Five years of the blog “When a wound in the skin won´t heal“ also means five years of “We have to think and do anything to close it as soon as possible“. It could not be otherwise because the story of this website is closely related to that of the wound clinic in Centro de Especialidades Vicente Soldevilla, Madrid. It all started in 2014 with Soledad Guisado, my dearest Sole, who trusted and supported me from the very first moment.
Nobody said the beginnings were easy, but we survived and since then the team has grown more and more. It has changed, too. But change is a purely formal issue because, sentimentally, all of you who have been part of this project at some point, will always remain part of the team 🙂
The great novelty of the last year has been the alliance of collaboration that we have established with the Department of Angiology and Vascular Surgery of the Hospital de la Cruz Roja, thanks to the motivation of its head of Service, the great expert in Phlebology (and beautiful person) Lourdes Reina.
If there is one thing that I have no doubt about (and time confirms it) it is that “in our wound clinic we can help a few people, but, by sharing knowledge and experiences, that help may increase exponentially”. This is the main idea of the blog, for which it was born and for which it is being maintained. But it is also my philosophy when organizing and participating in training activities.
In this context, two weeks ago we organized in our clinic a training course on leg ulcers for professionals who work both in primary care and in nursing homes, with the collaboration of La Roche Posay. We talked about the importance of a correct diagnosis for a successful treatment, the theoretical and practical principles of compression therapy and, as it could not be otherwise in a course conducted by our team, our star technique, punch grafting. The training of these professionals and the establishment of pathways to collaborate with them is essential. Essential because MOST PEOPLE WITH LEG LEGS ULCERS ARE CARED FOR IN PRIMARY CARE AND RESIDENCES FOR THE ELDERLY, NOT IN SPECIALIZED CARE CENTERS. Let’s get out of our offices and go where the problem is!
And many times the problem has started as a simple “wound” after a silly blow to the leg, which has grown over months into a large and extremely painful ulcer that has disrupted the life of an elderly person… On numerous occasions, the trigger is a minor laceration… Although we usually make the mental association “uncomplicated traumatic wound” = “acute wound” = “this closes smoothly without doing anything”, when the location is the leg, even in healthy patients without venous disease, these wounds can take time to close due to the pro-inflammatory effect of the force of gravity, which generates a state of venous hypertension. If the person has chronic venous insufficiency, the inflammation in the wound will be even greater. The issue is more complex in older people, whose skin fragility and age-related vascular damage (even without other comorbidities) are already a big reason to think about “potential chronic wound if we do not perform an adequate anti-inflammatory strategy“. And what does “anti-inflammatory strategy” mean in these patients? Essentially therapeutic compression and anti-oedema measures, which is the best anti-gravity and anti-inflammatory strategy for any leg ulcer provided there are no contraindications. See post “Compression is the key to treating leg wounds”. In addition, we will also select the dressing that best suits the conditions of the wound bed, protecting and preserving the perilesional skin.
Therapeutic compression adapted to the patient’s needs (always after pulses palpation and, in case of doubt, ABI greater than 0.5) and the recommendation of anti-oedema measures (walking, resting with the legs elevated, foot dorsiflexion exercises) can and should be done immediately after the occurrence of the wound, both in primary care and in nursing homes. Regarding compression bandages, we must insist on the protective padding, to avoid areas of hyperpressure in these fragile skins (see post “Wounds secondary to dermatoporosis or chronic cutaneous insufficiency” and “Band and bandage: not the same thing“). The degree of pressure must be adapted to the possible arteriopathy and other comorbidities of the patients. See post “Compression is the key to treating leg wounds”.
Compression stockings and adjustable compression wrap devices are interesting alternatives, mainly in the case of small wounds, patient preferences or inability to change bandages as often as necessary. In legs with dermatoporosis it is essential to use protective socks under the stocking (or wrap device) to avoid friction damage to the perilesional skin.
This is an example of a patient with skin tears treated in the first 48 hours with the best anti-inflammatory strategy. We adore to see these big wrinkles when we remove the compressive bandage, a sign of its effectiveness in reducing oedema…And these leg wrinkles are the most beautiful ones 🙂
Speaking of beauty, we can not fail to mention the beautiful mosaics that form punch grafts in the wound bed. As we saw in the post “Large leg wounds after mild trauma“, early punch grafting is the solution in many of these post-traumatic wounds to slow their progression, reduce pain and promote epithelialization. A simple solution, very well accepted and very efficient for a terribly limiting problem!
The success is in acting as soon as possible. Not only when the wounds have occurred, but already with preventive initiatives. Moisturized legs, with good control of edema and covered with protective tissues and devices to avoid potential trauma, will have fewer problems. Fluid communication between professionals working in nursing homes, primary care and specialized care is the key in preventing chronic wounds from developin in the elderly. TOGETHER WE CAN CHANGE THE LIFE OF THESE PEOPLE, REDUCING THEIR DAYS SUFFERING WITH WOUNDS!
Happy New Year and thank you very much for your confidence and interest in the blog! I hope to keep writing and drawing with the same excitement and love for many more years 🙂
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