Chronic Wound Care

Question 1

What are the three phases in acute wound healing?

What occurs in chronic wounds that prevents them from healing?

Answer 1

• inflammatory
• proliferative
• remodeling
• Wound heals in 4-6weeks.

Chronic wounds get stuck in the inflammatory phase, they are characterized by hypoxia, bacterial colonization
*wounds are unhealed after 6-12 weeks

Question 2

Debridement of an ischemia extremity?

Answer 2

-NO WAY JOSE!

Question 3

When you think you have a falsely elevated ABI what test do you od?

Answer 3

-Pulse volume recording (PVR)

Question 4

Whats the difference between arterial and venous ulcers?

Answer 4

Arterial: dry eschar, ususally non-painful

Venous: wet weepy, no eschar, hyperpigmentation (brown skin), exudate is common

Question 5

Venous ulcers are most common where? Arterial?

Answer 5

• Venous: mid-calf to heal of ankle “gaitor area”

- Arterial: ankle and foot

Question 6

how does venous insufficiency lead to ulcers?

Answer 6

-venous disease(valve incompetence) leading to blood pooling, becomes hypoxic and acidotic leading to skin breakdown

Question 7

Venous Ulcer Tx

Answer 7

• compression therapy (ACE wrap or CirAides)
• Debridement
• Abx (doxycycline)
• SKin graft

Question 8

Wounds should be healed ____% after 1month, if not consider ___.

Answer 8

• 33%-50% healed

- surgery consult

Question 9

What age group do most chronic wounds occur? Why?

Answer 9

• those over 60years

- collagen and desmosomes go away so their skin integrity is much worse

Question 10

Above what blood glucose do WBC no longer function properly?

Answer 10

-200

Question 11

Charcot Foot

Answer 11

Increased blood, bounding pulses in the foot, flow actually leads To calcium leeching. Leeches calcium out of the bone leading to fx. Bones weakened enough to fx, likely leads to flat foot.

Question 12

Why do we debride Diabetic Foot Ulcers

Answer 12

to control excessive or abnormal bacterial load and biofilm, which may lead to infection and delayed healing.

*need to remove senescent cells, these have sluggish response to healing.

Question 13

Tx of Diabetic Foot Ulcers

Tx of Osteomyelitis

Answer 13

• TCC (cast)** GOLD STANDARD for DFU offloading
• Fracture Boots
• Surgical shoes
• diabetic shoe inserts
• foam/felt padding

Osteomyelitis:

• clean the ulcer
• culture the bone
• abx
• hyperbaric chamber

Question 14

Best thing to help prevent pressure ulcers?

Answer 14

-nutrition and blood sugar control

Question 15

Exicisional Debridement converts a ___ wound to a ___ wound.

Answer 15

-chronic to acute