Chronic wounds: Treatment consensus

Abstract

The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub‐sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID‐19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.

Perceptions of Diet Quality, Advice, and Dietary Interventions in Individuals with Diabetes-Related Foot Ulceration; A Qualitative Research Study

“…Other studies in DFU populations have also determined that micronutrient deficiencies such as vitamin D, C, A, and zinc are common [10]. These nutrients are required to regulate synthesis of collagen, and extracellular matrix formation, essential to wound healing [10,44]. This further justifies the need for regular dietary assessment and intervention to optimise nutrition and accelerate healing capacity [45].…”

A Comprehensive Review of Natural Compounds for Wound Healing: Targeting Bioactivity Perspective

“…Closure of acute and chronic wounds is regarded as the wound healing endpoint in most clinical settings, yet wounds can continue to undergo remodeling or tissue maturation for months or even years [ 32 , 33 ]. This final stage of wound healing decides whether scarring will occur and whether the wound will reoccur.…”

Recent Advances in Hydrogel-Mediated Nitric Oxide Delivery Systems Targeted for Wound Healing Applications

“…Recent studies report that NO alone is effective against a wide range of bacteria without the creation of resistance, and most importantly, in a clinical set, the susceptibility of drug-resistant bacteria to antibiotics is enhanced when the latter are complemented with NO [ 53 ]. In general, antimicrobial agents tend to have higher cytotoxicity than desired while antibiotics require higher concentrations to be effective [ 16 ]. Hence, NO’s adequacy for efficient antibacterial activity is supported by its synergetic antibacterial activity when allied to antibiotics, and although its cytotoxicity needs to be extensively studied, NO has inherent lower cytotoxicity compared to typical antimicrobial agents since NO is endogenously present in cells.…”

“…Bacteria can generate an extracellular matrix in which the diffusion of antibiotics is hindered, which complicates the fight against infections. More than the presence of planktonic bacteria, biofilm formation actually dictates if an acute wound becomes chronic [ 16 ] since biofilms are predominant in at least 60% of chronic wounds [ 55 ]. Biofilms allow gene transfer between bacteria, which could lead to the dissemination of genes associated with antibiotic resistance.…”

“…Deficient or excess exudate absorption is detrimental for proper wound healing as it leads to a microbial-friendly environment or dry wound site, respectively. Exudate levels differ during the healing stages, with high levels for the first 48 h [16]; thus, the main guideline is that wound dressings should ideally only absorb Pharmaceutics 2022, 14, 1377 3 of 22 excess exudate without compromising the healing process [4]. Comparatively to normal skin, water loss is higher in wounds, reaching up to 5000 g•m −2 d −1 , around 20-fold the water loss of normal skin when at 35 • C. It has been disclosed that wound healing benefits from water vapor transmission values of around 2000-2500 g•m −2 d −1 [17].…”