The management and care of persons with severe or chronic wounds with their extensive effects have a challenge to both practitioner and patient. The challenging bit is the paucity of the treatment based on evidence strategies for the care of chronic wounds. After going through numerous databases, this paper will try to review chronic wound care and its management articles. Applying this available information, this literature review will be based on evidence concepts relating to the treatment of the chronic wounds while focusing on the basic principles for treatments.
Chronic wound management
According to Sørensen (2012), a wound is a distraction of the normal functioning of the skin or skin structure. An acute wound damage caused by trauma inflicted on skin cells. This can be intentional as in cases where doctors conduct surgical procedures or by accidents such as blunt objects, chemicals, electricity or heat. The best approach to the study was through classification and treatment to wound care. In his findings he concluded that; An acute wound is expected to heal progressively through the normal wound healing stages and with time the wound will close up. Sørensen (2012), further recommend that; It is important to recognize that, different causes of wound determines the length of time the skin would heal, the higher the level of trauma the longer the time the skin cells would take to have a quick recovery.
Romanelli (2014), establishes that chronic wound in his study found out that a chronic wound; is one that fails to respond to normal treatment or does not progress as other normal wounds over the normal expected healing time frame (usually four weeks). Instead, the healing process stagnates at the inflammatory phase.
Chronic wound care the essentials
Chronicity of wounds can be attributed to a series of intrinsic and extrinsic factors which include poor nutrition and inappropriate dressing. Other factors such as diabetes also lead to chronicity of a wound, poor nutrition and improper dressing alone do not determine the wound healing process. Medical interventions such as a boost of the immunity should be able to reduce the chronicity of a wound.
Dettmers, Brekelmans, Leijnen, & Ritchie (2016) found out that there are numerous causative types of wounds; acute surgical wounds: during surgical procedures, a sharp object may be used to deliberately cut through the skin tissues. Acute wounds normally undergo a natural process of healing where the damaged tissues and cells will undergo restoration and body anatomy, and functioning will ultimately achieve their integrity. An acute wound that fails to heal within a period of 6 weeks might end up becoming a chronic wound. Acute wounds require proper dressing, it also needs the patient to watch over their nutrition at the time. Medical interventions alone is not enough to help absolve the problems of chronic wounds.
Trauma wounds are as a result of a stressful event caused by mechanical or chemical injury that leads to damage of tissues. Trauma can have a serious short term and long term effects based on its level. It is important to treat each level of trauma with utmost care to avoid would chronicity.
Chronic wound care management and research
According Jeschke & Rogers (2016) Burns are injuries sustained by skin tissues due to heat, electricity, friction or radiation. Heat causes rug burns while friction cause rope burns. Chemicals, on the other hand, cause caustic burns when one comes into contact with them. Chronic wounds usually fail to heal orderly and within the expected times. There are different environments for chronic and acute wounds. Some of the clinical signs of chronic wounds include lack of reduction of the size of the wound as time progresses, frequent and recurrent breakdown of the wound, and the granulation tissue is unhealthy. Burns should therefore be handled through the use of heat dissipation mechanism in order to reduce any inflammatory conditions.
Pressure injuries according to Melbourne 2016, are injuries to the skin and the underlying tissues mostly on a bony surface as a result of friction or pressure, or a combination of both. Infected wounds: pathogenic microorganisms can invade wound tissues, causing additional damage to cells and tissues through secretion of toxic substances. It is valid to say that pressure injuries need more attention as they can turn to be inflammatory and swellings are a common part of it. Protection against festurization of the wound is important.
Dickinson & Gerecht (2016) study have generated sufficient evidence to show that a moist environment is ideal for the healing process of wounds. As a result of this, there has been a proliferation of wound dressings that have higher acquisition costs than standards dressings, leaving wound care providers in a state of confusion as to when be the appropriate time to use these relatively more expensive methods. Burn wounds, chronic wounds and pressure wounds require specialized dressing, other wounds such as sharp object wounds do not need any specialized care.
