Choosing wisely together-Recommendations on the treatment of chronic wounds

The scientific evidence for treatment of chronic wounds is not very high due to a lack of randomized clinical trials. The German S3 guidelines (2012) for local treatment of chronic wounds in patients with peripheral arterial occlusive disease (PAOD), diabetes mellitus or chronic venous insufficiency provide only a general direction and are currently being updated. Chronic wounds are a symptom of various underlying diseases. Therefore, early diagnosis and adequate treatment are of utmost importance. According to current data there is an undersupply in diagnostics and treatment, e.g. in compression therapy for venous leg ulcers/mixed ulcers or with respect to sufficient pressure relief in neuropathic diabetic foot ulcers. In this article five positive and four negative recommendations are given, which are based on scientific data and (inter)national expert consensus. The positive recommendations address the sufficient diagnostics, a digital wound documentation, effective exudate management and the question of local antibacterial treatment. The negative recommendations address avoiding the irrigation of chronic wounds with tap water, the use of hydrogen peroxide, octenidine hydrochloride and chlorhexidine for wound rinsing, the sequelae of neglecting compression therapy in mild PAOD or severe wound exudation as well as the prescription of systemic antibiotics for critically colonized wounds. An interdisciplinary and interprofessional cooperation is necessary for successful treatment of chronic wounds. For local treatment many expert recommendations exist, which can be a practical aid in decision making for nursing staff and physicians.