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A Team Approach to Chronic Wound Care
by Powen Hsu, M.D., Thomas P. Cody, M.D.,
Division of Physical Medicine and Rehabilitation,
and Kim Tremblay, R.N., Certified Nurse Practitioner
As our country's population ages, the treatment of chronic wounds and sores is becoming increasingly complex and costly. The Wound Clinic at Northeast Rehabilitation Hospital, led by New England Neurological Associates physiatrists, provides a comprehensive and effective approach to this troublesome and painful problem.
How Chronic Wounds Develop
Chronic wounds can arise from a variety of sources, including immobility and pressure, vascular disease, and inadequate post-operative healing. To facilitate healing, the Wound Clinic team identifies conditions which interfere with healing, including poor nutrition and hydration, diabetes mellitus, venous insufficiency or stasis, cardiopulmonary disease, anemia, obesity, smoking, and medications. The cause of the wound and risk factors are identified. The team then vigorously addresses these issues, through nutritional programs or supplements, oxygenation supplementation, and aggressive treatment of the underlying medical problems.
Wound Assessment and Treatment
Once the underlying risk factors and cause of the wound are identified, the next step is wound assessment. The elements of assessment include classifying and sizing the wound, identifying the tissue type at the wound base, evaluating the presence of undermining or tunneling, and assessing the color and amount of exudate. Surrounding tissue is examined for the presence or absence of sensation, pain, circulation and infection.
Following this evaluation, treatment goals are formulated and the treatment begins. Removal of foreign debris and/or debridement of necrotic tissue is the vital first step in the treatment of wounds and pressure sores. Subsequently, providing a moist environment is essential for wound healing. The Wound Clinic team chooses wound care products based on their effectiveness, ease of use, and cost. At each follow-up visit, wound status is re-evaluated and treatment is altered to address the degree of healing.
The Wound Clinic Team
The Wound Clinic specialists, including physiatrists, nurses, and therapists rapidly assess problems and risk factors, and formulate cost effective treatment plans. The team also works with the patient and family to teach principles of wound care and prevention. To provide further continuity, the team works with visiting nurses in the community. The Wound Clinic team approach results in faster wound healing and improved quality of life, while reducing health care costs.
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