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Skin is the largest organ that protects our body against external factors and provides thermal insulation. All kinds of damage to our skin is called a wound. The human body is programmed to heal wounds by itself.
In some cases, the healing of wounds may be delayed or disrupted. Wounds that do not heal in 4-6 weeks are called non-healing or chronic wounds. This delay may be caused by many internal or external factors.
The purpose of wound care is to find these causes that prevent wound healing, to eliminate these causes as much as possible and to provide a suitable environment for wound healing.
In wound care, laboratory investigations and imaging methods are used to reveal the underlying disease or disorder. Therapies are organized by the related branch physicians and necessary precautions are taken. Wound care is performed by using medical wound care tools and equipment.
Medical wound care devices are designed according to the type of wound and provide the transition from the place of the wound to the next healing stage. They are selected and used by the wound care specialist according to the stage of the wound and the need.
Wound care should be given by physicians and ancillary health personnel who are professionally trained in wound care. Otherwise, the patient's wound limb and life-threatening treatment can be made that may be forgotten should be remembered.
Wound Care Service Department Diagnostic Treatment Services
Home Wound Care
The aim of home care is to provide home care for patients who are difficult or impossible to come to the hospital. Another task of the wound care team providing home health services and wound care is to prevent the opening of new wounds by educating the relatives and caregivers of these patients who are mostly bed-dependent.
Wound Care in Hospital
Some wounds are not suitable for outpatient treatment or follow-up at home. These wounds are often infected and may cause endangering of the patient's limb or even life. Depending on the patient's general condition and the body area where the wound (s) is located, some patients need to be treated by specialists.
These patients should be treated in a hospital with all branches. It is very important that these wounds, which endanger the general condition of the patients, be closely monitored and frequent dressings are performed.
Some advanced wound treatment services are available only in hospitals. In such cases, the main goal of wound care is to improve the general condition of the patient rather than to heal the wound, to monitor the wound on an outpatient basis or to allow it to be closed with plastic surgery operations.
Who Can Wound Care?
Wound care should be given by physicians and ancillary health personnel who have received professional wound care training. Otherwise, the patient's wound limb and life-threatening treatment can be made that may be forgotten should be remembered.
Bed Wound Care and Treatment
Pressure or pressure ulcers, known as bed sores, are the damage of skin and subcutaneous tissues usually caused by bone protrusions caused by a combination of pressure or tear and pressure. People who cannot make even the simplest movements on their own are at greater risk of developing pressure ulcers.
Pressure ulcers can affect any part of the body, but areas with bone protrusions such as elbows, knees, heels, back and ankles are more sensitive to pressure ulcer development. Pressure ulcers can be treated but can cause fatal complications if treated late.
How do pressure ulcers occur?
The risk of developing pressure ulcers is quite high in a person who remains stationary at a single point for a long time and cannot change his position without assistance. Ulcers may develop, rapidly expand and deepen and may be difficult to heal.
Blood flow is disrupted at these points of the body under constant pressure and tissue death occurs as a result of disruption of circulation in tissues trapped between the bed surface and the bone protrusion. In the supine position, wound formation may begin in the event of a blood flow interruption of more than 2 hours and in the sitting position of more than 1 hour.
The causes of pressure ulcers are:
Continuous pressure
Friction
laceration
Moisture (wetness)
Continuous pressure
If there is constant pressure in one area of the skin and this pressure is placed on the bone, adequate blood collection of the skin and the tissues under it may not be achieved. Pressure is the most important factor in the development of pressure sores. The density, duration and tolerance of the tissue are important in the development of the pressure wound.
Friction
In some patients, especially if the person's skin and circulation are poor, uncontrolled rotating and moving the patient may damage the skin and increase the risk of wounds; in such cases, care must be taken and help is needed if necessary.
laceration
Tear damage occurs when the skin remains stable and the underlying tissues are displaced. The tearing effect is the stretching, stretching and curling of blood vessels in deep tissues. Therefore, blood and oxygen support to tissues is discontinued. As a result of this stress, the blood vessels and muscle layers in the deep rupture are attached to the bone membranes. Since the skin, which is firmly in contact with the bearing surface, cannot move freely, the main effect of the tearing is observed in the deep tissues above the bone protrusions.
