Medical teams caring for patients can request specific wound care and follow-up care at UC through specialist clinics – this may include nurse-led clinics or patients can be referred to their local GP for wound follow-up. The choice of dressing should be based on the specific characteristics of the wound and referral to stoma treatment should be initiated to promote optimal wound healing. Advanced wound treatments may be required, for example, surgical debridement, application of a negative compression dressing, hyperbaric therapy. Skin graft – removing a partial or complete segment of the thickness of the epidermis and dermis from its blood supply and transplanting it to another site to speed healing and reduce the risk of infection. Flap – surgical displacement of the skin and underlying structures to repair a wound. The valves are named after their tissue components and may involve an anastomosis of the blood supply to the vessels attached to the affected site. “Assessing wound healing is an ongoing process. All wounds require a two-dimensional evaluation of wound opening and a three-dimensional evaluation of decay or follow-up” (Carville, 2017) Acute surgical or traumatic wounds can heal by secondary intention – for example, a sinus, drained abscess, wound dehiscence, skin fissure or superficial laceration. The choice of dressing should be based on the specific characteristics of the wound. Referral to ostomy therapy should be considered to promote optimal wound healing. Pain can be an important indicator of abnormalities. The pain associated with chronic wounds and wounds that require frequent dressing changes may be underestimated.
An accurate assessment of pain is essential to choose the most appropriate dressing. Assessment of pain before, during, and after dressing change can provide important information for subsequent wound management and dressing selection. These wounds require little intervention other than protection and observation of complications. Recommended dressings include: Parents and caregivers should be given a plan for ongoing wound care at home. A range of suitable trim products are available from the RCH Equipment Distribution Center. Holistic patient assessment is an important part of the wound management process. A number of local and general factors can delay or impair wound healing. These may include: Wound infection can be defined as the presence of bacteria or other organisms that multiply and lead to overcoming host resistance.
The infection can interfere with scarring and damage tissue (local infection) or cause a spreading infection or systemic disease. An infection impairs wound healing and can be the cause of wound dehiscence. Local indicators of infection – a wound can be described in several ways; by its etiology, its anatomical position, whether acute or chronic1, by the type of closure, by its symptoms or by the appearance of the predominant tissue types in the wound bed. All definitions serve an essential purpose in the assessment and proper treatment of the wound until symptoms resolve or, if possible, heal. Produced by all acute and chronic wounds (more or less) as part of the natural healing process. It plays an essential role in the healing process because it: Occurs when the wound is contaminated or an infection is suspected. These traumatic or surgical wounds require intensive cleaning before healing can occur. Debridement with irrigation may be necessary. The recommended dressings are: There are different terminologies to describe certain types of wounds: such as surgical incision, burn, laceration, ulcer, abrasion. They can usually be classified as acute or chronic wounds. All aspects of wound care, including assessment, treatment and management plans, implementation and evaluation, must be documented in a clear and comprehensive manner.
Wound assessment and treatment documentation should be completed in the EMR using the “Treatment Flowsheet” activity using the “LDA” tab (Lines, Drains, Airway Assessment) or using the Avatar activity. Click the “Add New LDA” button to search for the correct wound type, such as burn, surgical incision, and pressure area. The LDA or avatar tab can be used to monitor and record the progression of the wound through its healing stages. Clinical images can be included in the assessment using the “Rover” device. A wound, by definition, is a break in the protective function of the skin; Loss of epithelial continuity, with or without loss of underlying connective tissue (i.e. Muscles, bones, nerves)2 after injury to the skin or underlying tissues/organs caused by surgery, blows, cuts, chemicals, heat/cold, friction/shear force, pressure, or as a result of diseases such as leg ulcers or carcinoma3. Accurate wound assessment and effective wound management require an understanding of the physiology of wound healing, combined with knowledge of the effects of available dressings. It is important that an ongoing process of assessment, clinical decision-making, intervention and documentation take place to allow for optimal wound healing. Currently, most skin lesions are called wounds and are mainly divided into acute and chronic, the difference being in the period in which they persisted and/or their tendency to heal properly or not. Etiology is not considered when applying definitions of chronic versus acute.
The traditional definition of wounds and ulcers was mainly based on etiology, with a wound (now called an acute or surgical wound) caused by violence (e.g., an external force such as a bullet, a surgical incision) and an ulcer currently called a chronic “wound” being defined as caused by some sort of internal etiology (e.g., venous hypertension with its secondary consequences for skin integrity). Based on differences in etiology and physiology, morbidity and mortality, treatment options and requirements, and other aspects of different types of skin lesions, this author proposes to reintroduce the “old” nomenclature. It is important to assess and document the type, amount, color and odour of exudate to detect changes. Excess exudate leads to maceration and degradation of the skin, while insufficient excess can cause the wound bed to dry out. It can become more viscous and odorous in infected wounds. Type of healing – Main intention – The edges of the wound are held together by artificial means such as sutures, staples, ligaments or tissue glue. Tissue loss is minimal and wounds heal with minimal scarring. Most clean surgical wounds and recent traumatic injuries are treated by primary occlusion. Delayed primary intention – if the wound is infected or requires intensive cleaning or more thorough debridement before primary closure, usually 3 to 7 days later.