The concept and proposed definition of "wound simplification"

Although an axiom of wound care is to achieve speedy, durable healing, there exists a small, but persistent, subset of patients for whom a more practical and achievable goal might not necessarily be to heal the wound, but rather to prevent its escalation. Similarly, there are patients with very large or complex wounds that may take months or even years to completely heal or may recur despite robust prevention efforts.When confronting such problematic conditions across the broad spectrum of a wound care practice, current definitions of success in wound repair are impractical and not universally applicable. We suggest that in certain clinical scenarios it might be worthwhile to redefine success based on achievable patient-oriented outcomes.We offer seven criteria that may categorize the patient who is in a "wound simplification" category. These include: (1) the wound is painless or minimally painful; (2) the patient's functional capacity is stable, without requiring increased assistance from baseline, and has not deteriorated secondary to ongoing treatment of the wound; (3) the patient or a non-medical family member can perform dressing changes him/herself; (4) the patient requires no more than two visits to the doctor per month; (5) the wound has neither significantly increased in area (<20%) nor depth; (6) the wound is free of clinical or advancing infection for at least 3 months including patients on antibiotic suppression therapy; (7) the patient has not required hospital admission for wound-related complications within the past three months.