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Use of modern methods in treatment of chronic wounds
LEPIČOVÁ, Zuzana
Healing and treatment for chronic wounds are big problems and they affect overall states and fate of patients who are immobile after heavy injuries in consequence of some diseases or because of penetrating wounds. Prevention and treatment flowing from profound knowledge of anatomy, skin physiology, pathology and patho-physiology of defects origins and of healing process is currently taking a big step forward in treatment for refractory wounds. The thesis is divided into two parts. The theoretical part deals with skin anatomy and physiology, pathology and patho-physiology of origins of defects, healing processes and proper treatments of wounds, especially chronic wounds such as ``diabetic foot syndrome{\crqq}, venous and arterial ulcerations and decubital ulcers. Preventative measures against decubital ulcers are described. Documentation of refractory wounds, 3 phases of healing and continuum of healing are described in detail. Re-bandages, the local wound care, are the most significant factor of treatment. Re-bandages follow standard procedures, which involve make-ready of patients, preparations of wounds for re-bandages, preparations of instruments and make-ready of attending staff. Good re-bandage assistance is crucial. Modern treatment methods include various new types of wound cleanup (from the mechanical one, chemical one and autolysis to the enzymatic one, with the use of larva therapy, for example) as well as the usage of very effective ``moist healing{\crqq} methods. Various contact - not adhesive bandages, foams, alginates, hydro gels, antiseptic bandages, dressings with active Carbon, hydrocolloids, hydro adherent dressings, hydro fibres, bandages with active AG ions, chitosin, dressings with hyaluronic acid, collagen bandages, dressings with iodine, mupirocin, or honey. The practical part is dedicated to qualitative research, in a way of non standardised interview. There were two thesis objectives: To map the usage of modern treatments for refractory wounds and to enlighten general nurses in this field. 15 nurses, who deal with chronic wounds, from various emergency wards and hospital wards took part in the interviews. Information was collected from February 2010 to April 2010 and it was elaborated into 15 casuistries. The result of analysed answers was digested into a table. In the Discussion I analysed the particular answers and set 3 hypotheses for each domain. Domain 1: H1: Modern treatments for healing of wounds are not systematically used at most units. H2: Monolithic systems for usage and indication of modern methods do not exist at most units. H3: Statistics of chronic wounds existence is not kept at many units. Domain 2: H1: Trainings are organised by medical facilities in collaboration with distributing companies but their capacities do not satisfy the interest of applicants. H2: Most nurses declare good knowledge of chronic wound healing phases and of continuum of healing. H3: Neither managers of medical facilities nor health insurance companies have sufficient knowledge regarding the ``cost {--} benefit{\crqq} of chronic wound treatments. The Conclusion summarise the whole thesis. The importance of follow up treatment and rehabilitation for subsequent fate of afflicted patients and their families is underlined in this part.
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