It is difficult to specify when a wound has become a chronic wound; it depends on the cause of the wound. A superficial wound that shows little signs of healing within three weeks can be classified as chronic. Yet a deep trauma wound that has not closed within three weeks, but is progressing within expected parameters, will not be classified as chronic.
The financial implications
Taking time off work to attend a wound clinic and the cost of travelling to the clinic may impact on your finances. Sometimes it is a younger working family member who has to take time off work to take an elderly parent or grandparent to the clinic.
Buying dressings and bandages may weigh up against buying food, or the cost may prevent you from buying nutritious meals that will help promote wound healing. Budget may be a consideration when having to choose between dressings and medication.
Unless there is guidance from a wound practitioner, who can advise on the benefit of using a more expensive dressing that can stay in place for seven days, the diabetic patient may buy a cheaper option that needs to be changed more frequently.
Most ointments have to be reapplied every eight hours because it is only active for eight hours (called the ‘half-life’ of the product). This is often ignored because of ignorance or because it is time-consuming to renew a dressing every eight hours.
A wound that stays closed under a seven-day dressing has less risk of infection and less risk of new growth being stripped off. The seven-day dressing then becomes an economical choice.
My mantra is cost-effectiveness versus cost-minimisation. Cars can be adapted to accommodate people with amputations – this adaptation will help to keep them independent. Consider having the pedals made longer to assist when the forefoot has been amputated.
Activities must be planned around visits to a wound clinic or doctor’s rooms and the time spent in waiting rooms. Daily planning must accommodate times for treating the wound. If help is needed, then a second person has to be available to do the dressing.
A chronic wound may become ‘the other person’ in a relationship. It demands money and attention. Foul odour may interfere with an intimate relationship, so will soiling from a weeping wound. A spouse, who is not comfortable with doing wound care, may find the responsibility very stressful and he/she may become resentful.
A bandage around the foot or leg prevents one from having a shower or a bath and steps have to be taken to keep the bandage dry and in place. This can be quite a difficult task. Protective boots and sleeves are available. Once again, this has financial implications but will allow one to maintain personal hygiene. Cast shoes, available from an orthotist, can also be worn over a dressing.
Expert quality care
A person with diabetes who has any type of wound deserves expert quality care. It may seem like overreacting when attending a specialised wound clinic, but the benefits will be reaped in the long-term when the wound heals quicker, the cost is minimised in the long-term, and there is less complications like the formation of excess scar tissue. The benefits to the patient and the family are:
- less frequent visits because of cost-effective dressings and education offered by a specialised medical and nursing team.
- No haphazard treatments due to a different person on duty with every visit.
- A treatment plan exists because of knowledgeable staff making assessments of the wound and the wound can be manipulated to encourage wound healing, instead of ‘wound care’ being practised.
- Wound ‘management’ is practised by advanced wound practitioners for the benefit of diabetic persons with wounds.
Any wound will have an impact on the ability to exercise because you cannot wear sport-specific gear, and the tissue involved in the injury has to be protected against an increase in temperature as well as against further injury.
Lack of exercise leads to weight gain and loss of muscle strength. Consider the loss of social contact which impacts on the emotional well-being of a person.
To have any wound, whether acute or chronic, impacts on the quality of life on all levels: economic, emotional, lifestyle, time. It also impacts on the quality of those close to the person with a wound.