Moisture (wetness)
Wetness affects the resistance of the epidermis, which is the top layer of the skin, against external forces. Friction and tear damage are increased in a light to moderately humid environment.
Bed Wound Types and Stages
Pressure ulcers have varying stages depending on their severity. In addition to the classification of stage 1 to stage 4, they are classified into six groups, which are suspected of deep tissue damage that cannot be staged by pressure ulcer. Patients with wheelchairs have a higher risk of developing pressure ulcers on their hips. Pressure ulcers can develop anywhere, depending on the patient's bed or wheelchair contacting body part.
Pressure ulcer stages
Stage 1: Skin appears red and warm to the touch. It may be itchy.
Stage 2 and stage 3: Colorless painful open wounds or blisters may appear or crater-like appearance may occur due to tissue damage beneath the skin surface
Stage 4: Serious infection of the skin is likely. Muscles, bones and even tendons can be seen.
Non-staging wound: Dark brown - black discoloration may be observed. Wound with suspected deep tissue damage: Skin with blood-filled water can be seen.
Who is a pressure ulcer and what are the risk factors?
In patients with reduced mobility due to injury, illness or sedation,
Patients with sensory loss due to nerve damage caused by spinal cord injuries or other causes,
Paralyzed patients who cannot sustain certain parts of the body are at increased risk of developing pressure ulcers.
Factors that increase the risk of pressure ulcers are:
In elderly patients with impaired tissue tolerance,
In stationary patients,
In overweight or very weak patients,
Anemia,
In patients with inadequate nutrient and fluid intake,
If the skin is wet with continuous urine or feces,
Loss of sensation, such as pain and decreased pain threshold due to spinal cord or other injuries,
Diabetes, vascular diseases, poor blood circulation due to smoking,
Deficiency of protein, vitamin C and zinc,
In case of reduced mental awareness due to illness, disability or medication,
In patients with impaired lymphatic circulation,
The risk increases after febrile diseases.
How to treat pressure sores?
Pressure Therapy
Treatment of pressure ulcers, ie bed sores, involves reducing pressure on the affected area of the skin, cleaning the wound, performing appropriate wound care, providing pain control, preventing infection, and good nutrition.
Necessary Team for Treatment
Treatment of pressure ulcers usually requires a multidisciplinary approach (involving many specialists from different disciplines). This team usually;
A physician who regulates the treatment process and plan
A doctor specializing in wound care
Wound Care Nurse
Home care nurse
A psychologist and / or psychiatrist who can help you and your family to alleviate concerns
A physical therapist who can help improve mobility
Dietitian who monitors your nutrition needs and regulates your diet
Dermatologist
It consists of an orthopedist or plastic surgeon.
Pressure Reduction
The first step in the treatment of pressure ulcers is to reduce the pressure and friction that cause the wound. Strategies include:
Repositioning
If a pressure ulcer is present, the position of the patient should be changed frequently. The frequency of changing the patient's position depends on the condition and quality of the surface on which the patient lies or sits. If a wheelchair is generally used, the load should be relieved every 15 minutes and the position changed every hour. If the patient is permanently in bed, the position should be changed every two hours.
Using Support Surfaces
Special mattresses, cushions and pillows should be used to help lay or sit to protect vulnerable skin.
Wound Cleaning and Wrapping
Care and treatment for pressure ulcers is about how deep the wound is.
Generally, cleaning a wound and dressing the bed wound is done as follows:
Cleaning
If the affected skin is not severely damaged, it should be gently cleaned, washed and left dry. Open wounds, antiseptics or clean water should be cleaned with each clothing change.
Placing the Bandage
Modern dressings keep the wound moist and clean, accelerating healing. It also forms a barrier against infection and keeps the wound around dry.
Cleaning Damaged Tissues
For wounds to heal properly; damaged, dead or infected tissues. This process is called debridement. Different debridement methods are available. Which debridement method will be used depends on the patient, the place of treatment (home, hospital) and the decision of the wound care specialist.
