Atypical and Complex Wounds

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.

Elizabeth Day Dechant, BSN, RN, CWOCN, CFCN

Diaper rash, more officially known as incontinence-associated dermatitis (IAD), affects hospitalized and incontinent patients of all ages. In my years as a WOC Nurse in a pediatric hospital, IAD has been by far the most frequently treated condition. However, outside of a health care setting, IAD is the most common skin problem in infants and young children who are not yet toilet trained. Diaper rash has plagued babies and new parents for centuries, yet its treatment remains highly debated. For the purpose of this article, I am focusing on the prevention and treatment of diaper rashes in infants and young children, although the principles of topical treatment discussed here apply to all patients.

Chronic and nonhealing wounds are a worldwide issue and are becoming more difficult to treat. In the United States alone, according to Medicare, over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion per year. If standard treatment does not adequately heal a wound, additional methods of wound care treatment may be required, and the underlying disorder must be examined to determine the need for advanced wound care modalities. Advanced wound care therapies are interventions that are used after standard wound care has failed.

By WoundSource Editors

Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs occur in 34% of people with diabetes, and approximately 14% to 24 % of patients with diabetes who develop a DFU will require an amputation.

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

May is Mental Health Awareness Month and with the staggering statistics of one in four adults living with mental illness, I immediately was motivated to write a personal blog. I previously shared my son’s experience here in 2020, in “Wound Management Challenges in Prison Populations,” and discussed the importance of establishing a quality of wound care. I started thinking about the high number of incarcerated people with mental health issues, and it prompted me to conduct a bit more research. Given my son's dual diagnosis of schizophrenia and post-traumatic stress disorder (PTSD), I recall having a conversation with him during this time about debridement methods because advanced wound care would become extremely complicated. I immediately started educating him on possible dressings and debridement methods that could be used on his wound. This gave him an idea of what to expect and allowed him to decline certain treatments if he so preferred.

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

by Tia Gray, PTA, CLT, CWT and Donald Thomas, PT, DPT, CLT-LANA, CWT

As lymphedema and wound care therapists at Penn Therapy & Fitness, we often see scenarios like those in the cases described in our abstract presented as a poster at the recent Symposium on Advanced Wound Care. Conditions such as lymphedema, chronic venous insufficiency, and phlebolymphedema that manifest in patients with wounds can lead to catastrophic and life-threatening skin breakdown (degradation). Complications of infections associated with lymphedema include cellulitis, lymphangitis, lymphadenitis, and ulcerations where protein-rich fluid provides a perfect medium for microbial growth.

For the wound healing process to be successful, it must pass through four stages: hemostasis, inflammation, proliferation, and remodeling or maturing. Wound healing requires inflammation, but it can be detrimental if it is persistent or encouraged by other factors, such as infection. It is during this phase that wound healing is most likely to stall.

By Christine Miller, DPM, PhD

Benjamin Franklin famously stated, “An ounce of prevention is worth a pound of cure.” This statement was made in reference to the importance of fire prevention in 18th century Philadelphia, but it aptly applies to modern diabetic limb salvage. The multidisciplinary model for amputation prevention has been in place now for almost two decades, but how far have we really come? Recent literature suggests that there has not been a significant decline in reamputation rates for diabetic patients despite the team approach to care. Diabetes is a complex and aggressive disease that affects multiple organ systems and robs patients of sight, sensation, limb, and quality of life. Treating such an aggressive disease is challenging, to say the least, and often the desired outcome is not achieved.

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

The literature suggests that patients with a high degree of adiposity are more at risk for inflammatory conditions, and the numbers of these patients continue to rise. Increased adipose tissue may impact activities of daily living, continence, and overall quality of life (QoL), among other complications. Abdominal (central) obesity may be associated with incontinence, mechanical and neurogenic changes (chronic strain or weakening of nerves in the pelvic area), and skinfold inflammation or irritation.