Wound Healing

By the WoundSource Editors

Necrotic wounds are characterized by devitalized, or dead, tissue. Necrosis may be caused by malignancy, infection, trauma, ischemia, inflammation, or exposure to toxins. It may also be caused by improper care of an existing wound site. Devitalized tissue has no blood supply, and its presence prevents wound healing. It is necessary for necrotic tissue to be removed to allow wound healing to occur.

By the WoundSource Editors

After an injury or surgery, the body responds by forming scar tissue. Scar formation is a normal part of the wound healing process, but not all scars are the same. Some scars form in only the superficial epidermal layers, whereas others encompass deeper subdermal layers, involving nerves and tendons. The process of scar formation is the result of myofibroblast cells forming new collagen fibers to repair a wound.

By the WoundSource Editors

The venous leg ulcer (VLU) is the most common type of chronic leg wound, and it can be challenging to manage. VLUs account for up to 90% of all chronic leg ulcers. Proper diagnosis and treatment planning are key to wound healing outcomes. This fact is particularly true for older adults, who have an annual VLU prevalence of 1.7%.

By the WoundSource Editors

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 the WoundSource Editors

Venous ulcers pose a worldwide problem that comes with high recurrence rates, risk of infection, and substantial costs to treat. Health care professionals must be knowledgeable about underlying causes and pathological features. The comorbidities that are often associated with venous ulcers contribute to these lesions and prolong healing times, which in return can cause further complications. Venous disease and venous hypertension are lifelong conditions requiring lifelong management. The vicious cycle of venous reflux and obstruction associated with chronic venous disease leads to ulceration(s). Management of venous ulcers requires comprehensive wound care and compression therapy for life.

By the WoundSource Editors

With multiple risk factors impeding wound healing and wounds often diagnosed with mixed etiology, wound healing can be complicated. Understanding the pathophysiology of wound healing can help clinicians to better comprehend the needs of a wound to help it progress through the stages of wound healing.

Fabiola Jimenez, RN, ACNS-BC, CWOCN

While I was providing foot care to a patient, one of my coworkers overheard me advising the patient that she will need a lot more protein to heal her wound, and some changes to her diet will be necessary and therefore tighter control of her blood glucose and improved hemoglobin A1c. Later, I was approached by a coworker who told me: "Because you are not a Registered Dietitian, you cannot discuss dietary needs with the patient." I disagree.

Temple University School of Podiatric Medicine Journal Review Club

Article Title: Using the Entropic Wound Cycle as the Basic for Making Effective Treatment Choices
Authors: Mcguire, J, Sebag JA, Solnik, J
Journal: WoundSource
Reviewed by: Cindy H. Duong, class of 2021, Temple University School of Podiatric Medicine

By Kathy Gallagher, DNP, APRN-FNP, CMC, UMC, BC, WCC, CWS, FACCWS

In 2010, Christiana Care Health System, a 1,000 bed Level I trauma center in Wilmington, Delaware, introduced an acute surgical wound service (ASWS) integration plan in with a single dedicated nurse practitioner, trauma surgeon, and administrative leader. Subsequently, trauma patients with complex wounds experienced decreased morbidity and length of stay. Closely aligned with these numbers, their patient days of negative pressure wound therapy fell from 11+ days in 2010 to 8.2 days in 2018, representing one of the lowest in the nation.

Christine Miller, DPM, DMM, PhD, FACCWS

One of the most difficult aspects of patient care is dealing with non-compliance. How do we help those who refuse to help themselves? This question is very convoluted indeed! The best treatment protocols in the world will be unsuccessful if the patient does not follow the recommendations. Patients with chronic wounds are usually those with multiple comorbidities such as uncontrolled diabetes, autoimmune disease, and uncontrolled hypertension. This complex medical picture is challenging enough for all of us trying to heal them, but add the patients' lack of concern for their own health and it is quite frankly maddening. I find myself often saying, "Help me help you" or "Healing is a team event," although mostly my genuine pleas for partnership fall on deaf ears.