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It happened 3 weeks ago. ![image (41)](https://challengercme.com/hs-fs/hubfs/image%20(41).png?width=311&height=223&name=image%20(41).png) *Figure.* He tells you that he first noticed it after he got out of his car. Since then, he has been using soap and water to clean the wound. He has been applying topical antibiotic ointment and covering the wound with gauze. He described some redness around the wound in the initial 48 hours, but this seems to have resolved. He is presenting to you because the wound is not healing. He is not experiencing much pain. He denies any fevers or chills and has not noticed any erythema or significant drainage from the wound. On examination, there is no edema in the lower extremities. His pulses are palpable and his sensation is preserved. What therapy would you suggest? - cultures and start empiric oral antibiotics - absorbent dressing such as foam or alginate - debridement - compression therapy The correct answer is: 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. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "Article", "about" : [ "laceration", "wound care", "debridement", "wound dressing", "wound infection", "compression therapy", "absorbent dressing", "diabetes mellitus", "medical education", "exam preparation" ], "articleSection" : "Internal Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-12-16T14:00:01.734Z", "datePublished" : "2024-12-16T14:00:00.000Z", "description" : "It's Laceration Quiz Time with Med-Challenger!", "headline" : "A 75-year-old man with well-controlled diabetes mellitus developed a laceration on his right lower extremity", "image" : [ { "@type" : "ImageObject", "description" : "Figure illustrating the nonhealing laceration on the right lower extremity described in the case.", "url" : "https://challengercme.com/blog/a-75-year-old-man-with-well-controlled-diabetes-mellitus-developed-a-laceration-on-his-right-lower-extremity#figure" } ], "inLanguage" : "en-US", "keywords" : [ "laceration", "wound care", "debridement", "topical antibiotic", "wound cultures", "compression therapy", "absorbent dressing", "diabetes mellitus", "exam question", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/a-75-year-old-man-with-well-controlled-diabetes-mellitus-developed-a-laceration-on-his-right-lower-extremity", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Debridement. The article states that wounds with devitalized tissue or sloughing should be debrided (sharp or enzymatic). There is no evidence of infection here, so cultures or empiric antibiotics are not indicated; compression is for venous ulcers with edema and is not useful without edema; absorbent dressings are for excessive drainage, which this patient lacks." }, "name" : "What therapy would you suggest for this nonhealing lower-extremity laceration?", "text" : "A 75-year-old man with well-controlled diabetes developed a laceration on his right lower extremity 3 weeks earlier. He has been cleaning with soap and water, applying topical antibiotic ointment, and covering with gauze. Initial redness resolved; he reports little pain, no fevers or chills, and no current erythema or significant drainage. On exam there is no edema, pulses are palpable, and sensation is preserved. What therapy would you suggest? (choices included: cultures and start empiric oral antibiotics; absorbent dressing such as foam or alginate; debridement; compression therapy.)" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Debridement — wounds with devitalized tissue or sloughing should be debrided using sharp instruments or enzymatic agents such as collagenase." }, "name" : "What is an important component of wound care for devitalized tissue?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Obtain cultures only if there are clinical signs suggestive of infection, such as erythema, swelling, tenderness, or increased drainage; routine cultures are not indicated because wounds are commonly colonized." }, "name" : "When should wound cultures be obtained?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Compression therapy (stockings or multilayer wraps) is an important component of treating venous ulcers by controlling edema; it is not indicated when there is no edema." }, "name" : "For which wounds is compression therapy indicated?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Absorbent dressings are appropriate when a wound has excessive drainage; they are not indicated for wounds with minimal drainage." }, "name" : "When are absorbent dressings like foam or alginate appropriate?" }, "position" : 4 } ], "name" : "Practice Questions", "numberOfItems" : 4 } ```