Vascular Wounds Quiz

Study Notes

Arterial Insufficiency Ulcers are caused by insufficient blood flow to the extremities, leading to wounds that are slow to heal (if at all).
Risk Factors for Arterial Insufficiency Ulcers:
- Atherosclerosis
- Overweight and Obesity
- Diabetes
- Smoking
- Hypertension
- Age
- Cardiovascular Disease
Prognosis for Arterial Insufficiency Ulcers:
- Good Prognosis: Ankle Brachial Index (ABI) > 0.5, Toe Pressure > 50 mmHg, Transcutaneous Oxygen Levels > 30 mmHg.
- Poor Prognosis: If wound doesn't decrease in size or heal within 2 weeks, referral to a vascular surgeon is needed.
Pulse Examination: Is essential for all open wounds.

Capillary Refill Test:
- Normal: Blood returns in 3 seconds or less.
- Impaired: Blood returns after more than 3 seconds.
Venous Filling Time:
- Normal: 15-20 seconds.
- Arterial Insufficiency: >15-30 seconds.
Rubor of Dependency Test:
- Normal: Color returns to the foot within 15 seconds.
- Arterial Insufficiency: Color returns after 30 seconds and turns bright red.

Infection Control:
- Ischemic wounds are susceptible to bacterial infections.
- Consider bacterial swab if classical signs of infection aren't present.
- Topical treatments: Silver dressings, cadexomer iodide.
- Deep tissue infections: Systemic antibiotics.
Wound Cleansing:
- Use 0.9% saline for wound cleansing - other solutions can be toxic.
Dressing:
- Arterial ulcers have minimal exudate and fragile surrounding skin.
- Use moist, non-adherent dressings with antimicrobial properties.

Compression therapy:
- Avoid high compression (30-40 mmHg) if ABI is above 0.80.
- Avoid compression dressings for patients with ABI greater than 0.50 - Refer to a vascular surgeon.
Debridement:
- Never use sharps to remove debris from wounds with low ABI.

Impaired Sensation:
- Lack of pain as an early warning sign of tissue ischemia.
- Individuals with impaired sensation are less likely to reposition themselves, making pressure ulcers more likely.
- Common causes: Spinal cord injuries, Spina Bifida, Stroke, Full thickness burns, and Peripheral Neuropathy.
Impaired Mobility:
- Hospitalization, diagnosis, and surgery can contribute to mobility issues.
- Typically occurs within 3 weeks of surgery and within 1 week of admission to a nursing home.
Previous Pressure Ulcer:
- Scar tissue is 80% as strong as the original tissue.
- Scar tissue + pressure injury = reduced tolerance to external load.
Other Risks: Individuals with high Diastolic Blood Pressure (DBP) are at increased risk.