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Healing Wounds, Healthy Skin

Healing Wounds, Healthy Skin: A Practical Guide for Patients with Chronic Wounds

Madhuri Reddy
Rebecca Cottrill
Illustrations by Victoria Cansino
Copyright Date: 2011
Published by: Yale University Press
Pages: 336
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  • Book Info
    Healing Wounds, Healthy Skin
    Book Description:

    Seven million Americans suffer from chronic or slow-healing wounds-this number includes people with diabetes, dementia, paralysis, spinal cord injury, multiple sclerosis, and poor circulation, as well as the elderly and those with reduced mobility.Healing Wounds, Healthy Skinprovides patients and caregivers with everything they need to know on the subject, including: •Why chronic wounds develop and who is at risk of developing them•What "normal healing" is•What the different types of wounds are, including those associated with chronic disease•How to find appropriate care and get a correct diagnosis•What role exercise and nutrition play in treatment and prevention•What treatment options are available, from surgery to alternative therapies

    Also covered are the patients' psychological and emotional experiences, myths about wounds and wound healing, steps to take in an emergency, and a wound patient's bill of rights. With up-to-date information, insightful patient case histories, and a wealth of essential resources, this is the book that chronic wound patients and their caregivers can turn to with confidence.

    eISBN: 978-0-300-17172-3
    Subjects: Health Sciences, Public Health

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Acknowledgments
    (pp. xi-xii)
  4. Healing Your Wound: The Top Ten Myths Dispelled
    (pp. xiii-xvi)
  5. Preface
    (pp. xvii-xxii)
  6. PART ONE: When You Have a Wound That Won’t Heal

    • [PART ONE: Introduction]
      (pp. 1-4)

      The skin is the largest organ in the body and is composed of an outer layer and an inner layer. A layer of fatty tissue lies beneath these two layers (Figure 1).

      The thickest skin is located on the palms of the hands and on the soles of the feet, and it can be ten times thicker than the thinnest skin, which is found around the eyes and over the eardrums.

      Skin acts as a protective shield between your vital organs (such as your heart and lungs) and the external world. The skin also acts as a barrier against bacteria...

    • 1 How Wounds Heal
      (pp. 5-9)

      Any break in the skin is considered a wound*. The severity of a wound depends on how much damage there is: a wound can vary from a superficial break in the top layer of skin to deep trauma that involves the muscle and bone.

      Healing a wound is like rebuilding a damaged house (Figure 2). The construction of a house is made up of a series of organized and synchronized processes. Without the right signals at the right time, a house cannot be rebuilt, nor will a wound be healed. Think of blood flow to the wound as the workers...

    • 2 Recognizing Your Fears
      (pp. 10-15)

      When your wound persists, you and your loved one may experience a variety of emotions ranging from anger, denial, and anxiety to depression. These feelings don’t occur in any particular order and vary from person to person. You may also experience emotions that are not directly related to the slowly healing wound, such as fear of what the future holds and worries about work or finances.

      Before you can take any positive steps towards feeling better, it’s important to identify your fears. In this chapter, we will address some of the more common fears associated with a prolonged nonhealing wound,...

    • 3 Creating Your Health-Care Team: It Takes a Village
      (pp. 16-23)

      The health-care system can be a complex maze that is difficult to navigate. Having to visit several different health-care specialists (as many people with chronic wounds do) can aggravate this already confusing situation. To help you avoid as many health-care challenges as possible, we will show you how to find and coordinate the care and support you need. It helps enormously to be well informed about your medical issues and your own care. We’ll assist you with strategies to achieve this goal, and also will help you understand some of the language that your wound team may use.

      The number...

    • 4 Your Initial Visit with the Wound Team
      (pp. 24-32)

      Finding out what caused your wound in the first place is the most important part in healing it. This investigation may involve one or more medical tests. In this chapter, we describe the various tests your wound care team may have to do to make a diagnosis and find the cause for any other symptoms you may be having.

      One of the factors that may complicate this process is that there is not always one specific test or type of X-ray that can be used to find the wound’s cause. Finding the cause of chronic wounds requires some detective work....

  7. PART TWO: Pressure Sores

    • [PART TWO: Introduction]
      (pp. 33-34)

      Pressure sores are known by many different names: bedsores, decubitus ulcers, or pressure ulcers. Nearly 3 million Americans have one or more pressure sores. Pressure sores are a serious health problem, particularly in certain populations, such as residents of nursing homes, patients in hospitals, older persons, and people with paraplegia.

