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Published in: Current Cardiology Reports 4/2013

01-04-2013 | Peripheral Vascular Disease (M Shishehbor, Section Editor)

The ABC’s of Wound Care

Authors: Kelly Bumpus, Michael A. Maier

Published in: Current Cardiology Reports | Issue 4/2013

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Abstract

Non-healing wounds represent a challenging problem for physicians and patients alike. Although treatment strategies are aimed at specific causes, there are basic management principles that apply to all wounds. The purpose of this article is to review these core management principles as they apply to lower extremity wounds. Key points include a multidisciplinary approach and individualized plans of care as per specific patient needs. A comprehensive treatment plan will lead to faster healing and improved outcomes.
Literature
1.
go back to reference Olin JW, Beusterien KM, Childs MB, Seavey C, McHugh L, Griffiths RI. Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study. Vasc Med. 1999;4:1–7.PubMed Olin JW, Beusterien KM, Childs MB, Seavey C, McHugh L, Griffiths RI. Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study. Vasc Med. 1999;4:1–7.PubMed
2.
go back to reference Cawley MI. Vasculitis and ulceration in rheumatic diseases of the foot. Baillieres Clin Rheumatol. 1987;1:315–33.PubMedCrossRef Cawley MI. Vasculitis and ulceration in rheumatic diseases of the foot. Baillieres Clin Rheumatol. 1987;1:315–33.PubMedCrossRef
3.
go back to reference Meyer V, Kerk N, Meyer S, Goerge TJ. Differential diagnosis and therapy of leg ulcers. Dtsch Dermatol Ges. 2011;9:1035–51. Meyer V, Kerk N, Meyer S, Goerge TJ. Differential diagnosis and therapy of leg ulcers. Dtsch Dermatol Ges. 2011;9:1035–51.
4.
go back to reference Tang JC, Vivas A, Rey A, Kirsner RS, Romanelli P. Atypical ulcers: wound biopsy results from a university wound pathology service. Ostomy Wound Manage. 2012;58:20–2. 24, 26–9.PubMed Tang JC, Vivas A, Rey A, Kirsner RS, Romanelli P. Atypical ulcers: wound biopsy results from a university wound pathology service. Ostomy Wound Manage. 2012;58:20–2. 24, 26–9.PubMed
5.
go back to reference Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1 Pt 2):S1–S296.PubMed Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1 Pt 2):S1–S296.PubMed
6.
go back to reference Rosero EB, Kane K, Clagett GP, Timaran CH. A systematic review of the limitations and approaches to improve detection and management of peripheral arterial disease in Hispanics. J Vasc Surg. 2010;51(4 Suppl):27S–35S.PubMedCrossRef Rosero EB, Kane K, Clagett GP, Timaran CH. A systematic review of the limitations and approaches to improve detection and management of peripheral arterial disease in Hispanics. J Vasc Surg. 2010;51(4 Suppl):27S–35S.PubMedCrossRef
7.
go back to reference Aboyans V, Ho E, Denenberg JO, et al. The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J Vasc Surg. 2008;48:1197–203.PubMedCrossRef Aboyans V, Ho E, Denenberg JO, et al. The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J Vasc Surg. 2008;48:1197–203.PubMedCrossRef
8.
go back to reference Apelqvist J, Elgzyri T, Larsson J, Löndahl M, Nyberg P, Thörne J. Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. J Vasc Surg. 2011;53:1582–8.PubMedCrossRef Apelqvist J, Elgzyri T, Larsson J, Löndahl M, Nyberg P, Thörne J. Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. J Vasc Surg. 2011;53:1582–8.PubMedCrossRef
9.
go back to reference Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761–91.PubMedCrossRef Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761–91.PubMedCrossRef
10.
go back to reference "Diabetes In America," 2nd Ed. National Diabetes Data Group, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication No. 95–1468, 1995. Diabetes Atlas, 3rd ed. International Diabetes Federation, 2006. "Diabetes In America," 2nd Ed. National Diabetes Data Group, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication No. 95–1468, 1995. Diabetes Atlas, 3rd ed. International Diabetes Federation, 2006.
11.
go back to reference Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113–41.PubMedCrossRef Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113–41.PubMedCrossRef
12.
go back to reference Alexandrescu V, Söderström M, Venermo M. Angiosome theory: fact or fiction? Scand J Surg. 2012;101:125–31.PubMed Alexandrescu V, Söderström M, Venermo M. Angiosome theory: fact or fiction? Scand J Surg. 2012;101:125–31.PubMed
