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9-3-099-3-09Wound CareWound Care

PreventionRecognize the risk factors: DiabetesVenous insufficiencyArterial insufficiencyMalnutritionDehydrationDeformityImmobility

PreventionOther Risk Factors

RA

Alcoholism

Cigarettes

Gout

Factitial

Idiopathic Neuropathy

PreventionHygiene

PreventionMovement- Aids in creating collateral blood flow.- Activates calf muscle pump. - Helps control blood sugar

PreventionMonitor risk factors:

Pulses

Sensation

Deformity

Atrophy

Callus

Integrity

Prevention

Shoes

Do the shoes fit?

Diabetic shoes

Extra depth shoes

PreventionSocks

Diabetic socks

Compression socks

Farrow wraps

How Wounds Heal

How Wounds HealChronic Wounds

Not 30% smaller at week 4 s/p injury

MMP’s

Senescent cells

Biofilm/Bioburden

Too few growth factors

BiofilmBiofilm is a community of planktonic bacteria in the extracellular matrix. Infection = 10 to the 6th

Biofilm = 10 to the 5th or greater60% of chronic wounds have biofilms.

Source: Costerton, J William. SAWC presentation 2006

Dressings for Bioburden

Silver dressings- bind and destroy cell walls of bacteria, yeast, fungi and viruses ON CONTACT (for colonized, critically colonized wounds)

Cadexomer Iodine- kills bacteria, viruses and fungus. Removes sloughy tissue.

(For colonized wounds)

Hydrofera Blue- methylene blue and crystal violet inhibit growth of bacteria.

Combination TherapySystemic antibiotics – use when SOI extend

beyond ulcer margins.

Topical anti-microbials

Types of UlcersPressure Ulcer

Types of UlcersDiabetic Ulcer

Types of UlcersVenous Ulcer

Types of UlcersArterial Ulcers

TreatmentLet the Punishment fit the Crime

Remove all necrotic tissue

Manage Infection

Understand patient’s lifestyle, goals and expectations.Wound Healing Society

When to change treatment

10-15% reduction in wound size

per week is normal healing.

Source: Plasti Reconstructive surgery. Attinger CE, et al 2006 June: 117

Treatment: Pressure Ulcers

Manage local or systemic infection

Manage Pain

Manage necrotic tissue

Offload pressure area

Cleanse

DressingsSource: European Pressure Ulcer Advisory Panel

Treatment: Diabetic Ulcers

Manage local or systemic infection

Manage Pain

Manage Blood Glucose

Manage necrotic tissue

Offload pressure area

Cleanse

Dressings

Treatment: Venous Ulcer

Vascular Studies

Topical wound management

Debridement

Leg Elevation

Compression- based on vascular studies

Source: Advances in Skin and Wound Care Vol 22 No.9

Treatment: Arterial UlcerReperfusion- surgical or pharmacological

Moisture balance

Pain control

Wet Gangrene – Needs immediate sharp debridement

Dry Gangrene – Must be kept dry until reperfusion.

Wound Care TeamNursePrimary Care PhysicianTrained wound care practitionerNutritionistInfectious Disease SpecialistVascular SpecialistSurgeonOrthotist/Prosthetist

ResourcesAdvances in Skin and Wound Care- free

publication

EPUAP/NPUAP

Wound Healing Society

Wound Care Information Network

World Wide Wounds

Thank You!Thank You!