Debridement

Aletha Tippett MD's picture

by Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

Like Rodney Dangerfield, maggot therapy sometimes gets no respect. Take, for example, the following comment which appeared on the WoundSource Facebook page, in response to a post by the publication’s editors about my blog discussing palliative maggot therapy use on a necrotic tumor.

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Aletha Tippett MD's picture

by Aletha Tippett MD

Does wound care need to be expensive? In the U.S. over a billion dollars per year is spent on wound care. When dealing on an individual basis, the cost of treating a pressure ulcer, our most common type of wound, has been computed to be $1600/patient/month, adjusted for CPI.1 What is driving this trend? It is expensive, high tech equipment such as pressurized beds, vacuum assisted closure, surgical techniques for debridement and skin grafting, and high priced dressings such as some of the foams, alginates and collagen dressings. Additionally, costs are increased when care is ineffective or counter-productive, prolonging the need for care.

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Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

This week I was asked about using maggot therapy for treating a tumor that eroded through the skin, causing a foul-smelling, necrotic draining wound. This is not an uncommon question, and it touches upon several important elements of biotherapy, as well as palliative wound care in general. This is also a timely subject because of the upcoming (third) Annual Palliative Wound Care Conference.

Ron Sherman's picture

by Ron Sherman MD, MSC, DTM&H

Numerous controlled studies of maggot therapy have been published during the past 20 years, each one demonstrating equality or superiority over standard care methods for debridement. It is almost as though we are trying to compensate for the previous 60 years of extensive clinical use supported only by case histories, but no clinical trials.

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Laurie Swezey's picture

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

The rate of wound closure is affected by systemic and local factors, as well as a number of the wound’s own inherent characteristics. It is important to understand these factors so that they can be managed optimally as part of an overall strategy to help achieve wound closure.

The eight wound characteristics that affect healing are described briefly below:

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Laurie Swezey's picture

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Whirlpool therapy, or hydrotherapy, is one of the oldest adjuvant forms of treatment for wounds still in use today. It was originally used in pain management, but later found a use in wound management, particularly in the management of burn patients.

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Aletha Tippett MD's picture

by Aletha Tippett MD

Biotherapy is the use of living creatures for the diagnosis or treatment of a human ailment. Creatures most commonly used include service animals (such as guide dogs or therapeutic horses), fly larvae (maggots), leeches, honey bees, and even viruses (phages). How does this relate to us in the wound care community?

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