      All tissues in the body (whether skin, muscle, or fat) depend on blood circulation for the oxygen and nutrients they need. Compression of these tissues (from immobility, for example) interferes with circulation, reducing or completely cutting off blood flow. The result, known as ischemia*, is that tissues fail to receive...

    • 5 Why Do Pressure Sores Happen?
      (pp. 35-45)

      If you have difficulty moving around, such as after a spinal cord injury, stroke, or simply being too weak from a long hospital stay, you are at risk of getting a pressure sore.

      Pressure sores are most common in areas on your body where an object (such as a mattress) compresses skin and the underlying tissues over a bone (such as a hip) in the body. Other factors that contribute to the problem include shearing forces, friction, and moisture. A little pressure and a little of one or more of these other factors will greatly increase your risk of developing...

    • 6 Prevention Is Always Best
      (pp. 46-54)

      Once you suspect that you may be at risk for developing pressure sores, you are already one step ahead of the game. Now you can take action to prevent them from occurring.

      Support aids, cushions, and beds play an important role in pressure ulcer prevention (for more information on beds and cushions, see Chapter 7). Proper nutrition, including a balanced diet and maintaining a healthy body weight, is also important for preventing and healing pressure ulcers (see Chapter 32). Common problems with skin that can make wounds more likely to occur, or keep wounds from healing properly, are discussed in...

    • 7 Beds and Cushions: Expensive Is Not Always Best
      (pp. 55-62)

      The variety of products geared to effective prevention and treatment of your pressure ulcer can be overwhelming. Options to choose from include special beds, mattresses, and seating options that now use foams, gels, water, and air as cushions. The more you and your loved ones learn about your options, the better prepared you all are to give the best care possible.

      Horizontal support surfaces include beds, mattresses, and mattress overlays. These products use foams, gels, water, or air to reduce pressure while you lie in bed.

      Specialty beds, such as rotating beds, relieve pressure by rotating your body or helping...

  8. PART THREE: Foot Wounds:: Diabetes and Beyond

    • [PART THREE: Introduction]
      (pp. 63-66)

      If you have diabetes, you may be prone to developing foot ulcers due to nerve damage (neuropathy*) and poor blood circulation. You are at even higher risk if your blood sugar is often too high or too low. In addition to foot ulcers, people with diabetes can also develop wounds in other parts of their body (we discuss these nonfoot wounds in Chapter 16).

      Good diabetes control may help prevent all of these potentially serious problems or at least make them less severe. It is never too early or too late to optimize your blood sugar control. Better control of...

    • 8 The Foot Wound That Doesn’t Hurt
      (pp. 67-75)

      When you have diabetes, wounds can happen for many reasons. Nerve damage, high pressure and friction (for example, shoes that rub because they do not fit properly), and poor circulation can cause foot ulcers.

      Neuropathy is the main reason that ulcers develop in people with diabetes. Neuropathy is a nerve disorder that results in impaired function in the skin or muscle served by the affected nerves. In diabetes, neuropathy may be caused by direct nerve damage or poor blood circulation leading to nerve damage.

      People with diabetes tend to have poor blood circulation due to thickening in the tiny blood...

    • 9 Shoes and Socks: When What You Wear Can Be the Best Medicine
      (pp. 76-82)

      If you have diabetes (or neuropathy from another cause) and your shoes and socks don’t fit properly, serious problems may occur. Wearing appropriate shoes and socks may help avoid potential wounds, and especially if you have had foot wounds in the past, preventing wounds is much easier than treating them. If you already have a wound, the correct socks and shoes are even more important.

      If you have diabetes, your socks should not be too tight, and should not have seams on the inside, where they can rub and put pressure on the skin. If they do have seams, you...

  9. PART FOUR: Blood Circulation:: Essential for Healing

    • [PART FOUR: Introduction]
      (pp. 83-86)

      The wordcirculation* refers to the system of blood circulating in your body. The circulatory system (also known as the vascular system) is made up of arteries, veins, capillaries, and lymphatics. Arteries carry blood from the heart to the rest of the body, and veins carry blood from the rest of the body back to the heart (Figure 14). Capillaries connect these two systems. Miles of arteries, capillaries, and veins keep blood circulating from the heart to every part of the body and back again.

