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
樟宜综合医院为慢性伤口患者设立一站式治疗中心
许多人皮肤上的损伤可能会在一夜之间愈合，但对有些人来说，可能需要数月甚至数年才能复原。这些难以愈合或慢性的伤口在全球，甚至新加坡已成为日趋严重的问题。老年人因患有潜在医疗状况如糖尿病、心血管和外周血管疾病等，以及行动不便，更容易受到此类问题所影响。慢性伤口的性质可为复杂和多原的，并带各种潜在原因。如果不深入调查，其中一些可能不易被发现。
从骨科到血管科、以及整形和重建手术外科，樟宜综合医院设立了跨学专科治疗团队的一站式伤口愈合中心，为患者提供方便和快捷的就诊机会。这项措施由伤口专科护士，以及足病学治疗师、放射技师、物理治疗师和营养师管理所支持。他们在诊断、护理和陪伴患者康复方面，各自扮演着重要的角色。患者可以在同一天内在伤口愈合中心接受诊断测试、评估和门诊治疗。
伤口延迟康复会导致并发症，例如傷口感染和以至于需要截肢的坏疽。樟宜综合医院伤口愈合中心主任兼外科顾问何俊贤说：“预防性干预、早诊断、及时治疗和持续护理是保持社区患者健康的关键，以便他们能够维持一定的生活质量。”该中心的专科和伤口护理护士都接受过全方位傷口护理的培训。护士会根据患者的需要并借助多种技术，例如电刺激愈合和超声波床边清创等来对复杂的伤口进行治疗以减轻疼痛。
樟宜综合医院伤口愈合中心副处长兼护理总监方月卿女士说：“慢性伤口通常会导致剧烈疼痛和情绪困扰。然而，患者和看护往往在伤口晚期才求诊，这让伤口更难治疗和愈合。一个全面和协调的护理方式将缩短康复过程。”中心也在筹备与社区医院和疗养院合作的计划，以及早发觉有慢性伤口症状的患者。
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