We have touched on wound aetiology previously, however in this episode we dive deeper into how wound types interface with mechanism of injury and dilemas faced when there are multiple causes - what actually is a mixed wound?. We canvass all the major hard to heal wound types including incontinence associated dermatitis, pressure injury, skin tears, moisture lesions, chronic oedema, venous, arterial and more. How does this all relate to management of these wounds? We're sure our discussions in this episode will raise a few clinical conundrums and questions for you. Indeed, you may start to see more of these in your own practice and become more aware of these prickly challenges. The simple isn't always so simple.
Timestamps:
00:00 Introduction
01:12 Mechanism of injury versus aetiology
02:30 The value of clinical audit and quality indicators
03:20 Misdiagnosis of Incontinence-Associated Dermatitis (IAD)
03:56 Intertriginous dermatitis misdiagnosed as IAD
05:29 The challenges of addressing gaps in clinical guidelines
06:03 Be confident to be unconfident
06:20 What is the mechanism of injury for skin loss in IAD?
07:21 When experts conclude that the simple ain’t that simple
08:45 When clinicians are approached by academics to fit a square peg into a round hole
10:36 Tips for researchers undertaking research in venous leg ulcers
11:52 When wound education is siloed and does not replicate clinical reality
13:35 Making clinical hunches and not always on the first visit/assessment and that’s OK
13:50 Current wound documentation does not support multiple aetiologies and impediments to healing
14:00 Challenge of teaching clinical realities to students when they are taught in siloes
14:33 Figuring out what is the predominant aetiology
14:50 How do we define and teach simple versus complex wound
15:13 Mixed aetiologies presenting above and below the groin
15:56 Prioritising which aetiology to treat / manage
16:57 Post operative wound dehiscence and lymphoedema
17:48 Capacity building in lymphoedema
19:27 The need for clinicians working in Hospital in the Home to understand lymphoedema
19:43 The challenge of diagnosing inflammatory conditions such as IAD and intertriginous dermatitis of the pelvic girdle
20:30 Influence of climate on dressing performance and skin injuries
21:00 Mixed aetiologies of the pelvic girdle
22:20 Is IAD avoidable and how easy is it to categorise, manage and report
24:00 Continue reevaluating aetiology
24:12 It is OK change or add to aetiology if clinical rationale can be provided
24:57 Call it what it is. A vascular assessment includes arteries, veins and lymphatics, not just the arteries
25:21 Venous disease plus a wound on the same leg does not necessarily mean the wound is of venous aetiology
26:57 Mechanism of injury v aetiology v impediments to healing. Simple v complex
28:40 Opportunities to improve accuracy of wound data reporting and quality improvement
30:27 When is a stage 1 Pressure Injury of the foot, a “Diabetic Foot Ulcer”
Resources mentioned:
- GlobIAD Incontinence Associated Dermatitis - Tools https://www.skintghent.be/en/onderzoek/tools/2/incontinence-associated-dermatitis-iad
- Australian Aged Care Quality and Safety Commission - Incontinence associated dermatitis and pressure injury https://www.agedcarequality.gov.au/news-publications/clinical-alerts/incontinence-associated-dermatitis-and-pressure-injury
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Disclaimer:
The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.