      Your circulation affects how much blood flow is going to and from the region of...

    • 10 Venous Wounds: Dealing with Foot and Leg Wounds if Your Circulation Is Good
      (pp. 87-93)

      When you have good blood flow to the legs and feet, your wounds are most likely due to problems with your veins (for example, varicose veins). Ulcers due to problem veins are called venous ulcers. Venous ulcers cause 70 to 90 percent of all leg ulcers. There are other, unusual causes for leg ulcers, however, so it is important that your wound care team assesses you and diagnoses the exact cause. This chapter explains why venous ulcers develop and discusses how they can be prevented and treated.

      Venous ulcers occur on the lower leg and become more common as people...

    • 11 Arterial Wounds: Dealing with Foot and Leg Wounds if Your Circulation Is Poor
      (pp. 94-102)

      Many people with diabetes have poor circulation as well, also called arterial disease. People may have arterial disease even without diabetes. If you have an arterial ulcer* it means that you do not have enough blood flowingtoyour legs and feet (venous ulcers are due to impaired blood flowfromyour legs and feet back up to your heart). These wounds are also called ischemic ulcers*. It is estimated that between 5 to 20 percent of all leg ulcers are caused by problems with arteries.

      Arteries carry blood leaving the heart to every part of the body. Arterial ulcers...

    • 12 Swelling: What Your Achy Feet Are Telling You
      (pp. 103-110)

      Have you wondered why your lower legs and feet at times seem to swell up like balloons? Have you wondered if there is something you can do for your loved one who complains of this swelling? As with so many other conditions, you don’t have to “just deal with it.” This chapter will teach you about this condition, also called edema, and what you can do to help you or your loved one.

      Swelling in the lower legs can occur because of underlying medical problems (such as heart or kidney failure), venous disease, or lymphedema. Blockage of the venous system...

  10. PART FIVE: Acute Wounds

    • 13 Healing After Surgery
      (pp. 113-119)

      A surgical wound is an intentional break in the skin as a result of surgery; these breaks in the skin are called incisions and are created by some sort of surgical tool, like a scalpel. In a healthy person, this type of wound responds well to postoperative care and heals without any major problems in a relatively short period of time.

      Sometimes wounds made during surgery can take a long time to heal and become chronic. Healing depends on the type of wound you have, and if you have any underlying medical conditions that contribute to poor wound healing. In...

    • 14 Traumatic Wounds: Burns, Cuts, and More
      (pp. 120-126)

      A traumatic wound is a sudden, unplanned injury to the skin that can range from minor (such as a skinned knee) to severe (such as a gunshot wound). Sometimes a traumatic wound can cause as many long-term problems as a chronic wound.

      If you or your loved one suffers a traumatic wound, call an ambulance. If the wound is severe, if there is a lot of bleeding, or if the wound is deep, you may need to go to the emergency room at the nearest hospital. Time is critical, especially if your injury is severe.

      The medical team will first...

  11. PART SIX: Nonhealing Wounds

    • 15 Infected Wounds
      (pp. 129-132)

      You’ve properly tended to your wound but it is not healing. In fact, it is looking worse as time goes on. Now what?

      If your wound is not healing, you and your wound team need to make sure that it is not infected. All wounds that have been open for a few days have bacteria growing in them. This is normal and does not mean that the wound is infected. An infected wound means that the wound has so much bacteria that normal wound healing is prevented.

      Studies suggest that infection may be the cause of almost half of all...

    • 16 Unusual Wounds
      (pp. 133-136)

      Unusual wounds can take a long time for health-care teams to diagnose properly. Sometimes, your wound team can tell what the cause of the wound is simply by looking at it; other times, the only way to determine the cause of the wound is to do a skin biopsy* (see Chapter 4).

      Pyoderma gangrenosum (also known as PG) causes ulcers to form, usually on the lower legs, but it can occur anywhere. Another common area for PG to occur is around stomas (see Chapter 27). Ulcers usually start out looking like a small bug bite or a blood blister but...

    • 17 Still Not Healing . . . What Are We Missing?
      (pp. 137-142)

      Some issues that may slow or prevent healing can be quite easily diagnosed with the help of your wound care team. We will discuss these issues in this chapter.

