Plastic surgery descends from Reconstructive surgery
Plastic Surgery Descends From Reconstructive Surgery
The Wound Consultation -
Wound Care Management in Dubai
Only a detailed doctor/patient consultation forms the basis for successful individual treatment and wound care management in Dubai.
Note: Please bring any existing medical reports and examinations (X-ray, MRI, …). They are helpful in any way
Core Group: Patients are initially seen by Plastic Surgery, Dermatology, and/or Vascular Surgery:
Multidisciplinary Wound Care Team: Depending on the findings of the initial wound examination, other specialities are consulted for individually tailored diagnostic and treatment.
Integrative Wound Care Concept
Based on many years of research and clinical experience in the field of wound care in Dubai, we have developed a so-called “integrative wound care concept” and successfully implemented it in our daily practice. This concept comprises:
Systemic Wound Care
We care about the Patient, not just the Wound: Especially in chronic wounds, it is always important not to see the wound as an isolated local problem (local wound healing), but also as a systemic problem (systemic wound healing).
Systemic wound healing includes, among other things:
- Treatment of the Underlying Disease/Improvement of General Health
- Treatment of Infection
- Pain Management
- Nutrition
Patients with a chronic wound (decubitus) are often brought to the emergency room with the requirement that local wound treatment be carried out. A chronic, non-healing wound is often a sign of deficiency and/or reduced general health. Intensive cooperation with internal medicine is the key to the successful treatment of many patients for wound care in Dubai.
Generalized adjuvant antibiotic therapy as part of conservative therapy should not be given, except in the case of:
- inflammatory, phlegmonous wounds
- septic conditions
Systemic antibiotic treatment of secondary infection should be started by untarget (initial) treatment and switched to well-target treatment once the antibiogram is available.
There is no indication for local antibiotic application
Pain can be caused by:
- Wounds
- Treatment
Therefore, pain must always be evaluated by a specialist for adequate wound healing in Dubai.
If necessary, a planned, continuous and adequate pain therapy must be ensured at the beginning of the treatment.
When choosing the pain medication, further immobilization by sedation must be avoided. Close cooperation with the wound management Pain Clinic in Dubai is highly recommended.
Eating well during wound healing helps you heal faster and fight infection. There is an increased energy requirement – calories, protein, fluid, vitamin A, vitamin C, and zinc – during wound healing
NOTE: Many elderly people are malnourished
Due to the physical changes of getting older, it’s often considered “normal” to eat less. A decrease in appetite can also result from naturally fluctuating hormonal levels. Older adults might make dietary adjustments with dentures or when taking medication to avoid certain side effects.
Therefore a closed cooperation with Dietics & Nutrition is mandatory in almost all clinical admitted patients for wound care in Dubai.
Additional Treatment (optional)
The immobile patient faces several risks of immobilization as early as 24 hrs. .
- Sitting in a (wheel) chair is better than lying in bed
With regard to chronic wounds, immobility and joint contractures significantly increase the risk pressure sore. Therefore close cooperation with Physiotherapy & Rehabilitation is of utmost importance. Contact Prof. Dr Robert Hierner for complete wound care management Dubai.
Urinary and fecal incontinence can have a detrimental impact on skin health. Prolonged exposure to urine or stool can cause inflammation or erosion of the epidermis or stratum corneum skin. Incontinence-associated dermatitis (IAD) is one type of moisture-associated skin damage (MASD).
Damaged skin will lead to
- Reduced spontaneous wound healing capacity
- Increased risk of pressure sores
Especially in the immobile, dement and fecal (stoel) incontinent patient an enterostomy should be placed at an early stage for nursing and medical reasons
Close cooperation with Urology, Gynecology and Abdominal Surgery is of utmost importance for complete wound care management in Dubai.
Local Wound Care
Local wound treatment includes
- the treatment of the wound
- the treatment of the surrounding skin
In local wound treatment, a distinction is made between the following steps:
1) Elimination of extrinsic and intrinsic risk factors
2) Wound cleansing
3) Wound bed preparation
4) Wound closure measur
Every local wound treatment begins with the removal/reduction or stabilization of the responsible risk factors, whereby a distinction is made between external and internal risk factors.
The next step is to remove coarse dirt and foreign bodies from the wound area.
The wound shower has proven itself for cleaning wounds
- A sufficient amount of liquid is necessary for a sufficient cleaning effect. Sprinkling the wound with 50 ml NaCl is not sufficient. This must be considered when douching the immobile patient.
