Wound care is a classic example of a surgical realm with a great variation in care. The diversity in
wounds and
wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in
wound care contribute to this undesirable variation in care. For chronic
wounds, such as arterial or
venous ulcers,
pressure sores, and
diabetic foot ulcers, but also for acute
wounds after surgery or
trauma, international and national guidelines provide recommendations on diagnostic procedures and treatment options, but rely mostly on expert opinion. We present the available evidence from Cochrane systematic reviews for the systemic treatment (i.e., not prevention) of patients with
wounds, as opposed to topical
wound treatments. This evidence shows: -
Venous ulcers: High-compression
therapy is the classic and evidence-based treatment for treating
venous ulcers. Oral
pentoxifylline promotes
ulcer healing with and without compression
therapy. Oral
zinc is not effective to heal
venous ulcers. - Acute
wounds: Recombinant
human growth hormone accelerates healing of large
burn wounds and donor sites, while high-
carbohydrate feeding might reduce the risk of
pneumonia.
Linezolid is more effective than
vancomycin for treating skin and
soft tissue infections. Hyperbaric
oxygen may help heal crush
wounds and skin grafts.
Therapeutic touch does not heal acute
wounds. -
Pressure sores: Air-fluidized and some low-tech devices appear effective for treating existing
pressure ulcers. Oral
zinc,
protein, or
vitamin C supplements seem ineffective. Also, evidence is lacking on the effectiveness of repositioning regimes as a treatment option. - Diabetic
ulcers:
Hyperbaric oxygen therapy and pressure-relieving devices may improve healing rates. - Arterial
ulcers:
Prostanoids and
spinal cord stimulation may be effective in healing ischemic
ulcers. Thus, fortunately, some high-level evidence exists for various local and systemic interventions in
wound care. Caregivers should be aware of, and apply, the strongest evidence available. Only when all stakeholders (patients, physicians,
wound care nurses, but also manufacturers and buyers) implement this available evidence will optimum quality of care for patients with
wounds be ensured.