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Hypoperfusion and Wound Healing: Another Dimension of Wound Assessment

Smollock, Wendy, MSN, APRN, CWS; Montenegro, Paul, MSN, APRN, CWCN; Czenis, Amy, MSN, APRN, CWS; He, Yuan, MS

doi: 10.1097/01.ASW.0000527964.87741.a7
Features: Original Investigation

OBJECTIVE: To examine the correlation between mean arterial pressure (MAP) and wound healing indices and describe an analytical process that can be used accurately and prospectively when evaluating all types of skin ulcerations.

METHODS: A correlational study in a long-term-care facility.

Participants (N = 230) were adults residing in a long-term-care facility with an average age of 77.8 years (range, 35–105).

MAIN OUTCOME MEASURES: Assessment through both an index of wound healing and wound surface area. Signs of wound healing included a reduction of surface area and surface necrosis and increased granulation or epithelialization.

RESULTS: Aggregate analyses for all wound locations revealed a positive correlation between the MAP and index of wound healing (r = 0.86, n = 501, P < .0001). A well-defined positive correlation between the MAP and stalled or poor wound healing was noted for all wound locations in this data set when MAP values were 80 mm Hg or less (r = 0.95, n = 141, P < .0001). Further, the data set of truncal wounds and MAP of less than 80 mm Hg yielded a very strong positive correlation. The data indicated that as perfusion decreased, wounds within the sample population declined (r = 0.93, n = 102, P < .0001).

CONCLUSION: The data suggest that MAP values less than 80 mm Hg can independently result in stalled wound healing or worsened wounds. A predictability of wounds stalling or declining related to the MAP was observed, regardless of topical treatment or standard-of-care interventions. Therefore, the data also suggest that remediating states of low perfusion should take precedence in making treatment decisions.

At Wound Healing Solutions LLC in Barrington, New Jersey, Wendy Smollock, MSN, APRN, CWS, is an Adult Nurse Practitioner and Co-owner; Paul Montenegro, MSN, APRN, CWCN, is an Adult Nurse Practitioner and Co-owner; Amy Czenis, MSN, APRN, CWS, is an Adult Nurse Practitioner; and Yuan He, MS, is a Data Scientist. The authors have disclosed no financial relationships related to this article. Submitted January 6, 2017; accepted in revised form June 21, 2017.

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