Prevention

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.

The purpose of this blog is to bring special attention to common dermatologic conditions connected with drug addiction. Although drugs are well known for their significant impact on all body organs (liver, bladder, stomach, and kidneys), various physical manifestations of drug use are often unknown or underrecognized. Many clinicians and even dermatologists fail to see the many symptoms of drug misuse in the skin. Skin lesions caused by substance use may be induced by the drug itself, an allergic reaction, the drug administration method, or any contaminants or infectious agents that may have been mixed in with the drug. It is possible to identify substance users based on the shape and pattern of their skin conditions. Clinicians can learn these signs to better help patients.

“Top-down skin injury” is an increasingly common term used to describe superficial cutaneous injury. These injuries result from damage beginning at the skin’s surface or soft tissue. In contrast, “bottom-up” injuries are often the result of ischemia. Top-down injuries are usually caused by mechanical forces, inflammation, or moisture. Medical adhesive-related skin injury (MARSI) is a frequently seen type of top-down skin injury that is almost always preventable. In this blog, I focus on preventing MARSI and describe the different techniques and adhesives (along with adhesive alternatives) available for use.1

Wounds have a significant negative impact on patients, including pain, decreased quality of life, and social isolation. Optimal wound healing can help patients and the health care system cope with the burden of chronic wounds. Wound management may not always be the priority in patients whose cases are complicated by severe comorbidities, palliative care, hospice care, surgery, chemotherapy, radiation, or management of a chronic condition.

I have been there, done that. Sitting in the fact witness chair in front of a plaintiff attorney who is wildly waving a copy of my facility’s wound care policy and procedure, demanding to know why certain things weren’t included in the policy, and why what was in the policy was not followed to the letter. Plaintiff attorneys have the right to demand copies of a facility’s policy and procedures as part of discovery and will go through them with a fine-tooth comb, compare what is in the policy with the care that was provided, and fault the facility for any deviations. It goes without saying that I promptly returned to my facility with a new understanding for how our policy was written and possible gaps and weaknesses.

Maceration is a common clinical complication that poses challenges in chronic wound treatment.1 Excessive moisture can be trapped on the wound surface, especially when occlusive dressings are overused or when nonbreathable cover dressings are applied for extended periods.

According to the definition from the International Skin Tear Advisory Panel (ISTAP), “a skin tear is a traumatic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer).”

Offloading is a cornerstone of pressure injury (PI) prevention. Certain patient populations, conditions, and environmental or institutional factors pose challenges to effective offloading that providers must mitigate to prevent PIs. It is important to note that these challenges often overlap with other complication risk.