Assessment of Non-Healing Wounds in Clinical Practice: Towards a Holistic and Systems-Based Approach
Summary: This article reviews the assessment of non-healing wounds, advocating a holistic, systems-based approach that integrates patient history, comorbidities, and environmental factors with accurate diagnosis to optimize management. Drawing on current guidance, it stresses multidisciplinary evaluation for chronic wounds like diabetic foot ulcers and venous leg ulcers, where delayed healing affects 2-3% of the population and costs billions. Key steps include comprehensive history-taking, vascular/neurological exams, and biopsy for malignancy, emphasizing early referral to prevent progression to infection or amputation, with tools like the TIME framework for structured care.
Key Highlights:
- Prevalence: Non-healing wounds affect 2-3% of populations, with diabetic ulcers leading to 20% amputation risk if untreated.
- Holistic Assessment: Include psychosocial factors, nutrition, mobility; use tools like PUSH or Bates-Jensen for objective scoring.
- Diagnostic Tools: Doppler for vascularity, monofilament for neuropathy; biopsy for suspected cancer or vasculitis.
- Systems Approach: Multidisciplinary teams (podiatry, vascular, nutrition) improve closure rates by 40%.
- Implications: Early, comprehensive evaluation reduces costs and enhances QoL; calls for standardized protocols.
Keywords: non-healing wounds, holistic assessment, systems-based approach, diabetic ulcers, multidisciplinary care, Aby Mitchell