Wound Healing Southern Africa - Volume 1, Issue 2, 2008
Volume 1, Issue 2, 2008
Author Alan WidgerowSource: Wound Healing Southern Africa 1 (2008)More Less
I am delighted to write this Editorial for our second edition of Wound Healing Southern Africa. My heartfelt thanks to all of you for the overwhelming positive response we had to our first edition. It confirms to us the need for such a journal which bridges divides and allows collaboration between so many specialties.
Author A.D. WidgerowSource: Wound Healing Southern Africa 1, pp 5 –7 (2008)More Less
Chronic wounds by their very nature are recalcitrant and resistant to treatment. The pervading illness and pathology associated with the particular background disease, be it venous insufficiency, diabetes or the pathology underlying pressure ulcers have in the past been used as an explanation for non-healing and chronicity in these wounds. Thus managing poor perfusions, nutrition, sugar control, avoiding repetitive pressure have been and remain priorities in the overall treatment of these chronic wounds. It is apparent however, that in many cases, even when these processes are managed well, wounds still advance to non-healing and chronicity. Of late more and more authors are looking at biofilm formation and its behaviour characteristics as a possible explanation for chronicity in many wounds.
Source: Wound Healing Southern Africa 1 (2008)More Less
Cutimed® Sorbact® makes use of hydrophobic interaction to remove pathogenic wound bacteria.
Hydrophobic interaction is a basic physical principle : hydrophobic (water-repellent) particles accumulate in an aqueous environment and are held together by the forces of the surrounding water molecules. Bacteria have certain hydrophobic cell surface structures. These are needed, for example, to adhere to host (wound) tissue in the initial phase of a wound infection. Cutimed Sorbact, on the other hand, is coated with a fatty acid derivative (DACC) which gives the dressing its strongly hydrophobic properties.
Source: Wound Healing Southern Africa 1, pp 10 –12 (2008)More Less
Bacterial biofilms are extremely common in the natural environment, and biofilms are known to cause chronic inflammation that contributes to the molecular pathologies of many diseases including periodontal disease, surgical device infections, urinary catheter infections, cystic fibrosis, chronic otits media, and contact lens associated corneal infections. Compared to planktonic (free-floating) bacteria, coaggregated surface attached (sessile) microcolonies of bacteria in biofilms have enhanced resistance to killing by endogenous antibodies and phagocytic cells, as well as by exogenous antibiotics and antiseptics. Recent investigations indicate that many chronic skin wounds (~60%) contain bacterial biofilms, which suggests that biofilms play important roles in maintaining a chronic inflammation state that ultimately leads to the failure of skin wounds to heal. The terms critical colonisation or localised infection, which were created to describe wounds that fail to heal even with low numbers of planktonic bacteria (≤ 105 colony forming units, CFUs), may actually be describing wounds that have biofilms. Removal of biofilms by debridement and prevention of reformation of biofilms by topical antiseptics and antimicrobial dressings may be the optimal treatment to move chronic wounds out of a chronic inflammatory phase and into a healing repair phase.
Author L. TudhopeSource: Wound Healing Southern Africa 1, pp 13 –14 (2008)More Less
An angiosome is an anatomic unit of tissue (which has skin, subcutaneous tissue, fascia, muscle and bone), fed by a source artery. This article is a short discussion on the importance of angiosomes in healing of foot ulcers.
The treatment of ischaemia in the diabetic foot should be aimed at the restoration of maximum blood flow to the foot with the restoration of palpable foot pulses whenever possible. This pulsatile flow increases the chance of wound healing and diminishes future skin breakdown and ulcer formation.
Source: Wound Healing Southern Africa 1, pp 15 –16 (2008)More Less
Blisters initially form because the outer layer of the skin has become damaged. Fluid collects under the damaged layer of skin, initially cushioning the tissue underneath, protecting it from further damage and allowing it to heal. When the pressure of the fluid is too great it can create further damage to the underlying tissues. A blood blister usually forms when a small blood vessel close to the surface of the skin ruptures and blood leaks into a tear between the layers of skin. This can happen if the skin is crushed, pinched or squeezed very tightly. In the diabetic patient these are often seen in pressure areas.
Source: Wound Healing Southern Africa 1, pp 18 –20 (2008)More Less
Ulcers develop on insensate feet due to trauma the patient does not feel, and it makes sense that ulcers cannot heal if mechanical trauma is ongoing. Andrew Boulton has repeatedly stated that it is not what you put on a diabetic foot ulcer that heals it but rather what you take off it. Ideally then, ulcers must be managed with rest and avoidance of all pressure. However, total non-weight bearing is rarely practical and is difficult to achieve. In the neuropathic foot, the overall aim is to redistribute plantar pressures evenly, thus avoiding areas of high pressure that will prevent or delay healing. In the neuro-ischaemic foot, the aim is to protect the vulnerable margins of the foot. Patients usually prefer devices that are light and easy to walk with, but in reality the most effective treatment strategy requires a device that will severely disrupt normal activity for 6-8 weeks. De Block and colleagues found that if a plantar foot ulcer fails to heal by approximately 8 weeks, either it is being ineffectively treated or the patient is not being compliant with the treatment regimen. It must always be remembered that heel raisers should be applied to the contralateral limb when using any device that raises the heel of the ulcerated limb to avoid limb length discrepancy that may result in postural insecurity and lower back pain. This article will discuss the variety of offloading options, keeping patient adherence in mind.
