Advanced Wound Care: When Is It Time to Move Beyond Routine Treatments?

What do wound care providers do when confronted with a stubborn, non-healing wound that just isn’t responding to standard, even best-practice, therapies? Try more of the same? Use a different product within the category? Throw up their hands?

One thing is for certain: Most wound care providers will continue to look for treatments that will succeed, especially as non-healing wounds are a common scenario for them. Yet they are also often puzzling, as many can be difficult to care for and seem resistant to treatments.

There are options that knowledgeable providers can explore. Complex cases require advanced wound care techniques to promote healing, prevent complications, and improve patient outcomes. Finding ways to help patients with non-healing wounds is not only vital for them . . . it’s essential for wound care providers who must familiarize themselves with advanced techniques and incorporate them into their box of tools.

It’s also crucial because the incidence of chronic and non-healing wounds continues to escalate. According to the most recent published figures, about 11 million Medicare recipients alone have either a chronic or non-healing wound—a surprising increase of more than 2.4 million from 2014. More than 157,000 surgical site infections (SSIs) are reported each year. And some 1.6 million Americans annually will suffer from a diabetic foot ulcer (DFU), another statistic that continues to climb.

Advanced Wound Care, Chronic and Non-Healing Wounds

Let’s start by clarifying what those in the industry mean by advanced wound care. There’s a general consensus in the industry that the term defines is a range of therapies and technologies designed to treat complex wounds when standard treatment fails. Advanced wound care is intended to accelerate healing, minimize complications, and enhance the quality of life for patients.

As we explore this topic, it’s also vital to understand the difference between chronic and non-healing wounds, the type that often requires advanced wound care techniques.

• Chronic wounds do not proceed through the normal stages of healing (hemostasis, inflammation, proliferation, and remodeling) in a timely manner, typically within three months. They may persist for months or even years. Chronic wounds are often associated with underlying conditions such as diabetes, venous or arterial disease, or pressure injuries.
• Non-healing wounds refer to wounds that do not show significant progress toward healing despite appropriate and consistent treatment. These wounds fail to reduce in size, do not produce healthy granulation tissue, or continue to exhibit signs of infection or inflammation. These wounds can arise from chronic conditions, inadequate blood flow, infection, repeated trauma, or other factors impeding the healing process.

The key difference between chronic and non-healing wounds is that the former is defined by a longer duration, generally over three months, while non-healing wounds are characterized by a lack of progress toward healing regardless of the time frame.

Examples of wounds that can be chronic, non-healing or at times both, include:

• Ulcers, including diabetic, venous and arterial
• Vasculitis-related wounds
• Traumatic and surgical wounds
• Pressure injuries, including bed sores
• Chronic infections, like bone infections or other underlying conditions that impede healing
• Malignant wounds, typically associated with cancerous growth that breaks through the skin

Understanding Advanced Therapies

What therapies are usually chosen when standard care fails to improve these wounds? While it runs the gamut and depends on a wide variety of factors, there are some proven advanced therapies that are frequently relied upon by wound care providers, as well as new innovations and exciting options on the horizon.

The Next-Level NPWT

Negative pressure wound therapy (NPWT) is a cornerstone of advanced wound care therapies. This technique involves applying a vacuum dressing to the wound, which helps reduce swelling, remove exudates, and promote tissue granulation. NPWT accelerates healing and reduces the risk of complications in various types of wounds, including diabetic foot ulcers, burns, and surgical wounds.

One of the more notable advances in this therapeutic category is the effort to make it more patient-friendly. This focus has enabled patients to continue their daily activities while receiving therapy and made it easier to stay connected to resources that can offer support if needed.

Hyperbaric Oxygen Therapy

While in use since the 1960s, the use of hyperbaric oxygen therapy (HBOT) for wound treatment continues to gain traction in treating chronic wounds. Patients are placed inside a special chamber filled with 100% oxygen, compared to the mix of gasses in the air we breathe in our daily lives. The process accelerates healing by promoting the formation of new blood vessels, reducing swelling, and combating infection.

Recent advancements in HBOT have introduced more promising outcomes. New portable hyperbaric chambers are making treatment more accessible and convenient for patients, particularly those in remote or underserved areas.

As an advanced wound care therapy, HBOT is typically used for non-healing diabetic foot ulcers, necrotizing soft-tissue infections, and pressure ulcers. It’s also often a first-line therapy for radiation-induced tissue damage and acute traumatic injuries.

