Wound care is a major part of medical care, especially for patients with multiple medical conditions and chronic illnesses. Severe wounds can result from trauma, surgery, being bed-bound, and various medical conditions. Most major wounds do not heal quickly and require months of high-quality care to heal well. In most patients, this healing will continue long after they are discharged from the hospital. This article will discuss the management of wounds in subacute care and what you or your loved one can expect regarding wound care once you are discharged from the hospital.
What is Wound Care and Who Needs It?
Wound care is not like other areas of medicine. Nurses, doctors, and therapists with multiple different types of training and titles all participate in wound care. Multiple medical specialties will often work together on a wound care team to determine the best possible treatment for a patient.
“Wound care” refers to the surgeries, medications, wound dressing, and wound assessment techniques used to speed up wound healing, prevent infection, and treat complications.
A wound care team will often be consulted if any of the following are present:
- Wounds that are healing more slowly than expected
- A wound too large to be closed with sutures (stitches)
- Wounds that appear to be infected and do not improve with antibiotics
- A wound that is the result of being bed-bound (pressure sores)
- Wounds in patients with chronic conditions such as diabetes
Appropriate wound care is critical to recovery. Many wounds will heal well if they are managed aggressively, in combination with treating other underlying medical conditions.
What are the Most Common Types of Wounds?
Pressure Injuries
Pressure injuries, also known as bedsores, occur in patients who have limited mobility. Being stuck in one position in a chair or bed leads to the gradual breakdown of the skin, muscles, fat, and other tissues. These injuries start with little more than small spots of red skin but can progress to large open wounds down to the bone.
Surgical Wounds
Any surgery can leave a large wound. Many of these wounds are closed with sutures at the time of the surgery and heal without further treatment. However, if a surgical wound is extremely large, becomes infected, or surgical compilations prevent the wound from being closed, specialized wound care may be required for healing.
Diabetic Foot Ulcers
Diabetes leads to gradual damage to the blood vessels and nerves of the legs. Nerve damage leads to small wounds going unnoticed. Reduced blood supply from damaged blood vessels slows healing. This combination allows small injuries to develop into large, slowly healing wounds that can penetrate deep into the foot and threaten the muscles and bones of the foot.
Chronic Ulcers
Medical conditions other than diabetes that damage the blood vessels can also lead to ulcers or other wounds. The most common conditions are autoimmune disorders, arterial disease, peripheral vascular disease, and some bacterial and fungal infections. Other medical conditions may worsen these ulcers and are also vulnerable to infection.
Burns
Burns can result from fire, boiling liquid, steam, friction, or chemicals. Severe burns can lead to massive wounds that require specialized wound care and prolonged recovery. The severity of burns is directly related to how much of the skin is burned, if the burn is over any critical body areas, and how deep the burn penetrates into the skin.
Complex Infections (MRSA, OSteo)
Infections can complicate simple wounds and may also cause wounds in rare cases. The smallest wound can develop into large, open, life-threatening injury if it becomes infected. Resistant bacteria such as MRSA and pseudomonas are common causes of large slowly healing wounds. Osteomyelitis, an infection of the bone, is another cause of chronic wounds that require specialized treatment.
Treatment Options for Wounds
Many treatment options exist for complex wounds. In almost all cases, more than one of these treatments will be used. The best treatment depends heavily on the type of wound, its location, and any other medical conditions a patient has.
Simple dressings
Dressing, covering a wound to protect it, is the simplest but most effective wound management technique. In the past, wound dressings were all about keeping the wound dry, to prevent infection. In the modern day, there are more complex dressings that help to speed healing, minimize scarring, and lower the risk of infection more effectively than a simple dry dressing.
- Wet to Wet Dressings: Damp dressings that are kept moist to allow for rapid formation of new tissue over a recently injured area. Removed when still damp to avoid new tissue from being pulled away from the wound.
- Wet to Dry Dressings: Damp dressings are applied to the wound and removed when dry, pulling away dead tissue, bacteria, and contaminants when removed.
- Nonadherent Dressings: Oily dressings that do not stick to the wound reduce the discomfort from removing the dressing and prevent the dressing from pulling away new tissue when removed.
- Dakins Dressings: Bandages soaked in a diluted bleach solution that reduces the risk of infection without causing damage to healing tissue.
- Dry to dry dressings: Dry bandages that are changed regularly to keep a wound dry and clean. Usually used on simple wounds that are already well-healed.
