Basic principles of wound management UPDATED ACTUAL Questions
and CORRECT Answers
1. Wound bed For optimal wound healing, the wound bed should be:
preparation -well vascularized
-free of devitalized tissue
-clear of infection
-moist
2. Debridement Sharp surgical debridement is recommended over nonsurgical methods for the
initial debridement of devitalized tissue associated with acute and chronic wounds
or ulcers when feasible (Grade 2C)
3. Topical Therapy -Agents such as antiseptics and antimicrobial agents can be used to control locally
heavy contamination.
-Significant improvements in rates of wound healing have not been found, and
toxicity to the tissues might be a significant disadvantage.
4. Antisceptics Typically should NOT be used in open wounds
-kills both bacteria and healing cells
-betadine
-hydrogen peroxide
-Dakin's Solution (sodium hypochlorite)
5. Role of antibi- -All wounds are colonized with microbes; does not indicate the presence of an
otics acute infection
-Abx not indicated for all wounds; reserved for wounds that appear clinically
infected.
-No evidence to support Abx prophylaxis in noninfected chronic wounds, or to
improve the healing potential of wounds without clinical evidence of infection.
6. Clinical signs of -Local - cellulitis, lymphangitic streaking, purulence, malodor, wet gangrene, os-
wound infection teomyelitis
that might war- -Systemic - fever, chills, nausea, hypotension, hyperglycemia, leukocytosis, change
rant antibiotics in mental status
,7. Glycemic control -Most clinicians make glycemic control a priority when treating wounds, although
there is no robust clinical evidence in support of short-term glycemic control as
directly affecting wound healing potential.
-However, clinical studies suggest that intensive glycemic control can reduce
incidence of diabetic foot ulceration by approximately 23 percent.
-Patients at risk for the development of chronic wounds often have comorbid
conditions associated with immunocompromised states (eg, diabetes) and may
not have classic systemic signs of infection such as fever and leukocytosis on initial
presentation. In these patients, hyperglycemia may be a more sensitive measure
of infection.
8. Wound Debride- -Irrigation
ment Methods -Surgical
-Enzymatic
-Biologic
9. Irrigation - part of routine wound management
-Low-pressure irrigation <15 psi using a syringe or bulb
-act and volume of irrigant probably provides the primary positive benefits
-Warm, isotonic (normal) saline is typically used; systematic reviews show no
significant differences in rates of infection for tap water compared with saline for
wound cleansing.
-addition of dilute iodine or other antiseptic solutions is generally unnecessary
10. antiseptic solu- chlorhexidine, hydrogen peroxide, sodium hypochlorite
tions
11. Biofilm bacterial overgrowth on the surface of the wound
12. Characteristics of -accumulation of devitalized tissue
chronic wounds -decreased angiogenesis
that prevent an -hyperkeratotic tissue
adequate cellu- -exudate
, lar response to -biofilm formation
wound-healing *majority of wounds often require planned serial debridement to restore an
optimal wound healing environment
13. Bleeding during -impairs the ability to see what tissue should be debrided
wound care -should be stopped before commencing debridement
-an occur from the healing surfaces or from the deep layers of the skin at the
wound edge
-from healing surfaces --> gentle pressure
-from deep payers--> subdermal vessel can be coagulated w/ electrocautery or a
silver nitrate stick.
14. Surgical Debride- -Sharp excisional debridement (scalpel,scissors or curette)
ment -removes devitalized tissue and accumulated debris (biofilm).
-decreases bacterial load and stimulates contraction and wound epithelialization
-most appropriate choice for removing large areas of necrotic tissue
-indicated whenever there is any evidence of infection (cellulitis, sepsis).
-indicated in the management of chronic nonhealing wounds to remove infected
tissue, handle undermined wound edges, or obtain deep tissue for culture and
pathology.
-associated with an increased likelihood of healing.
15. chronic critical surgical debridement should be coupled with revascularization in order to be
limb ischemia successful
16. Enzymatic de- -involves applying exogenous enzymatic agents to the wound. -results of clinical
bridement studies are mixed and their specific effect remains unclear.
-Ulcer healing rates are not improved with the use of most topical agents, including
debriding enzymes.
