Riza Stefania-Mihaela, Porosnicu Andrei-Ludovic, Hariga Cristian-Sorin, Sinescu Ruxandra-Diana
Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.
Department of Plastic Surgery and Reconstructive Microsurgery, Elias Emergency University Hospital, 011461 Bucharest, Romania.
Medicina (Kaunas). 2025 Jun 13;61(6):1085. doi: 10.3390/medicina61061085.
Chronic wounds pose a significant challenge to healthcare systems, requiring long-term management and multidisciplinary approaches. The absence of a standardized national therapeutic protocol in Romania has resulted in inconsistent clinical practices, which in turn affect treatment efficacy and patient outcomes. The implementation of structured guidelines and the integration of regenerative therapies could enhance the management of chronic wounds. This study employs a cross-sectional observational design to assess the current management strategies among physicians treating chronic wounds and to identify variations in treatment approaches. A 37-question questionnaire was distributed among plastic surgeons, general surgeons, vascular surgeons, and dermatologists via Google Forms. The data collection period spanned one month, resulting in a total of 240 responses from medical centers in Bucharest, Romania. The study found that most physicians treated several cases per week (40.8%) of delayed healing wounds, with the most frequent types being bedsores (57.5%) and diabetic (58.3%) or venous ulcers (55%). Challenges in wound care included patient reluctance, financial constraints, and the psychological burden on caregivers. The most relevant decision factor for surgical treatment was wound stage (86.7%). Most physicians used an initial conservative approach in wound care (52.5%) or did not have a standard approach (44.2%). Around a quarter of respondents (25.8%) used PRP as a treatment method, considering it to have moderate effectiveness (51.6%). The most important factor for encouraging PRP usage was having the necessary equipment for the procedure (72.5%). The most frequently considered benefit in the case of implementing a treatment protocol was increased treatment efficacy (62.5%). Physicians were also highly interested in the use of a standardized treatment protocol (40%). Approximately 41.7% of the physicians expressed a very high interest in having a standardized diagnostic system for chronic wounds. This study highlights that wound care practices remain variable and that the decision-making process is often challenging. There is a moderate belief in the effectiveness of PRP, suggesting that logistical barriers need to be addressed to facilitate access to it. Therapeutic protocols were seen as key to improving care efficacy and consistency, therefore pressing the need for national strategies that support protocol development.
慢性伤口给医疗系统带来了重大挑战，需要长期管理和多学科方法。罗马尼亚缺乏标准化的国家治疗方案，导致临床实践不一致，进而影响治疗效果和患者预后。实施结构化指南和整合再生疗法可以加强慢性伤口的管理。本研究采用横断面观察设计，以评估治疗慢性伤口的医生当前的管理策略，并确定治疗方法的差异。通过谷歌表单向整形外科医生、普通外科医生、血管外科医生和皮肤科医生发放了一份包含37个问题的问卷。数据收集期为一个月，共收到来自罗马尼亚布加勒斯特医疗中心的240份回复。研究发现，大多数医生每周治疗几例（40.8%）延迟愈合伤口，最常见的类型是褥疮（57.5%）以及糖尿病（58.3%）或静脉溃疡（55%）。伤口护理面临的挑战包括患者抵触、经济限制以及护理人员的心理负担。手术治疗最相关的决定因素是伤口阶段（86.7%）。大多数医生在伤口护理中采用初始保守方法（52.5%）或没有标准方法（44.2%）。约四分之一的受访者（25.8%）使用富血小板血浆（PRP）作为治疗方法，认为其有效性中等（51.6%）。鼓励使用PRP的最重要因素是拥有该 procedure 所需的设备（72.5%）。实施治疗方案时最常考虑的益处是提高治疗效果（62.5%）。医生们对使用标准化治疗方案也高度感兴趣（40%）。约41.7%的医生对拥有慢性伤口标准化诊断系统表示非常感兴趣。本研究强调，伤口护理实践仍然存在差异，决策过程往往具有挑战性。人们对PRP的有效性有一定程度的认可，这表明需要解决后勤障碍以促进其使用。治疗方案被视为提高护理效果和一致性的关键，因此迫切需要支持方案制定的国家战略。
