If you’re a wound care clinician, you’re well-aware more research is needed on wound care and wound healing.

Locating evidence-based findings on wound healing from literature can be a difficult undertaking.

There is a great need for more research and evidence regarding wound healing not only because of its scarcity, but also because of the pervasiveness and cost of chronic wounds.

“Two percent of the population at any given point in time in the U.S. and worldwide has a chronic open wound,” said Gayle M. Gordillo, MD, FACS, professor and chief in the Division of Plastic Surgery, Department of Surgery at the Indiana School of Medicine, Medical Director of Wound Services at Indiana University Health.

She is also president of The Plastic Surgery Foundation.

As president of The Wound Healing Foundation and founder of Precision Consulting based in Missouri City, Texas, Laura K.S. Parnell, M.S., B.S., points out the mortality rate for people with chronic wounds is quite high.

“A 2007 study concluded the five-year mortality rate for patients with diabetic foot disease was nearly as great as all cancers combined,” Parnell said.

This study was updated and published in 2020 with more recent disease statistics and the findings were similar.

Additionally, the economic impact in the U.S. from diabetic foot disease and cancer is nearly equal at approximately $80 billion dollars each, annually.

Why is there a shortage of research?

Wound care clinicians and others may wonder, why isn’t more research conducted on wound care and wound healing?

Parnell said wounds are generally viewed by many as a comorbidity and complication of other medical conditions.

“Wounds are not recognized as a specific entity to research by themselves,” Gordillo said. “Two examples are pressure injuries and diabetic foot ulcers. Many view pressure injuries as a complication of spinal cord injuries and diabetic foot ulcers as a complication of diabetes.”

Wounds don’t always get the same attention that other health conditions do. Patients with chronic wounds are generally the most marginalized in our society, such as nursing home patients, Gordillo said.

“You don’t see anyone organizing fundraising walks for patients with chronic wounds,” she said.

Healthy patients rarely have wounds

Another factor impacting a lack of wound healing research is that it’s unusual to see a chronic wound in healthy patients.

“Chronic wounds typically occur in patients with multiple comorbidities, so the cause can be multifactorial and very complicated,” Gordillo said. “This makes it more challenging and costly to conduct research.”

Another issue is when wound research does occur, most is based on animal models and not typically based on human models, Gordillo noted.

“When it comes to wound healing, conducting research with human materials and human subjects has the most impact,” she said. “However, doing so significantly increases the cost as well as the size of the research team that is needed.”

Wound research based on animal models will not reflect the complexities of humans with chronic wounds. “There is an old saying that mice don’t smoke, drink beer and eat cheeseburgers like humans do,” she said.

According to Gordillo, additional factors to consider with wound healing research and when providing clinical care include:

Where to get wound healing research grants

Both the Wound Healing Foundation and the Plastic Surgery Foundation award a variety of wound healing research grants for which researchers can apply.

The Wound Healing Foundation provides research grants to faculty, junior faculty and post-docs with nonprofit organizations, academic centers, and medical schools.

“It’s overwhelming how much we don’t know,” Parnell said.

Some points the Wound Healing Foundation considers when deciding where to award grant money include:

  • What is the scientific merit of the planned research?
  • Does the research address gaps in our current knowledge?
  • Will the findings impact clinical outcomes?

Gordillo said the Plastic Surgery Foundation gave out $1 million in funding last year for research.

The foundation awards funding to residents and research fellows in plastic surgery, plastic surgeons on faculty at academic institutions, and plastic surgeons in private practice.

Sometimes grant money also is awarded to Ph.D.s or MPHs, as long as they are collaborating with a plastic surgeon on their wound healing research, she said.

More wound research is crucial

There are many areas where more research and evidence are needed regarding wound healing, Gordillo said.

“One is the gap in knowledge regarding the role of biofilm and the role it plays in underlying wound infections,” she said.

One challenge with biofilm is that it is difficult to identify with traditional laboratory technologies currently used in clinical practice, she said.

“The only way to diagnose a biofilm is by using laboratory technology that is only available in academic centers involved in wound research,” Gordillo said.

She described one of the many problems that can develop with biofilm: When debriding a wound, one can inoculate the deeper tissues with biofilm if it’s present, thus, it’s important to know if it’s there or not.

“Biofilm is a smart and formidable foe,” she added.

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Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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