Wound Care

Disease Process

In patients with decreased sensation, blood flow or immune systems, skin ulcerations and open wounds can form quickly. These wounds can be shallow or very deep (into the underlying tissue, muscle and sometimes even bone [osteomyelitis]) and can heal slowly.

Causes

There are many reasons that a person can develop an open skin wound, but some of the most common reasons include:

• Diabetic Ulcers: patients oftentimes do not feel blisters or wounds due to decreased sensation.
• Venous Stasis: decreased blood flow causes a loss in skin elasticity.
• Burns
• Animal Bites: such as spiders, snakes or cats that are poisonous or become infected.
• Surgical Incisions: sometimes surgical sites will not heal properly and can re-open or become infected.
• Pressure: excessive pressure on the skin, especially over the boney areas can lead to skin breakdown and an ulcer forming.

Symptoms

Skin should be inspected daily for any areas of redness that could be signs of increased pressure, or any blisters or open areas. If you have diabetes, venous stasis, or a decreased immune system, you should see your doctor immediately. If a wound does not heal within a few days, appears red around it, is very painful or is getting larger, you should also see your doctor.

Diagnosis

Your doctor will take a medical history and perform a physical examination of the wound. He may do blood tests or an x-ray to rule out other possible causes of the wound.

Current Treatment
Your doctor may prescribe topical (applied to the skin) medication or antibiotics to help with healing. He may instruct you on the way to clean and bandage the wound. If the wound is larger than he feels you can manage on your own, or if it is infected, he may send you to a physical therapist for treatment.

How Can Physical Therapy Help

The physical therapist has been specially trained in the care of wounds. They will do one or more of the following:

• Evaluate the wound (will measure size, depth, color, amount of dead tissue [called eschar] and amount and color of drainage. They will also look for any tunneling [wounds connecting under the surface of the skin] or undermining [wound is larger under the skin than at the surface]).
• Clean the wound.
• Debride (remove) any dead tissue. This can be done using scissor and tweezers, a scalpel, medication (called enzymatic debriders), or whirlpool.
• Decide on what type of dressing to use and apply dressing.
• Apply compression dressing if they determine it is necessary.
• Educate patient or family members / caregiver on how to properly care for wound and change dressing at home.

Patient Resources
Wound Care Information Network
Wound Care Society
eMedicine

Disease Process
Causes
Symptoms
Diagnosis
Treatment
Physical Therapy
Patient Resources