Chronic Wound Management: The Significance of Evidence and Technology

Contents
1 Chronic Wound Management—A Continuing Challenge
	Wound Aetiology
	A Complex Profile
	Economic Impact
	Human Impact
	Healing Outcomes
	Future Opportunities
	References
2 The Role of Technology in Managing Vascular Wounds
	Abstract
	Introduction
		Background
	Venous Leg Ulcers (VLU)
	The Physics of Compression Delivered by Hosiery/Bandaging Systems
		Healing Rates of VLU Treated with Compression Are Variable
		Other Devices to Deliver Compression
	Mixed Arterio-Venous Ulcers
	Surgical Treatments of Venous Insufficiency in Conjunction with Venous Ulcers
		Ischemic Leg Ulcers
	Discussion
	References
3 The Diabetic Foot, Its Complications, Role of Technology in Evidence-Based Management
	Abstract
	Introduction
	Diagnosis
		Assessment of Neuropathy as a Predisposing Factor to Ulceration
			Use of Technology to Assess Large Fibre Neuropathy
				Monofilament
				Vibration Perception Threshold (VPT)
			Use of Technology to Assess Small Fibre Neuropathy
			Screening for Neuropathy
			The Value of Screening to Predict Outcome
			The Value of Screening to Affect Outcome
		Measurement of Pressure Abnormalities of the Foot as Precipitants of Ulceration
		Detection of Skin Temperature Rise as an Immediate Prelude to Ulceration
		Characterisation of Infection, Which Often Complicates Ulceration
	Wound Management
		Wound Debridement
			Innovative Technologies in Wound Debridement
				Microwater Jet Technology
				Ultrasound Assisted Wound Debridement
				Near Infrared (NIR) Optical Imaging
		Innovative Technology in Wound Applications to Accelerate Healing
		Innovative Technology in Cellular and Molecular Therapies to Accelerate Healing
			Stem Cell Therapy
			Gene Therapy
			Nanotechnology
		Evidence for the Use of Technology on Offloading
	Covid 19 Pandemic and Management of the Diabetic Foot
	Conclusion
	References
4 Role of Technology for wound Care in Diabetic Foot
	Abstract
	Introduction
	Burden of Diabetic Foot Ulcers in India
	Newer Technology as an Early Diagnostic Tool For DFU
		Foot Evaluation
	Recent Advances in the Management of DFU
	Impact of Covid 19 Among People With DFU
	Future in the Prevention of DFU
	Conclusion
	References
5 Biologic Transducers in Wound Healing
	Abstract
	Introduction
	Effectiveness of Enriched Platelet for Skin Chronic Wounds
	Effectiveness of Topical Recombinant Growth Factors/Cytokines for Chronic Skin Wounds
		Cytokines
		Growth Factors
			PDGF
			FGF
			EGF
		Combination Application of Growth Factors in Chronic Wound
	Effectiveness of (Stem) Cells for Skin Chronic Wounds
	Outlook
	References
6 Physical, Electromagnetic, Biologic Devices
	Abstract
	Introduction
	Physical/Delivery Systems
	Materials
	Skin Substitutes
	Bone Substitutes
	Vascular-Related Technologies
	Conclusions
	References
7 Medicinal Plants and Products from Traditional Medicine Systems Contribute to Clinical Wound Management
	Abstract
	Introduction
	What are Ideal Properties to Benefit Wound Healing?
	Randomized Clinical Trial on Wound Dressing Agents from Plant Origin
		Objectives
		Azadirachta Indica as Dressing Agent
		Ayurvedic Polyherbal Formulation as Dressing Agent
		Banana Leaves Dressings (BLD)
	Randomised Controlled Trial on Wound Healing Plant Medicine
		Topical Application
		Aloe Vera
		Hypericum Perforatum
		Honey
		Systemic Uses of Curcumin
			Curcuma Longa
			Centella Asiatica (L.)