      If your wound is very slow to heal, your wound team may do a skin biopsy (see Chapter 4). One reason to do a skin biopsy is to make sure there is no cancer in the wound. Often, a cancer in the wound is quite easily treated, once it is diagnosed, by having it removed.

      Many commonly used medications (over-the-counter and prescription) may slow or prevent wound healing. Types of medications...

  12. PART SEVEN: Wound Treatments:: Let the Healing Begin

    • [PART SEVEN: Introduction]
      (pp. 143-144)

      Coping with the stress of having a wound is plenty to deal with. But figuring out how to properly care for it shouldn’t be an additional burden. There are over one thousand dressings on the market so it can be very confusing to decide what to use.

      Just because one dressing is newer or more expensive than another does not mean it is better—in fact, the opposite can often be true. Even though new products arrive almost daily, and others are updated or improved frequently, some of the older wound care options work best.

      Keep in mind that dressings...

    • 18 What Do I Put on This Wound?
      (pp. 145-149)

      Treatment of all chronic wounds follows the same four basic steps—debridement*, moisture balance, wound protection, and nutrition. Your wound specialist may debride (remove) any dead tissue, provide a moist wound-healing environment through the use of proper dressings, protect the wound from further injury, and advise you on proper nutrition to aid wound healing.

      The first step to dressing your wound is proper cleansing. Wound cleaning is a very important step in the healing process because it gets rid of the dead tissue that harbors bacteria and slows wound healing. Flushing the wound or wiping it clean with sterile water...

    • 19 Growth Factors and Engineered Skin: The Future Is Here
      (pp. 150-153)

      Over the past few years, technologically advanced dressings (called biological dressings*) have become available. Some of these dressings sound like they came right out of science fiction: some look and function like skin but are made from pig membranes; some skin substitutes are made from actual living skin cells, skin growth-enhancing factors, and so on. These dressings can function like skin grafts, except that you don’t have to go through surgery.

      Biological dressings require a noninfected wound with healthy tissue. However, they can get infected so you may need an antimicrobial dressing in addition to the biological dressing. Biological dressings...

    • 20 Adjunctive and Alternative Therapies
      (pp. 154-157)

      A wide variety of wound care aids and products you put on the skin are available to enhance dressings and are used in addition to traditional therapies.

      There is not a lot of strong medical evidence that supports using these sometimes expensive products to heal wounds, but you and your wound team may decide in some cases that they are right for you. Sometimes it may be worth trying a product or device for a couple of weeks to see if there is an improvement in your wound. Remember that addressing the cause of the wound is far more likely...

    • 21 Surgery for Chronic Wound Treatment: When Cutting Can Heal
      (pp. 158-168)

      Most wounds will heal without requiring surgery. Minor procedures, such as cleaning out your wound, are not usually considered surgery, and can typically be done by your wound care team at the bedside or in the office. Sometimes, however, the best way to facilitate healing is through major surgery. Wounds such as pressure ulcers, venous ulcers, and arterial ulcers may benefit from surgery.

      You and your wound need to be a good fit for surgery in order for you to derive benefits from the operation (see box). For example, surgery that is done to heal a pressure ulcer can fail...

  13. PART EIGHT: Wounds in Specific Populations and Conditions

    • 22 Nervous System Damage: Spinal Cord Injury, Spina Bifida, and Multiple Sclerosiss
      (pp. 171-180)

      When it is functioning normally, the skin’s jobs include sweating (to help with cooling and regulating your body’s temperature) and normal sensation (for example, feeling pain, burning, and pressure). Nerves transmit messages from the brain and spinal cord (together called the central nervous system) to the skin and carry messages from the skin back to the spinal cord and brain.

      When these nerves are damaged (such as in spinal cord injury, spina bifida, or multiple sclerosis), the skin cannot do its jobs as well as it should. As a result, if you have nervous system damage, you need to take...

    • 23 Healing Challenges and the Older Person
      (pp. 181-184)

      Chronic wounds are more common in older people than in those who are younger. People over the age of eighty-five are the fastest-growing segment of the older adult population. About half of people over the age of eighty-five live in long-term care facilities (nursing homes), and the other half live at home.

      The reason that chronic wounds are more common in the elderly is that normal wound healing tends to slow with age and with chronic diseases such as diabetes, dementia, and stroke. However, with good care, these older adults with wounds do just as well as younger people do....

