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The principles to successful wound healing include using the TIME principle: Tissue debridement, Infection control, Moisture balance, and Edges of the wound. After these general measures have been addressed, treatment is specific to the wound type. Patients with arterial ulcers should have interventions such as balloon angioplasty to improve blood supply to the region. Treatment of venous ulcers involves compression bandaging and elevation of the legs and exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area. Other principles of successful management include:
1. Treating and preventing secondary infection of the wound
2. Debridement by removing dead skin and tissue from the wound bed and surrounding area. This will promote wound healing by changing the wound from a chronic form to an acute one.
3. Applying appropriate dressings impregnated with medicated gels or antibiotics to treat and prevent infection
4. Atypical non-healing wounds will be biopsied to check if there is an underlying malignancy.
5. Optimising blood sugar control in patients with diabetes
6. Regular monitoring and dressings of the wound
7. Topical pain management –There is a strong need for better pain treatment in chronic wounds. Local treatment with sustained release local anaesthetic is showing promise. Particularly in the patients with severe wound pain, any treatment that would eliminate or delay the need for systemic opioids would be very beneficial.
Advanced wound dressings
The VEC utilises a wide range of advanced wound dressings and wound healing devices. These include silver- based dressings, collagen- based dressings and Negative Pressure Wound Therapy (NPWT). Wounds require different dressings at different stages of wound healing to provide an optimal wound environment for regeneration.
Advanced wound dressings are designed to treat complex wounds. They have the ability to:
Maintain the wound in a moist environment, optimal for the healing process
Protect peri-wound skin from maceration and pressure injury
Promote growth of new tissue in the wound bed
Treat infected wound with topical antibiotics and maintain a clean wound bed for healing
Advantages of using advanced wound dressings:
Faster healing time
Reduced super reinfection risk
Decreased frequency of dressing changes therefore saving cost
Negative Pressure Wound Therapy (NPWT)
NPWT is a special wound management device used for complex larger open wounds. It uses gentle suction (negative pressure) via a wound dressing and a small electrical pump to help wounds to heal faster.
NPWT helps wounds to heal by:
- Maintaining a moist wound environment
- Removing excess fluid and infectious material
- Reducing swelling
- Promoting blood supply to the wound
- Promoting healthy tissue to grow
Hyperbaric Oxygen Therapy (HBOT) and Topical Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen at an ambient pressure within a special chamber. It has been recommended as a useful adjunct for patients with wounds that fail to respond to standard wound care. HBOT has been shown to be effective in improving wound healing and against severe infection, especially in the setting of diabetic foot ulcers. In diabetics the small vessels within the foot are sometimes too small to open with balloon angioplasty and therefore if the blood cannot reach those areas near the toes, oxygen from outside down a pressure gradient can sometimes be an effective substitute.
Natrox™ topical oxygen therapy (Inotec AMD Ltd, Hertfordshire, UK) employs a small battery-powered “oxygen generator” to concentrate atmospheric oxygen and feeds pure, moist, oxygen through a fine, soft tube to a dressing-like “oxygen distribution system”, which is placed over the wound and is held in place by a conventional dressing. This has proved highly satisfactory from the patient perspective and has helped reduce time to complete healing with some difficult diabetic foot wounds from our OTONAL study data from Singapore. This may be used instead of HBOT, when some patients cannot tolerate the pressure within the oxygen chamber.
Granulox Topical Oxygen Spray
Granulox is designed to provide wound bases with supplemental oxygen through facilitated diffusion (Figure 1). Granulox aims to provide topical, and hence extrinsic, oxygen supply via diffusion to promote healing. It has been shown to overcome the amount of exudate that chronic wounds make when applied to the wound bed directly after cleaning.
Blue Light Therapy (EMOLED)
Photobiomodulation therapy involves the use of photons from specific frequencies of the visible light spectrum to stimulate the wound healing process. The use of blue light (wavelength 400-450 nm) in particular has been shown to have anti-inflammatory properties, reducing bacterial load and promoting the tissue regeneration process particularly in venous leg ulcers.
Geko Therapy
This technology stimulates the motor neurones within the nerve bundle, that carry signals to the muscle fibres to cause contraction within the leg muscles causing the veins in the leg to empty intermittently. This has been shown to be effectively to heal some chronic venous leg ulcers and diabetic foot wounds.
Split Skin Grafting
Split-thickness skin grafting is sometime carried out to cover wounds with a large defect. It is a surgical procedure which involves removing the top layer of skin from one area of the body, usually the thigh, and moving it to cover the wound defect. The top layer from the donor site normally heals without an issue as the skin graft taken is very thin in nature. Skin grafting has been shown to increase the healing rate of diabetic foot ulcer and minimise complications such as major lower limb amputation.
