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When working with a person who has been living with a chronic wound, it can be frustrating to try to figure out why the wound isn’t closing as the wound healing model would predict. Not all patients follow the “traditional” timeline. The wound may not progress neatly through the four phases of wound healing as expected. There may be an underlying issue that is preventing the wound from healing. How, as clinicians, can we address this? Can we actually expect closure of this wound based on the specific patient’s condition, or should we consider a palliative approach?

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The last year and a half have proven to be an extreme challenge for many, especially health care providers. There have been lockdowns, quarantine, medical office closures, staffing shortages, and the overall concern of an unknown virus. The fallout from the last year and a half will likely be ongoing for many years, and although it’s still too soon to truly know all the effects of what has happened, it is an interesting point of reflection on how the field of wound care has been impacted.

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Managing chronic wounds can be difficult and often includes multiple treatment strategies. Management techniques can vary depending on the size of the wound, comorbidities of the patient, and the underlying etiology. However, many chronic wounds benefit from the application of negative pressure wound therapy (NPWT). This treatment is known for improving healing conditions across a wide range of acute and chronic wounds.

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Advanced treatment modalities: Wound care interventions that are typically applied when standard of care treatments have failed to lead to significant wound closure progress. Treatments include collagen products, cellular and/or tissue-based products, negative pressure wound therapy, hyperbaric oxygen therapy, and others.

Full-thickness wound: Tissue damage involving total loss of epidermis and dermis and extending, at the minimum, into the subcutaneous tissue and possibly through the fascia, muscle, or bone.

Granulation tissue: Tissue found in wounds beginning to heal. It is marked by pink or red tissue and may appear moist or shiny with an irregular or granular surface. Granulation tissue contains new vessels, tissue, fibroblasts, and inflammatory cells.

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Abscess: Inflamed tissue surrounding a localized gathering of pus, often caused by infection.

Antimicrobial resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antimicrobial stewardship: Collective measures that are taken to slow the evolution of multidrug-resistant organisms.

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Surgical site care is vital in preventing complications such as infection and dehiscence. Advanced therapies can help in the prevention of infection and the management of surgical sites and wounds. In patients who are deemed at risk, consider beginning the use of advanced technologies earlier in treatment to maximize overall outcomes.

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It was reported in 2014 that approximately 14 million operations were performed in the United States. The health care–associated infection prevalence survey conducted by the Centers for Disease Control and Prevention found an estimated 110,800 surgical site infections (SSIs) associated with inpatient surgical procedures in 2015. Even though many advances have been made in infection control practices, SSIs contribute to an overall surgical mortality rate of 3%, and 75% of deaths are specific to the SSI.

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Although advances in surgical techniques and operating room technologies have made many surgical procedures more successful and have led to easier recovery for many patients, surgical site infections (SSIs) remain a clinical problem. These infections are associated with increased morbidity, mortality, and health care costs.

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Despite modern precautions and protocols in place, surgical site infection (SSI) continues to be a risk. SSIs are the most common and costly of all hospital-acquired infections, with an estimated annual cost of $3.5 to $10 billion in the United States. Johns Hopkins Medicine reports that up to 3% of people who undergo a surgical procedure will develop an SSI. Additionally, SSIs can increase hospital length of stay by up to 9.7 days. Other complications of surgical wounds include osteomyelitis, gangrene, periwound dermatitis, periwound edema, wound dehiscence, and hematomas.

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Arteriography: Also called angiography, this technique is the medical imaging of blood vessels to look for aneurysm and stenosis.

Hemosiderin staining: Hemosiderin staining results in a red, ruddy appearance on the lower leg and ankle. This appearance is caused when red blood cells are broken down and not removed adequately as a result of venous insufficiency or another medical condition.

Phlebectomy: A minimally invasive procedure (usually outpatient) to remove varicose veins located near the surface of the skin.

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