Adjunctive Therapies

After attending the Spring Symposium for Advanced Wound Care and hearing many great lectures, I got to thinking, “What are the pillars of chronic wound care?” We have all heard of the concept “look at the whole patient and not the hole in the patient.” Heck, I have even written about it. But we also need to have a good foundation for how to implement this phrase or where to even start. I did a quick Internet search and came up with some interesting articles that talked about the basics of wound care and management. I found discussions on everything from maintaining a moist wound environment to being financially responsible. All of this information leads me to the concept of developing easy-to-understand pillars or categories to consider when caring for a patient with a chronic wound.

By Paula Erwin-Toth MSN, RN, CWOCN, CNS Now that summer is upon us we will soon be entering the orientation and entry of new residents, fellows and new nursing graduates in acute care. This is a terrific opportunity for you to reach out and engage the interest of these new clinicians in evidence-based wound care practice. Granted, they are overwhelmed with new information and new responsibilities, but prevention and management of wounds is knowledge they can apply to nearly all their patients and across all health care settings.

By Aletha Tippett MD In looking at technology that helps in wound care, how many know about—and use—lasers? Cold lasers have been used by physical therapists for years, but cosmetic lasers can also be used. I have had tremendous success using laser therapy on wounds. Healing is much improved (and faster), with less scarring. I am not a technocrat. I’m much more old-fashioned, but the laser is a wonder.

Wound chronicity is an ongoing challenge for patients and health care professionals around the globe. An astonishing 4.5 million people in the United States experience lower extremity wound chronicity, while an estimated 1% are affected in the Western population with all types of chronic wounds. The cascade of wound healing does not always follow suit in an orderly fashion of hemostasis, inflammation, proliferation, and remodeling.

By Angela Kujath, Executive Director of the ACHM Most of us can remember a time when we’ve felt extreme anxiety about taking an exam. This anxiety was accentuated if we felt inadequately prepared. In my role as Executive Director of the American College of Hyperbaric Medicine (ACHM), I have often been asked questions about exam preparation for hyperbaric certification. The ACHM has offered a hyperbaric certification exam since the late 90s, but participants simply studied their textbooks and relied on past experience to ready themselves for the exam. I can tell you that this led to many conversations with frustrated and anxious individuals who felt that studying a textbook that they had read as many as 10 years ago was simply not enough to help them feel prepared. This was even more worrisome for the physicians who hadn’t practiced hyperbaric medicine in several years, or for those actively practicing HBO but maybe only doing so part time.

The benefit of Negative Pressure Wound Therapy (NPWT) as an “active,” adjunctive treatment is well-established. Evidence has shown that wounds treated with negative pressure granulate faster than wounds managed with traditional dressings. There is ever-increasing literature to support the use of NPWT to treat wounds effectively and safely in even the youngest patients.1 Some specific benefits of NPWT for pediatric and adolescent patients include decreased frequency of dressing changes, as well as a dressing that is occlusive and unlikely to be removed by the patient.

When determining the course of action for treating a given wound, it is important that wound care clinicians evaluate how advanced wound care therapies have been deemed evidence based and how the specific product technology works. Evidence-based advanced wound care products are required to be safe and effective based on epidemiology, etiology, and pathophysiology. However, safety and efficiency are not a 100% guarantee of effectiveness in clinical practice.

Venous ulcers are known to be complex and costly. There is an array of evidence-based treatment options available to help formulate a comprehensive treatment plan toward wound closure. Health care professionals should utilize treatment options while encompassing a holistic approach to venous ulcer management. Involving the patient and/or caregiver in developing a treatment plan will increase the chances of successful wound healing outcomes. Wound closure is the primary goal of a treatment plan; however, preventing recurrence and infection should be considered just as important.

By Thomas Serena MD, Helen Gelly MD, Greg Bohn MD, Jeffrey Niezgoda MD Introduction The rise in specialized wound and hyperbaric centers across the United States has resulted in an increased need for physicians to oversee Hyperbaric Oxygen Therapy. However, there are no published national standards or recommendations for credentialing physicians for this service. The American College of Hyperbaric Medicine (ACHM) has drafted this document to guide hospital credentialing committees in this process. It represents the consensus opinion of leaders in the field of hyperbaric medicine in the United States. It is important to note that although this document applies to both hospital-based and non-hospital affiliated centers, they have separate requirements.

Diabetic foot ulcers (DFUs) continue to be a major problem, causing patient suffering, burden, infections, and high mortality. The cost of DFU treatment was estimated at $1.3 trillion globally in 2015. Despite evolving advanced wound care technologies through the years, DFUs continue to be among the most challenging chronic wound types.