The pressing need for new strategies to target Canada’s chronic wound epidemic

By Rosemary Hill

The critical link between long-term chronic wounds, poor quality of life and increased risk of mortality, is an issue drawing urgent attention amongst health professionals.

There are an estimated 11 million people living with diabetes or prediabetes in Canada, and of these between 15-25 per cent of people will go onto develop a diabetic foot ulcer (DFU) during their lifetime. In addition, lower leg ulcers are estimated to affect between 50,000 – 500,000 Canadians, with venous leg ulcers (VLUs) accounting for 90 per cent of all lower extremity ulcers.

These are serious statistics given that 85 per cent of lower limb amputations are preceded by the development of a neuropathic foot ulcer. For diabetic patients with ulcers, the risk of death is increased 2.5-fold compared with diabetic patients without foot wounds.

Yet for an issue this serious, new strategies are clearly needed. Understanding the aetiology of the ulcer and its link with a patient’s lifestyle is insightful and assists in defining the general management approach, however, the potential role of new technological interventions must not be underestimated. Indeed, there is much innovation taking place, the adoption of which in normal clinical practice could have far reaching effects.

Growing body of evidence
A growing body of evidence is emerging to recommend the use of negative pressure wound therapy (NPWT) in the management of patients with delayed healing or stalled lower extremity wounds. Whilst earlier versions of this canister-based technology have been highly effective clinically vs standard care, they retain limitations in their practical mobility, use in a community setting, and overall clinical management.

The technology, however, has been evolving from canister-based platforms of the treatment, to smaller, highly portable, single-use versions; and research is showing a remarkable improvement over an already proven and effective methodology.

A recent multi-centre randomized controlled trial (RCT) carried out by Dr. Robert Kirsner et al., across 18 Canadian and US hospitals looked at wound healing when comparing the use of single-use negative pressure wound therapy system (sNPWT) with traditional NPWT (tNPWT) in the management of patients with lower extremity ulcers over 12 weeks.

The results were promising, showing a significant reduction in wound area (by 39.1%), depth (by 32.5%) and a reduction of 91.1 per cent  in overall wound volume when sNPWT was used compared to traditional NPWT.

As well as improved clinical outcomes the study also noted a reduction in the number of dressing changes as sNPWT can be worn on average 3.4 days longer. Not only does this have clear benefits in terms of reducing nursing time, patients are required to attend less dressing change appointments which can become a barrier to living a ‘normal’ life.

The economic burden
Healing time, frequency of dressing change and incidence of complications are well established factors driving the cost of wound care. Both VLUs and DFUs impose a substantial cost burden on the Canadian health system, both estimated at $100 million and $547 million respectively. Existing methodologies of intervention need updating. The appropriate use of innovative and clinically proven wound management technologies can and must play their part in a step-change strategy.

This may require an evolution in the goal setting, clinical practice, and procurement process, but the upside of a coordinated effort is a direct impact on a significant area of medicine that will improve quality of life and reduce mortality.

Innovation should be at the forefront
The recent evidence from Dr. Kirsner’s study highlights how the adoption of technology and new treatment pathways can help to alleviate some of the current pressures. With an ageing population and the projected rise in diabetes, it is vital more than ever, that a strategy is in place to address the burden of wound care and ways to improve patients’ quality of lives. This includes embracing innovations which disrupt the inefficiencies that we are currently facing with wound care practice.

Click here For more information on the Kirsner study

Rosemary Hill BSN CWOCN WOCC(C) is a Nurse specialized in Wound Ostomy Continence at Vancouver Coastal Health – Lions Gate Hospital.