Chronic wound care

Chronic wounds are defined as wounds that have not proceeded through an orderly and timely reparation to produce anatomic and functional integrity after 3 months. All wound types have the potential to become chronic and, as such, chronic wounds are classified by cause, identification and treatment of which are essential. 1 McInnes E Cullum N Nelson A Duff L RCN guideline on the management of leg ulcers. Nurs Stand. 1998; 13: 61-63 Crossref PubMed Scopus (5) Google Scholar , 2 Royal College of NursingClinical practice guidelines: the nursing management of patients with venous leg ulcers: recommendations for assessment, compression therapy, cleansing, debridement, dressing, skin grafts and skin replacements, contact sensitivity, therapeutic ultrasound, laser electrotherapy, topical negative pressure and pharmacological agents, training/education and quality assurance. Royal College of Nursing, London2006 Google Scholar , 3 Royal College of NursingThe management of pressure ulcers in primary and secondary care: a clinical practice guideline. Royal College of Nursing, London2005 Google Scholar Venous or arterial insufficiency, diabetes, and local-pressure effects are the most common pathophysiological causes, whereas systemic factors, such as compromised nutritional status, infection, and altered immunological status further contribute to poor wound healing (table). TableTypes of chronic wounds and their specific therapy Pathology Specific therapy Common types Venous ulcer Deep venous insufficiency, post-thrombotic syndrome, primary varicosis Graduated compression bandaging (if ABI >0·6), physical activity, elevation, pain assessment, superficial vein surgery (with compression) Arterial ulcer Macroangiopathy Angioplasty, major vascular surgery, pharmacological improvement of blood flow, physical activity, reduction of risk factors Diabetic ulcer Neuropathy, small-vessels disease Glycaemic control, off-loading or orthopaedic footwear, therapy of possible arterial or venous insufficiency Mixed ulcer Venous/arterial See above (under venous and arterial ulcer) Pressure sore Immobility, neuropathy Mobilisation and positioning, pressure-relieving support surfaces (alternating and continuous low-pressure systems), nutritional support (eg, MUST assessment), surgical intervention (no evidence, but expert opinion) Rare types Vasculitis Rheumatoid arthritis, scleroderma, polyarteritis nodosa, pyoderma gangrenosum .. Haematological Cryoglobulinaemia, sickle-cell disease, haemolytic anaemia, Waldenström's macroglobulinaemia, leukaemia .. Neoplastic Marjolin's ulcer, ulcus rhodens basalioma, spinalioma .. Others Trauma, self-inflicted wounds, Martorelli's ulcer .. ABI=ankle-brachial index. MUST=Malnutrition Universal Screening Tool. Treatment for rare types includes therapy of underlying disease. Open table in a new tab ABI=ankle-brachial index. MUST=Malnutrition Universal Screening Tool. Treatment for rare types includes therapy of underlying disease.