Management of non-healable and maintenance wounds: a systematic integrative review and referral pathway

Abstract

Objective: This systematic integrative review aims to identify, appraise, analyse, and synthesise evidence regarding non-healable and maintenance wound management to guide clinical practice. An interprofessional referral pathway for wound management is proposed.

Data sources: An electronic search of Scopus, Web of Science, PubMed, Academic Search Ultimate, Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature database with Full Text, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition, and MEDLINE was conducted for publications from 2011 to 2019. Search terms included (non-healable/non-healing, chronic, stalled, recurring, delayed healing, hard-to-heal) and wound types most associated with non-healable or maintenance wounds. Published studies were hand searched by the authors.

Study selection: Studies were appraised using two quality appraisal tools. Thirteen reviews, six best-practice guidelines, three consensus studies, and six original non-experimental studies were selected.

Data extraction: Data were extracted using a coding framework including treatment of underlying causes, patient-centred concerns, local wound care, alternative outcomes, health dialogue needs, challenges within resource restricted contexts, and prevention.

Data synthesis: Data were clustered by five wound types and local wound bed factors; further, commonalities were identified and reported as themes and subthemes.

Conclusions: Strong evidence on the clinical management of non-healable wounds is limited. Few studies describe outcomes specific to maintenance care. Patient-centred care, timely intervention by skilled healthcare providers, and involvement of the interprofessional team emerged as the central themes of effective management of maintenance and non-healable wounds.