Edge Effect
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Ensure wounds have the ability to heal and optimize debridement, inflammation or infection, and moisture balance prior to advanced therapies. | Level of Evidence Not Assessed |
| 2 | Think DIM before DIME. | Level of Evidence Not Assessed |
| Address patient-centered Concerns | ||
|---|---|---|
| 3 | Involve patients and caregivers to consider different advanced therapies | Level of Evidence Not Assessed |
| 4 | Take into consideration of cost (reimbursement if applicable) and convenience factors (frequency, location, length of treatment) for each therapy | Level of Evidence Not Assessed |
| Provide Local Wound Care | ||
|---|---|---|
| 5 | Consider advanced therapies after debridement, infection/inflammation, and moisture balance have been optimized. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 6 | Consider cost effectiveness of advanced therapies and their potential to promoting wound healing and wound closure over time; not simply cost itself. | Level of Evidence Not Assessed |
| 7 | Critically evaluate of each advanced therapies based on the scientific evidence, expert opinion, and patient preference. | Level of Evidence Not Assessed |
Background
Chronic wounds do not always follow the normal healing trajectory. Healing is stalled due to many reasons including senescent cells that are indolent to cellular signaling, decreased growth facts, increased proteases and other pro-inflammatory mediators, and impaired cell migration. The epidermal edge of nonhealing chronic wounds often have a steep cliff-like appearance (edge effect) making it difficult for the keratinocytes to migrate across the granulation base for healing. To stimulate latent healing potential, cellular therapies and other complementary therapies may augment and replace the components that are deficient in nonhealing wounds. However, advanced therapies should only be considered in wounds that have the ability to heal and after debridement, inflammation or infection, and moisture balance should be addressed and optimized. To remember this, think DIM before DIME.Biological agents
ï¶ Growth factors
ï¶ Tissue matrix components/smart matrix
Skin grafting
ï¶ Autologous epidermis
ï¶ Allografts
ï¶ Living skin equivalents
Complimentary therapies
ï¶ Hyperbaric oxygen therapy
ï¶ Negative wound pressure therapy
ï¶ Electrical stimulation
ï¶ Therapeutic ultrasound
Summary of Advanced therapies Options
Substantiated Advanced therapies Indication RCT or meta-analysis available Results
Smart matrix (Oasis) VLU Yes Complete healing
DFU Yes Complete healing equal to PDGF
Apligraf (epidermal cells, dermal fibroblasts DNFU Yes Complete healing
VLU Yes Complete healing
Dermagraft (fibroblasts) DNFU Yes Complete healing
Hyperbaric oxygen therapy (HBOT) DNFU Yes Prevent amputation
Electrical stimulation PU Yes Complete healing
Therapeutic ultrasound VLU Yes Faster healing
DNFU Yes Complete healing
Negative pressure wound therapy (NPWT) (post surgical) Yes Complete healing
Promogran VLU Yes Decrease wound size
DNFU=diabetic neurotrophic ulcers; VLU=venous leg ulcers; PU=pressure ulcers
References
| Essential Publications |
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| 1 |
Quality Indicator
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Type: Narrative Review | |
| Woo K, Ayello EA, Sibbald RG. The edge effect: Current therapeutic options to advance the wound edge. Adv Skin Wound Care 2007;20(2):99-117. | |||
| The purpose of this paper is to examine the edge effect of chronic wounds and advanced treatment options available to practitioners. Keratinocytes are identified as having an important role in wound healing by restoring the epithelium as a protective barrier. Treatment options discussed in this paper include the use of keratinocytes, acellular preparations, cellular therapy, complementary therapies, and epidermal, dermal, and composite products. | |||