Editor`s Opinion: Keeping the Quest in Our Questions

You would think everything wound-related had been figured out by now. After all, wounds have been around for as long as people (and animals). In addition, the number of wound-related studies, publications, journals, websites, meetings, and wound care education programs has sky-rocketed during the past 50 or so years. But here we are, still with more questions than answers.

For example, in this issue of Ostomy Wound Management, Bai et al¹ observe that the underlying mechanisms of nonhealing are not completely understood and describe their efforts to find markers of inflammation that will help clinicians decide when a wound should be surgically closed. Meanwhile, wounds that are not so common continue to perplex and challenge even the most experienced clinicians — in part because there is so little evidence to help guide care. To that end, the descriptive study conducted by Fromantin et al² adds to our understanding of the natural progression and trends in outcomes of malignant breast cancer wounds. Although modern dressings were able to control many undesirable symptoms of these wounds, no matter what was used, patients who had uncontrolled pain continued to have pain and wound odor remained very difficult to manage. These observations are not encouraging for the patients, but they will help guide future research and may provide some comfort to clinicians and caregivers. After an extensive literature search, Faller et al³ found evidence to guide the care of peristomal pyoderma gangrenosum is limited to case studies. Although (fortunately) relatively rare, these wounds are painful and make it very difficult to obtain a secure appliance seal. Considering the etiology of pyoderma gangrenosum and the systemic side effects of oral prednisone therapy, the authors developed an approach to deliver prednisone topically and report the results of this approach with three patients.

If your very best efforts and ingenuity fail to provide the pain and symptom relief you aim for, you are not alone! However, as we continue to learn more about all aspects of wound healing and care, it is important to apply what is known in practice and research. Despite decades of studies showing gauze (whether moistened or dry) is one of the least effective dressings available, it continues to be used in clinical practice and as a control treatment in research studies. The guidance document for developing and testing wound treatments from the United States Food and Drug Administration, which clearly states a moist wound environment (which cannot be provided by any type of gauze dressing) is the standard of care was published 8 years ago.⁴ Last, but most important, while most studies and discussions focus on the wound itself, the care priority should be the person with the wound. His/her history and general health condition — and our attention to it — is more likely to affect the outcome of our care than what is or is not applied to the wound itself.

This article was not subject to the Ostomy Wound Management peer-review process.