Chronic Wound Management: The Significance of Evidence and Technology

Description:
This book describes how chronic wounds follow a completely different healing trajectory to acute wounds and discusses the factors associated with these poor healing trajectories. These factors include age, chronic inflammation, phenotypic changes in such cells as macrophages, fibroblasts, and keratinocytes, colder, alkaline wound milieu, wound related hypoxemia, and diabetes. Other factors implicated include reperfusion injury, poor patient compliance, presence of undiagnosed and therefore unmanaged biofilms and wound pain.
The past decades have yielded reliable evidence-based guidelines and standardized care, but the healing of diabetic foot wounds continues to be unpredictable notwithstanding these advances, while the recurrence rates are also high. The benefits of technology in wound diagnosis are evidence-based and the use of this technology also features in guidelines.  However, the same argument cannot be extended to adjuvant devices to facilitate wound closure even though many devices potentially benefit wound healing.
Chronic Wound Management describes how innovation is based on technology that itself informs evidence, the gap between the evidence available, the performance of technology and how do we bridge this gap. It reviews the lessons learnt from the COVID-19 pandemic and whether traditional medicine systems offer us real or imaginary benefits. Consequently, this book is an important addition to the literature in the area and an essential read for all healthcare professionals working with these patients.

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Table of contents :
Contents
1 Chronic Wound Management—A Continuing Challenge
Wound Aetiology
A Complex Profile
Economic Impact
Human Impact
Healing Outcomes
Future Opportunities
References
2 The Role of Technology in Managing Vascular Wounds
Abstract
Introduction
Background
Venous Leg Ulcers (VLU)
The Physics of Compression Delivered by Hosiery/Bandaging Systems
Healing Rates of VLU Treated with Compression Are Variable
Other Devices to Deliver Compression
Mixed Arterio-Venous Ulcers
Surgical Treatments of Venous Insufficiency in Conjunction with Venous Ulcers
Ischemic Leg Ulcers
Discussion
References
3 The Diabetic Foot, Its Complications, Role of Technology in Evidence-Based Management
Abstract
Introduction
Diagnosis
Assessment of Neuropathy as a Predisposing Factor to Ulceration
Use of Technology to Assess Large Fibre Neuropathy
Monofilament
Vibration Perception Threshold (VPT)
Use of Technology to Assess Small Fibre Neuropathy
Screening for Neuropathy
The Value of Screening to Predict Outcome
The Value of Screening to Affect Outcome
Measurement of Pressure Abnormalities of the Foot as Precipitants of Ulceration
Detection of Skin Temperature Rise as an Immediate Prelude to Ulceration
Characterisation of Infection, Which Often Complicates Ulceration
Wound Management
Wound Debridement
Innovative Technologies in Wound Debridement
Microwater Jet Technology
Ultrasound Assisted Wound Debridement
Near Infrared (NIR) Optical Imaging
Innovative Technology in Wound Applications to Accelerate Healing
Innovative Technology in Cellular and Molecular Therapies to Accelerate Healing
Stem Cell Therapy
Gene Therapy
Nanotechnology
Evidence for the Use of Technology on Offloading
Covid 19 Pandemic and Management of the Diabetic Foot
Conclusion
References
4 Role of Technology for wound Care in Diabetic Foot
Abstract
Introduction
Burden of Diabetic Foot Ulcers in India
Newer Technology as an Early Diagnostic Tool For DFU
Foot Evaluation
Recent Advances in the Management of DFU
Impact of Covid 19 Among People With DFU
Future in the Prevention of DFU
Conclusion
References
5 Biologic Transducers in Wound Healing
Abstract
Introduction
Effectiveness of Enriched Platelet for Skin Chronic Wounds
Effectiveness of Topical Recombinant Growth Factors/Cytokines for Chronic Skin Wounds
Cytokines
Growth Factors
PDGF
FGF
EGF
Combination Application of Growth Factors in Chronic Wound
Effectiveness of (Stem) Cells for Skin Chronic Wounds
Outlook
References
6 Physical, Electromagnetic, Biologic Devices
Abstract
Introduction
Physical/Delivery Systems
Materials
Skin Substitutes
Bone Substitutes
Vascular-Related Technologies
Conclusions
References
7 Medicinal Plants and Products from Traditional Medicine Systems Contribute to Clinical Wound Management
Abstract
Introduction
What are Ideal Properties to Benefit Wound Healing?
Randomized Clinical Trial on Wound Dressing Agents from Plant Origin
Objectives
Azadirachta Indica as Dressing Agent
Ayurvedic Polyherbal Formulation as Dressing Agent
Banana Leaves Dressings (BLD)
Randomised Controlled Trial on Wound Healing Plant Medicine
Topical Application
Aloe Vera
Hypericum Perforatum
Honey
Systemic Uses of Curcumin
Curcuma Longa
Centella Asiatica (L.)
