The ini­tial assess­ment and man­age­ment of a wound – be it a burn, dog bite or deep gash – has a huge bear­ing on the final out­come for the patient.

This is a key mes­sage from Dr Richard Bar­nett AM, the Chair­man of the Aus­tralasian Foun­da­tion for Plas­tic Surgery pro­vid­ing Wound Care train­ing work­shops across the Top End of the North­ern Ter­ri­to­ry to remote health practitioners.

Lead­ing a team of vol­un­teer spe­cial­ist plas­tic and recon­struc­tive sur­geons, Dr Barnett’s aim is for rur­al and remote health prac­ti­tion­ers to improve their skills and con­fi­dence, pro­vid­ing treat­ment that will result in faster-heal­ing wounds, less infec­tion, few­er trans­fers out of Coun­try and bet­ter scars.

Thanks to a Com­mon­wealth Gov­ern­ment grant, the Foun­da­tion has already con­duct­ed 20 work­shops, attend­ed by 300 health prac­ti­tion­ers, plus stu­dents at Bach­e­lor Insti­tute under­tak­ing the Cer­tifi­cate IV in Abo­rig­i­nal and Tor­res Strait Islander Pri­ma­ry Health Care Practice.

The Foundation’s plans are to expand the pro­gram through­out the NT and across the bor­ders into Far North Queens­land and the Kim­ber­ley region in West­ern Aus­tralia.

The hands-on sutur­ing class is by far the most pop­u­lar part of the train­ing, Dr Bar­nett says, with pig trot­ters the ide­al ​‘patients’ for prac­tis­ing clean­ing wounds and apply­ing anaes­thet­ic, learn­ing how to hold the instru­ments, and insert­ing var­i­ous types of skin sutures.

“Pig skin is very sim­i­lar in struc­ture to human skin. To han­dle and stitch a trot­ter is almost iden­ti­cal to deal­ing with a per­son,” he said.

And so a pile of frozen pig trot­ters can be found thaw­ing in the sink when-ever the team arrives at a work­shop loca­tion – in prepa­ra­tion for clean­ing and stitching.

The first lec­ture of the day is wound assess­ment, with a list of things to think about.

“Out of that comes under­stand­ing,” Dr Bar­nett said, ​“Whether it should or could be treat­ed local­ly, how to apply first aid and then how to man­age the wound, includ­ing stitch­ing it up. Or per­haps it’s more appro­pri­ate to be treat­ed in a big­ger cen­tre.

​“After the very first work­shop on the Tiwi Islands, a remote area nurse was faced with a young man whose cheek was split open badly.

Nor­mal­ly, that patient would be sent to Dar­win, but the nurse decid­ed: ​‘I think I can safe­ly assess and stitch’ and she did a beau­ti­ful job,” Dr Bar­nett said. ​“There are many sto­ries like that.”

“Burns, dog bites, and facial and hand wounds topped the list when health prac­ti­tion­ers were asked what top­ics they’d like covered.”

Dr Bar­nett said it was always a two-way learn­ing process at the train­ing work­shops at remote clin­ics. As well as pro­vid­ing new skills to local peo­ple, the sur­geons gain new knowl­edge about tra­di­tion­al and local approach­es to wound care.

While acute wounds is the focus of the train­ing, the team also touch­es on chron­ic wounds, which dis­pro­por­tion­ate­ly affect remote Indige­nous com­mu­ni­ties and are the sec­ond most com­mon rea­son for hos­pi­tal­i­sa­tion, Dr Bar­nett points out. ​“If not treat­ed cor­rect­ly, a chron­ic wound can take years to heal or may lead to amputation.”

Dr Bar­nett took the oppor­tu­ni­ty dur­ing his pre­sen­ta­tion on the Foundation’s Wound Care Pro­gram at the CRANAplus Vir­tu­al Sym­po­sium in Sep­tem­ber to launch a suite of online mate­ri­als to aug­ment the train­ing work­shops. The mate­ri­als include e‑learning mod­ules for self-direct­ed con­tin­u­ing edu­ca­tion and videos show­ing the var­i­ous types of sutures as well as gen­er­al wound care. There is also a spe­cif­ic COVID-safe mod­ule focus­ing on the needs and chal­leng­ing sit­u­a­tions faced in remote areas.