    • 24 Children and Teenagers
      (pp. 185-189)

      This book is focused on caring for adults coping with wounds. Sadly, however, newborns and children can also suffer from both acute and chronic wounds. If you are caring for a child’s wounds, this chapter is for you.

      Most wounds in children are caused by accidents, including playground injuries, which result in more than 200,000 emergency room visits each year. Wounds in children normally heal faster than wounds in adults. However, some children suffer from slowly healing wounds, often because of diseases they were born with. The normally rapid wound-healing response of babies and children can be slowed down due...

    • 25 Wounds in Dark Skin
      (pp. 190-195)

      In the United States, African American and Latino populations are the fastest-growing populations over the age of eighty-five. These ethnic groups, along with Asians, Native Americans, and those of Hawaiian/Pacific Islander descent all have high rates of certain types of chronic wounds.

      The color of the skin may sometimes make it difficult for your health-care team to figure out exactly the cause of your skin problems because skin conditions can look different in darker skin than in white skin. People with dark skin are less likely to get skin cancers than people with light skin, but can still get these...

    • 26 Wounds and Excess Weight
      (pp. 196-203)

      Obesity rates in the United States are high and increasing. Sixty-seven percent of Americans are overweight, and 10 to 15 percent are considered obese. Up to one in ten Americans is morbidly obese, with a body mass index (BMI)* greater than 40. Americans spend nearly $33 billion annually in attempts to control or lose weight, whereas $100 billion is spent on obesity-related health problems.

      The frequency of obesity among African American and white men is similar, but it is higher in African American women than in white women. More than 80 percent of African American women aged over forty are...

    • 27 Solutions to Stoma Struggles
      (pp. 204-210)

      If you are coping with a stoma, you are not alone—millions of people have stomas. Skin problems relating to the stoma are extremely common.

      Sometimes a person has an intestinal or urinary disorder where they cannot eliminate waste in the normal way. Therefore, they need a stoma—stomas are like bags and allow for excretion of urine or feces. A stoma is a surgically created opening of the intestinal or urinary tract on the body surface. Stomas most often open via a short spout onto the surface of the abdominal wall. They may be permanent or temporary (another surgical...

    • 28 Living with an Amputation
      (pp. 211-213)

      You or a loved one may have had a limb amputated because of a traumatic injury (such as a motor vehicle accident), because it was a lifesaving measure (for example, when the risk of infection is high), or to improve your quality of life (as when pain in the affected limb is uncontrollable by other methods). If you have had an amputation of any kind, this chapter is for you.

      One might say that every amputation is traumatic, but in medicine the term has a specific meaning. A “traumatic” amputation occurs due to an accidental injury, such as in a...

    • 29 The Wounds of War
      (pp. 214-216)

      Thanks to improved medical care, 90 percent of soldiers who are injured in the conflicts in Iraq and Afghanistan survive. However, a new generation of physically and emotionally wounded veterans is now returning home. Many come home having lost an arm or leg.

      After loss of an arm or leg, prostheses can be fitted. As a result of the amputations in the Iraq War, there have been advances in prosthetics, such as anatomic socket designs and silicone gel liners. A new innovation is the “biohybrid,” which treats the prosthesis as if it is part of the person’s body. The biohybrid...

    • 30 Wounds and Cancer
      (pp. 217-220)

      Up to one in ten people with cancer develop nonhealing wounds. A wound may appear at the site of the cancer (for example, on the breast in some people with late-stage breast cancer) or at a location far away from the cancer. The cancer can be present in the wound itself, or a person with cancer can develop wounds for other reasons. Some cancers may ulcerate as they outgrow their blood supply.

      In Chapter 17, we discussed skin cancers that develop in wounds. In this chapter, we look at other kinds of wounds associated with cancer.

      Certain cancers are more...

    • 31 Wounds in the Dying: When Comfort Comes First
      (pp. 221-226)

      If you or a loved one has a wound that cannot heal for any reason, or is at the end of life, the goals of wound treatment should be based on symptom control and comfort, rather than only on wound healing. It is very important that the focus of care is to make you as comfortable and pain-free as possible. You and your loved one should talk to your wound team to ensure that you are all on the same page regarding goals of care and that you understand the correct procedure for dressing changes. Controlling pain, drainage, and odor,...

