Brown David B, Chibi Mohamed Tazi, Searles Raymond V, Hassani Nadia
Utah National Guard, Salt Lake City.
Morocco Forces Armie Royale, Rabat.
Fed Pract. 2023 Aug;40(8):248-255. doi: 10.12788/fp.0400. Epub 2023 Aug 13.
Approaches to chronic wound care are worlds apart: In developing nations, the care of chronic wounds often involves traditional management with local products (eg, honey, boiled potato peels, aloe vera gel, banana leaves); whereas in developed nations, more expensive and technologically advanced products are available (eg, wound vacuum, saline wound chamber, hyperbaric oxygen therapy, antibacterial foam). The cost for wound care plays a significant role in total health care costs, and that cost is expected to rise dramatically.
A healthy, 60-year-old man presented after being bitten by a spider 6 days earlier. He was treated and prescribed clindamycin 300 mg 4 times daily for 14 days. Despite treatment, the wound continued to enlarge, and the patient showed symptoms of septicemia. The patient was admitted to the hospital and remained for 3 days. On discharge the patient was given a prescription for doxycycline 100 mg twice a day for 10 days and instructed to use iodoform gauze to pack the wound during daily dressing changes. However, the gauze was ineffective. The patient's dressing was switched to an antibacterial foam dressing impregnated with gentian violet and methylene blue.
There is a disparity in available wound care product availability. Modern products may yield faster healing times with fewer adverse effects than traditional products. Products used by local healers can produce satisfactory results when more modern products are unavailable and at a fraction of the cost.
慢性伤口护理方法截然不同:在发展中国家,慢性伤口护理通常采用使用当地产品的传统方法(如蜂蜜、煮过的土豆皮、芦荟凝胶、香蕉叶);而在发达国家,有更昂贵且技术更先进的产品可供使用(如伤口负压吸引、盐水伤口腔、高压氧治疗、抗菌泡沫)。伤口护理成本在总体医疗保健成本中占重要比例,且预计该成本将大幅上升。
一名60岁健康男性在6天前被蜘蛛咬伤后前来就诊。他接受了治疗并被开了克林霉素,每日4次,每次300毫克,服用14天。尽管进行了治疗,伤口仍继续扩大,患者出现败血症症状。患者入院并住院3天。出院时,患者被开了多西环素,每日2次,每次100毫克,服用10天,并被指示在每日换药时使用碘仿纱布填塞伤口。然而,纱布无效。患者的敷料换成了浸渍有龙胆紫和亚甲蓝的抗菌泡沫敷料。
可用的伤口护理产品存在差异。与传统产品相比,现代产品可能愈合时间更快且不良反应更少。当无法获得更现代的产品时,当地治疗师使用的产品能以较低的成本产生令人满意的效果。