une is wound healing awareness month and wounds can impact a patient’s life. There are three main types of wounds in the lower legs and foot including chronic venous leg ulcers, arterial and diabetic foot ulcers. Regardless of the type of wound, they often have a severe impact on patients’ quality of life. Symptoms may range from mild to devastating results, depending on the location and severity. Lower extremity wounds are estimated to occur in up to 13 percent of the United States population, and the annual cost of treating these wounds is at least $20 billion.
Lower extremity/limb wounds are those on the leg and foot. They can be caused by one, or a combination of problems including poor circulation, diabetes and other medical problems. The goals of treatment are to heal the wound, relieve pain, regain a high quality of life and keep the wound from returning.
There are large numbers of people in The Bahamas that also have lower extremity wounds that have a great impact on their quality of life. For healing, these wounds need constant care and attention but can be expensive and take a while to heal.
These wounds can impact a person’s life in a variety of ways based on the severity and location of the wound. An overview of some of the common effects of lower extremity wounds includes the following:
Pain: The prevalence of pain in chronic wounds ranges from 48 percent to 81 percent, and between 19 percent and 46 percent of these patients report moderate to severe pain. The pain can make it challenging to complete daily tasks such as housework or care for the family. It can also interfere with sleep, cause anxiety and depression in patients when it is not managed adequately. Pain can also be worse during dressing changes or other treatment for wound healing.
Limited mobility: Pain from these wounds can make it difficult to complete any type of physical activity, including engaging in paid employment. People may feel they can’t do anything or go anywhere because of the wound, leading to feelings of social isolation. Even daily tasks such as preparing meals, completing housework, and conducting personal hygiene tasks can be difficult or impossible for some of these patients.
Exudate or odor: Lower extremity wounds, and particularly chronic wounds, can be extremely difficult to manage. These wounds often have moderate to heavy drainage or wound fluid that can seep on to the bandage and can sometime smell unpleasant. Many patients may be embarrassed just because of the bandage and worse if there is odor from the bandage. This drainage can also be dry which makes performing wound care and dressing changes difficult and painful.
Psychosocial impacts: Many complications of these wounds can prolong the healing time and continue to impact daily life for these patients. Patients with chronic lower limb wounds often experience a wide range of psychosocial effects, such as diminished confidence in their appearance, loss of dignity, and altered self-perception and self-esteem. These wounds may also limit their desire for maintaining family, social, and professional relationships out of embarrassment about their physical limitations and wound symptoms, such as moderate to heavy exudate and odor.
Complications: Lower limb wounds can also lead to complications, such as becoming a chronic wound meaning it takes a long time to heal, infection, limb loss to amputation, and even death.
Financial hardship: Caring for chronic lower extremity wounds can be extremely expensive not only for the health system but also for the person with the wound. The actual cost of care for weekly or more often doctor or clinic visits and dressing changes, the actual cost of the medical supplies can lead to the increased cost of care. For many working patients, lower limb wounds correlate with work absences, job loss, and a negative impact on finances. The combination of lost income and medical expenditures can lead to profound financial hardships for many patients.
The reality is that lower limb wounds are far more than the physical damage to the body. They often have widespread effects on nearly every aspect of a patient’s life.
There are many wound treatment options available today, but the most important start is to determine the actual cause of the wound which will guide treatment. It is also best to treat wounds comprehensively and with a multi-disciplinary team, meaning a team of specialists. Standard wound care treatments include cleaning the wound bed regularly – maybe weekly based on the wound; keeping the wound bed moist and warm after removing the dead tissue on the wound bed; using appropriate wound care treatment options and other supportive therapy such as removing pressure, occupational or physical therapy. Advanced or enhanced wound healing may include surgery, hyperbaric oxygen therapy, and electrical stimulation, among others. Nutrition and living a healthy lifestyle are also important to promote wound healing. Utilizing a number of these strategies together can improve the healing process for lower extremity wounds.
Pain management is very important to improving the healing environment of the wound itself and for the quality of life of the person with the wound. Pain in the wounds can be linked to increased depression and anxiety. So, healthcare providers must take the time to assess and appropriately treat the wound pain based on the patient’s report. Patients can take pain medication prior to or after the wound care visit.
When these treatment options are combined with proper pain management, overall quality of life for the patient is enhanced, and this approach can lead to healing and better patient outcomes.
• For more information, email us at firstname.lastname@example.org or visit www.apma.org. To see a podiatrist, telephone 325-2996 for an appointment, visit Bahamas Foot Centre on Rosetta Street, or call 394-5824 for an appointment; or visit Bahamas Surgical Associates Centre on Hilltop Medical Centre off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment.