For patients with impaired sensation, prolonged periods of immobility, or advanced age, pressure ulcers remain a serious health concern. O’Connor Hospital’s Wound Care Clinic offers treatment for diabetic, pressure, traumatic, arterial insufficiency and venous ulcers.
Diabetics are prone to foot ulceration, since they may not have protective sensation in their feet. Foot ulcers are caused by excessive pressure or rubbing against the skin from things such as wearing ill-fitting shoes, walking barefoot, or stepping on a sharp object.
In treating diabetic foot ulcers, we take particular care to:
- Prevent infection
- Take pressure off the area
- Remove dead skin and tissue
- Apply medication and/or dressings to the ulcer
- Manage blood glucose and other health problems
Bedridden patients, paraplegics and quadriplegics are at increased risk of developing pressure ulcers, as are patients with impaired mental function and/or incontinence. When too much pressure is applied to one area for a prolonged period of time, the tissue starts to break down. Pressure ulcers are most common over the buttocks, hips, spine, shoulder, ankles and heels. Treating pressure ulcers involves:
- Relieving pressure over bony prominences
- Removing dead tissue
- Optimizing the wound environment to promote healing
- Avoiding trauma, friction, and shear force
- Searching for underlying conditions that may cause ulcer development or impede wound healing
Trauma or injury to the body may result in a loss of tissue layers and in damage or loss of body parts or organs. Trauma may also compromise the arterial, venous, or lymphatic systems of the body. Treatment of traumatic ulcers would include:
- Assessing the cause of the ulcer
- Preventing infection
- Pain relief
- Using proper dressing to promote wound healing
Ulcers Due To Arterial Insufficiency
Complete or partial arterial blockage can lead to ulceration. There are several signs that indicate possible blockage of an artery. They include:
- Lack of a pulse in the extremity
- Pain while resting
- Cool or cold skin
- Thin, dry, or shiny appearing skin
- Loss of foot or toe hair
- Purple coloration of the feet
If your medical history and exam suggest the presence of arterial disease, you may have tests to measure blood flow or to locate a blockage in your arteries.
Treatment of an arterial ulcer primarily involves increasing circulation to the area in question. If your circulation is severely impaired, procedures such as angioplasty or bypass surgery may be recommended and this in turn will help to heal your wound.
Venous ulcers are usually a symptom of venous disease, and are the most common type of ulcer affecting the lower extremities. Typical venous ulcers appear near the ankle and are usually moderately painful. Indications that a wound is a venous ulcer include irregular shape, superficial ulceration and the presence of drainage.
Treatment of venous ulcers can be lengthy. The goals of treatment are to prevent infection, control drainage, maintain a moist environment, provide compression to control swelling, promote patient activity, and control pain.
Patient education is very important since the underlying venous problem is often lifelong. In some selected cases, surgical or interventional treatment may cure the underlying venous disorder. Identifying which patients are amenable to curative treatment is a major goal in the assessment of patients with venous ulcers.