Acute to Chronic Wounds
Common complication that includes infection of marrow cavity of bones
Osteomyelitis
Venous ulcer drug therapy
Pentoxifylline 800 mg TID can accelerate healing
black and dry necrotic tissue
black eschar
venous skin ulcers develop when there is _________
venous insufficiency
the 3 big chronic wounds
venous ulcers diabetic ulcers pressure ulcers(decubious) dehisced wounds
Risk factors for venous ulcers
-Deep Vein Thrombosis -Leg surgery -obesity -blood-clotting -work that requires hours of surgery -CHF -smoking
usually DM pts present with ...
-Peripheral neuropathy(no feeling in the foot) -Ischemic Peripheral Vascular Disease -Charcot Osteoarthropathy(Sharko Foot)
Cofactors and Comorbidities
-insufficient oxygenation/perfusion -malnutrition -bioburden -excess pressure -concomitant conditions( PVD,DM) -adverse effects of Tx
- ABI of ____ or less suggests presence of PVD
0.9
venous ulcers account for _____% of all ulcers
80-90%
the ratio of systolic blood pressure in the ankle to that in the brachial artery
ABI(ankle-brachial index)
ultrasound method use to find foot pulse
Doppler examination
with wound bed score, the lower score means the better off you are...T/F
F... the lower score means yur worse off
in the Wagner Ulcer Classification System, at what grade does the bone get involved and what grade are you at highest risk
Grade 3 for osteo Grade 5 highest risk
what may be done in a nursing home to reduce the number fo pressure ulcers
Have elderly on turning schedules every 2 hours... Takes lots of manual labor and costs big $$$
imaging studies such as ___are useful in detecting bone infections
MRI
should compression be used with arterial ulcers?
NOPE
what if you had osteo in the spine and you couldnt cut it off??
Treat with IV anti-microbials for 6 to 8 weeks followed by weeks to months to maybe life of oral anti-microbials
Most venous ulcers develop on either side of the lower leg, above the ____ and below the _______.
above the ankle and below the calf
Venous ulcer 1st line Tx
compression bandaging (1st ) leg elevation biofilm based strategies
If a patient heals from a stage 3 pressure ucler and get another ulcer in the same spot... would it be classified as a stage 1 or stage 3
due to scar tissue would classify as a stage 3 and not revert back to stage 1
what is the first signs of venous ulcers
edema and varicose veins Dermatitis usually present
Historically, the standard procedure for treating osteomyelitis
excision of bone, toe amputation and major amputation
without venous ablation Sx, recurrence within 5 yrs is high or low
high
1st line for ulcer Tx
offloading using wheelchair/crutches
pressure ulcers risk factors
old age Immobilization Malnourishment incontinence DM
Pressure ulcers most commonly occur when??
over bony prominences
an area of skin that breaks down when you stay in one position for too long without shifting your weight.
pressure ulcer
1st line Tx for pressure ulcers
relief of pressure all biofilm based wound care nutritional support
are venous ulcers usually deep or shallow wounds??
shallow
difference between arterial and vasculitis ulcers in shape, margins and surrounding skin
shape: art...round vas...irregular margins: art... smooth vascular... irregular skin: art...pale vascular...hyperemic
wound assessment model
size surrounding skin(color, moisture, suppleness) wound bed (necrotic, exudate, odor, slough) wound edges(undermining, margins)
presentation of the skin in venous ulcers Pain??
skin often hyperpigmented only pain with infection
what stage in pressure ulcer staging involves the bone
stage 4