Wound Healing Southern Africa - Volume 8, Issue 1, 2015
Volume 8, Issue 1, 2015
Author Alan WidgerowSource: Wound Healing Southern Africa 8 (2015)More Less
We have an ongoing struggle that tends to be unique to South Africa. Most likely, it reflects the constant quest of medical insurers to try and limit coverage of their plans to hospital-related events primarily, and to preventive medicine outside of these hospital events. While this is understandable from a cost-containment perspective, and while we all recognise that there is a limited pool of funds available for a massive volume of patients, wound care has fallen casualty to this philosophy for many years.
Source: Wound Healing Southern Africa 8, pp 6 –16 (2015)More Less
This consensus document of the Wound Healing Association of Southern Africa addresses ulcers of the lower limb, focussing on arterial, venous and mixed ulcers. The diabetic foot ulcer and malignant ulcers have been addressed in other documents and readers are referred to these documents.
Source: Wound Healing Southern Africa 8, pp 17 –30 (2015)More Less
The management of the diabetic foot is often a costly endeavour due to the magnitude of foot complications that can arise when not managed within the multi-disciplinary team. The International Working Group on the Diabetic Foot (IWGDF 2011) states that: "A strategy that includes prevention, patient and staff education, multidisciplinary treatment of foot ulcers, and close monitoring can reduce amputation rates by 49-85%". This document is based on the work done by the IWGDF and fully endorses International Consensus Document on the Management and Prevention of the Diabetic foot (2011). Other Guidelines that play a predominant role in adapting the International Guidelines to the South African and also African context are comprehensively detailed in the SEMDSA guidelines (2012), NICE guidelines (2008), Wound Bed Preparation Guidelines (2011), SIGN guidelines (2010) and the International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers(2103). Wound Care for the Diabetic Foot poses unique challenges due to the predisposing risk factors as well as the psychological impact on both the patient, family and care givers. It is also noted that a Diabetic Foot Ulcer (DFU) is a pivotal event in the life of a person with diabetes and is seen as a clear marker of serious underlying disease. Rapid wound deterioration is inevitable if wound care interventions are not done early to avoid ultimate amputation. The purpose of this document is to describe the basic principles in managing the diabetic foot by focussing on both prevention and ulcer treatment within the African context.
Differential assessment : pressure ulcers versus incontinence-associated dermatitis versus intertriginous dermatitis : review articleAuthor T. IdensohnSource: Wound Healing Southern Africa 8, pp 31 –33 (2015)More Less
The differential assessment of incontinent-associated dermatitis (IAD), pressure ulcers and other forms of skin damage is difficult for healthcare workers. Accuracy in differential assessment is positively impacted by education and the use of structured differential tools. Differential assessment is a critical element of their effective management.
Source: Wound Healing Southern Africa 8, pp 34 –38 (2015)More Less
Background: Successful healing of venous leg ulcers can only be achieved by compression therapy in combination with moist wound healing. Therefore this treatment is recommended by therapy guidelines. Still it is a widely held belief that its implementation in daily practice is complicated or even impossible.
Aim: To generate further experience about the practicability of the recommended holistic therapy for venous leg ulcers.
Methods: 63 patients (Germany, Italy, Austria) were treated for 12 weeks in daily medical practice with a therapy concept including phase-adapted moist wound dressings, microbe-binding wound dressings and compression bandages in the initial oedema phase, followed by a compression stocking system with high stiffness characteristics.
Findings: 85% of all wounds reduced in size significantly; 53% of all wounds healed completely within 12 weeks. The patients' well-being was substantially improved leading to high compliance. As the majority of patients had not experienced any progress in healing for extended periods of time due to their complicated health situation or ineffective treatment the results were rated very positively by patients and physicians.
Conclusion: Holistic therapy concepts offer significant advantages and can successfully be implemented in daily practice independent of national or local wound care traditions.
A random prospective pilot study of Sorbact versus Acticoat versus Silverlon for the treatment of burn wounds in a South African adult burns unit : general reviewSource: Wound Healing Southern Africa 8, pp 43 –52 (2015)More Less
The Tygerberg adult burns unit is a level three provincial service for severe burns. Burn patients of 12 years or older are admitted. Annually about 300 patients are treated, of which 110 would be intensive care admissions. The burn unit has bed capacity for 22 patients, of which 6 are intensive care and the rest ward beds. Adequate operating time is available to optimally manage about 50% of the patients weekly. During the colder periods from April to September management of patients is compromised due to the severe workload demands and lack of resources.
A random prospective non-controlled clinical study of Cutimed Sorbact® as a skin substitute for the treatment of partial thickness burn wounds in a South African adult burns unit : clinical studySource: Wound Healing Southern Africa 8, pp 54 –58 (2015)More Less
Author L. NaudeSource: Wound Healing Southern Africa 8, pp 56 –60 (2015)More Less
Foot ulcerations are the most common complications associated with the patient living with diabetes worldwide, and South Africa is no different. Several total contact casing methods worldwide are available. The description of the application of a total contact cast (TCC) with plaster bandage (Gypsona®), as described in Levin and O'Neal's The Diabetic Foot is probably the most well known. Undisputedly, total contact casing is regarded as the gold standard offloading method used for the rapid healing of neuropathic plantar foot ulcers. Numerous studies and papers indicates its effectiveness. Unfortunately, total contact casing is still underused in the South African environment and other offloading devices, such as felt padding in shoe inserts, are used primarily. Several reasons for this have been discussed with peers and other healthcare professionals. The most common seems to be "the fear of failure". Health professionals are uncertain as to how to apply the TCC, and are worried that they will cause more harm than good. From this, it is clear that guidance and education are needed, including skills training, in order to change this perception. It has been shown in several studies that total contact casing is safe for the patient in skilled hands.