Wound care is a critical aspect of healthcare, particularly in aged care, chronic disease management, and postoperative recovery. Effective wound management focuses on promoting healing, preventing infection, and minimising complications.
Types of Wounds
- Pressure Ulcers – Common in immobile patients, particularly over bony prominences such as the heels and sacrum.
- Diabetic Ulcers – Usually occur on the feet due to neuropathy and poor circulation.
- Arterial and Venous Ulcers – Related to peripheral vascular disease, often found on the lower limbs.
- Surgical Wounds – Result from medical procedures and require specific post-operative care.
- Traumatic Wounds – Caused by external injury and can vary in severity.
Principles of Wound Care
- Assessment and Staging
Wounds should be assessed for size, depth, exudate, surrounding tissue, and signs of infection. For pressure ulcers, staging helps guide treatment:- Stage 1: Red, intact skin with non-blanchable erythema.
- Stage 2: Partial thickness skin loss, appearing as a blister or shallow ulcer.
- Stage 3: Full-thickness skin loss involving subcutaneous tissue.
- Stage 4: Deep ulceration with exposure of muscle, bone, or tendons.
- Wound Cleansing and Debridement
- Use saline or appropriate wound cleansers to remove debris.
- Debridement (removal of nonviable tissue) may be necessary for healing.
- Dressing Selection
The choice of dressing depends on the wound type:- Transparent films & barrier creams – For Stage 1 ulcers.
- Hydrogels & foams – For Stage 2 wounds requiring moisture balance.
- Calcium alginate & silver dressings – For deeper Stage 3 and 4 wounds with infection risk.
- Infection Control
- Signs of infection include increased pain, erythema, and purulent discharge.
- Systemic antibiotics may be needed for cellulitis or osteomyelitis.
- Pressure Redistribution & Offloading
- Essential for pressure ulcers and diabetic foot ulcers.
- Use of cushions, mattresses, and repositioning techniques to prevent prolonged pressure.
- Optimising Patient Health
- Ensure adequate nutrition (especially protein and vitamins like C and zinc).
- Manage underlying conditions like diabetes and vascular disease.
- Address pain management and patient comfort.
Prevention Strategies
- Regular skin checks in at-risk patients.
- Maintaining skin hygiene and hydration to prevent breakdown.
- Educating patients and caregivers on early signs of skin damage.
Effective wound care involves a multidisciplinary approach, including general practitioners, nurses, wound care specialists, and allied health professionals.
A2BC2D – Wound Care
- Assessment of the wound – TIME
- Tissue
- Infection
- Maceration
- Edge
- Assessment of the patient
- Best dressing
- Compression? – ABPI +/- Duplex
- Graduated compression
- Concerns of the patient
- Document