Patient education is an important component to a successful healing process. Patients that learn about their condition and treatment are better able to care for themselves, assist in the healing treatment and prevent future recurrences. Below is some basic information about wounds and wound care treatment. We encourage all patients to learn about their conditions and the treatments they are receiving. Please ask your nurse or doctor any questions you may have.
ACUTE VS. CHRONIC WOUNDS
Acute: These are wounds that heal uneventfully and within an expected time frame, although there can be complications that require prompt medical attention
Chronic : These are wounds that do not heal in the standard time frame and may last for weeks, months or even years. Typically there are not complications with these wounds other than slow healing.
TYPES OF WOUNDS
Pressure Ulcers: Also known as bedsores or decubiti, these wounds involve an area were localized tissue necrosis (death) has occurred. They are caused by pressure on a bony area against a surface, which causes a decrease in blood supply to the area that eventually leads to cell death.
Arterial Leg Ulcers: These are also known as ischemic ulcers and are caused by a lack of adequate blood supply to an organ, usually due to a blocked artery. These wounds are often seen on the tips of the toes. To properly treat arterial ulcers, blood flow must be assessed.
Neuropathic / Diabetic Ulcers: These wounds are associated with diabetes and result from damage to the nerves to the foot. These ulcers are typically located on the the foot.
Venous Wounds/Leg Ulcers: These wounds result when there is a failure of the valves in the veins, creating swelling in the lower legs. The valves become damaged and cannot effectively return blood from the lower extremities to the heart. These wounds are typically located from the ankle to the mid calf.
PRESSURE ULCER STAGING
Stage I: Non-blanchable erythema
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons.
Stage II: Partial thickness
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister.Presents as a shiny or dry shallow ulcer without slough or bruising*. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.
*Bruising indicates deep tissue injury.
Stage III: Full thickness skin loss
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage IV: Full thickness tissue loss
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.
Unstageable/Unclassified: Full thickness skin or tissue loss – depth unknown
Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth cannot be determined; but it will be either a Category/Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.
(From the National Pressure Ulcer Advisory Panel, http://www.npuap.org)
WOUND CARE CORE PRINCIPLES
1. Wound type and documentation
2. Risk assessment and prevention
3. Identification & modification of barriers to healing including vascular impairment
4. Relieve pressure and mechanical forces
5. Control infection & bioburden
6. Debride necrotic tissue
7. Maintain a moist wound healing environment
8. Absorb exudate
9. Eliminate dead space
10. Support nutrition
11. Control pain
12. Appropriate Dressing
13. Consider adjunctive therapy such as HBO (Hyperbaric Oxygen Therapy)