Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review

Abstract

Healing of non‐traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta‐analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non‐traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta‐analysis to quantify their prognostic value for delayed ulcer healing.

Infrared thermography to prognose the venous leg ulcer healing process—preliminary results of a 12‐week, prospective observational study

“…In the pathogenesis of VLUs, a key event is a self‐accelerating inflammatory reaction triggered by hemodynamic abnormalities, including venous hypertension, venous stasis, and microcirculatory disturbances . The reasons for ulcer occurrence are complex, and their multifactorial etiology makes successful treatment a difficult, long, and unpredictable process . Even if the wound heals, recurrence may appear .…”

“…It is also possible to use the methods of prediction suggested in the references, considering the most frequent prognostic factors of the healing time, such as the initial surface area, wound duration or anatomical classification of venous pathology . The mentioned methods do not provide insight into the dynamics of inflammatory state changes and vascular damage changes that coexist with the healing process, such as the acute inflammatory state, perfusion disturbance, and local and deep tissue damage . Monitoring these processes would enable predicting some complications and an assessment about whether the wound tends to heal or not.…”

“…5 The reasons for ulcer occurrence are complex, and their multifactorial etiology makes successful treatment a difficult, long, and unpredictable process. 3,5,6 Even if the wound heals, recurrence may appear. 7 Nonhealing ulcers are the greatest challenge because they are resistant to standard methods of therapy.…”

“…10,11 The mentioned methods do not provide insight into the dynamics of inflammatory state changes and vascular damage changes that coexist with the healing process, such as the acute inflammatory state, perfusion disturbance, and local and deep tissue damage. 5,6 Monitoring these processes would enable predicting some complications and an assessment about whether the wound tends to heal or not.…”

Thymosin β4: potential to treat epidermolysis bullosa and other severe dermal injuries

“…D ermal wound healing is a multistep process that is impaired or delayed for many individuals, such as aged, immobilized, and/or diabetic patients. Furthermore, many patients suffer from deep and/or large wounds that do not heal quickly and result in significant scarring and thus loss of tissue function [1,2]. Patients with epidermolysis bullosa suffer from repeated dermal blisters that result in painful wounds that in some forms of the disease are life-threatening [3,4].…”