Suspicious minds are good for practice
21/11/11 | Complex wounds, Service development and delivery, Skin integrity | Suzie Calne
The mission to uncover new treatments requires an enquiring mind, says Suzie Calne
Effective wound management involves making well-informed and accurate clinical decisions by using all the clues and data available. It should go without saying that talking to and observing the patient and the wound closely are key parts of this process. In the Wound infection in clinical practice: an international consensus document on managing infection, key opinion leaders discuss exercising a 'high level of clinical suspicion around wounds'.
I was struck by this phrase when it emerged at the consensus meeting for this document. It perfectly encapsulates the need for clinicians to be on constant alert, whilst effectively conveying the importance of the experiences that help them develop those extra decision-making antennae.
The care given at the first consultation is of particular importance in wound management, as poor decisions at this point can have lasting repercussions. Even with a relatively simple trauma wound, choices about whether to suture or to debride can impact massively on the patient's experience and the quality of healing.
Using the wrong dressing on a wound can also be detrimental. The damage caused by inappropriate dressing choices is sometimes underestimated. With the many choices available, it is possible to slip into a trial and error mentality, which is evidently a costly approach on a number of levels. Again, it is important to use all the history, evidence and data available to make the right decisions.
Skin tears are a classic example of a seemingly simple wound, which requires expert management to avoid long term problems and chronicity. Managing skin tears Made Easy illustrates the need for careful, clear and informed decision making at an early stage.
Sometimes, even experts with the most developed decision-making skills will struggle to manage certain wounds effectively, due to the underlying and sometimes unrelated aetiology. These patients will then suffer with wounds that are inevitably hard-to-heaI. A really skilled clinician will be able to identify a hard-to-heal wound at an initial consultation and it is important to identify if there are factors that increase the risk of delayed healing as early as possible (see Hard-to-heal wounds Made Easy).
It is difficult to properly appreciate the effect of living with a wound that has stopped healing. The financial burden of a hard-to-heal wound is also high, which can seriously increase a patient's cost of living as well as impact their quality of life. Many describe that patients with hard-to-heal wounds, pain and discomfort can experience depression, anxiety, fear of amputation, feelings of isolation and have difficulties maintaining employment. It is important to remember that although the patient leaves the clinic with a comfortable-looking dressing, they are still likely to experience a significant disruption to their normal lifestyle. Having a hard-to-heal wound will, without doubt, create challenging inconveniences and lifestyle changes.
Therefore, at the 21st European Tissue Repair Society congress in Amsterdam in October I was encouraged to hear that work continues into understanding wound healing at a cellular level. The wide range of experimental work and the excitement of the researchers illustrates the potential for gaining a better understanding of the biochemical characteristics of hard-to-heal wounds. This, in turn, will lead to more effective uses of available treatments.
The mission to find alternative therapies and new treatments continues. For example, one of the posters presented at the congress looked at the topical use of frog skin secretions to reduce the microbial load in skin wounds. While this work is experimental, its potential to move from the bench to the bedside is of critical importance in providing the necessary data for making good, clinical decisions and moving the science of wound care forward.
Editor, Wounds International
If you would like to contribute to a future issue of the journal, please contact Suzie Calne, the editor of Wounds International at: email@example.com