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Wound Care

WC: Introduction (2012)

The Academy Evidence Analysis Library Wound Care Workgroup was assigned the responsibility of researching evidence-based information to support guidelines for medical nutrition therapy for individuals with wounds. The systemic process used for searching, analyzing and grading evidence for MNT guidelines is defined in the Methodology section of the EAL.

Since evidence-based guidelines for pressure ulcers had recently been completed by external groups (NPUAP and EPUAP), the expert workgroup elected to explore the evidence for other types of wounds with concurrent co-morbidities. The Academy Evidence-Based Practice Committee approved the NPUAP-EPUAP Nutrition Guidelines based on them meeting the Academy criteria for use in the EAL. Applicable questions posed by the workgroup are linked to these guidelines. Additional questions were formulated to address the role of specific nutrients in enhancing or inhibiting wound healing for individuals with pre-existing renal disease and/or obesity.

The workgroup brainstormed topic areas based on nutrition intervention questions that were consistently asked by other practitioners, and based on what they encountered in daily practice. These topic areas were not addressed by existing guidelines. Questions were further refined using the Evidence Analysis Library Analytical Framework.

While peer-reviewed articles and case reports have been published on the role of nutrition in wound healing using specific commercial products and other combinations of dietary supplements, none specifically answered the questions posed by the expert work group. For more information on the inclusion and exclusion criteria and specific search terms see the search plan which is linked to the conclusion statements for each question. The systematic search for each of the questions resulted in no evidence and therefore each of the conclusion statements received a grade V defined as no evidence available that directly supports or refutes the conclusion.

Implications for Practice:

Due to the limited evidence available, on these topics of wound care, dietetic practitioners must rely on appropriate clinical judgment and best practice resources when making recommendations for nutrition care and counseling individuals with wounds and stay alert to emerging research in this area. Additionally, as a member of the healthcare team, dietetic practitioners should collaborate with other professionals to conduct studies that support the outcomes of nutritional interventions for individuals with wounds.

List of wound care resources: (1-10)

1. Academy of Nutrition and Dietetics. Nutrition Care Manual. Chicago: Academy of Nutrition and Dietetics.

2. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. (National Pressure Ulcer Advisory Panel). Prevention and treatment of pressure ulcers: clinical practice guideline. 2009.

3. Dorner B. The Complete Guide to Nutrition Care for Pressure Ulcer Prevention and Treatment, Becky Dorner & Associates, Inc. Akron, OH, 2012.

4. Dorner B, Posthauer ME, Thomas D, National Pressure Ulcer Advisory Panel. (National Pressure Ulcer Advisory Panel). The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel White Paper. 2009.

5. Posthauer ME, Droner B, Collins N. Nutrition: A Critical Component of Wound Healing. Adv in Skin and Wound Care. December 2010;23:560-571

6. Sharon Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles Third ed. Ambler, PA: Wolter Kluwer/ Lippincott Williams & Wilkins; 2011.

7. Sussman C, Bates-Jensen B, eds. Wound Care: A Collaborative Practice Manual for Health Professionals Fourth ed. Ambler, PA: Wolter Kluwer, Lippincott Williams & Wilkins; 2012.

8. Krasner DL, Rodeheaver GT, Sibbald RG, Kevin Y, eds. Chronic Wound Care:  A Clinical Source Book for Healthcare Professionals Fith ed. Malven , PA: HMP Communications; 2012.

9. Litchford MD. Advanced Practitioner's Guide to Nutrition & Wounds Greensboro, NC: CASE Software & Books; 2010 www.casesoftware.com).

10. Molnar J, ed. Nutrition and wound healing. Boca Raton, Fl: CRC Press; 2007.

Suggested Journals:

1. Advances in Skin and Wounds http://journals.lww.com/aswcjournal/pages/default.aspx

2. Ostomy Wound Management http://www.o-wm.com/

3. Journal of WOCN (Wound, Ostomy, and Continence Nursing) http://journals.lww.com/jwocnonline/pages/default.aspx

4. Wounds http://www.woundsresearch.com/