Practice Accelerator

Abscess: Inflamed tissue surrounding a localized gathering of pus, often caused by infection.

Antimicrobial resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antimicrobial stewardship: Collective measures that are taken to slow the evolution of multidrug-resistant organisms.

Surgical site care is vital in preventing complications such as infection and dehiscence. Advanced therapies can help in the prevention of infection and the management of surgical sites and wounds. In patients who are deemed at risk, consider beginning the use of advanced technologies earlier in treatment to maximize overall outcomes.

It was reported in 2014 that approximately 14 million operations were performed in the United States. The health care–associated infection prevalence survey conducted by the Centers for Disease Control and Prevention found an estimated 110,800 surgical site infections (SSIs) associated with inpatient surgical procedures in 2015. Even though many advances have been made in infection control practices, SSIs contribute to an overall surgical mortality rate of 3%, and 75% of deaths are specific to the SSI.

Although advances in surgical techniques and operating room technologies have made many surgical procedures more successful and have led to easier recovery for many patients, surgical site infections (SSIs) remain a clinical problem. These infections are associated with increased morbidity, mortality, and health care costs.

Despite modern precautions and protocols in place, surgical site infection (SSI) continues to be a risk. SSIs are the most common and costly of all hospital-acquired infections, with an estimated annual cost of $3.5 to $10 billion in the United States. Johns Hopkins Medicine reports that up to 3% of people who undergo a surgical procedure will develop an SSI. Additionally, SSIs can increase hospital length of stay by up to 9.7 days. Other complications of surgical wounds include osteomyelitis, gangrene, periwound dermatitis, periwound edema, wound dehiscence, and hematomas.

Arteriography: Also called angiography, this technique is the medical imaging of blood vessels to look for aneurysm and stenosis.

Hemosiderin staining: Hemosiderin staining results in a red, ruddy appearance on the lower leg and ankle. This appearance is caused when red blood cells are broken down and not removed adequately as a result of venous insufficiency or another medical condition.

Phlebectomy: A minimally invasive procedure (usually outpatient) to remove varicose veins located near the surface of the skin.

Approximately 2.5 million Americans are diagnosed with chronic venous insufficiency, and approximately 20% will go on to develop venous leg ulcerations. Chronic venous leg ulcers (VLUs) account for 90% of all chronic ulcers of the lower limb region. Wound chronicity takes place in wounds that are stalled and/or remain unhealed after four to six weeks. Although evidence-based care has been established, it has been reported that 30% of patients still experience delayed healing, with wounds often failing to heal within a 24-week time frame. Identifying risk factors for VLUs is imperative in best outcomes.

Venous leg ulcers can be slow to heal; the longer a wound is present, the less likely it is to heal. To move a venous leg ulcer through the phases of wound healing may require more than just basic wound care.

Chronic venous leg ulcers can be prone to chronic inflammation. Changes in the microcirculation down to the capillary level can elevate levels of cytokines and proteases, thus leaving the wound stuck in the inflammatory cycle. Controlling, reducing, or eliminating inflammation is necessary to move the wound toward closure.

Of all the types of chronic wounds in lower extremities, venous leg ulcers are the most common, and they account for up to 70% of lower leg ulcers. Infection is a common complication in these wounds, however, and may contribute to chronicity. Biofilm is another common complicating factor. Preventing infection, removing unhealthy tissue from the wound, providing dressings that manage exudate, and using advanced modalities can help heal these chronic wound types and prevent a recurrence.

Hard-to-heal venous leg ulcers (VLUs) comprise the most common type of leg ulcer and impose a major economic burden on the health care system. These wounds can be difficult to heal, and they often experience recurrence within three months of closure, thus further complicating treatment. When managing VLUs, it is important to select strategies that are evidence based and cost-effective. Early diagnosis and implementation of interventions can encourage best outcomes.