Wound Healing Southern Africa - Volume 1, Issue 1, 2008
Volume 1, Issue 1, 2008
Author Alan WidgerowSource: Wound Healing Southern Africa 1 (2008)More Less
Over the past few years, the explosion of knowledge related to molecular biology, genetics and basic science has catapulted 'Wound Healing' as a field to the forefront of interest as an exciting new medical specialty. This fact has not been overlooked by many of us here in Southern Africa.
The WHASA WHEEL - integrating multiple specialities in patient management with wound healing as the common basis : case studyAuthor A.D. WidgerowSource: Wound Healing Southern Africa 1, pp 7 –14 (2008)More Less
There is not a speciality in Medicine that I can think of today where Wound Healing does not impact. The surgical specialities by their very nature involve the healing of wounds in one form or another, but it is not always appreciated that almost every chronic medical condition also has associated wound problems. This reality results in an unprecedented amalgamation of medical minds and basic scientists all contributing to a surge in knowledge related to this relatively new field.
The WHASA (Wound Healing Association of Southern Africa) WHEEL is a concept that has been developed to demonstrate the impact of interspeciality co-operation for the ultimate benefit of the patient. This article, by means of a hypothetical case, attempts to demonstrate this co-operation and to highlight esoteric situations that arise when considering wound healing among the different fields. It is by no means exhaustive of surgical scenarios but merely representative of fairly common situations that any of us could encounter on a daily basis.
The article takes the form of a case report which is interspersed with 'wound healing' discussions that I have added under the heading 'WHASA background comments'. In addition invited comments from our esteemed colleagues that make up the components of the WHASA WHEEL are included within the text.
Source: Wound Healing Southern Africa 1, pp 16 –21 (2008)More Less
Holistic patient Assessment forms an integral part of wound assessment - the wound is part of a person with individual qualities and needs that should be considered. A wound can never be treated without considering the unique physiological and psychological aspects of the human being. The Wound Healing Association of Southern Africa developed a wound assessment form in 2007 to facilitate holistic patient assessment in order to aid with quality wound assessment and wound management.
Source: Wound Healing Southern Africa 1, pp 25 –27 (2008)More Less
The South African government made the inclusion of ICD 10 codes on all medical accounts compulsory from 1 July 2005. By law, practitioners are required to include the ICD 10 code that applies to the relevant medical diagnosis for every single line item on a medical account since 1 July 2005. This should be used in conjunction with Nappi-codes when medicine or stock is issued. The ICD 10 codes also ensure that the medical aid has the necessary information to route claims to the correct benefit categories for the patient's benefit options. This is particularly beneficial in the case of Prescribed Minimum Benefits (PMBs) to ensure that these claims are funded via the medical scheme fund and not the day-to-day savings account of the patient.
ICD 10 coding is still very new in South Africa, and the diagnostic codes are often used incorrectly. To understand the use of ICD 10 codes we first need to answer a few questions.
Source: Wound Healing Southern Africa 1, pp 29 –34 (2008)More Less
Chronic wounds are often recalcitrant to healing and they often do not follow the expected trajectory (30% smaller in 12 weeks). They are disabling and constitute a significant burden on patients' activities of daily living and the healthcare system. Of persons with diabetes, 2-3% develop a foot ulcer annually, while the lifetime risk of a person with diabetes developing a foot ulcer is as high as 25 percent. It is estimated that venous leg ulcers affect 1% of the adult population and 3.6% of people over 65 years old. As our society continues to age, the problem of pressure ulcers is growing. To address this burgeoning problem, this article will incorporate the wound bed preparation model into a practical clinical guide for the treatment of chronic wound (see Figure 1). Central to this paradigm is the importance of treating the cause and addressing patient centered concerns prior to optimising local wound care. The three important components of local care are : debridement, infection and inflammation, moisture balance (DIM). If wound bed preparation is optimised and healing is stalled, the additional E or the edge of non-healing wounds represents the potential use of advanced active therapies to stimulate healing. Remember this, DIM before DIME.
Author L. TudhopeSource: Wound Healing Southern Africa 1, pp 37 –39 (2008)More Less
Diabetes mellitus is increasing globally at an alarming rate. The disabling complications of the disease are draining the healthcare resources of both developed and developing nations, and admissions for diabetic foot-related complications to hospitals and clinics worldwide are the most common reason for hospital bed occupancy in this patient population.
The World Health Organization (WHO) has predicted that there will be 330 million diagnosed diabetics worldwide by 2025. That equates to 660 million feet at risk of possible ulceration with all the attendant sequelae of amputation and limb loss. Africa will face the second highest increase in prevalence of the disease; an expected increase of 160%; second only to the increased prevalence expected in the Middle East. Considering that 85% of all amputations done in diabetics are preceded by ulceration, it is of paramount importance that diabetic footcare protocols are developed and implemented immediately. Foot screening programmes that identify those feet at risk need to be taught to all healthcare professionals involved in the care of the diabetic patient.
Source: Wound Healing Southern Africa 1, pp 40 –42 (2008)More Less
The podiatrist is a key member of the multidisciplinary healthcare team involved in managing the diabetic foot and its complications. Foot screening and assessment to identify the high-risk foot is aimed at preventing the serious complications of ulceration and amputation. In addition, podiatric management involves individualised foot health education, management of non-ulcerative pathologies and ulcer care. The International Working Group on the Diabetic Foot (IWGDF) Consensus Guidelines is a useful tool to enable podiatrists to perform their multifactorial role in diabetic foot care. In South Africa this role is hampered by a lack of resources in personnel and finance. A national plan for the management of the diabetic foot, based on evidence-based practice is urgently needed to focus scarce podiatric skills on improving diabetic foot care.
Author G. WeirSource: Wound Healing Southern Africa 1, pp 44 –47 (2008)More Less
The management of leg ulcers has proven to be a tremendous burden on patients, healthcare practitioners and healthcare resources. The refractory nature of venous ulcers affects the quality of life and work productivity of those persons afflicted. This, in combination with the high costs of long-term therapy, makes venous ulceration a major health problem. The majority of lower limb ulcers are associated with venous disease (80%), but other causes or contributing factors include arterial disease, neuropathy (often due to diabetes), pressure (immobility, obesity), vasculitis, trauma, infections and cutaneous neoplasia. Very little information is available with regards to the estimated cost of the management of venous ulcers in South Africa. The cost of venous leg ulcers is estimated to be $1 billion per year in the United States, and the average cost for one patient over a lifetime exceeds $40 000. In the United Kingdom this cost is estimated at more than £400 000 000 a year. Proper diagnosis and adequate management are vital when caring for patients with venous leg ulcers to promote faster healing and prevent recurrences. By standardising the treatment of patients with venous leg ulcers, the patients could be treated more efficiently and the total cost of treatment, could be reduced.
Source: Wound Healing Southern Africa 1, pp 48 –50 (2008)More Less
Wound healing is a complicated process needed to restore homeostasis in the body. The two arginine utilising pathways involved in wound healing are the inducible nitric oxide synthase (iNOS) to produce NO, and the arginase pathway producing ornithine, proline and the polyamines. iNOS is highly active in the inflammatory phase with NO affecting the cyclooxygenase enzymes and the release of inflammatory mediators. In the proliferative phase, NO affects arginase and therefore collagen production and cell proliferation. Both supplemental arginine and ornithine appear to be beneficial in wound healing. The roles and regulation of these pathways are discussed in the different stages of wound healing. Interpretation of data from wound healing research is complicated by the extrapolation of animal model data to the human situation and a lack of human studies.