Under the initiative and supervision of Dr. Angelos Karatzias, Plastic, Aesthetic and Reconstructive Surgeon, Specialist Doctor in Wound Management and Tissue Repair, AKP Wound Healing – The Professional Mobile Unit is an innovative service provision for home health care, consisting of a team of health care professionals who are responsible for following the health care needs of their patients on
a continuous long-term basis across settings. AKP Wound healing is a home care company dedicated to dealing with chronic wounds and traumas for people unable or unwilling to be transferred from their home, hospital or nursing home. This professional unit provides complete, adequate and holistic treatment of the patients with ulcer-traumas, having as final objective the complete healing. At the moment, this is the only medical unit of this type operating in Cyprus, with an experience as a mobile unit, operating according to international quality standards in both evaluating the needs of the patient and the specific treatment. Our patients are:
- people who have access at times to alternative treatments but they are simply unaware or do not know how to effectively make use of them;
- people who do not have physically access to medical services or advice;
- people who prefer privacy and confidentiality for their treatments or medical interventions, and they prefer the setting of their own homes;
- people who cannot be transferred or transported to a medical facility
Our Mobile Unit has the ability to add individual treatments, perform detailed assessments, and schedule follow-ups. The nurse of the Mobile Unit takes pictures of the patient’s wound and sends them to the Specialist (Dr. Karatzias) who can assess the progress of the wound and advise both patient and home caretaker. Thus, early symptoms of complications such as infections could be diagnoses quickly, avoiding degeneration of patient’s health and the need for surgical procedures such as amputations due to long-term ineffective care. Our services include the treatment of:
1) BEDSORES
Evaluation
Tests
Treatment
Reduce pressure
Cleaning and dressing wounds
Remove damaged tissue
2) POST-OPERATIVE WOUNDS
Keep wounds clean (dressing & cleaning the wound, Antibiotic treatment, debridement)
Timely review of the wound, appropriate cleansing and dressing, early recognition and intervention of wound complications
3) DIABETIC ULCERS
Prevent ulcer from getting infected
Keep the ulcer clean and bandaged
Cleanse the wound daily, using a wound dressing or bandage / apply medication or dressing to the ulcer.
4) VENOUS ULCERS
Compression therapy
Wound debridement – remove necrotic tissue and bacterial burden through debridement
Apply dressings and antibiotics
Patient education
5) ARTERIAL ULCERS
Patient education
Debridement
Use of occlusive dressings
Pain control
Improve circulation
6) OTHER WOUNDS
First aid for superficial wounds (require cleansing and dressing), in order to prevent complications and preserve function. Prevent infection; assure there are no associated injuries
Control bleeding
Our Procedure
Assessment
All patients with wounds will have their wounds appropriately assessed by our nurse. The considerations for the assessment are:
- Wound bed – granulating, epithelial, slough, necrotic, hyper granulating
- Wound measurement
- Wound edges
- Exudates
- Infection
- Surrounding skin
- Pain
Among the factors delaying the wound healing are to be mentioned:
- Malnutrition- inadequate supply of protein, carbohydrates, fatty acids, and trace elements essential for all phases of wound healing
- Reduced Blood supply - Cardiovascular disorders and Ischemia
- Medication - Non-steroidal anti inflammatory drugs and Corticosteroids.
- Psychological stress and lack of sleep- increase risk of infection and delayed healing
- Obesity - decreases tissue perfusion
- Infection -prolong inflammatory phase, use vital nutrients, impair epithelialisation and release toxins
- Reduced wound temperature - prolonged dressing changes or use of cold cleansing products.
- Underlying Disease - Diabetes Myelitis and Autoimmune disorders
- Maceration - excess wound exudates or contact with bodily fluids reduces wound tensile strength
- Patient compliance
- Unrelieved pressure
- Immobility
- Substance abuse including alcohol and smoking
Phases of wound healing we consider:
Inflammatory phase – it is the body’s normal response to injury. Proliferative phase – the time when the wound is healing. In this phase we include reconstruction and epithelialisation. The wound becomes smaller and starts to heal. Maturation phase – the final healing, when the scars form. In this stage the wound is still at risk and must be protected as much as possible. The mechanisms in wound healing we consider:
• Primary Intention - most clean surgical wounds and recent traumatic injuries are managed by primary closure. The edges of the wounds are approximated with sterile strips, glue, sutures and/or staples. Minimal loss of tissue and scarring results.
• Delayed Primary Intention - is defined as the surgical closure of a wound 3 -5 days after the thorough cleansing or debridement of the wound bed. We use for traumatic wounds, and contaminated surgical wounds.
• Secondary intention - occurs slowly by granulation, contraction and re-epithelialisation and results in scar formation. Most commonly we use it for pressure Injuries, leg ulcers and open discharging wounds
• Skin Graft - removal of partial or full thickness segment of skin from its blood supply and transplanting it to another site to speed up healing and reduce the risk of infection.
• Flap - is a surgical relocation of skin and underlying structures to repair a wound. Our team carefully re-assesses each and every wound with every dressing change to ensure the most appropriate products are used. Evaluation of assessment
In the evaluation phase of assessment, we ensure the information collected is complete, accurate and documented appropriately. Our nurse will draw on critical thinking and problem solving skills to make clinical decisions and plan care for the patient being assessed. If any abnormal findings are identified, the nurse ensures that appropriate action is taken. This may include communicating the findings to the Specialist Doctor. Our patients are continuously assessed for changes in condition.