Other Interventions
Other medical interventions include:
Use of drugs to control pain: A number of drugs are effective in reducing pain, these drugs can be used with the knowledge of the doctor.
Antibiotic use against infection: In some cases, antibiotic use may be required under local supervision of a wound if the infection cannot be prevented, under the supervision of a physician and after the bacterial growth has been detected.
Diet: Choosing a healthy diet arranged under the control of a dietitian and feeding well can accelerate wound healing.
Wound treatment with negative pressure (vacuum or case treatment): It is a scientifically proven treatment that ensures the wound to remain clean and heal by absorbing the secreted fluid from the wound.
Operation
Surgical operation may be required in cases where the wound does not heal and all other methods do not work.
Diabetic Foot Care and Treatment
What is Diabetic Foot? How does it occur? What are the reasons?
Foot wounds in diabetic patients, that is, diabetes, are a very common problem that threatens the life of the patient. Studies have shown that approximately 10-15% of diabetic patients have diabetic foot wounds at some point in their lives.
In studies of Turkey's population of 70 million it is calculated as is assumed to be approximately 10-11 million diabetic patients. This means that 1 to 1.5 million people with diabetes will have to deal with diabetic foot wounds at some point in their lives.
The worst effect of these wounds; it is possible that some of these patients will be exposed to amputation due to these wounds. Studies show that diabetic patients are exposed to amputation 15 times more than the normal population.
Half of the patients whose limbs have been cut are expected to lose their other limbs within 2 years and to die within 4 years. Therefore, diabetes and the treatment of diabetes-related wounds should be taken more seriously than other diseases.
Two basic disorders play a role in the development of the wound in a diabetic patient. The first and foremost is nerve damage called neuropathy and the other is vasculopathy: vascular damage:
Motor neuropathy leads to weakness and melting of standing muscles, sensory neuropathy leads to loss of sensation of pain, and autonomic neuropathy leads to dryness of the feet, defect of standing, pain that cannot be felt, and dry, calloused skin where the wound is easier to open.
The patient cannot feel the callus and the pain of the wound opened due to callus. Infection develops in the wound and progresses to the deepest parts of the foot. Eventually, it is noticed when there is outward discharge, but at this stage the wound has reached the dimensions that threaten the limb and its treatment is difficult. For this reason, the main treatment is to take precaution before opening the wound.
What Are the Symptoms of Diabetic Foot?
Any changes in the foot of a diabetic patient are included in the definition of “diabetic foot..
Dryness in the feet of these patients; changes in shape of the fingers and feet (hammer-shaped fingers, claw-shaped feet); calluses on the soles of the feet, the faces of the fingers facing the shoes, the edges of the feet, and the heels are structural changes that facilitate wound opening in these feet.
A diabetic patient's foot may present with diabetic foot infection, redness, increased heat, new pain or pain, swelling of the feet or fingers, and a sore wound.
Which Doctor Does Diabetic Foot Treatment?
In the treatment of diabetic foot wounds; endocrinology or internal diseases, infectious diseases, orthopedics, cardiovascular surgery, plastic surgery, general surgery and infectious diseases, underwater medicine, interventional radiology physicians.
Any branch of this team can carry out the follow-up and treatment of the patient with the opinion of other branches.
How to Care for Diabetic Foot?
If a diabetic patient has a wound on his foot, care should be taken first. In the care of this wound, the wound is recovered from the load as well as the dressing (using special tools and insoles to prevent the patient from stepping on the wound), the treatment of the patient's infection (arranging appropriate dressing and antibiotic treatment), the patient's leg arteries and angioma regulating sugar level is also of great importance.
After the patient's diabetic foot wound is closed, the foot molds of the patient are taken and walking analysis is performed and special insoles and shoes should be made to reduce the compression of the areas that are over-pressured. All calluses of diabetic patients should be properly cleaned by those skilled in the art after they have started to wear appropriate insoles and shoes.
Diabetic patients have to use their skin moisturizers regularly. Otherwise, dry skin may open new wounds. In the opinion of the physician, the patient should go for a diabetic foot examination every 1-3 months.
