Authors:
- Tamara Sinožić – Specialist Family Medicine Practice Tamara Sinožić, MD, Specialist in Family Medicine, Barba Rike 5a, Mošćenička Draga, University of Rijeka, Faculty of Medicine, Department of Family Medicine
- Jadranka Kovačević – Specialist Family Medicine Practice Tamara Sinožić, MD, Specialist in Family Medicine, Barba Rike 5a, Mošćenička Draga
Article type:
Case Report
Abstract:
In the process of wound healing, numerous mechanisms occur that, even under ideal circumstances, produce functionally less valuable tissue with structural and functional changes. There are many risk factors for the development of chronic and so-called hard-to-heal wounds. The presence of a wound, as well as prolonged treatment duration, affect all aspects of the patient’s life and lead to a decline in quality of life.
A model of care based on the principle of comprehensive individualized care with a biopsychosocial approach is presented through the case of an obese patient with lower leg wounds, lymphedema, and difficult, painful mobility due to hip osteoarthritis and peroneal nerve paresis with clubfoot. Non-healing wounds and obesity were obstacles to the necessary surgical total hip endoprosthesis implantation.
Diagnostic procedures included patient and healing factor assessments, vascular status evaluation of the legs by ultrasound color Doppler imaging and ankle-brachial index measurement, as well as assessment of edema, wounds, and the patient’s psychosocial status. Therapy involved compression therapy devices, local wound therapy, dressings, and skin care. The patient and a family member were educated on compression therapy, with advice and counseling on diet, exercise, and supportive psychotherapy.
Chronic wounds on the right lower leg healed in two weeks, and on the left in eleven weeks, without recurrence for two years. Within 20 months, the patient achieved the recommended body weight and underwent the planned operation, resulting in the disappearance of pain and improved walking without complications. The partnership relationship with the patient, characterized by high motivation and adherence—especially to compression therapy—influenced not only wound healing, which was the primary goal, but also the overall improvement of the patient’s quality of life.
Such a scope of care requires additional specific knowledge and skills of healthcare professionals, as well as additional equipment for medical institutions caring for patients with wounds.
Keywords:
chronic wound, comprehensive care, compression therapy, lymphedema, obesity