Complex Wound Management
At Truworth Care, we are dedicated to providing high-quality complex wound management services to you. When it comes to caring for complex wounds, we understand that you are different and requires individualised care. That’s why we take a holistic, person -centred approach to wound treatment, considering the psychosocial, extrinsic, and physical risk factors in order to develop a care plan that promotes successful healing..
Complex Wound Care
Complex wounds are wounds that possess at least one of the following characteristics:
- take longer than three months to heal.
- are infected.
- there is risk of tissue death and impaired circulation.
- are related to a medical condition that affects the body’s ability to heal.
Types of complex wounds
There are several types of complex wounds that may require specialised treatment:
Pressure ulcers: Also known as bedsores, pressure ulcers are caused by prolonged pressure on the skin and underlying tissues. They can occur in areas of the body that are subjected to constant pressure, such as the heels, ankles, and buttocks.
Diabetic foot ulcers: These ulcers are a common complication of diabetes and can lead to amputation if not properly treated. They are often caused by poor circulation and neuropathy (nerve damage) in the feet.
Venous stasis ulcers: These ulcers are caused by poor circulation in the legs and often occur in people with varicose veins or other conditions that affect blood flow.
Arterial ulcers: These ulcers are caused by poor circulation due to narrow or blocked arteries. They often occur in the legs and feet and may be painful.
Other wounds: Wounds that are caused by inflammation of the blood vessels (vasculitis) or the use of drugs that suppress the immune system (immunosuppressive therapy) and have not healed after simple treatment.
Risk Factors for Complex Wounds
It is important for you to be aware of the risk factors for complex wounds in order to prevent them from occurring or to identify them early on in order to provide proper treatment. Some common risk factors for complex wounds include:
Massive skin loss: If you have lost a large amount of skin, it can weaken your tissues and make you more prone to injury and slower to heal.
Severe burns: Burns can be particularly difficult to heal and may result in scarring.
Comorbidities: If you have certain medical conditions, such as peripheral vascular disease or diabetes, it can increase your risk of developing complex wounds.
Immunocompromised: If you have a weakened immune system due to illness or certain medications, it can make it more difficult for your body to fight off infections and promote healing.
Taking certain medications: Some medications can affect your ability to heal wounds, such as steroids and nonsteroidal anti-inflammatory drugs.
History of local tissue injury: Previous injuries to the area, such as from radiation therapy or surgery, can affect your ability to heal a wound.
Pressure Injury: Prolonged pressure on the skin and underlying tissues can lead to pressure ulcers.
Changes in temperature or moisture: Exposure to extreme temperatures or sudden changes in humidity can affect your ability to heal a wound.
Other wound-related conditions: The presence of conditions such as osteomyelitis (bone infection), necrosis (dead tissue), gangrene (tissue death), peri-wound dermatitis (skin irritation), oedema (swelling) or hematoma (blood clot) can also increase the risk of developing complex wounds
Wound Assessment
When conducting initial and ongoing wound assessments of your wound, there are several factors that should be taken into account in order to allow for appropriate management in conjunction with the Multi- Disciplinary Team (MDT). These considerations include the type of wound you have, such as whether it is acute or chronic, the cause of the wound, the location and surrounding skin, the amount of tissue loss, and the clinical appearance of the wound bed and stage of healing.
To assess the type of wound, it is important to consider whether it is:
acute or chronic. Acute wounds are typically less than three months old, while chronic wounds are older than three months and have not progressed through the normal stages of healing.
The aetiology of the wound, or the cause of the wound, is also important to consider. Wounds can be caused by a variety of factors, including surgical procedures, lacerations, ulcers, burns, abrasions, trauma, pressure injuries, and neoplastic conditions.
The location and surrounding skin of the wound should also be evaluated, as this can affect the healing process.
The tissue loss, or the amount of damaged or missing tissue in the wound, should also be assessed, as this can impact the wound maangement plan.
The clinical appearance of the wound bed and stage of healing should also be considered, as this can help determine the best course of treatment.
To assess the measurement and dimensions of the wound, it is important to use a ruler or calliper to take accurate and consistent measurements.
The wound edge, or the border of the wound, should also be examined for any signs of infection or inflammation.
The exudate, or drainage, from the wound should be assessed for its volume, colour, and consistency, as this can provide clues about the health of the wound and the healing process.
Finally, it is important to assess the presence of infection and the presence of pain, as both of these can impact the healing process.
By considering all of these factors during initial and ongoing wound assessments, you and your wound care team can develop an effective treatment plan and monitor the progress of healing to ensure the best possible outcome.
Wound Bed Preparation
Tissue Management: If you have a wound, proper tissue management is important for promoting the healing process. If clinical observation shows that there is nonviable, necrotic, or infected tissue in your wound bed, your doctor may recommend debridement to remove this tissue. Debridement is the process of removing damaged tissue and can be done using various methods, including autolytic, enzymatic, biological, sharp or surgical, and mechanical debridement. The method chosen will depend on factors such as your overall health, the type of tissue present in the wound, the location of the wound, and whether you are taking immunosuppressant medications. By properly managing the tissues in your wound bed and removing any damaged or infected tissue, you can help your body heal your wound and get on the path to recovery.
Inflammation and infection: As you know, inflammation and infection can have a major impact on your wound healing process. When you have an infection, your body’s natural response is to send white blood cells and other immune cells to the infected area to fight off the infection. This can cause inflammation, which is a normal part of the healing process. However, if the infection is severe or if the inflammation becomes chronic, it can actually delay or disrupt the healing process.
