DMRR special issue: Interventions to improve wound healing

Drs. Garwood and Steinberg critically discuss the current situation in wound healing products, starting with describing the high influx of emerging wound care modalities, while lacking adequate research.

They continue with describing the positive outcomes from negative pressure wound therapy, and the mixed outcomes on both cellular and tissue based products, as well as amniotic membranes. Evidence on emerging wound care modalities may seem overwhelming when presented as part of the launch of a new product, but limited high-quality evidence remains available as concluded in the IWGDF systematic review.

The key issue with interventions to improve wound healing are patient selection and outcome of interest. Most of these interventions should be seen as adjunctive therapy to standard good care. Further, healing is not always the primary outcome for which a product is developed, since they may for example target speeding up the early phases of wound healing rather than the later phases of wound closure. However, it is hard to carefully select patients in trials to meet these complexities.

Garwood and Steinberg bring us back to the basics, describing that the goal of any wound regimen should be to optimize wound healing by combining basic wound care modalities including debridement, off-loading, and infection control with the addition of advanced therapies when necessary. Only when you are fully confident that you have all fundamentals in the right spot should you start looking for advanced wound care products.