Atypical and Complex Wounds

By Roshni Patel, BSc (Hons), MCOptom

The cornea, as we know it, is a complex and fast-healing tissue that provides protection from infectious and non-infectious defects. However, it can still be injured through environmental impacts or surgical procedures, such as cataract operations or laser-assisted in situ keratomileusis (LASIK), as well as traumatic injuries. Although most corneal wounds repair themselves without further drawbacks, possible complications may occur and delay the healing process. This blog outlines the natural healing process of corneal wounds and post-surgical wound healing, as well as the obstacles to healing that may occur in diabetic patients.

By Lauren Lazarevski, RN, BSN, CWOCN

As summer begins to wind down and we look ahead to Halloween, let’s discuss some “creepy crawlies” we may encounter in wound care that may cause apprehension in even the most seasoned health care staff.

By Temple University School of Podiatric Medicine Journal Review Club

An appropriate timeline to initiate biofilm-based wound care (BBWC) has been a topic of question since the incorporation of biofilm therapy was introduced. In hard-to-heal delayed wounds, it is largely agreed upon that biofilms are a significant barrier to healing, and that removal is essential. By definition, hard-to-heal wounds are wounds that have failed to respond to evidence-based standard of care and contain biofilm. Biofilms are polymicrobial communities residing in an extracellular matrix produced by bacteria, which is well-hydrated and resistant against antimicrobial agents and host defenses. Biofilm can form within hours, can reach maturity within 48-72 hours, and has the ability to regrow within 24-48 hours. A first critical step to BBWC is debridement, though it requires additional suppression methods, as well as considerations of a patient’s risk factors. Risk factors include peripheral vascular disease, infection, diabetes, and pressure off-loading, which encourage biofilm development by delaying wound healing. Risks and costs with early BBWC are most likely less than those associated with biofilm-related wound complications. Thus, in March 2019, a panel of nine experts met in London for an Advisory Board Meeting, where they developed solutions to barriers preventing early BBWC and methods of appropriate “wound hygiene” for all health professionals. They reconvened in the summer of 2019 to create a clinical consensus document published in the Journal of Wound Care supported by ConvaTec Limited.

Paula Erwin-Toth, RN, MSN, FAAN

Hello to my wound care colleagues around the world. As I write this blog, the news relating to the results of COVID-19 continues to provide evidence of the profound impact this pandemic has had on those suffering from the disease and the negative impact shut downs and quarantines have had on the health of people with chronic illnesses. We, as health care providers, are under tremendous stress as many of us have been re-deployed to maintain and support the overwhelming challenges of front-line health care providers serving patients with COVID-19. We, too, are on the front lines helping to maintain skin integrity in critically ill patients who are often intubated and placed in the prone position. The physical, emotional, and financial strains on patients, health care providers, businesses, and governments are going to affect us for years to come.

By the WoundSource Editors

Wounds of the lower extremity, such as chronic venous leg ulcers and diabetic foot ulcers, often have a severe impact on patients' quality of life. Symptoms may range from mild to debilitating, depending on the location of the injury and its severity. These types of wounds also affect a tremendous number of people because lower extremity wounds are estimated to occur in up to 13% of the United States population. The estimated annual cost of treating lower extremity wounds is at least $20 billion in the United States.

By the WoundSource Editors

Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

I am into my 20th year working as a wound care specialist. I must admit, I never thought much about wound management in the prison population until my son's wound care experiences during his incarcerations. I am quite transparent with this blog, and after you finish reading it, I hope you will have a different perspective on wound care in prison populations. I want to point out that this was my son's experience, which he encouraged me to share to help others. This blog is my view and does not define correctional nurses or wound care management in all prisons. I have the utmost respect for correctional nurses because I know that I could not do it. Through my son's experience, I identified various gaps in education and factors affecting quality of wound care that led to my interest in researching this area of wound care.

By Christine Miller DPM, PhD

It is an understatement to say that these are trying and uncertain times, as we ride this unpredictable wave of the COVID-19 pandemic. All of us in wound healing as part of the greater health care force are deemed essential, so we cannot "shelter in place." As health care workers, we have to balance our duty to render care with that of protecting ourselves, a tricky tightrope balancing act. The media coverage of this pandemic is constant and anxiety producing, but it has made me ponder the term essential and what that truly means to our patients.

By the WoundSource Editors

The World Health Organization declared COVID-19 a pandemic on March 11, 2020. Whether you are a provider or a frontline health care professional, we are experiencing a worldwide increase in “unavoidable” medical device–related pressure injuries (MDRPIs) during the current COVID-19 pandemic. Health care workers are challenged with a higher risk of pressure injury development secondary to prolonged wear time of the N95 mask, face shield, and goggle personal protective equipment (PPE). The intensity of one or more factors of pressure, moisture, shear, and friction influence pressure injury risk.

By the WoundSource Editors

The current COVID-19 pandemic has changed various aspects of care across the health care continuum. Health care professionals have been forced to develop different strategies for engagement for those patients at higher risk for infection, those who are quarantined, and those who have tested positive for COVID-19. We know that telemedicine cannot replace an in-person visit to a provider, but during this time of crisis it serves as an advanced approach in wound care.