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wound care

Laboratory: - wound culture if suspected infection - bone biopsy with culture for suspected osteomyelitis Radiology: - radionuclide bone scan, CT or MRI if osteomyelitis suspected - see osteomyelitis Management: - also see management of cutaneous ulcer - see wound dressing - thorough cleansing is often sufficient for most cuts & scrapes [3] - non-stick dressing over white petrolatum is a more expensive option [3] - wounds heal faster with less scarring with kept moist & occluded [3] - use white petrolatum rather than antibiotics on clean wounds [3] - wound debridement - remove debris - remove necrotic tissue (unless arterial insufficiency) - gauze for exudative wounds - ribbon gauze packs for deep tunnels - control pain associated with wound care procedures - control infection - use Silvadene for wounds with > 1 million CFU/g tissue or any infection with beta-hemolytic Streptococci - consider topical antibiotic for clean wounds that are not healing after 2-4 weeks of optimal care - systemic antibiotics for signs of spreading infection, cellulitis, or osteomyelitis - see treatment of cellulitis - see treatment of osteomyelitis - adjunctive therapy for wound healing - negative pressure wound therapy - electrical stimulation - growth factor therapy - Regranex - prevent further injury (see pressure ulcer) - nutritional support for repair processes - protein: 1.25-1.5 g/kg/day unless contraindicated, i.e. ESRD - calories: 30-35 kcal/kg/day - correct vitamin C deficiency - correct zinc deficiency - avoid exposure to cold - vasoconstriction reduces blood flow to the wound - ensure adequate hydration - re-evaluate if wound does not show healing within 2 weeks

Related

cutaneous ulcer debridement wound wound dressing wound healing

Specific

complex wound repair, eyelid/nose/ear/lip complex wound repair, forehead/cheeks/chin//mouth/neck/axillae/genitalia/hand/foot complex wound repair, scalp/arm/leg intermediate wound repair, face/ear/eyelid/nose/lip/mucous membrane intermediate wound repair, neck/hand/foot/genitalia intermediate wound repair, scalp/neck/axilla/genitalia/trunk/extremity laser ablation burn/scar laser ablation open wound negative pressure wound therapy no-touch technique simple wound repair, face/ear/eyelid/nose/lip/mucous membrane simple wound repair, scalp/neck/axilla/genitalia/trunk/extremity ultrasound wound therapy wound care, burn wound care, dehiscence wound care, eyelid/nose/ear/lip wound care, face/ear/eyelid/nose/lip/mucous membrane wound care, forehead/cheek/chin/mouth/neck/axilla/genitalia/hand/foot wound care, neck/genitalia/hand/foot wound care, scalp/arm/leg wound care, scalp/axilla/trunk/extremity wound care, scalp/neck/axilla/genitalia/trunk/extremity wound care, trunk wound irrigation

General

clinical procedure

References

  1. Prescriber's Letter 15(5): 2008 Comparison of Chronic Wound Care Products Detail-Document#: 240511 (subscription needed) http://www.prescribersletter.com
  2. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018
  4. Gist S, Tio-Matos I, Falzgraf S, Cameron S, Beebe M. Wound care in the geriatric client. Clin Interv Aging. 2009;4:269-87. Epub 2009 Jun 9. PMID: 19554098
  5. Fonder MA, Lazarus GS, Cowan DA et al Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol. 2008 Feb;58(2):185-206 PMID: 18222318
  6. Alam W, Hasson J, Reed M Clinical approach to chronic wound management in older adults. J Am Geriatr Soc 2021. May 17 PMID: 34002364 Review https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.17177