Dehisced surgical wounds are a common occurrence and are seen both in primary and secondary care. The impact of a dehisced wound is far reaching. For the National Health Service, there are increased in-patient costs and additional resources in terms of an extended healing time, such as staffing and dressing materials and therapies. For the patient, a dehisced wound can impact significantly on their wellbeing and quality of life and for patients of working age, the economic impact of not being able to work can be enormous. This article discusses the incidence of wound dehiscence, outlines the types of wounds which are most likely to dehisce, and the most common reason for this, wound infection. Strategies for managing wound infection, including the use of antiseptic and antimicrobial products, together with a frequently used therapy, topical negative pressure therapy (TNPT), are also discussed.
Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.
Patient experiences with wound care treatment are being recognised as central to prudent care. Leg Clubs provide community-based treatment, education and ongoing health promotion and care for people with leg-related problems. This article considers the growing evidence of patients’ experiences of being treated in a Leg Club setting. Six participants from a Leg Club setting were interviewed via a semi-structured interview, and interviews were transcribed verbatim and investigated for themes using interpretative phenomenological analysis in accordance to Smith et al (2009). An overarching theme, the holistic approach to treatment, was identified, with two subthemes: Leg Club education and a sense of autonomy and trust in Leg Club staff. This study revealed the importance of a holistic approach to treatment within a Leg Club setting, and adds to, and complements, the body of evidence.
The suboptimal management of leg ulcers has been identified as a UK-wide problem that involves a high financial and personal cost (Guest et al, 2015). One common omission identified in the care of patients with a leg ulcer is a failure to establish the underlying aetiology of the wound. Ideally, an accurate leg ulcer diagnosis should initiate the appropriate therapy, which should, in turn, facilitate healing; however, an inaccurate diagnosis at the outset means that the patient may not be started on an appropriate management pathway. Although vascular disorders are the major cause of leg ulcers, there are other aetiologies that should be considered when the leg ulcer has failed to respond to evidencebased therapy (Rayner et al, 2009). This article outlines some of the atypical leg ulcer types the author has encountered, as well as detailing the signs that were identified within the assessment process and which allowed the author to formulate an accurate diagnosis.
A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful (NHS Improvement, 2018a). The consequences of pressure ulcers are increased length of hospital stays for the patient, estimated at 4.31 days (National Institute for Health and Care Excellence [NICE], 2005), but also an increase in cost to the NHS, which is identified at around £14-21 billion annually (Nutritional Pressure Ulcer Advisory Panel et al, 2014). Poor nutrition has been recognised as one of the risk factors in the development of pressure ulcers. Improving nutritional intake of patients is thus paramount in reducing patient harm and unnecessary cost. This article looks at the role nutrition plays in the prevention and treatment of pressure ulcers, provides practical advice and signposts readers to the resources produced by the Nutrition and Pressure Ulcer Task and Finish Group.
Over the years, there has been a plethora of evidence-based literature on effective and ineffective wound management practices; however, some healthcare professionals continue to manage wounds using outmoded or ritualistic practices. The key areas are: frequency of dressing changes; maintenance of a moist environment to aid healing; when wounds should be cleansed; and which cleaning solutions to use. This article presents the evidence base in these key four areas and aims to dispel some of the myths and misconceptions to ensure that healthcare professionals can be confident that they are delivering upto- date, evidence-based wound care in accordance with the Code of Conduct (Nursing and Midwifery Council [NMC], 2015).