-However, collagenase may promote endothelial cell and keratinocyte migration,
thereby stimulating angiogenesis and epithelialization as its mechanism of action,
rather than functioning as a strict debridement agent.
and CORRECT Answers
1. Wound bed For optimal wound healing, the wound bed should be:
preparation -well vascularized
-free of devitalized tissue
-clear of infection
-moist
2. Debridement Sharp surgical debridement is recommended over nonsurgical methods for the
initial debridement of devitalized tissue associated with acute and chronic wounds
or ulcers when feasible (Grade 2C)
3. Topical Therapy -Agents such as antiseptics and antimicrobial agents can be used to control locally
heavy contamination.
-Significant improvements in rates of wound healing have not been found, and
toxicity to the tissues might be a significant disadvantage.
4. Antisceptics Typically should NOT be used in open wounds
-kills both bacteria and healing cells
-betadine
-hydrogen peroxide
-Dakin's Solution (sodium hypochlorite)
5. Role of antibi- -All wounds are colonized with microbes; does not indicate the presence of an
otics acute infection
-Abx not indicated for all wounds; reserved for wounds that appear clinically
infected.
-No evidence to support Abx prophylaxis in noninfected chronic wounds, or to
improve the healing potential of wounds without clinical evidence of infection.
6. Clinical signs of -Local - cellulitis, lymphangitic streaking, purulence, malodor, wet gangrene, os-
wound infection teomyelitis
that might war- -Systemic - fever, chills, nausea, hypotension, hyperglycemia, leukocytosis, change
rant antibiotics in mental status
,7. Glycemic control -Most clinicians make glycemic control a priority when treating wounds, although
there is no robust clinical evidence in support of short-term glycemic control as
directly affecting wound healing potential.
-However, clinical studies suggest that intensive glycemic control can reduce
incidence of diabetic foot ulceration by approximately 23 percent.
-Patients at risk for the development of chronic wounds often have comorbid
conditions associated with immunocompromised states (eg, diabetes) and may
not have classic systemic signs of infection such as fever and leukocytosis on initial
presentation. In these patients, hyperglycemia may be a more sensitive measure
of infection.
8. Wound Debride- -Irrigation
ment Methods -Surgical
-Enzymatic
-Biologic
9. Irrigation - part of routine wound management
-Low-pressure irrigation <15 psi using a syringe or bulb
-act and volume of irrigant probably provides the primary positive benefits
-Warm, isotonic (normal) saline is typically used; systematic reviews show no
significant differences in rates of infection for tap water compared with saline for
wound cleansing.
-addition of dilute iodine or other antiseptic solutions is generally unnecessary
10. antiseptic solu- chlorhexidine, hydrogen peroxide, sodium hypochlorite
tions
11. Biofilm bacterial overgrowth on the surface of the wound
12. Characteristics of -accumulation of devitalized tissue
chronic wounds -decreased angiogenesis
that prevent an -hyperkeratotic tissue
adequate cellu- -exudate
, lar response to -biofilm formation
wound-healing *majority of wounds often require planned serial debridement to restore an
optimal wound healing environment
13. Bleeding during -impairs the ability to see what tissue should be debrided
wound care -should be stopped before commencing debridement
-an occur from the healing surfaces or from the deep layers of the skin at the
wound edge
-from healing surfaces --> gentle pressure
-from deep payers--> subdermal vessel can be coagulated w/ electrocautery or a
silver nitrate stick.
14. Surgical Debride- -Sharp excisional debridement (scalpel,scissors or curette)
ment -removes devitalized tissue and accumulated debris (biofilm).
-decreases bacterial load and stimulates contraction and wound epithelialization
-most appropriate choice for removing large areas of necrotic tissue
-indicated whenever there is any evidence of infection (cellulitis, sepsis).
-indicated in the management of chronic nonhealing wounds to remove infected
tissue, handle undermined wound edges, or obtain deep tissue for culture and
pathology.
-associated with an increased likelihood of healing.
15. chronic critical surgical debridement should be coupled with revascularization in order to be
limb ischemia successful
16. Enzymatic de- -involves applying exogenous enzymatic agents to the wound. -results of clinical
bridement studies are mixed and their specific effect remains unclear.
-Ulcer healing rates are not improved with the use of most topical agents, including
debriding enzymes.
-However, collagenase may promote endothelial cell and keratinocyte migration,
thereby stimulating angiogenesis and epithelialization as its mechanism of action,
rather than functioning as a strict debridement agent.
