Anglais médical - tout savoir sur les plaies et la cicatrisation

Vocabulary

Read the terms (stressed syllables are underlined)
ankle-brachial pressure index (ABPI)
compression therapy
debridement
doppler
exudate
non-healable
slough
systemic
topical
wound bed

Activity 1: Match the English term with the correct French term.

Activity 2: Complete the definitions using the terms from the vocabulary list.

The preparation of the ⁽¹⁾ ________________________ is essential to create an optimal healing environment with minimal ⁽²⁾ ___________________ (wound drainage)  present in the wound.   
⁽³⁾  ________________________, a type of necrotic tissue, must be removed from the wound before healing can take place. ⁽⁴⁾ _________________ of slough can be achieved by carefully cutting away dead tissue or by using chemical or biological methods.
The ⁽⁵⁾ ___________________________ is the comparison of the blood pressure at the ankle with the blood pressure in the arm. The resulting number gives an indication about blood flow to the peripheral arteries, e.g., in the legs. An alternative assessment of peripheral blood flow uses a hand-held ⁽⁶⁾ ____________ , an ultrasound device which evaluates blood flow using reflected sound waves which indicate blockages or narrowing of the arteries or veins.
A ⁽⁷⁾ _______________________ has the potential to heal but may be slow to heal because of contributing factors. ⁽⁸⁾ _________________ wounds are usually not able to heal because of co-existing conditions, e.g. cancer, which cannot be eliminated.
⁽⁹⁾ _____________________ can be stressful for patients, especially those with chronic wounds which require regular dressing changes. Pain can be minimised through the use of ⁽¹⁰⁾ ______________ anaesthetic creams which help to numb the area around the wound.

Activity 3: Read the text about wound bed preparation and answer the questions that follow.

Wound Bed Preparation 2021

Wound Bed Preparation is a paradigm to optimize chronic wound treatment. This holistic approach examines the treatment of the cause and patient-centered concerns to determine if a wound is healable, a maintenance wound, or non-healable (palliative).

For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation.

In maintenance and non-healable wounds, the emphasis changes to patient comfort, relieving pain, controlling odor, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control.

Wound Bed Preparation (WBP) is a structured approach to wound healing. Now entering its third decade of widespread use, the WBP paradigm was first published in 2000, with periodic updates in 2003, 2006, 2011, 2015, and now 2021. This latest iteration features the following key changes:

1. Audible handheld Doppler (AHHD) of dorsalis pedis or posterior tibial artery as an alternative to the traditional ankle-brachial pressure index (ABPI) for the clinical assessment of adequate arterial supply to heal and ability to apply compression therapy safely. The AHHD is a quicker alternative to the ABPI that does not require the patient to be recumbent, does not cause pain from a BP cuff, and is not influenced by arterial calcification.

2. Updated approaches to topical and systemic pain management for persons with wounds. A recent systematic review on topical analgesics associated with pain in chronic leg ulcers demonstrated a topical cream (eutectic mixture of local anesthetics) was superior to other formulations for people living with chronic leg ulcers. There are other topical modalities that may be associated with pain relief and strategies including the use of silicone adhesives to replace other, more traumatic acrylic adhesives at dressing removal.

1. A non-healable wound is also called a palliative wound. Why do you this is?
    A   It only happens at the end-of-life
    B   It is not possible to heal the wound, only provide comfort measures
    C   It is a difficult type of wound to manage
    
2. The management of healable wounds includes …
    A   active measures to promote wound healing
    B    comfort measures such as pain relief
    C    control of unpleasant smells from wound discharge
    
3. The latest version of the WBP paradigm includes updates on …
    A   anaesthetic use in chronic leg ulcers
    B   the use of the ankle-brachial pressure index in place of doppler assessment
    C   blood circulation assessment and pain reduction during dressing changes
    
4. One of the benefits of using doppler ultrasound to assess blood circulation is …
    A    less calcification in blood vessels if ultrasound is used
    B    increased patient comfort as patients do not have to lie down for the procedure
    C    more effective compression when doppler applied to the lower legs
    
5. Silicone adhesive use is preferable to acrylic adhesives as they …
    A    cause less pain when adhesive dressings are removed.
   B    are more appropriate for trauma dressings.
   C    are a topical type of adhesive dressing

T.I.M.E Wound Bed Preparation

Before you start, review:

VAC dressing also called Negative Pressure Wound Therapy (NPWT) Thérapie par Pression Négative (TPN). VAC stands for Vacuum Assisted Closure

Activity 4: Watch the video   about T.I.M.E and complete the dialogue using the words below to help you.

Interviewer: Welcome back, everyone. John is here again to talk about wound management.

John: Right, I'd like to talk about TIME now. TIME is an ⁽¹⁾ __________for a framework which helps to identify barriers to healing in the wound bed and identifies expected
outcomes of treatment.

The acronym TIME stands for Tissue, Infection, Moisture balance and Edges of the wound.

Looking at the tissue factor first; the tissue is not ⁽²⁾ _______ if there are still areas of necrosis in the wound. This means that the tissues of the wound bed do not have sufficient blood supply to survive.

Debridement of necrotic tissue is necessary to prepare the wound for healing. This is often a ⁽³⁾ _________ procedure especially if large amounts of necrotic tissue have to be removed.

The expected outcome is a wound bed which is well ⁽⁴⁾ ________________ and has a good blood supply.

Interviewer: OK, so the first factor looks at the blood supply to the tissues around a wound?

John: That's right.

The second factor to consider is whether ⁽⁵⁾ ______________or infection is present. The aim is to remove the infection and reduce the bacterial load.

This is done by using ⁽⁶⁾ ______________ dressings as well as antibiotic medication.

Reduced inflammation around the wound is the expected outcome.

Interviewer: This factor is the presence of infection, right?

John: That's exactly right. Next, the moisture ⁽⁶⁾ ____________ of the wound is treated.

Excessive exudate or discharge of fluid from the wound cause maceration or softening of the wound edges.

On the other hand, desiccation or excessive ⁽⁷⁾ _________________ also slows healing.

In order to restore the moisture balance, it's necessary to use hydrating dressings which add ⁽⁸⁾ ____________________ to dry wounds.

Negative pressure dressings, e.g., VAC dressings remove ⁽⁹⁾ ______________ fluid in macerated wounds. The expected outcome is that the wound will have an optimal moisture balance.

Interviewer: So, whether the wound is too wet or too dry is also important?

John: Very important. Finally, if the edge of the wound does not heal or advance, the wound becomes a ⁽¹⁰⁾ _______________ wound. It then becomes necessary to reassess the wound.

During reassessment different wound management needs to be considered. An example of this is a ⁽¹¹⁾ ___________________ which is used to replace damaged skin. The desired result is that the edge of the wound will advance and heal.

Interviewer: Thanks for coming in today. A very interesting talk indeed.

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Virginia ALLUM Author and Consultant in English for Medical Purposes