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Five Principles of Wound Management

Chronic wounds are a significant burden to the global healthcare systems. With the increase in the aging population, the prevalence and complexity of wounds are only expected to increase. Despite the wide range of wound care products and treatment options currently available in the market, the basics of wound care can be simplified into five principles. These principles can assist clinicians in providing holistic and comprehensive wound care to patients. This article will review the five fundamental principles of wound care that all wound care specialists and podiatrists need to be aware of. 

Wound Management: An Overview 

A wound is a disruption in the continuity of the epithelium. A normal physiological wound healing process consists of four stages namely homeostasis, inflammation, proliferation, and remodeling. In a chronic wound, the wound healing mechanism is disrupted which results in prolonged and protracted healing. Several complex etiologies can be the causative factors behind delayed wound healing. Therefore, a systemic approach to wound management and assessment is necessary to streamline the diagnostic process. 

Assessment of the Wound

The initial and most important step in the management of the wound is a comprehensive and detailed assessment of the characteristics of the wound and patient factors. A useful mnemonic that can help clinicians in wound assessment is the TIME principle. It involves the assessment of wound tissue, presence of infection, moisture, and edge of the wound respectively. 

It is important to note the size, location, and depth of the wound as these can provide diagnostic clues that will aid in further management. For instance, diabetic ulcers are more likely to occur in regions of the foot which sustain high pressure. On the other hand, the medial malleolus or the gaiter region is considered to be the typical location for venous ulcers. A chronic, non-healing wound can also be suggestive of malignancy. Therefore, a tissue biopsy might be needed if a wound fails to heal despite intensive treatments. 

Cleaning of the Wound

Wound cleansing helps to reduce bacterial load, decreases wound infection rates and optimizes the pH at the wound site. In addition, it also helps to remove external contaminants. Irrigation of the wound with normal saline should be carried out after each dressing change if possible. Normal saline is an isotonic solution and does not interfere with normal, healthy granulation tissue. In clinical settings, wound irrigation is carried out using a fluid jet that removes bacterial contaminants and debris from the wound surface. Some studies have also demonstrated the use of tap water as a wound cleanser can help to reduce bacterial colonization.

Regular Dressing Change

Timely dressing changes help clinicians to regularly review and inspect the wounds, and helps to reduce infection rates. All contaminated or soiled dressings need to be changed. As dressing changes can be quite painful for some patients, patient comfort should be ensured by giving them analgesics. Moreover, care should be taken while removing adhesives. Soaking the dressings can also aid in their removal. To protect the periwound skin, barrier films can be used. These improve the adherence of the dressing material and minimize skin trauma caused during dressing removal. 

Selection of Appropriate Wound Dressing

A wide-range of dressing materials are currently available in the market. This can complicate the selection of appropriate wound dressing. Knowing the characteristics of an ideal wound dressing can help wound care specialists and podiatrists in the selection of an appropriate dressing. An ideal dressing is non-toxic, hypoallergenic, easy to use, cheap and readily available. Moreover, it should cause minimal discomfort and pain during dressing removal. It is also important for clinicians to take patient wishes into consideration during dressing selection. This helps to improve compliance. 

Antibiotic Use

Wounds should be thoroughly inspected for signs of infection before prescription of antibiotics. It is common for healthcare professionals to prescribe indiscriminate use of antibiotics even in patients with little evidence of clinical infection. It is important to carefully assess the signs and symptoms of clinical infection before an antibiotic is prescribed. This is because regular use of antibiotics can result in an increased risk of antibiotic-resistant infections. The clinical signs and symptoms that point towards a likely wound infection include fever, increased wound exudation, odor, and skin redness. 

Antibiotics should not be used for a long period and should be targeted towards the likely bacterial cause of infection. For chronic wounds with biofilms, irrigation with an antimicrobial is recommended. 

Conclusion

Wound care is increasingly becoming complex with the introduction of advanced wound technology. However, the entire wound care can be distilled into five basic principles. These five principles include wound assessment, wound cleansing, timely dressing change, selection of appropriate dressings, and antibiotic use. These basic principles of wound management can be used by any member of the healthcare team to provide systematic and comprehensive management to the patients with chronic wounds.