Treatment and follow-up of other risk factors of the patient is very important. Controlling the sugar level may prevent new wound opening and slow the progression of neuropathy and vasculopathy.
These patients should be allowed to quit smoking, cholesterol levels and blood pressure should be controlled, appropriate diet should be provided to lose weight and should be encouraged to exercise regularly if possible.
How is diabetic foot dressing done?
Diabetic foot treatment is not only about wound dressing. Diabetic foot wounds are among the wounds that only physicians trained in this field should care for. At the right time and with the treatment provided by the physician, situations that endanger both the patient and the limb can be prevented.
For this reason, a doctor should be consulted as soon as possible after the diabetic foot wound is noticed.
The patient should be considered as a whole and treatment should be organized with a holistic approach. The wound should not be left open until it reaches the physician dealing with the diabetic foot and should not come into contact with water. After cleaning the wound and surrounding area with a suitable disinfectant solution, it should be covered with a clean dressing and kept closed until the next dressing.
The patient should not step on the wounded foot. Shoes that touch the foot or the wound area should be avoided.
Diabetic Nails Care
Persons with a diabetic foot should cut their toenails carefully and straight, provided that they are not short with a sharp nail clipper. The nail should be filed after being cut. If there are visual problems, another person, preferably a podologist, should do this care.
It is very important that all care materials used are clean and sterile. It should be noted that diabetic patients have a weaker immune system than others and are more susceptible to infections. Preferably, the diabetic patient should have his own set, which should be carefully cleaned after each use.
How is Diabetic Foot Treated?
Diabetic foot wound should be treated by a team of physicians and nurses trained in this field.
Depending on the patient's general condition and the condition of the wound, this treatment can be treated either as an outpatient or inpatient. In both cases, the relief of the foot with the wound, the removal of the infection, the opening of the occluded leg arteries, the regulation of sugar treatment, the regulation of appropriate wound care and the fight against risk factors are the basis of treatment.
The treatment of diabetic foot wound can last for weeks or months. The so-called “dead tissue kısım indeki in the wound area should be surgically removed from the wound site. The wound area should be dressed regularly. Nowadays, medical wound care dressings and products which are specially designed and manufactured are used to accelerate wound healing.
These products keep the wound clean while reducing infection, discharge and odor. They increase the comfort of the patient as well as reduce the need for frequent dressings. Some of these products include collagen, hyaluronic acid and growth factors that the wound needs.
Yardımcı Hyperbaric Oxygen (HBO) yardımcı is one of the most frequently used adjunctive methods in the treatment of diabetic foot. With HBO, oxygen is breathed to the patient at high pressures to eliminate the lack of oxygen in the wound area, to improve the effects of the immune system cells that kill bacteria, to increase the efficiency of the wound healing cells and thus to accelerate wound healing. Laser, ozone treatment, larval treatment are other auxiliary treatment methods.
What should be considered in diabetic foot?
If a patient with diabetic sensory loss develops; the patient should check his / her feet for skin discoloration, redness, cuts, picking of water, fungus or a newly opened wound with a mirror at least once a week. If the patient's physical condition or visual functions are not suitable for this, they should be performed by their caregiver or a relative.
Rubberless socks should be preferred and changed daily. Socks should not be squeezed foot and cotton should be taken care of. Before wearing the shoe, it must be checked manually and visually for foreign objects.
The choice of shoes should be preferred from comfortable, soft, round toe, rubber soled shoes. According to the person's gait analysis, the use of specially manufactured insoles should be preferred. Do not walk barefoot.
High-heeled shoes and open-toe or narrow shoes are also unsuitable. Shoe lace should be preferred in terms of expandability. In addition, worn-out, worn shoes lose their comfort and cause problems.
If the patient's feet are formally defective, custom made shoes should be preferred. When new shoes are used, they should not be worn for more than 2-3 hours a day until they are used. The patient should not get too close to the stove, electric heater or heater honeycomb to warm the feet, and never try to warm the feet with a hot water bag.
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