Chronic wound treatment
Ubbink et al. (2013) found that advanced wound dressing, using foam, for instance, has more control of the wound surface through the retention of moisture and absorption of exudates; in the process, the wound base and the surrounding tissues are protected. Maintenance of optimal moisture content ensures that the patient remains comfortable before, during and after the wound dressing process. The choice of which dressing to use will vary depending on the nature of wound base and the exudates. The selection of the dressing to be used therefore calls for training, experience and a level of expertise in wound care. Wound dressing using foam should be used in cases where a patient has experienced a high level of trauma on the skin such as a burned skin. This mechanism of dressing works best for wounds that are highly septic and require multiple change of dressing.
Paul (2015) established that; the inflammatory phase takes up to three days from the point of infliction of injury. It is characterized by the body’s natural reaction to injury and is characterized by vasodilation that leads to increased blood flow that leads to swelling, pain and redness. At times wound ooze may be experienced which is a normal function of the body response. The proliferation phase takes between 3 to 24 days and is the phase when the wound is undergoing healing. The body generates new blood vessels and tissues that cover the wound surface. It is the reconstruction phase, and the wound will ultimately become smaller as the healing process progresses. The maturation phase takes between 24-365 days is the final phase of healing and is characterized by the formation of scar tissues. At this phase, the wound is still at risk and should be adequately protected. In many other cases, wound healing takes a shorter time that the projected 24 days, the level of trauma and chronicity of the wound can push the healing period past the 24 days mark.
Inconclusion chronic wound care and management based on evidence should recommend the following healing mechanisms; Primary intention: this is where surgical wounds and recent traumatic injuries are dealt with by primary closure- the edges of the wound are secured by staples and minimal tissue loss and scarring occurs. Delayed primary intention is the surgical closure of a wound that is performed 3 to 5 days after a thorough cleaning of the wound bed has been done. Skin graft: this is the removal of a partial or full segment of the epidermis and the dermis, removing it from its blood supply source and transplanting it on another site to expedite the healing process and prevent infections. Skin grafts can be a perfect mechanism of hastening the healing process but it is important to be highly careful when selecting a skin graft section as a mismatch can create another wound due to poor match of the skin parts. A skin graft can be a perfect cure but it is a risky measure in wound healing process.
Dettmers, R., Brekelmans, W., Leijnen, M., & Ritchie, E. (2016). Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat Infected Orthopedic Implants: A 4-patient Case Series | Ostomy Wound Management. O-wm.com. Retrieved 18 September 2016, from http://www.o-wm.com/article/negative-pressure-wound-therapy-instillation-and-dwell-time-used-treat-infected-orthopedic
Dickinson, L. & Gerecht, S. (2016). Engineered Biopolymeric Scaffolds for Chronic Wound Healing. Frontiers In Physiology, 7. http://dx.doi.org/10.3389/fphys.2016.00341
Hirsch, T., Limoochi-Deli, S., Lahmer, A., Jacobsen, F., Goertz, O., & Steinau, H. et al. (2011). Antimicrobial Activity of Clinically Used Antiseptics and Wound Irrigating Agents in Combination with Wound Dressings. Plastic And Reconstructive Surgery, 127(4), 1539-1545. http://dx.doi.org/10.1097/prs.0b013e318208d00f
Jeschke, M. & Rogers, A. (2016). Managing severe burn injuries: challenges and solutions in complex and chronic wound care. Chronic Wound Care Management And Research, 59. http://dx.doi.org/10.2147/cwcmr.s86762
Melbourne, T. (2016). Clinical Guidelines (Nursing) : Wound care. Rch.org.au. Retrieved 18 September 2016, from http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/wound_care/
Paul, J. (2015). Wound pruritus: pathophysiology and management. Chronic Wound Care Management And Research, 119. http://dx.doi.org/10.2147/cwcmr.s70360
Romanelli, M. (2014). Chronic wound management and research. Chronic Wound Care Management And Research, 1. http://dx.doi.org/10.2147/cwcmr.s57937
SÃ¸rensen, L. (2012). Wound Healing and Infection in Surgery. Annals Of Surgery, 255(6), 1069-1079. http://dx.doi.org/10.1097/sla.0b013e31824f632d
Ubbink, D., Lindeboom, R., Eskes, A., Brull, H., Legemate, D., & Vermeulen, H. (2013). Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study. International Wound Journal, 12(5), 531-536. http://dx.doi.org/10.1111/iwj.12149