Wound Care Resources

Over 3.8 million people in the UK are living with chronic wounds — and how they are managed can shape a person’s quality of life, for better or worse (Mölnlycke Health Care, 2022). However, their management often falls low on the priority list, and the system pressures facing the NHS since the Covid-19 pandemic have exacerbated the problem. This means that patients are facing worsening outcomes through inadequate services — and are paying the price with their physical and mental health.

This case report is to help raise awareness of a rare autoimmune disorder, cold agglutinin disease (CAD), which is characterised by the premature destruction of red blood cells (haemolysis) (National Organisation for Rare Disorders [NORD], (2020). It can have a severe
physical and psychological impact on those suffering with it. Caring for patients with CAD can also be extremely challenging and even traumatic for clinicians. The importance of good multidisciplinary team (MDT) working both within hospital and when discharging
a patient to a community healthcare setting is also highlighted (NORD, 2020), as well as the importance of clear communication for the patient from medical staff on the expectations of treatment and prognosis. Approximately one person in 300,000 gets CAD, which is more prevalent in those aged 60 years and older. Women are also more likely to get it than men (Smith, 2021).

Normal wound healing follows four distinct phases: haemostasis, inflammation, proliferation and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or ‘proud flesh’. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed.

The suffering caused by lower limb and leg ulcer-related conditions often languishes
in the periphery of healthcare. However, the prevalence, distress and economic implications of these conditions are far more substantial than commonly acknowledged.

Delivery of health care is undergoing unprecedented changes. There are increasing requirements for care which are not matched by a comparable increase in resources. Services are frequently under pressure and at times overwhelmed; wound care is no exception. 

Wound management places a major demand on healthcare resources, which will continue to escalate with the increasing age and associated diseases of patients. But, that is no reason for inconsistent treatment, or treatment where the concerns and priorities of patients are not being addressed.

Of course, prevention and education need to be a priority, along with evidence-based wound treatments and research into developing existing pathways. However, patients also have rights and expectations that need to be considered. In our view, it is here where we have fallen down and where we continue to do so.

There is an abundance of literature on the management of venous ulceration, however, increasing numbers of patients are presenting with ulcers of mixed aetiology — arterial and venous. Compression therapy is the gold standard treatment for venous ulcers, however, high levels of compression are contraindicated in the presence of severe arterial disease. Nevertheless, the venous element of a mixed aetiology ulcer needs to be addressed, which
can pose a dilemma for healthcare professionals caring for these patients. This article discusses the different aetiologies and current literature on how these ulcers can be managed effectively to achieve healing.

Debridement is the removal of non-viable tissue from the wound bed and surrounding skin and is an important part of wound healing and wound bed preparation. Devitalised tissue, such as necrosis, slough and hyperkeratosis, interfere with the process of wound
healing. When a wound fails to progress, there is a need to assess the wound bed and surrounding tissue and promote an optimum environment that encourages the formation of healthy granulation tissue (Young, 2014). Recent advances in debridement techniques
using monofilament fibre technology can be practised by nonspecialist nurses and used safely and effectively in a patient’s home. In a recent audit, a dataset of 486 patients who had been newly prescribed a monofilament fibre debridement pad was obtained to
validate clinical effectiveness and cost efficiency. The total cost of wound care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 after (Burnett et al, 2021). This evidence reinforces the National Institute for Health and Care Excellence (NICE) recommendations for use of monofilament fibre debridement in the community, based on evidence of its effectiveness and estimated cost savings (NICE, 2019).

This article looks at the cost and incidence of wound dehiscence, together with an overview of the most common operation sites where dehiscence is likely to occur. Patient factors predisposing to wound dehiscence are discussed, together with the most common cause, surgical site infection (SSI). The identification and management of SSI is explored, together with recommendations for wound management for both infected and non-infected dehisced wounds.

Seven percent of the population in Britain — around 3.8 million people — currently rely on wound care services (Guest et al, 2020); a staggering, and surprising number. Wound care is often an unrecognised service, hidden away as part of the treatment for other conditions, such as diabetes. This lack of awareness led to a situation where variation in standards meant that patients were having mixed experiences of care across the country (Patients Association, 2021).