Chronic Wounds

By Bruce E. Ruben MD In order to heal a wound, the body needs oxygen, nutrients, energy and a fully functioning vascular system that brings those resources to the wound and takes waste products away from the wound.

By the WoundSource Editors Nurses and other health care professionals providing care to patients regularly face challenges that can make it more difficult to perform routine tasks and ensure patient comfort and well-being, especially with regard to pressure ulcer/injury prevention and treatment. From a lack of mobility to chronic diseases, these challenges often coincide and interplay, creating unique risks and complications in managing the care of patients. To address these issues effectively, it is important to be aware of key best practice techniques for preventing pressure injuries and to stay proactive. This blog provides a brief overview of three of the most common patient challenges related to pressure injury prevention and offers strategies for effectively addressing each.

By Lauren Lazarevski, RN, BSN, CWOCN Could metallic micronutrients be the missing link for your patient with a chronic wound? When we consider the nutrition required to optimize wound healing, protein supplementation is usually the star of the show. However, there are micronutrients involved in wound healing on a cellular level. Although the daily requirements may be small, they are mighty—and if deficient, they may be the missing step in healing a chronic wound.

by Lydia A Meyers RN, MSN, CWCN At the start of December, I was looking at graduation from my Master's Degree program and the completion of my final paper. A capstone to the Master's program is much like the dissertation to the doctoral program. My journey has been long and along the way I have increased my base of knowledge. What I have learned on this journey will enhance my practical knowledge of wound care and patient care. I learned that health care must change, and we must look hard at how we are doing business and be willing to challenge the status quo. Health care needs highly knowledgeable leaders to assure patients receive quality care by being good stewards of the money given to promote that care. The provider must be educated to assure the patient's wishes are followed first and always.

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.

Chronic and non-healing wounds are those that do not progress through the healing process in a timely or predicted manner. They are a global problem and are becoming harder to treat. Medicare estimates that over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion dollars annually.

By Martin D. Vera LVN, CWS As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

by the WoundSource Editors Biofilm is a complex microbial community containing self- and surface-attached microorganisms that are embedded in an extracellular polymeric substance.1,2 The extracellular polymeric substance is a primarily polysaccharide protective matrix synthesized and secreted by the microorganisms that attaches the biofilm firmly to a living or non-living surface. This protective covering does not allow the body's immune system to recognize the presence of the microorganism; therefore, the bacteria evade an immune response, avoid detection by standard diagnostic techniques, and avoid destruction by standard treatments.3 Because of the tenacity of the attached biofilm, the microoganisms are able to resist physical forces, such shear, and are able to withstand nutrient and moisture deprivation, altered pH, and the impact of antibiotics and antiseptics. For the purposes of this discussion we break down the formation and actions of biofilms and discuss their impact on wound healing.

By the WoundSource Editors Biofilm: this term is frequently used in the wound care space, but biofilm continues to be largely undertreated in wound care. What do the bedside nurse or clinician need to know about biofilm? Should clinicians care less about biofilm on a maintenance or palliative wound versus a wound they are actively trying to heal? Let's address these questions and get to the root of the biofilm in managing complex wound cases.

by the WoundSource Editors Advancements in molecular microbiology, microscopy technology, and techniques for study of bacteria have increased the ability to identify the existence of biofilms, but there still remains the unknown, such as differentiating between planktonic bacteria and biofilm.1 Chronic non-healing wounds harbor bacteria across the wound etiology classification.2–4 Malone et al. determined that the prevalence of biofilms in chronic wounds was 78.2% (confidence interval, 61.6–89, P < 0.002).2 The development of biofilms moves through a common pattern: attachment, microcolony formation, maturation, and dispersion. The initial attachment is reversible, but the attachment becomes stronger as cells multiply and change their gene expressions. This cell communication process is referred to as quorum sensing, allowing cells to survive.