The management of wounds can be complex, time consuming and expensive. Wounds occur for a variety of reasons and there ability to heal can be influenced by many factors including the initial injury, underlying medical issues, adequacy of circulation and presence of infection.
Many medical issues can contribute to wound formation. Common causes include diabetes, arterial insufficiency, venous insufficiency, infection and malignancy.
Investigation and management of the underlying cause is an important part of wound management. Careful wound care is also required to enable optimise wound healing and to prevent further tissue damage.
Careful wound care includes cleaning the wound and surrounding tissues and removal of any necrotic tissue or slough.
Wound care requires aggressive treatment of infection with antibiotics. In severe wounds Intra-venous antibiotics are often required.
A variety of wound dressings are available to aid wound healing. Dressings have been designed to assist with different situations. Some dressings are useful to dry wounds, others to moisten the wound area and some apply a vacuum to the wound bed. Depending on the type of wound and the progress of the wound appropriate dressings will be used by your surgeon to optimise healing for your specific needs. At times different dressings may need to be tried if wound healing is not progressing satisfactorily.
Negative Pressure Wound Therapy (VAC)
Negative pressure wound therapy is a recent advance in wound treatment. It is particularly useful in wounds where a cavity or significant defect in the tissues has occurred.. In wounds where there is a loss of deeper tissue as well as skin the defect needs to fill up before closure of the skin can take place and it is this filling up which is accelerated by using a vacuum dressing. Once a wound is clean, and provided it has a good blood supply, application of negative pressure devices speed up the filling in of the wound. The negative pressure also tends to draw the edges of the wound together to facilitate healing. Any fluid or exudate weeping across the wound is better controlled and dressing changes can be less frequent. Negative pressure is usually applied at -80 to -125 mmHg for an adult and is suitable for the majority of wounds providing they are clean.
There are now a number of commercial devices on the market that provide negative pressure to wounds. Some devices provide intermittent suction and may also allow wound irrigation through the vacuum tubing.
Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy may be helpful to heal certain wound types. The treatment involves being placed in a chamber that allows oxygen to be breathed at higher pressure. In certain situations this may allow better wound healing by delivering oxygen to the wound area. This treatment is useful in only certain situations and is not recommended for the majority of wound types.