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A new look at old wounds

Experts say limiting bandage options and providing special skin care can improve healing for aged patients.

Wound care management is a delicate matter. Ensuring that a wound doesn’t become infected is crucial.

Amongst the elderly, whose recovery from illness and injury will take longer, managing wounds is especially important.

Current research reveals that more than 25 per cent of residents in aged- care facilities have a wound. Care for wounds accounts for more than 50 per cent of community nursing and it’s a daily requirement for nurses in clinical practice to care for people with wounds.

Not surprisingly then, Australia is one of many countries investigating best practice for wound care management. It has some leading authorities on the matter.

In the area of research and practice for venous leg ulcers, Dr Carolina Weller, senior research fellow, health service management research unit department of Epidemiology & Preventive Medicine, Alfred Hospital, is an expert.

“Compression is used to treat venous leg ulcers that are secondary to venous insufficiency; it assists by reducing venous hypertension, enhancing venous return and reducing peripheral oedema,” Weller says. “Healing potential is decreased if compression is not applied.

“A study published in the Australian Family Physician in May 2012 showed that nurse knowledge of venous leg ulcer management is suboptimal and that current practice does not comply with evidence-based management guidelines.

“Evidence-based practice integrates the best available research evidence with information about patient preferences, clinician skills and available resources to make decisions about patient care. Barriers to the use of research-based evidence can occur when time, access to the literature, search skills, critical appraisal skills and implementation skills are lacking.”

Weller states that many different clinical trials have reported the large number of bandage options complicates the different compression systems, as various bandages require different application techniques.

“Up until recently, there was no simple way to apply an economic alternative for health professionals,” Weller says. “A clinical trial published in Wound Repair and Regeneration in November 2012 reported that the three-layer, tubular-form bandage could heal people with venous leg ulcers. This system has now been translated into practice and used in primary health care and hospital settings with good results.”

Weller also states that it is important for nurses and medical staff to be up to date on the latest research and practice concerning wound care management.

“Clinical guidelines appear to be [among] the most effective methods of applying evidence to improve quality of care, but little is known about the best way to implement them into everyday practice,” Weller says. “The Australian Wound Management Association has developed clinical practice guidelines for prevention and management of venous leg ulcers in collaboration with the” New Zealand Wound Care Society.

Associate professor Geoff Sussman has been involved in wound management for over 30 years, in clinical research, clinical practice and teaching, and has over 100 publications.

He says understanding the cause of wounds is critical to research.

“Much of the latest research centres on our understanding of the mechanisms of wound repair and what has gone wrong with a non-healing wound,” says Sussman, director wound research, Wound Foundation of Australia, Monash University.

“This will lead to the development of new products that will correct the imbalance in the wound. The important issue in treatment is to fully identify the cause of the wound and then consider what properties the product to be applied requires.”

Sussman also explained some particular issues related to wounds in elderly patients.

“Ageing has a significant impact on the body’s ability to regenerate tissue and heal after injury,” Sussman says. “Some of the effects ageing has on tissue are reduced dermal thickness, weakened dermal-epidermal junction, reduced Vitamin D, collagen and moisture, reduced migration of capillary epithelial cells, epidermal turnover, increased fragility of capillaries and compromised inflammatory response.

“Skin integrity reduces with age. Acute and chronic wounds are common in older people in particular. Skin tears are very common. If treated correctly, they will heal quickly; if treated incorrectly they will take a long time to heal.

“It is essential to ensure as the skin ages that appropriate measures are taken, such as not using soap or other alkaline pH products that will increase the drying and therefore cracking of the skin.”

Repeated washings with soap may reduce the normal skin flora, leading to an increased colonisation of the organ with coagulase-negative staphylococci; this effect has been linked to the shift in skin pH caused by soaps.

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