CHRONIC WOUNDS: A HEALTHCARE CHALLENGE

One in 20 Singaporeans is afflicted with chronic wound conditions such as diabetic foot ulcers, pressure injuries, arterial and venous ulcers. Chronic wounds tend to affect the elderly due to underlying comorbidities such as diabetes, cardiovascular and peripheral vascular diseases, and reduction in mobility.

What are the signs of poor healing?
Signs of poor wound healing include a persistent wound with no reduction in size, ischaemic edges and slough at the wound base. Due to their underlying ethology, these wounds are unlikely to heal by themselves without appropriate medical intervention.

Impact and Complications
Quality of life impacted

Patients with chronic wounds have a reduction in quality of life with pain and emotional distress.

Complications

Delayed wound healing can lead to complications such as infections and gangrene requiring amputations. Singapore’s major lower extremity amputation rate is 28.5 per 100,000 population, much higher than all the Organisation for Economic Co-operation and Development (OECD) countries, based on data published in 2015.

Early diagnosis and treatment is therefore crucial in preventing complications.

Prevalence in Singapore
With an ageing population and increasing prevalence of diabetes, we are expecting to see more cases of chronic wounds among this group of patients in the coming years.

According to a local study, there has been a 100% increase in chronic wound-related admissions from 2013 to 2017 in Singapore, making chronic wounds a growing healthcare challenge in terms of wound-related admissions. In 2017, a local public hospital saw an estimated 12,000 wound-related admissions.

ABOUT THE WOUND HEALING CENTRE

Given that chronic wounds are complex and multifactorial with various underlying pathologies, there are situations where patients could be referred to a clinical speciality which may not have the expertise to treat the chronic wound – for example, referring a patient with an ischaemic ulcer to a non-vascular surgeon, resulting in delay of treatment.

Multidisciplinary team for wound care
Recognising the need to improve and streamline care for patients with chronic wounds, Changi General Hospital (CGH) has set up a Wound Healing Centre (WHC).

It is a multidisciplinary outpatient facility focusing on early intervention and fast-track treatment of chronic wounds by a team of specialists and nurses trained in the full spectrum of wound management.

By providing timely access to outpatient treatment, we can reduce avoidable hospitalisation via the emergency department. At this one-stop clinic/centre, patients can receive treatment, diagnostic tests and assessments all within the same day. This reduces the need for multiple visits to receive appropriate care.

The WHC is a collaboration between a multidisciplinary group of specialist-accredited surgeons across the three disciplines of Vascular Surgery, Orthopaedic Surgery, and Plastics, Reconstructive & Aesthetic Surgery, providing their expertise to handle a full spectrum of wounds with support from specialist wound nurses.

The WHC also provides a full continuum of care for patients with poor mobility, where the Hospital-to-Home teams are well-equipped to bring wound care to patients within their home setting.

International certification
The care team is certified by the American Board of Wound Management (ABWM) as Certified Wound Specialist Physicians (doctors) and Certified Wound Specialists (nurses). The nurses are also trained and certified by the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB).

OUR SERVICES

  • Wound Assessment
  • Ultrasonography for Arterial/Venous Pathology
  • Transcutaneous Oxygen Measurement
  • Conservative Sharp Wound Debridement
  • Simple/Complex Wound Dressing
  • Compression Therapy for Venous Ulcers
  • Negative Pressure Wound Therapy
  • Electrical Stimulation for Wound Healing
  • Ultrasonic-assisted Wound Debridement
  • Podiatry for Diabetic Foot Care

HOW GPs CAN REFER

Patients can be referred directly to CGH from their primary care provider - general practitioners (GPs), polyclinics, community hospitals and nursing homes.

For GP referrals, please contact the Wound Healing Centre at:
6936 5470 or 6936 5471 (Mondays to Fridays, 9am – 5pm)

OUR CARE TEAM

Director & Consultant

Asst Prof Derek Ho Chunyin
Dept of Surgery (Vascular Surgery)

Co-director

Ms Png Gek Kheng
Chief Nurse

Senior Consultant

Dr Kinjal Vidyut Mehta
 Dept of Orthopaedic Surgery

Consultants

Asst Prof Darryl Lim Mingjun
Director, Vascular Service;
Dept of Surgery (Vascular Surgery)

Dr Lew Pei Shi
Dept of Surgery (Vascular Surgery)

Dr Jeremy Sun Mingfa
Director, Plastic and Reconstructive Surgery;
Dept of Surgery (Plastic & Reconstructive Surgery)

Dr Charles Kon Kam King
Dept of Orthopaedic Surgery

Associate Consultant

Dr Vincent Tay Khwee Soon
Dept of Surgery (Plastic & Reconstructive Surgery)