One of the main ways that inflammation and infection can affect wound healing is by interfering with the blood supply to the wound. When you have an infection, your body’s immune response can cause swelling and inflammation in the area around the wound. This can cause the blood vessels to become constricted, which can reduce the amount of blood and oxygen that reaches the wound. Without enough blood and oxygen, your body’s cells won’t have the resources they need to repair the damage and close the wound.
In addition to interfering with the blood supply, inflammation and infection can also make it harder for your body to clean the wound and remove dead or infected tissue. When you have an infection, your body produces pus and other fluids that can build up in the wound and create a breeding ground for bacteria. This can make it harder for your body to get rid of the infection, and it can also make it harder for your body to close the wound.
To help your body heal your wound as quickly as possible, it’s important to address any inflammation or infection as soon as possible. This may involve taking antibiotics to get rid of the infection, using dressings impregnated with animicrobials, and cleansing of the wound to remove dead or infected tissue. Your doctor may also recommend using wound dressings that contain antimicrobial agents to help kill bacteria and prevent the wound from becoming infected again.
Moisture Balance: To help your wound heal properly, it’s important to keep the right balance of moisture in the wound. A moist wound environment can help promote healing, but if there is too much moisture it can cause problems. To keep the right balance, your healthcare provider may recommend using dressings that help add moisture to the wound while also absorbing any excess drainage. This can help keep the wound moist and healthy and prevent problems like excess moisture or tissue degradation. By paying attention to the moisture levels in your wound, you can help ensure that it is healing properly.
Epithelial Edges: It’s important to look closely at the edges of your wound and the skin around it to make sure it is healing properly. Signs that your wound may not be healing as it should include rolled edges, a lack of advancement of the edges, and the presence of callus or dry, flaky skin. If you notice any of these things, your healthcare provider may need to take some extra steps to help your wound heal. This may include cleaning out any rolled or dry skin around the edges, treating any infections, and taking care of the skin around the wound. By paying close attention to the edges of your wound, you can help make sure it is healing properly.
Regeneration and Repair: When you have a wound that is not healing well, there are special treatments that can help. These treatments are called advanced therapies. The goal of these therapies is to help the wound close and heal. They can do this by providing support for cells that help the wound heal and by using special substances or techniques to make the cells work better. Some examples of advanced therapies are using oxygen, using special cells called stem cells, and using special substances like growth factors. If your wound is not healing with the usual treatments, your healthcare provider may suggest trying one of these advanced therapies. They can help the wound close and heal better.
Social factors: It is important for you to be aware of how psychosocial, extrinsic, and physical factors and comorbidities can impact your wound healing. By addressing these factors, you can receive patient-centred care that promotes successful wound healing.
For example, if you are dealing with mental health issues, such as depression or anxiety, it may be more difficult for you to follow your care plan and this can hinder the healing process. It is important for you to seek ongoing education about your care plan and how to care for your wound at home, as this can help you better understand your treatment and promote successful healing.
It is also important to consider extrinsic factors, such as your living conditions, social isolation, distance from medical care, and economic situation. If you live alone or are socially isolated, it may be more challenging for you to receive the support you need to care for your wound. Similarly, if you live a long distance from medical care, it may be difficult for you to access the necessary treatment and follow-up care. Your economic situation may also affect your ability to follow your care plan, as certain treatments or supplies may be financially out of reach. By considering these extrinsic factors, your healthcare provider can develop a care plan that takes them into account and helps you heal successfully.
Physical factors, such as your mobility and comorbidities, can also impact your wound healing. If you have limited mobility, it may be more difficult for you to properly care for your wound at home and this can hinder the healing process. Comorbidities, or other health conditions that you may be living with, can also impact your ability to heal. For example, if you have diabetes or vascular disease, these conditions may affect your body’s ability to heal wounds. By considering these physical factors, your healthcare provider can develop a care plan that takes them into account and helps you heal successfully.
How Truworth Care Can Assist You in Complex Wound Care
As a participant in the NDIS, you have the right to receive complex wound management support that is tailored to your individual needs. This support is outlined in the NDIS Practice Standards under the High Intensity Daily Personal Activities Module.
The goal of these standards is to ensure that you receive high quality care that is relevant and proportionate to your needs. This may involve engaging you in the assessment and development of a complex wound management plan, which identifies any potential risks or emergencies and outlines the steps that should be taken to manage these situations.
To meet the NDIS Practice Standards, your NDIS provider, Truworth Care ensures that:
- You are involved in the assessment and development of your complex wound management plan
- Your health status is regularly reviewed (with your consent)
- Disability Support Workers who provide your complex wound care are informed by appropriate policies, procedures, and training plans
- Support Workers who provide your complex wound care have received all necessary training that relates to your specific needs, either from a qualified health practitioner or another appropriately qualified individual.
NDIS worker supporting you are responsible for:
- Recognising the signs of pressure injuries and seeking medical attention if necessary
- Following your wound management plan, which may include inspecting and replacing dressings
- Performing these tasks under the supervision of a health practitioner.
The NDIS workers who are responsible for your complex wound care are knowledgeable about:
- Factors that can damage your skin and cause wounds
- Signs of infection and how to respond to them
- The risks of prolonged or worsening infection
- Techniques for repositioning and providing pressure area care (PAC) to prevent you from developing pressure injuries and choking
- How complex wound management can impact your other daily activities such as showering, toileting, mealtime assistance and mobility.