Question: 4.1- Discuss and evaluate your approach to the management of wounds classified as healable, non-healable or maintenance. Comment on the differences in therapeutic approach between these classifications. Our approach to wound management was far from optimal in our setting. After reading the article by Sibbald et al (1) and attending the presentations during the first residential weekend, our approach to the Family Medicine Clinic at St. Mary's Hospital Center must change. We did not classify wounds as healable, maintenance, or non-healable. We have always viewed wounds in our practice as healable, despite system constraints or patient preferences. In the following lines I will define and summarize the methods to be used for the initial management of wounds and how to best integrate them into our site. The first objective we must set ourselves is to determine his ability to heal. To ascertain whether a wound is healable, maintenance or non-healable. The first element to consider is whether the wound has an adequate vascular supply which can be assessed by.1. Peripheral impulses2. Ankle Brachial Pressure Index (ABPI)3. Sound Doppler examination4. Tip pressure5. AngiographyOnce the vascular component has been evaluated you have a clear idea of ​​the main organic factor limiting wound healing. We can then build on this information by evaluating the patient's cofactors in recovery. This step is essential to maximize the vascular network possessed by the patient. These cofactors are:1. Systemic diseases (diabetes, immunosuppression, skin diseases)2. Nutrition/Diet (low protein diet, vitamin deficiencies)3. Medications (corticosteroids, immunosuppressive drugs and... half of the document... expressed by most treating doctors if the best treatment is not possible. Most of these wounds are unfortunately sent to a community nurse for change of dressing without the patient returns to the treating physician for evaluation of “wound maintenance” treatment Non-healing wound treatment When a wound is determined to be non-healing, as described by Sibbald et al (1), it should not be treated with a moist treatment and must be kept dry to reduce the risk of infections that would compromise the limb. It is also important to consider the patient's preferences and try to control their pain, discomfort in activities of daily living and wound odor. can produce. In this case, special attention must be paid to infection prevention and control. Some charcoal dressings may be of interest in the care of our non-healing wounds at St. Mary's Hospital.