From the Guidelines
The optimal treatment for delayed wound healing is a multifaceted approach that includes wound cleansing and debridement, moist wound healing, infection control, nutritional support, offloading, managing underlying conditions, and considering advanced therapies such as negative pressure wound therapy or growth factor treatments, as recommended by the most recent guidelines 1. The treatment of delayed wound healing should prioritize the following key components:
- Wound cleansing and debridement: Regularly clean the wound with saline solution and remove any dead or infected tissue, as outlined in the standards of care for diabetes 1.
- Moist wound healing: Apply appropriate dressings (e.g., hydrocolloids, alginates, or hydrogels) to maintain a moist environment, which promotes healing, as supported by the evidence 1.
- Infection control: Use topical antimicrobials like silver sulfadiazine or mupirocin if infection is present, as part of a comprehensive wound management plan 1.
- Nutritional support: Ensure adequate protein, vitamin C, and zinc intake through diet or supplements, to support the body's natural healing processes, as emphasized in the guidelines 1.
- Offloading: Reduce pressure on the wound area, especially for diabetic foot ulcers, to promote healing and prevent further injury, as recommended by the standards of care 1.
- Manage underlying conditions: Control diabetes, improve circulation, and address any other health issues impeding healing, to create an optimal environment for wound healing, as highlighted in the evidence 1.
- Advanced therapies: Consider negative pressure wound therapy, hyperbaric oxygen therapy, or growth factor treatments for stubborn wounds, as supported by the most recent guidelines 1 and systematic reviews 1. Implementing these steps immediately and consistently can help create an optimal healing environment, addressing both local wound factors and systemic issues, and promoting tissue regeneration, reducing infection risk, and supporting the body's natural healing processes, as recommended by the most recent and highest quality study 1.
From the Research
Optimal Treatment for Delayed Wound Healing
The optimal treatment for delayed wound healing involves a combination of patient-related and local factors, including:
- Wound debridement to remove nonviable tissue 2
- Specialty dressings, such as silver-oxysalt (AgOx) dressings and oxidized regenerated cellulose/collagen (ORC/C) dressings, to manage infection and inflammation in the wound environment 3
- Advanced technologies, such as the V.A.C. device, hyperbaric oxygen, skin substitutes, growth factor, or plastic surgical techniques, to facilitate the healing process 4, 2
- Physical therapies, such as laser, photobiomodulation, photodynamic therapy, electrical stimulation, and ultrasound therapy, as complementary treatments to promote wound healing and reduce scarring 5
Key Factors in Delayed Wound Healing
The main local impediments to delayed healing are:
- Presence of nonviable tissue
- Excessive inflammation
- Infection
- Moisture imbalance 4
- Underlying pathologies, such as diabetes, venous insufficiency, or pressure ulcers, which can differ among various types of chronic wounds 6
Treatment Approach
A stepwise approach to identify and treat these barriers, termed wound bed preparation, is essential for facilitating the healing process 4. This approach involves:
- Assessing the wound and the patient to determine the underlying causes of delayed healing
- Developing a comprehensive treatment plan that addresses patient-related and local factors
- Selecting appropriate therapies, such as wound debridement, specialty dressings, and advanced technologies, to promote wound healing
- Monitoring the wound's progress and adjusting the treatment plan as needed 6, 3