Innovations in technology are used in managing chronic wounds. Despite the wide range of technologies available, healing of chronic wounds remains variable. In this paper, the authors offer an evidence based approach to the use of technology for diagnosis and management based on the concept of standardised care.
GameFLHinchliffeRJApelqvistJA systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28(S1):119-141.
2.
AshbyGabe RAliSVenUSIV (Venous leg ulcer study IV). Compression hosiery compared with compression bandaging in the treatment of venous leg ulcer: a randomised controlled trial, mixed comparison and decision analytic model. Health Technol Assess. 2014; 18.
DiniVOrangesTRotellaLRomanelliM. Hidradenitis supprativa and wound management. Int J Low Extrem Wounds. 2015;14:236-244.
5.
IacopiECoppelliAGorettCPiaggesiA. Necrotising fasciitis and the diabetic foot. Int J Low Extrem Wounds. 2015;14:316-327.
6.
EbellMSiwekJWeissBStrength of Recommendation Taxonomy (SORT): a patient-centred approach to grading evidence in medical literature. Am Fam Physician. 2004;69:548-556.
7.
RookeTWHirschATMisraSACCF/AHA 2005 Focused Guidelines Update of the guidelines for the management of patients with peripheral artery disease (updating the 2005 guidelines). J Am Coll Cardiol. 2011;58:2020-2045.
8.
TenderaMAboyansVBartelinkKMEur Heart J. 2011;32:2851-2906.
9.
Scottish Intercollegiate Guidelines Network. August2010. ISBN 97811905813667.
10.
CollinsRCrannyGBurchJA systematic review of duplex ultrasound, magnetic resonance angiography, and computed tomography angiography. Health Technol Assess. 2007;11:iii-iv, xi-xiii, 1-184.
11.
SmithFCTShearmanCPSimmsMHGwynnBR. Falsely elevated ankle pressures in severe leg ischaemia: the pole test an alternative approach. Eur J Vasc Surg. 1994;6:408-412.
12.
GardnerSEFranzRADoeblingBN. The validity of the clinical signs and symptoms used to identify local wound infection. Wound Repair Regen. 2001;9:178-186.
13.
HutchinsonAMcIntoshAFederGClinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems. London, UK: Royal College of General Practitioners; 2000. Cited by: McIntoshAPetersJYoungRPrevention and Management of Foot Problems in Type 2 Diabetes: Clinical Guidelines and Evidence. Sheffield, UK: University of Sheffield; 2003.
14.
PhamHArmstrongDGHarveyCHarklessLBGiuriniJMVevesA. Screening techniques to identify people at high risk for diabetic foot ulcers. Diabetes Care. 2000;23:606-611.
15.
FengYSchlüsserFJSumpioBE. The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus. J Vasc Surg. 2011;51:220-226.
16.
GellfandJMHoffstadtOMargolisDJ. Surrogate end points for the treatment of venous leg ulcers. J Investig Dermatol. 2002;119:1420-1425.
17.
KurdSKHoffstadOJBikerWBMargolisDJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17:318-325.
18.
CleelandCSRyanKM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med. 1994;23:129-138.
19.
FoxEJMelzackR. Transcutaneous electrical stimulation and acupuncture: comparison of treatment for low back pain. Pain. 1976;2:141-148.
20.
FrankAJMollJMHortJF. A comparison of three ways of measuring pain. Rheumatol Rehabil. 1982;21:211-217.
21.
JensenMPKarolyPO’RiordanEFBlandFJrBurnsRS. The subjective experience of acute pain: an assessment of the utility of ten indices. Clin J Pain. 1989;5:153-159.
22.
JensenMPKarolyPBraverS. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27:117-126.
23.
JensenMPFriedmanMBonzoDRichardsP. The validity of the Neuropathic Pain Scale for assessing diabetic neuropathic pain in a clinical trial. Clin J Pain. 2006;22:97-103.
24.
MelzackR. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1:277-299.
25.
MelzackRKatzJ. Pain measurement in persons in pain. In: MelzackRWallPD eds. The Textbook of Pain. Edinburgh, UK: Churchill Livingstone; 1999:716-751.
26.
PaiceJACohenFL. Validity of verbally administered Numeric Rating Scale to measure cancer pain intensity. Cancer Nurs. 1997;20:88-93.
27.
RosentielAKeefeFJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain. 1983;17:33-44.
28.
SeymourRA. The use of pain scales in assessing the efficacy of analgesics in postoperative dental pain. Eur J Clin Pharm. 1982;23:441-444.
29.