13.
go back to reference Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S–93S.PubMed Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S–93S.PubMed
14.
go back to reference Varela C, Acin F, Haro JD, et al. The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model. Vasc Endovasc Surg. 2010;44:654–60.CrossRef Varela C, Acin F, Haro JD, et al. The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model. Vasc Endovasc Surg. 2010;44:654–60.CrossRef
15.
go back to reference • Neville RF, Attinger CE, Bulan EJ, Ducic I, Thomassen M, Sidawy AN. Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann Vasc Surg. 2009;23:367–73. This article offers statistically significant differences in ulcer healing rate when the angiosome corresponding to ulcer location is revascularized, compared with a boundary angiosome, supporting the significance of the theory. PubMedCrossRef • Neville RF, Attinger CE, Bulan EJ, Ducic I, Thomassen M, Sidawy AN. Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann Vasc Surg. 2009;23:367–73. This article offers statistically significant differences in ulcer healing rate when the angiosome corresponding to ulcer location is revascularized, compared with a boundary angiosome, supporting the significance of the theory. PubMedCrossRef
16.
go back to reference Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23:80–9.PubMedCrossRef Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23:80–9.PubMedCrossRef
17.
go back to reference Mutluoglu M, Uzun G, Turhan V, Gorenek L, Ay H, Lipsky BA. How reliable are cultures of specimens from superficial swabs compared with those of deep tissue in patients with diabetic foot ulcers? J Diabetes Complications. 2012;26:225–9.PubMedCrossRef Mutluoglu M, Uzun G, Turhan V, Gorenek L, Ay H, Lipsky BA. How reliable are cultures of specimens from superficial swabs compared with those of deep tissue in patients with diabetic foot ulcers? J Diabetes Complications. 2012;26:225–9.PubMedCrossRef
18.
go back to reference Peters EJ, Lipsky BA, Berendt AR, Embil JM, Lavery LA, Senneville E, et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes Metab Res Rev. 2012;28 Suppl 1:142–62.PubMedCrossRef Peters EJ, Lipsky BA, Berendt AR, Embil JM, Lavery LA, Senneville E, et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes Metab Res Rev. 2012;28 Suppl 1:142–62.PubMedCrossRef
19.
20.
go back to reference Young JR. The swollen leg. Clinical significance and differential diagnosis. Cardiol Clin. 1991;9:443–56.PubMed Young JR. The swollen leg. Clinical significance and differential diagnosis. Cardiol Clin. 1991;9:443–56.PubMed
21.
go back to reference • Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012;55:122–8. This study determined a safe level of compression in mixed arterial/venous ulcers, while improving venous return, which has not previously been established. PubMedCrossRef • Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012;55:122–8. This study determined a safe level of compression in mixed arterial/venous ulcers, while improving venous return, which has not previously been established. PubMedCrossRef
22.
go back to reference Falanga V. The chronic wound: impaired healing and solutions in the context of wound bed preparation. Blood Cells Mol Dis. 2004;32:88–94.PubMedCrossRef Falanga V. The chronic wound: impaired healing and solutions in the context of wound bed preparation. Blood Cells Mol Dis. 2004;32:88–94.PubMedCrossRef
23.
go back to reference Ennis WJ, Foremann P, Mozen N, Massey J, Conner-Kerr T, Meneses P. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. Ostomy Wound Manag. 2005;51:24–39. Ennis WJ, Foremann P, Mozen N, Massey J, Conner-Kerr T, Meneses P. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. Ostomy Wound Manag. 2005;51:24–39.
24.
go back to reference Voigt J, Wendelken M, Driver V, Alvarez OM. Low-frequency ultrasound (20–40 kHz) as an adjunctive therapy for chronic wound healing: a systematic review of the literature and meta-analysis of 8 randomized controlled trials. Int J Low Extrem Wounds. 2011;10:190–9.PubMedCrossRef Voigt J, Wendelken M, Driver V, Alvarez OM. Low-frequency ultrasound (20–40 kHz) as an adjunctive therapy for chronic wound healing: a systematic review of the literature and meta-analysis of 8 randomized controlled trials. Int J Low Extrem Wounds. 2011;10:190–9.PubMedCrossRef
25.
