Wound Bed Preparation 2024: Delphi Consensus on Foot Ulcer Management in Resource-Limited Settings
Hiske Smart, R. Gary Sibbald, Laurie Goodman, Elizabeth A. Ayello, Reneeka Jaimangal, John Gregory, Sadanori Akita, Afsáneh Alavi, David G. Armstrong, Helen Arputhanathan, Febe Bruwer, Jeremy Caul, Beverley Chan, Frans Cronje, Belen L. Dofitas, Jassin Hamed, Catherine Harley, Jolene Heil, Mary Hill, Devon M. Jahnke, Dale Kalina, Chaitanya Kodange, Bharat Kotru, Laura Lee Kozody, S. J. Landis, Kimberly LeBlanc, Mary MacDonald, Tobi Mark, Carlos Martı́n, Dieter Mayer, Christine Murphy, Harikrishna K.R. Nair, César Orellana, Brian Ostrow, Douglas Queen, Patrick Rainville, Erin M. Rajhathy, Gregory S. Schultz, Ranjani Somayaji, Michael Stacey, Gulnaz Tariq, Gregory Weir, Catharine Whiteside, Helen Yifter, Ramesh Zacharias
Abstract
ABSTRACT GENERAL PURPOSE To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Summarize issues related to wound assessment. 2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes. 3. Synthesize strategies for wound management, including treatment in resource-limited settings. 4. Specify the target time for edge advancement in chronic, healable wounds. BACKGROUND Chronic wound management in low-resource settings deserves special attention. Rural or underresourced settings (ie, those with limited basic needs/healthcare supplies and inconsistent availability of interprofessional team members) may not have the capacity to apply or duplicate best practices from urban or abundantly-resourced settings. OBJECTIVE The authors linked world expertise to develop a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. METHODS A group of 41 wound experts from 15 countries reached a consensus on wound bed preparation in resource-limited settings. RESULTS Each statement of 10 key concepts (32 substatements) reached more than 88% consensus. CONCLUSIONS The consensus statements and rationales can guide clinical practice and research for practitioners in low-resource settings. These concepts should prompt ongoing innovation to improve patient outcomes and healthcare system efficiency for all persons with foot ulcers, especially persons with diabetes.