Pyoderma gangrenosum (PG) is a rare neutrophilic skin disorder, that exhibits the “pathergy phenomen”, i.e. the wounds are enlarged by trauma, surgical revisions or even biopsying. This has led to the culture of a very conservative way of wound management of PG ulcers. However, recent evidence shows that advanced wound therapies, such as NPWT, are feasible when the inflammatory reaction of PG has been reduced by immunosuppressive therapy. In addition, revisions and skin grafting are possible, or better said, recommendable, at that stage. This presentation will show the current evidence behind surgical treatment of PG and will also cover post-surgical PG, that is a diagnosis often delayed in surgical settings.
The management of wounds can present many challenges to the ultimate goal of complete wound closure. Any failures in the normal wound healing process result in abnormal scar formation, and chronic states which can result in an infection. Technology has helped to advance the management of wounds dramatically, from simple dressings to more advanced, evidence-based options that promote and prevent wound healing. Most of the advanced technologies are current dependent. The global energy sparing effect may also affect technology in wound care. During this presentation the evolution of technology being used in wound care will be described; the opportunities to improve personal clinical practice by implementing new technology in wound care will be identified; and the consequences of the global energy sparing effect will be outlined.
Combat wounds, despite advances in the field of wound care, remain a therapeutic challenge of considerable proportions for several reasons: a. The non-permissive ground where first aid is given to the wounded. 2. The complexity of the trauma which is usually high energy. 3. The limited immediate availability of dressings and devices in the field environment. 4. The capacity for care available in the field hospital. 5. The possibility of resorting to timely medical evacuation (medevac).
The asymmetry of the current conflicts also rises more difficult to determine a correct assessment of the lesions for the purpose of a targeted triage and the consequent treatment of large tissue losses of not perfectly known etiology.
The correct collection of data by health intelligence to predict the emerging needs of a medical treatment facility and the necessary experience of the surgical team are only the basis on which to build a therapeutic project suitable for dealing with the multifaceted variety of combat injuries.
In the light of the long clinical experience gained in 30 years of humanitarian missions around the world, I can still state that a suitable therapeutic strategy for combat wounds is based on 7 pillars: 1. Patient/wound assessment and triage 2. Cleansing and Debridement 3. N.P.W.T 4. Antimicrobial Dressing 5. Intravenous antibiotics 6. Reconstructive Surgery eligible for the Field Hospital 7. Medevac/Stratevac.
Inadequate or insufficient nurse staffing levels increases the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient death in hospitals and poorer patient experience of care. Additionally insufficient or inappropriate nursing staffing has an impact on staff well-being and recruitment and retention of staff. There is a worldwide shortage of suitably qualified nurses and post-COVID this shortage is projected to worsen. All of this is of direct relevance to wound prevention and wound management and there is an urgent and critical need to address this.