Seven Rivers Regional Medical Center - Conditions Appropriate For Wound Care

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Conditions Appropriate for Wound Care

Pressure Ulcers

A pressure sore is a lesion that develops on the skin and underlying tissues due to unrelieved pressure usually over a bony prominence. The skin and tissues rely on an adequate blood supply for oxygen and nutrients. When tissues are compressed for an extended period, (even two hours), blood supply can be cut off, leading to development of a sore. >> more

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Neuropathic (Diabetic) Ulcers

Neuropathic ulcers are usually located at increased pressure points on the bottom of the feet. However, neuropathic ulcers related to trauma can occur anywhere on the foot. They occur primarily in people with diabetes, although they can affect anyone who has impaired sensation of the feet.

The base of the ulcer is variable, depending on circulation. It may appear pink/red or brown/black. The borders of the ulcer are punched out, while the surrounding skin is often calloused.

Neuropathy and peripheral artery disease often occur together in people who have diabetes. Nerve damage (neuropathy) in the feet can result in loss of foot sensation and changes in the sweat-producing glands, increasing the risk of being unaware of foot calluses or cracks, injury or risk of infection. Symptoms of neuropathy include tingling, numbness, burning or pain.

Because people with diabetes are more prone to foot ulcers than other people, it is extremely important to inspect the feet daily using a mirror if direct visualization is not possible. Proper footwear is essential. Going barefoot is not an option and white cotton socks should be worn. Toenails should only be trimmed by a trained professional, and prompt medical evaluation should be sought for any break in the skin of the foot to prevent complications such as infection.

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Ischemic Ulcers

Ischemic ulcers are also called arterial ulcers. These ulcers are located on the feet and can also be found on the tips of the toes, on the heels, between the toes wherever there is pressure or anywhere the bones may protrude and rub against sheets, socks or shoes. These ulcers may also be located in the nail bed if the toenail cuts into the skin or if recent aggressive toe nail trimming has been done.

The base of an arterial/ischemic ulcer usually does not bleed. It has a yellow, brown, grey or black color. The borders of the ulcer look as though the area has been punched out. These wounds are very painful. If irritation or infection are present, there may or may not be redness or swelling around the base of the ulcer. There may also be redness of the entire foot when the leg is dangled; this redness often turns pale white or yellow color when the leg is elevated.

Arterial/ischemic ulcers are typically very painful at night when the leg is elevated to the level of the bed. Instinctively the person may dangle the leg over the side of the bed to get relief.
Treatment options are usually somewhat limited. Since the problem is poor bloodflow to the extremity, wounds are very difficult to heal without reestablishing bloodflow to the area.

Sometimes hyperbaric oxygen treatments may be used if bypass surgery has been done or if the person is not a candidate for surgery as a limb saving attempt. It is important to discuss any issues regarding poor circulation and ischemic ulcers with your healthcare provider so that the appropriate plan of care can be designed for an optimal outcome.

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Venous Insufficiency/Ulcers

Venous stasis ulcers are located below the knee and are primarily found on the inner part of the leg just below the ankle. However, they may also be found on the outer ankle area.

The base of the ulcer is usually red but yellow fibrous tissue may also be seen. There may be a yellow or green discharge if the wound is infected. Drainage may be significant with venous ulcers. The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discolored and swollen. It may even feel warm or hot. The skin may appear dry and flaky.

Venous ulcers are common in patients who have a history of leg swelling, varicose veins or a history of blood clots in either the superficial or deep veins of the legs. Ulcers may affect one or both legs. Other causes include excessive weight, having children, inherited disease or trauma to the venous system. Venous ulcers affect approximately 600,000 people in the United States every year and account for 80 to 90 percent of all leg ulcers.

Treatment options almost always include compression therapy of some sort over dressings used to treat the wounds. Elevation of the legs is paramount to successful healing. Exercise is also very important as the motion of the calf muscle enhances the flow of blood and fluid back to the heart.

For more information on venous ulcers and treatment options, discussion with your healthcare provider will be beneficial.

Surgical Wounds

These wounds are surgically created but for various reasons may not heal according to original expectations of the surgeon. Many factors play into wound healing and a deficit in any of these factors can cause an acutely created surgical wound to become a chronic non-healing wound.

With the assistance of highly-trained wound specialists, your physician and other specialists, a specific plan of care can be designed to enhance the wound healing process. Hyperbaric oxygen therapy treatments may also be ordered by your physician if appropriate for your specific wound issues.

Burns

A burn is damage to the skin and sometimes to the underlying tissues. Burns are categorized according to the depth and extent of the damage to the skin:

Superficial burn (also called first-degree burn)
Superficial partial-thickness burn (also called second-degree burn)
Deep partial-thickness burn (also called second-degree burn)
Full-thickness burn (also called third-degree burn) >> more

Peristomal Skin Irritations

Peristomal skin irritations and wounds are generally caused by malfitting equipment. For those with colostomies and ileostomies, effluent/stool usually seeps under the wafer irritating the skin to the point where a wound is formed. For those with urostomies, wounds can occur from a collection of urine that is too alkaline sitting against the skin for the duration of time between each wafer change. These wounds can be complicated by poor nutritional status or a poor immune response.

Many times, patients will go for years with no skin problems only to develop an ulcer for 'no reason'. The source of this is usually a change in the acidity of the surrounding skin affecting the adhesiveness of the wafer. Stress can be another contributing factor in the development of peristomal ulcerations.

Treatment is generally focused on modifying existing equipment, nutritional intake and stress reduction measures. Medications may also be prescribed.

Wound Care & Hyperbaric Medicine services at the Seven Rivers Rehab & Wound Center (affiliated with Seven Rivers Regional Medical Center) provides evaluation and management of all of these issues in collaboration with primary care providers. If you believe you suffer from any of the above, discuss the concern with your primary healthcare provider for guidance and assistance.