Management of Chronic Wounds

Initial Management Strategy

The American Diabetes Association recommends offloading of plantar ulcerations to reduce pressure on the wound site and promote healing 1
Debridement of necrotic, nonviable tissue converts a biologically chronic wound to an acute wound, accelerating the healing process, as suggested by the American College of Radiology 1, 4
Revascularization of ischemic wounds should be performed when necessary to improve blood supply to the affected area, according to the American College of Cardiology 1, 5
Management of infection through appropriate antimicrobial therapy is crucial for wound healing, as recommended by the American College of Radiology 1, 4
The use of physiologic, topical dressings to maintain a moist wound environment while controlling exudate is recommended by the American College of Radiology 1, 6

Advanced wound therapy should be considered if a wound fails to show at least 50% reduction after 4 weeks of appropriate standard wound management, as suggested by the American Diabetes Association 1, 3
Treatment of chronic wounds is best managed in a multidisciplinary/interprofessional setting, according to the American Diabetes Association 3, 7
Negative-pressure wound therapy is especially useful for deep, large wounds and in preparation for skin grafts, as recommended by the American Diabetes Association 1, 8
Topical oxygen therapy has shown efficacy in healing chronic diabetic foot ulcers at 12 weeks, according to the American Diabetes Association 8
Hyperbaric oxygen therapy may be considered for nonhealing diabetic foot ulcers after revascularization, as suggested by the American College of Cardiology 5

Proper pressure offloading is critical for diabetic foot ulcers, as recommended by the American Diabetes Association 3
After healing, patients with diabetic foot ulcers should be enrolled in a formal comprehensive prevention program to reduce recurrence, according to the American Diabetes Association 8
For venous leg ulcers, adjunctive techniques like split-thickness skin grafting and cellular therapy should only be considered after 4-6 weeks of standard therapy failure, as suggested by the American College of Radiology 4
Surgical debridement helps convert chronic wounds to acute wounds, according to the American College of Radiology 4

Using advanced therapies without first addressing the five basic principles of wound care is not recommended, as suggested by the American Diabetes Association 1, 3
Topical antimicrobial dressings should not be used without clear indication, as they have shown no benefit in venous ulcers, according to the American College of Radiology 4
Neglecting to evaluate for osteomyelitis in non-healing ulcers is a common pitfall, as recommended by the American Diabetes Association 7

Evidence to support advanced wound therapy is challenging to produce and assess due to difficulty in randomization of trial participants, as noted by the American Diabetes Association 1
Products or agents with robust RCTs or systematic reviews should generally be preferred over those without level 1 evidence, according to the American Diabetes Association 8