Wound Management


Wound care issues

Wound care is often a big part of managing your care after you have been discharged from hospital. You may have been given what seems a huge amount of information on what to do when you are back at home and how to care for your wound,  when and how it should be dressed and what to do if things go wrong.

This can be a worrying time for you and your family, pain and irritation from the wound can often be a cause of distress and anxiety. It may also add to your worry if you live a long way from the hospital or trauma centre that initially treated you after your accident. You may also feel that your wound may smell or impact on your life, be painful and often needing frequent changes of dressing.

Firstly you should remember that you are not alone. Thousands of people in the UK living with a long term wound are at home and managing well.

Before you left hospital you would have been given some choices regarding managing your wound, either by dressing it yourself, by District Nurses, or the Practice Nurse at your GP surgery.

Mostly, wounds will heal given time, but there are instances where this may not always be the case. Certainly a good balanced diet and exercises you may have been given to do at home will help. However some wounds can become more long term, something that health professionals call chronic in nature.

If you or your District or GP Practice nurse feels that your wound is not healing well, they can refer you to a specialist service run by Tissue Viability Nurses. These services are provided locally by your Clinical Commissioning Group (CCG). The CCG is there to overlook health care services locally and your GP. These nurses are experts in managing wounds and have access to a vast array of wound care products that are available on the NHS, some of which can aid in speeding up the healing process.

Don’t be afraid to talk to these specialist nurses, they have a wealth of experience and they are there to help you after all and don’t be surprised if you are asked questions about your lifestyle, such as smoking or other health problems you may have, or your working and home life, as this gives them an idea of how your wound may be impacting on your life and how it can be treated. Remember your wound is a natural reaction to your accident and that you are in charge of it and not the other way around. You should also try to remember that although it may have an impact on your day to day activities, it something that can be managed.

You may have appointments at the hospital that treated you after your accident and this is a good time to ask questions about your on-going care at home. One way of doing this is to write your questions down so that you are prepared.

Follow on reconstructive surgery

Whilst you were in hospital your care could have been shared by many specialities one of which is Plastic Surgery.

Plastic Surgery often plays an integral part of the major trauma centres. Some of the work carried out can often be treating wounds that can be hard or difficult to heal and in reconstructing traumatic injuries months and often years after the initial accident.

In some cases this would involve surgery to remodel areas of the body such as scars or releasing scar contractures. In other areas it can often involve treating hard to heal wounds with skin graft or flaps and the use of specialised dressings such as topical negative wound dressings or specialised anti-bacterial dressings.

Plastic surgery can take place over several episodes of time as often scars, skin grafts and flaps can take time to remodel themselves and may need to be refashioned as some areas can appear bulky and prevent such simple things as wearing shoes or types of clothes. Plastic Surgery takes a comprehensive view of your wound and lifestyle and you will have a consultation in the outpatients department where a close examination of your wound would be performed. You will have possibly more than one option to discuss and choose, and you will be given a chance to ask questions on healing times and what to expect afterwards.

You should always have realistic expectations regarding any further surgery to either correct or reconstruct your injured areas and wound. By closing one wound it involves creating another one, which is called a donor area. Donor areas are where skin grafts and or muscle flaps are taken from one part of your body to close the other area that may have either been hard to heal or where your injury needs to be reconstructed. Although the plastic surgeons do their best, you must understand that the results afterwards may not be what your body looked like before your injury and some people may need more reconstructive surgery than others as this type of surgery can often take time and mean spending more periods in hospital. A good way of reinforcing what you have been told is information leaflets you may be given to read whilst you see the plastic surgeons or while you are in hospital. Often these will have links to further information found on the internet or other areas you can ask for more information.

Your follow up may initially be at the hospital where you had plastic surgery. Many plastic surgery units have their own dedicated dressing clinics which are run by specialised plastic surgery nurses. These nurses, like their Tissue Viability colleagues, have a great deal of experience in managing wounds in their early stages and beyond. They can give you and your family sound advice on what to expect at home. They can refer you to the Tissue Viability nurses in your local area and often share wound care with them until your wound has healed or until you return to see the plastic surgeons.

Often people will look at internet search engines to find answers to questions. In most cases this is a good way of finding out more information and what support you can find from others who may have the same questions that you have or have suffered similar situations. However you should be aware that some of this information may be for certain types of surgery that may be carried out in other countries or may not be suitable for you or be carried out on the NHS.

Above all, don’t be afraid to ask questions, health care professionals have a wealth of experience and if they do not know the answer they can find someone who can, or point you in the right direction. Remember you aren’t alone, though at times you may feel that you are, there are self-help groups and often other services you can access via the trauma network or via your GP.

This information was provided by Daren Edwards MBE RGN, Lead Nurse for Burns & Plastic Surgery at the Royal London Hospital