An audit to assess the perspectives of U.S. wound care specialists regarding the importance of proteases in wound healing and wound assessment

Abstract

Chronic wounds represent an aberrant biochemistry that creates a toxic proteolytic milieu which can be detrimental to the healing process. Rebalancing the wound microenvironment and addressing elevated protease activity (EPA) could therefore help facilitate healing. To understand how clinicians currently diagnose and manage excessive proteolytic activity, 183 survey responses from US wound specialists were collated and analysed to find out their perceptions on the role of proteases. The majority of respondents (>98%) believed proteases were important in wound healing and that a point-of-care (POC) protease test could be useful. This study yielded a low response rate (7.1%, n = 183); however, there were adequate data to draw significant conclusions. Specialists perceived that fibrin, slough, granulation tissue and rolled wound edges could indicate EPA. About 43% of respondents, however, failed to give a correct response when asked to review photographs to determine if excessive protease activity was present, and the perceived visual signs for EPA did not correlate with the wounds that had EPA; no statistical differences between professions were observed. Respondents chose debridement, wound cleansing and advanced therapies as important in reducing excessive protease activity. It was concluded that specialists have a need for POC diagnostic tests. On the basis of the responses to wound photos, it was determined that there were no visual cues clinicians could use in determining excessive protease activity. Additional research is recommended to evaluate the efficacy of a POC diagnostic test for protease activity and the treatments and therapies applied when EPA is found.

Keywords: Human neutrophil elastase; Matrix metalloproteases; Point‐of‐care diagnostic tests; Proteases; Serine proteases; Wound care.

Figure 1

Cullen circle: a theoretical model to explain delayed wound healing .

Figure 2

182 clinicians responded to this question.

Figure 3

178 clinicians responded to this question.

Figure 4

179 clinicians responded to this question.

Figure 5

98% responded ‘yes’ to the question. 2% responded ‘no’.

Figure 6

99% responded ‘yes’ to the question. 1% responded ‘no’.

Figure 7

97% responded ‘yes’ to the question. 3% responded ‘no’.

Figure 8

Of the 178 clinicians that responded to this survey debridement was ranked first choice and stimulation of epithelialization was ranked as least important.

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167 clinicians responded to this question.

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177 clinicians responded to this question.

Figure 11

Photos for this study were supplied courtesy of Dr. Thomas Serena, MD, FACS.

Figure 12

Therapies were ranked, 1 being most important and 7 being the least important. Of the 177 clinicians that responded to this survey debridement, cleansing and advanced therapies were their top three choices.