BriggsMNelsonEAMartyn-St JamesM. Topical agents or dressings for pain in venous leg ulcers. Cochrane Database Syst Rev. 2012;(11):CD001177.
30.
GottrupFJorgensenBKarlsmarkTReducing wound pain in venous ulcers with Bitain Ibu: a randomised controlled clinical investigation on performance and safety. Wound Repair Regen. 2008;16:615-625.
31.
SimpsonElDuenasAHolmesMWPapaionnouDChilcottJ. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess. 2009;13:iii, ix-x, 1-154.
32.
HAS/Service évaluation de dispositifs. Evaluation des pansements primairese et secondaires. http://www.has.sante.fr.
33.
Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers: a National Clinical Guideline; 2012.
34.
BarbulA. Wound healing society chronic wound care guidelines. Wound Repair Regen. 2006;14:645-711.
35.
NorgrenLHiattWRDormandyJAIntersociety consensus for the management of peripheral artery disease (TASCII). Eur J Vasc Endovasc Surg. 2007;33:s1-s75.
36.
BakerSRBurnandKSommervilleKGComparison of venous reflux assessed by duplex scanning and descending phlebography in chronic venous insufficiency. Lancet. 1993;341:400-403.
37.
O’MearaSCullumNNelsonEADumvilleJC. Compression for venous leg ulcers (review). Cochrane Database Syst Rev. 2012;(11):CD000265.
38.
MauckKFAsiNElriyahTAComparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence. J Vasc Surg. 2014;60:73S-92S.
39.
PartschHClarkMMostiGClassification of compression bandages: practical aspects. Dermatol Surg. 2008;34:600-609.
40.
O’DonnellTFPassmanMAMarstonWAManagement of venous leg ulceration: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60:3S-59S.
41.
NelsonEAManiRThomasKVowdenK. Intermittent pneumatic compression for treatment of venous leg ulcers. Cochrane Database Syst Rev. 2011;(2):CD001899.
42.
MostiGCavezzAPartschHUrsoSCampanaF. Adjustable Velcro® compression devices are more effective than inelastic in reducing venous edema in the initial treatment phase: a randomised controlled trial. Eur J Vasc Endovasc Surg. 2015;50:368-374.
43.
NelsonEABell-SyerSECullumNA. Compression for preventing leg ulcers. Cochrane Database Syst Rev. 2000;(4):CD002303.
44.
GohelMSBarwellJTaylorMLong term results of compression along versus surgery in chronic venous ulcers (ESCHAR): a randomised controlled trial. BMJ. 2007;335:83.
45.
van GentWBHopWCPraagMCMackaayAJBoerEMWittenCH. Conservative versus surgical treatment of venous leg ulcers: a prospective randomised, multi-centre trial. J Vasc Surg. 2006;44:563-571.
46.
FernandezRGriffithsRUssaC. Water for wound cleaning (review). Cochrane Database Syst Rev. 2008;(1):CD0003861.
47.
WollinaUAbdel-NasserMBManiR. A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic option. Int J Low Extrem Wounds. 2006;5:169-180.
48.
SimkaMMajewskiE. The social and economic burden of venous leg ulcers. Am J Dermatol. 2003;4:573-581.
49.
PerrinMRameletAA. Pharmacological treatment of primary chronic venous disease: rationale, results and unanswered questions. Eur J Vasc Endovasc Surg. 2011;41:117-125.
50.
BackTLPadbergFTJrArakiCTThompsonPNHobsonRWII. Limited range of ankle motion of the ankle joint is a significant factor in venous ulceration. J Vasc Surg. 1995;22:19-23.
51.
BarwellJRTaylorMDeaconJDaviesCWhymanMRPoskittKR. Ankle mobility is a risk factor related to the failure of venous leg ulcers to heal. J Vasc Surg. 2001;49:1242-1247.
52.
CullumNAl-KurdiBell-Syer SEM. Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev. 2010;(6):CD001180.
53.
EnnisWJForemannPMozenNMasseyJConner-KerrTMenesesP. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. Ostomy Wound Manage. 2005;51:24-39.
54.
FlemmingKCullumN. Laser therapy for venous leg ulcers. Cochrane Database Syst Rev. 2000;(2):CD001182.
55.
AzizZCullumNAFlemmingK. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev. 2011;(3):CD002933.
56.
GreerNFomanNAMacDonaldRAdvanced wound therapies for non-healing diabetic, venous and arterial ulcers: a systematic review. Ann Intern Med. 2013;159:532-542.
57.
