WOUND CARE OVERVIEW


Chronic Wounds - Big Problem.
Nearly 5 million Americans suffer from chronic wounds, including 1.5 million with diabetic ulcers, 2.5 million with pressure ulcers. 1 million with venous ulcers and others with wounds from traumatic injury or nonhealing surgical incisions.

A chronic wound is one that has not demonstrated notable improvement after four weeks, or has not healed after a period of eight weeks. Diabetes, long-term immobilization or circulatory problems frequently cause chronic open sores or wounds. With diabetes, blood flow to the legs may be decreased, increasing the likelihood that small injuries a foot or toes may result in sores, serious infections and/or tissue death.

Often, effective treatment is given and the patient returns to near normal. Patient then should be careful to employ good strategies to avoid a recurrence. Regrettably, other cases may end in amputation, the solution of last resort for approximately 56,000 Americans with diabetes each year.

Management for Wound Care

The American Diabetics Association (ADA) estimates that diabetes related amputation could be reduced by 50 percent through proper foot care and testing for neuropathy (nerve damage), and education to prevent injury or complications.

Traditional wound management typically relies on topical ointments and wound dressings, often counting on patients to manage their own care, or being referred from one physician to the next. If the condition worsens, as frequently occurs, it results in prolonged illness, lost work productivity, deterioration of quality of life, complications and amputations.

Outcome data from Curative Health Services (the largest nationwide network of wound care specialists with more than 160 affiliated Wound Care Centers) has shown that a focus on a complete, interdisciplinary management for treating chronic, hard-to-heal wounds is a sensible alternative, reducing the number of amputations. A thorough case management approach tailors optimum treatment pathways and provides each patient with the most appropriate level of care. It has emphasis on patient education. Obviously, prevention is the first line of defense, particularly for people with diabetes, who, among other precautions, should be very careful to maintain a diet that will not adversely affect circulation to extremities.

Appropriate foot care also is important, including:

• Not going barefoot either indoors or outdoors.

• Preventing excessively dry feet by using a thin film of moisturizing cream on the soles after bathing.

• Trimming nails straight across, gently rounding corners with a fine emery or pumice stone.

• Avoiding exposure of feet to temperature extremes.

• Wearing well-fitting, comfortable shoes.

• No open toe or heel shoes.

• No sandals.

• Feet check by doctor on each visit.

A quality case management approach may include: vascular surgery, lab work, radiology, growth factor therapy, skin grafting, use of living skin equivalents such as ApligrafTM, home health care, pharmaceutical services, nutrition counseling, infraction control, protection devices, rehabilitation, hyperbaric oxygen treatment and more. Again, the services needed are determined on a case-by-case basis.

The use of hyperbaric oxygen (HBO) offers several potential benefits to chronic wound patients. Increasing oxygen in a patient's system, as well as the site of a wound, to help the healing process. Hyperbaric oxygen allows health care professionals to supersaturate or soak bodies with oxygen, in a very controlled, closely monitored environment. Because of the potential for harm with improperly administered hyperbaric oxygen, thorough training in its use is critical.

Living skin equivalents (and shortly cloned skin cells prepped from the patients own cells) offer another technological contribution to the case management arsenal. As a result, it is no longer always necessary to graft donor skin from one part of a patient's body (or from another donor) to the wound site. Living skin products give physicians the option to use a product that doesn't require surgery beyond what is needed to cover the wound.