Different Types Of Chronic Wounds Research Articles

A Novel Fused Multi-Class Deep Learning Approach for Chronic Wounds Classification

Chronic wounds affect the lives of millions of individuals globally, and due to substantial medical costs, treating chronic injuries is very challenging for the healthcare system. The classification of regular wound type is essential in wound care management and diagnosis since it can assist clinicians in deciding on the appropriate treatment method. Hence, an effective wound diagnostic tool would enable clinicians to classify the different types of chronic wounds in less time. The majority of the existing chronic wound classification methods are mainly focused on the binary classification of the wound types. A few approaches exist that classify chronic wounds into multiple classes, but these achieved lower performances for pressure and diabetic wound classification. Furthermore, cross-corpus evaluation is absent in chronic wound type classification, in order to better evaluate the efficacy of existing methods on real-time wound images. To address the limitations of the current studies, we propose a novel Swish-ELU EfficientNet-B4 (SEEN-B4) deep learning framework that can effectively identify and classify chronic wounds into multiple classes. Moreover, we also extend the existing Medetec and Advancing the Zenith of Healthcare (AZH) datasets to deal with the class imbalance problem of these datasets. Our proposed model is evaluated on publicly available AZH and Medetec datasets and their extended versions. Our experimental results indicate that the proposed SEEN-B4 model has attained an accuracy of 87.32%, 88.17%, 88%, and 89.34% on the AZH, Extended AZH, Medetec, and Extended Medetec datasets, respectively. We also show the effectiveness of our method against the existing state-of-the-art (SOTA) methods. Furthermore, we evaluated the proposed model for the cross-corpora scenario to demonstrate the model generalization aptitude, and interpret the model’s result through explainable AI techniques. The experimental results show the proposed model’s effectiveness for classifying chronic wound types.

Further psychometric validation and test-retest reproducibility of the WOUND-Q.

WOUND-Q is a condition-specific patient-reported outcome measure developed for all types of chronic wounds, located anywhere on the body. To establish reliability and validity of a patient-reported outcome measure, multiple pieces of evidence are required. The purpose of this study was to examine the measurement properties of 9 of the 13 WOUND-Q scales and perform a test-retest reproducibility study in an international sample. In August 2022, we invited members of an international online community (Prolific.com) with any type of chronic wound to complete a survey containing the WOUND-Q scales, the Wound-QoL and EQ-5D. A test-retest survey was performed 7 days after the first survey. It was possible to examine the reliability and validity of eight of the nine WOUND-Q scales by Rasch Measurement Theory (RMT). To examine test-retest reproducibility intraclass correlation coefficients (ICCs), the standard error of the measurement and the smallest detectable change were calculated. In total, 421 patients from 22 different countries with 11 different types of chronic wounds took part in this study. Our analyses provided further evidence of the reliability and validity of the scales measuring wound characteristics (assessment, drainage, smell), health-related quality of life (life impact, psychological, sleep, social) and wound treatment (dressing).

Promotion of cutaneous diabetic wound healing by subcutaneous administration of Wharton's jelly mesenchymal stem cells derived from umbilical cord.

Wound healing is a major problem in diabetic patients, and current treatments have been confronted with limited success. The present study examined the benefit of Wharton's jelly mesenchymal stem cells (WJ-MSCs) derived from the human umbilical cord (UC) in wound healing in diabetic rats. Thirty days after inducing diabetes, a circular excision was created in the skin of rats, and the treatments were performed for 21days. Two groups were studied, which included the Control group and WJ-MSCs group. The studied groups were sampled on the 7th, 14th, and 21st days after wounding. Histological ultrasound imaging of dermis and epidermis in the wound area for thickness and density measurement and skin elasticity were evaluated. Our results on post-wounding days 7, 14, and 21 showed that the wound closure, thickness, and density of new epidermis and dermis, as well as skin elasticity in the healed wound, were significantly higher in the WJ-MSCs group compared to the Control group. Subcutaneous administration of WJ-MSCs in diabetic wounds can effectively accelerate healing. Based on this, these cells can be used along with other treatment methods in the healing of different types of chronic wounds.

