Advanced Therapies

By Shannon Solley, Assistant Editor, WoundSource

Is there an irremovable offloading device suitable for lower extremity pressure injuries? “An irremovable heel offloading device encourages increased compliance,” says Dr. Lenz and Dr. Hussain within their poster presentation at SAWC, “Heel Offloading Posterior Splint for Treatments of Heel Ulcerations.” However, most total contact casting (TCC) proves a greater risk of injury through iatrogenic complications and possible increases in pressure. Dr. Lenz and Dr. Hussain present the use of a particular posterior splint application method that may resolve possible complications traditional splints pose.

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Wound healing typically progresses through four phases: hemostasis, inflammation, cell proliferation or granulation and repair, and epithelialization and remodeling of scar tissue. Clinicians should achieve wound closure through a standardized framework such as the TIMERS (tissue management, infection or inflammation, moisture balance, edge or epithelialization, regeneration, and social factors) tool, which provides a comprehensive approach to wound management and optimizes the wound bed and conditions to support progression of wounds through the healing process.

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Wound healing is a complicated process that restores the skin's barrier function to prevent further damage or infection. The healing process normally progresses through 4 phases: hemostasis, inflammation, proliferation, and remodeling. However, a chronic wound may result when a wound fails to progress through the normal phases of healing.

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When a wound fails to progress through the phases of healing in a timely fashion despite the standard of care wound treatment provided, advanced therapies may be warranted. Wound care often needs a multifaceted approach that involves the treatment of entire patient, not just the wound. Clinicians should obtain a comprehensive medical history of the patient and conduct a thorough skin and wound assessment of the patient. This medical history and assessment will lay the foundation of initial treatment.

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Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

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Wound repair and regeneration comprise a complex process of biological and molecular events that consists of cell migration and proliferation, along with extracellular matrix deposition and remodeling. Unfortunately, not all wounds progress through healing easily. Certain pathophysiologic and metabolic conditions can alter the course of healing and impair or delay it, resulting in chronic, nonhealing wounds. The costs to treat nonhealing wounds can be high, and the patient’s quality of life can be impacted by any related loss of mobility or productivity. For these reasons, advanced wound care modalities and products may be introduced to help address underlying factors that impair the healing process.

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By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Moisture-associated skin damage (MASD) is becoming increasingly prevalent in today’s health care system. Often associated with discomfort and pain, MASD ultimately negatively impacts quality of life. MASD is usually broken down into 3 or 4 categories, most commonly incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound dermatitis, and peristomal dermatitis. In this blog, I focus on the prevention and treatment of IAD and subsequent pressure injuries in critical care through a nurse-led approach.

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By Dr. Lenz and Dr. Hussain

For the patient, the prevention of sores and injuries is better than treating them. Pressure-relieving mattresses may be essential for preventing pressure injuries (bed sores). These mattresses aid in relieving and redistributing pressure and can thereby cause a reduction of friction and shearing. Pressure-relieving mattresses provide support for the body and reduce the amount of force applied to a given area. Thus, for bedbound patients and patients who are unable to reposition themselves, these types of beds can be especially beneficial.

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By Dr. Lenz and Dr. Hussain

Heel pressure injuries and various forms of ulcers are easy to identify, but are you overlooking sleeping position as a cause for wounds in other locations? Do you have a wound you are sure is venous but has normal venous insufficiency testing results and fails to respond to compression? Can pressure while sleeping slow or stop healing in your patients with venous and arterial wounds? Do you ask patients about their sleeping position in your history taking and physical examination? After reading this article, you will be able to ask patients about their sleeping habits and heal more wounds with that knowledge

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By the WoundSource Editors

The process of wound healing ideally progresses from inflammation to epithelialization and, finally, remodeling. If at any point bacterial (or fungal) colonization becomes prominent, the process of wound healing is disrupted. The creation of biofilm is a microbial defense mechanism that stalls the trajectory of healthy wound healing and can contribute to the development of a chronic wound. It is estimated that 90% of chronic wounds and 6% of acute wounds contain biofilms generated by microbes. Epidemiologically, chronic wounds impact 2% of the entire US population. Because of this large impact, knowledge of proper wound healing and use of clinical tools to assist the wound healing process are essential.