wound care

Wound Care

Wound healing consists of a cascade of interrelating reactions triggered by an injury. Any disruption to the cascade could lead to delay or non-healing. A chronic wound frequently has multiple etiologies.

It is estimated that 1-2% of the U.S. population will have a chronic wound at some time during their life. The number of these wounds, the cost of their treatment, and their impact on an individual’s quality of life and independence is almost certain to grow with aging and the increasing incidence of obesity in our population.

Types of Most Common Chronic Ulcers

Chronic ulcers can be classified based on the etiology (cause), however, many people have multiple systemic conditions and the chronic ulcers frequently have multiple causes.
Arterial ulcers are developed due to compromised circulation and are frequently a result of acute wounds that do not heal.
Venous ulcers occur secondary to edema (swelling). They are commonly located at the inside of the ankle.
Neuropathic ulcers are sometimes called diabetic ulcers since diabetes is the most common cause of neuropathy. The ulcers are usually located on the pressure points of the foot due to repetitive microtraumas. Diabetic foot ulcers result in the most non-traumatic amputations and proper diabetic foot care is an important part of ulcer prevention.
Pressure ulcers are also called bedsores that are injuries to the skin and tissues due to prolonged pressure. The most common areas to develop pressure ulcers are coccyx (tailbone), hips, heels and ankles. Besides pressure, friction from moist and reduced circulation from the pressure are contributors.
Other ulcers can develop secondary to other systemic conditions, such as gout and inflammatory diseases. Some chronic ulcers develop cancer but some cancers manifest as ulcers.

Systemic Approach to Wound Management

Similar to any disease, physicians at Rochester Clinic treat the whole person, not the disease. It is important to identify any systemic comorbidity to properly treat the ulcer.

Etiology – The etiology is the immediate cause for the ulceration. A correct classification initiates the proper wound management protocol.
Systemic comorbidity – A wound will not heal in a timely manner if it does not receive adequate blood flow or if it is compromised with a systemic problem such as high blood sugar and edema.
Infection – Skin serves as the first line of defense against infections, however, a wound inhibits the defense mechanism, making it then prone to infection. Infection is one of the leading causes of chronic ulcerations.
Offloading – Repetitive traumas continue to injure a chronic wound. It is most frequently seen in pressure and neuropathic/diabetic ulcerations. Offloading is meant to remove pressure and repetitive traumas to the ulcer. Similarly, compression therapy reduces pressure applied to the ulcer by edema.

Standard of Care in Wound Management

Wound management is a complicated process and the standard of care can be summarized into six principles.

  • Infection Diagnosis and Management

  • Vascular Diagnosis and Management

  • Offloading Pressure

  • Promoting a Good Wound Healing Environment

  • Regular Re-evaluation of Wound and Treatment Plan

  • Managing Systemic Comorbidities

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