Evaluating the 2015 WoundsUk posters revealed that the most used inclusion criteria to match a patient to any intervention were A. “stalled” wound healing or B “suitability” of the patient; not exactly an exact approach.
Of course we have Time, Wagner etc etc. But these are based upon “superficial” examination. Even after assessment there are patients who do not follow expectations. This is because they describe the current state of the wound but only partially. They do not describe what is causing a delay in healing. I would love to have the possibility to look under the hood and have some more clues about what is happening in the wound healing process. It is amazing we do not have a standard set of parameters which will help us assess the gravity of the wound.
Luckily medical science is more than wound care so it makes sense to look for progress in other fields. Here are some thoughts.
The first idea is to do an immuno assay. Recently, application of mass cytometry in patients undergoing hip arthroplasty revealed strong immune correlates of surgical recovery in blood samples collected shortly after surgery. In the study below it is shown that the Immune correlates identified in presurgical blood samples mirrored correlates identified in postsurgical blood samples. Hence the immune status can predict the recovery. http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=2470768 I think it is worth while to see if this also has an effect on wound healing.
And there are more factors worth investigating to assess the chronicity of a given wound. Another example may be serum albumin. Which not only reflects the nutritional status of a patient but also has a link to IL6 and TNFα. See http://www.ncbi.nlm.nih.gov/pubmed/25782627 and it already has an application in DFU http://www.ncbi.nlm.nih.gov/pubmed/26554804 and in and distal bypass surgery http://www.ncbi.nlm.nih.gov/pubmed/26482994.
or as we see here, http://www.ncbi.nlm.nih.gov/pubmed/26246260 simply collecting basic parameters may already provide some clues.
And this is all old techniques, imagine what we may find with some of the newer analytic techniques.
All in all, discovering parameters is not rocket science but we have not done it yet so it is time to do it.