Once you have identified that the wound is not healing with standard therapy, there are several steps to take to select the best therapeutic alternative.

Manage the Environment
Is the wound bed moist or dry? Normal wound healing must take place in a moist environment as the epithelial cells need moisture to move from the wound edge to replicate and close the wound. In a dry wound, the epithelial cells burrow down underneath the wound bed where they can find moisture to move in. A moist wound healing environment is not as simple as just retaining moisture in the wound so that it does not dry out. The contents of the wound fluid, in particular the harmful substances generated in chronic wounds, may be efficiently removed or neutralized to establish a normal balanced wound environment, therefore reducing the level of tissue destruction in the chronic wound.

Address the Underlying Problem
Understanding the cellular mechanisms of wound healing has provided wound care clinicians with greater awareness of when and how to apply new biologically active treatments to wounds not responding to standard therapy. As clinicians try to heal wounds faster, they are more likely to make treatment choices that directly address the underlying biological problem. Replacing the missing growth factors cytokines and chemokines in non healing wounds directly address the underlying biological problem. Growth factors can come from two sources: a patients’ own platelets from a small sample of blood or in a concentrated drug form dispensed from a tube. Tissue-engineered skin equivalents have also been used to manage chronic wounds. Research continues to focus on the optimal range of growth factors, concentration and stage in the healing process when growth factors best enhance healing.