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Wound healing is a critical physiological process to maintain the integrity of the skin as a mechanical barrier after trauma. It can be generally divided into hemostatic, inflammatory, proliferative, and remodeling phases. Complex wounds classically arrest in the inflammatory phase without further progression. Many factors can lead to this, including poor systemic conditions or poor local tissue environments such as vascular compromise or infection. Proper understanding of the healing process is essential when addressing any complex wound. This activity reviews the evaluation and treatment of complex wounds and highlights the importance of the interprofessional team approach when evaluating patients with this condition. Objectives: Review the basic concepts of wound healing and discuss factors that affect the healing process. Explain how to evaluate patients presenting with complex wounds. Describe the current practice in the treatment of complex wounds. Outline the management by an interprofessional team in dealing with complex wounds. Access free multiple choice questions on this topic.

Wound healing is a complex dynamic biomechanical process as the body attempts to restore the integrity of traumatized or devitalized tissues. Chronic wounds are defined as longstanding tissue injuries that cannot be treated with conventional methods of wound dressing or closure either due to local tissue factors or systemic factors.[1] Recently, chronic wounds have been described as “complex wounds,” a term more representative of the multifactorial dynamic tissue healing process. For a wound to be classified as a complex wound, it should show one of the following features[2]: Persistent for more than three months Compromised vascularity or necrosis Presence of infection Associated comorbidities impair healing potential There are many factors, both local and systemic, that can affect wound healing. Local factors include wound depth, infection, peripheral vascular disease, radiotherapy, sustained pressure, and excessive moisture. While systemic factors include metabolic disorders such as diabetes mellitus, immunodeficiency, and nutritional deficiencies.[3] Complex wounds cause a huge burden on both the individual level (health-related quality of life) and the institutional level (economic cost). It is estimated that 1 to 3% of the health care expenses in developed countries go for complex wound management. This represents around the US $25 billion a year in the united states. This figure is subjected to further increase as the number of chronic morbidities rises in the community.[4][5][6][7]

General complications include bleeding, failure of the treatment regime, skin maceration, and infection. Specific Complications Leech therapy: The mouth and digestive tract of the leech contain Aeromonas spp., which aids in the digestion of the blood. It is pathogenic to man, and the presence of venous congestion leads to localized immuno-suppression. Hence the need for antibiotic prophylaxis. Persistent, prolonged bleeding can occur, which may be significant, especially in children. Therefore, daily monitoring of the hemoglobin level is mandatory. Allergic reactions, migration to healthy tissues, and pre-renal azotemia are also reported complications.[61][73] Hyperbaric oxygen: Potential unwanted effects include claustrophobia, ear discomfort, potential neural toxicity due to high oxygen pressure.[65]

Complex wounds are challenging clinical situations. An interprofessional team approach that provides holistic assessment and evaluation of each patient and addresses their different needs is the cornerstone in managing such cases. Regular communication between the team members is a key element for a better outcome. Thus should include wound care specialists such as tissue viability nurses, dietitians, microbiology, occupational therapists, and other specialists, such as diabetic team, vascular or plastic surgeons. The primary goal should be wound closure if possible. In some cases, this may not be achievable. Thus, optimization of the quality of life should be the aim.[88][1] [Level 4]