Optimizing wound treatment through health care structuring and professional education.

Considerable developments have occurred in wound healing and care over the last few decades. Innovative technologies such as use of growth factors, bioengineered skin, topical negative pressure, heat, oxygen, and others have entered the clinic. These techniques have been advantageous, but even the most advanced and sophisticated product requires proper wound care and wound bed preparation in order to function optimally. It has been shown that the organization of a wound team, not the change in products, increases the healing of problem wounds (MTV Report, Denmark, 2003). Efficacy studies are generally performed in a few centers with investigators already experienced in the field. This probably leads to an optimal efficacy of the product. Problems arise when the product is marketed and is used by clinicians not specially educated in wound care. If no treatment plan and education is performed, product efficacy and cost-effectiveness decrease dramatically. This is clearly a major problem for patients, but also for communities and, in the end, for companies' sale of the product. Structuring of treatment and education is for these reasons the largest present challenge in the area of wound healing. The optimal way to treat nonhealing wounds is based on a multidisciplinary concept that has been implemented in a national health care system as a recognized expert function. It should consist of a specific treatment plan including modern wound care products and well-educated personnel. This structure is similar to other areas of the medical profession, but has to a lesser degree been established in the treatment of problem wounds. A growing understanding of the importance of this area is, however, shown by the increasing number of working groups focusing on organization and education in wound care. Presently the European Wound Management Association, the World Union of Wound Healing Societies, and The Danish Wound Healing Society have created such types of working groups.