go back to reference Driver VR, Yao M, Miller CJ. Noncontact low-frequency ultrasound therapy in the treatment of chronic wounds: a meta-analysis. Wound Repair Regen. 2011;19:475–80.PubMedCrossRef Driver VR, Yao M, Miller CJ. Noncontact low-frequency ultrasound therapy in the treatment of chronic wounds: a meta-analysis. Wound Repair Regen. 2011;19:475–80.PubMedCrossRef
26.
go back to reference Kavros SJ, Liedl DA, Boon AJ, Miller JL, Hobbs JA, Andrews KL. Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis. Adv Skin Wound Care. 2008;21:416–23.PubMedCrossRef Kavros SJ, Liedl DA, Boon AJ, Miller JL, Hobbs JA, Andrews KL. Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis. Adv Skin Wound Care. 2008;21:416–23.PubMedCrossRef
27.
go back to reference Medrano S, Beneke MJ. Acoustic pressure wound therapy to debride unstageable pressure ulcers in the acute care setting: a case series. Ostomy Wound Manag. 2008;54:54–8. Medrano S, Beneke MJ. Acoustic pressure wound therapy to debride unstageable pressure ulcers in the acute care setting: a case series. Ostomy Wound Manag. 2008;54:54–8.
28.
go back to reference Hopf HW, Ueno C, Aslam R, Burnand K, Fife C, Grant L, et al. Guidelines for the treatment of arterial insufficiency ulcers. Wound Repair Regen. 2006;14:693–710.PubMedCrossRef Hopf HW, Ueno C, Aslam R, Burnand K, Fife C, Grant L, et al. Guidelines for the treatment of arterial insufficiency ulcers. Wound Repair Regen. 2006;14:693–710.PubMedCrossRef
29.
go back to reference Mulder GD, Lee DK, Jeppesen NS. Comprehensive review of the clinical application of autologous mesenchymal stem cells in the treatment of chronic wounds and diabetic bone healing. Int Wound J. 2012;9(6)595–600. Mulder GD, Lee DK, Jeppesen NS. Comprehensive review of the clinical application of autologous mesenchymal stem cells in the treatment of chronic wounds and diabetic bone healing. Int Wound J. 2012;9(6)595–600.
30.
go back to reference Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Offloading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2003;24:1019–22.CrossRef Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Offloading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2003;24:1019–22.CrossRef
31.
go back to reference Katz IA, Harlan A, Miranda-Palma B, Prieto-Sanchez L, Armstrong DG, Bowker JH, et al. A randomized trial of 2 irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28:555–9.PubMedCrossRef Katz IA, Harlan A, Miranda-Palma B, Prieto-Sanchez L, Armstrong DG, Bowker JH, et al. A randomized trial of 2 irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28:555–9.PubMedCrossRef
32.
go back to reference • Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125:188–97. This article provides current statistical data on CVD, obesity, and diabetes, as well as current vascular surgical procedure trends and usage, and quality and cost of cardiovascular associated costs of care. PubMedCrossRef • Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125:188–97. This article provides current statistical data on CVD, obesity, and diabetes, as well as current vascular surgical procedure trends and usage, and quality and cost of cardiovascular associated costs of care. PubMedCrossRef
33.
go back to reference Mitchell ME. Lower extremity major amputations. In: Sidawy AN, editor. Diabetic foot, lower extremity arterial disease and limb salvage. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 341–50. Mitchell ME. Lower extremity major amputations. In: Sidawy AN, editor. Diabetic foot, lower extremity arterial disease and limb salvage. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 341–50.
34.
go back to reference Game FL, Hinchliffe RJ, Apelqvist J, Armstrong DG, Bakker K, Hartemann A, et al. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28 Suppl 1:119–41.PubMedCrossRef Game FL, Hinchliffe RJ, Apelqvist J, Armstrong DG, Bakker K, Hartemann A, et al. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28 Suppl 1:119–41.PubMedCrossRef
35.
go back to reference Kavalukas SL, Barbul A. Nutrition and wound healing: an update. Plast Reconstr Surg. 2011;127 Suppl 1:38S–43S.PubMed Kavalukas SL, Barbul A. Nutrition and wound healing: an update. Plast Reconstr Surg. 2011;127 Suppl 1:38S–43S.PubMed
Metadata
Title
The ABC’s of Wound Care
Authors
Kelly Bumpus
Michael A. Maier
Publication date
01-04-2013
Publisher
Current Science Inc.
Published in
Current Cardiology Reports / Issue 4/2013
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-013-0346-6

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