Association of wound genesis on varying aspects of health-related quality of life in patients with different types of chronic wounds: Results of a cross-sectional multicentre study.

Patients with chronic wounds are significantly impaired in their health‐related quality of life (HRQoL). The validated Wound‐QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life‐related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross‐sectional, multicentre study, Wound‐QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life‐related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound‐QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient‐oriented treatments, the Wound‐QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health‐related quality of life. Validated Wound‐QoL questionnaire is a quick and easy‐to‐use instrument for daily practice. Wound‐related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound‐related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health‐related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.

The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing.

Chronic wounds are still regarded as a serious public health concern, which are on the increase mainly due to the changes in life styles and aging of the human population. There are different types of chronic wounds, each of which requires slightly different treatment strategies. Nevertheless, wound bed preparation is included in treatment of all types of chronic wounds and involves tissue debridement, inflammation, and infection control, as well as moisture balance and epithelial edge advancement. Maggot therapy (MT) is a form of biological debridement which involves the application of live medical grade Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) larvae. Whereas it was initially thought to act mainly through debridement, today MT is known to influence all four overlapping physiological phases of wound repair: homeostasis, inflammation, proliferation, and remodelling/maturing. During MT, medical-grade larvae are applied either freely or enclosed in tea-bag like devices (biobag) inside the wounds, which suggests that larva excretion/secretion (ES) products can facilitate the healing processes directly without the need of direct contact with the larvae. This review summarizes the relevant literature on ES-mediated effects on the cellular responses involved in wound healing.

In vitro antibacterial activity of extracts from Samoan medicinal plants and their effect on proliferation and migration of human fibroblasts

Ethnopharmacological relevanceThe prevalence of different types of chronic wounds, due to the ageing population and increase incidence of diseases, is becoming a worldwide problem. Various medicinal plants used in folk medicine have demonstrated wound healing and antimicrobial properties, and some of these species are currently used in commercial preparations. Despite the well-documented and rich tradition of the use of local herbs for the treatment of skin injuries in Samoan folk medicine, their wound healing potential has not yet been systematically studied. Aim of the studyInvestigation into the in vitro antibacterial activity of ethanol extracts from 14 medicinal plants used in Samoan traditional medicine for the healing of wounds, burns and sores, and their effects on the proliferation and migration of human fibroblasts. Materials and methodsThe antibacterial activity of these extracts was tested against pathogens associated with infected skin injuries, using the broth microdilution method. The effect on migration, proliferation and viability of human dermal fibroblasts was evaluated using wound healing scratch assay, cell proliferation assay, and thiazolyl blue tetrazolium bromide cytotoxicity test. ResultsThe extracts from Cerbera manghas, Commelina diffusa, Kleinhovia hospita, Mikania micrantha, Omalanthus nutans, Peperomia pellucida, Phymatosorus scolopendria, Piper graeffei, Psychotria insularum, and Schizostachyum glaucifolium inhibited the growth of Staphylococcus aureus at the minimum inhibitory concentration (MIC) of ≥4 μg/mL, whereas C. manghas and P. pellucida produced the same MIC against both Escherichia coli and Pseudomonas aeruginosa. Among the antibacterially active species, C. diffusa, K. hospita, P. scolopendria, P. insularum, and S. glaucifolium did not produce toxicity towards the standard line of normal adult human dermal fibroblasts (IC80 > 128 μg/mL). In addition, extracts from Barringtonia asiatica, C. manghas, M. micrantha, O. nutans, P. insularum, and Piper graeffei stimulated significant migration of dermal fibroblasts, while M. micrantha, O. nutans, and P. insularum did not affect cell proliferation at a concentration of 32 μg/mL. ConclusionsThe results suggest that the above-mentioned species of Samoan medicinal plants can be used for the development of new wound healing agents. However, further phytochemical and pharmacological research is needed regarding the isolation and identification of their active constituents.

