More Than One Problem: Wound Management in Complicated Patients
Our patients are largely exempt from the common human comorbidities adversely affecting wound healing such as obesity, alcoholism, chronic diabetes and cardiovascular disease. Nevertheless, we are regularly presented with wounds that do not appear to be healing well. The history of such wounds needs to be revisited in detail, and the wounds themselves examined and defined – is it slowly-healing, non-healing or recurrent in nature? Does it have an atypical appearance? More diagnostics than usual are performed, including full laboratory work-up, advanced imaging with contrast, histopathology and macerated tissue cultures for atypical organisms. A standardized approach to problem-solving will optimize outcomes: address wound management issues, investigate underlying systemic conditions and consider individual wound factors.
- Recognize and characterize an atypical or slowly healing wound.
- Develop a systematic approach to elucidate the underlying cause(s) for delayed healing.
- Be prepared to biopsy, perform macerated tissue cultures and perform advanced imaging.
- Be cognizant that many wounds do not heal optimally due to management failures.
- Be aware of how to diagnose and manage specific wound issues that impair healing.
- Always test for underlying patient conditions that can affect wound healing.