Introduction

Wounds have a significant negative impact on patients, including pain, decreased quality of life, and social isolation. Optimal wound healing can help patients and the health care system cope with the burden of chronic wounds. Wound management may not always be the priority in patients whose cases are complicated by severe comorbidities, palliative care, hospice care, surgery, chemotherapy, radiation, or management of a chronic condition.

Identification of Patient Goals for Treatment

Listen to your patients. Planning may require some creativity to be most effective. According to research, engaging patients in planning, involving them in decision making, and providing continual education on good self-care and prevention are the most effective ways to promote patient concordance. Monitoring wound healing and goals may vary depending on the patient's overall health and condition.¹

Patient Monitoring and Wound Healing Progress

Wound assessment should include the moderation of wound healing progress and the management of chronic conditions. Clinicians should assess wound status and regularly reassess to ensure proper healing, overall patient well-being, and treatment plan concordance.¹

Prevention of Infection

Treatment should be directed toward the prevention of infection by following universal infection principles, removing nonviable tissue, and managing exudate. Where infection has been diagnosed, the goal will be to treat with topical antimicrobials for local infection and systemic antibiotics for an infection that has spread or is systemic.^2,3

Nutritional Management

Certain drugs or chronic illness–related symptoms can limit nutrient absorption. Without enough nutritional support, the chance of a delayed healing process increases dramatically. As a result, the requirement to promote nutrient consumption frequently outweighs any other dietary limitations.^2,3

Pain Control

Pain management should always be the primary objective. Because pain affects one's quality of life, it must constantly be handled. Additionally, dressing removal can be a painful aspect of the wound care regimen. The most appropriate anaesthetic (e.g., lidocaine) should be administered topically before every dressing change procedure, with sufficient time for the analgesic to take effect. Pain can be minimized by using dressings that are minimally painful to remove and by gently cleansing the wound before dressing removal.^2,3

Management of Existing Comorbidities

Chronic conditions have a direct effect on the body's healing capacity. Clinicians should ensure that while assessing a patient's health status and underlying disease, they consider these conditions when developing treatment plans and goals for wound care.

Wound Bed Preparation

To create an optimal healing environment, debris and necrotic or nonviable tissue should be removed. Necrotic tissue serves as a breeding ground for bacteria, triggers inflammation, and delays wound healing. Optimize healing by supporting a proper bacterial balance.¹

Odor Control

Although wound odor is not necessarily a barrier to wound health, it should be considered in terms of the patient's quality of life and psychological consequences. Infected wounds can have a detrimental effect on a patient's interaction with family and friends, thus contributing to social isolation. Typically, wound odor is caused by bacteria present in the wound. Limiting the bacterial load in the wound, regulating exudate, cleansing the wound, and applying odor-controlling dressings, such as those containing charcoal, can all assist in reducing wound odor.^2,3

Advanced Wound Care Dressings

Appropriate dressing selection should be based on the wound assessment. The primary goals of an effective dressing are to absorb exudate, protect the wound edge and periwound, and promote bacterial balance, all while maintaining a moist healing environment.¹ Collagen, biological dressings, biological skin equivalents, platelet-derived growth factors, platelet-rich plasma, silver products, negative pressure wound therapy, and hyperbaric oxygen therapy are advanced wound care methods or products that can be used alone or in conjunction with other treatment modalities.⁴

Conclusion

It is crucial to understand the influence of chronic illnesses on wound formation, healing, and therapy and how their combined impacts can increase the effects of chronic wound healing. Consider the overall health of your patients and their physical and psychological well-being, as well as their personal preferences when building a care plan. Aiding a chronic wound in closure consists of more than just selecting the right dressing; it involves wholistic management of the patient’s complicating factors, malnutrition, comorbidity management, and infection prevention and management. Clinicians who create and follow a wholistic plan of care are more likely to see favorable results.

References

1. Keast D, Brennan M, Liberato M, et al. The Wound table of content care pathway – a step-by-step approach towards wound healing. Coloplast. 2021. Accessed February 7, 2022. 210407_CP_Wound_Care_Pathway_A5_LOWRES_020921.pdf
2. Woo K, Krasner D, Kennedy K, Wardle D, Moir O. Palliative wound care management strategies for palliative patients and their circles of care. Adv Skin Wound Care. 2015;28(3):130-140.
3. Woo K, Krasner D, Sibbald R. Pain in People with Chronic Wounds: Clinical Strategies for Decreasing Pain and Improving Quality of Life. Why Wound Care. 2018. Accessed January 30, 2022. www.whywoundcare.com/Resources
4. Greer N, Foman N, Dorrian J, et al. Executive summary. In: Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review. Washington, DC: US Department of Veterans Affairs; 2012. Accessed February 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK132243/