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  What is and isn’t known about wound care? What approaches and products are effective?

  The Agency for Healthcare Research and Quality (AHRQ) awarded the Johns Hopkins Evidence-based Practice Center, the John Hopkins Wound Center at Bayview, almost $500,000 to find out.

  The 1-year project will comprise comparative effectiveness research in an evidence-based assessment of the benefits and risks of various wound care treatment options focused on chronic venous ulcers. The study is under the direction of co-principal investigators Gerald Lazarus, MD, Bayview wound center founder, Jonathan Zenilman, MD, the center’s newly appointed director, and Eric Bass, MD, MPH, Director of the Evidence-based Practice Center. Johns Hopkins researchers, with contributions from key clinical opinion leaders, will compile and analyze all available evidence from existing relevant literature to determine the therapeutic value of interventions for healing chronic wounds. The goal of this analysis is to define general truths regarding the current state of knowledge and ultimately to instruct the medical establishment on how to approach ulcer healing using dressings, antimicrobials, and surgery relevant not only to venous ulcers, but also to all types of ulcers. A three-part report of the findings is forthcoming.

  Wound care is an intrinsic part of Johns Hopkins, one of 14 AHRQ evidence-based practice centers. The wound care center has 6,000 patient visits per year and is staffed by five full-time nurses and multiple senior physicians from a variety of disciplines, including internal medicine, dermatology, orthopedics, and general and vascular surgery. The institution historically has been involved in understanding the role of microbial flora in wounds and previously published on the role of bacteria in wound healing and the misuse of antibiotics that may complicate care.

  “People who are healthy don’t get chronic wounds,” says Dr. Lazarus, a professor of dermatology and medicine. “There is some underlying reason — disease, lifestyle — why a person gets a wound. The wound is the end result or manifestation of a patho-physiological process. As such, we take an internal medicine approach, asking 1) why the wound and 2) what can be done to make it better.”

  Dr. Lazarus acknowledges that much of what is known about wound care is anecdotal, especially with regard to topical agents and devices; published reports are often conflicting and confusing. This study intends consolidate the best information available to enable patients and providers to make sound care decisions that integrate an evidence-based approach. “We need to figure out what we know and then determine what knowledge can be applied to wounds and patients and what is specific to individual conditions and situations,” he says.

  The Johns Hopkins study focuses on venous ulcers, the most common ulcers and slightly less complicated when compared to arterial, pressure, and diabetic ulcers. Considerations include venous disease factors important to determining whether evidence exists to support use of advanced, antimicrobial, silver, and enzymatic debriding wound dressings, along with the roles of antibiotics and surgery and how to mix-and-match interventions to optimize healing.

  Dr. Lazarus says this unique research endeavor not only underscores the scientific credibility and intellectual honesty of the Wound Center, but also is a great example of how translational research affects everyday lives. Project leaders have solicited input from influential wound care clinicians and researchers, including OWM Board members Robert Kirsner, MD, and Laura Bolton, PhD. Once the meta-analysis is complete, results will be posted for broader wound care community input. “We want to ensure we get away from parochialism and focus on key issues,” Dr. Lazarus says.