Wound Infection Preconference Session at SAWC Fall

In this preconference session, Dr. Fernandez discusses the topic of wound infection and the key takeaways from his session co-presented with Abigail Chaffin, MD; Elizabeth Faust, MSN, CRNP; Paul Kim, DPM; Carol Marshall Hanson, MSN; and Dot Weir, RN, CWON at SAWC Fall 2023 in Las Vegas, Nevada.

Transcript

Luis Fernandez, MD:

My name is Luis Fernandez, I'm a professor of surgery at University of Texas, Tyler. I'm the endowed chair in trauma surgery there, and I'm a trauma critical care surgeon and complex wound specialist.

It's a bit of a complex argument, excuse me, response. The wounds itself carry their own issues, so depending on the mechanism, the contaminants for the field, et cetera and so forth, those are the things that the wound brings into the equation. And also, there's comorbidities from each individual patient. For example, you may have patients that are vasculopaths. You may have patients that have some form of immunocompromised, diabetic, for example, are fairly common, or someone who's been treated for a malignancy who is receiving chemotherapeutic agents or radiation and so forth. All of these things impact the whole process of wound healing. There's two components. One is what the causative agent of the wound was, and then the host itself, and how those 2 things interact. And it's very complicated in many cases, and it requires a multiple disciplinary approach to achieve the best outcome.

There's been some recent consensus guidelines, particularly in wound irrigation, for example, using hypochlorous acid as the preferred agent. This is something we've discussed for many, many years, and I know I published in your publication on some of these issues, and so has many of my colleagues. The reason that it's come more to the fore is that it's actually, we do it all the time, and we do it as a part of our oxidative burst mechanism within our own body's immune response. And now we have an agent that provides us more than adequate kill ratios on offending organisms with minimal toxicity, which has been like the holy grail of wound irrigation and wound debridement substances. I think that's one of the components.

The other components that you have are, "What other things can stimulate granulation tissue?" Well, we have biomechanical ones such as negative pressure therapy. Some of which we've discussed before, the 3M KCI products and so forth have been published significantly on this. And that actually causes direct physical contact to the cellular exoskeleton, which causes etiologic response for cellular duplication. And there's many different approaches, but primarily the one important thing that you have to do, particularly in chronic wounds, is to remove the bioburden that's in that wound so that not only can you control what's happening locally in the wound, but it allows the host organism to remove that process off themselves and then hopefully enhance its ability to heal. And that's what we're all going after.

I think when you look at wound infections, the way I look at, it's the canary in the coal mine. It's only what you're seeing, but there's a myriad other components that one has to take into consideration. I've mentioned some of them, which is the immunocompetence of the host. Also, nutrition is a huge important component. Vascular supply, lymphatics, venous, et cetera. There are multiple aspects that one has to take into consideration in order to achieve the end goal in the most effective and cost-effective fashion. It requires more than just, "Hey, look, I've got this wound and we're going to cut this stuff out, and we're going to put this salve, or dressing, or whatever on it. Maybe put some negative pressure and I'll see you in a week." That's a very superficial approach. You actually have to go in depth into the patient, find out what is this particular person, what are their resources, what are their capabilities from a physiologic standpoint, and then how can we enhance those things so that they can heal.