PagetJ. Clinical lecture in bed sores. Students J Hospital Gaz. 1873;1:144-147.
LindenOGreenwayRMPiazzaRM. Pressure distribution on the surface of the human body in lying and sitting positions using a “Bed of Springs and Nails.”Arch Phys Med Rehabil. 1965;46:378-385.
60.
OhuraTOhuraNJr.Pathogenetic mechanisms and classification of undermining in pressure ulcers: elucidation of relationship with deep tissue injuries. Wounds. 2006;18:329-339.
61.
OhuraTOhuraNJrOkaH. Incidence and clinical symptoms of hourglass and sandwich shaped tissue necrosis in stage IV pressure ulcers. Wounds. 2007;19:310-319.
62.
OhuraTTakahashiMOhuraNJr.Influence of external forces (pressure and shear force) on superficial layer and subcutis of porcine skin and effects of dressing materials: are dressing materials beneficial for reducing pressure and shear force in tissues?Wound Repair Regen. 2008;16:102-107.
63.
MimuraMOhuraTTakahashiMKajiwaraROhuraNJr.Mechanism leading to the development of pressure ulcers based on shear force and pressures during a bed operation: influence of body types, body positions, and knee positions. Wound Repair Regen. 2009;16:102-110.
64.
GouldLStuntzMGiovannelliMWound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair Regen. In press.
65.
WagstaffMJDriverSCoghlanPGreenwoodJE. A randomized, controlled trial of negative pressure wound therapy of pressure ulcers via a novel polyurethane foam. Wound Repair Regen. 2014;22:205-211.
66.
HoCHBensitelTWangXBogieKM. Pulsatile lavage for the enhancement of pressure ulcer healing: a randomized controlled trial. Phys Ther. 2012;92:38-48.
67.
HollisazMTKhedmatHYariF. A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers. Br J Dermatol. 2004;15:18.
68.
TrialCDarbasHLavigneJPAssessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT. J Wound Care. 2010;19:109.
69.
FordCNReinhardERYehDInterim analysis of a prospective, randomized trial of vacuum-assisted closure versus the health point system in the management of pressure ulcers. Ann Plast Surg. 2002;49:55-61.
70.
SussiaDDaninoAAndreasN. Negative pressure therapy versus standard wound care: a meta-analysis of randomised controlled trials. Plast Reconstr Surg. 2011;128:498-503.
71.
NixonJNelsonEACrannyG; PRESSURE Trial Group. Pressure relieving support surfaces: a randomized evaluation. Health Technol Assess. 2006;10:iii-iv, ix-x, 1-163.
72.
RussellLReynoldsTMCarrJEvansAHolmesM. Randomised controlled trial of two pressure-relieving systems. J Wound Care. 2000;9:52-55.
73.
AlvarezOMFernandez-ObregonARogersRSBergamoLMassoJBlackM. A prospective, randomized, comparative study of collagenase and papain-urea for pressure ulcer debridement. Wounds. 2002;14:293-301. http://www.woundsresearch.com/article/946. Accessed April 12, 2016.
74.
DumvilleJoCWorthyGBlandJMLarval therapy for leg ulcers (VenUSII): a randomized controlled trial. BMJ. 2009;338:b3773.
75.
AdunskyAOhryA; DDCT Group. Decubitus direct current treatment (DDCT) of pressure ulcers: results of a randomized double-blinded placebo controlled study. Arch Gerontol Geriatr. 2005;41:261-269.
76.
RitzMCGallegosRCanhamMBEskalaiMGeorgeFR. PROVANT wound-closure system accelerates closure of pressure wounds in a randomized, double-blind, placebo-controlled trial. Ann N Y Acad Sci. 2002;961:356-359.
77.
TalyABSivaraman NairKPMuraliTJohnA. Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: a randomized double-blind controlled trial. Arch Phys Med Rehabil. 2004;85:1657-1661.
78.
NicolasBMoiziardASBarroisBWhich medical device and/or which local treatment for prevention in patients with risk factors of pressure sores in 2012. Towards development of French guideline for clinical practice. Ann Phys Rehabil Med. 2012;55:482-488.
79.
BakkerKApelqvistJLipskyBAVan NettenJJSchaperNC; International Working Group on the Diabetic Foot (IWGDF). The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev. 2016;32(suppl 1):2-6.
80.
McIntoshAPetersJYoungRPrevention and Management of Foot Problems in Type 2 Diabetes: Clinical Guidelines and Evidence. Sheffield, UK: University of Sheffield; 2003.
81.
