A 75-year-old man with well-controlled diabetes mellitus developed a laceration on his right lower extremity

debridement

Educational Objective:

List the tenets of wound care.

Key Point:

Important components of wound care include debridement of devitalized tissue, treatment of active infection, and use of appropriate dressings to keep the wound moist.

Explanation:

Debridement is an important component of wound care. Wounds that have devitalized tissue or sloughing should be debrided with a scalpel or other sharp instruments. Enzymatic debridement with collagenase is an alternative that can also be used.

Another important component of wound care is treatment of infection. All wounds are colonized with bacteria and cultures are invariably positive. Cultures should be obtained only if there are clinical manifestations suggestive of infectious causes such as erythema, swelling, tenderness, or increased drainage. In this case, there is no evidence of infection, so obtaining a culture or starting antibiotics is not indicated.

Compression therapy with compression stockings or multilayer wraps is an important component to the treatment of venous ulcers. Compression devices control the edema, thereby favoring the healing of ulcerations. This patient does not have edema, so he would not benefit from compression therapy.

Appropriate dressing is indicated for wound healing. Wounds should be kept moist. If there is excessive drainage, then an absorbent dressing, such as foam or alginate, should be used. In this case, the patient does not have much drainage and absorbent dressing is not indicated.

References:

Janis JE, Harrison B. Wound healing: part I. Basic science. Plast Reconstr Surg. 2016;138(3 suppl):9S-17S.

Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(suppl 1):S1.