Bioengineered Skin Substitutes

Some of the most talked-about advancements in wound therapy are in the area of bioengineered skin substitutes. Derived from human, or animal tissue, often something like fish skin, these products mimic the structure and function of natural skin, providing a temporary or permanent cover for the wound. They promote tissue regeneration by providing a foundation for cell attachment and growth.

These therapies are often recommended for:

• Chronic wounds unresponsive to conventional treatments
• Burns and extensive skin loss
• Venous and diabetic ulcers
• Surgical and traumatic wounds requiring rapid closure

Innovations in Wound Care Dressings

While dressings are a wound care staple, several new options are now on the market. Products introduced over the past decade include hydrocolloids, typically gelatin, pectin, or cellulose-based dressing that absorbs wound fluids and keeps the wound moist to promote healing; alginates (seaweed used to absorb extra fluid); silicone foam, which provide more gentle adhesion, effective absorption, and minimize pain during dressing changes; and hydrofibers, which are soft, sterile dressing made from material that can absorb a lot of wound fluid, including fluid with bacteria. 

Clinicians recommend advanced dressings for:

• Chronic wounds with high exudate levels
• Dry or necrotic wounds requiring moisture
• Infected or at-risk wounds

New Debridement Techniques

In addition to new products, there are new techniques to consider as part of an advanced wound care regimen. Debridement techniques, particularly, have seen considerable advances over the past few years. Removing necrotic tissue is vital for wound healing, and advanced debridement methods, such as enzymatic, autolytic, and mechanical debridement, are now routinely employed to prepare the wound bed for healing.

Highlighting the innovations in the field, one of the more promising forms of debridement is the development of bromelain-based enzymatic debridement, which is derived from pineapple stems, and in studies, has shown significant promise in reducing biofilm and inflammation, facilitating faster and more effective wound healing.

Biophysical Therapies

Emerging biophysical therapies, such as electrical stimulation and ultrasound therapy, are gaining recognition for their potential to enhance wound healing. These therapies use specific energy modalities to stimulate cellular activity, improve blood flow, and promote tissue regeneration. They are especially beneficial for non-healing and chronic wounds such as diabetic and venous ulcers and pressure injuries.

As research in these areas continues, the potential for even more effective wound care treatments becomes increasingly promising.

When to Move on to Advanced Wound Care Therapies

On the technology front, several breakthrough technologies have emerged over the past decade, helping to identify when advanced therapies might be warranted. These therapies encompass everything from AI to wearable devices.

AI-powered Wound Care

In wound care, AI is increasingly used as a solution to provide actionable information about non-healing wounds. AI-powered wound care software provides insights on everything from wound healing rates to early signs of infections. When integrated into a specialty EHR, this tech also helps busy providers manage workflow and ensure proper documentation and coding, saving daily hours for wound care doctors and nurses more time with patients.

Predictive Analytics

Predictive analytics has also proven to be an exciting innovation for providers. Predictive analytics, another subset of AI, uses machine learning and historical data to forecast future events. In wound care, this can mean predicting the likelihood of wound healing under different treatment regimens, identifying patients at high risk of complications, or suggesting personalized treatment plans based on similar cases.

Wearable Wound Tech

Wearable devices for wound monitoring represent a significant technological advancement in healthcare. These sensor-equipped devices can monitor healing progress, detect infection signs, and even administer therapeutic agents directly to the wound site. Their non-invasive design and remote data transmission capabilities make them indispensable tools for nurses, particularly in managing chronic wounds in outpatient settings.

Embracing Advanced Wound Care

For wound care providers dedicated to improving patient outcomes and quality of life, advanced wound care techniques offer valuable solutions for managing complex wounds. It’s also an area within the profession that is dynamic and constantly evolving as new products, therapies, and research continue to be introduced. All that translates into a topic worth the time and effort to better understand and study.

That effort and time will pay off. An improved understanding of advanced wound care also benefits providers, as by staying informed, they can deliver more efficient and effective treatments, enhance patient outcomes, and improve workflow. Plus, prompt deployment of advanced therapies allows busy providers to focus more on hands-on care and activities that bring professional fulfillment.

Advanced wound care will continue to advance. Wound care providers can continue to fulfill their commitment to patients and their profession when they commit to keeping up with its latest innovations for next line therapies.