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Evidence-Based Outcomes
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The normal process of wound healing has been described in Chapter 2 of this book. Unfortunately, many patients fail to proceed through the sequential phases of healing and end up with chronic, nonhealing wounds. The term chronic wound implies a temporal relationship with defined, fixed time points. In fact, the terms acute and chronic carry a slightly different meaning for wound care compared to other areas of medicine. A chronic wound is one that fails to heal within the expected time frame for the underlying wound etiology.1 This definition implies there are evidenced-based wound healing time frames for various wound etiologies. The clinical reality is that there is rather a continuum of healing, with physiological steps that require completion before healing can proceed. If these time frames were known and accepted, then a clinician could turn to more advanced therapeutic options when the healing process fails to proceed.2 Does a 70-year-old patient with ischemia and a diabetic foot ulcer heal within the same time frame as a 48-year-old patient with a venous ulcer and severe lipodermatosclerosis? The answer to these questions must be obtained before we can classify any wound as acute or chronic. We hope that in the future genetic and biochemical markers will be available to guide our therapy and to classify acute and chronic wounds.3,4 Despite the well-accepted theory that a wound healing trajectory is dependent on the underlying wound etiology, a review of our own data failed to reveal any statistically significant differences in Kaplan-Meier–derived survival time plots.5
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This exemplifies the importance of taking an evidence-based approach to practice. Since a universal diagnostic and therapeutic approach known as the Comprehensive Wound Assessment and Treatment System (CWATS), which includes the least common denominator (LCD) model, was used in the treatment of all wounds, it is not surprising that similar healing rates were achieved.6 (Table 5.1 and Box 5.1) These findings raise the question of whether there are truly significant wound healing rate variations or simply wide practice variations. This also makes meta-analysis techniques difficult in wound care.
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