Complex wound management

• Wound healing is a complex dynamic biomechanical process as the body attempts to restore damaged tissues.

• Chronic or “complex” wounds are defined as longstanding tissue injuries that cannot be treated with conventional methods of wound dressing or closure

The term “complex wound” represents the multifactorial dynamic tissue healing process. For a wound to be classified as a complex wound, it should show one of the following features:

• Persistent for more than three months

• Compromised blood supply

• Presence of infection

• Associated comorbidities that impair healing potential such as Diabetes

There are many factors, both local and systemic, that can affect wound healing.

• Local factors include wound depth, infection, peripheral vascular disease, radiotherapy, sustained pressure, and excessive moisture.

• Systemic factors include metabolic disorders such as diabetes mellitus, immunodeficiency, and nutritional deficiencies.

Complex wounds cause a huge burden of suffering on both the individual and their family.

I work within an experienced Multi- Disciplinary Team of consultants to ensure that no detail is missed in the assessment of the patient to deliver the objective of healing any wound.

Assess:

Confirm that blood is entering and leaving the wound using:

• Doppler ultrasound: this allows us to see your blood flow in real time.

• CT angiogram: we take x-ray images from several different angles to build a 3D picture of what is happening inside your body

• MR angiogram: this allows us to create detailed images especially including the soft tissues and bones which may have infection.

• Nuclear Medicine:

• PET

• Lymphocyntogram

• Formal angiogram: if there is doubt from the non-invasive imaging techniques this allows us to see inside your blood vessels.

Assessment for infection using bloods, wound swabs and tissue biopsies and Radiology.

Assessment of the patient risk factors such as Diabetes and other Cardiovascular factors

Nutritional assessment

Wounds require a bespoke treatment plan for each of my patients taking into consideration the underlying cause and the individual risk profile.

I work within an experienced Multi- Disciplinary Team of consultants to ensure that no detail is missed to deliver the objective of healing any wound.

Diabetologist

Microbiologist

Dermatologist

Tissue Viability

Podiatrists

The principles of treatment will be to:

• Ensure enough blood is entering wound using Endovascular, Conventional Surgery or Hybrid Suregry

• Ensure blood that no longer contains oxygen and nutrients leaves the wound using specialised Compression bandaging and Endovenous ablation surgery (EVLT, Venfit and Glue)

• Treatment of infection with the right Antibiotics

• Nutrition is optimised

• Specialised dressings such as negative pressure (VAC and PICO)

• Platelet Rich Plasma: A technique to spin your own blood to concentrate the growth factors within into either an injectable solution or gel. This is a very useful adjunct in the “complex”wound healing.