Search parameters The literature review for this paper used the following data- bases: CD ROM MEDLINE & CINAHL (1984–96) and BIDS EMBASE (1992–96). The keywords employed were ‘tissue viability’, ‘skin viability’, ‘tissue survival’, ‘cell sur- vival’, ‘regional blood flow’, ‘wounds and injuries’, ‘wound assessment’, ‘wound care’, ‘wound healing’ and ‘wound management’. Only literature published in English was con- sidered. There was a vast literature of which a large propor- tion was devoted to animal studies. What was surprising in relation to the literature was the very limited number of clin- ical studies related to general surgical, postoperative wound healing and our bibliography reflects this lack of recent work. Reports of studies in nursing were almost always descriptive in nature, with little information on the actual samples employed, or studies were so small as to be almost meaningless. The result is that the few available studies, limited as they are in scope and design, are widely quoted. Introduction The practice of wound management has seen much change over the past decade: • scientific evidence has led to changes in wound manage- ment from dry to moist wound healing (Bolton et al., 1990) • there is a preponderance of new and varied wound care products available on the market • there is greater acceptability of a particular type of product to suit individual patients’ life styles. Journal of Clinical Nursing 1998 7: 11–17 © 1998 Blackwell Science Ltd 11 Review Wound management: a literature review MARGARET E. LAIT Lecturer, Nursing & Midwifery Studies, University of Glasgow, Glasgow LORRAINE N. SMITH Professor, Nursing & Midwifery Studies, University of Glasgow, Glasgow Accepted for publication 20 August 1997 Summary • This paper provides an overview of literature on wound management, including wound assessment and wound care and their relationship to the healing process. • No attempt is made to describe individual tools or dressing materials as this lit- erature can be found elsewhere. • Patient and economic benefits of accurate wound assessment and choice of dressing material are highlighted. • The case for an improved and updated nursing knowledge base regarding all aspects of wound care is made. Keywords: wound assessment, wound dressings, wound management, wound measurement. Correspondence: Margaret E. Lait, Nursing & Midwifery Studies, University of Glasgow, 68 Oakfield Avenue, Glasgow G12 8LS, UK

Lazarus et al. (1994) estimate annual world-wide expen- diture on wound care to be in the region of $7 billion (US). Therefore the implications of efficient and effective wound healing are massive for both the patient and the economy. There has been a proliferation of wound care-related lit- erature advocating systematic approaches to and standard- ization of wound care. This activity is evidenced by the emergence of specialist wound care journals, 30 000 refer- ences on CD ROM bases, the emergence of RCN specialist wound groups, tissue viability groups within and across trust hospitals, wound protocol groups and wound special- ist nurses. Nursing and wound management Wound management is a multidisciplinary concern, although it is usually seen as the responsibility of nursing (Sutton, 1989). Carr (1993) states that, as nurses are the professionals most involved in the management of wounds, they need to be able to report changes accurately and con- tribute to discussions on continued care. However, as noted earlier, much of the nursing literature appears to be descriptive in nature, with few clinical trials reported and offering little evidence of the validity and reli- ability of the tools designed (e.g. Jaber, 1986 Morison, 1987 Mather & Woods, 1987 Sutton, 1989 Carroll & Johnson, 1991 Flanagan, 1994). The nursing literature focuses on the following areas: wound assessment (Sutton, 1989 Dealey, 1991a Banfield & Shuttleworth, 1993) wound measurement (Kundin, 1989 Dealey, 1991b Anthony, 1993) dressing choice (Griffiths, 1991 Bolton et al., 1990 Bolton & Rijswijk, 1991) evaluation of wound progress (Dealey, 1991c) and recommendations for a systematic approach to wound management (Bale, 1991 Griffiths-Jones, 1991 Banfield & Shuttleworth, 1993). Bryant (1992), whilst praising this new enthusiasm for wound care, cautions against wound management becom- ing an end in itself rather than managing the total care of the patient. Assessment It has been stated that formal assessment of wound status is a prerequisite for good wound care (Gould, 1984), in that assessment enables nurses to set realistic and measurable goals (Banfield & Shuttleworth, 1993). Sutton (1989, p. 71) is of the view that ‘accurate assessment is vital to planning appropriate care and evaluating its effectiveness’. Generally it is agreed that there is a need for continuity and consis- tency in the assessment of patients with wounds. Gould (1984) argues that the further assessment and planning of treatment should be individualized. This holistic approach to wound care is considered by Bale (1991), Johnson (1993), Flanagan (1994) and Benbow (1995) to be of great importance. Morison (1987) believes that assessment is facilitated by a systematic and reliable tool. PURPOSE OF WOUND ASSESSMENT Lazarus et al. (1994, p. 490) state that ‘assessment of a wound in the environment in which it occurs is essential for diag- nosis, treatment, management and study’. Flanagan (1994) identifies four purposes: 1 to monitor the progress of wound healing 2 to evaluate the effectiveness of planned treatment/inter- vention 3 to improve the morale of both patients and staff 4 to provide a valuable teaching tool for patients, staff and carers. This supports the work of Dealey (1991a), who believes that wound assessment with patient assessment has two main aims: the first is to provide baseline information to enable progress to be monitored, the second is to enable the appropriate selection of dressings. Bolton & Rijswijk (1991, p. 147) state that nurses must remember that a wound is attached to a patient and that the aim of assessing a wound is to ‘restore biochemical balance by identifying and removing the cause of tissue break- down’. Carr (1993) emphasizes the importance of a sound knowledge of the healing process and the ability to recog- nize the stage of wound healing. She is also of the opinion that before a wound can be assessed, its history has to be ascertained i.e. the origin of the wound, the patient’s general condition, the patient’s nutritional status in rela- tion to wound healing, and whether there are complicating factors, e.g. diabetes. Griffiths-Jones (1991) states that assessment occurs at two levels. The first level is an understanding of what is happening within the wound environment itself, while the second level is the effect the wound has on the patient and family. This information should be collected in a systematic way which progresses through four stages (Griffiths-Jones, 1991): 1 collection of objective information from nursing and medical notes 2 patient interviews 3 observation and measurement of the wound 4 identification and validation of actual or potential prob- lems. Lazarus et al. (1994) are of the opinion that assessment should commence with the extent of the wound, followed 12 M. E. Lait and L. N. Smith © 1998 Blackwell Science Ltd, Journal of Clinical Nursing, 7, 11–17