Conclusion and References


The clinical use of any of the aforementioned adjunctive therapies depends on the healability potential, expected outcome, and risk-benefit ratio. However, it is important to note that many of these therapies lack sufficient scientific evidence assessing their efficacy and cost-effectiveness (Sibbald et al. 2021). Therefore, adjunctive therapies should be considered after an interprofessional comprehensive patient assessment, correctable factors have been addressed and regular evaluations of the wound (Sibbald et al. 2021).

Key Takeaways

  • Adjunctive therapies are valuable and appropriate modalities for the right patient when a wound is identified to be healed, stalled and the patient is in agreement
  • Adjunctive therapies are valuable and appropriate modalities for the right patient when a wound is identified to be healed, stalled and the patient is in agreement
  • Prior to the application of adjunctive therapies, clinicians are responsible for monitoring the latest evidence, confirming an accurate diagnosis and healability of the wound, prior to application


Abdo, James, and Holly Ortman. 2020. “Biologic and Synthetic Cellular and/or Tissue-Based Products and Smart Wound Dressings/Coverings.” Surgical Clinics of North America 100(4): 741–56.

Alkahtani, Saad Ahmed et al. 2017. “Ultrasound-Based Techniques as Alternative Treatments for Chronic Wounds: A Comprehensive Review of Clinical Applications.” Cureus 9(12). /pmc/articles/PMC5814295/.

Boersema, Geertien C. et al. 2021. “Management of Nonhealable and Maintenance Wounds: A Systematic Integrative Review and Referral Pathway.” Advances in Skin and Wound Care 34(1): 11–22.

Braakenburg, Assa et al. 2006. “The Clinical Efficacy and Cost Effectiveness of the Vacuum-Assisted Closure Technique in the Management of Acute and Chronic Wounds: A Randomized Controlled Trial.” Plastic and Reconstructive Surgery 118(2): 390–97.

Brassard, Joelle, and Melanie Tardif. 2015. Toward the Optimal Use of Negative Pressure Wound Therapy for the Treatment of Complex Wounds.

Elseth, Anna, and Omar Nunez Lopez. 2021. StatPearls Wound Grafts. StatPearls Publishing.

Health Quality Ontario. 2017. “Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment.” Ontario Health Technology Assessment Series 17(5): 1. /pmc/articles/PMC5448854/.

Herskovitz, Ingrid et al. 2016. “Epidermal Skin Grafting.” International Wound Journal 13(S3): 52–56.

Hierner, Robert et al. 2005. “Skin Grafting and Wound Healing—the ‘Dermato-Plastic Team Approach.’” Clinics in Dermatology 23(4): 343–52.

Ho, Chuong et al. 2005. Artificial Skin Grafts in Chronic Wound Care: A Meta-Analysis of Clinical Efficacy and a Review of Cost-Effectiveness. Ottawa.

Huang, Chenyu, Tripp Leavitt, Lauren R. Bayer, and Dennis P. Orgill. 2014. “Effect of Negative Pressure Wound Therapy on Wound Healing.” Current problems in surgery 51(7): 301–31.

Huang, Enoch, Marvin Heyboer, and Davut J Savaser. 2019. “Hyperbaric Oxygen Therapy for the Management of Chronic Wounds: Patient Selection and Perspectives.” Chronic Wound Care Management and Research 6: 27–37.

Jalilifar, Mostafa, Ali Yadollahpour, and Samaneh Rashidi. 2015. “Electromagnetic Fields and Ultrasound Waves in Wound Treatment: A Comparative Review of Therapeutic Outcomes Neuromodulation in Neuropsychiatric Disorders View Project Non-Ionizing Radiation for Wound Healing View Project.” Article in Biosciences Biotechnology Research Asia.

Jirangkul, Puripun, Sopon Baisopon, Danai Pandaeng, and Phutsapong Srisawat. 2021. “Hyperbaric Oxygen Adjuvant Therapy in Severe Mangled Extremities.” Injury (xxxx).

Kanapathy, Muholan et al. 2017. “Systematic Review and Meta‐analysis of the Efficacy of Epidermal Grafting for Wound Healing.” International Wound Journal 14(6): 921. /pmc/articles/PMC7950096/.

