Wound healing society 2014 update on guidelines for arterial ulcers

Abstract

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006. These guidelines provided recommendations, along with their respective levels of evidence on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy, and long-term maintenance. Over the last 7 years, a great deal of literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians, and researchers was chosen to update the 2006 guidelines. Members included vascular surgeons, internists, plastic surgeons, anesthesiologists, emergency medicine physicians, and registered nurses, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings, upon which an updated version of the guidelines will be based. METHODS Data sources and searchesWe sought to capture the highest quality of literature available regarding arterial insufficiency ulcer diagnosis and treatment using a key word search of PubMed, Embase, and Cochrane Library databases. Similarly, the citations of relevant articles were examined by hand. Key terms were generated from the existing guidelines. The search was limited to meta-analyses, systematic reviews, randomized controlled trials (RCTs), retrospective series reviews, clinical case series, and expert panel recommendations published between January 2006 and 2013. It was further limited to only English publications, and review articles and case reports were excluded.The findings of these articles have been divided into one or more of the appropriate categories (diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy, and long-term maintenance) as performed in the original guideline.

The beneficial effect of traditional Japanese herbal (Kampo) medicine, Hochu‐ekki‐to (Bu‐Zhong‐Yi‐Qi‐Tang), for patients with chronic wounds refractory to conventional therapies: A prospective, randomized trial

“…Unified systemic and local therapy were not appropriate for improving the wound healing of each patient because patients incorporated into this study had various diseases and different levels of declined physical strength, and the wound healing process had been stopped for >3 weeks because of these combined causes. Even in individual patients, although they continued the same systemic and local treatments as they had before taking part in this study, when systemic condition and local wound bed status improved, the treatments were changed according to the guidelines for wound treatments …”

“…The selection criteria for this research were patients with chronic ulcer and wound healing that had not proceeded for >3 weeks under existing standard systematic and local treatments according to The Chronic Wound Care Guidelines of the Wound Healing Society and The Guideline for Chronic Wound of the Japan Society of Plastic and Reconstructive Surgery and Japan Society for Surgical Wound Care, while observing treatment covered by Japanese health insurance .…”

“…The selection criteria for this research were patients with chronic ulcer and wound healing that had not proceeded for >3 weeks under existing standard systematic and local treatments according to The Chronic Wound Care Guidelines of the Wound Healing Society and The Guideline for Chronic Wound of the Japan Society of Plastic and Reconstructive Surgery and Japan Society for Surgical Wound Care, while observing treatment covered by Japanese health insurance. [31][32][33][34][35][36] The severity of the wound was evaluated using DESIGN-Rating (DESIGN-R), a validation tool for the severity of pressure ulcers that is used for longitudinal and comparative monitoring of various pressure ulcers among different patients. [37][38][39] The DESIGN-R scores the depth, exudate, size, inflammation/infection, granulation tissue, necrotic tissue, and the pocket size (undermining).…”

“…During the observation period of 12 weeks, all patients in both groups continued the same systemic and local treatments for the wound as they had received for more than 3 weeks before registration (existing standard systematic and local treatments according to the Chronic Wound Care Guidelines of the Wound Healing Society and the Guideline for Chronic Wound of the Japan Society of Plastic and Reconstructive Surgery and Japan Society for Surgical Wound Care, while observing treatment covered by Japanese health insurance). [31][32][33][34][35][36] Patients in the medication group received HET fine granules (Tsumura & Co., Tokyo, Japan) at 7.5 g three times daily. The patients took HET orally with cold or lukewarm water before each meal.…”

Trauma and Stem Cells: Biology and Potential Therapeutic Implications

“…There is an abundance of papers and clinical trials on stem cells and wound healing. At present the Wound Healing Society guidelines state the role of stem cells in current practice is promising yet still undefined [119]. Most published clinical trials are regarding stem cell use in critical limb ischaemia.…”