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DIAGNOSIS AND MANAGEMENT OF LOWER EXTREMITY WOUNDS

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DIAGNOSIS AND MANAGEMENT OF LOWER EXTREMITY WOUNDS

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    1. DIAGNOSIS AND MANAGEMENT OF LOWER EXTREMITY WOUNDS

    3. ASSESSMENT HISTORY AND PHYSICAL EXAM

    4. GENERAL Determine comorbidities: DM, ESRD, HTN, etc. Laboratory tests Dietary lifestyle Quality of life questions Smoker Drug/Medications

    5. LOWER EXTREMITY EVALUATION NEUROLOGIC Vibration perception with 128-Hz tuning fork 10g monofilament tests

    6. VASCULAR EXAM 1. Palpation of pulses, ABI (ankle brachial index), and TBI (toe brachial index) 2. If suspect vascular insufficiency, refer for segmental pressure volume and skin perfusion pressure (SPP) and transcutaneous oxygen measurement (TCPO2) 3. refer for vascular consult and angiography

    7. FOOT AND ULCER EXAM HISTORY: initial wound event, previous wound healing problems, recurrent problem Prior diagnostic testing and therapies Functional impact of the wound on the pt Social history and potential adverse effects on wound healing

    8. ASSESS DERMATOLOGIC CHANGES callus, musculoskeletal deformities and muscle wasting

    9. ULCER CHARACTERISTICS Location Shape Size measurement

    10. CLINICAL PROBING TO CHECK FOR SINUS TRACTS

    11. CLINICAL EVALUATION: WOUND EDGES WOUND BED WOUND BASE PERIWOUND SKIN EXUDATES

    12. WOUND CLASSIFICATION WAGNER

    13. UNIVERSITY OF TEXAS

    14. INFECTION CLASSIC SIGNS: HEAT, PAIN , REDNESS, AND SWELLING SECONDARY SIGNS: EXUDATES, DELAYED HEALING, FRIABLE GRANULATION TISSUE, FOUL ODOR PROBE TO BONE TEST NOT RECOMMENDED:ROUTINE CULTURE AS AN EVALUATION UNLESS INFECTION APPARENT OR SENSITIVITIES REQUIRED FOR APPROPRIATE ANTIBIOTIC SELECTION

    16. RADIOLOGY PLAIN FILMS MRI: EVALUATES OSTEOMYELITIS VS CHARCOT JOINT DISEASE BONE SCANS CERETEC OR INDIUM WHITE BLOOD CELLS SCANS

    17. DEBRIDEMENT COLD STEEL SURGICAL DEBRIDEMENT ENZYMATIC DEBRIDEMENT VERSAJECT

    18. Infection control Bacterial colonization or infection Infection by clinical evaluation Signs of infection: redness warmth swelling pain or tenderness

    19. Cultures done when clinical signs of infection Bone cultures and bone biopsy definitive for osteomyelitis

    20. TREATMENTS OFFLOADING DEBRIDEMENT ADEQUATE WOUND CARE APPROPIATE ANTIBIOTICS

    21. OFFLOADING TOTAL CONTACT CASTING SHOE THERAPY BRACING

    22. DEBRIDEMENT

    23. WOUND CARE

    24. ADVANCED THERAPIES IF AFTER 4 WEEKS OF THERAPY THERE IS AN END POINT TO THE WOUND HEALING THERE IS A NEED FOR ADVANCE THERAPY OR WOUND CARE CHANGE IF THE WOUND HAS NOT PROGRESSED TOWARD HEALING OF APPROXIMATELY 50% REDUICTION THEN ADVANCE THERAPY IS NEEDED

    25. REFERENCES Synder, RJ, DPM CWS et al. Consensus Recommendation on Advancing The Standard of Care for treating Neuropathic Foot Ulcers in Patients with Diabetes. Wounds: A Compendium of Clinical Research and Practice April 2010 (Supp)S1-S24. Bollero,D. MD et al. The Role of Negative Pressure Wound Therapy in the Spectrum of Wound Healing. Wounds: A Compendium of Clinical Research and Practice. May 2010 (supp) S1-S18. Hermans, M.H. MD. Wounds and Ulcer: Back to the old Nomenclature. Wounds: A Compendium of Clinical Research and Practice. November 2010 Vol 22. p289-293. Stolt,m, MNSc et al. Effect of Educational Intervention on Nurses’ knowledge of Foot Care and on Foot health of Older Residents. JAPMA. Vol 101 No2 March/April 2011. p159-168.

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