Wound Healing Southern Africa - Volume 4, Issue 2, 2011
Volume 4, Issue 2, 2011
Author Alan WidgerowSource: Wound Healing Southern Africa 4 (2011)More Less
This edition of Wound Healing Southern Africa (WHSA) provides yet another collection of articles that feature multiple specialties, dealing with a range of subjects from basic wound healing principles to specialised treatment regimens for complex surgical situations. As such, we continue to fulfill our mandate of catering to a broad subsection of medical specialties that have one common goal: the promotion of complex wound healing.
Source: Wound Healing Southern Africa 4, pp 55 –72 (2011)More Less
This article builds and expands upon the concept of wound bed preparation introduced by Sibbald et al in 2000 as a holistic approach to wound diagnosis and treatment of the cause and patient-centered concerns such as pain management, optimizing the components of local wound care: Debridement, Infection and persistent Inflammation, along with Moisture balance before Edge effect for healable but stalled chronic wounds.
Use of the Braden Scale for Predicting Pressure Sore Risk© at a school for learners with special needs : original researchAuthor C.P. SwartSource: Wound Healing Southern Africa 4, pp 74 –79 (2011)More Less
Children with physical disabilities face numerous daily challenges. They might suffer ridicule and rejection from peers based on their appearance, or the way in which they talk and walk. They also face the possible occurrence of co-morbid medical conditions as a result of poor relay of information, or lack of assessment. This would further impact their compromised quality of life. In 2010, as an occupational therapist (OT) at a special needs school, I encountered two wheelchair-bound spinal cord injury (SCI) learners who had been suffering from pressure-related ulcers for more than a year. This was due to ignorance about the pressure ulcer (PU) formation mechanism. Attempts to address this led to use of the Braden Scale for Predicting Pressure Sore Risk© (the Braden Scale) to predict and prevent PU development in six SCI learners, after which its efficacy was assessed.
Source: Wound Healing Southern Africa 4, pp 80 –83 (2011)More Less
Maggots are known to clean wounds by removing slough and dead tissue. This was put to therapeutic use in the last century, between the world wars, when it was in use in at least 300 hospitals in the United States and being prescribed by at least 1 000 doctors. Antibiotic use replaced it for a while, but the emergence of antibiotic resistance has led to a renewed interest in maggot debridement therapy.
Maggot treatment works on three levels: debriding dead and necrotic tissue by extracorporeal digestion, disinfection by the secreted enzymes and the stimulation of wound healing.
We have access to a maggot laboratory at the Steve Biko Academic Hospital in Pretoria, where maggot therapy is frequently used to debride and clean wounds. The results are at least comparable to other modalities of wound debridement, and can be used on patients who are high-risk candidates for general anaesthesia, and also when a shortage of beds in the hospital prevents admission for inpatient treatment.
Author H. SmartSource: Wound Healing Southern Africa 4, pp 84 –85 (2011)More Less
Influencing factors that must be taken in account on assessment of the patient with a wound can be broadly divided into intrinsic factors that are part of the patient's make-up, and extrinsic factors that may exert an outside influence on the outcome of wound healing. As the list may become an endless preamble, history-taking is often difficult and not complete enough to make a full assessment of all factors that influence a patient with a wound.
Author A.D. WidgerowSource: Wound Healing Southern Africa 4, pp 86 –93 (2011)More Less
The non-healing wound is encountered by practitioners in multiple clinical situations. It is characterised by a stalled process in the healing trajectory. The non-healing wound is not necessarily a chronic wound, although the two conditions have many similarities. With the advent of improved molecular biological understanding, many cellular events can be recognised as patterns for non-healing, and possible interventions may become evident. Thus, once obvious host disease problems have been excluded, exaggerated inflammation with high matrix metalloproteinase levels and the presence of biofilm are causative factors in many cases of non-healing wounds. Intervention may range from a simple change of dressing type and debridement to more sophisticated wound bed interventions. A systematic approach to the non-healing wound is presented.
The open abdomen
Part 3 : Management of the Grade 3 open abdomen with entero-atmospheric fistulae : general reviewSource: Wound Healing Southern Africa 4, pp 94 –102 (2011)More Less
Entero-atmospheric fistulae are a disastrous complication when laparostomes have to be used in abdominal surgery. Patients must be approached from a global and localised perspective, with heavy focus on management of fluid balance, electrolytes, nutrition, and prevention of infective complications. Specialised dressing of the laparostome and fistulae is essential for optimisation of the patient's condition before undertaking more definitive forms of management, as well as for dignity and quality of life. Depending on the fistula classification, the dressing method may be successful. Fistula isolation is the key concept behind these specialised dressings. Ultimately, the objectives are to achieve either spontaneous or surgical closure of the fistula, and closure of the laparostome.
Source: Wound Healing Southern Africa 4, pp 104 –122 (2011)More Less