Chronic Wounds: A Case Study

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One of the major treatments for this wound is patient education. The patient should be advised to cease smoking immediately (Sieggreen & Kline, 2004, p. 52). The patient should also be encouraged to increase his caloric and protein intake as well, because nutrition is extremely important for wound healing (Sieggreen & Kline, 2004, p. 52)
This patient is also complaining of extreme pain in his leg during physical exertion. Due to his pathology, this pain is classified as intermittent claudication. Intermittent claudication is pain that occurs when the exercising muscle are not receiving adequate blood perfusion for normal function (O’Sullivan et al., 2014, p. 586). “Intermittent claudication may begin to manifest when patients have an ABI value …show more content…
“Chronic wounds are open for a prolonged period of time and have the propensity to become heavily colonized. There is evidence that hypoxia, impaired blood flow, and bacterial load are associated with healing impairment” (Hopf et al., 2006, p. 701). Due to the foul odor and redness surrounding the wound, a tissue biopsy may be done to determine if there is any infection in the wound. This can be done through a simple swab culture. Identifying infection is very important, as infection can greatly affect wound healing. Hopf et al. emphasized, “Necrotic tissue is laden with bacteria. Devitalized tissue impairs the ability to fight infection and serves as a rich environment for bacterial growth” (Hopf et al., 2006, p. 699). Therefore, this wound should first be debrided to remove all necrotic tissue and properly clean the wound (McCulloch & Kloth, 2010, p.267). For this patient, it may be appropriate to use pulsed lavage, if tolerated. Though, the PTA should be cautious of the exposed tendon. If pulsed lavage is ineffective, enzymatic or autolytic debridement may be indicated. However, it should also be noted that if eschar is stable, debridement should not be performed if there is inadequate arterial inflow to heal the wound following debridement. Debridement in this case is only performed after revascularization (Hopf et al., 2006, p. …show more content…
A hydrogel wound dressing would be indicated for this wound due to the scant drainage, granulation tissue, and increased pain. This would be applied with a secondary dressing and changed daily. The therapist should also use an antimicrobial wound dressing to address the bacteria likely present in the wound (Hopf et al., 2006, p. 701). For this reason a silver impregnated hydrogel would be the most effective, due to its antimicrobial effects. One modality that may be affected to enhance the healing process is electrical stimulation. Applying a high-voltage pulsed current “has been shown to promote microcirculation and healing of ischemic wounds and increase perfusion of periwound tissues” (McCulloch & Kloth, 2010, p.
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