Open Wound Care: Treatment and Complications

Open wounds create significant health, economic, and social challenges. One analysis reviewed the number of Medicare beneficiaries with wounds from 2014-2019. Over the five-year period the number of Medicare recipients with wounds increased from 8.2 million to 10.5 million, a 13% increase in wound prevalence. Open wound care treatment and complications can have significant impacts on a patient’s quality of life. 

Wound prevalence continues to rise due to the increase in obesity, increased age of the population, and rise in chronic medical conditions such as diabetes and peripheral vascular disease.

In healthy people, a wound can be expected to move through the stages of wound healing normally. If a wound stalls in one of these stages, it may turn into a chronic wound, which are more difficult to heal. According to the National Library of Medicine, the wound care product market is expected to reach 15-22 billion dollars by 2024.

That’s a hefty cost passed on to individuals and to our healthcare system. Researching, studying, and teaching open wound treatment can help reduce some of that burden.

Before we move to specifics, let’s look at some basics. An open wound is any break in the protective skin layer. The depth of the open skin may be superficial, such as with an abrasion, or extend through the skin layers and into the underlying structures, as seen in a stage four pressure injury. Wound location and etiology are varied, and the basics of wound care is fundamental for them all.

Open wound cleansing

Cleansing is an important step in the treatment of wounds. It carries away wound debris and bacteria and can help reduce bioburden in the wound bed. It is important to gently cleanse the wound with each dressing change. Mild soap and water is effective for cleaning most wounds that are being cared for at home.

Wound care clinics often use normal saline or a water-based surfactant wound cleanser. A hypochlorite or acetic acid solution can be effective at reducing bacterial load in an infected wound or a wound at high risk of infection such as a pressure wound in the coccyx, perineal, or gluteal region of an incontinent patient.

Dressing selection

Choosing a wound dressing is one of the most difficult decisions in wound care treatment. There are many different types of wound care products on the market today. For a wound to properly move through the stages of healing, the wound bed should remain moist but not overly wet.

A dry wound bed will not move through the proliferative phase of healing. An overly wet wound bed puts the wound edges at risk for maceration. Ongoing maceration will breakdown the wound edges as well as intact periwound skin. This can cause the wound to enlarge or cause new areas of tissue to open, creating new wounds.

Dressing choice will also depend on what the provider intends to achieve — such as choosing a daily dressing change with gauze and hypochlorite solution for an infected wound — or to slowly debride a wound with heavy necrotic tissue on a patient that is unable to tolerate a sharps debridement, a gel and hydrocolloid dressing combination.

A wound may require an alginate dressing for moderate to heavy drainage or even a super absorber dressing for a wound with copious drainage. Dressings may also be chosen to pad or offload an area such as a pressure injury to the Achilles heel.

Dressing change frequency

The frequency of dressing changes will depend upon the type of dressing in use, the amount of drainage from the wound, and if topical medications or gels are being used. It is important to change dressings at proper frequencies to avoid unnecessary dressing changes, which can lower the temperature of the wound bed and unnecessarily expose it to potential bacteria.

There are many specialty wound dressings that are made to last three, five, and up to even seven days when used appropriately. Referring to the product packaging inserts for specialty dressings will give specifics on what type of wounds the product is best used on as well as what amount of drainage the product is able to handle. This will help to determine the best frequency of change for each patient and their particular wound needs.

Additional treatments

There are other wound care treatments that certain wounds may benefit from. These include negative pressure wound therapy, total contact casting, lower extremity compression wraps, the application of topical skin substitutes, and hyperbaric oxygen therapy.

These additional wound care treatments are normally provided and managed by a specialty wound care clinic. Patients at specialty wound care clinics are individually assessed for the appropriateness of these additional treatments.

Open wound complications

Open wounds are susceptible to several complications, the most common of which is infection. Any disruption to the integrity of the skin layer creates a pathway for bacteria to enter.

Infection can include a localized infection of the wound bed, progression to cellulitis of the surrounding skin, progression to osteomyelitis in nearby bones, infection of nearby structures such as muscle, tendons, or ligaments, and even bacteremia leading to sepsis.

Open wounds should be monitored on a regular basis to assess for signs of infection such as redness, warmth, increased drainage, odor or drainage from the wound after adequate cleansing, edema, induration, and signs of progressed systemic infection such as nausea, fever, vomiting, malaise, and chills. Other open wound complications include bleeding, surgical wound dehiscence, difficult to control pain, and scarring.

Patients with open wounds who are experiencing signs of infection or have a slow-to-heal wound should see a medical professional. Patients who also have a chronic medical condition such as diabetes, peripheral vascular disease, or an immunologic disorder should also see a medical professional to assist with healing.

Doing our best to manage and properly identify and treat open wounds can help to relieve the social, personal, and economic burden of wound treatment and will improve the quality of life for patients. Outpatient wound care clinics are widely available to help primary care physicians manage their patients with open wounds. Together, they can move towards healing wounds quickly and efficiently.