- Mechanical manipulations (brushing, scratching, ….) must be avoided in the shower.
According to FALANGA, wound bed conditioning is the entire “management” of the wound in order to increase endogenous healing or to facilitate the effectiveness of other therapeutic methods. The following steps are distinguished:
Debridement
(Removal of necroses and wound coverings)
Debridement is performed as an independent primary treatment step as part of wound bed conditioning.
The definitive extent of the defect only becomes apparent after adequate debridement, so that a decision on the final type of further therapy can only be made at this point in time
There are different debridement techniques from non- surgical (Alginat) to minimal-invasive (Maggot, Water jet) to surgical
Bacterial Balance
(Establishing a bacterial balance on the wound surface)
Every chronic wound shows colonization with microorganisms. Bacterial growth in the microbiological swab is normal. Up to 1000 microorganisms per gram of tissue are considered physiological.
Complete elimination of a clinically relevant (pathological) wound infection is necessary for wound healing in Dubai. The diagnosis of a clinically relevant wound infection is primarily based on
- clinical symptoms (heat, redness, swelling, pain, loss of function)
- Laboratory chemical infection parameters
Wound Exudate Management
Avoiding skin maceration by managing wound exudate is another prerequisite for undisturbed wound healing. One distinguishes:
- Indirect management of wound exudate
- Silver dressing
- Antiseptics (Lavasept ®, Octinisept ®, …)
- Direct management of wound exudate
- absorbent dressings
- TNP (VAC) therapy
- compression treatment
Moist Wound Healing
For the treatment of dehiscent acute wounds and chronic wounds, it has been shown that the phases of secondary wound healing proceed more quickly in a moist wound environment
Oxygen Balance
Oxygen is vital for healing wounds. Oxygen is known to accelerate wound healing and reduce wound infection. It is intricately involved in numerous biological processes including cell proliferation, angiogenesis, and protein synthesis, which are required for restoration of tissue function and integrity.
Wound closure measures
Conservative (non-operative) and operative therapy are available for wound closure and defect coverage. It is important to note that these are not competing but complementary processes.
Conservative therapy is the basic therapy of any wound treatment.
Surgical therapy can be understood as a supportive measure of conservative therapy. There are several surgical procedures to choose from for defect coverage, which can be arranged in the sense of a reconstructive ladder. The choice of the surgical procedure depends on the etiology, the general condition and the expected future stress on the defect area to be reconstructed.
Prevention of Recurrence
The best wound care in the hospital is only short-lived if it cannot be continued after discharge from the hospital at home. Close contact and communication between the Hospital and Home are of utmost importance. The wound network is a cooperation platform for all those involved in the care of chronic wounds at home in the catchment area of the Wound Care Center (Hospital)
Hospital-to-Home Transition
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Home Wound Care Awareness/Preparedness
/Response
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Home-to-Hospital Transition
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A standardized wound care transition from hospital-to-home is of crucial importance. Only a complete continuation of the treatment started in the hospital, at home, guarantees the sustainability of the treatment success. We specifically seek contact with the GP and the outpatient nursing service, as they often know the patient and their living conditions best.
It must be ensured that all necessary nursing aids (assistants, wheelchair, decubitus mattress, ….)
– could be obtained before dismissal
– that these also work
– and can be perfectly operated by home nursing care.
Most chronic wounds and problem wounds can be successfully treated by outpatient treatment (Outpatient Nursing Service). The following principles should be applied:
Awareness: Outpatient nursing Service must be familiar with the prevention of wounds
Preparedness: In case of a recurrence, the outpatient nursing Service must be familiar with basic principles of wound care
Response: In case of a recurrence, the outpatient nursing service must be able to decide, whether to go on with home wound care or (re-) admission to the wound center
Home care can be delivered by several systems
- Health Home Care: qualified wound care nurses from the hospital
- Permanent
- Temporary (“visiting educational nurse”: in-person or Telemedicine)
- Home nursing: Nursing staff from a third provider
In the event of a significant deterioration in the wound condition, which cannot be improved despite changes in the outpatient care measures, rapid admission to the hospital is necessary in order to avoid further harm to the patient
Treatment of Specific Wound Types
We offer the full range of “state of the art” multidisciplinary und multiprofessional systemic and local Wound Care at the highest level.
