1. B: Arterial ulcers, also known as ischemic ulcers, are found commonly on tips of toes, phalangeal head, lat- eral border of the foot, or the lateral malleolus. Arterial ulcers have a punched-out appearance with uniform edges, and the wound beds have little to no exudates.

2. C: Research has shown improved healing when IP care is provided, and the coordinator or liaison is crucial for coordination and continuity of care.

3. B: Because of Chip’s complex care needs and social situation, he will benefit from an IP team that includes nursing, radiology, nutrition, and social work for the best chance to heal his wound.


Test Result TcPO2

Finding >30 mmHg Adequate perfusion TcPO2 <20 mmHg Marked ischemia (wounds will not heal)

presence of a wound infection). When ABI results are elevated falsely, this is an additional test that helps determine the degree of microvascular perfusion. It is helpful in assessing for vascular disease and wound healing potential, and predicting amputation level and benefits of hyperbaric oxygen therapy.14

the metabolic state of the limb. Healthy people typically have a reading above 50 mmHg. The test is performed by placing one set of electrodes on viable healthy tissue and another set in the area of question. Oxygen may be given to the patient to see if the oxygen levels in the tissue increase. CT angiography is another useful test for diagnosing PAD. This

has become a desirable test due to advances in the technology, higher resolution, and shorter acquisition times.1 Contrast arteriography is the gold standard for evaluating

PAD. The quality of the contrast arteriography can vary de- pending upon the differences in the generation of the scanners. As an example, some facilities have multidetector scanners that can examine thinner cross-sections at a much higher rate of speed. The contrast arteriography test can show the entire arterial tree and determine the site of the stenosis or occlu- sion. This test is indicated for patients most likely to undergo a revascularization procedure. Magnetic resonance arteriography is another noninvasive test

that allows the visualization of the peripheral vasculature and is used to confirm a diagnosis of PAD.15 These imaging techniques are used in several interventions in

which stents or balloons are used. These tests can help determine appropriate candidates for endovascular repair.15,16

Treatment of lower extremity ulcers Regardless of the type of wound, all wound management has basic elements in common. For example, preventing infection and controlling pain are fundamental, and most wounds require debridement and a topical agent as part of the treatment plan.10 Debridement methods include sharp, enzymatic, mechanical, autolytic, or biologic.11

Necrotic tissue, bacterial burden, and

slough must be debrided. There are many topical agents and dressings available to treat

wounds, and the agent selected depends on the assessment of the wound. These include hydrocolloids, foams, pastes, and hydrogels, as well as others. Elastic net dressing material or stockinette are excellent secondary dressings that can be cus- tomized, allow for air flow, and secure the primary dressing to the wound site without tape.11

) It also reflects

Chip, age 76, was widowed one year ago and now lives alone. His wife did all of the shopping, prepared all meals, and managed his medications. Chip had diabetes and coro- nary artery disease. He relied on his children to take him to appointments, as he could not drive due to macular degen- eration; however, his children do not live locally. He tried to walk outdoors, but after a short distance, his lower legs burn and cramp. It was relieved with a period of rest. His children hired a home health nurse to check on Chip once a week and to fill his pillbox. During the home health nurse’s first visit, she found a bulky gauze wrap on his right lower leg; the leg had no hair, and the skin was thin and shiny. Chip told her he thought he cut his leg on the metal bracket of his recliner. He reported that the wound had been present for about five weeks and was slow to heal. The wound was located over the lateral malleolus, and the edges were irregular without odor or exudates. She checked his kitchen, and noted a lack of good protein and fresh produce. She referred him to the wound clinic, and he was appointed a wound-care coordinator/liaison to guide and direct his care. The home health care nurse also functioned as his resource and contact person during his care at the clinic.

1. Chip’s wound is a: a. Pressure ulcer b. Arterial ulcer c. Venous ulcer d. Abscess

2. The role of the wound-care coordinator/liaison is: a. To provide in-home dressing changes

b. To collect information from interprofessional (IP) care- givers to use for his care

c. To function as the contact person/resource for the pa- tient and family, as well as communicate all treatments to all members of the wound-care team

d. To provide only community and social services to the patient

3. Which IP roles are most appropriate to collaborate on Chip’s immediate wound healing team?

a. Endocrinology, interventional radiology, and oph- thalmology

b. Medicine, nursing, radiology, nutrition, and social work

c. Endocrinology, interventional radiology, nursing, and vascular surgery

d. Medicine, wound-care nursing, social work, and vascular surgery

Avoid using tape against the

patient’s skin whenever possible. Topical antiseptics, such as alcohol and iodine-based products, are not recommended as they can dry the wound bed and delay healing. Oral antibiotics are discouraged unless there is evidence of cellulitis. Many venous ulcers have bacterial colonization that

2016 • Visit us at 23

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