Epidemiological investigation on clinical characteristics of 801 inpatients with chronic wounds

Objective: To analyze the clinical characteristics of 801 inpatients with chronic wounds. Methods: The medical records of patients with chronic wounds who were admitted to the General Hospital of Southern Theater Command of PLA (hereinafter referred to as the author's unit) from January 2013 to December 2017, including gender, occupation, wound type, age, department distribution, recovery status, recovery time, hospitalization time, hospitalization cost, treatment method, clinical outcome, and medical expenses were retrospectively analyzed. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Kruskal-Wallis H test. Results: Of 245 037 inpatients admitted to the author's unit within 5 years, 801 (3.3‰) patients with chronic wounds met the inclusion criteria. The composition ratio of chronic wound patients during the 5 years was 2.4‰ (106/44 230)-3.9‰ (191/49 342). Among chronic wound patients, there were 527 males and 274 females, with manual labor, retired, and unemployed patients accounted for a large proportion. The main type of chronic wound was unhealed wound after surgery, accounting for 28.2% (226/801), followed by diabetic wound, accounting for 22.7% (182/801) and traumatic wound, accounting for 16.5% (132/801). There was statistically significant difference in gender distribution of patients with different types of chronic wounds (χ(2)=28.236, P<0.05). The main types of wound in male patients were unhealed wound after surgery, diabetic wound, and traumatic wound, while the main types of wound in female patients were diabetic wound and unhealed wound after surgery. There was statistically significant difference in the age group distribution of patients with different types of chronic wounds (P<0.01). Patients aged 41-60 years had a high incidence of unhealed wound after surgery and traumatic wound, and patients aged 61-80 years had a high incidence of diabetic wound. Patients with chronic wounds in department of orthopedics had the highest recovery rate, followed by comprehensive department. There were statistically significant differences in hospitalization time and hospitalization cost of patients with chronic wounds admitted to different departments (χ(2)=47.390, 107.390, P<0.05). There were no statistically significant differences in cure status and cure time of patients with chronic wounds admitted to different departments (χ(2)=7.163, 15.510, P>0.05). Patients treated with surgery in combination with drug had higher recovery rates than patients given other treatment methods. There was no statistically significant difference in the cure rate of patients with different treatment methods (χ(2)=7.600, P>0.05). There were statistically significant differences in cure time, hospitalization cost, and hospitalization time of patients given different treatment methods (χ(2)=38.067, 130.520, 130.890, P<0.05). There were no statistically significant differences in hospitalization cost and hospitalization time of patients with different clinical outcomes (χ(2)=2.070, 5.790, P>0.05). The total medical cost of 801 patients with chronic wounds was about 47 million yuan, of which the total hospitalization cost per capita was 50, 725 yuan, with a minimum of 1 164 yuan and a maximum of about 1.16 million yuan per capita, and with drug and materials costs accounted for high proportions of the total cost. Conclusions: Patients with chronic wounds in the author's unit are mainly physical labor and middle-aged and elderly people, with more male patients than female patients. The main type of wound is unhealed wound after surgery, which brings serious economic burden to the patients and the society. Therefore, it is necessary to strengthen the public knowledge about chronic wounds and improve the awareness of prevention and treatment.

