Wounds can be acute – injuries that occur suddenly due to trauma, surgery or accidents – or chronic – wounds that do not heal within 4 to 6 weeks, and are a result of underlying health conditions such as diabetes (Type 2 diabetes mellitus) or vascular disease. 

Chronic wounds can be complex and multi-factorial, and require specialised care to prevent complications like infections. 

Locally, 1 in 20 Singaporeans have chronic wound conditions, and this is expected to increase in the coming years due to an ageing population and the prevalence of diabetes.

Early intervention and tailored wound management plans is critical to address this, promote faster recovery, and achieve the best possible outcomes.

Common types of chronic wounds include: 

• Venous leg ulcers: Wounds on the legs resulting from impaired circulation in the veins.

• Arterial leg ulcers: Wounds on the feet, toes or ankles resulting from poor blood flow in the arteries.

• Diabetic foot ulcers: Open sores on the feet that are caused by poor blood flow and nerve damage due to diabetes. 

• Pressure injuries: Also known as bedsores, these occur from prolonged pressure on the skin, often in bedridden or immobile patients.

Effective wound care combines advanced therapies such as negative pressure wound therapy, bioengineered skin substitutes, and specialised dressings, alongside a multidisciplinary approach involving wound specialist nurses, radiographers, podiatrists, physiotherapists, and dietitians.

This forum also serves as a great chance to discover more about wound care and the innovative solutions available for managing chronic and complex wounds. So start sending in your questions today!  

For more on wound care and management, check out these articles:

• Time does not heal all wounds

• Ouch! Does my wound need stiches?

• CGH's wound healing centre speeds up access for treatment of chronic wounds

About Dr Lew Pei Shi

Dr Lew Pei Shi is a consultant with the Department of Surgery, Changi General Hospital (CGH). 

She graduated with a Bachelor of Engineering (Chemical) from National University Singapore, obtained her MBBS from University of Queensland (Australia), and was subsequently accepted in the SingHealth General Surgery Residency. She was awarded the Outstanding Resident Award in 2017.

Dr Lew obtained her fellowship from the Royal College of Surgeons of Edinburgh, and is an accredited specialist in the field of general surgery with a subspecialty interest in vascular and endovascular surgery. 

Currently, Dr Lew is the Chairperson of the Wound Care Committee in CGH and she has a keen interest in the management of chronic and difficult wound management, and novel wound therapies.

Questions and answers on wound care

1. Question by Cheong TW

Dear Dr Lew Pei Shi,

I had robotic-assisted radical protatectomy about seven and a half weeks ago. By the sixth week all the scabs from the six keyhole wounds have fallen off.  However, the scars and their margins are still red and itchy. Should it be so?

Three days ago, I began applying petroleum jelly on the scars after washing them with soap and drying them with a clean tissue.

Is this a good way to care for the wounds?  What better way should I follow? Thank you.

Answer by Dr Lew Pei Shi

It is common to experience itching and redness alongside normal wound healing. These sensations are due to increased blood flow for healing and the release of chemicals by the body which simulate nerve endings. 

While common, persistent or intense itching and redness may indicate possible issues such as hypertrophic or keloid scars, or infection.

Moisturising is a good way to manage the wounds, as keeping scars hydrated reduces itchiness. It will also help to refrain from scratching, avoid friction, and keep the area clean.

Do raise your concerns to your surgeon at your next visit so that he/she can assess the scars and render treatment where required.

2. Question by Goh

Dear Dr Lew Pei Shi

I recently had an operation to remove a large Lipoma at the upper part of my body. The results were good but it has left an large ugly scar there.

There is a large cavity and it really upsetting me. I had the ugly Lipoma removed and ended up with an even uglier scar and cavity.

My question is, is there any way to smoothen out the cavity and scars?

Thank you and look forward to your favourable reply.

Answer by Dr Lew Pei Shi

There are treatments available for scar management, which range from topical, surface, or injectable treatments, such as laser and injectable fillers. 

As each patient’s scar is different, and treatment should be based on the patient’s scar condition, needs and expectations, it is best to consult your regular doctor or a plastic surgeon to address your concerns and decide on the best course of action.

3. Question by Eileen

Dear Dr,

Is it better to cover up a wound with dressing or to leave the wound open to air? When changing wound dressing, strands of cotton gauze will get stuck to the wound. It is very painful. Would it then be better to leave the wound open?

Answer by Dr Lew Pei Shi

Wounds require an appropriate amount of moisture for healing, as well as to reduce the risk of scarring. It is a common misconception that you need to leave wounds open to dry them out, and this may not be optimal for healing. 

I usually recommend that my patients apply suitable antiseptics – such as a lotion, cream or gel – before covering their wounds with non-occlusive dressings – dressings that does not seal the wound completely and which allow air and moisture to pass through them.

When removing your wound dressing, there are some ways to reduce pain. You can wet the cotton gauze with sterile saline or water first to reduce adherence to the wound before peeling it off, or you can choose a non-adherent dressing pad to cover the wound.

4. Question by Kevin

Dear Dr Lew,

I heard that amputation as a result of diabetes is quite common in SG, is this true? What advice would you give diabetes patients when it comes to taking care of wounds? What do they need to be aware of? And what can they do to minimise the risk of getting wounds?

Answer by Dr Lew Pei Shi

Thank you for your question. Indeed, approximately 80% of major amputations in Singapore is attributed to diabetes, and almost five amputations occur every day in patients with diabetes.

Patients with diabetes are more likely to develop foot ulcers due to peripheral neuropathy, a nerve condition affecting the peripheral nervous system, which predisposes these patients to foot deformities and foot numbness. 

In addition, diabetes may also lead to peripheral vascular disease, a circulatory condition which causes narrowing of blood vessels. These conditions may further impact the healing of foot ulcers in patients with diabetes.

• Regular foot assessment by a podiatrist is recommended for diabetic patients to identify and manage their risk of developing diabetic foot ulcers.

• At home, patients should inspect their feet daily for wounds. Seek medical advice if foot wounds do not heal after two weeks, or if the wounds are associated with redness, pain, a foul smell or discharge, or when patients feel unwell or have a fever. These are signs of infection and require prompt treatment to manage the wound, or in more severe cases, to save the limb.

• Proper footwear is very important in preventing the development of foot ulcers in diabetic patients. Diabetic patients should avoid walking around barefoot. They should choose shoes that are well-padded, roomy, and comfortable, and avoid wearing safety boots and slippers.

• In addition, diabetic patients can proactively take care to reduce the risk of a major amputation. They should control their diet and sugar intake, take required medications, exercise regularly, and stop smoking.

Ref: G25