Wound management is an essential process that involves the proper care and treatment of wounds to prevent infection, promote healing, and reduce scarring. Proper wound management involves cleaning and dressing the wound, controlling bleeding, preventing infection, and promoting healing. The cause of the skin break will need to be fully addressed for many complicated wounds to allow healing to occur.
Wound management for diabetic foot ulcers will require a multidisciplinary approach. Blood sugar needs to be regulated with dietary changes and medication management. Offloading is a common need to allow foot wounds to heal and often result in long term use of specialty shoes. Mobility may be affected if weight bearing on the foot is restricted which leads to the need for durable medical equipment and physical therapy.
When circulatory changes limit blood flow, surgical interventions are often required to bring adequate blood flow to a distal wound area for healing. If circulation issues are caused by venous disease, external compression becomes another intervention needed. Compression can be in the form of garments and the use of sequential pumping devices. Compression may become a lifetime need to maintain healthy vessel support especially when edema becomes chronic or lymphedema is present. Infection also becomes an issue when circulation and poor skin integrity are combined and compounded by poor hygiene or household care.
The dressings used to manage open wounds will depend on many factors. The amount of drainage, where the wound is located on the body and how the skin reacts to products used must all be considered when making a treatment plan. Good wound management accounts for these factors and adjusts as needed. Drainage will likely decrease over time. The dressing should be adjusted to maintain optimal moisture balance. Everyone’s skin is different and not all can tolerate adhesive bandages. Irritation from tape can cause lots of discomfort and further skin breakdown. The use of compression often results in poor compliance for many people as application of garments can be difficult and cumbersome. Regardless, to heal wounds where there is venous insufficiency or lymphedema, compression will be an essential part of the treatment plan.
Developing a wound management plan must take into consideration the direct needs of the wound but also the person who has the wound and the caregivers that will provide care. People have needs that might include: cost of supplies, how often the dressing is changed, what the dressing looks like and how complicated the wound care regimen is going to be. Finding a perfect balance for optimal compliance is ideal and leads to the best experience for all parties involved. When an individual has multiple health-related issues compounded by mobility issues and lack of caregiver support, the complicating factors are compounded.
Managing a wound also includes managing expectations. People want the process to be fast but not all wounds will progress quickly. Individuals can do a lot to support their own healing in between medical office visits. Healthy habits like adequate nutrition, hydration and exercise while following any restrictions provided will go a long way to helping an individual improve their situation. However, not all wounds will heal especially as people near end-of-life stages and wounds may even decline as general health declines. Caregivers often carry a lot of the load of wound management in the home which can be a daunting task as the health of their person begins to fail. Knowing what to expect and how to manage wounds that are not expected to heal can help with the burden.
Compliance and communication is key. Facilities will provide caregiver training for wound management. Communicating when the care plan is too difficult to manage or issues arise leaves the medical team the opportunity to provide more guidance and to make adjustments to help heal. There are thousands of products on the market from different dressings, turning and positioning devices and mobility aides that can be considered for the best possible outcomes to be obtained.