• Helena Jorge Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Cláudia Silva Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Cíntia Pinto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Ana Almeida Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Luís Mendes Pedro Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
Keywords: Complex Wound Management


Introduction: The treatment of wounds is a topic with growing interest due to the physical and psychosocial implications, to the costs associated with the treatments and also due to the stress caused to the patients, families and the health system.

The World Health Organization (WHO) considers chronic wounds as an epidemic due to its high prevalence. In Portugal the available epidemiological data is limited but it is estimated that there are 3.3 wound carriers per thousand inhabitants. The aim of the present narrative review is to clarify the approach to the treatment of complex wounds in light guidelines issued by the European Wound Management Association (EWMA).

Material and Methods: A narrative review was carried out on the current aspects of the approach to the complex or difficult-to-heal wound (wound that does not heal by 40–50% of its size in 4 weeks). A literature search was carried out in Pubmed and in the latest consensus documents prepared by the EWMA (European Wound Management Association) which was integrated in the authors' experience.

Results: The approach to the complex wound must be systematic in dedicated centers and conducted by multidisciplinary teams. It should be mediated by a wound manager and the wounded person must always act as a partner. Proper training of the person/family/caregiver is also crucial. Infection control should start with simple and inexpensive interventions such as hand hygiene and the use of personal protective equipment for patients and professionals in the treatment rooms. The most advanced therapies are based on new principles and technologies and its application should be evidence-based. Algorithms in health are useful tools to support the clinical decision and an algorithm for the treatment of complex wounds is presented.

Conclusion: The approach of complex wounds must encompass multifactorial aspects and the choice of advanced therapies must be judicious.


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Review Article