Abstract and Introduction
This review highlights the range of therapeutic options available to clinicians treating difficult-to-heal wounds. While certain treatments are established in daily clinical practice, most therapeutic interventions lack robust and rigorous data regarding their efficacy, which would help to determine when, and for whom, they should be used. The purpose of this review is to give a broad overview of the available interventions, with a brief summary of the evidence base for each intervention.
Despite wounds existing since the beginning of time, scant attention has been paid to treating patients over recent centuries. Many clinicians still consider wound healing an art rather than a science. As society has developed, and increasingly bloody conflicts have taken place, the nature and complexity of wounds have changed beyond recognition. Increasingly, patients now suffer significant systemic or local disease, which impact wound healing. This has resulted in major challenges in treating patients with diabetic foot ulceration (DFU), venous (VLU) and arterial leg ulceration (ALU), and pressure ulceration (PU). In addition, challenges to reduce surgical site infection and wound complications postoperatively remain.[1–3] The only wound type that is decreasing in frequency is major burn injury, owing to better prevention and safety strategies.
Many challenges remain in converting nonhealing to healing wounds, and the modulation of scarring, a cause of both cosmetic and functional challenges for many patients. Owing to the immaturity of the subject due to a lack of focus and academic investment, there is an almost complete absence of objective validated tools that predict outcomes in patient with wounds.
The British Journal of Dermatology. 2022;187(2):149-158. © 2022 Blackwell Publishing