Non healing wounds

Question 1

Q: What is a non-healing wound?

Answer 1

A: A non-healing wound is a chronic skin and soft tissue wound that fails to heal within 4 to 6 weeks.

Question 2

Q: What are the two main categories of non-healing wounds?

Answer 2

A: The two main categories are ulcers (pressure, neuropathic, venous, and arterial) and non-ulcer related chronic wounds (postoperative wound complications, neoplastic or radiation-induced skin lesions, and infectious or inflammatory wounds).

Question 3

Q: What is the first step in assessing a patient with a non-healing wound?

Answer 3

A: Obtain a focused history and physical exam.

Question 4

Q: What are common underlying conditions that prevent proper wound healing?

Answer 4

A: Common underlying conditions include diabetes, peripheral arterial disease, and poor nutritional status.

Question 5

Q: What type of imaging is often obtained for pressure ulcers to evaluate for osteomyelitis?

Answer 5

A: Common underlying conditions include diabetes, peripheral arterial disease, and poor nutritional status.

Question 6

Q: What type of imaging is often obtained for pressure ulcers to evaluate for osteomyelitis?

Answer 6

A: An MRI is often obtained to evaluate for osteomyelitis if there is exposed bone in the wound bed.

Question 7

Q: What is the significance of checking HbA1c in patients with neuropathic ulcers?

Answer 7

A: Checking HbA1c helps ensure that the patient’s diabetes is under control to prevent further progression of the neuropathic ulcer.

Question 8

Q: What is the common location of venous ulcers?

Answer 8

A: Venous ulcers are typically located at the medial malleolus.

Question 9

Q: What is the diagnostic test for arterial ulcers?

Answer 9

A: An ankle-brachial index (ABI) is used to diagnose arterial ulcers, with an ABI of less than 0.9 confirming peripheral arterial disease.

Question 10

Q: What should be considered if a patient has exposed bone in the wound bed of a pressure ulcer?

Answer 10

A: Consider obtaining an MRI to evaluate for osteomyelitis.

Question 11

Q: What are the key features of neoplastic lesions in chronic wounds?

Answer 11

A: Neoplastic lesions can appear as hypo or hyperpigmented nodules, ulcers resembling a crater, or hard fixed raised nodules known as cauliflower lesions.

Question 12

Q: What is a pressure ulcer?

Answer 12

A: A pressure ulcer is a wound caused by prolonged pressure that decreases blood flow to an area of skin and underlying soft tissue.

Question 13

Q: What are the clinical features of a pressure ulcer?

Answer 13

A: Partial or complete skin loss with dark ischemic discoloration or necrosis over bony prominences, potentially exposing underlying fat, muscle, or bone.

Question 14

Q: What is the typical onset of pressure ulcers?

Answer 14

A: Pressure ulcers typically develop in patients with a history of immobility and poor nutrition, often seen in those who are hospitalized or reside in nursing homes.

Question 15

Q: How is a pressure ulcer diagnosed?

Answer 15

A: Diagnosis is based on clinical examination; MRI may be used to evaluate for osteomyelitis if there is exposed bone.

Question 16

Q: How is a pressure ulcer managed and treated?

Answer 16

A: Management includes relieving pressure on the affected area, improving nutrition, and treating any underlying infections.

Question 17

Q: What is a neuropathic ulcer?

Answer 17

A: A neuropathic ulcer is a wound occurring in patients with peripheral neuropathy, often from diabetes.

Question 18

Q: What are the symptoms/clinical features of a neuropathic ulcer?

Answer 18

A: Deep painless “punched out” ulcer with surrounding callus, typically around pressure points such as the plantar metatarsal heads of the feet.

Question 19

Q: What is the typical onset of neuropathic ulcers?

Answer 19

A: Neuropathic ulcers develop in patients with chronic conditions like diabetes that cause peripheral neuropathy.

Question 20

Q: How is a neuropathic ulcer diagnosed?

Answer 20

A: Diagnosis involves clinical examination, checking HbA1c, and obtaining an ankle-brachial index to rule out peripheral arterial disease.

Question 21

Q: How is a neuropathic ulcer managed and treated?

Answer 21

A: Management includes controlling diabetes, wound care, and reducing pressure around the wound with appropriate footwear and orthotics.

Question 22

Q: What is a venous ulcer?

Answer 22

A: A venous ulcer is a wound caused by venous insufficiency, often seen in patients with a history of prolonged standing, smoking, or deep vein thrombosis.

Question 23

Q: What are the symptoms/clinical features of a venous ulcer?

