Atypical and Complex Wounds

By Becky Naughton, RN, MSN, FNP-C, WCC

When I was in my APRN program, a phrase that I heard from an instructor has stuck with me throughout my practice: "When it comes to diagnosing, if you hear hooves, think horses, not zebras." Essentially, think of the obvious or likely reason first before jumping to a more obscure diagnosis. In the large majority of cases, the more common ailment is likely the cause. But what happens if the symptoms just don't quite add up?

Becky Naughton, RN, MSN, FNP-C, WCC

What if I told you that there is a substance that we can isolate from your own blood that can help to heal the most difficult wound? I envision a scene out of "Star Trek" where Bones does a quick scan of his patient, draws some blood, runs it through some machines, and then out pops a seemingly magical elixir. He studies this new yellow substance and then injects it back into his patient (with a quick and seemingly painless puff from his high-tech injector gun).

By the WoundSource Editors

Venous ulcers pose a worldwide problem that comes with high recurrence rates, risk of infection, and substantial costs to treat. Health care professionals must be knowledgeable about underlying causes and pathological features. The comorbidities that are often associated with venous ulcers contribute to these lesions and prolong healing times, which in return can cause further complications. Venous disease and venous hypertension are lifelong conditions requiring lifelong management. The vicious cycle of venous reflux and obstruction associated with chronic venous disease leads to ulceration(s). Management of venous ulcers requires comprehensive wound care and compression therapy for life.

By the WoundSource Editors

Fistulas are abnormal connections or passageways between two organs or vessels that do not usually connect. Although they typically develop as a result of an injury or surgery, they can also be caused by infection or inflammation. The World Health Organization estimates that there are between 50,000 and 100,000 new cases of obstetric fistula annually, and the number of all types of fistulas is substantially higher.

By the WoundSource Editors

A pilonidal cyst is a pimple-like cyst typically located in the sacrococcygeal region of the body, usually near the top of the intergluteal cleft (also referred to as the natal cleft). Rarely, pilonidal cysts may also manifest between digits. This common condition is seen most frequently in men who are between 16 and 24 years old. The name "pilonidal”" is derived from Latin and literally means "nest of hair" because this condition frequently involves a hair follicle. The pit of the pilonidal cyst contains hair and skin debris that produce a foreign body reaction, resulting in localized inflammation and pain.

By Emily Greenstein, APRN, CNP, CWON, FACCWS

It’s that time of year again. For the leaves to change, all the ghouls and goblins to come alive, and for a sudden influx of sugar! After the success of last year's blog post "How Being a Wound Specialist Can Help You Survive a Zombie Apocalypse," I knew I had to do another Halloween-themed post. In my practice I have seen an influx of animals bites this summer, which got me to thinking, what if you were bitten by a werewolf or vampire?

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.

By Alton R. Johnson Jr, DPM

Four weeks ago, I was granted the privilege to treat a patient with type 2 diabetes with neuropathy who presented to the wound care center after developing a full-thickness pressure ulceration on the lateral aspect of her right leg as a result of an ill-fitted brace used four weeks earlier. The first clinical feature I noticed about the patient's lower extremity compared with the previous encounter was marked increased pitting edema. As a sequela of the lack of compression, the patient's lower extremity edema had increased, causing the wound to break down further in comparison with our last encounter with her. I first asked the patient why she discontinued the multipurpose tubular bandage that was dispensed and applied to her right extremity during the last visit. Her immediate response was that the home health aide had disposed of it by mistake; however, the patient stated that the aide used an available non-compressive stockinette instead.

By the WoundSource Editors

Caseous necrosis: Caseous necrosis is found in tuberculosis, syphilis, and some fungal diseases. It forms in response to intracellular pathogens, such as mycobacteria, and can also be found in association with granulomas. With this type of cell death, the tissue assumes a cheese-like appearance.

Clostridium difficile: Also referred to C. diff, this bacterium can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. On a lesion, semihard nodules may be found, in which case lymph node tuberculosis may be present.

Complex wounds: Wounds that have one or more complicating factor, such as exudate, infection, comorbidity, or polypharmacy. They can be acute or chronic wounds that defy cure with conventional therapies. Treating complex wounds generally requires a multidisciplinary approach.

By the WoundSource Editors

A vast percentage of wounds become chronically stalled because of mixed etiology and other underlying comorbid medical conditions. This means the wound is multifactorial, and using a singular approach won’t be enough. Lower extremity wounds, for example, can have diabetes, venous and arterial issues, and pressure all as factors playing into the same wound.