  14. PART NINE: Beyond the Wound

    • 32 Eating Well: The Healing Potential of Food
      (pp. 229-235)

      Proper nutrition is crucial for the body to heal itself effectively. After surgery, if your surgical wound heals but you have poor nutrition, your wound may split open. After any type of surgery, the body quickly uses up its stores of nutrients, especially if you have a wound that is draining a great deal. Eating well also helps maintain a healthy immune system which can be important for fighting infection. It is important for you and your health-care team to develop a plan to make sure your diet, nutrient, and water intake is sufficient.

      Malnutrition is common among people with...

    • 33 Exercise for Wound Healing
      (pp. 236-240)

      You’ve heard it before: exercise is good for you. It helps you lose weight, stay flexible, keeps you strong, and reduces the risk of many health problems such as diabetes and heart disease. What you may not have heard before is that exercise also probably helps your wounds heal faster.

      One study found that regular exercise may speed up wound-healing by as much as 25 percent. In this study, the participants began with ten minutes of warm-up floor exercises and stretching, followed by thirty minutes of pedaling on a stationary bike. After that, participants either jogged or walked briskly on...

    • 34 Pain: The Burden of Suffering
      (pp. 241-250)

      Pain in a slow-to-heal wound can be distressing. The pain can decrease your ability to function and do things that you normally would do, such as go to work or spend time with friends. Pain can affect you not only physically, but also emotionally and mentally. The mental and emotional aspects of pain and wound healing are discussed further in Chapter 36. In this chapter, we will discuss the physical pain itself, and what you can do to help prevent and manage it.

      Pain has an important job—it indicates to the body that something is wrong. For example, pain...

    • 35 Skin Problems That Coexist with Wounds
      (pp. 251-260)

      In this chapter, we will discuss some common issues that occur in or around wounds. In order to take care of your skin, you need to inspect it regularly to make sure there is no skin irritation or breakdown. You also need to clean and moisturize your skin properly. We’ll show you how you can do this the right way.

      If you are at risk for developing pressure ulcers (see Chapter 5) it is important to routinely inspect your skin at least once daily. Redness that occurs after pressure is removed is commonly the first sign of a pressure ulcer....

    • 36 Emotional Aspects of Wound Healing: When the Wound Is More than Skin Deep
      (pp. 261-265)

      Chronic wounds affect your quality of life and can take an emotional toll on you and your family. There is a wide range of emotional reactions you may have to your situation. It is common to feel frustrated, anxious, angry, or depressed (sometimes all at the same time). You can be sure that they are all normal feelings commonly experienced by people with wounds.

      In this chapter, we help you to identify when you are having these feelings and help you decide when to seek help. We offer suggestions on how you can begin to heal emotionally so that you...

    • 37 Care for the Caregiver: Beating the Burnout
      (pp. 266-275)

      The caregiver is an essential member of the patient’s team and needs to be considered in every treatment decision. Approximately 22.4 million people in the United States provide some form of care to someone who is elderly, ill, or disabled. The situation is particularly challenging for those in the “sandwich generation” who are caring for aging parents and raising children at the same time. Caregiver stress is associated with increased risk of illness for the caregiver and even death.

      While you may get much gratification from caring for a loved one, as a caregiver you are also responsible for someone...

    • 38 Online Medical Resources: How to Separate Clever Advertising from Effective Medicine
      (pp. 276-278)

      The Internet can be a great tool to learn more about your health and there is a lot of great information out there. The problem is that there is also a lot of misinformation on the Internet. Some of this untrustworthy information can simply be misleading or inaccurate, and other information may be downright dangerous. It can be difficult to know the difference between useful information based on good science and useless information not based on science.

      The most important thing to know is that anyone can put health information on the Internet. Generally, good quality information will have the...

    • 39 Payment and Reimbursement Issues: Who’s Picking Up the Check?
      (pp. 279-282)

      Gary’s situation illustrates how your wound care team can work with you and your family to optimize care. Filing the correct forms, obtaining preauthorizations, and using specific language and procedure codes are essential for receiving all the services you are entitled to under your insurance. The wound team should be accurate and precise about the wound treatment indications. The wound care team should also document all treatments and indications clearly in the chart for future reference.

      You may be well aware that wound care can be expensive, and many costs may not be covered by your insurance. It is essential...

  15. Glossary of Terms
    (pp. 283-290)
  16. Additional Resources
    (pp. 291-294)
  17. References
    (pp. 295-296)
  18. Index
    (pp. 297-310)