We have touched on Wound Aetiology previously, however in this episode we dive deeper into how wound types interface with mechanism of injury and dilemas faced when there are multiple causes - what actually is a mixed wound?. We canvass all the major hard to heal wound types including incontinence associated dermatitis, pressure injury, skin tears, moisture lesions, chronic oedema, venous, arterial and more. How does this all relate to management of these wounds? We're sure our discussions in this episode will raise a few clinical conundrums and questions for you. Indeed, you may start to see more of these in your own practice and become more aware of these prickly challenges. The simple isn't always so simple.

Timestamps:

00:00 Introduction

01:12 Mechanism of injury versus aetiology

02:30 The value of clinical audit and quality indicators

03:20 Misdiagnosis of Incontinence-Associated Dermatitis (IAD)

03:56 Intertriginous dermatitis misdiagnosed as IAD

05:29 The challenges of addressing gaps in clinical guidelines

06:03 Be confident to be unconfident

06:20 What is the mechanism of injury for skin loss in IAD?

07:21 When experts conclude that the simple ain’t that simple

08:45 When clinicians are approached by academics to fit a square peg into a round hole

10:36 Tips for researchers undertaking research in venous leg ulcers

11:52 When wound education is siloed and does not replicate clinical reality

13:35 Making clinical hunches and not always on the first visit/assessment and that’s OK

13:50 Current wound documentation does not support multiple aetiologies and impediments to healing

14:00 Challenge of teaching clinical realities to students when they are taught in siloes

14:33 Figuring out what is the predominant aetiology

14:50 How do we define and teach simple versus complex wound

15:13 Mixed aetiologies presenting above and below the groin

15:56 Prioritising which aetiology to treat / manage

16:57 Post operative wound dehiscence and lymphoedema

17:48 Capacity building in lymphoedema

19:27 The need for clinicians working in Hospital in the Home to understand lymphoedema

19:43 The challenge of diagnosing inflammatory conditions such as IAD and intertriginous dermatitis of the pelvic girdle

20:30 Influence of climate on dressing performance and skin injuries

21:00 Mixed aetiologies of the pelvic girdle

22:20 Is IAD avoidable and how easy is it to categorise, manage and report

24:00 Continue reevaluating aetiology

24:12 It is OK change or add to aetiology if clinical rationale can be provided

24:57 Call it what it is. A vascular assessment includes arteries, veins and lymphatics, not just the arteries

25:21 Venous disease plus a wound on the same leg does not necessarily mean the wound is of venous aetiology

26:57 Mechanism of injury v aetiology v impediments to healing. Simple v complex

28:40 Opportunities to improve accuracy of wound data reporting and quality improvement

30:27 When is a stage 1 Pressure Injury of the foot, a “Diabetic Foot Ulcer”

Resources mentioned:

• GlobIAD Incontinence Associated Dermatitis - Tools https://www.skintghent.be/en/onderzoek/tools/2/incontinence-associated-dermatitis-iad
• Australian Aged Care Quality and Safety Commission - Incontinence associated dermatitis and pressure injury https://www.agedcarequality.gov.au/news-publications/clinical-alerts/incontinence-associated-dermatitis-and-pressure-injury

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