		Taking a Wound Healing Agent from Bench to Bedside: Validating a Natural Wonder with Advanced Technology
	Discussion
	Acknowledgements
	Conflict of interest
	References
8 Innovation in Laboratory Evaluations of the Performance of Treatment and Prophylactic Dressings Under Clinically-Relevant Usage Conditions
	Abstract
	Introduction
	Robotic Wound Systems Designed and Built for the Evaluation of Treatment Dressings
	Computational Modelling Reveals the Efficacy of Wound Dressings in Prophylactic Use
	Summary and Conclusions
	Acknowledgements
	References
9 Atypical Wounds and Wounds Resulting from Infection
	Abstract
	Introduction
	Neoplastic Ulcers
	Haematologic Ulcers
		Haemoglobinopathies-Associated Ulcers
		Polycythaemia Vera and Leg Ulcers
	Metabolic Anomalies
		Calcific Uremic Arteriolopathy (Calciphylaxis)
	Inflammatory and Immune Disorders-Correlated
		Vasculitis
		Pyoderma Gangrenosum
	Occlusive Non Vasculitic Vasculopathies
		Livedoid Vasculopathy
		Antiphospholipid Antibodies-Associated Leg Ulcers
	Drug-Induced
		Hydroxyurea
		Drug-Related Cutis Embolism (Nicolau’s Disease)
		Warfarin-Induced Skin Necrosis
		Drug Abuse
	Ulcer Resulting from Arterial Hypertension (Martorell Hypertensive Ischemic Ulcer)
	Atypical Ulcers Associated to Infections
		Mycobacterial-Induced Ulcers
		Buruli Ulcer
		Lehismania
		Deep Fungal Infection-Related Atypical Wounds
			Sporothricosis
			Mycetoma
		Ecthyma Gangrenosum
	Microbiological Investigations: Methods and Drawing Techniques
		Mainly Qualitative Methods
		Qualitative and Quantitative Methods
		Laboratory Markers
		The Future
	References
10 Biofilms and Impaired Wound Healing: How Do We Detect the Presence of Biofilms in Chronic Wounds Non-invasively
	Abstract
	How Biofilms Impair Wound Healing
		Disruption of Immune and Skin Cells
		Disruption of Microenvironment
	Detection Methods
		Biofilm Detection Issues
		Conventional Detection Methods
		Novel Sensor-Based Detection Methods
		Novel Imaging-Based Detection Methods
	Discussion
	References
11 Update on Technology and Evidence-Based Management of Scars
	Abstract
	Introduction
	Biological Resume of Events Occurring After a Skin Injury
	Factors Impacting Scars
	The Young Age
	The Elderly
		The Reappearance of a Wound on a Scar
		Degenerescence/Marjolin’s Ulcer
		Hyperkeratosis
	Scar Assessment Scales
	Non-surgical Technologies
	Intra-Lesional Steroid Injections
	Silicone Gel/Sheet
	Radiotherapy
	Photodynamic Therapy (PDT)
	Electrical Stimulation
	Surgical Strategies
	Scar Prevention
	Conclusion
	References
12 Surgical Flaps in Wound Healing—An Update on Evidence-Based Management
	Abstract
	Introduction
	Patient Selection, Multidisciplinary Approach and the Wound Preparation
	Surgical Techniques
		Case Examples
	Outcomes
	Conclusion
	References
13 Wound Measurement is an Essential Part of Wound Management
	Abstract
	Introduction
	Skin Assessment
		Wound Size Analysis
		Hyperspectral Imaging
		Laser Doppler Imaging (LDI)
		Laser Speckle Imaging (LSI)
		Near-Infrared Spectroscopy (NIRS)
		Thermography
		Videomicroscopy
		Optical Coherence Tomography
		Fluorescence Imaging
		Confocal Microscopy
		Ultrasound
	Discussion
	References
14 Translation of Wound Devices into Practice—A Myth? Translation is the Process of Taking an Invention Through to Clinical Practice—How Successful Are We?
	Abstract
	Gaining Approval for Clinical Use of an Innovation
	Gaining Adoption and Usage of a Translated Product or Therapy
	Case Studies
	Discussion
	References
15 Pain in Chronic Wounds: Mechanism and Management
	Abstract
	Introduction
	The Burden of the Problem
	Pathophysiology of Wound-Related Pain
	Pain Pathways
	Effects of Pain in Patients with Chronic Wounds
	Diagnosis and Assessment
	Pain Assessment
	Management
	WHO Pain Management Ladder
	Management of Breakthrough Pain
	Wound Pain Management
	Topical Treatment
	Management of Infection
	Moisture Balance
	Management of Specific Wounds
		Diabetic Foot Ulcer
		Venous Ulcers
		Ischaemic Leg Ulcers
	Conclusion
	References