Speciality Medical Dialogues
    • facebook
    • twitter
    Login Register
    • facebook
    • twitter
    Login Register
    • Medical Dialogues
    • Education Dialogues
    • Business Dialogues
    • Medical Jobs
    • Medical Matrimony
    • MD Brand Connect
    Speciality Medical Dialogues
    • Editorial
    • News
        • Anesthesiology
        • Cancer
        • Cardiac Sciences
        • Critical Care
        • Dentistry
        • Dermatology
        • Diabetes and Endo
        • Diagnostics
        • ENT
        • Featured Research
        • Gastroenterology
        • Geriatrics
        • Medicine
        • Nephrology
        • Neurosciences
        • Nursing
        • Obs and Gynae
        • Ophthalmology
        • Orthopaedics
        • Paediatrics
        • Parmedics
        • Pharmacy
        • Psychiatry
        • Pulmonology
        • Radiology
        • Surgery
        • Urology
    • Practice Guidelines
        • Anesthesiology Guidelines
        • Cancer Guidelines
        • Cardiac Sciences Guidelines
        • Critical Care Guidelines
        • Dentistry Guidelines
        • Dermatology Guidelines
        • Diabetes and Endo Guidelines
        • Diagnostics Guidelines
        • ENT Guidelines
        • Featured Practice Guidelines
        • Gastroenterology Guidelines
        • Geriatrics Guidelines
        • Medicine Guidelines
        • Nephrology Guidelines
        • Neurosciences Guidelines
        • Obs and Gynae Guidelines
        • Ophthalmology Guidelines
        • Orthopaedics Guidelines
        • Paediatrics Guidelines
        • Psychiatry Guidelines
        • Pulmonology Guidelines
        • Radiology Guidelines
        • Surgery Guidelines
        • Urology Guidelines
    LoginRegister
    Speciality Medical Dialogues
    LoginRegister
    • Home
    • Editorial
    • News
      • Anesthesiology
      • Cancer
      • Cardiac Sciences
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endo
      • Diagnostics
      • ENT
      • Featured Research
      • Gastroenterology
      • Geriatrics
      • Medicine
      • Nephrology
      • Neurosciences
      • Nursing
      • Obs and Gynae
      • Ophthalmology
      • Orthopaedics
      • Paediatrics
      • Parmedics
      • Pharmacy
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
    • Practice Guidelines
      • Anesthesiology Guidelines
      • Cancer Guidelines
      • Cardiac Sciences Guidelines
      • Critical Care Guidelines
      • Dentistry Guidelines
      • Dermatology Guidelines
      • Diabetes and Endo Guidelines
      • Diagnostics Guidelines
      • ENT Guidelines
      • Featured Practice Guidelines
      • Gastroenterology Guidelines
      • Geriatrics Guidelines
      • Medicine Guidelines
      • Nephrology Guidelines
      • Neurosciences Guidelines
      • Obs and Gynae Guidelines
      • Ophthalmology Guidelines
      • Orthopaedics Guidelines
      • Paediatrics Guidelines
      • Psychiatry Guidelines
      • Pulmonology Guidelines
      • Radiology Guidelines
      • Surgery Guidelines
      • Urology Guidelines
    • Home
    • News
    • Dermatology
    • Management of Chronic...

    Management of Chronic Wounds—a multimodal approach

    Written by Vinay Singh singh Published On 2018-09-26T19:28:06+05:30  |  Updated On 26 Sept 2018 7:28 PM IST
    Management of Chronic Wounds—a multimodal approach

    Effective care for chronic wounds requires a multimodal approach, including wound bed optimization, management of chronic medical conditions, and consistent follow-up. The chronic wound management in the ambulatory setting reviewed in the JAMA Clinical Update highlights the evidence supporting a diverse array of treatment options.


    The goals for dressing management for chronic wounds include the following: (1) maintaining a moist wound environment; (2) preventing or treating infection; and (3) minimizing skin irritation or friction between the wound and clothing or devices such as wheelchairs.


    Dressing Selection


    Wound dressings are selected based on clinical assessment of the patient’s wound. The goals for dressing management for chronic wounds include the following: (1) maintaining a moist wound environment; (2) preventing or treating infection; and (3) minimizing skin irritation or friction between the wound and clothing or devices such as wheelchairs. Dressings may also deliver debriding or antimicrobial agents.