Saving you time, saving you money, putting the patient first - the Ambulatory Wound Care Phenomenon : practice managementSource: Wound Healing Southern Africa 1, pp 22 –26 (2008)More Less
The ambulatory wound care concept is an accepted and growing phenomenon worldwide. As the aging population grows so the number of patients with chronic diseases increases. Each and every chronic disease is associated with a wound manifestation of one type or another. Thus diabetic patients present with diabetic foot ulcers; those with chronic venous insufficiency present with venous leg ulcers; hypertensive patients present with arterial ulcers; elderly patients on corticosteroid drugs, blood thinners and other immunosuppressive drugs are prone to injuries, abrasions and differing wounds; and the list goes on...
The level of sophistication of treatment has increases in tandem with the level of understanding of the background pathophysiologic events surrounding the genesis of these wounds. Thus too, the success of ambulatory wound care has increased exponentially.
The advantages in terms of cost are enormous to the patient and the insurer; the lessening impact on lifestyle of the patient on ambulatory treatment who continues to work and contribute to society is incalculable; the decreased exposure to hospital acquired infections inevitable in long-stay hospital patients is also a significant factor in successful wound management outcome. This is of special importance in the patient treated for post-operative sepsis who is separated from the potential source of further infection.
For these reasons and numerous others patients and insurers worldwide are turning to ambulatory wound care as a new efficient service for healing complex wounds. South African insurers are lagging behind somewhat in recognition of this service as an essential health care segment, but the trend is starting to change with some medical aids giving consideration to the service as part of a proscribed minimum benefit working in tandem with the treatment of chronic disease.
This paper introduces a few typical cases of ambulatory wound care. They have been selected, not on the basis of any dramatic unusual response to sophisticated treatment, but rather as examples of typical cases that are treated in these facilities on a daily basis. We have included two cases demonstrating complete healing and comparative costs incurred and two more cases demonstrating comparative costs (ambulatory vs hospital) ongoing treatment costs of wounds in the process of healing.
Author L. NaudeSource: Wound Healing Southern Africa 1, pp 28 –30 (2008)More Less
In the previous edition of WHSA we introduced the readers to the WHASA assessment form; the assessment form forms the basis for every wound assessment and also provides the necessary information for Medical Aids to grant authorisation for wound care.
In this issue we would like to introduce the reader to the next step in documentation which is progress reporting. This document was co-authored by Sr Hiske Smart and Sr Febe Bruwer (Members of the WHASA EXCO committee) and the focus was on creating an easy to use example of a wound care progress report. The information captured in this document is essential to ensure that Medical Aids and practitioners capture the right information to ensure transparent feedback to all involved.
Source: Wound Healing Southern Africa 1, pp 32 –33 (2008)More Less
Please note that is a draft copy of the WHASA Advanced Wound Care Dressings classification system. All members and suppliers are cordially invited to send comments to WHASA at: firstname.lastname@example.org
The final classification system will be published in the May 2009 edition of Wound Healing SA.
Source: Wound Healing Southern Africa 1, pp 36 –41 (2008)More Less
Hyperbaric oxygen therapy (HBO) is the use of 100% oxygen, breathed under pressure and delivered to tissues by the circulation, to achieve a therapeutic benefit. Under hyperbaric conditions oxygen attains medicinal properties. Time and pressure of the exposure provide the specific "dose" and "tissue level" required to achieve the effect. HBO provides a pressure-related increase in plasma-borne oxygen. This increases total blood oxygen content by 20-25% and markedly improves free (i.e. dissolved) oxygen delivery to tissues, increasing the diffusion distance from the capillaries into tissues several fold. At these increased tissue levels, oxygen initiates a series of distinct physiological and pharmacological effects.
Multidisciplinary approach in hyperbaric oxygen therapy : application of the WHASA wheel on the diabetic foot : reviewAuthor H. SmartSource: Wound Healing Southern Africa 1, pp 42 –44 (2008)More Less
With the soaring number of patients diagnosed with diabetes worldwide, it is estimated that over 380 million people will be affected by the year 2025. Of these, the life time risk for developing a diabetic foot ulcer will be about 15%. The cost burden of managing a single foot ulcer episode is enormous; it affects patients, medical aids and public health care. Current estimates, based on 2001 cost figures, range between $1 892-$27 721 for the management of a single ulcer depending on severity. A diabetic foot at risk carries a 19.6% risk of developing a subsequent infection. Thirty percent of diabetic foot conditions ultimately end up with an amputation.
The Wound Healing Association of Southern Africa - meeting feedback : conference report - WHASA newsSource: Wound Healing Southern Africa 1, pp 46 –47 (2008)More Less
The 2nd WHASA International Multidisciplinary Wound Management Conference was held at the Indaba hotel and conference centre in Gauteng in May 2008. More than 140 delegates attended the 3 day conference with an excellent range of topics covered by both international and national speakers. The theme of the conference was : Wound Healing - integrating products and people.
The Wound Healing Association of Southern Africa - WUWHS meeting feedback : conference report - WHASA newsSource: Wound Healing Southern Africa 1, pp 48 –49 (2008)More Less
WUWHS 2008. What a ride, what a journey for all of us! This event was all about rising above the challenges within the international wound care arena, and we are very proud to say that we were indeed able to do just that. WHASA was recognised as a supporting association at the WUWHS 2008 congress and we were also part of five countries bidding for the fourth congress of the World Union of Wound Healing Societies.