NEW PARADIGMS IN THE MANAGEMENT OF COMPLEX WOUNDS

  • Helena Jorge Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Cláudia Silva Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Cíntia Pinto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Ana Almeida Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  • Luís Mendes Pedro Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal http://orcid.org/0000-0003-4310-9324
Keywords: Complex Wound Management

Abstract

Introduction: The treatment of wounds is a topic with growing interest due to the physical and psychosocial implications, to the costs associated with the treatments and also due to the stress caused to the patients, families and the health system.

The World Health Organization (WHO) considers chronic wounds as an epidemic due to its high prevalence. In Portugal the available epidemiological data is limited but it is estimated that there are 3.3 wound carriers per thousand inhabitants. The aim of the present narrative review is to clarify the approach to the treatment of complex wounds in light guidelines issued by the European Wound Management Association (EWMA).

Material and Methods: A narrative review was carried out on the current aspects of the approach to the complex or difficult-to-heal wound (wound that does not heal by 40–50% of its size in 4 weeks). A literature search was carried out in Pubmed and in the latest consensus documents prepared by the EWMA (European Wound Management Association) which was integrated in the authors' experience.

Results: The approach to the complex wound must be systematic in dedicated centers and conducted by multidisciplinary teams. It should be mediated by a wound manager and the wounded person must always act as a partner. Proper training of the person/family/caregiver is also crucial. Infection control should start with simple and inexpensive interventions such as hand hygiene and the use of personal protective equipment for patients and professionals in the treatment rooms. The most advanced therapies are based on new principles and technologies and its application should be evidence-based. Algorithms in health are useful tools to support the clinical decision and an algorithm for the treatment of complex wounds is presented.

Conclusion: The approach of complex wounds must encompass multifactorial aspects and the choice of advanced therapies must be judicious.

Downloads

Download data is not yet available.

References

1. Organização Mundial Saúde. (2008). Best Practice Recommendations for Wound and Lymphedema Management. Association for the Advancement of Wound Care Leads World Health Organization Initiative to Establish Guidelines for Wound and Lymphedema Care. Press realease.

2. Atkins, L. et al. (2019). Implementing TIMERS: the race against hard-to-heal wounds. J.Wound care. 2019; 28 (3 Suppl 3): S1-S49.

3. Alves, Paulo. (2014). Feridas: Prevalência e custos. Tese apresentada à Universidade Católica Portuguesa para obtenção do grau de doutor em Enfermagem, na especialidade de Enfermagem Avançada. Instituto Ciências da Saúde. Universidade Católica Portuguesa. Consulta da em novembro de 2019 e disponível em: http://repositorio.ucp.pt/bitstream/10400.14/20105/1/Repositorio_UCP_Tese_doutoramento.pdf.

4. Piaggesi, A., 2018.Advanced therapies in wound management:cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J. Wound Care, 27(6), Suppl 6.

5. Menoita, E. 2018. Gestão de feridas complexas. Loures: Lusodidata.

6. Moffatt, V. 2016. Preparação do leito da ferida na prática. Documento de orientação da EWMA. Consultado em 20 Novembro. Disponível em: http://www.gaif.net/sites/default/files/Doc%20EWMA_0.pdf

7. Ousey, K, et al. (2018). Identifying and treating foot ulcers in patients with diabetes:saving feet, legs and lives. J. Wound
Care; 2018; 27 (5 Suppl 5b).

8. Stryja J. 2020. Surgical site infection: preventing and managing surgical site intection across health care sectors. J. Wound Care , 29:2, Suppl 2b, S1 – S69.

9. Yamada K, Abe H, Higashikawa A et al. Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery. Spine 2018; 43(24):1765–1773. https://doi.org/10.1097/BRS.0000000000002709

10. Ferrão, A.; Gutierres, M. 2013. Aplicação de fatores de crescimento no tratamento de lesões musculotendinosas,
solução ou ilusão? Consultado em Janeiro 2020. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&
pid=S1646-21222013000300003. Revista Portuguesa de Ortopedia e Traumatologia.Vol. 21, Fasciculo III.

11. Lacerda, D. 2016. Plasma Rico em Plaquetas: Alternativa terapêutica em tendinopatias Crónicas. Consultada em Janeiro 2020. Disponível em: https://repositorio.ul.pt/handle/10451/26554. Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa.

12. Apelqvist, J. 2017.Negative Pressure Wound Therapie – overview, challenges and perspectives.J. Wound Care, 26:3, Suppl 3, S 1 – S 113.

13. Schaper, N; Netten, J.; Alpelqvist, J,; Bus, S.; Hinchliffe, R .; Lipsky, B. 2019. International Working Group on the Diabetic Foot (IWGDF) Guidelines on the prevention and management of diabetic foot disease. Consultado em Dezembro 2019. Disponível em: https://iwgdfguidelines.org/guidelines/guidelines.

14. Moura, A.; Malcato, E.; Gonçalves; V, Alves, P. 2018. Terapia por pressão Negativa na Prevenção e Tratamento da ferida Complexa. Associação Portuguesa de Tratamento de feridas. ISBN:978-989-20-9012-2.

15. Gottrup,F. 2017.Use of oxigen therapies in wound healing, with special focus on topical and hyperbaric oxygen treatment. J. Wound Care, 26(5), Suppl. S1 – S42.

16. Turns, M. (2013). The Diabetic foot: an overview for community nurses. British Journal of Community Nursing. Vol. 17, nº 19.Pp 422 -433.Wuthrich, J. et a l. (2017). Recognition of wound care centres in Switzerland. EWMA Journal, vol. 18 nº 2.

17. Ramos, P. et al. (2018). Decisão clínica no desbridamento de feridas. APTF. ISBN 978-989-20-8936-2.

18. Bazalinski, D., 2019.Effectiveness of Chronic Wound Debridment with the Use of larvae of Lucilia Sericata. Journal of Clinical Mediicine, 8, 1845; doi:10.339/jcm8111845.

19. Polit, D. Beck, C. (2019). Fundamentos de Pesquisa em Enfermagem Avaliação de evidências para a prática de Enfermagem. Porto Alegre: 2019. Artmed editor, 9ª edição. Pp 431.ISBN 978-85-8271-489-8.

20. Wuthrich,J. et al. 2017. Recognition of wound care centres in Switzerland. EWMA Journal, vol. 18 nº2.

21. Direção Geral da Saúde. Orientação 003/2011 de 21/01/2011, Organização dos Cuidados, prevenção e tratamento do Pé Diabético.

22. Silva, R, Fernandes, F. (2019).Wound Navigator Profiling: Scoping Review. Rev. Gaúcha de Enferm. 40:e 20180421. doi: https://doi.org/10.1590/1983–1447.2019.20180421.

23. Brown MS, et al. 2018.Wearable Technology for Chronic Wound Monitoring: Current Dressings, Advancements, and Future Prospects. Consultado em janeiro 2019. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29755977. Front Bioeng Biotechnol. Apr 26;6:47. doi: 10.3389/fbioe.2018.00047.

24. Pott, F. et al. (2013). Algoritmo de prevenção e tratamento de úlcera de pressão. Cogitare Enfermagem.2013. Abr/Jun;
18 (2): 238–44.
Published
2021-09-10
Section
Review Article