Wound Prevention
As the US population ages, the number of persistent and recurring wounds will continue to rise. Knowledge of key prevention practices and guidelines will help save patients from possible pain and suffering, as well as keep treatment costs to a minimum. Ch
- PDF / 1,144,212 Bytes
- 17 Pages / 547.087 x 737.008 pts Page_size
- 39 Downloads / 167 Views
22
Cynthia A. Fleck
As the US population ages, the number of persistent and recurring wounds will continue to rise. Knowledge of key prevention practices and guidelines will help save patients from possible pain and suffering, as well as keep treatment costs to a minimum. Chronic wounds are caused by a variety of issues. Among the many factors, the aging process by itself takes its toll, predisposing the skin to wounds and other problems such as xerosis and skin tears. The clinical implications of aging are numerous and contribute greatly to the incidence and prevalence of wounds. For example, dry, inelastic skin with larger, more irregular epidermal cells leads to decreased barrier function.1 Flattening of the dermal–epidermal junction (rete ridges) has been observed with the height of the dermal papillae declining by 55% from the third to ninth decade of life.2 As the spaces between the well-vascularized dermis and epidermis increases, several functional changes occur: • A 30–50% decrease in epidermal turnover rate during the 30s–80s.1 • Loss of sub-Q fat reduces protection from injury from pressure, shear, and friction. • Decreased sensory perception increases risk of mechanical forces such as pressure. A cross-sectional diagram of the changes that occur during the aging process are illustrated in Fig. 22.1. Wound prevention in the geriatric patient therefore, requires a multifaceted approach, considering the etiology of each wound type. Within this chapter, the
C. A. Fleck The American Academy of Wound Management (AAWM), Past President, The Association for the Advancement of Wound Care (AAWC), Past Director, Medline Industries, Inc., Vice President, Clinical Marketing, St. Louis, MO, USA e-mail: [email protected]
most prevalent wound categories will be described with practical measures for preventing these troublesome wounds, as well as other prevention topics related to wounds, such as skin care, support surfaces, and nutrition.
22.1 Venous Insufficiency Ulcers Venous ulcers, also known as venous hypertension ulcers or venous insufficiency ulcers are caused by problems with venous blood return to the heart potentially produced by nonfunctioning or inadequate calf muscle pump, incompetent perforator valves, ineffectual valves in the vein, arteriovenous (AV) fistulas, venous obstruction, and varicose veins,3 all leading to venous hypertension as venous blood pools in lower extremities and feet. Chronic venous disease is most likely the underlying cause in 80–95% of lower leg ulcers.4,5 The skin is often firm, indurated and hyperpigmented, or “stained” a brown or deep color (Fig. 22.2).6
22.1.1 Lower Limb, Calf Pump, Maintenance Compression, ABI/TBI, ETC Some prevention tactics that should be embraced by individuals with venous insufficiency include: • • • • •
Do not smoke. Consume adequate nutrition. Keep skin clean and well lubricated. Elevate the legs above the heart. Avoid sitting with the legs crossed.
R. A. Norman (ed.), Preventive Dermatology, DOI: 10.1007/978-1-84996-021-2_22, © Sprin
Data Loading...