AielloAAnichinRBrocoETreatment of peripheral artery disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICUI). Nutr Metab Cardiovasc Dis. 2014;24:355-369.
82.
HinchliffeRJBrownriggJRApelqvistJ; International Working Group on the Diabetic Foot (IWGDF). IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes Metab Res Rev. 2016;32(suppl 1):37-44.
83.
BusSAvan NettenJJLaveryLA; International Working Group on the Diabetic Foot (IWGDF). IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. 2016;32(suppl 1):16-24.
84.
PhamHArmstrongDGHarveyCHarklessLBGiuriniJMVevesA. Screening techniques to identify people at high risk for diabetic foot ulcers. Diabetes Care. 2000;23:606-611.
85.
FengYSchlösserFJSumpioBE. The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus. J Vasc Surg. 2011;5:220-226.
86.
BusSAValkGDvan DeursenRWThe effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008;24(suppl 1):S162-S180.
87.
PiaggesiAViacavaPRizzoLSemiquantitative analysis of the histopathological features of the neuropathic foot ulcer: effects of pressure relief. Diabetes Care. 2003;26:3123-3128.
88.
KatzIAHarlanAMiranda-PalmaBA randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28:555-559.
89.
ArmstrongDLaveryLAWuSBoultonAJM. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds. Diabetes Care. 2005;28:551-554.
90.
PiaggesiAMacchiariniSRizzoLAn off-the-shelf instant contact casting device for the management of diabetic foot ulcers: a randomized prospective trial versus traditional fiberglass cast. Diabetes Care. 2007;30:586-590.
91.
FagliaECaravaggiCClericiGEffectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer. Diabetes Care. 2010;33:1419-1423.
92.
NubeVLMolyneauxLBoltonTClinganTPalmerEYueDK. The use of felt deflective padding in the management of plantar hallux and forefoot ulcers in patients with diabetes. Int J Clin Foot Sci. 2006;16:38-43.
93.
LipskyBAAragón-SánchezJDiggleM; International Working Group on the Diabetic Foot (IWGDF). IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32(suppl 1):45-74.
94.
DumvilleJCHinchliffeRJCullumNNegative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2013;(10):CD010318.
95.
DriverVRBlumePA. Evaluation of wound care and health-care use costs in patients with diabetic foot ulcers treated with negative pressure wound therapy versus advanced moist wound therapy. J Am Podiatr Med Assoc. 2014;104:147-153.
HongCCNatherALeeJKMaoHT. Hydrosurgery is effective for debridement of diabetic foot wounds. Ann Acad Med Singapore. 2014;43:395-399.
98.
BremHStojadinovicODiegelmannRFMolecular markers in patients with chronic wounds to guide surgical debridement. Mol Med. 2007;13:30-39.
99.
EnnisWJForemannPMozenNMasseyJConner-KerrTMenesesP. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multi-center study. Ostomy Wound Manage. 2005;51:24-39.
100.
UlbrechtJSHurleyTMaugerDTCavanaghPR. Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial. Diabetes Care. 2014;37:1982-1989.
101.
BanchelliniEMacchiariniSDiniVUse of nanotechnology-designed footsock in the management of preulcerative conditions in the diabetic foot: results of a single, blind randomized study. Int J Low Extrem Wounds. 2008;7:82-87.
102.
AbbruzzeseLIacopiECoppelliABoninoGGorettiCPiaggesiA. Safety and effectiveness of therapeutic magnetic resonance in the management of postsurgical lesion of the diabetic foot. Int J Low Extrem Wounds. 2015;14:4-10.
103.
HopfHWUenoCAslamRGuidelines for the treatment of arterial insufficiency ulcers. Wound Repair Regen. 2006;14:693-710.
104.
ArsenaultKAMcDonaldJDevereauxPJThorlundKTittleyJGWhitlockRP. The use of transcutaneous oximetry to predict complications of chronic wound healing: a systematic review and meta-analysis. Wound Repair Regen. 2011;19:657-663.
105.
ApelqvistJAPLeplantaloMJA. The ulcerated leg: when to revascularise. Diabetes Metab Res Rev. 2012;28(S1):30-35.
106.
GurtnerGLJonesGENelliganPCIntraoperative laser angiography using the SPY system: a review of the literature and recommendations for us. Ann Surg Innov Res. 2013;3:1.
107.
NouvangAHoogwerfBMohlerEDavisBTajaddiniAMaedenillaE. Evaluation of diabetic foot ulcer healing with hyperspectral imaging of oxyhaemaglobin and deoxyhaemoglobin. Diabetes Care. 2009;32:2036-2061.