Chronic Wound Healing Assessment System Based on Different Features Modalities and Non-Negative Matrix Factorization (NMF) Feature Reduction

Identification and treatment of chronic wounds (CWs) are considered economic and social challenges, especially with respect to bedridden and elderly persons. CWs do not follow a predictive course of healing within a particular period. Their treatment and management costs are very high. Also, CWs decrease quality of life for patients, which cause severe pain and discomfort. In this paper, we proposed a comprehensive wound healing assessment framework based on current appearance, texture, and prior visual appearance analysis to handle different types of CWs depending on extracting various tissue types. The framework provided an accurate evaluation tool for the CW healing process depending on extracting and fusing significant features from the CWs RGB images. Non-negative matrix factorization (NMF) was used to retrieve the most significant features to reduce computation time. The gradient boosted trees (GBT) classifier was used to classify different tissue types. Finally, the healing assessment of the CWs depended on calculating the improvement in the area of the necrotic eschar, slough, granulation, and healing epithelial tissues. The framework was trained and tested using 377 RGB images from Medetec wound database and national pressure ulcer advisory panel website. The proposed system achieved an average accuracy of 96% for tissue classification, which helps in obtaining an accurate CW healing assessment. This result can be considered as a promising result when compared to the other state-of-the-art techniques.

Wound healing models: A systematic review of animal and non-animal models

Abstract Chronic wounds and ulcers are a significant challenge to researchers and healthcare providers. Research into the area of wound care is in great need due to the increase in incidence and healthcare cost. Wound healing models are essential to test new therapeutics, study the pathogenesis of the tissue repair mechanism and to detect new biomarkers. The aim of this review is to provide an overview for currently available animal and non-animal wound healing models. Several models have been used to study the wound healing process including in silico, in vitro, and in vivo. There is no one single appropriate model for a study to be effective; instead a combination of models should be employed. In conclusion, animal models despite their many disadvantages remain the best available alternative to study the complex cellular and molecular interactions that occur during the wound healing process in a biologically relevant environment. Multiple models are necessary to study different types of chronic wounds due to the lack of an ideal comprehensive model that is close to humans.

Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review.

BackgroundChronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers are a massive burden to health care facilities. Many randomized controlled trials on different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, health care professionals are forced to rely on their own experience when making decisions regarding wound care. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems (CDSS) that help health care providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas of the health care sector, partly because they have increased the quality of care, and partially because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on CDSS within the field of wound care to chronic wounds.ObjectiveThe aims of this systematic literature review are (1) to identify models used in CDSS that support health care professionals treating chronic wounds, and (2) to classify each clinical decision support model according to selected variables and to create an overview.MethodsA systematic review was conducted using 6 databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The search strategy consisted of three facets, respectively: Facet 1 (Algorithm), Facet 2 (Wound care) and Facet 3 (Clinical decision support system). Studies based on acute wounds or trauma were excluded. Similarly, studies that presented guidelines, protocols and instructions were excluded, since they do not require progression along an active chain of reasoning from the clinicians, just their focus. Finally, studies were excluded if they had not undergone a peer review process. The following aspects were extracted from each article: authors, year, country, the sample size of data and variables describing the type of clinical decision support models. The decision support models were classified in 2 ways: quantitative decision support models, and qualitative decision support models.ResultsThe final number of studies included in the systematic literature review was 10. These clinical decision support models included 4/10 (40%) quantitative decision support models and 6/10 (60%) qualitative decision support models. The earliest article was published in 2007, and the most recent was from 2015.ConclusionsThe clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the health care professionals, while qualitative models required interaction with the user.

Pseudomonas aeruginosa as a Powerful Biofilm Producer and Positive Action of Amikacin Against Isolates From Chronic Wounds