Pressure Offloading
Critical to healing wounds caused by reduced mobility, pressure offloading stops the cycle of injury that leads to pressure injuries (bedsores). The three most common methods of pressure offloading are repositioning, fluid beds, and specialized chair and mattress pads.
Turning and repositioning is the simplest form of pressure offloading. By turning a bed-bound patient, you rotate the areas of the body that are contacting the bed, preventing any one area from sustaining injury. Turning needs to be done regularly, sometimes as often as every 30 minutes. Turning a patient can be combined with the other methods below to reduce how often turns are required and increase the effectiveness of turning.
Fluid beds are hospital beds where the mattress is filled with sand and air is pumped through to create a surface that equally supports the body without any high-pressure areas. These beds are commonly used in hospitals for patients with pre-existing pressure sores in the process of healing.
Specialized chair pads and mattresses are less bulky than fluid beds but are still effective at reducing pressure on the body. Specialized pads and mattresses are most effective at reducing the risk of injury in those with partial mobility. They are not as effective in preventing injuries in patients with severely limited mobility or speeding up the healing of existing pressure injuries.
Surgical debridement
Debridement is the removal of dead or infected tissue from a wound. Debridement is performed by surgeons and is usually done in an operating room under anesthesia. Large, infected, and old wounds often require debridement before healing can begin. The decision to debride a wound is unique to each patient and each wound. These decisions are typically made by a wound management team that includes the surgeon performing the surgery.
Negative pressure dressing (wound vac)
Some wounds may produce a large amount of protein-rich serous fluid. In excessive amounts, serous fluid can slow wound healing by promoting the growth of bacteria, slowing the growth of new tissue, and complicating dressing changes. A wound vacuum is a sponge-like dressing that is placed over the wound with a vacuum attached that pulls away this excess fluid. The negative pressure created by this vacuum pulls more blood to the wound, increasing the amount of oxygen, protein, and blood cells present near the wound. This speeds healing and reduces the risk of infection.
Maggot therapy
Maggots have been used for centuries to help cleanse wounds. Maggots exclusively eat dead and decaying tissue, avoiding healthy tissue with a good blood supply that is actively growing and healing. Maggots are used as an alternative to surgical debridement in some patients. These maggots are grown in a sterile environment and are a well-studied option that can be effective for certain patients.
Skin grafting
Skin grafting is the process of transplanting an area of skin from an undamaged area onto a wound. This is often done for large wounds that are nearly completely healed. Skin grafts are usually used for large wounds over thin areas of skin such as the shin, skull, hands/wrists, and ankles. Burn wounds are the most common type of wound that requires a skin graft for healing. However, severe infections and traumatic injuries may also lead to wounds that require skin grafting.
The Role of Subacute Care in Wound Care
Patients with severe wounds often require daily evaluation, wound dressing changes, and changes in their treatment plan. However, most patients with severe wounds are medically stable and do not require most of the services of a traditional hospital, making them the perfect patients for subacute care.
Subacute care is a level of care that sits between admission to the hospital and discharge home. While there are many types of subacute care, all share one thing in common: they provide more medical services than patients could get if they were to rely on doctors’ office visits or home health visits.
Subacute care typically begins with being admitted to a live-in facility where nursing care, physical therapy, dietary assessments, and evaluations by doctors can all be performed on a daily basis. There are many other forms of subacute care as well, for more information on subacute care, see our articles focused on what exactly is involved in subacute care and what other conditions can benefit from subacute care.
Sierra Care and Subacute Care for Wounds in California
At Sierra Care, we provide subacute care at our facilities in central California. Our modern and updated facilities are staffed with skilled nurses, therapists, and medical specialists. All of whom are dedicated to helping our patients on their road to recovery following a catastrophic injury, severe illness, or any other disabling condition.
Our team has experience caring not only for patients with wounds but also for the many complications that develop in patients recovering from a severe illness or injury. Choosing a facility with excellent access to medical specialists, quality nursing care, skilled therapists, and case managers is critical.
- Our medical specialists have wound care experience and work together to create comprehensive plans for wound assessment, management, and healing.
- Our nursing and therapy teams are well-staffed, kind, and compassionate. They can spend the time you or your loved one needs for a full and comfortable recovery.
- Our case managers have experience with multiple insurance plans, making navigating the healthcare system easier and removing financial and administrative burdens from patients and their families.
If you or a loved one has been hospitalized with a chronic wound or have been recently discharged from a hospital and are experiencing issues with your recovery at home. Please contact us so we can help you on your road to recovery!
