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  1. K G Harding, professor of rehabilitation medicine (wound healing) (HardingKG@cf.ac.uk),
  2. H L Morris, specialist registrar in surgery,
  3. G K Patel, specialist registrar in dermatology
  1. Wound Healing Research Unit, University of Wales College of Medicine, Heath Park, Cardiff CF14 4UJ, UK
  1. Correspondence to: K G Harding

    New physical, pharmacological, biological, and surgical treatments offer the possibility of tailor made therapy

    Chronic wounds represent a major health burden and drain on resources. Recent advances in our understanding of chronic wound biology have led to the development of several new treatments that offer renewed hope to patients with ulcers and other chronic wounds. Defining the role of these new treatment, in the context of the increasing number of patients with chronic wounds, represents the next challenge. This review describes our view of the current and future developments in chronic wound management.

    Summary points

    Greater interest in wound healing is needed to ensure higher standards of basic care

    Precise identification of the systemic, local, and molecular factors underlying the wound healing problem in individual patients should allow better tailored treatment.

    Allogeneic skin grafting and bioengineered skin equivalents are being used successfully in patients with venous leg ulcers and diabetic patients with foot ulcers

    Methods

    The material presented in this article has been compiled from the published literature (located by searching Medline, PubMed, Embase, and Zetoc with the search terms “wound healing,” “treatment and venous leg,” “treatment and diabetic foot,” and “treatment and pressure ulcer”) presentations at international meetings, and our own 30 years of clinical experience managing acute and chronic wounds.

    The clinical burden of wounds

    The management of chronic wounds places an enormous drain on healthcare resources; studies have calculated the cost of wounds to the NHS to be about £1bn a year.1 In the United Kingdom around 24 000 admissions a year are for patients with diabetic foot ulceration, thereby costing the NHS some £17m.2 Foot ulceration is the commonest complication of diabetes that requires hospitalisation, and in the United States management of this problem is estimated to cost $150m a year.3 Venous leg ulceration costs an estimated £400m annually in the …

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