    Standard Gauze


    Sterile gauze dressings are the standard to which other wound care products are compared. Wet-to-dry packing consists of moistened gauze placed into the wound with changes at least once daily, which provides debridement. If wet-to-dry packing is used, it should not be in contact with the adjacent intact skin around the wound because it causes maceration of healthy tissue, enlarging the wound.


    Negative-Pressure Wound Therapy(NPWT)


    High-quality evidence has shown that NPWT reduces wound exudate, debris, and bacterial contamination while increasing vascular perfusion and granulation of the wound base. A meta-analysis of randomized trials showed that NPWT, compared with standard wound care, was associated with decreased wound size and shorter time to healing.


    Advanced Dressings


    Dressings such as alginates, foams, hydrocolloids, and hydrogels are intended to maintain a moist wound environment. Alginates and foams absorb excess exudate, while hydrocolloids prevent tissue dehydration. Hydrogels hydrate dry wounds and absorb exudate in overly moist wounds. Limited evidence suggests that patient comfort is improved with these moisture-modulating dressings. Topical antimicrobial agents used in wound management are iodine and silver-based preparations that have antimicrobial properties. Silver agents may lower bacterial contamination in a wound but inappropriate extended use may impede healing.


    Skin substitutes provide temporary wound coverage but are generally used in specialty wound care settings given their costs and specific indications. Porcine collagen products, composed of an acellular dermal matrix, extracellular matrix, or both products, have progressed from use solely in burns to widespread application.


    Adjuvant Wound Therapies


    Key adjunctive wound therapies are recommended based on high-quality evidence. Compression therapy is the mainstay of treatment for venous stasis ulcers, with 8 randomized clinical trials showing improved time to healing with compression vs no compression treatment. To prevent pressure ulcers and promote their healing, patient repositioning and pressure offloading is recommended, although no high-quality comparative trials exist to support this recommendation. A meta-analysis of clinical trials suggested that foam alternatives (such as egg crate foam overlays) to standard hospital mattresses was associated with reduced incidence of pressure ulcers in at-risk patients. In contrast, there is good evidence to support the use of hyperbaric oxygen therapy to decrease mucosal defects.


    There was moderate-quality evidence from 3 trials that complete mucosal cover of exposed bone which was more likely to be achieved in patients with osteoradionecrosis when hyperbaric oxygen therapy was administered and from 2 trials that showed wound dehiscence was less likely following operations to repair mandibular osteoradionecrosis with the addition of hyperbaric oxygen therapy.


    The authors concluded that proper management for chronic wounds requires a multimodal approach and advanced wound therapies, such as NPWT, can benefit some patients, but evidence to support the use of one specific advanced dressing type over another is limited. However, dressing selection can generally be based on wound assessment, physician and patient familiarity with the products, availability, and affordability.


    For reference log on to http://10.1001/jama.2018.12426


    chronicclinicaldressingeffectivegauzeJAMAmanagementpressuretherapytreatmentupdateWound
    Source : With inputs from JAMA

    Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd

    Vinay Singh singh
    Vinay Singh singh
      Show Full Article
      Next Story
      Similar Posts
      NO DATA FOUND

      • Email: info@medicaldialogues.in
      • Phone: 011 - 4372 0751

      Website Last Updated On : 12 Oct 2022 7:06 AM GMT
      Company
      • About Us
      • Contact Us
      • Our Team
      • Reach our Editor
      • Feedback
      • Submit Article
      Ads & Legal
      • Advertise
      • Advertise Policy
      • Terms and Conditions
      • Privacy Policy
      • Editorial Policy
      • Comments Policy
      • Disclamier
      Medical Dialogues is health news portal designed to update medical and healthcare professionals but does not limit/block other interested parties from accessing our general health content. The health content on Medical Dialogues and its subdomains is created and/or edited by our expert team, that includes doctors, healthcare researchers and scientific writers, who review all medical information to keep them in line with the latest evidence-based medical information and accepted health guidelines by established medical organisations of the world.

      Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription.Use of this site is subject to our terms of use, privacy policy, advertisement policy. You can check out disclaimers here. © 2025 Minerva Medical Treatment Pvt Ltd

      © 2025 - Medical Dialogues. All Rights Reserved.
      Powered By: Hocalwire
      X
      We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok