Tackling wound healing

It is not in the big league of diseases like heart attacks or strokes and few give little thought to wounds and wound-healing.

The 2nd meeting of the Asian Wound Healing Association which Sri Lanka is hosting on September 3 and 4, at the Cinnamon Grand Hotel, therefore, should help focus on this critical area, with many findings and diverse ideas being discussed and debated by both local and foreign delegates.

Eminent speakers from Asia including India, Malaysia, Singapore, China, Japan and the Philippines will participate, explains the association's Chairman, Prof. Mandika Wijeyaratne, Professor in Surgery of the Medical Faculty of the University of Colombo. He also heads the Wound Care Foundation of Sri Lanka
Chronic wounds don't kill people, says Prof. Wijeyaratne, pointing out, however, that such wounds make hell out of their lives. "The wounds are painful, smelly, emit a discharge and end up having bulky dressings. This entails a huge recurrent cost with regular visits to doctors as dressings have to be changed. The family income gets depleted, the household routine is disrupted and the patient's job is affected."

About 20-25% diabetics who develop a small injury end up with an amputation. The start in many cases is just a small toe injury, the Sunday Times learns.

A major shortcoming, laments Prof. Wijeyaratne, is that there are no statistics of how big the wound burden is because wounds are not thought of as important. Whether good or bad, the situation is unknown and this is a common phenomenon in Asia.

Topics to be discussed

Among the highlights of the meeting, aptly named 'Open minds, close wounds', will be the session with a podiatrist from India, due to the importance of foot-care in preventing amputations.

Other interesting sessions would be stem-cell therapy and the ayurveda and indigenous approach to managing wounds and also wound-healing, with discussions revolving around the use of papaw, bee's honey and the piper betel.

Explaining that wounds like minor scratches are common and our bodies are naturally programmed to heal wounds, he says that in many instances though healing may go awry and wounds carry on.

Huge, complicated wounds such as gunshot injuries, burns, wounds suffered in traffic accidents and also civilian trauma, require assistance to heal. "In the last century, people who suffered complicated injuries would have died but times have changed and along with the gathering of knowledge and experience, death in such instances is considered unacceptable," he says.

Some people may also be prone to diseases such as diabetes and a few other rarer conditions and in the olden days leprosy, which impair wound-healing according to him, and it is important for people to have a knowledge about wounds, to prevent ending up with a bigger wound and ultimately even the loss of a leg.

Citing the example of diabetes which is on the rise, he says, more and more foot problems are arising out of this. "We need to look at not only how we should manage diabetes foot ulcers but also how to prevent them in the first place. Another important factor is the type of shoe that should be worn. The patient must have the right shoes," he stresses, explaining that in the case of foot deformities the shoe must be tailored for the foot and not vice versa to prevent re-ulceration.

In a surgical ward, the backyard is usually the "wound corner" where about one of three patients has a wound problem, points out Prof. Wijeyaratne. Chronic wounds, the surgeons would struggle and heal only for the patient to come back because the underlying condition is persisting and people don't comply with instructions.

Referring to the common perception, he says that wound-healing is equated with removing one dressing and replacing it with another and administering antibiotics. "Today, however, doctors are questioning what dressing is good for which wound and whether there is a need to prescribe antibiotics. Knowledge and realization of how natural healing occurs and why it fails sometimes have advanced and many solutions have come about."

Nurses will be participating for the first time in a doctors' meeting, the Sunday Times learns, with Prof. Wijeyaratne explaining that nurses are heavily involved in wound dressings both at the OPD and in the ward.

Usually doctors have access to new knowledge but nurses rarely have a continuing education and wound care is hardly dealt with in detail in their curriculum in nursing school, he says.Generally surgeons take a lead role when dealing with wounds but in the west, this is slipping into the hands of nurses, with routine, repetitive work being done by them and doctors only making the decisions, he adds.

Kumudini H

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