Journals on repair and regeneration of the skin are abundant and far reaching and have greatly helped in the the development of skin care. Many wound healing organisations were initiated by Dermatologists in dermatology departments from the work of Ryan and Lapiere, Westerhoff, and Romanelli in Europe to Eaglestein and Lazarus In America, and management has had a strong nursing input through tissue viability organisations. These organisations have brought us some of the most far reaching aids and industry devices such as dressings and many offloading devices . Also, the advances in stem cell research have provided insight into regeneration. There are numerous partners, many growing out of dermatology departments recognising the need for better management of non-healing wounds and the burden of lymphoedema. They include plastic surgery podiatry and the nursing profession.
Warning Much work is still to be done in this area, continuing from a broad and dense base of work across multiple disciplines. We must strive to focus and aim our work, consolidating research across plains of illness.
Action It was the need for additional advice on wound healing in the management of Buruli Ulcers that lead to lists of five essential interventions for wounds and three for lymphoedema.
1. Treat Systemic Illness eg Anaemia Diabetes, Malinancy.
2. Protect the wound from Trauma.Cover and offload.
3. Promote a clean wound bed and reduce infection of the wound base.
4. Maintain a moist environment.
5. Control oedema.
1. Increase Lymph flow: eg by body movements including breathing.
2. Reduce overload from a failing venous system; eg by elevation and ankle movement.
3. Reduce overload by managing Inflammation due to infection or irritants.
Arterial Disease of lower limb:
1. Stop smoking.
2. Keep walking.
3. Wash and apply emollients to the whole leg.