At Columbus Community Hospital’s Wound, Ostomy and Continence (W.O.C.) Health Center, we care for both acute and chronic wounds.
A wound is a disruption of the normal structure and function of the skin and skin architecture. An acute wound has normal wound physiology and usually heals within three weeks. An acute wound will progress through the normal stages of wound healing, whereas a chronic wound is defined as one that is older than three weeks and is physiologically impaired.
To ensure proper healing, the wound needs to be well connected to blood vessels, free of lifeless tissue, clear of infection and moist. Wound dressings should eliminate dead space, control oozing, prevent bacterial overgrowth and ensure proper fluid balance. Wound dressings need to be cost-efficient and manageable by the patient and/or nursing staff. Wounds that demonstrate progressive healing can undergo closure either right away or at a later time. Also, it is important to know that all wounds are colonized with microbes; however, not all wounds are infected.
Acute wounds vary in their presentation. A simple cut may be cleansed and closed right away, either with staples or sutures and should be kept covered for approximately 48 hours. A complicated cut needs a cleansing of the wound and removal of torn, lifeless or contaminated tissue. Often this is more than a patient can do on their own and it may require a physician to do it. A large tissue defect may require wound packing and removal of cut, lifeless or contaminated tissue until the wound can be closed or sealed at a later time, either by skin grafting or flap closure. Burn wound care varies based on many factors, especially, the depth of the burn and the location.
An ideal dressing is one that has the following characteristics:
• Absorbs excessive fluid while maintaining a moist environment.
• Protects the wound from further mechanical damage.
• Prevents bacterial invasion or growth.
• Conforms to the wound shape and eliminates dead space.
• Removes dead tissue.
• Does not cause damage to the surrounding, unharmed tissue.
• Reduces bleeding and minimizes swelling through a compression garment.
• Does not shed fibers or compounds that could cause a foreign body or hypersensitivity reaction.
• Eliminates pain during and in between dressing changes.
• Minimizes dressing changes.
• Is inexpensive, readily available and has a long shelf life.
• Is transparent in order to monitor the wound appearance without disruption of the dressing.
Complicated wounds and chronic wounds often require the assistance of your family physician and/or a wound center. Many chronic wounds have underlying diseases which delay wound healing, such as diabetes, lower extremity chronic venous disease, pressure inducted skin and soft tissue injuries, and lower extremity ischemia. Often, these underlying medical issues have to be addressed in order for a chronic wound to heal.
Often, simple wounds do not require medical assistance. However, if, at any time, a patient is concerned that a wound is more than a simple problem, they should seek medical evaluation.
Dr. Ron Ernst is a board-certified general surgeon with Columbus General Surgery and Jen Fjell, RN, is the Service Line Coordinator for the Columbus Community Hospital Wound Clinic.