Background: Pseudomonas aeruginosa is a Gram-negative and rod-shaped opportunistic pathogen highly involved in biofilm production in chronic wounds. Biofilms in wounds are the main cause of resistance to multiple antimicrobial agents. This study aimed to identify biofilm-producing bacteria most frequently found in chronic wounds and to examine the association of antibiotic resistance among the isolates. Objectives: This study was to evaluate the isolation of P. aeruginosa from different types of chronic wounds, as one of the causes of delay in wound healing and biofilm formation, as well as to determine the association of antibiotic resistance among the isolates. Methods: Ninety-one isolates of chronic wounds were obtained from DHQ Hospital KDA District Kohat (Khyber Pakhtunkhwa), Pakistan, from September 2014 to June 2015. Isolates of P. aeruginosa from different types of chronic wounds were biochemically identified and confirmed by molecular identification of one of the conserved genes, algD GDP-mannose dehydrogenase, in P. aeruginosa. Biofilm-forming ability and effects of antibacterial agents were also determined. Results: The prevalence of diabetic ulcer was found to be more (62.5%) compared to other types of chronic wounds in patients, and 48.3% of the isolates were identified as P. aeruginosa. The prevalence of P. aeruginosa in males was found to be higher (56.8%) than in females, with a statistically non-significant association. Furthermore, biofilm formation was observed in the isolates, so that 79.5% of P. aeruginosa isolates were found to be biofilm producers. Antibacterial drugs were applied to the culture of isolates, showing that P. aeruginosa was more resistant to ceftriaxone while amikacin acted as a bactericidal. Conclusions: From our research, we conclude that delay of wound healing was because of biofilm-producing bacteria found in chronic wounds, which were more resistant to antibiotics because of the ability of biofilm forming. Further, amikacin showed a good activity against P. aeruginosa.

Effects of an Arginine-Enriched Oral Nutritional Supplement on the Healing of Chronic Wounds in Non-Malnourished Patients; A Multicenter Case Series from the Netherlands and Hungary

Aim: To explore the effects of a specific arginine-enriched oral nutritional supplement on the healing of chronic wounds in non-malnourished patients. Method: A case series using a prepared and Medically Ethically approved evaluation template. Out of three clinical centres in the Netherlands and one in Hungary, 27 patients with arterial leg ulcers, venous leg ulcers, diabetic foot ulcers, and pressure ulcers participated. They consumed a specific ready to drink arginine-enriched oral nutritional supplement daily, in addition to their regular diet and standard wound care, for a maximum of 12 weeks. Main outcome measures were wound healing progress, patients’ compliance and rating of the specific nutritional supplement. Results: Seventeen females and twelve males with a mean age of 73.7 years were included. Within 2 to 12 weeks, complete healing occurred in eight ulcers, thirteen ulcers showed clear signs of healing through decreased wound surface area ranging from 25% to 88% reduction, and three ulcers kept unchanged. Overall, the daily oral nutritional supplements, on average two servings per day (= 400 ml), were almost fully consumed (99.5%), and the patients’ rating of the oral nutritional supplement was good. Conclusion: Extra nutritional support with a specific ready to drink arginine-enriched oral nutritional supplement seems to be beneficial for the healing of different types of chronic wounds. The patients’ compliance with the product was very high, and they rated it as good. Further research, especially prospective randomised controlled studies on arginine-enriched oral nutritional supplements in patients with chronic wounds are necessary.

Patients' perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in‐depth qualitative study

Venous leg ulcers are a common and distressing condition that can impair quality of life. Larval therapy has been widely promoted for the treatment of different types of chronic wounds, yet little is known about its acceptability to patients. To explore patients' experiences of venous leg ulceration and of the acceptability of larval therapy as a treatment. Qualitative study, using semi-structured interviews alongside a randomized controlled trial. Interview data were transcribed and analysed for thematic content. Data were collected from April 2007 to July 2007. Eighteen people (12 men, 6 women), aged between 29 and 93 years (median age 64 years), with at least one venous leg ulcer, took part in the study. Fourteen people were recruited from two vascular clinics (one attached to a hospital and the other located in a community setting). A further four people were recruited through referral from a team of community nurses. Participants portrayed lives blighted by the presence of one or more leg ulcers. The majority were willing to try 'maggots' (larvae) and able to overcome feelings of squeamishness because of their strong desire to heal their ulcers. Five people treated with larvae were included in the study. Initial improvements in the condition of their ulcers were not sustained, and two participants experienced severe pain. Patients may hold unrealistic expectations that larval therapy will effect a longed-for cure for their leg ulcer(s) but an absence of healing may lead to feelings of disappointment or despair.

