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Classification for Wound Bed Preparation and Stimulation of Chronic Wounds

Falanga V (2000) Classification for Wound Bed Preparation and Stimulation of Chronic Wounds, Wound Repair and Regeneration; 8 (5): 347 - 352 (Editorial)

Abstract

Over the last several years, we have seen the exciting development and marketing of new and innovative technologies for the treatment of chronic wounds, such as topically applied growth factors and bioengineered skin products. However as excitement continues to build and more technologically advanced products are developed, pharmaceutical companies and clinicians alike are discovering a harsh reality, which, perhaps, should have come as no surprise. The reality is that even the most advanced and sophisticated products require proper wound care and wound bed preparation. In my opinion, there are two closely linked factors playing a role in this interesting failure to recognise the importance of optimal basic wound care. One reason is that clinical trials performed for testing the efficacy of wound care products are generally performed in experienced centres and by investigators already well versed in the evaluation of wounds and their basis care. Under these circumstances, the likelihood of a useful product to show efficacy is maximized. Once products are marketed, the second explanation comes into play. Pharmaceutical and biotechnology companies simply did not realise that general knowledge about the management of chronic wound is often lacking in the medical community. Standards and guidelines for treatment are generally available, but are often not followed. Thus, for a product to succeed once it's on the market, considerable efforts have been proven necessary to teach or remind clinicians about proper wound care. Ironically, there is a real and dramatic beneficial effect of all this. Because more advanced, and often expensive products have to be very effective to be properly marketed, the standards for wound care in the medical community at large are also improving. You might say that new products are driving appropriate wound care and are improving the very therapeutic approaches they are competing with. Although this editorial is about wounds, I feel that the discussion would be similar if we were talking about treatments for hypertension, or congestive heart failure, or diabetic control. As clinicians, we think we are always doing the very best for our patients, but there seems to be a drive to do more and to do it better when we want a new therapy to work well. This discussion is centred on chronic wounds in the context of using advanced therapeutic agents. Specifically, I am proposing two chronic wound classifications which I hope will prove useful in the clinical setting and in therapeutic trials. One classification deals with scoring wound bed preparation, and should be applicable to all types of wounds. The other classification is more specific, having to do with classifying the appearance and early clinical outcome of bioengineered skin.