Poster: A Surgically Based Multidisciplinary Algorithm for the Management of Complex Wounds

Research presented in a recent poster abstract at SAWC Fall 2021 found that 75% of wounds healed when treatment followed a multidisciplinary surgical approach provided by a wound care team.

The authors cite the significant burdens that complex wounds can create, adding that although technology in the wound care space has skyrocketed, there are concerns about the consistency and real-world applicability of the literature. Currently, available data suggests that only 40% of wounds go onto healing,^1,2 these authors contend that a multidisciplinary surgical approach with a specialized wound healing team may improve this metric.

Researchers conducted a single-center, prospective study of 100 patients admitted to a tertiary wound referral academic hospital for operative treatment of infected wounds. Each patient underwent the same treatment algorithm, including sharp, surgical debridement to healthy tissue and negative pressure wound therapy with instillation (NPWTi) applied in the operating room. Each patient also had multidisciplinary follow-up care to address concerns such as vascular issues, gait abnormalities, and metabolic dysfunction. They followed these patients for up to one year following the initial inpatient course. Researchers did not set any exclusions for wound site, severity, patient demographics, or comorbidities.

The cohort had multiple notable characteristics and comorbidities, including an average body mass index (BMI) of 30.1; mean age of 60.5 years; 61% male; 46% with diabetes (type 1 or 2); 18% with peripheral vascular disease; and 33% with a past history of amputation. The wounds in question had multifactorial etiologies and significant severity, including bone involvement, along with wound size and depth. The authors found that at one year, and only eight patients lost to follow-up, at least 75% of the wounds studied healed.

The authors feel that precise surgical technique and a multidisciplinary team led to more effective attention to infection, chronic inflammation, and biomechanical abnormalities, leading to well-vascularized wound beds, infection resolution, and optimization for long-term wound remission. They add that further examination of issues such as the influence of significant comorbidities may improve future understanding of the best pathways and protocols for patients with wounds.

References:

1. Fife CE, Eckert KA, Carter MJ. Publicly reported wound healing rates: the fantasy and the reality. Adv Wound Care (New Rochelle). 2018;7(3):77-94. doi:10.1089/wound.2017.0743
2. Carter MJ, Fife CE, Walker D, Thomson B. Estimating the applicability of wound care randomized controlled trials to general wound-care populations by estimating the percentage of individuals excluded from a typical wound-care population in such trials. Adv Skin Wound Care. 2009;22(7):316-324. doi:10.1097/01.ASW.0000305486.06358.e0

Poster CR-003 was featured at SAWC Fall 2021.