Implications to Wound Care
Most skin and wound experts agree that wound prevention and treatment are more complex when addressing the specific needs of the person who has excess body weight or weight maldistribution. Outcomes may be delayed or not as forthcoming as expected. This delay often interferes with a positive patient experience because patients generally value wound healing that is provided in a timely and pain-free manner that supports principles of dignity and respect.
Barriers to wound healing in the presence of excess adiposity are numerous. Pierpont et al6 suggest factors such as anatomic properties and poor vascularity of adipose tissue may impact the wound formation and healing processes. Further, vascular insufficiency that leads to decreased oxygen tension may decrease collagen synthesis, the capacity to fight infection, and the ability to support mechanisms of the healing cascade. Pokorny7 explains that wound healing generally is an orderly process involving inﬂammation, proliferation, epithelialization, and remodeling; decreased collagen deposition is thought to have an effect on the structural changes of the tissue during the proliferation stage, which delays the natural healing process.6 Others8 believe wound formation and delayed healing are more closely linked with well-documented hazards of immobility. Hospitalized patients who are obese may have limited mobility due to several factors such as their excess weight, environmental space limitations, and workers’ fear of occupational injury associated with standard mobility activities, each of which can lead to immobility and thus risks for skin injury.9,10
Key considerations for understanding the bariatric patient care experience include11:
- Rates of obesity are increasing among patients and clients in all practice settings and specialties;
- Physiologic changes and comorbid conditions associated with adiposity impact wound healing;
- Care of the bariatric patient with a wound is more complex and requires vigilance;
- Dignity, sensitivity, and respect humanize the bariatric patient experience; and
- Preplanning for care in all settings is essential.
In this issue of OWM, Beitz describes that dignity and sensitivity are at the heart of patient care outcomes. Dr. Beitz takes readers on a journey that explores the meaning of sensitivity, not as an addition to the patient care experience, but as the patient experience.12 Hales et al13 present methods to simulate the bariatric experience for workers. Many individuals and facilities worldwide have invested in bariatric body suits as an adjunct to their bariatric sensitivity training. The authors describe a way to introduce workers who otherwise would not have the experience of using a standard-sized restroom or clinic waiting area to navigating related scenarios as an individual who is obese. Study participants wore the body suit onto public transportation to simulate the challenges some patients experience as part of the trip to a clinic. Each participant expressed an all-new understanding for the challenges associated with excess weight or weight maldistribution. However, the authors caution that although the bariatric body suit can be helpful to begin patient mobility training and enhance knowledge of respiratory and skin consequences to obesity and more, to date a process for such training has not been designed and/or tested.
No stranger to providing information on obesity and bariatric care, OWM has published more than 2 dozen articles over the past 20 years that include research on these topics. For this issue, we have assembled a compendium14 of these publications so readers can utilize relevant findings in practice.