p = 0.03). An inverse correlation was noted between surface peri-wound transcutaneous oxygen pressure and improvement in wound score per treatment (r = -0.74, p = 0.006). Elevated peri-wound transcutaneous oxygen measurements at 2.4 atmospheres absolute and reduced peri-wound oxygen measurements at 1 atmosphere absolute were associated with a more rapid response to hyperbaric oxygen treatments in patients with chronic leg wounds. The use of these measurements should allow this expensive and time-consuming therapy to be limited to those patients most likely to benefit.
The Wound Healing Society (WHS) is a professional society of physicians, nurses, physical therapists, podiatrists, and other wound care specialists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, evidence-and consensus-based guidelines were developed to address the Prevention of Lower Extremity Arterial Insufficiency Ulcers. The guidelines are presented in generic terms; the details of specific tests, therapies, and procedures are at the discretion of an interdisciplinary team of health care professionals who establish, implement, and evaluate policies and procedures directed at prevention of arterial ulcers. METHODSAs with the arterial ulcers treatment guidelines published in 2006, 1 PubMed, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews were searched and reviewed for evidence on arterial insufficiency ulcer prevention. In addition, a search of health care databases for current evidence-based guidelines addressing the prevention of arterial insufficiency ulcers was conducted using electronic and online resources. The panel classified studies based on whether the intervention being evaluated addressed arterial ulcer risk screening and assessment, arterial ulcer prevention plans of care (including interdisciplinary approaches), or patient and caregiver education.Evidence references for each standard are listed and coded. The code abbreviations for the evidence citations were as follows:
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