Therapy goals Pain relief Healing Therapy recommendations Analgesics (painkillers), as needed. Notes on diabetic foot and ulcus cruris venosum (“open leg“) (see under the disease patterns of the same name). Agents to support the healing of ulcers / ulcers (platelet aggregation inhibitors, rheologics, prostaglandin, flavonoids such as diosmin- / hesperidin-combi; coumarin- / troxerutin-combi). Substitution of … Chronic Wound: Drug Therapy
The medical history (history of the patient) represents an important component in the diagnosis of a chronic wound. Family history Are there people in your family who suffer from skin lesions, wounds, and/or ulcers? Social history Current medical history/systemic history (somatic and psychological complaints). Have you noticed any skin changes/skin defects? Where are these localized? … Chronic Wound: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Factor V mutation – genetic blood clotting disorder leading to an increased tendency to thrombosis. Klinefelter syndrome – gonosome (sex chromosome) abnormality of the male sex leading to primary hypogonadism (gonadal hypofunction). Spina bifida – embryonic closure disorder in the area of the spine (malformation of the neural … Chronic Wound: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by chronic wounds: Skin and subcutaneous (L00-L99). Hypodermitis (subcutaneous inflammation). Recurrent leg ulcer Recurrent wounds, unspecified Infectious and parasitic diseases (A00-B99). Infection of the wound Neoplasms – tumor diseases (C00-D48) Malignant transformation (transition from normal cells controlled in their growth to … Chronic Wound: Consequential Diseases
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing) of the skin [Leading symptom: wound or ulcer (ulcer) (existing > 3 months)] [Associated symptoms: Hyperpigmentation, eczema, dermatosclerosis (hardened, atrophic skin), atrophie blanche (whitish discoloration of the skin, often … Chronic Wound: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar) Blood gas analysis (BGA) Albumin (blood protein) Laboratory parameters 2nd order – depending on the results of the history, physical examination and the obligatory laboratory parameters – for differential diagnostic clarification. Blood levels … Chronic Wound: Lab Test
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. Doppler sonography (ultrasound examination that can dynamically depict fluid flows (especially blood flow)) or duplex sonography (ultrasound examination: combination of a sonographic cross-sectional image (B-scan) and the Doppler sonography method; medical imaging … Chronic Wound: Diagnostic Tests
The following surgical measures can be performed in the presence of chronic wounds: Decubitus For decubiti of stage 2 or greater, where cure cannot be achieved by conservative therapy, surgical debridement (wound debridement, i.e., removal of dead (necrotic) tissue from ulcers) should be performed. If this also does not lead to a good result, plastic … Chronic Wound: Surgical Therapy
The following symptoms and complaints may indicate a chronic wound: Leading symptoms Wound or ulcer (ulcer) existing longer than three months. Accompanying symptoms Hyperpigmentation Eczema Dermatosclerosis – hardened, atrophic skin. Atrophy blanche – whitish discoloration of the skin; often painful. Neuropathic pain (nerve pain) in the ulcer area, if necessary.
The therapy of chronic wounds depends on the exact cause. Caution!Therapy-resistant or morphologically conspicuous ulcerations (ulcers) must be clarified histologically (fine tissue)! For specific recommendations on pressure ulcers or diabetic foot, see under the respective clinical picture. General measures Aim for normal weight!Determine BMI (body mass index) or body composition using electrical impedance analysis. Falling … Chronic Wound: Therapy
