Rashmin Adesara, Practice Medical Director, Community Health Network
Few months ago while I was putting bandage on my 10 years old son’s knee wound, he scrapped his knee while riding his bike, he told me “Dad, did you know wound heals faster if you keep it open.” I am not sure where he got this information from but ever since then I wanted to write this article explaining about basic wound care method for both acute wounds as well as for chronic wounds. It is well known misconception that keeping the wound open helps it heal faster but that is not true because wound requires moisture to help facilitate the healing process. The moisture helps stimulate autolyticde bridement and supports cell migration from normal surrounding skin. Also by keeping the wound covered we are preventing the wound from getting infected. After any injury it is very important to clean wound with tap water to remove all the dirt and debris and to keep the wound covered with bandage. For deeper wounds it is important to see a health care provider as soon as possible in case if the wound requires stitches. If these kind of wounds are not attended in time healing period can get longer. Hand, head and neck are very complex parts of body and injury in these area can require immediate attention to prevent any further complications. As a parent
giving mental and emotional support is as important as getting wound dressing.
A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do. These following conditions can cause wound to prolong healing
• Poor blood circulation caused by smoking and diabetes related arterial disease.
• Swelling in legs from vein disorders, lymphedema, and congestive heart failure.
• Uncontrolled diabetes.
• Chronic infection in the wound and/or bone.
• Pressure in the wound area.
• Certain medications and cancer can also cause delay in wound healing.
There are few ways to help improve the healing process of a chronic wound:
• Keeping diabetes under control in a diabetic patient is important
• Smoking cessation is important
• Improving blood circulation by opening the blood vessels
• Keeping swelling under control with multilayer compression dressing (only when patient has good blood circulation)
• Managing proper moisture
• By using absorbent dressing and by frequent dressing change
• Certain wounds with significant drainage requires negative pressure wound therapy called Wound Vacuum System, which collects drainage from the wound to keep wound’s moisture under control and promote formation of granulation tissue
• For dry wounds provide moisture by using gel based dressing
• Treating wound infection with the proper antibiotic is vital
• Offloading pressure from the wound
• For patients with ulcer and bedsores this can be done by foam dressing or by special offloading device like mattress or cushions
• For patients with diabetic neuropathic foot ulcer this can be done by using total contact cast
• Providing high protein diet with certain minerals and vitamins for patients with malnutrition is essential
• Treating bone infection in chronic wound with intravenous antibiotic and hyperbaric oxygen therapy (HBOT)inhibits amputation
Advance wound care center works with a goal to heal wound within fourteen to sixteen weeks. In order to heal the wound in this time advance wound care center has been using special dressing, offloading device, skin grafts, and hyperbaric oxygen as advance modalities in wound care.
HBOT is done in a pressurized chamber that is see-through and oxygen-rich environment where the patient can watch TV or movie while getting treated. Patients breathe 100% oxygen under 2 to 2.5 ATA pressure. Providing oxygen-rich environment helps carrying oxygen not only by red blood cell but also by plasma to circulation compromised wounds and surrounding tissues to help stimulate growth of new blood vessels and tissues. While the length of treatment for each patient is different, most patients receive 90 minutes treatment 5 days a week for one to three months.
Most common indication for hyperbaric oxygen therapy
• Delayed radiation injury (soft tissue and bony necrosis)
• Compromised skin grafts and flaps
• Diabetic foot ulcer with infection.
• Carbon monoxide poisoning
I consider wound care as team-based care to treat patient as a whole not just the hole in patient. In order to heal the wound in time it is very important that patients keep their weekly appointments with the advance wound care center and follow recommendations for dressing change. It is also important to keep patient’s medical condition under control by taking medication as directed and also by following up with primary care physician and specialist in timely manner.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine