Managing Wounds, Non Healable Or Maintenance

Question: 4.1- Discuss and appraise your approach to managing wounds that are classified as either healable, non-healable or maintenance. Comment on the differences of care approaches between these classifications.

Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.

The first element to consider is if the wound has an adequate vascular supply that can be assessed by.

1. Peripheral pulses

2. Ankle brachial pressure index (ABPI)

3. Audible Doppler examination

4. Toe pressure

5. Angiography

Once the vascular component has been assessed, we get a clear idea of the main limiting organic factor in wound healing. We can then build on this information by assessing the patient 's cofactors in healing. This step is essential in order to maximize the vascular network the patient possesses. Those cofactors are:

1. Systemic diseases (Diabetes, immunosuppression, skin disease)

2. Nutrition/Diet (Low protein diet, vitamin deficiencies)

3. Medication (Corticosteroids, immunosuppressive drugs and ...

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...s expressed by most treating physicians if best treatment is not possible. Most of those wound are sadly sent to a community nurse for dressing change without the patient coming back to the treating physician for assessment of "maintenance wound" treatment.

Non-healable wound treatment

When a wound is determined as non-healable, as described by Sibbald et al (1), it should not be treated with a moist treatment and should be kept dry in order to reduce the risk of infection that would compromise the limb. It is also important to consider the patient 's preferences and try to control his pain, his discomfort in activities of daily living and the odour that their wound may produce. In this case, special attention must be given to infection prevention and control. Some charcoal dressing would be interesting in the care of our non-healable wounds at St. Mary 's Hospital.