Kavros, Steven J. et al. 2008. “Expedited Wound Healing with Noncontact, Low-Frequency Ultrasound Therapy in Chronic Wounds: A Retrospective Analysis.” Advances in skin & wound care 21(9): 416–23.,.6.aspx.

Khouri, Charles et al. 2017. “Hierarchical Evaluation of Electrical Stimulation Protocols for Chronic Wound Healing: An Effect Size Meta-Analysis.” Wound Repair and Regeneration 25(5): 883–91.

Kranke, Peter et al. 2015. “Hyperbaric Oxygen Therapy for Chronic Wounds.” The Cochrane Database of Systematic Reviews 2015(6). /pmc/articles/PMC7055586/.

Liu, Yukun, Adriana C. Panayi, Lauren R. Bayer, and Dennis P. Orgill. 2019. “Current Available Cellular and Tissue-Based Products for Treatment of Skin Defects.” Advances in Skin and Wound Care 32(1): 19–25.

Lyu, Wenhan et al. 2021. “Flexible Ultrasonic Patch for Accelerating Chronic Wound Healing.” Advanced Healthcare Materials 10(19): 2100785.

Nicholas, Mathew N., and Jensen Yeung. 2017. “Current Status and Future of Skin Substitutes for Chronic Wound Healing.” Journal of Cutaneous Medicine and Surgery 21(1): 23–30.

Ontario Health Technology Advisory Committee. 2017. “Electrical Stimulation for Pressure Injuries: A Health Technology Assessment.” 17(14): 1. /pmc/articles/PMC5700239/ .

Orgill, Dennis P, and Lauren R Bayer. 2013. “Negative Pressure Wound Therapy: Past, Present and Future.” International Wound Journal 10(s1): 15–19.

Rajendran, Saranya B., Kirsty Challen, Karen L. Wright, and John G. Hardy. 2021. “Electrical Stimulation to Enhance Wound Healing.” Journal of Functional Biomaterials 12(2).

Rhee, Susan M. et al. 2015. “Negative Pressure Wound Therapy Technologies for Chronic Wound Care in the Home Setting: A Systematic Review.” Wound Repair and Regeneration 23(4): 506–17.

Ruby Chang, Ying Ju, Julie Perry, and Karen Cross. 2017. “Low-Frequency Ultrasound Debridement in Chronic Wound Healing: A Systematic Review of Current Evidence.” Plastic Surgery 25(1): 21. /pmc/articles/PMC5626185/.

Serra, Raffaele et al. 2017. “Skin Grafting for the Treatment of Chronic Leg Ulcers – a Systematic Review in Evidence‐based Medicine.” International Wound Journal 14(1): 149. /pmc/articles/PMC7949524/.

Sibbald, R. Gary et al. 2021. “Wound Bed Preparation 2021.” Advances in skin & wound care 34(4): 183–95.

de Smet, Gijs H.J. et al. 2017. “Oxygen Therapies and Their Effects on Wound Healing.” Wound Repair and Regeneration 25(4): 591–608.

Shores JT, Gabriel A, Gupta S. Skin substitutes and alternatives: a review. Adv Skin Wound Care. 2007;20:493–508

Thakral, Gaurav et al. 2013. “Electrical Stimulation to Accelerate Wound Healing Electrical Stimulation to Accelerate Wound Healing.”

Voigt, Jeffrey, Martin Wendelken, Vickie Driver, and Oscar M. Alvarez. 2011. “Low-Frequency Ultrasound (20-40 KHz) as an Adjunctive Therapy for Chronic Wound Healing: A Systematic Review of the Literature and Meta-Analysis of Eight Randomized Controlled Trials.” International Journal of Lower Extremity Wounds 10(4): 190–99.

Webster, J et al. 2019. “Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scu Ham P, Stankiewicz M, Chaboyer WP.” Cochrane Database of Systematic Reviews (3): 151.

Woo, Kevin, Elizabeth A. Ayello, and R. Gary Sibbald. 2007. “The Edge Effect: Current Therapeutic Options to Advance the Wound Edge.” Advances in skin & wound care 20(2): 99–117.

Yadollahpour, Ali, Mostafa Jalilifar, and Samaneh Rashidi. 2014. “Ultrasound Therapy for Wound Healing: A Review of Current Techniques and Mechanisms of Action.” Article in Journal of Pure and Applied Microbiology.


Share This Book