Wound Healing Southern Africa - Volume 3, Issue 1, January 2010

My exposure to the US and Canadian markets of late has reinforced my belief that traditional healthcare as practised for decades in most countries is about to change dramatically. The combination of costs and new age technology has necessitated changes in treatments, hospitalisation and reimbursement.

We have come a long way in our understanding of the mechanisms involved in producing an exaggerated scar. One of the important factors to consider is that, as in so many other medical conditions, the answer lies in a multipronged approach. It serves no purpose targeting one area in a cascade of events that result in scarring. Thus we previously published a set of principles that govern the sequential areas of control that we have used to minimise scarring - support, hydration, collagen maturation and controlled inflammation. These principles will be elaborated on in respect of new scientific facts and with particular reference to the practical management of different wound sites.

It is the opinion of many that the incidence of burn injuries is taking on epidemic proportions. This epidemic is not subsiding. Allorto et al investigate the clinical incidence and the challenges of managing burns in a busy rural hospital within KwaZulu-Natal, South Africa. These investigators describe the situation as an "epidemic of insurmountable proportions". Large burns cannot be managed at their centre, and they need access to a tertiary regional centre. The moderate to small burns are so numerous that the resources available are inadequate. The standard wound treatment that is available is not yielding acceptable healing rates; the ratio of healing days to percentage burn is 1:1. The result is that the maintenance of function and aesthetics is not achieved.

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This discussion will focus on the identification and management of minor burn wounds, according to modern day moist wound healing principles.

Hyperuricaemia is the underlying cause of a condition commonly known as gout. Patients with hyperuricaemia may be asymptomatic for life or may experience frequent attacks of painful gouty arthritis. Gout is, therefore, a condition with both acute and chronic characteristics.

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It is a priority of the management of chronic gout to lower the serum urate (SU) level to below 6 mg/dL, which is the goal range. Failure to do so allows the SU level to cross the limit of solubility in the body. Once that threshold is crossed, it ultimately results in the laying down of uric acid deposits in joints and soft tissue, as the ability of the kidneys to clear the body of uric acid is reduced. The long term complications of poorly controlled uric acid levels include recurrent acute incidences of flare-up and the development of tophaceous gout.

Leg length discrepancy (LLD) affects about 60% to 95% of the general population and can result in functional complaints due to dynamic changes in musculoskeletal biomechanics. However, many people who have about 1 to 2.5 centimeters (cm) of LLD do not seem to have any clinical symptoms. Therefore, controversy still remains as to at what level of LLD intervention should be instituted. Yet, in a disease like diabetes mellitus, where the foot may be neuropathic and/or affected by some form of peripheral vascular disease, any amount of lower extremity discrepancy must be a cause for concern to any practitioner managing a diabetic foot. This article will review LLD and its biomechanical influence on the foot and how it may lead to plantar ulceration.

Wound management continues to present a major health challenge throughout the world. In an attempt to meet the demanding difficulties encountered in the management of chronic ulcers, clinicians often seek the intervention of technology and evidence-based methods for assistance. Advanced wound technology has conveyed a series of benefits in wound care, and whilst these advancements have been appreciated, it is equally important to emphasise that such technology has introduced some new challenges for clinicians. The purpose of this paper was to highlight the practical and clinical challenges encountered by the authors when using ambulatory vacuum assisted closure therapy in the management of diabetic foot ulceration.

The daily intake of food is an activity that is associated with life and the maintenance thereof. Unfortunately, there is more to food than meets the eye and what is eaten is not necessarily exactly what the body needs. When confronted with skin breakdown and wounds, evidence is mounting to support the notion that intake of food and additional nutritional supplementation in these individuals are paramount in facilitating the wound healing process. It is a well known fact that wounds heal the quickest in well-nourished patients.

This is an update following the first research pilot project on venous ulceration which was overseen by the Wound Healing Association of Southern Africa, and published in Wound Healing Southern Africa 2009 Volume 2 Number 2.