Skin Ulcers (11/4) Flashcards
Types of Ulcers
Pressure
Venous
Arterial
Neurotrophic (diabetic, loss of sensation)
Special cases - pyoderma gangrenosum, cancer
Pressure Ulcer Staging
Stage 1 - Intact skin w/ non-blanching redness
St. 2 - Shallow, open ulcer with red-pink would bed (unroofed blister, dermis exposed)
St. 3 - Exposed subdermal tissues, undermined edges (full thickness, see fat)
St. 4 - Exposed tendon or bone, full thickness
Unstageable - cannot see base
3 steps wound healing (surgical)
Inflammation, Epithelialization, Remodeling
Granulation Tissue
Richly vascular fibroblast stroma, provides supportive base for advancing epithelial tissue – good in ulcer healing (no fibrin clot on top)
May exude serous fluid
Pressure Ulcer Treatment
Take pressure off, manage infection (colonized, may not need treatment - topical abx, worry about bone/systemic), nutritional support (protein), local wound care/dressings
need to know underlying cause
Stage 1 PU Care
Epidermis intact –> No debridement/dressing needed, clean with soap/water, pressure relief, maybe protective film
Stage 2 PU Care
Blister-like –> No debridement, saline cleanse, dressing polyurethane film/hydrocolloid wafer, provide moist wound bed/surrounding area dry
Stage 3 PU care
Debridement: If eschar/slough present - autolytic, wet-to-dry, enzymatic, sharp
Cleansing: Saline
Dressing: Hydrocolloid, alginate, hydrogel (may need packing/foam if undermined)
Debride necrotic tissue, protect granulation tissue
Stage 4 PU care
Same as Stage 3
Debridement: If eschar/slough present - autolytic, wet-to-dry, enzymatic, sharp
Cleansing: Saline
Dressing: Hydrocolloid, alginate, hydrogel (may need packing/foam if undermined)
Debride necrotic tissue, protect granulation tissue
Odor - metronidazole gel, activated charcoal
Venous Leg Ulcers (overview)
Medial malleolus typical (most common LE ulcer)
Chronic edema, varicose veins often
2 systems of veins in LE - superficial and deep with deep having more pressure
Valve system between - overloaded by CHF, obesity, obstruction, inactivity (muscle pumps)
Venous Leg Ulcers Treatment
Same as Pressure Ulcers
Control of Edema essential (like 30-40mmHG at ankle)
Arterial Ulcers
Circumscribed “punched-out” ulcers, often multiple
Areas least well perfused (lateral malleolus, tibial, feet/toes), shiny/hairless skin, absent pulses, claudication (Cramping w/ exercise)
Ankle-Brachial Index
Normal is 1 or above
ABI below 0.8 - claudication
ABI below 0.4 - rest pain
worry about ulcers at 0.8 - also coronary/cerebral arterial disease
Not usually just stenosis in one place…
Buerger’s Disease
Thombangiitis obliterans Occurs in (young) smokers Hands and feet Sensitivity to vasoactive effects of nicotine Impaired endothelium relaxation Both venous and arterial involvement Allen test
Allen Test
Test patency of ulnar artery (smaller - first to be occluded)
Occlude radial and ulnar arteries after making a fist to empty blood from hand
Open hand and release pressure over ulnar artery - should refill with blood from ulnar artery - pink
