Ulceations, Aneurysms and AV fistulae Flashcards
What is an ulceration?
clinical defects in soft tissue caused by trauma ischemia infection noninfectious inflammatory disorders
The common denominator in any wound healing is
The presence of tissue necrosis
What is wound healing?
A condition in previously injured tissue represented by
Removal of necrotic tissue
Resolution of infection and inflammation
Organized collagen and mature, stable epithelium overlying viable tissue
Phases of wound healing
Inflammatory phase
Fibroblastic (lag) phase or proliferative
Remodeling phase
Remodeling phase begins at about
4th week and can last for years
Factors affecting would healing
Diabetes Infection Necrotic tissue Neuropathy Medication Pressure Abnormal metabolic processes Hyperlipidemia
Ulceration risk factors in DM foot
LOPS PAD limited joint mobility Foot deformities Abnormal foot pressure Minor trauma History of ulcerations or amputation Impaired visual acuity `
peripheral neuropathy is in category
1
check for peripheral neuropathy
semi-annualy
Neuropathy, deformity and PAD is in category
2
check for Neuropathy, deformity and PAD
quaterly
if you have previous ulcer or amputation evaluate
monthly or quarterly
what the the category for previous ulcer or amputation
3
Risk factors for amputation
Neuropathy LOPS PAD Inection history of prior foot ulcer or amupyation structural foot deformity Trauma Charcot foot Impaired vision Poor glycemic control older age male sex Ethnicity
Causes of LE wounds
Ischemia Venous dz Trauma Pressure Neuropathy Infection Dermatitis Surgery Thermal injury Hypertension Diabetes Renal dz
Ischemic ulcer can happen in
Lateral lower leg bony prominences
>Malleolus
>5th met base
>5th met head
What are some non-invasive vascular tests
ABI/TBI
Segmental pressure
TcPO2
Ischemic ulcer management
Referral for underlying dz
Stop smoking
Nutritional support
Wound care and dressing
Pressure induced ischemic injury results within
1-2 hrs
Pressure induced ischemic injuries are usually located at
Pressure points
>heel
>MPJ
Appearance of Neuropathic ulcer?
HPK border
Possibly undermined border
Typically not painful
Location of Neuropathic ulcer?
dorsal aspect of digits
Plantar aspect of met heads
heel
Neuropathic ulcer evauation
Semmes-Weinstein Nylon monofilament test
Plain-film radiographs should be obtained to look for soft tissue gas and foreign bodies
Adequate debridement
Probe the ulcer with a sterile blunt instrument to determine the involvement of underlying structures such as tendon, joint capusle or bone
probe the bone to test for osteomylitis
How much should you debride?
you should remove all necrotic tissue and surrounding hyperkeratosis until a healthy bleeding edge is revealed
What is the gold standard for Neuropathic ulcer managament ?
total contact casting
What does total contact cast do?
reduces pressure
immobilizes tissues
Reduces edema
Non- removable
What are some indications for TCC?
chronic non healing ulceration associated with neuropathis d/o
well perfused
non infected
wagner 1 & 2
What are some contraindications for TCC?
Active infection Poor perfusion Ischemia narrow and deep ulcerations History of dermatitis Wagner 3,4,5 Claustrophobia
Classification/staging systems
Wagner UTHSC-SA Gibbons Forest Ten-level seattle wound classification system
Wagner classifications
most ulcers will be grade I or II
Doesnt differentiate well between ulcers
No predicative value for prognosis
Wagner classification-0
foot at risk
Wagner classification-1
Superficial ulcers
Wagner classification-2
Deep ulcers
Wagner classification-3
Abscessed deep ulcers
Wagner classification-4
limited gangrene
Wagner classification-5
Extensive gangrene
UTSA
Grades pt medical condition and wound
UTSA-0
Areas of pressure which are sometimes called pre-ulcerative lesion
UTSA-I
Superficial ulcer not including tendon, capsulla or bone
UTSA-II
Deep ulcer incuding tendon, capsula but not bone
UTSA-III
deep ulcer including bone and articulation
