Challenges in the Treatment of Chronic Wounds.
Challenges in the Treatment of Chronic Wounds.
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DOI：
10.1089/wound.2015.0635
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发表时间：
2015-09-01
影响因子：
4.9
通讯作者：
Banks J
中科院分区：
文献类型：
--
作者：
Frykberg RG;Banks J
意义：慢性伤口包括但不限于糖尿病足溃疡、下肢静脉溃疡和压疮。它们对伤口护理专业人员是一个挑战，并且消耗了地球仪的大量医疗资源。这篇综述讨论了复杂慢性伤口的病理生理学以及目前可用于此类患者愈合的方法和模式。最新进展：虽然通常难以治疗，但了解潜在的病理生理学并特别注意管理这些扰动通常可以导致成功愈合。关键问题：克服导致延迟愈合的因素是伤口护理综合方法的关键组成部分，也是治疗慢性伤口的主要挑战。当伤口在标准治疗4周后未能实现充分愈合时，应重新评估潜在病理学并考虑是否需要高级治疗药物。然而，选择适当的治疗往往不是基于证据的。未来发展方向：护理的基本原则需要定期遵循，对患者及其伤口的系统评估也将有助于适当的护理。导致这些伤口无法愈合的潜在病理在各种类型的慢性伤口中是不同的。在分子和细胞水平上更好地了解各种类型的慢性伤口之间的差异，应该会改善我们的治疗方法，从而提高愈合率，并促进新的更有效的治疗方法的开发。目前和未来先进的伤口治疗的有效性需要更多的证据，以确保其正确使用。
Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients. Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing. Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based. Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.