Introduction

Chronic and nonhealing wounds are a worldwide issue and are becoming more difficult to treat. In the United States alone, according to Medicare, over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion per year.¹ If standard treatment does not adequately heal a wound, additional methods of wound care treatment may be required, and the underlying disorder must be examined to determine the need for advanced wound care modalities. Advanced wound care therapies are interventions that are used after standard wound care has failed.

The development of a wide range of advanced wound care therapies with varying compositions and indications has increased recently in tandem with the acceleration of chronic wound complications. Clinicians should familiarize themselves with these modalities to combat this wound care crisis.

Digital Imaging Technologies

Wound photo documentation gives a visual reference for the patient's medical record while also providing a timeline for the patient's healing progress. Digital imaging technologies can aid in making accurate measurements, encouraging objective assessments, reducing misinterpretation of the wound’s cause, using evidence-based practices as a teaching resource for both patients and new clinicians, and promoting evidence-based practices.²

Thermal Imaging

Thermal imaging techniques have been shown to be effective for predicting whether a wound requires additional management, by providing early warning signals for chronic wound care. This increased efficiency is because there are significant tells between traditional images due to differences in lighting conditions, image quality, and camera angle at various moments in treatment. According to a recent study, textural analysis of thermal images of venous leg ulcers can determine whether a wound requires additional management as early as the second week for clients who are treated at home.³

Additionally, researchers reported a substantial decrease in the incidence of deep tissue pressure injuries (DTPIs) as compared with the historical incidence at the study institution when these investigators used a commercially available thermal imaging device. Long-wave infrared thermal imaging technology can detect thermal anomalies in anatomical areas susceptible to developing DTPIs and execute clinical interventions to minimize or reduce the severity of emerging DTPIs.⁴

Fluorescence Imaging

Another innovative modality that has significantly impacted wound care is an advanced technology that uses fluorescence imaging to identify or exclude the presence of bacteria. Microorganisms emit intrinsic fluorescent signals when exposed to specific wavelengths, which can be detected and analyzed. Using these specific wavelengths in a handheld device, the clinician can determine whether bacteria are present and can proceed accordingly.

Telehealth Services

With the use of a HIPAA-compliant two-way communication system and a specialized close-up camera, the wound care clinician may see the wound in greater detail and assess its characteristics and severity. Through the use of live secure video, the wound care clinician can communicate with the patient and patient’s caregiver, as well as provide recommendations and answer questions. Telehealth is especially beneficial for patients who reside in remote locations, are older, or have conditions that make it difficult to access a local clinic.⁵

Bioactive Dressings

Bioactive dressings deliver substances active in wound healing, either bioactive compounds or materials with endogenous activity.⁶ Tissue-engineered products derived from artificial or natural sources can be used in bioactive wound care dressings.⁷ Examples of the materials used in bioactive dressings include:

• Alginates
• Antimicrobials
• Cell-containing matrices
• Cell-free matrices
• Chitosan
• Collagen
• Elastin
• Growth factors
• Hyaluronic acid
• Silicone
• Skin equivalents

Pressure Mapping

By using pressure mapping, a patient's position on a pressure-sensitive mat can be visualized in three dimensions. Numbers, colors, and graphic images can be viewed in multiple ways on the computer's display screen. The coloration indicates areas of high or low pressure. To interpret data appropriately, a clinician must be aware of the type of pressure mapping device used.⁸

Shockwave Therapy

Shockwave therapy is a noninvasive adjunctive treatment that uses biphasic, high-energy acoustic shockwaves to promote wound healing. Extracorporeal shock wave therapy has been shown in clinical studies to be effective in accelerating tissue repair and regeneration in a wide range of wounds. Potential mechanisms include initial neovascularization followed by long-term and functional angiogenesis. Furthermore, mesenchymal stem cell recruitment, stimulated cell proliferation and differentiation, anti-inflammatory and antimicrobial effects, and nociception suppression are all considered important aspects of the biological responses to therapeutic shock waves.⁹

Topical Oxygen Therapy

A wide range of wound types can benefit from the use of topical oxygen as an additional treatment option. Topical oxygen therapy can be used as an adjunctive, advanced modality to treat chronic wounds that have failed to respond to conservative management. Typical wound types for which topically applied oxygen is indicated and/or has demonstrated success include a wide range of wound types.¹⁰

Conclusion

Chronic wounds are a major concern in clinical practice around the world, and they have a negative impact on the quality of life of affected patients. Understanding the biological processes that occur in the wound bed can help clinicians and providers optimize these conditions. Some wounds require the use of advanced technologies to overcome the obstacles that cause complexity and chronicity in wound healing.

References

1. Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic on-healing wounds. Value Health. 2018;21:27-32.
2. Langemo D, Hanson D, Anderson J, Thompson P, Hunter S. Digital wound photography: points to practice. Adv Skin Wound Care. 2006;19(7):386-387.
3. Monshipouri M, Aliahmad B, Ogrin R, et al. Thermal imaging potential and limitations to predict healing of venous leg ulcers. Sci Rep. 2021;11(1):13239. doi:10.1038/s41598-021-92828-2
4. Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of thermal imaging to identify deep-tissue pressure injury on admission reduces clinical and financial burdens of hospital-acquired pressure injuries. Adv Skin Wound Care. 2019;32(7):312-320. doi:10.1097/01.ASW.0000559613.83195.f9
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6. Schoukens G. 5 - Bioactive dressings to promote wound healing. In: Rajendran S, ed. Advanced Textiles for Wound Care. Woodhead Publishing; 2009:114-152. ISBN 9781845692711. doi:10.1533/9781845696306.1.114. Accessed May 12, 2022. https://www.sciencedirect.com/science/article/pii/B9781845692711500054
7. Bioactive wound care market research report: Market Size, industry outlook, Market Forecast, demand analysis,market share, market report 2021-2026. IndustryARC. https://www.industryarc.com/Report/5344/Bioactive-Wound-Care-Market-Ana…. Accessed May 16, 2022.
8. Hanson D, Langemo D, Anderson J, Thompson P, Hunter S. Can pressure mapping prevent ulcers? Nursing. 2009;39(6):50-51. doi:10.1097/01.NURSE.0000352337.67771.e0
9. Mittermayr R, Antonic V, Hartinger J, et al. Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012;20(4):456-465. doi:10.1111/j.1524-475X.2012.00796.x
10. Oropallo A, Andersen CA. Topical Oxygen. StatPearls Publishing; 2022. Accessed May 12, 2022. https://www.ncbi.nlm.nih.gov/books/NBK574579/