title: Evolution or revolution? Adapting to complexity in wound management.
abstract: Wound clinics are seeing an increase in the number of 'complex' wounds, which arise as the result of the interaction between multiple coexisting systemic pathologies, environmental factors and local wound factors. These complex wounds require an approach to diagnosis and management that can encapsulate all these factors. Unified wound assessment approaches such as HEIDI (History, Examination, Investigations, Diagnosis and management plan), wound bed preparation and applied wound management systems are essential to reach a definitive diagnosis and to ensure that management is agreed between the various clinical specialities that may be involved. A series of case histories is presented that illustrate the benefits of a unified approach to wound management. Results of a study into the cost-effectiveness of an improved foam dressing are presented, and the problems of demonstrating the ability to make long-term savings through short-term expenditure are discussed.
authors.affiliation: Wound Healing Research Unit, Cardiff MediCentre, Wales, UK. hardingkg@cardiff.ac.uk
authors.forename: Keith
authors.initials: K
authors.lastname: Harding
authors.forename: David
authors.initials: D
authors.lastname: Gray
authors.forename: John
authors.initials: J
authors.lastname: Timmons
authors.forename: Theresa
authors.initials: T
authors.lastname: Hurd
mesh_terms: D016512:Ankle Injuries / Q000628:therapy; D001458:Bandages; D002481:Cellulitis / Q000175:diagnosis / Q000628:therapy; D015897:Comorbidity; D003646:Debridement; D004867:Equipment Design; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D007871:Leg Ulcer / Q000628:therapy; D009336:Necrosis; D011140:Polyurethanes / Q000627:therapeutic use; D003668:Pressure Ulcer / Q000601:surgery / Q000628:therapy*; D016135:Spinal Dysraphism / Q000453:epidemiology; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D011140:Polyurethanes; C081143:allevyn