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Chronic wounds

Abstract

Chronic wounds are characterized by their inability to heal within an expected time frame and have emerged as an increasingly important clinical problem over the past several decades, owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. Even up to a few years ago, the management of chronic wounds relied on standards of care that were outdated. However, the approach to these chronic conditions has improved, with better prevention, diagnosis and treatment. Such improvements are due to major advances in understanding of cellular and molecular aspects of basic science, in innovative and technological breakthroughs in treatment modalities from biomedical engineering, and in our ability to conduct well-controlled and reliable clinical research. The evidence-based approaches resulting from these advances have become the new standard of care. At the same time, these improvements are tempered by the recognition that persistent gaps exist in scientific knowledge of impaired healing and the ability of clinicians to reduce morbidity, loss of limb and mortality. Therefore, taking stock of what is known and what is needed to improve understanding of chronic wounds and their associated failure to heal is crucial to ensuring better treatments and outcomes.

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Fig. 1: Representative clinical photographs of typical chronic wounds.
Fig. 2: Wound healing in acute and chronic wounds.
Fig. 3: The inflammatory component of wound healing in normal healing and chronic wounds.
Fig. 4: Key pathway components to impaired healing in chronic wounds.
Fig. 5: General algorithm of evaluation, diagnosis and treatment of chronic wounds.
Fig. 6: Wound bed scoring system.

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Introduction (V.F.); Epidemiology (D.M.); Mechanisms/pathophysiology (R.R.I. and A.M.S.); Diagnosis, screening and prevention (M.R. and M.G.); Management (K.H.); Quality of life (S.K.); Outlook (V.F.).

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Cochrane Wounds systematic reviews database: https://wounds.cochrane.org/news/reviews

Diabetic Foot Consortium: http://diabeticfootconsortium.org/

Lindsay Leg Club Foundation: https://www.legclub.org/

United States Diabetes Surveillance System: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html

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Falanga, V., Isseroff, R.R., Soulika, A.M. et al. Chronic wounds. Nat Rev Dis Primers 8, 50 (2022). https://doi.org/10.1038/s41572-022-00377-3

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