"Wound Bed Preparation: Standards of Care and Predictability of the Healing Time of Chronic Wounds"

Abstract

We intend to highlight the need to establish a hypothetical time of healing for chronic wounds. Such innovative aspect within the TIME acronym [tissue, infection/inflammation, moisture balance and edge of wound] is based on a more correct analysis of the general and local symptoms that the patient presents, classifying them in different ways according to their characteristics. The analysis of medical history, pathogenesis and clinical leads to a total score that can direct the clinician to choose principals important and aggressive that can be used according to basic concepts. Ortho Surg Ortho Care Int J Copyright © Erind Ruka 2/7 How to cite this article: Claudio L, Fabio S, Emiliano J, Erind R. Wound Bed Preparation: Standards of Care and Predictability of the Healing Time of Chronic Wounds . 2(1). OOIJ.000527.2018. DOI: 10.31031/OOIJ.2018.02.000527 Volume 2 Issue 1 relation with the therapy. The TH is=to IG and will not change if the therapeutic choice [soft] resides on the left side of the table; is <30% of IG if therapy undertaken [medium aggressive] is in the middle of the table; is <60% of IG if therapy choice [aggressive] is on the right side of the table. We assume that we are faced with an ulcer from healing [healing time >60 days]. We can change the situation by customizing the type of therapy on the individual case. In this way we can modify the healing time [4]. Take for example a lesion volume between 50 and 100cm3. We can have a lesion T0, I0, M0, E0, thus devoid of necrotic tissue, bacterial contamination, exudate and with re-epithelialisation rate >75%, or a lesion T4, I4, M4 and E4 with 100% of necrotic tissue infections, exudate and the absence of spontaneous reepithelialization: with the same situation, in any case, the choice of therapy will change the history of the lesion and the timing of healing. For example, the T, we can see how, by choosing a soft treatment [such as autolysis, we have a significant improvement of the lesion as low as 25 days [25-27]. This time can decrease, even drastically, by level up in the type of strategy used: the time passes to 20 days with osmosis, 15 days with the larvae, until a day using hydrotherapy, ultrasound or surgery. Regarding the I: we passed from an improvement of 55 days with saline [strategy blander], to 21 days of antiseptics/ dressings with silver/NPWT [negative pressure wound therapy] up to 7 days after the surgery/ antiseptics/antibiotics/NPWT. The M represents an increase in 55 days with hydrogel/hydrocolloid, hydrofibre 28 days with up to 10 days of the surgery. Finally, the E: re-epithelialization from 100 days with advanced medications, VAC 45 days with up to 10 days with autologous graft [28-56]. Time of Healing The numerical value is in direct relation to the selected therapy. It is=to that of IG patient and its value will not change if the therapy choice [soft] is in the left side of the table therapeutic It is <30% of IG patient if treatment choice [medium-aggressive] is in the centre of the table therapeutic It is <60% of IG patient if treatment choice [aggressive] is on the right side of the table. Result The test results have shown that the margin of error in predicting the healing time was <10% of the 40 patients analysed in detail (Table 1): Table 1: Soft: not aggressive treatment. Type of Wound P Performed Treatment Performed Treatment Time of Healing Time of Healing Difference of Healing in Days Time 40 First 30 days 30-180 days Expected (days) Realized (days) Post-traumatic wound 7 3=soft 3=MA 21 24 3 2=MA 2=MA 28 32 4 2= A 2=A 40 45 5 Cutaneous vascular venous ulcer 21 12=soft 7=soft 32 35 3 7=MA 12=MA 28 30 2 2=A 2=A 28 32 4 Diabetic foot 9 4=soft 2=soft 21 24 3 3=MA 5=MA 30 32 2 2=A 2=A 40 44 4 Pressure ulcers 3 1=MA 1=MA 56 59 3 2=A 2=A 60 65 5 MA: Medium-Aggressive Treatment; A: Aggressive Treatment Report of the results obtained with the averages of the healing times on a number of 22 patients, obtaining a slightly higher percentage of error of 10% in the prediction of healing time. Our protocol GI is <23=and ASA 1-5 soft therapy GI is 24-50 and ASA <4 with infection between 1-2=mediumaggressive therapy GI is >50 and ASA <4 with infection between 3-4=aggressive therapy GI is >50 and ASA is 4-5 with infection between 1-2=soft therapy GI is >50 and ASA is 4-5 with infection between 3-4=mediumaggressive therapy Discussion Nowadays, various systems today try to give a prediction of healing time, taking into account various parameters. Troxler et al. [4] studied the importance of periodic evaluations of the wound, accompanied by measurements of its surface, for the identification of potentially hard-to-heal wounds. The early detection of a reduction Ortho Surg Ortho Care Int J 3/7 How to cite this article: Claudio L, Fabio S, Emiliano J, Erind R. Wound Bed Preparation: Standards of Care and Predictability of the Healing Time of Chronic Wounds . 2(1). OOIJ.000527.2018. DOI: 10.31031/OOIJ.2018.02.000527 Volume 2 Issue 1 Copyright © Erind Ruka in the size of the wound is set by measuring the progress of the margin [epithelial advancement]. Phillips et al. [57] considering the percentage reduction in venous ulcer area found that in about 77% of cases, healing outcomes could be predicted based on a wound size reduction of more than 44% at three weeks. Margolis et al. [58,59] were able to show that for venous leg ulcers a simple rating system score based on size and duration can give a good indication of the likely outcome at 24 weeks. Falanga et al. [60] incorporated measurement of epithelial advancement into a scoring system on the healing of venous leg ulcers. This system [wound bed score] also examines other characteristics including the extent of skin dermatitis around the wound, the presence of eschar, callus and/or fibrosis around a wound, pink or red wound bed, exudate and the volume of the edema (Table 2). Table 2. Protocol A1 30 Days Soft T=fibrin autolytic cream I=absent saline or ringer Lactate M=absent hydrogels or hydrocolloids E=depth 0 hydrocolloids, hydrofibres, collagen, ac. Ialuronico The complexity of the wound is likely to exert a significant influence on the progression of the healing process, and the factors that combine to determine it can be classified into four main groups: patient factors, factors related to the wound, knowledge of the HCP, factors and resources related to the treatment. In a study by Margolis et al. on a group of patients with venous ulcers, it has emerged a correlation between some specific characteristics of the wound and the healing process: wound duration, size, depth of the wound]. Ulcer size [>2cm2], the duration [>two months] and depth [penetration through exposed tendon, ligament, bone or joint] were the three most important factors for predicting the outcome. Patients with all three factors had only a 22% chance of healing by 20 weeks (Table 3).