References

Diabetes and amputation: everything you need to know to avoid amputation. 2018. https://tinyurl.com/y2fxy6gt (accessed 22 October 2019)

Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017; 376:(24)2367-2375 https://doi.org/10.1056/NEJMra1615439

Atkin L, Bućko Z, Conde Montero E Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019; 23:S1-S50 https://doi.org/10.12968/jowc.2019.28.Sup3a.S1

Health economic implications for wound care and limb preservation. 2008. https://tinyurl.com/y3m4tycu (accessed 22 October 2019)

Hambleton IR, Jonnalagadda R, Davis CR, Fraser HS, Chaturvedi N, Hennis AJ. All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study. Diabetes Care. 2009; 32:(2)306-307 https://doi.org/10.2337/dc08-1504

Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006; 29:(6)1288-1293 https://doi.org/10.2337/dc05-2425

Schultz GS, Barillo DJ, Mozingo DW, Ghin GA. Wound bed preparation and a brief history of TIME. Int Wound J. 2004; 1:(1)19-32 https://doi.org/10.1111/j.1742-481x.2004.00008.x

Schultz G, Bjarnsholt T, James GA Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair Regen. 2017; 25:(5)744-757 https://doi.org/10.1111/wrr.12590

Schultz GS, Sibbald RG, Falanga V Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003; S1-S28

Tettelbach W, Cazzell S, Reyzelman AM, Sigal F, Caporusso JM, Agnew PS. A confirmatory study on the efficacy of dehydrated human amnion/chorion membrane dHACM allograft in the management of diabetic foot ulcers: A prospective, multicentre, randomised, controlled study of 110 patients from 14 wound clinics. Int Wound J. 2019; 16:(1)19-29 https://doi.org/10.1111/iwj.12976

TIMERS: expanding wound care beyond the focus of the wound

14 November 2019
Comment
02 November 2019
Volume 28 · Issue 20

Hard-to-heal wounds affect not only the patient's quality of life, but also place a significant burden on healthcare systems around the world. The incidence of hard-to-heal wounds continues to rise wherever the age of the population is increasing. Correct diagnosis and treatment at an early stage in the treatment course, therefore, holds the potential to favourably impact the outcomes of such wounds.

Once healed, clinicians cannot continue to view that their objective has been reached, because 40% of healed diabetic foot ulcers (DFUs) and up to 69% of venous leg ulcers recur within the first year (Armstrong et al, 2017).

The race to heal hard-to-heal ulcers is driven by the fact that a foot ulcer precedes 85% of lower-limb amputations in patients with diabetes (Almekinder, 2018). Once a patient with diabetes undergoes a non-traumatic lower extremity amputation their 5-year mortality rate can be as high as 70% (Hambleton, 2009). These statistics are ominous but, to look on the positive side, it is estimated that between 49% and 85% of DFU-related amputations may be preventable (Driver and de Leon, 2008).

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