Is this correct practice?

[Gaby63]

I work as an RNAC in LTC and would appreciate feed back on a wound issue that has come up. We have a resident that has had a chronic pressure wound that was initially staged as a 4, about 2+ years ago. Now measures 0.2x0.2x0.2 and hasn't changed for the past year. Typically wound rounds are done weekly by wound team and wound consultant and tracked accordingly. The team and consultant have now classified this wound as "resolved with a defect" and will no longer track. I'm struggling with this description and not comfortable coding it on a MDS as "healed" since that means completely epithelialized....

is "resolved with a defect" accepted terminology in the wound world?

thanks!

[kim.jonescw]

As a CWS for 8 years, I have never heard the phrase "resolved with a defect". If the wound is not completely re-epithelialized, then it is not "resolved", defect or not. I would look into specifics concerning the inability for this wound to achieve complete closure. Are the wound edges epibolized, is the patient malnourished?, have you tried an e-stem unit, such as Micro-Z?, nutritional supplements, have you ruled out wound bed bioburden? I assure you that for MDS purposes, "resolved with a defect" is NOT acceptable terminology.

[carl5480]

I've also never heard of the term "resolved with a defect" before. To me, this would be more like a wound that has healed but will always have a noticeable, er, defect. Like it is actually concave compared to the surrounding skin, or the resulting scar from a previous graft site maybe. That sort of thing. But it's definitely NOT resolved if it's still an open wound. Chronic wounds can takes years to heal, but if something has stopped the wound from epithelializing completely there is something going on. Also, I believe it is acceptable practice to get a biopsy of the site for a wound that does not heal despite optimal conditions (many of which kim.jonescw has identified). Not saying this would provide any definitive information you don't already have, but it could.

[Davidaugustyn]

No

Have them pick it back up.

[CWONgal]

Yep, have never heard of using that terminology. I would think a "defect" would be something like a keloid or scar tissue formation. Wonder if that wound is critically colonized and that's why it won't heal? Also, even though the wound may re-epithelialize it's not truly "healed"....can take up to a year.