Guest JF, Ayoub N, McIlwraith T Health economic burden that wounds impose on the National Health Service in the UK. BMJ. 2015;

Vowden P. Hard-to-heal wounds made easy. Wounds International. 2011; 2:(4)1-6

Chamanga E. Clinical management of non-healing wounds. Nursing Standard. 2018; 32:(29)48-63

Parnham A, Bousfield C. The influence of matrix metalloproteases and biofilm on chronic wound healing: a discussion. British Journal of Community Nursing. 2018; 23:S22-S29

Boyd G, Butcher M, Glover D, Kingsley A. Prevention of non-healing wounds through the prediction of chronicity. J Wound Care. 2004; 13:(7)265-266

Cullum N, Buckley H, Dumville JC Wounds research for the patient benefit: a 5-year programme of research. Programme Grants for Applied Research. 2016; 4

Malone M, Swanson T. Biofilm-based wound care: the importance of debridement in biofilm treatment strategies. British Journal of Community Nursing. 2017; 22:S20-S25

Attinger C, Wolcott R. Clinically addressing biofilm in chronic wounds. Advances in Wound Care. 2012; 1:127-132

Newton H, Edwards J, Mitchell L, Percival SL. Role of slough and biofilm in delaying healing in chronic wounds. Br J Nurs. 2017; 26:S4-S11

Leid JG The exopolysaccharide alginate protects Pseudomonas aeruginosa biofilm bacteria from IFN-g-mediated macrophage killing. J Immunol. 2005; 175:(11)7512-7518

Wolcott RD, Rhoads DD. A study of biofilm based wound management in subjects with critical limb ischaemia. J Wound Care. 2008; 17:(4)145-155

Greener B, Hughes AA, Bannister NP, Douglass J. Proteases and pH in chronic wounds. J Wound Care. 2005; 14:(2)59-61

Munro G. Causes and considerations with chronic wounds: a narrative review of the evidence. Wound Practice and Research. 2017; 25:(2)88-97

Woundchek protease atatus for assessing elevated protease status in chronic wounds. Medtech innovation briefing No. 83.: NICE; 2016

Gibson D, Cullen B, Legerstee R MMPs made easy. Wounds International. 2010; 1:1-6

Bosanquet DC, Harding KG. Wound duration and healing rates: cause or effect?. Wound Repair Regen. 2014; 22:143-150

Schultz GS, Sibbald RG, Falanga V Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003; 11:S1-S28

Best practice statement: holistic management of venous leg ulceration.: Wounds UK; 2016

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Dowsett C. Biofilms: a practice-based approach to identification and treatment. Wounds UK. 2013; 9:(2)68-72

Shultz G, Bjarnsholt T, James GA Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. 2017; 25, 25:(5)744-757

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Management of hyperkeratosis of the lower limb: consensus recommendations. Wounds UK. 2015; 11:(4)

Graves N, Finlayson K, Gibb M Modelling the economic benefits of gold standard care for chronic wounds in a community setting. Wound Practice & Research. 2014; 22:(3)163-168

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Assessment and management of chronic wounds

02 February 2019
Volume 3 · Issue 1

The prevalence of chronic wounds is rising, partly due to the increase of longevity in the population but also they can occur in younger people also. Chronic wounds are more prevalent in adults over 65 years, and have a significant burden on both the NHS and the patient. A recent study extrapolated that there are 2.2 million people with wounds in the UK with an overall cost of £5.3 billion of which £3.2 billion was spend on chronic wounds.1

Chronic wounds are described as those that fail to heal within a predicted timeframe, they are also known as hard-to-heal, non-healing, recalcitrant, challenging or complex wounds.2 It is thought that during the process of normal healing, there is a balance of healthy proteins and enzymes in the wound that promote healing.

Any disruption in this balance can lead to the development of a chronic wound.3 In addition, any intrinsic factors, such as age or comorbidities, or extrinsic factors, such as lifestyle, smoking, excessive alcohol or medication, can affect the chemical balance in the wound bed, leading to a prolonged inflammatory response, a defective extracellular matrix (ECM) and a failure to re-epithelialise. One study suggests that chronic wounds are more complex than acute wounds, due to this prolonged inflammatory response and therefore are more difficult to heal and last many months or years.4 Another suggests that a wound that has not exhibited any signs of progression within first 2–3 weeks could be demonstrating chronicity.5

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