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October 01, 2019

Why Some Wounds Won’t Heal

Why Some Wounds Won’t Heal

We get so used to relying on our bodies to heal wounds, that we sometimes forget what happens when they don't. Why won't some wounds heal?

This feature is brought ot you by Professor Richard White and Alexandra Bishop.

We turn our attention to wounds in the older population and consider why some wounds are slow to heal, or do not heal at all. In either circumstance it must never be regarded as “just one of those things” but instead be reason for further medical investigations and careful scrutiny of treatments and lifestyle. We no longer accept that wounds need ever be slow to heal, or impossible to heal without just cause.

First however, we need to take a quick look at the problem of wounds in our NHS. It has been calculated that wounds cost our health system well over £5 billion a year. This is about 4% of the total spend on health! In the older segment of our population, leg and foot ulcers, and pressure ulcers (formerly known as bed sores) are expensive to manage - as well as being a major quality of life issue for both patients and their families. Surgical wounds in patients discharged from hospital can also be problem healers in the community situation. Far too many wounds do not heal, why might that be and, what can be done about it?

Firstly, we at DDRC Wound Care take the view that few, if any, wounds are ‘unhealable’. Most can, with the correct management, heal up. However, in many cases this does not happen. To understand this we must look at the factors which lead to wounds being slow to heal, or even non-healing.

The term “chronic wounds” has long been applied to leg and foot ulcers and to pressure ulcers. Indeed some innocuous trauma wounds become chronic. This means that they do not heal in the typical way and rate that we understand wounds to heal. Chronic wounds are unremitting, never-ending, recurrent and as such take up valuable resources including dressings and nurse time. This need not be the case; it is important that patients and their families do not despair when wounds don’t heal, help is at hand.

A chronic wound is at risk of infection until it is fully healed. It may well leak or ooze and become smelly. Pain is frequently a major factor causing loss of sleep and great distress. The accepted approach that experienced doctors and nurses take to avoid this happening is clear and should be made available to all patients.

Firstly, a thorough assessment must be conducted, preferably by a wound care nurse specialist or Tissue Viability nurse. This will take up to an hour. It will involve a detailed medical, lifestyle and dietary history and an examination of the wound. It is only by this approach that the next stage, the care plan, can be deduced. Assessment is not a one-off event but rather a regular occurrence, conducted to monitor progress or to revise the care plan if healing does not happen as expected.

The care plan is an essential component of every patient’s management. It will outline in detail exactly how the wound and related medical issues, such as pain or infection, must be managed such that if the patient is cared for in their own home, all nurse or doctor visits will focus on the care plan. This way the constant changing of dressing types can be avoided. Similarly, if healing does not progress as anticipated, the patient can be re-assessed and the care plan revised to take account of changing circumstances. In our experience, we frequently see patients who have non-healing leg ulcers and find that bandaging has been inconsistently applied, dressings changed without due cause, vital diagnostic tests not done or misinterpreted and social and nutritional intake has not been considered.

In our hands these deficiencies can be quickly remedied and the patient treated in a fashion which will optimise healing, otherwise we will arrange referral to the appropriate medical, surgical or other specialty for detailed investigations. No patient deserves to be left with a wound which is not healing!

A brief note on DDRC Wound Care: we are a part of a medical charity, DDRC Healthcare, providing expert wound assessments and care. Referrals to us may be privately, and we are currently working on a referral pathway for GPs. We aim to prepare detailed care plans such that patients may then be managed by their local doctors and nurses with our guidance. We are based on the Plymouth Science Park close by Derriford Hospital, Plymouth. 

DDRC Wound Care is pleased to work co-operatively with Advancis Medical as both a research and clinical partner. By doing so we are able to access quality wound care products as well as to have advanced experience with new developments in the management of wounds.

“At Advancis Medical, we are passionate about working with patients and clinicians to develop the best wound care solutions. We do not accept that some wounds simply will not heal and by working with proven care providers like DDRC Wound Care, it is our mission to provide products that can help every wound to heal.” Victoria Smallwood, Marketing Manager.

No patient deserves to be left with a wound which is not healing, and there is no justifiable excuse for doing so.  

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