Combining Advanced Treatment Modalities for Complex Wounds

Background: As wound care practitioners we are facing increasing number of patients with complex wounds and high recurrence rates, especially DFU`s or VLU`s. There are many treatment options presented as "advanced modalities". Each of these modalities show 50% or 70% of patients that heal at 12 or 16 weeks, but none have 100% heal rate. As a result, in daily practice we will have many patients that have already failed an advanced treatment modality and we have the challenge of coming up with a treatment plan without having any established clinical guidelines. Methods: This presentation includes my clinical experience with combination of advanced treatment methods used for challenging situations that allowed a good outcome. Results: - Case 1 : refractory VLU treated with collagen scaffold, NPWT, compression, epidermal grafting - Case 2: DFU with osteomyelitis treated with outpatient bone resection, Integra dermal regeneration template, NPWT, total contact casting and HBO - Case 3: DFU/ abscess treated with Integra dermal regeneration template followed by micrografting procedure in outpatient settings - Case 4: Refractory DFU treated with hyaluronic acid dermal matrix followed by epidermal grafting - Case 5: refractory elbow pressure ulcer treated with NPWT, fetal bovine collagen matrix, micrografting technique and cast immobilization Conclusion: The combination of multiple advanced treatments allowed a successful outcome for these patients with refractory and complex wounds. Further work for establishing a consensus for a standardized approach for these situations is needed.