Balancing the wound micro-environment:​ interconnecting issues leading to outcomes

Wound balance is a conceptual framework that combines the science of wound healing with patient factors that can limit successful outcomes. To attain wound balance a key management strategy includes the identification and mitigation of factors associated with delayed wound healing prior to observing “chronicity” of 4-12 weeks. These factors can include inflammation, biofilm, nutritional deficiencies, co-morbid disease control, social determinants of health, and lifestyle.

A case-based example of complex wounds was utilized to demonstrate the attainment of wound balance. To maintain an internal focus of control the patient’s individual needs were continually solicited with each key case management strategy (ie site of care delivery, compression, off-loading, dressing selection) and at each visit. A flexible spectrum of interventions are offered contingent upon patient centered variables and escalated/titrated as tolerated and accessible to the patient.

Goal based care plans were implemented consistently with healing as the end point unless palliative care was mutually agreed upon due to non-modifiable barriers at the time. Multi-modal wound management included appropriate cleansing agents, anti-inflammation and biofilm-based treatment, and moisture management. Wound etiology provides an overarching consideration for adjunctive healing interventions and the identification of factors that limit healing.

Proactive wound management with a goal directed care plan that focuses on healing, or symptom management when appropriate, limits factors associated with delayed wound healing. Skilled communication of evidence-based practices to address modifiable risk factors associated with dysfunctional wound environments expedites healing as well as limits the psychosocial stress and decreased quality of life that often accompanies the presence of a complex wound.

Wound balance of local and systemic inhibitors of wound healing was achieved as evidenced by wound tissue viability and epithelialization in this example cohort of complex wounds. Moisture management of inflammatory drainage, including proteases and cytokines, was consistently addressed utilizing silicone SAP dressings with additional inflammation management utilizing collagen with anti-biofilm elements as needed.

Laura Swoboda

DNP, APNP, FNP-C, FNP-BC, CWOCN-AP, WOCNF | The Healing Institute | Clinical & Translational Science Institute of Southeast Wisconsin, Milwaukee Metro, Wisconsin

This poster, presented at the SAWC Fall 2023 (Symposium on Advanced Wound Care Fall), alongside a corresponding presentation by Dr. Alton Johnson, offers an in-depth look into the Wound Balance Concept. Through cases and comprehensive discussion, they illustrate the practical application of achieving Wound Balance, emphasizing its benefits for both patients and the care team.