Hard-to-Heal Wound Management: Real World Implementation of Community-Based Health Care Recommendations

Introduction: Once a wound develops, patients often present to community-based health care providers for wound management. However, these providers may not be specialized in wound care. Additionally, some wounds may stall and not follow a normal healing trajectory, resulting in a hard-to-heal wound (HTHW). A panel meeting was held to develop recommendations and a simplified approach to wound care for community-based health care providers.1 These recommendations included using clinical signs to identify a HTHW, assessing the wound and periwound condition, and choosing optimal wound care products and methods based on patient and wound characteristics. Real-world implementation of these panel recommendations is described in 3 cases.Methods:Patient and wound assessments were performed according to HTHW panel recommendations.1 Patient history, wound tissue, infection/inflammation, moisture/exudate, wound edge, wound progression, and social considerations were assessed.2 Dressings were selected based on the wound environment, with more absorbent dressings being used for patients with higher levels of exudate. Dressings were changed twice per week. Wound healing was monitored with modifications to the wound care plan as needed.Results:Three males (33-84 years old) with 3 wounds (degloving injury, pyoderma gangrenosum, and diabetic foot ulcer) were treated. Previous medical history included hypertension, diabetes, congestive heart failure, immunosuppressive medication, and anemia. All 3 patients were at risk for developing a HTHW based on their medical history and complexity of the wound. Wound management included collagen dressings, hydrogel dressings and compression therapy, or hydrogel dressings for 14 days followed by use of collagen dressings. All wounds healed 26-90 days after presentation.Discussion: Following the HTHW panel recommendations, all 3 wounds were assessed, and a care plan was created based on the needs of the patient and the wound. Early recognition of the potential for HTHW status and a patient-centric approach resulted in all 3 wounds fully healing within 90 days of presentation. These positive clinical outcomes support the use of a simplified approach to wound care that may be easily implemented in the community health care environment.References:1. Beeckman D, Cooper M, Greenstein E, et al. The role community-based healthcare providers play in managing hard-to-heal wounds. Int Wound J. 2023;doi:10.1111/iwj.14402 2. Atkin L, Bucko Z, Conde Montero E, et al. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019;23(Sup3a):S1-S50. doi:10.12968/jowc.2019.28.Sup3a.S1