Identifying and overcoming barriers to healing is of primary importance in the developement of any wound treatment regime. A thorough wound assessment should be conducted including a holistic review the health of the patient and local assessment of the wound characteristics and history. Assessing these factors assists in establishing an appropriate treatment pathway (products and techniques) to achieve rapid wound healing.
Assessing the General Health of the Patient
The aim of a general health assessment is to identify and eliminate any underlying causes or contributing factors which may impact the healing process. These may include:
- The age of the patient
- Presence of disease and/or use of medication
- Obesity or poor nutrition
- Impaired blood supply
- Lifestyle (smoking, alcohol abuse)
Local Wound Assessment
After assessing the patitent as a whole, it is important to make an accurate assessment of the wound itself in order to identify any local factors which might delay healing. Local assessment is an ongoing process and should include:
- A review of the wound history
- Assessment of the physical wound characteristics
- location, size, base/depth
- presence of pain
- condition of the wound bed
Overcoming Local Barriers to Healing
Clinical research into non-healing wounds has highlighted several barriers to healing, which the clinician can remove through specific treatment. These barriers include the presence of infection, dead or non-viable tissue and an imbalance of moisture levels within the wound. Preparing the wound bed by selecting treatment according to wound characteristics helps to foster an ideal environment to advance healing.
The International Advisory Board on Wound Bed Preparation, established by Smith & Nephew, has identified four areas crucial to overcoming local barriers to wound healing.
Addressing Tissue Viability
Does the wound contain dead tissue or debris?
Identifying Inflammation and Infection
Does the wound show signs of infection or inflammation?
Maintaining Optimal Moisture Levels
Is the wound too moist or too dry?
Monitoring Wound Healing
Is the wound failing to close? Are the edges worn away or damaged?