Jacky has worked in burn care since 1988 and throughout this has been involved in surgical wound management through both burns and plastic surgery.

In 2012, she was Nursing Times Nurse of the Year for the development of the Burns Outreach Service which has now been replicated across many burns services and was the only Consultant Nurse in Burns in the UK. She is currently the Lead Nurse for the Northern Burn Care Network.

In terms of surgical wounds she was previously involved in chairing the group that wrote the NWCSP Surgical Wound Recommendations and following her decision to retire in August 2022, she recommenced work with the NWCSP and has taken the recommendations in a completely different direction. The emphasis is now on surgical wound complications and the impact of increased day surgery on community and primary care.

She is very excited to be involved in this work and also leads on the education and workforce workstream, which she sees an essential to underpin the recommendations the NWCSP publishes.

Presentation at The Society of Tissue Viability 2023 Conference

Update on the surgical stream for NWCSP – current position and what we can do to improve it

Objectives

After attending this session, persons will be able to:

• Understand the role of the National Wound Care Strategy
• Understand the need to implement the Surgical Wound Recommendations
• Understand the issues with surgical wound complications and how the NWCSP is hoping to address these

Abstract

The frequency and complexity of surgical wound complications are often under-estimated but surgical wounds are the most commonly managed wound type (57%) and delayed healing in surgical wounds is estimated to cost the National Health Service (NHS) £982.9 million per year. Reducing surgical wound complications could have a significant financial impact on NHS costs. However, there are challenges to such quality improvement work as we lack accurate information about the scale of the problem.

• Most surgical wound complications (SWC’s) occur post discharge but most national surgical wound data collection ends on hospital discharge.
• To date, the focus has been on surgical site infections (SSI’s) but not all surgical wound breakdown (dehiscence) is due to infection.
• The impact of surgical wound breakdown, whether or not associated with SSI, has a significant impact on quality of life for patients and NHS costs.

Therefore, there is an urgent need to broaden the scope of surveillance to focus on surgical wound complications rather than the more narrow focus on just surgical site infection.

This presentation will therefore look at how the NWCSP will develop a range of strategies to try and improve the prevention of SWC’s including: educational resources, updating the recommendations, patient resources, improvement in clinical data.

Presentations at The Society of Tissue Viability 2022 Conference

Chronic Burn Wound Management

Objectives

After attending this session, persons will be able to:

• Understand that burns can be chronic wounds
• Understand the role of an integrated care pathway in managing these wounds

Abstract

Chronicity in burns is poorly recognised, however these wounds often take months if not years to heal and have a significant impact on the patient.   In clinical practice, burn wounds that remain unhealed for many weeks or months often continue to be treated as burn wounds, as opposed to wounds that have become chronic. This means that they are treated topically with antimicrobials and reassessed every 2–3 days (Edwards 2013).

Having undertaken a previous audit of time to healing in burn wounds, it was identified that from a cohort of 83 patients with deep dermal or full thickness wounds, the mean time to healing was 87 days with a range from 21-376 days regardless of skin grafting. Key indicators of prolonged healing included lack of first aid, lower leg burns, and wound infection. Diabetic patients were represented as per the general population with this not having a significant impact. Other factors which are mirrored in studies, included quicker healing in the under 40year olds, flame burns and TBSA having an impact on time to healing.

This was supported by Guest et al (2019) who found that having reviewed 260 patients with burn, 30% of all the burns healed within 1month, 39% within 6 months, 46% within 12 months and a further 24% by 24 months (a total of 70% healed within 24 months.

To try and manage these wounds an Integrated Care Pathway was developed. The pathway consists of Debridement, Bacterial Burden, Wound Modulation and Steroid Therapy so all the information was in one place and colour coded for each stage of the pathway. This ensures that each section is completed for the appropriate amount of time. All the information is in one place and products in the pathway can be audited.

Use of the Pathway has led to quicker healing of non-healing burns and is now an integral part of caring for burn patients.   The pathway continues to develop as new technologies become available and we become more confident in managing these wounds.  Earlier acceptance of burn wound chronicity enables us to alter the treatment pathway and heal these wounds before they become long term problems.

1. Edwards, J (2013) Burn wound Chronicity – myth or reality? Wounds UK.   9 (3); 4-5
2. Guest JF, Fuller GW, Edwards J. (2020) Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes. BMJ Open;10:e035345

Hypertrophic scar management

Objectives

After attending this session, persons will be able to:

• Understand the difference between hypertrophic and keloid scars
• Understand how to assess abnormal scarring
• Understand the treatment modalities available to prevent/manage these scars

Abstract

Scarring has major psychological and physical repercussions – for example, scarring on the face and visible regions of the body can be very traumatic for the patient, whether they are simple acne scars or large, raised surgical or traumatic scars. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities.

Keloid and Hypertrophic scar differences will be discussed. Hypertrophic scars present as a deep red to purple colour, and become more elevated, firm, warm to the touch, hypersensitive and itchy as the scar progresses.  It is more efficient to prevent hypertrophic scars than treat them. Meaume et al (2014) suggest that early diagnosis of a problem scar can considerably impact the overall outcome.   Schmidt et al (2001), suggest that hypertrophic scars appear between 3-5 weeks after trauma, but often patients are discharged with no follow up to check whether hypertrophic scarring is forming.

The management of newly healed wounds to prevent scar formation is one of the most profound things a nurse can do for the patients’ physical and mental well-being.  Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed.  Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.

This presentation will discuss practical ways in which hypertrophic scars can be managed.

1. Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol 2014; 24(4): 435-43
2. Schmidt A, Gassmueller J, Hughes-Formella B, & Bielfeldt S. (2001) Treating  hypertrophic scars for 12 or 24 hours with a self-adhesive hydroactive polyurethane dressing. Journal of Wound Care, 10, 5, 149-153