Clinical Practice 2: Wound Care Theory

Wound Dressings

• Protect open lesions, facilitate healing, increase drug absorption, and protect the patient's clothing.
• Non-occlusive dressings, such as gauze dressings, allow air to reach the wound and help it dry.
• Wet-to-dry dressings are non-occlusive dressings that are wet with a solution (usually saline) to help cleanse and debride thickened or crusted lesions.

Types of Wounds

Venous Ulcers

• Typically have an irregular shape and well-defined borders.
• Located over bony prominences, such as the gaiter area.
• Symptoms include limb heaviness, pruritus, pain, and edema that worsens throughout the day and improves with elevation.
• Physical examination signs include varicose veins, edema, venous dermatitis, telangiectasias, and corona phlebectatica (abnormally dilated veins around the ankle and foot).
• Additional signs include haemaciderin deposits, atrophie blanche (atrophic white scarring), lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg.

Arterial Ulcers (Ischaemic Ulcers)

• Caused by poor perfusion (delivery of nutrient-rich blood) to the lower extremities.
• Characterized by a lack of blood supply, leading to tissue necrosis and/or ulceration.
• Tend to have a "punched-out" appearance, with small, round, and smooth, well-demarcated borders.
• Wound base is typically pale and lacks granulation tissue.
• Wet or dry gangrene may be present.
• Often occur over the distal part of the leg, especially the lateral malleoli, dorsum of the feet, and the toes.
• Can be shallow or deep and are frequently painful.
• Physical examination signs include:
  • Limb feels cool or cold to the touch.
  • Extremity has little to no distinguishable pulse.
  • Skin and nails on the extremity appear atrophic.
  • Hair loss on the affected extremity.
  • Skin is shiny, thin, dry, and taut in appearance.
  • Extremity may turn red when dangled and pale when elevated.
  • Delayed capillary return in the affected extremity.
• Vascular assessment techniques include Doppler and Buergers elevation test.
• These ulcers are generally very painful, especially during exercise, at rest, or during the night, and dangling the affected legs over the edge of bed may provide temporary relief.

This quiz covers the basics of wound care, including the role of wound dressings in protecting open lesions, facilitating healing, and increasing drug absorption.