Basic Wound Care Treatment principals for simple ulcers Wound healing Classification of diabetic foot ulcers Causes for non-healing ulcers Checklist- basic review Management of Chronic Ulcers wound dressing

1. Basic Wound Care
Treatment principals
for simple ulcers
JOEL ARUDCHELVAM
MBBS (COL) , MD (SUR), MRCS (ENG)
CONSULTANT VASCULAR AND TRANSPLANT
SURGEON

2. Aim
• To give an overview of basic wound care
principles for treating superficial diabetic foot
ulcers.

3. Objectives
1. To understand etiologies of (superficial ) ulcer
2. To evaluate the ulcer
3. To remove the cause
4. To determine a management plan for each
ulcer

4. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridement
 Proliferation / granulation
 Remodelling / maturation

5. Healing process
Different steps to heal the wound

6. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridment
 Proliferation
 Remodelling / maturation

7. Healing process
Different steps to heal the wound

8. Phases overlap

9. Classification of diabetic foot
ulcers
 Classification systems that do not stratify
severity of infection
 Wagner
 University ofTexas
 Classification systems that stratify severity
of infection
 Infectious Diseases Society of America (IDSA)
 SINBAD system
 Wound/Ischemia/Foot Infection (WIfI)

10. Wagner Diabetic Foot Ulcer Grade
Classification System
 Grade 0 – Intact Skin
 Grade 1 – Superficial Ulcer of skin or subcutaneous tissue
 Grade 2 – Ulcers extend into tendon, bone, or capsule
 Grade 3 – Deep ulcer with osteomyelitis, or abscess
 Grade 4 – Partial foot gangrene
 Grade 5 –Whole foot gangrene

11. Examples of simple ulcers

12. Causes for non-healing ulcers
1. Local causes
2. Regional causes
3. Systemic causes

13. Identifying underlying
etiologies
Main reasons in diabetic foot
1. Poor arterial supply
2. Infection
3. Repeated trauma

14. Checklist- basic review
 Arterial supply
 Palpation of foot pulses, clinical signs
 Neuropathy
 Infection
 classic signs of infection
 Sudden pain/discomfort
 Increase in exudate,
 Irregular wound surface,
 Unexpected raise in blood sugar levels,
 Unexplained wound deterioration

15. WOUND ASSESSMENT FORM

16. Characteristics of a
healing ulcer
• Sloping edges
• Flat even base
• Granulating
• Epithelializing base
• Evidence of wound
contracture

17. Characteristics of a non
healing ulcer
• Increase in size, depth, exudate, pain
• Edges of ulcer undermined
• Presence of callus at margins
• Presence of slough, surrounding or
spreading cellulitis
• Wound base granular in appearance

18. Basic Concepts
• Identify the cause of the wound and remove it ,
prevent recurrence
• If no evidence of healing – refer immediately

19. Management of Chronic Ulcers
 Regional causes
 Arterial- revascularization
 Regional causes
 Venous - Strapping
 i.e. multilayer compression
 Regional causes
 Neuropathic- off loading

20. Ideal wound dressing
• Provide a protective cover
• Maintain moisture
• Absorb exudates
• Easy to change
• Allow gaseous exchange
• Cheap
• Not painful
• Freely available
Dressing choice depends on the wound stage and patient condition

21. Types of Wound Dressings
 Gauze dressings
 Tulle
 Hydrocolloid dressings
 Hydrogel dressings
 Alginate dressings
 Foam dressings
 Film dressings

22. Gauze
 Cheap
 Freely available
 Dry
 Painful on removing
 Damages epithelium

23. Tulle
 Cheap
 Freely available
 Easy removal
 E.g :Vaseline tulle

24. Hydrocolloid Dressings

25. Hydrocolloid Dressings
 Made up of pectin based material
 Absorb exudate
 Occlusive – should not be used on infected
wounds
 Come in various shapes and sizes

26. Hydrogel Dressings

27. Hydrogel Dressings
 Made up of primarily water in a polymer to
maintain moist wound base
 used in dry wounds
 Should not be used in exudating wounds

28. Foam Dressings

29. Foam Dressings
 Made up of polyurethane foam
 Absorbs moderate to large amounts of fluid

30. Silver Dressings
 Antimicrobial to
reduce bio burden
 Through slow
release of silver ion
 e.g. Acticoat, Biatin
Ag, AtrumanAg

31. Summary
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Slough Hydrocolloid, hydrogels

32. Remember…
• Dressing can be harmful if inappropriate
•

33. Topical treatment
• Improve conditions of the wound
• Debride wounds, removing necrotic and
nonviable tissue
• Before using active agents, correct all
underlying factors and conditions

34. Fixation methods
• Adhesive hypo-allergenic tape – be aware of
thin devitalised skin (avoid skin- tape tears)
• Conforming bandages – not too tight but not
too loose
• Remember, any wound dressing must be able
to be fitted within patients footwear
including what is worn at home

35. Overview of care
• Screen for PAD, Neuropathy, Infection
• Identify and remove cause of lesion
• Wound assessment and documentation
• Dressing choice and frequency
• Education/ advice – patient centred
• Review, review and… review
• If no improvement – refer immediately

36. ThankYou