Many of us who treat wounds spend the majority of our time in well-defined niches, whether it’s treating diabetic foot ulcers, venous leg ulcers, truncal pressure ulcers, or dermatologic conditions. In these areas we have numerous, although not always well designed, trials to supplement our knowledge. There are many commonalities in these wound types—necrotic debris, bioburden, hostile microenvironment, microscopic and macroscopic tissue perfusion—to name a few. Many of us believe that we are experts in many of these fields. However, it is in the area of revascularization that we are more likely to have to send a patient with ischemic issues elsewhere.

  Additionally, data are scarce regarding ischemic patients’ actual wound healing, whether revascularized or not—in almost all randomized controlled trials they are excluded from enrollment. Many insurance providers, including Medicare, preclude patients with diminished circulation from certain treatments, such as bilayered skin substitutes. Once these patients return to the clinic, their procedure is deemed as successful or not successful based upon procedural criteria, not usually upon how the patient’s wound actually progresses. If deemed “non-operable,” we are then limited to arterial pumps, hyperbaric therapy, or possibly a “gene” therapy trial.

  Comparative research and product evaluation is a new endeavor, which should be applauded and supported. Dr. Didomenico and colleagues are to be commended for their attempts to meet that goal. Before any meaningful data is to result from comparative product evaluation, the use of the products must be maximized if the data is to be useful. Unfortunately, the data collected leaves much to be desired. As reported, the treatment of diabetic foot ulcers with Apligraf resulted in a 12-week healing rate of 41.3% and a 20-week healing rate of 47.1%.

Abstract:   Currently, most skin lesions are called wounds and primarily are divided into acute and chronic, the difference being the time period during which they have been in existence and/or their tendency to heal properly or not. Etiology is not taken into account when applying the definitions of chronic versus acute.

Dr. Cockbill is the Section Editor for the Veterinary Wounds section

     The preceding review article, Off-Label Use of Prescription Medication, highlights many of the frustrations wound care practitioners experience today. Despite the many wound treatment products available, we still do not have a “magical cure” for wounds that is equally effective for all patients. This sends the thoughtful wound care practitioner searching for treatments that may be unproved yet seem appropriate for the patient or the condition. A word of caution must be interjected at this point because great care must be taken when utilizing unproven treatments. The tim

Abstract: The use of negative pressure for wound healing has been based on a set of parameters and devices that until recently were combined into a single paradigm. Despite historical and more recent evidence providing viable alternative considerations, it is only recently that this paradigm and its tenets have come into question. As the understanding of the limits of the current paradigm and specific instances of its benefits and drawbacks are identified, shifts in the paradigm must take place if the therapy is to evolve, develop, and continue to be efficacious. The pertinence of the c

     The authors randomized 42 patients with venous stasis ulcers who were divided to receive either a nonadherent silver-based foam dressing or a nonadherent foam. The authors reported faster healing in the silver foam group. The authors are to be commended on comparing newer, “advanced” wound technologies in a randomized trial. The vast majority of trials seem to compare an “advanced” method to moist gauze. Additionally, there are added complexities in performing a randomized clinical study.

     Despite these accolades, there are many issues with th

     In recent years, exciting advances have been made regarding both wound bed and surrounding skin measurement. We are just beginning to quantify, characterize, and measure different aspects of chronic wounds and pathophysiology that occur in what we perceive as normal tissue repair. Areas with substantial progress include new imaging technologies, biochemical assessment of the wound bed, and physical measurement of surrounding skin. The use of new devices, which range from sophisticated and highly-engineered technologies to the scientific evaluation of wound assessment has pa