Proactive wound care

Abstract

In June, 2003, a paper by Sheehan et al. (Diabetes Care 26:1879-82, 2003) caused many physicians to think about the need for proactive wound care. In this paper, the authors demonstrated a pattern of healing in diabetic foot ulcers in which wounds that did not show a significant decrease in size within 4 weeks of standard treatment, had less than a 10% chance of being closed by week 12. As a result, a benchmark was established, whereby one could say with reasonable certainty that in the absence of at least 50% closure after 4 weeks of standard care, a new approach was needed. When wounds fail to close from initial treatments, it is prudent to reassess the wound environment, the condition of the patient, adjust the treatment, and take proactive steps to enhance and stimulate the healing process. Proactive wound care involves a series of steps to stimulate the wound to progress towards closure. These steps should be broad in their scope, and should focus on the shortcomings of the wound, and on the barriers to healing. Once potentially problematic issues are identified, the wound care specialist should consider the options that they have to gain control and improve the wound environment.