Taking a Wound Healing Agent from Bench to Bedside: Validating a Natural Wonder with Advanced Technology
Discussion
Acknowledgements
Conflict of interest
References
8 Innovation in Laboratory Evaluations of the Performance of Treatment and Prophylactic Dressings Under Clinically-Relevant Usage Conditions
Abstract
Introduction
Robotic Wound Systems Designed and Built for the Evaluation of Treatment Dressings
Computational Modelling Reveals the Efficacy of Wound Dressings in Prophylactic Use
Summary and Conclusions
Acknowledgements
References
9 Atypical Wounds and Wounds Resulting from Infection
Abstract
Introduction
Neoplastic Ulcers
Haematologic Ulcers
Haemoglobinopathies-Associated Ulcers
Polycythaemia Vera and Leg Ulcers
Metabolic Anomalies
Calcific Uremic Arteriolopathy (Calciphylaxis)
Inflammatory and Immune Disorders-Correlated
Vasculitis
Pyoderma Gangrenosum
Occlusive Non Vasculitic Vasculopathies
Livedoid Vasculopathy
Antiphospholipid Antibodies-Associated Leg Ulcers
Drug-Induced
Hydroxyurea
Drug-Related Cutis Embolism (Nicolau’s Disease)
Warfarin-Induced Skin Necrosis
Drug Abuse
Ulcer Resulting from Arterial Hypertension (Martorell Hypertensive Ischemic Ulcer)
Atypical Ulcers Associated to Infections
Mycobacterial-Induced Ulcers
Buruli Ulcer
Lehismania
Deep Fungal Infection-Related Atypical Wounds
Sporothricosis
Mycetoma
Ecthyma Gangrenosum
Microbiological Investigations: Methods and Drawing Techniques
Mainly Qualitative Methods
Qualitative and Quantitative Methods
Laboratory Markers
The Future
References
10 Biofilms and Impaired Wound Healing: How Do We Detect the Presence of Biofilms in Chronic Wounds Non-invasively
Abstract
How Biofilms Impair Wound Healing
Disruption of Immune and Skin Cells
Disruption of Microenvironment
Detection Methods
Biofilm Detection Issues
Conventional Detection Methods
Novel Sensor-Based Detection Methods
Novel Imaging-Based Detection Methods
Discussion
References
11 Update on Technology and Evidence-Based Management of Scars
Abstract
Introduction
Biological Resume of Events Occurring After a Skin Injury
Factors Impacting Scars
The Young Age
The Elderly
The Reappearance of a Wound on a Scar
Degenerescence/Marjolin’s Ulcer
Hyperkeratosis
Scar Assessment Scales
Non-surgical Technologies
Intra-Lesional Steroid Injections
Silicone Gel/Sheet
Radiotherapy
Photodynamic Therapy (PDT)
Electrical Stimulation
Surgical Strategies
Scar Prevention
Conclusion
References
12 Surgical Flaps in Wound Healing—An Update on Evidence-Based Management
Abstract
Introduction
Patient Selection, Multidisciplinary Approach and the Wound Preparation
Surgical Techniques
Case Examples
Outcomes
Conclusion
References
13 Wound Measurement is an Essential Part of Wound Management
Abstract
Introduction
Skin Assessment
Wound Size Analysis
Hyperspectral Imaging
Laser Doppler Imaging (LDI)
Laser Speckle Imaging (LSI)
Near-Infrared Spectroscopy (NIRS)
Thermography
Videomicroscopy
Optical Coherence Tomography
Fluorescence Imaging
Confocal Microscopy
Ultrasound
Discussion
References
14 Translation of Wound Devices into Practice—A Myth? Translation is the Process of Taking an Invention Through to Clinical Practice—How Successful Are We?
Abstract
Gaining Approval for Clinical Use of an Innovation
Gaining Adoption and Usage of a Translated Product or Therapy
Case Studies
Discussion
References
15 Pain in Chronic Wounds: Mechanism and Management
Abstract
Introduction
The Burden of the Problem
Pathophysiology of Wound-Related Pain
Pain Pathways
Effects of Pain in Patients with Chronic Wounds
Diagnosis and Assessment
Pain Assessment
Management
WHO Pain Management Ladder
Management of Breakthrough Pain
Wound Pain Management
Topical Treatment
Management of Infection
Moisture Balance
Management of Specific Wounds
Diabetic Foot Ulcer
Venous Ulcers
Ischaemic Leg Ulcers
Conclusion
References