For Surgeons


Wound Care Clinics and the Plastic Surgeon in South Africa

It is important that we understand wound care and adapt to the concepts. Plastic Surgeons must play the main role in managing wound care. There are many role players but Plastic Surgeons must be the leaders in wound care.

In the New World of thinking we are faced with new challenges and shifts in medical care which need planning and a vision. The new concepts of Level 1, 11 and 111 patient care demonstrate this and will have a major impact on future care. Plastic Surgeons are seen as only Level 111 care specialists in the new dispensation but it is through our wound care clinic that we prove that we can help the governments new policy of increasing Level 1 care to bring health to our disadvantage communities.

What contribution do we deliver through a wound care clinic:

  • Provide cost effective service
  • Assist in protocols
  • All types of wounds and patients management
  • Multi-disciplinary care
  • Improve outpatient care and reduce inpatient care

Five Essential Steps in Developing a Successful Wound Care Clinic:

Step 1 – Define the conceptual framework

  • Characterize the problem
  • Collect data and information
  • Assess infrastructure, human resources, equipment and budget
  • Define mission and goals

Step 2 – Identify options to reach your goals

  • Enhance quality of wound care
  • Upgrade patient access to care
  • Guarantee supply of materials and services
  • Project demand patterns to be met

Step 3 – Evaluate Options

  • Cost effectiveness
  • Acceptability
  • Available resources

Step 4 – Implement and Re-evaluate

  • Set up valid, reliable methods of patient, wound assessment and diagnosis methods
  • Determine effective methods of care
  • Set up methods for evaluating effectiveness
  • Establish logistics of materials and resources
  • Hire and schedule human resources

Step 5 – Have a vision for the future

  • Anticipate supply and demand problems
  • Adapt information, education, training activities according to population / demand
  • Emphasize preventative action
  • Promote research and quality control

Keys to Success: These five steps could not happen without the following highlights for a successful hospital-based wound and ostomy clinic, which contributed to the potential of the clinic’s success

  • Personnel must have initiative, motivation and dedication as well as good skills training.
  • Appropriate administrative and budget support is needed.
  • The volume of patients should be great enough to justify the service.
  • Quality of care always comes first.

When serious complications arise, always infinitive the patient.

  • High quality care must be cost-effective for the patient who can be treated on an out-patient basis.
  • A skilled enterostomal nurse in wound and ostomy care must foster his/her interaction with the multi-disciplinary team.

Important is training sessions of:

  • Medical staff
  • Nursing staff
  • Peripheral clinic staff

Important equipment needed can be minimised to:

  • Basic dressing set
  • Computer equipment for storing information and to evaluate results
  • Camera to monitor improvement or not
  • Audio-visual equipment for educational purposes

To run a clinic you need:

  • Registrars / Medical Officers
  • Plastic Surgeons and consultants from various departments
  • Sister and staff

Patients do not walk into a clinic with a label of Level 1, 11, or 111 on their foreheads. The clinic sisters must know their limits and we can help to educate them to treat Level 1 patients who need wound care but to refer Level 11 and 111 patients to Medical Practitioners (Level 11) or Specialists (Level 111).