Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland.
General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland.
World J Surg. 2021 Apr;45(4):1071-1079. doi: 10.1007/s00268-020-05901-8. Epub 2021 Jan 12.
Although the lifetime prevalence of chronic ulcers tends to be approximately 2.2-10 per 1000 population, no systemic solutions for this problem have been implemented in many countries. It is still not fully agreed whether treatment of chronic wounds requires hospitalization, which incurs high costs, or whether the therapy can be carried out entirely in an outpatient setting. Therefore, the aim of this study was to evaluate the 5-year activity and effectiveness of a national programme for the comprehensive treatment of chronic wounds based on hybrid care for patients. Treatment of nonhealing chronic wounds begins in the hospital, where necessary diagnostic actions are carried out, followed by surgical cleansing of the wound and selection of appropriate dressings. Then, the treatment is continued in the outpatient setting with a continuous patient education. The programme is divided into four subsequent stages. In addition, the present study compared the effectiveness of chronic wound treatment with that in the period before implementation of the programme.
From January 2015 to December 2019, 383 patients were treated at a centre for chronic wounds. We analysed the outcomes in 227 individuals with chronic venous ulceration or diabetic foot syndrome.
The mean wound area at the time of introduction of treatment was 36 cm2 (1-290; SD 34). After three stages of treatment, wounds were completely healed in 139 patients (61.2%), 78 patients with venous ulcers (55.3%) and 61 patients with diabetic foot (70.9%). In an additional 67 cases (29.5%), a significant reduction in wound area and depth was achieved, and the treatment was continued beyond the actual treatment programme. No significant effect was achieved in 21 patients (9.2%). In the group of patients treated without systematic application of the guidelines of the programme, wound healing occurred only in 19 cases (26.8%), reduction in the wound area occurred in 27 patients (38.0%), and lack of any healing progress or even worsening of the wound status was found in the remaining 25 cases (35.2%); these differences were statistically significant (p < 0.001).
Treatment of chronic wounds based on a systematic dedicated programme using an experienced multidisciplinary team of professionals allows to obtain better results in terms of reduction in wound area and might be an effective procedure. The combination of frequent, scheduled outpatient visits, access to inpatient treatment, and regular education of patients based on a standard form improves treatment outcomes.
尽管慢性溃疡的终生患病率约为每 1000 人中有 2.2-10 人，但许多国家尚未针对这一问题实施系统性解决方案。对于慢性伤口的治疗是否需要住院，这会产生高昂的费用，还是可以完全在门诊环境中进行，人们仍未完全达成共识。因此，本研究旨在评估一项基于混合护理为患者提供全面治疗的慢性伤口综合治疗的全国性计划的 5 年活动和效果。非愈合性慢性伤口的治疗始于医院，在那里进行必要的诊断措施，然后对伤口进行外科清创，并选择适当的敷料。然后，在门诊环境中继续进行治疗，并对患者进行持续的教育。该计划分为四个后续阶段。此外，本研究还比较了实施该计划前后慢性伤口治疗的效果。
从 2015 年 1 月至 2019 年 12 月，在一个慢性伤口中心治疗了 383 名患者。我们对 227 名慢性静脉溃疡或糖尿病足综合征患者的结果进行了分析。
引入治疗时的平均伤口面积为 36cm2（1-290；SD 34）。经过三个阶段的治疗，139 名患者（61.2%）、78 名静脉溃疡患者（55.3%）和 61 名糖尿病足患者（70.9%）的伤口完全愈合。在另外 67 例（29.5%）中，伤口面积和深度显著减小，治疗继续超出实际治疗计划。21 名患者（9.2%）未取得显著效果。在未系统应用该方案指南治疗的患者组中，仅 19 例（26.8%）伤口愈合，27 例（38.0%）伤口面积减小，25 例（35.2%）无任何愈合进展甚至伤口状况恶化；这些差异具有统计学意义（p<0.001）。
基于使用经验丰富的多学科专业人员的系统专用计划治疗慢性伤口可以获得更好的结果，降低伤口面积，可能是一种有效的治疗方法。频繁、定期的门诊就诊、获得住院治疗以及基于标准表格对患者进行定期教育的组合可改善治疗结果。
