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COMPLEX WOUNDS
1 Complex wounds may be chronic or acute.
These wounds are superficial, partial-thickness,
or full-thickness wounds that heal by 5 A wound is classified as chronic
if it fails to heal within 30
secondary intention. days despite clinical interven-
tions to promote healing.
2 Common
complex
6
Complex
wounds include wounds are
extremely
fungating lesions, difficult and costly to
venous leg treat. The annual cost
of managing these
ulcers, diabetic wounds is estimated
foot ulcers, to be around
$25 billion in
pressure injuries, the United
open trauma, States.
and wound
fistulas. 7 The number of
complex wounds has
been increasing and will

3 The prevalence of
complex wounds in the
United States is estimated to be
likely continue to increase
as a result of an aging
population and trauma in
2.5% of the total population. large urban centers.

4 8
Most complex wounds are pressure Skilled complex wound management is
necessary because these wounds have a
injuries, which have a global diverse etiology and clinical presentation.
prevalence of 12.8% of adult hospi-
talized patients.
9 The presence of complex 10 The development of 11 Additional risk fac-
12 Individuals with peripheral vascular
disease, HIV or AIDS, a high body
mass index, or inflammatory disease may
wounds also leads to complex wounds usually tors for complex wounds have an elevated risk for developing
increased morbidity includes one or more risk include massive skin loss or
and mortality rates and factors. The most frequent severe burns, infection-com- complex wounds. Those who smoke or
longer hospital risk factors are the promised blood flow from use corticosteroids or other medications
stays. presence of diabetes an underlying condition, that compromise wound healing
and advanced age. poor overall health, and also have an elevated risk.
medication side effects.

13 Complex wounds often require advanced care strategies because

the use of traditional dressings is often insufficient to promote healing.

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16
14 Advanced 15 NPWT is also called vacu- NPWT can provide many benefits for com-
therapies for complex um-assisted wound closure. plex wounds by promoting wound
wounds include It uses a suction pump, tubing, healing and preparing the wound
negative pressure and dressings to remove excess
wound therapy exudate and promote healing
bed more quickly. It achieves this by stimulat-
(NPWT) and cellular in complex wounds by applying ing granulation tissue formation, increasing blood
and tissue-based subatmospheric pressure to the flow to the wound, and reducing the amount of
products (CTPs). wound environment. exudate and edema present.

17 18
NPWT often leads to a reduction NPWT often also
improves the quality
in wound size and quicker wound of life for patients
because it requires fewer
closure, less need for and complexity of dressing changes and leads to a
faster healing time and a quicker
surgical therapy, and improved clinical outcomes. return to normal activities.

20 Dermoinductive 22 CTP use is an 23 CTPs facilitate

CTPs are derived effective treatment the regeneration of
from living cell strategy for complex skin appendages,
cultures contain- 21 Dermoconductive wounds and demon- such as hair follicles,
ing keratinocytes, CTPs provide strates evidence of ac- sweat glands, and
19 CTPs comprise fibroblasts, or both. scaffolding within celerating the healing microvessels. They
another treatment These products recruit a healing wound process for both acute also speed up the
option for complex and activate tissue that allows cells from and chronic wounds. healing process, 24 CTPs are often
wounds. There are within the surrounding tissue increase angiogenesis, costly and are usually
two categories of wound to migrate across the and modulate the in- used only when a plan
CTPs: dermoinductive bed. wound and create flammatory response for wound closure has
and dermoconductive. new tissue. and scarring. been identified.

25
Alternative treatments for complex wounds include gene therapy, hyperbaric oxygen, cell repro-
gramming technology, natural or synthetic biomaterials, and skin scaffolding technologies, such as
three-dimensional (3D) bioprinting.

26 The use of 3D bioprinting

combines 3D printing technol-
ogies with biomaterials to replicate
parts that imitate natural tissues,
bones, and blood vessels in the body.
27 Managing complex wounds often requires
a multidisciplinary approach, especially
when underlying conditions are present such
as diabetes, venous insufficiency, and chronic
obstructive pulmonary disease (COPD).

28 29 There should be significant evidence of response to complex wound

Wound bed prepara- therapies within two weeks or the current care plan should be re-evaluated.
tion can be achieved You may need to shift management strategies to assist with wound closure.
using the TIMERS

principles, which include
tissue management, infection
or inflammation, moisture
balance, edge or epithelial ad-
vancement, regeneration and
repair, and social factors.
30
Complex wounds present a formidable clinical
challenge. Finding success in achieving closure often
requires application of advanced therapies when
clinically indicated.
31 Advanced wound care therapies should be incorporated
only after taking a holistic approach to treating the
patient. This includes addressing any underlying conditions or
complications.

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