The "Wound Warrior" Approach to Chronic Wound Management
by Mary Ellen Posthauer RDN, CD, LD, FAND
During the past year, I have had the opportunity to collaborate with Dr. Steven Gale and a group of wound care specialists on the development of a standardized approach for treating chronic wounds, often considered the new global epidemic. The January 2014 issue of WOUNDS featured the strategy that organizes wound care using "wound warrior wisdom" to assist clinicians to DOMINATE wounds.1 The idea is to train "wound warriors" who will use this approach to treat and manage wounds in any setting, acute care, long-term care, wound clinics or home care.
A Standardized Treatment Strategy for Chronic Wounds
The DOMINATE approach was the focus of the May 2014 Wound Care Symposium, "Dealing with Healing" held in Perrysburg, Ohio and was enthusiastically received by the attending clinicians.2 The elements of the acronym DOMINATE can be applied in the majority of wound scenarios as a checklist to ensure that measures of proven efficacy are being implemented to encourage healing in an orderly progression.
When Dr. Gale introduced the concept at the Wound Care Symposium, he incorporated some clever verbiage to help the clinicians focus on the concepts, which set the stage for guest facility as they discussed the science behind each letter.
D=Debride "Be picky, picky, picky 'cause it helps the wounds to heal. No more black, brown, greenish sticky, and you'll see the real deal."
O=Offload "Trauma to the wound is a dead end road. Ulcer pressure is traumatic… offload! offload!"
M=Moisture Balance, Malignancy, Medications, Mental "Not too wet, not too dry. Just nice and moist, so cells don't die."
"If a wound’s been really hangin' on make sure it's not to cancer gone."
"Some drugs help the way you feel but not good for the wound to heal."
"If you're stressed and depressed, you may not be at your best, to do what's needed, to get your wound treated."
I=Infection, Inflammation "Contaminated, colonized or infected, it makes a difference you know. If you want the wound to heal, the biofilm has got to go."
N=Nutrition "You may be what you eat, or so the saying goes. If you don't pay attention, the wound may never close."
A=Arterial Wounds "Need food or they will not heal. Oxygen must be a big part of their meal."
T=Technical Advances "Some wounds get stuck and fail to heal. But newer techniques can seal the deal."
E=Edema, Education "It can be nice to be just swell, It can have a real good feeling. But legs that swell may not do very well, especially if the wound's not healing."
Serving Your Community as a "Wound Warrior"
Education and ethics are both important concepts that fit into the E category. Patients often are non-compliant with their treatment or in the case of nutrition their diets because we as clinicians may have failed to illustrate how each step of the DOMINATE strategy relates their wound healing.
I encourage you to learn more about the DOMINATE strategy and apply it to your setting to become a "wound warrior."
1. Gale SS, Lurie F, Treadwell T, Vazquez J et al. DOMINATE wounds. WOUNDS. 2014; 26(1) 1-12.
2. Gale, SS. DOMINATE Wounds: Road to Recovery [PowerPoint]. Perrysburg, OH: Wound Care Symposium: Dealing with Healing; 2014. Excerpt used with permission.
About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Advisory Panel and the American Dietetic Association's Unintentional Weight Loss work group.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.