1. Wound Management for Primary Care Providers
What can I do before referral to a Wound Center?

2. Basic Principles Determine underlying etiology
Pressure? Venous? Diabetic? Traumatic?
Manage infection, if present
Remove pressure/ off-load the wound
Choose topical therapy to maintain moist wound bed
Determine dressings based on location, amount of drainage
Is diagnostic testing needed?

3. Basic Wound Care Cleanse with normal saline, wipe with dry gauze
Contact lens saline
2 tsp table salt to 1 qt. boiled water
Avoid peroxide, Betadine, alcohol
Avoid tub baths; showering generally permitted, if wound cleansed and dressed immediately afterward

4. What type of wound is this?
                                                               
What type of wound is this?

5. Venous Leg Ulcer—Typical findings
Located medial lower leg (“gaiter” area)
Hemosiderin staining
Liposcleroderma
Maceration---heavy drainage
Leg edema
Irregular shape, larger in size

6. Treatment of Venous Wounds
Culture/ treat if infection is suspected
Debridement: Santyl ointment for yellow wounds
Control exudate: Use alginate, ABD pads, roll gauze
COMPRESSION: Ace wrap, Tubigrip 1-2 layers
*Must check ABI (Ankle BP per Doppler divided by arm systolic BP. Normal = 0.9 – 1.3)

7. Santyl: Enzymatic debridement
Apply daily, thin layer
15 or 30-gram tube
Cost: $50-70
No generic
Smith-Nephew

8. Alginate Seaweed product Absorbs drainage Turns into gel when wet
                                                        
Alginate
Seaweed product
Absorbs drainage
Turns into gel when wet
Some contain silver
Can use to pack cavity
Sheets or rope

9. Compression Ace wrap: 4-inch, from base of toes to knee
50% overlap, 50% stretch
Tubigrip: 1 layer = 10 mm Hg
Sizes C, D

10. What type of wound is this?
Often located over pressure areas
Foot deformities common
History of diabetes?
Check circulatory status
Monofilament testing

11. Diabetic/ Neuropathic Wounds
Control infection
Topical antibiotic ointment such as Bactroban or gentamicin
Vaseline gauze if wound bed dry or dressings are sticking

12. Conforming Dressings Roll gauze Tegaderm clear film Cover-Roll
Use skin prep with
adhesives

13. Off-Loading Diabetic Wounds
Reduce ambulation
Crutches **Use caution with elderly
Wedge shoe (off-loads forefoot or heel)

14. What type of wound is this?

15. Arterial Ulcers Often very painful, well circumscribed
May be infected without typical S&S
Dependent rubor
Pain in dependent position
Weak/ absent pulses
No hair, shiny thin skin
Delayed capillary refill
Skin cool to touch

16. Arterial Ulcers Order arterial Doppler
TCOM (transcutaneous oxygen measurement)
Arteriogram
Vascular surgeon referral

17. Management of Arterial Ulcers
Limit sharp debridement
Avoid too much moisture
Vaseline gauze
Protect foot from further trauma
If revascularization not an option, healing may not be possible
Pain management
Nitroglycerin patch showed no increase in perfusion

18. What type of wound is this?

19. Dry, stable eschar
If adherent without drainage or obvious infection, do not debride
Paint with Betadine or skin prep to keep dry
Cover with dry gauze
If edges are loose or draining, or wound is infected, refer for surgical debridement
Requires circulatory assessment
Remove pressure
Waffle boot or multipodus boot for heel wounds

20. Off-Loading the Heel Wound
Waffle boot
Multipodus boot

21. Collaboration with Primary Care
Management of underlying diseases
Pain control
Prevention
Diabetic foot care/ routine exams/ podiatry care
Compression stockings for venous disease
Nutritional support
Pressure ulcer prevention
Skin care, positioning, incontinence management, pressure reducing surfaces