Wound Care

“We heal wounds in 40 days”


How many times have we heard the following quotes: “We heal wounds in 40 days”, “Our healing rate is 100%”, “we have the fastest healing rates”, and the list goes on. The positive side of it is that we (wound care services and clinicians) want to improve outcomes. But why are outcomes so important? The main two reasons are that patients will most likely avoid complications related to chronic wounds; and maintain trust with health insurance companies.

But we are far from the truth. First of all the term “heal” or “healing” is not the right term to be used. Our main goal with any open wound is to CLOSE it. Therefore we should be saying “We close wounds in 40 days”; right? Well, this quote is 50:50 correct. Remember when we took that great wound care course for at least a week or so not so long ago? When discussing the phases of wound healing in the physiology section there’s a fourth and final phase called “remodeling”. This phase is also known as maturation phase and lasts from 21 days up to 2 years. In this last and longest phase, collagen synthesis is ongoing in order to strengthen the tissue. The wound continues to contract and fibers are being reorganized. The granulation tissue matures into scar and tissue tensile strength is increased. Keep also in mind that the tensile strength will never be a 100%; therefore I always encourage all my patients that although the wound is considered “closed” it is still in its remodeling phase of wound healing and special care and protection should be the priority to avoid reopening or any other complication.

So… can we heal a Stage III pressure injury wound in 30 days? Absolutely not. We may close it, but the maturation phase may take up to 2 years. That may be a reason why recurrence of wounds may be so common.

In terms of metrics… As some of you may already know I am the owner and main designer of Wound Charts (https://woundcharts.app), which is a web based electronic medical record for wound care practice. I recently decided to remove the following two (2) metrics from the software: “days to close a wound” and “healing rate”. Why did I remove this two stats?

“Days to close a wound” is kind of controversial since it all depends on the kind of patients and wounds we treat. Complicated patients with multiple comorbidities and complicated wounds may take months or even maybe years to just close the wound. In my 18 years experience in wound care and hyperbaric medicine I have seen (also based on actual data) that around 10% of all patients with wounds will never improve (this will vary). This population will only be managed to avoid further complications. So if a clinic remove this population from their roster or list to improve their outcomes then their metrics would not be accurate. The same goes with “healing rate”. If we do not count the patients that will never “heal” then we should have a 100% “closure rate” or “healing rate” making it inaccurate. We are currently working with a metric that would measure the clinic’s performance, but keep in mind that there are a few variables in the equation that may either help or affect the metrics for any clinic or wound care service.

So for now, we should keep doing the best we can for our patients and close the wounds as soon as possible. Our patients are always grateful and know we are just trying our best to help them.

Any thoughts? Please feel free to share any ideas or comments.

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