Ulcers

Temple University School of Podiatric Medicine's picture

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

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Temple University School of Podiatric Medicine's picture
wound care journal club

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

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Laurie Swezey's picture
superficial venous insufficiency ulcer

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Lower extremity venous insufficiency ulcers represent approximately 80% of the leg ulcers typically seen in wound care facilities. The following statistics help to bring home the seriousness and chronicity of this common health problem:

  • Healing time for venous insufficiency ulcers averages 24 weeks
  • Approximately 15% of these ulcers will never heal
  • In 15 to 71% of cases of venous insufficiency ulcers, the ulcers represent a recurrent lesion
  • It is estimated that the cost of treating venous insufficiency ulcers is 1 to 5 billion dollars every year
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Lindsay Andronaco's picture
Necrobiosis lipoidica

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

I had an interesting case come into the clinic and I wanted to share it with all of you. This is the first time in my clinical experience with a patient who has full-thickness ulcerations due to necrobiosis lipoidica. Necrobiosis lipoidica is a disorder of collagen degeneration with a granulomatous response, thickening of blood vessel walls, and fat deposition. The main complication of the disease is ulceration, usually occurring after trauma to a particular area. Although infections are rare, full-thickness ulcerations appear to be rarer from my literature search. This particular patient had full-thickness ulcerations with an active infection on presentation.

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Laurie Swezey's picture
Skin moisture

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Patients with bariatric needs present a special challenge in terms of skin care and prevention of pressure ulcers. Once damage to the skin occurs, bariatric patients heal more slowly due to decreased vascularity of the skin and reduced perfusion of adipose tissue. Bariatric patients are at high risk for acute wounds, pressure ulcers, venous ulcers, non-healing surgical wounds and diabetic wounds of the foot.

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Temple University School of Podiatric Medicine's picture

by Rizwan Tai and James McGuire DPM, PT, CPed, FAPWHc

According to Centers for Disease Control and Prevention (CDC), the number of adults between the ages of 18-79 with newly diagnosed diabetes has more than tripled in the last 30 years. Foot ulcers are a major complication of uncontrolled diabetes, and 25% of the patients will be affected with foot ulcers in their lifetime, the majority of which lead to lower extremity amputations.

Temple University School of Podiatric Medicine's picture

by Tedman L. Tan and James McGuire DPM, PT, CPed, FAPWHc

The management of diabetic foot ulcers is becoming an increasingly significant concern with the growing population of patients with diabetes in the United States. Most amputations involving the lower extremity in patients with diabetes are preceded by foot ulcers, and in turn, lower extremity amputations are associated with a high 5-year mortality rate at around 45% among individuals with diabetes.1 Therefore, diabetic foot ulcers require special attention due to the possible life-threatening complications associated with such wounds.

Aletha Tippett MD's picture

by Aletha Tippett MD

This month's blog is in response to a comment on Recognizing and Treating Wounds Caused by Pyoderma Gangrenosum:
"What is green clay? Where do you get it? What does it do? Thanks for discussing pg in your blog. I'm working with a person whose ulcer is identical to the photo."

Our introduction to clay began with a study of buruli ulcers. Buruli ulcers are caused by Mycobacterium ulcerans, endemic in Africa, affecting poor people who live near rivers or wetlands. It is the third most common mycobacterial disease after tuberculosis and leprosy. It is quite common, with surveys of one community in Ghana showing 22% of people with the disease. Buruli ulcers occur worldwide, but data on the total burden is scant. It has been reported in Australia, Asia, and in Central and Southern America. Children under age 15 are predominantly affected. I was looking at pictures of Buruli ulcers with a realization that they looked a lot like some of the ulcers we were seeing. Buruli ulcers of course can be treated surgically, but in remote areas treatment often is not available. We were especially intrigued by the work of Madame Line Brunet de Courssou who had two decades experience treating Buruli ulcers successfully with French clay. This led to exploration of clays available and how and what to use.

Mary Ellen Posthauer's picture

by Mary Ellen Posthauer RDN, CD, LD, FAND

Since we are fast approaching the deadline for the national elections, I decided to join the fray and campaign for accurate completion of the Braden Scale nutrition sub-score. The Centers for Medicare and Medicaid Services (CMS), Minimum Data Set (MDS) 3.0 Section M, Skin Conditions requires pressure ulcer risk assessment. Nursing facilities may use a formal assessment instrument such as the Braden or Norton tool to determine pressure ulcer risk. The most commonly used pressure ulcer assessment tool is the Braden Scale and one of the sub-scales is nutrition. Studies completed by Bergstrom and Braden in skilled nursing facilities found that 80% of pressure ulcers developed in two weeks after admission and 90% within three weeks of admission.

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Karen Zulkowski's picture

by Karen Zulkowski DNS, RN, CWS

Taking a positive approach when a pressure ulcer develops at your health care facility usually isn’t the first thing that comes to mind. However, it should be. When a patient develops a pressure ulcer the first thing that usually happens is the blame game: It wasn’t our fault—it must have happened at the (take your pick) nursing home, hospital, OR, ER, etc. In reality, the pressure may have happened prior to the patient’s arrival at the facility.

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