Basic Principles of wound care
First step is assessment of the wound.
- Is the wound greater or less 2 cm?
- Is the edge and bed pink and healthy or necrotic?
- Is surrounding area erythematic, celluliltis, streaks indicating infection?
- Is the wound penetrating to fascia, tendon, bone?
- Are there any foreign bodies?
- Assess lower extremity blood flow using pulses or ABI.
- Are there signs of systemic infection, elevated temp or WBC?
Uncomplicated ulcers can be handled by primary care providers.
- less than 2 cm in diameter
- do not involve deep spaces
- margins of erythema < 2 cm
- no signs of systemic infection
- No vascular insufficiency
Follow general management principles for treating uncomplicated wounds.
- Clean and moist environment:
- Periodic wound debridment
- Regular dressing changes
- Off loading to relieve pressure
- Limited infection treated with oral antibiotics directed by culture
- Monitor size of wound
- Follow-up on weekly basis
- Control glucose
- If wound does not heal in 4 weeks, refer to specialist
Follow general principles of dressing changes to enhance wound healing.
- Wet to dry saline gauze dressing daily
- Absorbent compounds good for soupy wounds
- Hydrocolloid gels and occlusive dressings have a role in dry wounds
- Enzymatic debridement can be useful in softening thick eschar
Wound healing requires good nutrition.
- Positive Nitrogen Balance for anabolic state
- Vitamin C 500mg/day
- ZnSO4 220mg/day for 10 days
- Follow with multi-vitamin with trace minerals daily
Patience is required for wound healing; may take months