Innovative Wound Care

Many wounds heal naturally without any problems. However, the most common complication after surgery is wound infection. This indicates that germs start to infect and grow in the wound which delays wound healing. Wound infections are usually treated by dressing the wound regularly and maybe with a course of antibiotics as well. (In some cases further surgery may be required).

There are people who are more likely to develop wound infections than others. Those at higher risk include smokers, people who have diabetes; or have a condition or treatment that affect their immune system, such as leukaemia or chemotherapy. The appropriate post-operative surgical wound care is essential in preventing potential ‘infection’ which may be a response to injury that takes place immediately after the wound is formed. After an operation, you’ll have a surgical wound. It’s important to take good care of a wound, to lower your risk of infection and ensure it heals in the best way possible.

Often having a major operation, such as bowel surgery, where one’s diet does not supply enough nutrients for wound healing. Doctors and nurses do everything they can to prevent the wound from being infected, while under their care in the hospital, it is important know if infection sets in. If a wound becomes infected it may become more painful, look red or swollen, weep or leak some blood-like liquid, pus or blood, have an unpleasant smell. If you develop a high temperature, or notice any of the signs mentioned above, or have any concerns about your wound, then make contact with your physician, nurse, or the hospital. Wound infections can be treated successfully if we catch them early.

Wound healing is a complicated process but can be divided into three main phases.

• Inflammation – this happens straight away and lasts for up to six days, during which time the blood flow to your wound increases.
• Proliferation – this starts after a few days and can carry on for several weeks. New blood vessels grow to bring nutrients to your wound and new tissue starts to develop.
• Maturation – new cells develop to strengthen your wound and soften the scar. This phase can continue for over a year.

Notably the skin edges usually form a seal within a day or two of an operation. This may vary from person to person and from operation to operation. Closing your wound surgically (with stitches, clips or staples) encourages your wound to heal faster. The first phase of wound healing can take around two to three weeks but some people experience delayed wound healing. This can depend on the type of wound you have and how your body responds to healing.

Diabetic patients have around 25% lifetime risk of developing foot complications, the most common of which is skin ulceration. More than 50% of those wounds end up being infected, that exponentially raises the risk of below-knee amputation. The soft tissue infections represent the majority of diabetic foot infections, bone involvement accounts for 20–60% of cases. A diabetic sufferer with a lower leg ulcer, a foot ulcer, or any wound find it is difficult to heal. Diabetic ulcers are the most common cause of foot and leg amputation.

A large number of patients with diabetic foot ulceration will develop infection, which can spread rapidly and, when care is not taken to manage infection effectively, the wounds can become deep, and osteomyelitis and serious soft tissue infection may occur. Early identification and prompt management of infection is crucial to prevent limb loss. In addition, infection in the feet can spread elsewhere through the blood, leading to potentially life-threatening complications.

An international new research study backs the innovative BRH System which is now available in SA, has identified that the BRH system uses the combination of Low Intensity Ultrasound and Low Frequency Electric current fields. The thermal and non-thermal physical effects (resonance) of the combination of US and EC does increase blood flow, reduces muscle spasm and increases extensibility of collagen fibres and a pro‐inflammatory response.

A clinical assessment pilot was carried out by four (4) doctors and performed in three (3) countries Spain, Romania and Israel, where 21 patients with severe diabetic ulcers were identified and included in this study. All patients were treated prior to affiliation for at least 6 months with systemic and local treatments such as debridement, antibiotics, hyperbaric oxygenation, vacuum systems and ozone therapy. During this time their wounds did not close.

In the study, patients were treated, a one hour treatment, 1-4 times a week. Systemic and local ozone therapies were performed in conjunction with the study’s treatments. Wounds parameters were photographed and measured by depth and surface area. The results, exciting as the wounds of all 21 patients closed or dramatically reduced its size and or depth within 2-13 weeks. The BRH-A1 has an ISCS (internal size calculation software) calculating the size of each photographed wound, so each wound size reduction can be automatically calculated for the full data record and analysis. In addition, the full health data recorded prior to each treatment session is saved and the changes in the health status during the whole treatment period are fully registered. The study positively concluded that the use of IBFUSEC-BRH system enabled rapid healing of complicated wounds which had previously failed to heal.

The therapy, primarily through its resonance effects, induces an increase in blood flow particularly in terms of microcirculation; increase collagen fiber formation over the affected area; and an increase in the inflammatory response. When compared to other Ultrasound and Electrotherapy systems intended for the purpose of wound healing of the BRH-A series systems does not only focus solely on healing the infected ulceration but on increasing blood circulation in and around the ulceration by the unique frequency and intensity changes, which rapidly close ulceration.

The BRH System treatment uses a combination of both ultrasound and electrotherapy to synergistically accelerate wound healing. Now in South Africa for the first time we have a new innovative way of dealing with chronic wounds using electromagnetic fields and ultra sound. The combination of ultrasound & electrotherapy varies over the course of the treatment (frequency +intensity) causes mechanical movement below the wound bed and encourages increased blood circulation in the wounded region. Both technologies have been proven to be safe in the healing of chronic wounds, and purports positive patient feedback.

If we take a panoramic health educational view, it is not enough to treat nor prevent or reduce recurrence of re-ulceration. A combination of tight glycaemic control, cholesterol-lowering therapy, anti-platelet therapy, BP control, psychological adjustment, family support, protective therapeutic footwear, regular screening, nutritional support, smoking cessation and an integrated healthcare approach is sure to minimise the risk of ulceration and re-ulceration, especially among high-risk patients.

The family physician with specialised training in managing diabetic foot conditions is an added advantage compared to his counterparts such as podiatrists and orthopaedic surgeons. The family physician certainly is in a position to provide other services to the patient, including metabolic control, and BP and cardiovascular risk management. They can counsel and prescribe anti-depressants, since one-third of diabetic patients with foot ulceration are already depressed, perhaps even offer dietary advice. As a result, the involvement of family physicians with a special interest in diabetic foot management may represent a paradigm shift in the management of diabetic foot pathology.

REFERENCES: Eco Health Sense

https://youtu.be/P_UpBc6-o-Y

www.brhmedical.co.za

 http://www.woundsinternational.com/media/issues/654/files/content_10737.pdf

http://www.awma.com.au/journal/2004_08.pdf

http://www.whasa.org/images/WHASABOOKLETMARAPR2009.pdf

http://emedicine.medscape.com/article/237378-overview