Complex Wound Management

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 Becky Naughton, RN, MSN, FNP-C, WCC

If you've ever had a painful red bump after shaving, you've probably chalked this up to razor burn or an ingrown hair. After an irritating day or so, the bumps will likely fade and disappear on their own, and you don't give it any more thought. But what if these bumps just kept growing and became more and more painful? And even worse, what if they developed in sensitive areas such as the axilla or the groin? What if these bumps got so bad, they eventually opened, started to drain, and even formed tracts under the skin? Not only are these bumps painful, but they are also embarrassing. Forget about wearing a sleeveless shirt or bathing suit in the summer. Would people think you had a horrific contagious disease? You go to doctor after doctor, but no one has been able to treat this successfully. The bumps may disappear for some time but then suddenly reappear. They may leave scars that seem to open and close persistently, and at times they may become infected, requiring antibiotic therapy. Finally, you get the diagnosis for this awful condition: hidradenitis suppurativa (HS).

By Becky Naughton, RN, MSN, FNP-C, WCC

Picture this: you've been seeing a patient in your wound center for the last several months to treat a slowly healing post-operative abdominal wound. The wound has been gradually responding to an assortment of treatments, including initial wound vacuum therapy after the surgery, followed by alginate and now a collagen dressing. The wound is getting smaller and has new granulation tissue at the base. You're actually a bit surprised that it's healing so nicely because the patient has multiple serious chronic illnesses, including severe chronic kidney disease that requires hemodialysis sessions three times per week, type 2 diabetes, morbid obesity, cardiovascular disease, and peripheral vascular disease.

By the WoundSource Editors

Fistulas are abnormal connections or passageways between two organs or vessels that do not usually connect. Although they typically develop as a result of an injury or surgery, they can also be caused by infection or inflammation. The World Health Organization estimates that there are between 50,000 and 100,000 new cases of obstetric fistula annually, and the number of all types of fistulas is substantially higher.

By the WoundSource Editors

Caseous necrosis: Caseous necrosis is found in tuberculosis, syphilis, and some fungal diseases. It forms in response to intracellular pathogens, such as mycobacteria, and can also be found in association with granulomas. With this type of cell death, the tissue assumes a cheese-like appearance.

Clostridium difficile: Also referred to C. diff, this bacterium can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. On a lesion, semihard nodules may be found, in which case lymph node tuberculosis may be present.

Complex wounds: Wounds that have one or more complicating factor, such as exudate, infection, comorbidity, or polypharmacy. They can be acute or chronic wounds that defy cure with conventional therapies. Treating complex wounds generally requires a multidisciplinary approach.

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

A vast percentage of wounds become chronically stalled because of mixed etiology and other underlying comorbid medical conditions. This means the wound is multifactorial, and using a singular approach won’t be enough. Lower extremity wounds, for example, can have diabetes, venous and arterial issues, and pressure all as factors playing into the same wound.

By the WoundSource Editors

Although complex wounds typically present with clinical challenges in treatment, there are certain types of wounds that clinicians are used to facing: pressure wounds , arterial wounds, venous wounds, diabetic wounds, moisture-related wounds, end-of-life wounds, dehisced or complicated surgical wounds, and wounds of mixed etiology. However, the uncommon complex wounds are the ones often misdiagnosed or misidentified because of a lack of understanding or even ability to have them diagnosed properly. Often the rare or unusual skin lesions or ulcers require advanced diagnostic capabilities, such as the ability to perform a biopsy, tissue culture, radiological study, or other examination. So how do you know that what you’re treating is what you think you’re treating?

By the WoundSource Editors

Complex wounds pose a significant challenge for many health care providers. These wounds are often multifaceted, making treatment tremendously difficult. They represent a substantial burden on the health care industry, with annual costs in North America alone estimated at $10 billion annually. They often also result in patient discomfort and pain, caregiver frustration, individual economic losses, and diminished quality of life.