The management of Complex Wounds in a South America Country

Introduction: Complex wound is the term used more recently to identify those chronic wounds or even some acute wounds that despite being well-known, challenge medical and nursing  teams (Ferreira, Tuma, Fernandes, & Kamamoto, 2006; Vowden, 2011).  Aim: To present the management of complex wounds implemented by an interdisciplinary team in a wound care ambulatory. Methods: Prospective description of clinical cases of patients with complex wounds managed in a South America Country, between November 2011 and March 2012, after approval of a Research Ethics Committee (No. 2011/139). The criteria to select the dressing to the management of complex wounds were: availability of the products/dressing, patients’ preference, aetiology and characteristics of the wound and knowledge and skills of the professionals. Thus, considering the criteria above the products and dressing used were the following: 1) alginate associated to coal dressing; 2) alginate dressing alone; 3) papain-based-paste; and 4) compression therapy. The conservative sharp debridement was associated with an enzymatic debridment performed by a wound-care nurse. Results: six patients were selected, 4 (66.7%) were female and 2 (33.3%) males, aged ≥ 60 and retired (66.7%) and aged <60 years and working on trade (33.3%). Regarding to the etiology of complex wounds, 3 (50%) were venous ulcers, 2 (33.3%) were neuropathic ulcers and 1 (16.7%) ulcer due to dermal reaction to the treatment of leprosy in a patient with diabetes mellitus. The healing process was resolved at 4 months in the majority of the cases (66.7%) with 2 cases (33.3%) healing in 2 months and 3 months respectively.  Conclusions: Assessment of the patient, identification of the underlying causes, availability of the dressing and patients’ preference as well as considerations of competency, skills and access to a reference service are essentials to the success of the management of complex wounds in a developing country.