Medical Dermatology

Wound Care

For every wound or ulcer, there are a few standards of care that must be followed closely to ensure proper and timely healing:

1. Maintain a moist wound environment. Contrary to popular belief, it is not helpful to let a wound “dry out”. Keep an ointment like Vaseline or Aquaphor in place on a wound at all times.

2. Gently wash a wound or ulcer with water, saline or a gentle cleanser. Antibacterial cleansers are fine if they are not alcohol based. Avoid cleansers that dry out the wound.

3. Remove necrotic or infected tissue. This is called debridement. Debridement should be done by a physician or a nurse specialist. Enzymatic debridement creams are sometimes used to help remove minor amounts of necrotic tissue.

4. Infection control with antibiotics (Polysporin ointment, dilute vinegar soaks or systemic antibiotics, for example) is very important. The proper antibiotic approach for each wound should be determined by a physician.

5. Nutritional support of a wound includes eating a balance diet. Remember, the best wound care in the world cannot heal a wound if there is underlying malnourishment. For diabetics, there must be adequate caloric intake and strict control of blood glucose levels.

Diabetic ulcers are caused when the foot skin looses sensitivity (peripheral neuropathy) or when the skin circulation is impaired (ischemia). Peripheral neuropathy can lead to wounds that a diabetic person can’t feel. There is no cure for loss of sensitivity in the feet, but careful glucose control can prevent progression. Peripheral neuropathy can cause skin ulcers and also infection of the underlying bone (osteomyelitis), which can eventually lead to lower limb amputation if, in addition, the circulation in the feet and legs is poor.

  • Prevention of diabetic ulcers is crucial.
    • Close control of blood glucose level.
    • Maintain proper body weight.
    • Avoid smoking, it damages the circulation in the feet.
    • Foot inspection should be performed daily.
    • Wear comfortable well-fitting shoes.
    • Regular washing and thorough drying of the feet (between toes!) is encouraged.
    • Sensory neurological examination should be performed to monitor sensation.
    • Nails should be kept trimmed; cutting them too short should be avoided.
  • Avoid weight bearing on a diabetic foot ulcer. Weight bearing relief can come from the use of contact casts, shoe inserts, special shoes, and even crutches.
  • Referral to a specialist in foot shoes may be recommended by your physician.
  • Off-loading (relief of pressure) is the most important aspect of treating diabetic foot ulcers. Special fitting shoes and casting of the ulcerated foot are helpful.
  • Not taking a diabetic ulcer seriously early may lead to amputation later.

Venous Ulcers are one of the most common forms of leg ulcers. Small valves that normally prevent blood from pooling in the legs become damaged. As a result, the legs swell. This swelling can eventually cause breaks in the skin that lead to ulceration. Compression therapy is the most important aspect of venous ulcer therapy Unna Boots or other compression bandages can be helpful to heal venous ulcers. Long-term use of compression stockings is recommended after a venous ulcer has healed to prevent recurrences.

Pressure ulcers arise when pressure inhibits blood flow to the skin (ischemia). The pressure is usually over a bony prominence like the side of the foot, an ankle or the sacrum (lower back bones). A bedsore is an example of a pressure ulcer. With prolonged pressure (sometimes even a few minutes), the skin changes to red, blue or black, signifying destruction of skin cells over the bony area. Pressure ulcerations are usually very painful. On the feet and legs, pain is worse when the leg is elevated, and this type of pain is often relieved by dangling the foot over a bedside. Off-loading all pressure and strict prevention of secondary infections are the most important aspects of pressure ulcer therapy. Special fitting shoes, casting and frequent turning of a bedridden person can prevent bedsores (decubitus ulcers) or other pressure induced ulcers.