Wounds: Looking beyond the surface☆☆☆

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Abstract 

J Vasc Nurs 2003;21:2-3.

Location, Location, Location … In the real estate industry, this is a key phrase. It signals that a successful real estate investment is directly related to the property's location. The successful outcome, a profitable return on investment, is a result of the property's physical location and the amount of work invested in the real estate for improvements and repairs. Much like this catch phrase and mindset for the successful real estate investor, a similar mindset should apply in clinical wound healing: Etiology … Etiology … Etiology. Yet, more often than not this is not the case.

Investment of time into researching and addressing wound etiology can bring about positive return with regard to healing rates and quality of life. In the United States, the cost of managing wounds exceeds 20 billion dollars, annually.¹ The wound care scenario, which has become all too common, includes:

This scenario is a result of the health care professional “missing” or not fully addressing the etiology of the wound. Some health care professionals have a tendency to evaluate wounds as though they are detached from the patient's body and biological systems. The wound is treated as a separate entity, extending the already lengthy treatment and resulting in poor outcomes. It behooves treating physicians and wound care nurse specialists to identify etiologies of non-healing wounds and develop a strategic plan of care with specific attention to the wound and the underlying co-morbidities that contribute to the non-healing status. An example of such a strategy is outlined below (see Table).

Table. Evaluating wound etiology

It is uncomplicated and “common sense” when utilized in detecting the source of a non-healing wound:

•Obtain a general medical history and review medications.

•Identify co-morbidities that may slow the healing process.

•Determine the etiology and treat it while treating the wound.

A thorough medical history can supply the clinician with the needed tools to develop a plan of care specific to the wound type. While it may be difficult to predict the actual healing time for each chronic wound, investigating the source provides a jump-start for determining the etiology and treatment of the wound.

Additionally, it is critically important to understand that the success of wound care products and protocols is related to the specific types of wounds to which they are applied. Wound care products work in conjunction with the patient's biological systems and they are dependent on the integrity of those systems. Thus, if there is a deficit in the biological system, the clinician needs to correct the deficit in order to facilitate the efficacy of the wound care product and the success of the wound protocol, and to provide a positive healing outcome.

In summary, clinicians can begin view non-healing wounds as a sign of an underlying medical problem or pathology. Thereupon the wounds can be treated more cost effectively, with shorter healing times and with less physical and emotional devastation to the patient. If wound care is to become a “specialty area” of practice, the clinician needs to be willing to invest the time to research and learn, so that healing outcomes improve.

Editor's note: Please see commentaries on following page.

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References 

1. Telemedicine and Wound Care Management. Valerie J Ablaza, MD, and Jack Fisher, MD, Nashville Plastic Surgery, Ltd. Available from http://www.rubic.com/articles/article1.html.
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