Chronic wounds - how to prevent and manage them

Chronic wounds are having a massive impact on older Australians, their families and the health and aged care system. So how do you recognise the signs that something is turning into a chronic wound and how do you get help?

Wounds Australia is the peak body for wound prevention and management in Australia. It’s Chair Hayley Ryan highlighted the enormity of the problem when she said, “Over 420,000 people suffer from chronic wounds each year and they will spend an average of $340 per month on dressings and painkillers. Chronic wounds also damage mental health as they stop people from enjoying activities others take for granted.”

“However, the solution to chronic wounds for thousands of Australians is bleeding obvious. By simply knowing the warning signs and understanding who is at risk, chronic wounds can be avoided or be quickly healed by talking to a healthcare professional.”

Who is at risk of chronic wounds?

According to Wounds Australia, anyone can be afflicted by a chronic wound at any time, however it’s older Australians and people with health complications are most likely to suffer.

“Sadly, they are also the people who are least able to afford treatment. That’s why Wounds Australia wants older Australians and their family to know help is available,” Hayley Ryan said.

The greatest risk factors are seen in people who are:
• over 65 years
• suffering from chronic diseases like diabetes, cardiovascular diseases and renal disease
• struggling with poor mobility
• obese.

What are the warning signs that something will become a chronic wound?

Warning signs that an ordinary wound has become a chronic wound include:
• taking more than a month to heal or returning for no apparent reason
• pain and heat
• an unpleasant odour
• a thick, yellowish fluid.

Who do I turn to for help?

Healthcare professionals qualified to give advice and treatment include:
• Doctors
• Nurses
• Pharmacists
• Podiatrists
• Aboriginal and Torres Strait Islander Health Workers
• Diabetes Educators
• Some physiotherapists, occupational therapists and dieticians.

How to manage some common wounds before they turn into chronic wounds

Please note that you should seek advice from a person in the list above. This is general information provided by Wounds Australia.

Skin tears

As we age the skin becomes thinner, frailer and more prone to injury, especially skin tears. A skin tear is an acute wound caused by shear, friction and/ or blunt force resulting in separation of the skin layers. It’s mainly caused by trauma from knocks around the house especially to arms and legs. Prevention of skin tears may include putting padding on objects that are causing skin tears such as the edges of furniture. There is good evidence that the use of a moisturising lotion twice a day can reduce the incidence of skin tears by 50 percent. Likewise drinking fluids and a nutritious diet will help with optimal skin condition.

Management of skin tears

Skin tears can bleed a lot. Place a sterile cloth over the wound and hold until bleeding ceases. If possible reposition the skin flap back into place. Using a cotton bud to ‘roll’ back the skin can help. Dress with a sterile non-stick dressing and if feasible it is best to bandage the dressing rather than using adhesives on the skin. As a general rule do not use any adhesive products on fragile skin. Dressings should be removed gently and in the direction of the skin tear as doing it the reverse may open the skin tear up again. If the skin tear is becoming larger or not healing then see your doctor.

Burns

Burns can be caused by fire, hot objects, hot liquids (scald) , radiation eg; sunburn, electricity, extreme cold, lightning and some chemicals. Regardless of the cause, a burn destroys some or all of the cells in the skin and sometimes other underlying tissues such as nerves, muscle or bone.

Burns vary from minor acute wounds through to life-threatening emergencies. All burns require immediate first aid treatment.

Classification

Burns are classified according to the amount of damage done to the different layers of skin and to the structures within and below these layers. There are three levels of burns:
1. Superficial or first degree burns: these burns cause damage to the outer or first layer of skin only. The burn site will be red and painful. Most of these burns can be managed at home or by seeing a general practitioner
2. Partial thickness or second degree burns: these burns cause damage to the first and second layers of skin. The burn site will likely be swollen and red, with blisters and peeling. There may also be leakage of clear or straw coloured fluid from the skin. Pain from the burn site can be severe.
3. Full thickness or third degree burns: involve damage to the first and second layers of skin as well as the underlying fatty tissue. Very deep burns may also damage the underlying muscle or bone. In full thickness burns the site often appears brown, black or charred with white fatty tissue visible. The skin may look stiff, waxy white or leathery. The nerve endings are often destroyed and so there is little or no pain at the site of the full-thickness burn. However, any surrounding partial thickness burns are likely to be very painful.

Only apply water to second or third degree burns until they have been medically assessed.

Management of simple burns

Simple burns and scalds can generally be managed at home. They require pain relief, dressings and checking to make sure they have not become infected.
To treat minor burns, follow these steps:

• Hold the burned area under cool (not cold) running water for 20 minutes or apply a cool, wet compress until the pain eases. Don’t use ice. Putting ice directly on a burn can cause further damage to the tissue. Depending on the location of the burn a cool or lukewarm shower may be appropriate.
• Remove rings or other tight items. Try to do this quickly and gently, before the burned area swells.
• Avoid braking small blisters as they are sterile when they are intact. Breaking them may lead to infection. If blisters break, gently clean the area with mild soap and water, and cover the wound with a non-stick gauze bandage.
• Apply lotion. Once a burn is completely cooled, apply a lotion, such as one that contains aloe vera or a moisturiser. This helps prevent drying and provides relief.
• Bandage the burn. Cover the burn with a non-stick dressing and then bandage it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
• Take a pain reliever if required.

Seeking help for wounds during COVID

There has been a nation-wide pattern of people avoiding health services during the pandemic, however when it comes to wound care, this could have far-reaching consequences.

Wounds Australia has urged everyone with a wound to seek treatment, saying failure to do so put people at risk of long term damage, amputations and even death.

“While most wounds can be healed with timely and appropriate care, many people aren’t getting it because they’re worried about exposure to the coronavirus”, Hayley Ryan said.

“While fear of Covid-19 is understandable, the avoidance of treatment is causing an escalation in the incidence and severity of wounds, and chronic wounds in particular. An untreated wound can quickly become a long term health risk. For example, a small foot sore on someone with diabetes can lead to an amputation within days.

“The result is long term suffering, greater financial burden and eventually, huge strain on hospitals as more severe wounds demand more intensive and long-lasting treatment.”

People worried about visiting hospitals have other options for wound care. These include the use of online and phone consultations by doctors and nurses, as well as pharmacists, podiatrists and others from the list above.