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Optimal Care for Chronic Wounds

A chronic wound refers to a lesion which causes a break in the skin and may also generate damage to the tissues surrounding the affected area. Chronic wounds can result from deep ulcers, open wounds, severe burns, and infected cuts.

The way to take care of wounds has tremendously advanced in the last few years. With all the state of the art improvements, wounds can be treated in a more appropriate way. These latest advances have helped to better evaluate and identify conditions or problems associated with wounds, in a more timely manner, which in turn, aids in offering the best medical intervention and decreases the prevalence of diseases.

This article intends to provide the reader with accurate, updated information on how to properly care for wounds as well as how to obtain the perfect wound healing environment and dressing.

To create the best wound care program, there must be an exact and detailed assessment of the patient as well as the wound. It is also important to differentiate between a chronic and an acute wound.

A wound which normally takes more than the expected reasonable time (usually three months) to heal, is considered a chronic wound. On the other hand, an acute wound is a type of injury which heals more promptly (within   four to six weeks). Acute wounds generate very little loss of function in the affected area.

It is also fundamental to determine the cause of the wound. In case the cause analysis of the wound is not recognized, an exhaustive investigation of the patient’s medical background, including medicines prescribed and being taken, nutritional aspects, level of pain and calculating if the patient is capable of taking care of the wound by himself/herself, must be carried out  to discover potential causes of the wound. Specialists also emphasize the importance of identifying factors that may hinder an optimal wound healing.

There are many factors which can greatly affect wound healing, such as:

  • Height
  • Weight fluctuation (weight loss or gain may interfere with wound healing)
  • Proper nutrition
  • Skin color,
  • Temperature and pliability around the wound

Proper evaluation of the skin will allow for better results. The wound must be measured thoroughly and the status of the wound setting must also be recorded. Following all the proper guidelines of measuring and evaluating the wound regularly, will provide the best guidance for wound care and better results. Nevertheless, it is imperative to be aware that wounds may be different in size and texture and that may also change with time. Also, the different specialists taking care of the wound may have different opinions regarding the wound, so it can become a bit difficult for specialists to evaluate it effectively.

The location of the wound as well as the depth and circumference, can have great impact on how the wound is taken care of. Depending on the part of the body that has suffered a wound and the location, the care and healing plan may differ a lot, since the treatment may not be similar.  When it comes to circumference and depth, the most preferred method is carried out in the head to toe direction. It involves measuring the wound at its greatest length and then measuring the width at a 90-degree angle, where the greatest width of the wound is. This is followed by a multiplication of the two measurements, following which   results are obtained to provide the total area of the wound. Despite the process not being the most accurate one, when done regularly, it provides vast information about how well the wound is healing.

Wounds which normally heal through the restoration of epithelium (regeneration of injured tissue), are classified as partial-thickness wounds. These types of wounds do not affect the dermis, they only impact the layers of the skin. Wounds considered to be partial-thickness wounds are the following: blisters, lacerations, and abrasions. Full-thickness wounds, on the other hand, include subcutaneous and tissue damage.

Be sure to check and take note of any abnormal reddening of the skin or mucous membranes, because of inflammation (erythema) or black and blue spots due to escape of blood or broken arteries/capillaries (ecchymosis) around four centimeters of the wound contours.  To do this regularly, is extremely important to avoid possible rupture of the skin. Also, be very careful of any foul odor originating from the wound as well as tissue that is not capable of   regeneration, such as granulation, epithelial, muscle or tissue under the skin.

Specialists should also take into consideration, the color, smell, and amount of oozing. Discharge with an increased amount of protease level and decreased growth levels can hinder wound healing. Other important aspects to be very careful with, are the contours of the wounds, since this can determine the epithelialization pattern and identify a potential cause as to why the wound has become chronic.

Medical sites generally provide a scale for pain level measurement. Make sure to ask the patient if he or she can calculate the amount of pain currently experienced. It is essential to ask patients about the medication or methods they have been using, to have a better idea as to how the next pain management plan is to be designed. A constant reevaluation of pain level must be carried out as well.

Careful and correct preparation of the wound site is extremely important for an optimal healing process. The main objective is to lessen all aspects which may impede a proper recuperation of the wound and to increase the positive effects of a well done wound care treatment. The most essential components of wound bed preparation are to keep the affected area moist and to control bioburden.

Chronic wounds are generally considered contaminated and therefore, healing of the wound may become jeopardized if the right measurements are not followed. To control bioburden, the wound site must be regularly cleaned and there must also be a surgical removal of contaminated tissue.  To maintain moisture balance, oozing must be appropriately controlled and the wound bed must always be kept moist.

The appropriate medical covering or dressing must also be acquired to increase the positive effects of wound healing. It can sometimes become a nuisance to find the right dressing, since there are so many varieties and options available in the market.  Therefore, it can get a little overwhelming to obtain the best dressing for each specific need. The type of dressing or medical cover to be used, depends a lot on the way the wound looks, oozing or discharge originating from the wound and the level of pain.

It is fundamental to reevaluate the wound at least once every week, to determine how well the healing process is advancing. Take into consideration that controlling the wound healing process is a combined effort from both the patient and the health professional. It is always advisable to share ideas and opinions with other medical professionals to obtain an idea of better alternatives and results.

Understanding and knowing more about how to properly take care of wounds, will definitely provide better results for patients. It is imperative to understand how distressing it can be for patients, relatives, as well as for health professionals, to experience problems with delayed wound healing. Having a quicker wound healing process, decreasing incidence of disease, and leading a healthier life, are totally possible by being cautious when evaluating and personalizing a patient’s wound care program and using right protocols, based on evidence to control wounds. Chronic wounds can impact a patient’s life in a very negative way. The need to change several aspects in one’s daily lifestyle may arise, as well as the risk of severe infections, loss of function and unfortunately, death.

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