[New therapeutic strategies for the treatment of difficult wounds]

BACKGROUND: The medical-surgical treatment of the difficult wounds represents a socio-sanitary problem in continuous growth, currently involving in our Country around 2,000,000 people. The "difficult wound" is a loss of cutaneous substances, usually due to multifactorial pathogenesis, that do not spontaneously lead to a complete recovery. Numerous studies in the literature have evidenced that the use of the advanced wound dressings allows to reach the best clinical and economic results in the process of recovery of the difficult wounds. The advanced would dressing assures a longer period of permanence on the injury and shorten the time of treatment and, as a consequence, it is required a smaller number of applications in comparison with the traditional medications. The Wound Bed Preparation (WBP) can be defined as the global and coordinate management of the cutaneous injury, enabling to chip off the local barriers to the recovery, or promoting the effectiveness of the innovative therapeutic instruments. The term advanced wound dressing indicates the dressing material having biocompatibility characteristics. The purpose of the advanced wound dressings is the one to create the ideal environment for the cicatrization process and isolate the wound from traumas and external infections. PATIENTS AND METHODS: The "Difficult Wounds" Unit of the Department of Plastic and Reconstructive Surgery of the Policlinico Umberto I in Rome, from January to December 2006, treated 570 patients (308 men and 262 women), whose age was between 2 days and 85 years, affected by ulcers of various nature. Among our cases, 200 patients were selected and randomly separated in two different groups: group A consisting of 100 patients entirely treated with traditional medications; group B composed by 100 patients treated with advanced dressings. Every patient has locally been treated with periodic and specific medications, according to the type of difficult wound, and subsequently they proceeded to find out how to treat the systemic factors causing ulcer. The patients underwent 3 times a week to medications in those cases presenting infection signs and 2 times a week in those cases where no infection signs were shown, for period varying from 1 month up to one year for the chronic forms. RESULTS: The results showed a higher percentage of recovery reached by using the advanced dressings. Group A showed the followings results: the 53% of patients recovered from wounds; the remaining 47% patients did'nt not recover but in 17% cases medications showed to be of some help in the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges), while the remaining 30% has shown a scarce improvement of the injury and they are still under treatment. Group B showed the 65% of patients recovered from wounds; as for the remaining 35% not recovered patients, medications represented an auxiliary aid to the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges) for the 15% of patients, while the remaining 20%, even if not completely recovered, showed a notable improvement of the injury (reduction of the dimensions and disappearance of the infection and improvement of the patient quality of life). CONCLUSIONS: In synthesis, it emerges that the advanced dressings, if correctly used, offer advantages in terms of clinical effectiveness (rapid recovery from the injury), patient quality of the life and cheapness. It has also to be considered that the difficult wound is often the epiphenomenon of a systemic illness. The difficult wound requires, therefore, a multidisciplinary treatment.