Even with increasing knowledge and the development of more sophisticated interventions, many clinicians will encounter wounds that are "hard to heal" despite all efforts. This often causes psychological stress and anxiety for all persons involved and creates a considerable financial burden for an already overloaded healthcare system.

The importance of regular wound assessment and wound size measurement in identifying potentially hard to heal wounds has been reviewed by Troxler. (from “Hard-to-heal wounds: a holistic approach”)."Hard to heal" wounds need a complex approach, correct patients’ evaluation and advanced medications, as well as plastic surgery; all this is hard to provide to elderly and socially impaired patients.

E-mail exchanged between our service and GPs, Nurses and Caregivers together with traditional visits are used to improve the monitoring and the advice of the patients as well as advanced medications, according to the patients needs; this also facilitates the communication with personnel coming from other countries. The project started three years ago in one of the largest public hospitals in Italy; the service is now running in the Lazio region, in the frame of the public reimbursement system.

A data base for patient management, integrated with the hospital data base is used to gather all the relevant information; appointments with patients, statistics on number of visits, patients and prescribed medications are also available in the hospital database.

The project is based on a long experimental background started in 1987; the personnel were initially in charge of telemedicine researches and in a second moment of telemedicine services for the Italian Antarctic Expeditions.
We believe this could be a model for introducing telemedicine services in the public hospitals.