Today's Wound Clinic - Winter 2008 - (Page 32) inperspective or Coban 3M™, St. Paul, Minn). The overall healing rate was 85% within approximately 6 months. What was interesting was that among the “frustrating 15%” (who had not healed), all had either diabetes or rheumatoid arthritis or both, most of the latter were on prednisone.When the author performed a similar data review 15 years later, despite the plethora of new options available for dressings and compression, the “frustrating 15%” remained; overall healing rates continued to be 85%, simply by implementing consistently good compression. When so much changed in the wound care industry between the years 1990 and 2006, how could so little have changed in terms of outcome for stasis patients? Free Resources The AAWC Government and Regulatory Task Force established a content-validated venous ulcer guideline supported with a summary of best available evidence for each element of venous ulcer practice, available on the websites: www.aawconline.org www.blackwell-synergy.com/doi/abs/10.1111/j.1524-475X.2006.00172.x www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7109&nbr=4280 Guideline.gov also offers evidence-based guidelines developed by the Wound Ostomy and Continence Nurses. PLOTTING THE TRAJECTORIES Numerous studies have shown that dressing or bandage choice has no significant impact on time of healing or healing rates in stasis ulcer patients provided with good compression.5,6 However, when Steed’s data were separated into two categories—ie, patients who healed by 20 weeks and patients who did not—plotting the wound-healing trajectories revealed very different curves. This suggested that the latter group’s underlying comorbidities interfered with healing. It is this latter group that may benefit from advanced technology. For example, a randomized controlled trial (RCT) of human skin equivalent (HSE)7 showed that 63% of patients receiving HSE were healed at 6 months compared to 49% for the control group. Likewise, for an RCT of the OASIS extracellular matrix graft (Healthpoint, Fort Worth, Tex), at 12 weeks the experimental group was 55% healed versus 34% for the control group.8 IDENTIFYING THE HARD-TO-HEAL PATIENT Most experienced industry professionals would like to think that over a career of practice, they have gotten better at screening for vascular dis32 Winter 2008 Today’s Wound Clinic What was interesting was that among the “frustrating 15%” (who had not healed), all had either diabetes or rheumatoid arthritis or both, and most of the latter were on prednisone. ease, diagnosing vasculitis or atypical ulcerations, and controlling the other factors that negatively affect healing like poor nutrition, bacterial bioburden, or out-of-control diabetes. But the fact is that the majority of venous ulcer patients do well with little more than good, basic compression. That is why it does not take a lifetime of experience to do a good job with these patients. However, a small percentage of patients will fall into a hard-to-heal category; clinicians should now recognize the criteria early rather than waiting for them to fail after several months of conservative care. These patients may have chronic or large wounds or certain “red flag” comorbid conditions. In some cases, these wounds should be http://www.aawconline.org http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-475X.2006.00172.x http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7109&nbr=4280 http://Guideline.gov
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