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Letters to the Editor: Healing Wounds in Long-Term Care
The study presented in Takahashi PY, Kiemele LJ, Chandra A, Cha SS, Targonski PV, A retrospective cohort study of factors that affect healing in long-term care residents with chronic wounds (Ostomy Wound Manage. 2009;55[1]:32–37) provides valuable insights into factors affecting healing in long-term care (LTC) residents with chronic wounds.
A prospective cohort study1,2 conducted in several settings including LTC reported ulcer depth, characterized as partial-thickness or full-thickness, was a significant predictor of chronic wound healing time as well as percent of ulcers healed over 12 weeks. Approximately twice the proportion of partial-thickness venous or pressure ulcers were found to heal in 12 weeks, with average healing times respectively about half as long for the partial-thickness counterparts. It would be interesting to hear if Takahashi and his colleagues made the same observations in their population.
Laura Bolton, PhD
References
1. Smitten A, Bolton L. Burden of pressure ulcer care. In: Ayello E. Research Forum. Advances Skin Wound Care. 2005;18(4):192–193.
2. Bolton L, McNees P, van Rijswijk L, et al. Wound healing outcomes using standardized care. J WOCN. 2004;31(3):65–71.
Reply
I appreciate Dr. Bolton’s observations and agree with her comments about pressure ulcer depth (partial- versus full-thickness) and the proportion of healing.1 Higher pressure ulcer staging (or partial- versus full-thickness depth) certainly could influence and reduce pressure ulcer healing.2 In our study, we had a mixed population of pressure and other ulcers (eg, ischemic and venous). In a subset of 168 patients with pressure ulcers only, we had staging on 134 patients — of those, 56 patients had Stage I or Stage II ulcers and 68 patients had Stage III or Stage IV ulcers. Using chi-square analysis, we found an association between ulcer healing and stage of ulceration, with a chi-square of 11.0 and a P value of 0.015. Thus, it is clear that there is an association with increased ulcer size and healing.
Our cohort included some inherent biases, making underestimates of the effect of pressure ulcer staging likely. Our cohort was comprised of referral patients; thus, many patients with Stage I or Stage II (partial-thickness) ulcers likely were not referred for management and healed with pressure reduction and good skin care. Ultimately, I strongly agree that providers should look at pressure ulcer stage or partial- versus full-thickness depth as an important prognostic factor for future healing. Patients with more severe ulceration (Stage III or Stage IV) should be monitored carefully for healing, and providers should make a realistic assessment about healing.
1. Bolton L, McNees P, van Rijswijk L, et al. Wound-healing outcomes using standardized assessment and care in clinical practice. J WOCN. 2004;31(2):65–71.
2. Jones KR, Fennie K. Factors influencing pressure ulcer healing in adults over 50: an exploratory study. J Am Med Dir Assoc. 2007;8(6):378–387.
