Chronic wound care in Jordan

Most wounds heal through overlapping stages: stopping the bleeding, inflammation, new tissue formation and remodelling. A wound is described as chronic, or “hard-to-heal”, when it stalls in one of these stages, most often inflammation.

There is no single agreed time limit, but many clinicians re-assess a wound thoroughly if it has not clearly improved after about four weeks of appropriate care.

Common types of chronic wound include:

• Pressure injuries (bedsores)
• Foot wounds in people with diabetes
• Venous leg ulcers
• Arterial ulcers caused by poor blood supply
• Surgical wounds that are slow to heal

There is rarely a single cause. Factors in the wound itself usually combine with factors in the person’s general health, which is why changing the dressing alone is often not enough.

Common factors include:

• Reduced blood supply to the area because of arterial disease.
• Poorly controlled blood glucose in people with diabetes.
• Ongoing pressure or friction on the wound.
• Infection, or a bacterial layer on the wound surface known as biofilm.
• Dead or sloughy tissue in the wound bed.
• Unbalanced moisture: a wound that is too dry, or heavy exudate that damages the surrounding skin.
• Poor nutrition or low fluid intake, smoking, and some medicines such as corticosteroids.
• Long-standing swelling in the legs.

Wound specialists use a structured framework so that nothing stopping healing is missed:

A thorough assessment comes before choosing any dressing or treatment. It usually includes:

• Health history: long-term conditions, medicines, how long the wound has been present and previous treatments.
• Measuring and documenting the wound regularly to track progress.
• Describing the tissue type, the amount and type of exudate, and the condition of the edges and surrounding skin.
• Assessing pain and signs of infection.
• An initial circulation check, with referral for vascular assessment when needed.
• Reviewing pressure, mobility, nutrition and other factors that delay healing.
• A clear care plan agreed with the treating physician, and education for the patient and family.

• Follow the written care plan from the treating team, and don’t change the dressing type or how often it is changed without advice.
• Wash your hands well before and after touching the wound or dressing.
• Don’t put home remedies, herbs or unprescribed creams on the wound.
• Help a person with limited mobility change position regularly, as advised by the care team, to relieve pressure on the skin.
• Support good nutrition and fluids, and blood glucose control for people with diabetes.
• Write down any change in the wound, pain or temperature, and tell the care team.