Clinical Care

All too often, a patient will present with a chronic wound that has progressed too far to be easily treatable. Patients suffering from diabetes or peripheral arterial disease may lack the necessary knowledge about the risk of chronic wounds. In many cases, the primary care physicians or specialists fail to adequately mention these wounds prior to their emergence. They may not consider chronic wounds to be a serious threat to the patient's health, or they may rely too strongly on the patient following the prescribed course of treatment to eliminate such potential complications.

For the wound care specialist, the first step is to determine the type of wound and its stage. Common chronic wounds include: pressure ulcers, diabetic foot ulcers, venous leg ulcers, and ischemic ulcers. Once the wound type is identified, the critical issues for determining the appropriate treatment regimen are:

• Is there sepsis?
• Is there cellulitis and/or drainage?
• Has the wound progressed to the level of the muscle or the bone?

These questions help to establish the stage of the wound:

Due to the complex nature of advanced chronic wounds, multi-disciplinary treatment is mandatory to ensure optimal healing. A wound care clinician fully cognizant of the nature of chronic wounds will call upon the expertise of specialists as needed. Typically, the more advanced the wound, the more likely additional expertise will be required.

Standard treatment protocols offer the most effective course of action in wound treatment. These protocols offer procedural steps that take into account the type and stage of the wound. Certain steps, however, are common to the treatment of all types of wounds. Debridement should be utilized regardless of type to cleanse the wound of possible sepsis, cellulitis, and drainage. Physicians should tailor the pain management approach according to the type and stage of the wound.