The International Journal of Lower Extremity Wounds

The announcement of another wound care journal, The International Journal of Lower Extremity Wounds (IJLEW) in this case, usually evokes a medley of responses; from the groans of those straining under an information deluge and increasing workload to the glee of those who feel underrepresented—most frequently specialists. Why a new journal focused on lower extremity wounds? The reason is simple: wounds are a major clinical challenge. Wounds, especially chronic wounds, are a vast global problem. The worldwide prevalence of wounds is believed to be 1% of the world population. Most organs are liable to be affected by wounds; the lower extremities of our bodies are especially susceptible to them. Acute wounds—caused by trauma—usually follow an acceptable healing course. Chronic wounds are slow to heal and recur frequently. Leg ulcers are most commonly caused by venous disease, whereas foot ulcers mainly result from arterial disease, diabetes, or both. The clinical management of chronic wounds can be frustrating for both the patient and the health provider, and resource implications are staggeringly high. Venous ulcers annually cost the U.K. National Health Service £600 million (US $840 million). Add the cost of diabetic foot ulcers, which can significantly increase morbidity through limb loss and, occasionally, death, and the consequences of ignoring chronic wounds grimly tower over our communities. Chronic wounds deserve greater attention not only because of an increasing prevalence of diabetes globally but also because of an aging population in Western societies; there is a growing burden for everyone in society to shoulder. Have there been advances applicable to the clinical management of lower extremity wounds? Should we indulge in more systematic reviews? Of course there have been advances in concepts; putting advances into practice calls for strategic research and development. Wound research has been sadly neglected by major funding agencies, and this is discouraging. Wound healers should be encouraged by developments in another chronic disease entity— osteoporosis. During the last 20 years, as therapeutic advances were taking place in laboratories, it became possible to quantify the risk of hip fracture—common in patients with osteoporosis. By measuring bone mineral density, it is possible to predict hip fractures and treat to prevent them. Reducing complications aids resource planning as well as disease management. This success should invigorate wound specialists into studying the effects of preventable and modifiable risk factors for chronic wounds. Risk factor modification is applicable to diabetic as well as venous ulcers. Who works on lower extremity wounds? Vascular surgeons, diabetic physicians, podiatrists, nurses specializing in wound care, orthopedic surgeons, orthotists, angiologists, phlebologists, and not the least, vascular and pathology laboratories, all get involved. Some rarer lesions, but chronic wounds no less, invite the opinion and support of rheumatologists and gastroenterologists. Clearly the wound management fraternity is large and, definitely, multidisciplinary. A multidisciplinary model of wound care has been developed in Denmark with success. It is also a major descriptor for this new journal. Fittingly, the inaugural issue of this journal presents reviews of basic and applied research, clinical reviews, and the opinions from 2 clinical scientists who have devoted much of their lives to studying wound healing. IJLEW will feature original as well as teaching reviews and longer seminar papers since it is envisioned as a “rolling textbook. ” It is timely that IJLEW is launched to inform, educate, and provoke wound workers, so that the pathway to progress is energized for the benefit of those who suffer, and those who care.