Orthopedics - Non Healing Wound
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Non Healing Wound
Chronic Wound: any non-healing wound and/or
ulcer that has been present for 3-4 week duration and has not responded to
Initial Diagnosis and Management
- Pressure Ulcers:
Management involves assessment of systems, wound management, and evaluation
by a plastic surgeon.
- Stage III - full
thickness skin loss involving damage or necrosis of subcutaneous tissue
that may extend to, but not through, fascia.
- Stage IV - full
thickness skin loss with extensive destruction, tissue necrosis, or damage
to muscle, bone, or supporting structures (tendon, joint capsule).
- Non-Healing Surgical
Wounds: Wounds that are taking longer to heal because of underlying
problems such as diabetes, poor nutritional status, immune compromised, or
infection. Any surgical wound of 3-4 week duration that is not responding
to conventional therapies. Management includes assessment of systems, wound
management, and evaluation of a general surgeon.
- Lower Extremity
Ulcerations: Any non-healing ulcer of a lower extremity that has been
present for 3-4 week duration and has not responded to conventional
- ARTERIAL ULCER - caused
by ischemia; related to the presence of arterial occlusive disease;
generally present on the foot, typically the distal appendages and lateral
malleolus; very painful; onset can be precipitated by trauma. Management
involves assessment of blood flow to the extremity, wound management, and
evaluation by a vascular surgeon.
- VENOUS STASIS ULCER -
result of edema and impaired venous return; loss of epidermis and various
levels of dermis and subcutaneous tissue occurring on the medial aspect of
the distal 1/3 of the lower extremity. Often found in combination with an
edematous and indurated lower extremity. Management involves assessment of
blood flow to the extremity, wound management, compression stockings
and/or wraps, and evaluation from a vascular surgeon. A dermatologist
consult may be obtained if chronic dermatitis is present.
- MIXED VESSSEL (ARTERIAL
AND VENOUS ULCER) - presence of arterial insufficiency and venous disease.
Typically, ulcers are found on the lower extremity including the foot.
Management includes assessment of blood flow to the lower extremity, wound
management, and evaluation by a vascular surgeon.
- All patients should be
encouraged to decrease their risk factors (e.g., smoking, etc.) and to
manage co-existing conditions such as diabetes.
- All other ulcerations
assessed individually and treated according to the underlying etiology.
Ongoing Management and Objectives
Allow healing of all wound and/or ulcers;
management is tailored to the specific wound and etiology.
Indications for Specialty Care Referral
Any non-healing wound and/or ulcer that has
been present for 3-4 week duration and has not responded to conventional
therapies should be referred to the wound clinic.
Criteria for Return to Primary Care
Once the wound-care plan is effective,
follow-up can be done by primary care for risk factor reduction.