KEYS FOR SUCCESS IN WOUND MANAGEMENT

1
KEYS FOR SUCCESS IN WOUND MANAGEMENT

• Associate Professor
• Michael Woodward
• Austin Health
• Heidelberg,Victoria

2
HOW DO WE DEFINE SUCCESS?

• Establish a successful service
• Establish a reputation for high-quality care
• Conduct high-quality and influential research
• Establish a successful teaching program

3
SUCCESS

• ORheal wounds
• BUT.what do we mean by healing?
• Full healing
• ?time frame
• ?all wounds
• ?remain healed
• healing
• ?volume
• ?surface area
• ?which wound, if several

4
SUCCESS

• OTHER MEASURES
• Control of microbial burden
• Improved quality of wound tissue
• Control of pain
• Improved quality of life
• Failure of a healed wound to recur

5
TEAMWORK

• However defined, essential to success in wound
  management.
• Many disciplines play a role, including
• Doctor (GP, geriatrician, various surgical
  specialties, dermatologist)
• Nurse
• Podiatrist
• Pharmacist
• Patient

6
ASSESSMENT

• FULLY ASSESS THE PATIENT
• treat the whole patient,not the hole in the
  patient
• THIS INCLUDES
• Full history
• Examination
• Patient
• Wound
• Investigations as indicated
• Blood tests
• Imaging
• Doppler
• Biopsy
• Cultures

7
APPRECIATE THE ROLE COMORBIDITIES AND SOCIAL
CIRCUMSTANCES PLAY

• Medications
• Reduced mobility
• Reduced dexterity
• Nutrition
• Incontinence
• Psychiatric illness
• Dementia
• Poor living conditions
• Financial problems

8
TREATMENT SHOULD BE EVIDENCE-BASED

• Theories, no matter how persistent they
  are,cannot eradicate the existance of fact
• Jean
  Martin Charcot

9
EVIDENCE IN WOUND MANAGEMENT

• The gold standard (even if a little tarnished) is
  the RCT- randomised, controlled, trial
• Also ideally prospective, concurrent, double-
  blinded
• Rare in wound management
• This would not be acceptable for a new drug
• Yet many new wound products are pharmaceutically
  active
• Industry and practitioners can and should do
  better

10
RESEARCH IN WOUND Mx

• There have been successfully-conducted RCTs
  involving Australian sites
• One coordinated out of Adelaide (GroPep)
• Others
• PAI-2, a protease inhibitor
• Proguide vs Profore
• At least 2 in progress currently

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SUCCESSFUL WOUND MANAGEMENT NEEDS SUCCESSFULLY
CONDUCTED RESEARCH
12
SO WHAT GUIDES PRACTICE UNTIL EVIDENCE IMPROVES?

• Faith
• Our faith comes in moments,our vice is
  habitual (R.W.Emersen)
• Hearsay
• What we are taught/ mentored is this if not
  evidence-based
• Marketing
• Experience
• But some of this may be faith and theory

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AND OTHER EVIDENCE

• We do have some,even if not RCT
• In-vitro studies
• Case studies
• Case series
• Non-randomised/non-comparator trials

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..AND GOOD SENCE

• Even without direct evidence, successful wound
  management is guided by basic,sound principles
• Control microbial burden
• Ensure adequate blood supply
• Relieve/avoid pressure
• Compress if venous
• Moist wound management principles
• Control pain
• Enhance nutrition
• Treat comorbidities

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SUCCESSFUL CHOICE OF DRESSING

• Appropriate for wound
• Eg foam if heavily exudative
• Appropriate for patient
• Affordable
• Comfortable
• Patient can apply,or someone available to do so
• Successful
• Wound quality improves
• Wound size/volume reduces
• In reasonable timeframe

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THE NON-HEALING WOUND

• Reassess patient/wound
• ?wrong diagnosis
• ?comorbidities missed
• ?poor compliance
• Consider change of dressing type
• Even within same class
• Seek help if needed
• Try completely different approach
• Eg HBO2

17
SUCCESSFUL WOUND MANAGEMENT

• Is more science than art
• Is almost always achievable
• Is extremely satisfying
• To the patient
• To you!