Nothing is difficult in the world. Talk about "difficult wound care"

        As Taiwan has entered the aging society, many elderly people suffer from chronic diseases, such as diabetes, renal failure, peripheral artery ischemia, etc. Once wounds appear, they are not easy to heal, and even lead to skin ulceration and necrosis in serious cases, resulting in huge physical and mental pressure on patients and their families. In fact, if you can accept the evaluation and diagnosis of doctors immediately, apply the right medicine to the case, and cooperate with the joint care of multi-specialty teams, any difficult wound can eventually heal. This issue of "Health Column" will help you understand the treatment tools of chronic wounds and establish new concepts of care.

                Generally speaking, wounds can be divided into acute and chronic. Acute wounds are usually caused by trauma, such as cut, scratch, avulsion or burn, etc. It is easy to heal because the wound is deep or large. As for chronic wounds, textbooks define them as wounds that have not healed for more than four weeks or whose area has not shrunk by 40%. Common causes include diabetes ulcers, venous ulcers, ischemic ulcers, pressure ulcers, or ulcers caused by radiation therapy.

        Basically, chronic wounds need to be fundamentally improved according to the cause of disease, cooperate with the cooperative care and long-term follow-up of various specialties, select appropriate care methods and dressings, and perform immediate debridement and reconstruction to recover smoothly (as shown in the chart).

                Benefiting from the progress of medical science and technology, there are many sharp tools in wound care at present, each with different effects. The sub-items are as follows--

        Hyperbaric Oxygen Therapy

        Hyperbaric oxygen is to treat patients with 100% pure oxygen in an environment above 1.4 atmospheric pressure, which can increase tissue perfusion and oxygen concentration, and promote wound healing. There are many medical evidences for the efficacy of ischemic ulcer, diabetes ulcer or radioactive ulcer, and the monitoring of transcutaneous oxygen partial pressure is more helpful to accurately judge the choice of treatment.

        Far Infrared Therapy

        Far infrared ray is a kind of low-energy physical therapy. After the skin absorbs the energy of this special wave band, it can be transmitted to the vascular tissue through the biochemical reaction between proteins, activate the vascular endothelium, and achieve the effects of repairing the tissue, improving the vascular function, and reducing the inflammatory reaction.

        Wound Dressings

        At present, many dressings can be used for clinical treatment. Each dressing contains different ingredients and materials, and its efficacy is also different. For example, seaweed gel can promote wound moisturizing and help epithelial migration and growth; Silver ion can sterilize and control infection; Foam dressings can lock water and prevent it from seeping back, helping to control seepage; Wet dressing is helpful to dissolve necrotic tissue; Negative pressure drainage device can promote granulation tissue proliferation, reduce bacterial biofilm, etc. However, the treatment of wounds with difficult healing is a long-term war of resistance. When choosing dressings, you can refer to the doctor's advice. In addition to paying attention to the curative effect, you should also reduce frequent dressing changes to avoid pain and burden for patients.

        Bioengineering Skin Substitutes

        Some difficult wounds need reconstruction operations such as skin flaps or skin grafts to heal. However, in the case of limited skin supply area or exposure of bones and tendons in the wound bed, skin substitutes (or artificial dermis) synthesized by tissue engineering can be selected. This kind of product uses cow, pig, or allogeneic tissue. After cell removal, it forms a framework with collagen to cover the wound, so that the cells migrate and gradually grow into their own skin, which can save the loss of autologous skin tissue.

        cell therapy

        In recent years, the Ministry of Health and Welfare announced special management methods, and open cell therapy is applied in six fields, including the treatment of chronic wounds. In addition to being able to differentiate and replace the defective tissue, the autologous collected and cultured stem cells can also produce cytokines and growth factors that can resist inflammation, regulate immune function, and promote wound healing. Although the price is expensive, the clinical trial results are good, which is an opportunity for the patients who have not recovered for a long time and cannot operate.

        The way of care is all-encompassing, and the medical team needs to tailor a comprehensive treatment plan for patients. In response to the needs of the general public, Far Eastern Memorial Hospital has established a "Burn and Difficult Wound Care Center" by taking advantage of the field of the burn ward and combining various specialized teams such as orthopedics, hyperbaric oxygen center, cardiovascular medical center, and integrated medicine. It emphasizes on providing a complete and rapid wound care process from the perspective of "whole-person care". At present, many patients have been successfully cured. All parties are welcome to refer and consult, Benefit more patients.