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Wound Healing 45

As care providers, it is important to approach our patients with Evidence-Based Research
compassion and understanding. Treatment of physical and emotional Table 8.1 presents an evaluation of enteral support in patients at risk of
pain is essential. We must provide the best care within our means developing or who already have pressure ulcers. Table 8.2 presents a
and recognise when to transfer patients with greater needs. Finally, study of negative pressure wound therapy.
we must recognise and adequately control pain for our patients. Pain
management should be an integral part of wound care and a regimen Table 8.2: Evidence-based research.
selected to achieve successful healing while treating the pain associated Title Negative pressure wound therapy after severe open
with the injury and caused by wound care measures. fractures: a prospective randomized study
Authors Stannard JP, Volgas DA, Stewart R, et al.
Table 8.1: Evidence-based research.
Institution Division of Orthopaedic Surgery, University of Alabama at
Title Enteral nutritional support in prevention and treatment of Birmingham, Birmingham, Alabama, USA
pressure ulcers: a systematic review and meta-analysis
Reference J Orthop Trauma 2009; 23(8):552–557
Authors Stratton RJ, Ek AC, Engfer M, et al.
Problem Treatment of significant wounds related to trauma.
Institution Institute of Human Nutrition, University of Southhampton,
Southhampton General Hospital, Southhampton, UK Intervention Negative pressure wound therapy (NPWT).
Reference Ageing Res Rev 2005; 4(3):422–450 Comparison/ Twenty-three patients with 25 fractures were randomised to
control a control group and underwent irrigation and debridement
Problem Evaluation of nutritional support in patients with, or at risk of followed by standard dressing, with repeat irrigation and
developing, pressure ulcers. (quality of debridement every 48–72 hours until wound closure. Thirty-
evidence)
Intervention Enteral nutritional support. five patients were randomised to the NPWT group and had
identical treatment except that NPWT was applied to the
Comparison/ Fifteen studies (including eight randomised controlled trials wounds between irrigation and debridement procedures
control (RCTs)) of oral nutritional supplements (ONS) or enteral until closure.
(quality of tube feeding (ETF), were included in the systematic review. Outcome/ There was a significant difference between the groups for
evidence) effect total infections (P = 0.024). The relative risk ratio was 0.199
(95% confidence interval: 0.045–0.874), suggesting that
patients treated with NPWT were only one-fifth as likely to
Outcome/ Meta-analysis showed that oral nutritional supplements have an infection compared with patients randomised to the
effect (250–500 kcal, 2–26 weeks) were associated with a control group.
significantly lower incidence of pressure ulcer development
in at-risk patients compared to routine care (odds ratio 0.75, Historical NPWT represents a promising therapy for severe wounds
95% CI 0.62–0.89, 4 RCTs, n=1224, elderly, postsurgical, significance/ after high-energy trauma.
chronically hospitalised patients). Enteral nutritional support,
particularly high protein ONS, can significantly reduce the comments
risk of developing pressure ulcers (by 25%).
Historical This highlights the need for nutritional optimisation of
significance/ patients to prevent pressure ulcers and to aid in healing.
comments

Key Summary Points

1. Understanding the basic mechanisms involved in normal 4. Surgery remains an important aspect of wound care,
wound healing and tissue response to injury is critical in particularly for chronic and complex wounds.
surgical treatment and management. 5. Elucidating the molecular aspects of foetal response to tissue
2. The healing response involves four broad, overlapping phases: injury, which leads to scarless wound repair, may provide
haemostasis, inflammation, proliferation, and remodelling. insights to new wound-healing therapies.
This dynamic process optimally leads to restoration of tissue
integrity and function.
3. Identifying and treating all the factors that negatively impact
wound healing requires detailed patient evaluation and careful
thought.

References

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wounds and evaluation of healing. Wound Repair Regen 1994; repair. In: Anderson DK, Lee RC, Mustoe TA, Siebert, JW, eds.
2(3):165–170. Advances in Wound Healing and Tissue Repair, World Medical
Press, 1993, Pp 1–25.
2. Gross RJ. Regeneration versus repair. In: Cohen IK, Diegelmann
RF, Lindblad WJ, eds. Wound Healing: Biochemical and Clinical 5. Keswani SG, Crobleholme TM. Wound healing: cellular and
Aspects, WB Saunders, 1992, Pp 20–39. molecular mechanisms. In: Oldham KT, Colombani PM, Foglia
RP, Skinner MA, eds. Principles and Practice of Pediatric Surgery,
3. Olutoye OO, Cohen IK. Fetal wound healing: an overview. Wound
Repair Regen 1996; 4(1):66–74. Lippincott Williams and Wilkins, 2005, Pp 223–238.