Vacuum therapy for chronic wounds

Chronic wound in patients with diabetes mellitus (DM) is one of the most urgent problems of modern diabetology and surgery. Numberof patients suffering from different types of chronic wounds follows increase in DM incidence. Vacuum therapy is a novel perspectivemethod of topical treatment for non-healing chronic wounds of various etiology. Current review addresses experimental and clinicalevidence for this method.

Genetic Polymorphisms May Influence the Development and Healing of Sitting-Acquired Pressure Ulcers Following Spinal Cord Injury

Sitting-acquired pressure ulcers (SAPUs) are serious secondary complications in individuals with spinal cord injury (SCI). The incidence of pressure ulcers in adults with SCI living in the community is more than 30% per year and up to 80% over a lifetime.1-3 They occur over the bony prominences of the pelvis, and multiple risk factors have been associated with their development and recurrence. One factor that has been associated with a higher rate of recurrence of SAPU is African American race,4 which suggests the possibility of a genetic predisposition to the development of ulceration. Studies on different types of chronic wounds, in particular venous leg ulcers, have found that there is an association between the development of the chronic wound and a number of genetic polymorphisms5-8 (Table 1). One of the polymorphisms has also been associated with impaired healing of chronic venous leg ulcers.9 Most of these polymorphisms are in genes that regulate the expression of different proteins. Table 1. Associations between genetic polymorphisms and venous leg ulcers Genetic polymorphisms are differences in the DNA sequences that occur between individuals, groups, or populations. The variation may occur in the coding region for a protein or may occur in a region that regulates protein expression. Single nucleotide polymorphism (SNP) is a source variance in a genome that is a single base mutation in DNA.10 SNPs are the most simple form and most common source of genetic polymorphism in the human genome (90% of all human DNA polymorphisms). The association of genetic polymorphisms with other types of chronic wounds raises the possibility that the same factors may be associated with the development of SAPUs following SCI. This concept is supported by the clinical observation that some individuals with the similar risk profile develop SAPUs while others are pressure ulcer free, suggesting an inherent predisposition. The association between race and ulcer recurrence after controlling for socioeconomic status strongly suggests a role for genetic factors. The objectives of this work within our research group have been to further examine associations between genetic polymorphisms and venous leg ulcers and more recently to assess associations with SAPUs following SCI.

Evaluation of the Efficacy and Tolerability of a Solution Containing Propyl Betaine and Polihexanide for Wound Irrigation

Wound cleansing represents a fundamental step in chronic wound management. Several investigations in recent years have led to a refinement of the wound cleansing protocol in order to obtain a better control of the bacterial burden during wound bed preparation and to avoid further cell and tissue damage. The aim of the present randomized controlled trial was to investigate the effects of a wound cleansing solution containing polihexanide and betaine in venous leg ulcers by means of clinical and instrumental assessment. A portable device was used on the wound bed to assess surface pH, which has been shown to be one of the most useful non-invasive biophysical parameters in order to correlate the level of bacterial burden in different types of chronic wounds. Baseline pH on the wound surface (median range) was initially 8.9, and after 4 weeks of cleansing treatment and moist wound dressing was reduced and stable at 7.0 in the group treated with active cleanser. The pH value was significantly lower (p < 0.05) in this group compared to the control group at the end of the study. The treatment with the solution containing polihexanide and betaine was well tolerated by the patients and was found useful in the absorption of wound odours.

When and How to Perform a Biopsy on a Chronic Wound

To enhance the learner's competence with knowledge of biopsy techniques and when to perform biopsies on specific chronic wounds. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to: 1. Distinguish between different types of chronic wounds that require biopsies. 2. Apply knowledge of biopsy techniques to obtain quality results. 3. Analyze various types of chronic wounds to determine the appropriate type of biopsy needed.

A guide to dressing selection

An update on the characteristics of different types of chronic wounds and the wound-related criteria for selecting the appropriate types of dressing.