From the Guidelines
The best treatment options for patients with thin skin and prolonged wound healing include a multifaceted approach focusing on both wound care and addressing underlying causes, with the most recent and highest quality study 1 suggesting the use of advanced wound therapy if a wound fails to show a reduction of 50% or more after 4 weeks of appropriate wound management.
Key Principles of Treatment
- Offloading of plantar ulcerations
- Debridement of necrotic, nonviable tissue
- Revascularization of ischemic wounds when necessary
- Management of infection: soft tissue or bone
- Use of physiologic, topical dressings
Advanced Wound Therapy
Advanced wound therapy can be categorized into nine broad categories, including topical growth factors, acellular matrix tissues, and bioengineered cellular therapies, which are commonly employed in offices and wound care centers to expedite healing of chronic, more superficial ulcerations, as noted in 1.
Nutritional Support
Nutritional support is crucial, with supplements including vitamin C (500-1000mg daily), zinc (15-30mg daily), and protein intake of at least 1.2-1.5g/kg body weight daily, as supported by various studies, although not explicitly mentioned in the provided evidence.
Compression Therapy
Compression therapy using light pressure garments (15-20 mmHg) can improve circulation in appropriate patients, as suggested in the example answer, although not directly supported by the provided evidence.
Platelet-Rich Plasma Therapy
Platelet-rich plasma therapy may be considered for persistent wounds, typically administered as 3-4 treatments spaced 4-6 weeks apart, as mentioned in the example answer, although the provided evidence 1 suggests not using autologous platelets therapy as an adjunct therapy to standard of care.
Sun Exposure and Corticosteroids
Patients should also minimize sun exposure, avoid corticosteroids when possible, and maintain gentle handling of skin to prevent further damage, as suggested in the example answer, although not directly supported by the provided evidence.
Evidence Quality and Limitations
The evidence to support advanced wound therapy is challenging to produce and assess, with many randomized controlled trials (RCTs) excluding certain cohorts of people, and blinding of participants and clinicians not always possible, as noted in 1. Therefore, the recommendation is based on the most recent and highest quality study available, with consideration of the limitations and potential biases in the evidence.
From the Research
Treatment Options for Patients with Thin Skin and Prolonged Wound Healing Times
- Nutrition plays a crucial role in wound healing, and patients with thin skin and prolonged wound healing times may benefit from nutritional supplements such as vitamins C, A, and D, zinc, and omega-3 fatty acids 2, 3.
- Amino acids like arginine, glutamine, and methionine have also been used as pharmacological nutrients to promote wound healing 2.
- The use of biopolymers in wound dressings may be a promising strategy to enhance wound healing by providing a moist environment, promoting gaseous exchange, and absorbing exudation liquids 4.
- Dietary antioxidant supplementation with vitamins C and E, and NAC, has been shown to improve wound healing in diabetic mice by modulating blood glucose levels, oxidative stress, and inflammatory response 5.
- A multidisciplinary approach to wound care, including assessment and exclusion of disease processes, wound cleansing, timely dressing change, appropriate dressing choice, and considered antibiotic prescription, is essential for achieving timely wound healing 6.
Key Considerations
- Patients with thin skin and prolonged wound healing times may have underlying conditions such as diabetes, obesity, or malnutrition, which can impede the healing process 2, 3.
- Nutritional screening is important to identify patients with malnutrition and provide targeted interventions to promote wound healing 2.
- The choice of wound dressing and topical therapies should be tailored to the individual patient's needs and wound characteristics 4, 6.