wound care
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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)
- wound odor
- wound debridement of necrotic tissue will address the bacterial burden but will not remove all anaerobic bacteria
- palliative management with topical metronidozole for anaerobic bacteria causing the odor[2][7]
- 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
- 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
More general terms
More specific terms
- 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
Additional terms
References
- ↑ Prescriber's Letter 15(5): 2008 Comparison of Chronic Wound Care Products Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240511&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/19554098
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/18222318
- ↑ Alam W, Hasson J, Reed M Clinical approach to chronic wound management in older adults. J Am Geriatr Soc 2021. May 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34002364 Review https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.17177
- ↑ 7.0 7.1 Lyvers E, Elliot DP. Topical metronidazole for odor control in pressure ulcers. Consult Pharm. 2015;30(9):523-526 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26350892 https://www.ingentaconnect.com/content/ascp/tcp/2015/00000030/00000009/art00005;jsessionid=h8q5e0oi00ie8.x-ic-live-01