Chronic wounds do not progress normally through the stages of healing. Chronic wounds often remain in the inflammatory phase of the healing process, resulting in extended healing times or a complete failure to heal. Achieving healing in chronic wounds is a huge clinical challenge. Chronic wound care is thus a great financial burden to the health care system and causes a significant negative impact on a patient’s life.
Diabetic Foot Ulcer. Diabetes mellitus is one of our most common chronic diseases and its prevalence is still increasing. The life expectancy of diabetics is shortened by up to 15 years, and 75 % die of macrovascular complications. It is estimated that about 10 % of all diabetic patients will have a diabetic foot ulcer at some point of their disease. Diabetes is the most common cause of non-traumatic limb amputation, and patients with such amputations have a 5-year mortality rate of 68 %.
Diabetic foot ulcers are further classified as neuropathic (54%), ischemic (10%), or a combination of the two, commonly called neuroischemic (34%). As different therapeutic strategies may be required, differentiating between ischemic and neuropathic diabetic foot ulcers is essential to prevent further complications.
Independent of aetiology, chronic wounds often result in malodour, pain, and infection. This has a negative impact on an individual’s quality of life, including the inability to continue with daily activities such as work, shopping, cooking, exercise and socialising.
In general, chronic wound healing is influenced by several local factors such as infection, oxygenation, foreign body invasion, blood supply, as well as by systemic factors such as age, gender, comorbidities, medication, and lifestyle.
People with chronic wounds are usually cared for by nurses in their homes, at general practitioner practises, community-based clinics, or in residential care. For many patients healing is not their primary concern, but rather the restriction in their daily life activities. The use of various dressings remains the mainstay in most markets. There is also a range of alternative treatments of chronic wounds. Some are invasive, such as wound debridement and skin substitute therapy, while others are non-invasive, such as compression bandaging, hyperbaric oxygen therapy, negative pressure therapy, ultrasound, and traditional ES therapy.
WMCS Case Study from University Hospital of the Ruhr-University of Bochum, Germany