A tear in the skin may heal overnight for many, but for some, it can take months or even years for the wound to recover. These hard-to-heal or chronic wounds are an escalating problem worldwide and in Singapore. Today, one in 20 Singaporeans is afflicted with chronic wound conditions such as diabetic foot ulcers, pressure injuries, and arterial and venous ulcers. This is expected to increase due to an ageing population and prevalence of diabetes.
Seniors are more likely to be affected by such issues, due to underlying comorbidities such as diabetes, cardiovascular and peripheral vascular diseases, and reduced mobility. Chronic wounds can be complex and multi-factorial, with various underlying causes — some of which may not be obvious without further investigations. For example, a chronic wound on the lower limb may be referred to an orthopaedics specialist based on its location. However, the wound may not be recovering because the valves in the veins are not working effectively, and this would actually be best treated by a vascular surgeon.
CGH vascular consultant Dr Derek Ho and Nurse Clinician Ong Ling attending to a patient’s chronic wound.
Bringing together a multi-disciplinary care team — from orthopaedics to vascular, plastic and reconstructive surgery — Changi General Hospital (CGH) has set up a one-stop
Wound Healing Centre (WHC) to provide easy, fast-tracked access and convenience for patients with non-healing wounds. This is supported by wound specialist nurses, as well as radiographers, podiatrists, physiotherapists and dietitians who each play a key role in diagnosing, caring and journeying with patients to recovery.
“Preventive interventions, early diagnosis, timely treatment and continued care are essential to keep our community well so that they can maintain their quality of life.”
Dr Derek Ho, WHC Director and Consultant, Department of Surgery (Vascular Surgery), CGH
Patients can undergo diagnostic tests, assessments and outpatient treatments all within the same day at the Centre. This reduces the need for multiple visits to receive appropriate care, and this is crucial for those who are afflicted. “Time is of the essence. When you have a wound that does not seem to recover after a month or two, do not let it fester longer but seek treatment early,” said Professor Ng Wai Hoe, Chief Executive Officer, Changi General Hospital. “We designed the care journey at the Wound Healing Centre to achieve the best possible outcomes with our patients in mind.”
Delayed recovery can lead to complications such as infections and gangrene requiring amputations. Gangrene occurs when body tissue dies due to a lack of blood flow or a serious bacterial infection. About 200 amputations are done in CGH yearly due to diabetes or peripheral vascular disease, which is a slow and progressive blood circulation disorder.
Specialists and wound care nurses at the Centre are trained in the full spectrum of wound management. Depending on the needs of the patient, the nurses are able to perform therapy for complex wounds and leverage a variety of technologies such as electrical stimulation for healing and ultrasonic bedside debridement to ease the pain.
CGH EMBARKS ON RESEARCH FOR BETTER PATIENT OUTCOMES
To further establish the WHC in the areas of research and innovation, CGH signed a Memorandum of Understanding (MOU) with local biotechnology company Celligenics, marking the start of a new public-private partnership. Besides conducting joint research and development focused on accelerating healing, CGH will also be a test bed for innovative wound care solutions through clinical trials.
“Chronic wounds often cause immense pain and emotional distress. However, patients and caregivers often come to us only during the late stages of the wounds, which makes them harder to treat and heal. A holistic and coordinated care approach will shorten the runway for the healing process,” added Ms Png Gek Kheng, Chief Nurse, CGH, and an Advanced Practice Nurse specialising in geriatric care.
Plans are also in the pipeline to work with community hospitals and nursing homes to identify patients with chronic wound symptoms for early detection.
FACTS AND FIGURES
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