Optimal Care of Chronic, Non-Healing, Lower Extremity Wounds: A Review of Clinical Evidence and Guidelines [Internet]

Excerpt

Chronic wounds are those which do not progress through the healing process in a timely and predicted manner. Chronic leg and foot ulcers occur in many adults with vascular disease or diabetes. These ulcers last, on average, 12 to 13 months, are recurring in up to 60% to 70% of patients, and can lead to loss of function, poor quality of life, and ill-health. As the population ages, chronic wounds are becoming more prevalent, more difficult to treat, and care for chronic wounds has been reported to cost 2% to 3% percent of the healthcare budgets in developed countries.

The goal of chronic wound management is to facilitate healing, which may include optimal moisture balance, restoration of blood flow to the wound, compression therapy, prevention of infection, and debridement. This variability of treatment options and treatment needs for chronic wounds requires a multidisciplinary team. This team collaboration can allow for earlier diagnosis, better management, and may reduce the cost of treating wounds. Although nursing and non-specialist care are parts of an optimal multidisciplinary team, there is the need for specialist consultation and specialist-lead advanced care both as a part of and outside of the multidisciplinary teams as well. It is sometimes unclear when the advanced care is needed, at what point in the process specialists should be involved in the care pathway, and which patients should be referred for specialist care, especially with respect to vascular and plastic surgeons.

The objective of this review is to summarize the clinical evidence regarding the need for specialist-lead advanced care, indications for referral to specialist care, and the guidelines regarding the multidisciplinary management, including specialist care, for chronic, non-healing, non-pressure-related lower extremity wounds