Chronic wounds affect approximately 8.2 million people in the United States (Nussbaum et al., 2018) and their incidence is expected to rise due to an aging population and risk factors such as diabetes and obesity increasing in our nation. Severe disabilities may result due to chronic wounds despite the best care delivered, and it has been reported that ulcers precede 85% of all amputations (Järbrink et al., 2017). Negative effects of chronic wounds in the patient’s quality of life have been reported due to mobility restrictions, pain, social isolation and work restrictions (Kapp, 2018).

Timely referral to a wound healing specialist of a patient with a chronic wound is vital because they are familiar with coordinating the care of the patient with a multidisciplinary team approach with subspecialists such as endocrinology and infectious disease; and surgical specialties such as orthopedic, vascular and plastics. They also collaborate with nutritionists, physical therapists, orthotists, home health nurses and social workers with a common goal to heal a wound and help the patient (Moore, Webster & Samuriwo, 2015). Several studies, including a recent one from 2019, have reported higher wound closure rates for patients treated by certified wound healing specialists and found that they were more likely to initiate off-loading strategies earlier in the treatment and to use specialized wound care products for intervention (Gonzalez, Delgado & Buscemi, 2019).

Which patients should be referred to a wound healing specialist?

• Patients with non-healing wounds that have been present for more than 4-6 weeks.
• Patients with non-healing wounds with significant risk factors for wound healing such as diabetes, peripheral vascular disease and renal failure.
• Patients with chronic wounds with nerve, tendon, bone or muscle exposed.
• Patients with non-healing diabetic foot ulcers, ischemic ulcers, neuropathic ulcers, pressure injuries (previously called pressure ulcers), vasculitic ulcers and venous stasis ulcers.

References

Gonzalez, A., Delgado, V., & Buscemi, C. P. (2019). Wound Closure Rates: A Comparison Between Advanced Practice Registered Nurse and Primary Care Physician Treatment. Journal for Nurse Practitioners, 15(9), e173—e176. 

Järbrink, K., Ni, G., Sönnergren, H., Schmidtchen, A., Pang, C., Bajpai, R. & Car, J. (2017). The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Systematic Reviews, 6 (15), 1-7. doi:10.1186/s13643-016-0400-8

Kapp, S, Miller, C. & Santamaria, N. (2018). The quality of life of people who have chronic wounds and who self‐treat. Journal of Clinical Nursing: 27: 182— 192. 

Moore, Z.E.H., Webster, J., Samuriwo, R. (2015). Wound-care teams for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews, 9. Art. No.: CD011011. doi: 10.1002/14651858.CD011011.pub2.

Nussbaum, S.R., Carter, M.J., Fife, C.E, et al. (2018). An economic evaluation of the impact,      cost, and Medicare policy implications of chronic nonhealing wounds. Value Health, 21, 27—32.