Wound-Healing Technologies

Chronic wounds are a major source of morbidity, lead to considerable disability, and are associated with increased mortality; therefore, they have a significant impact on public health and the expenditure of healthcare resources. The incidence of chronic wounds in the United States is approximately 5 to 7 million per year, and the annual cost for management of these wounds is greater than $20 billion. In addition, chronic wounds can lead to complications, such as infections, contractures, depression or limb amputation. These complications are associated with a need for assisted living and with higher mortality. he objective of this report is to systematically review the evidence on the outcomes of two technologies for wound healing: low-level laser therapy and vacuum-assisted closure. This report addresses the following specific questions: 1. In the treatment of chronic nonhealing wounds, what are the outcomes of low-level laser therapy for specific indications and patient types as a substitute for conventional therapy? Or as an adjunct to conventional therapy, compared with conventional therapy alone? 2. In the treatment of acute or chronic wounds, what are the outcomes of vacuum-assisted closure for specific indications and patient types as a substitute for conventional dressings? And as an adjunct to conventional therapy, compared with conventional therapy alone? This report also provides an overview of clinical and methodologic issues relevant to evaluating the evidence on interventions for wound healing. Many variables affect the course of wound healing; so well-controlled, randomized trials are necessary to reach conclusions on treatment efficacy. Skin wounds are a heterogeneous and complex group of disorders with a wide variety of causes. Approximately 70 percent are classified as pressure ulcers, diabetic ulcers, or vascular ulcers. Vascular ulcers are further classified as due to arterial or venous insufficiency. Other less frequent causes include inflammatory conditions, malignancies, burns, and radiation injuries. Often the causes of wounds are multifactorial, such as in the diabetic patient who has both arterial insufficiency and peripheral neuropathy. Each wound type has distinct physiologic characteristics and exists in a unique host environment with varied clinical and psychosocial factors. Wounds are often classified as acute or chronic. Acute wounds are generally less than 8 weeks in duration and have not yet completed the natural healing cycle. Chronic wounds are defined as wounds that have failed to proceed through an orderly and timely process that produces anatomic and functional integrity. Chronic wounds either require a prolonged time to heal, do not heal completely, or recur frequently. A large number of factors can impede wound healing and may predispose a patient to the development of chronic wound(s). These include both systemic factors (poor nutrition, metabolic derangements, and drugs) and local factors (tissue hypoxia, infection, and dry wound bed). Conventional treatment for established wounds incorporates common principles that apply to the management of all wounds, including debridement of necrotic tissue, maintenance of a moist wound bed, and control of infection. These common elements are combined with treatment modalities targeted to each type of wound and the clinical characteristics of the patient. Optimal treatment also entails consideration of the appropriate intensity of treatment. Unfortunately, there are no widely accepted, standardized protocols that define optimal standard treatment or the appropriate intensity of treatment delivery.