Answer 23

A: Shallow ulcers with irregular borders, surrounded by edematous, firm skin with reddish-brown hyperpigmentation, typically located at the medial malleolus.

Question 24

Q: What is the typical onset of venous ulcers?

Answer 24

A: Venous ulcers develop in patients with chronic venous insufficiency and other risk factors like smoking or prolonged standing.

Question 25

Q: How is a venous ulcer diagnosed?

Answer 25

A: Diagnosis involves clinical examination and a venous duplex ultrasound to check for venous reflux.

Question 26

Q: How is a venous ulcer managed and treated?

Answer 26

A: Management includes compression therapy, elevation of the affected leg, and treating any underlying venous insufficiency.

Question 27

Q: What is an arterial ulcer?

Answer 27

A: An arterial ulcer is a wound caused by peripheral arterial disease, often seen in patients with a history of atherosclerosis or smoking.

Question 28

Q: What are the symptoms/clinical features of an arterial ulcer?

Answer 28

A: Punched-out, pale, gray, or yellow ulcer with a dry base, often located at the distal ends of digits like the toes, with reduced or absent peripheral pulses.

Question 29

Q: What is the typical onset of arterial ulcers?

Answer 29

A: Arterial ulcers develop in patients with chronic conditions like peripheral arterial disease or atherosclerosis.

Question 30

Q: How is an arterial ulcer diagnosed?

Answer 30

A: Diagnosis involves clinical examination and an ankle-brachial index (ABI) to evaluate for arterial insufficiency.

Question 31

Q: How is an arterial ulcer managed and treated?

Answer 31

A: Management includes improving arterial blood flow, possibly through surgical interventions, and managing underlying conditions like atherosclerosis.

Question 32

Q: What are postoperative wound complications?

Answer 32

A: Postoperative wound complications include wound disruption, dehiscence, evisceration, infection, or drainage following a surgical procedure.

Question 33

Q: What are the symptoms/clinical features of postoperative wound complications?

Answer 33

A: Fever, tachycardia, partial or complete incisional disruption, drainage (serosanguinous, pus, or GI contents), and foul smell.

Question 34

Q: What is the typical onset of postoperative wound complications?

Answer 34

A: These complications typically develop soon after a surgical procedure.

Question 35

Q: How are postoperative wound complications diagnosed?

Answer 35

A: Diagnosis involves clinical examination, lab tests (CBC, ESR, CRP, albumin), and imaging (ultrasound or CT scan).

Question 36

Q: How are postoperative wound complications managed and treated?

Answer 36

A: Management includes treating any infections, ensuring proper wound care, and addressing nutritional deficiencies.

Question 37

Q: What are neoplastic lesions and radiation-induced skin changes?

Answer 37

A: Neoplastic lesions are malignant growths that can appear in chronic wounds, and radiation-induced skin changes result from radiation treatment.

Question 38

Q: What are the symptoms/clinical features of neoplastic lesions and radiation-induced skin changes?

Answer 38

A: Neoplastic lesions can appear as nodules, ulcers, or raised nodules; radiation-induced changes can look like a rash that turns into shiny taut skin.

Question 39

Q: What is the typical onset of neoplastic lesions and radiation-induced skin changes?

Answer 39

A: These conditions typically develop in patients with a history of malignancy or radiation treatment.

Question 40

Q: How are neoplastic lesions and radiation-induced skin changes diagnosed?

Answer 40

A: Diagnosis involves obtaining a wound biopsy to check for malignant cells or epidermal necrosis with dermal inflammatory changes.

Question 41

Q: How are neoplastic lesions and radiation-induced skin changes managed and treated?

Answer 41

A: Management depends on the specific condition and may involve treating the underlying malignancy or managing radiation-induced changes.

Question 42

Q: What are infectious and inflammatory wounds?

Answer 42

A: These wounds result from inflammatory destruction of the skin and soft tissue, often triggered by infection or inflammatory conditions.

Question 43

Q: What are the symptoms/clinical features of infectious and inflammatory wounds?

Answer 43

A: Open sores with necrotic debris, purulent discharge, and possible abscess; inflammatory wounds can resemble a dry rash with erythema.

Question 44

Q: How are infectious and inflammatory wounds diagnosed?

Answer 44

A: Diagnosis involves clinical examination, wound swab cultures for infectious wounds, and biopsy for inflammatory wounds.

Question 45

Q: How are infectious and inflammatory wounds managed and treated?

Answer 45

A: Management includes treating the underlying infection or inflammatory condition and providing appropriate wound care.