A Wound on Wound Care or a Wake-up Call?

The headline¹ read, “Wounds that won’t heal fuel $5B business, but little evidence.” The photograph showed a woman, seated in her home, who has been “fighting a diabetes-related wound on the bottom of her left foot for 2 years.” The report, reprinted from Kaiser Health News, described all the different treatment modalities she has received, the despair of the millions of patients living with nonhealing open wounds, and the painful procedures they frequently endure. Information to support the headline included the amount of money spent on wound care (the Centers for Medicare and Medicaid Services spends $25 billion per year); how evidence to support many treatments is limited, of poor quality, and mostly paid for by the manufacturers; and that public funding is scarce. On the surface, this looked like a collective “Ouch!” for everyone involved in wound care and a reason for wound care patients to get even more depressed. However, as with most things in life this recent article comes with a valuable silver lining. 

First, it is important for people to know wound treatment studies comprise only 0.1% of research spending by the National Institute of Health (NIH).² This article might inspire some legislators to make the connection between the scope of the wound care problem and the increasing need for research in new areas (eg, genomic) and flat NIH budgets that have caused the ratio of newly registered industry-sponsored drug studies to NIH-sponsored trials to increase from 4:1 to 6:1 between 2006 and 2014.² As an aside, the latter also shows that manufacturer-sponsored research is not as unusual as the article implies. 

Second, we absolutely need more evidence in wound care. However, the focus of the article is on what practitioners would consider second-line or adjuvant topical treatment modalities, which often become options when other approaches have failed. The provision of optimal wound care encompasses a whole lot more than topical treatments. We may not have supportive research for many of the adjuvant treatments described in the article, but there is ample evidence for many other interventions, especially those we would describe as “first-line” therapy.^3-6 

But here is the rub: there also is substantial research to suggest the evidence we have is not used consistently in practice, which may result in delayed healing, additional complications, and the quest for the more advanced treatments that are the topic of the article. Unfortunately, we continue to read “standard wound care” (ie, moist gauze) was provided, wet-to-dry dressings continue to be ordered at rates as high as 42%, and the vast majority of patients with foot ulcers do not receive appropriate offloading devices.^7,8 Case-in-point: from what I could tell, the foot of the woman pictured in the article, who has had an ulcer for more than 2 years and describes herself as “feeling like a guinea pig sometimes,” is not in a total contact cast or removable offloading device. So, yes, we need more research. We need more evidence. But let’s also make sure the evidence we have is put into practice.

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