It has always fascinated to me to watch how the human body heals itself, even after the most appalling trauma and ill health. Think about ulcers, burns and the problems of pressure sores in our hospitals and aged-care homes. With care and attention, these wounds can heal.
But sometimes they don’t, and that’s when they become chronic and problematic. As a nurse I feel a duty to contribute to enabling other nurses to provide the best possible wound care.
It is an area of the healthcare system that is somewhat hidden and often forgotten. I am looking at the impact of living with wounds that take more than four weeks to heal, such as venous leg ulcers, pressure ulcers and foot wounds. Sometimes these wounds can take years to heal.
Chronic wounds typically affect older people, and delayed healing is often talked about as though it’s inevitable consequence of getting older with ageing skin. More often than not, we can treat the most problematic of wounds and achieve positive outcomes. Timely diagnosis and evidence-based treatment are the keys to success.
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Most people don’t realise the numbers of people within the healthcare system afflicted with wounds. In fact, at any time, at least two per cent of the total population have a wound. Even younger people can develop chronic wounds, as wounds can arise from unmanaged diabetes and vascular disease, which do not only afflict the elderly.
People living with chronic wounds are often disadvantaged financially and emotionally, and remain a hidden group in our healthcare system. Wound dressings are not subsidised for community patients, and my research has found that dressing cost can consume 10 per cent of the person’s disposable income.
I’ve also investigated the detrimental affect of chronic wounds on quality of life, both physically and emotionally. Wounds can be painful and restrictive, while the care required can be expensive and time consuming.
The challenges of caring for wounds are many. With an ageing population and increasing numbers of younger Australians living with chronic health conditions, we can’t afford to give this a ‘Band-Aid’ solution.
One of the areas that I am interested in is self-treatment. I’ve found that many chronically wounded may prefer to treat themselves as it has a positive impact on their quality of life.
I am also interested in the history of healing. Back in Ancient Egypt, honey was used in wrapping wounds and there is evidence that raw meat, wine and herbs were also used. These methods disappeared with the rise of antibiotics, but some of them are still useful, even today.
Maggots, for example, can also be used for treating certain kinds of wounds. Maggots are free workers, helping to remove dead skin cells that are blocking a wound from healing.
While the thought of this might make you feel uncomfortable, chronic wounds can be so debilitating that patients will try anything and it is a therapy that can work.
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Dressings made of potato skins, banana leaves and turmeric are a low-cost alternative to more expensive dressings. Their use can still be seen in low resource communities in Asia and Africa. Although the evidence is limited, case series research and a number of small trials have demonstrated positive healing outcomes, effective management of wound pain and low unit cost.
The use of botanical and food-based wound dressing products in our neighbouring countries, and the need for low cost dressing alternatives, justifies more rigorous research in this field.
At the other end of history, there’s the impact of technology. As with other aspects of medicine, there are advances in digital-wound imaging and measurement that are improving diagnosis and care. For example, my research has identified how to accurately measure wounds, and the benefits of e-learning education for people who have leg ulcers.
The use of e-health for chronic wound management offers a range of benefits to patients, including access to specialists, standardisation of health information and remote assessment and monitoring.
But like any health care, there are perils attached to getting information on wound care from social media or Dr Google.
That’s balanced by the fact there are great benefits to e-health treatment approaches - for patient education and enablement. It just needs to done responsibly.
As told to Annie Rahilly, University of Melbourne.
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