Clinical Care Treatment Protocols

For a chronic wound to heal as quickly as possible, it must be recognized at onset or soon thereafter and be treated appropriately. Four stages of chronic wounds have been identified, with Stage I as initial onset and Stage IV as the most advanced stage. If a chronic wound progresses to Stage IV, there is a high likelihood that the patient will suffer complications including amputation, sepsis, and other serious consequences of an improperly treated chronic wound.

In the experience of the Wound Healing Center, early recognition and treatment results in timely wound healing, regardless of the patient's age. All too often, physicians focus on treating presenting conditions, such as cardiovascular or renal disease, and ignore co-morbidities such as wound care. The elderly in particular suffer from this neglect of wounds.

The basis for correct treatment of chronic wounds is a standard protocol that is administered in a systematic manner.^2-4 The Wound Healing Center has established standard protocols that have achieved significant improvements in the time to substantial improvement of wounds and wound closure—regardless of the wound type. It is critical that clinicians utilize all available methods of wound treatment, including relatively new therapies like skin cell matrices/human skin equivalents. Debridement is a critical component of the wound healing process as well and should be performed on all non-viable tissue.

A brief synopsis of the four major types of chronic wounds, with links to their respective treatment protocols, follows:

• Diabetic foot ulcers can occur in any person with diabetes who has a break in the skin. Most commonly it is associated with neuropathy. Every person must be fitted for proper offloading devices/orthotics and should have non-invasive flow studies. Please click here to learn about our standard treatment protocol for diabetic foot ulcers.
• Since pressure ulcers can occur in any bed- or wheelchair-bound patient. Pressure ulcers may remain unnoticed for a substantial period of time. By the time they are recognized as a serious problem, progression to an advanced stage may have occurred. In advancing stages, a pressure ulcer will be characterized by skin loss, drainage, and necrotic tissue. In the most advanced stage, muscle and bone will be affected. Please click here to learn about our standard treatment protocol for pressure ulcers.
• Sickle cell ulcers are a complication associated with sickle cell disease, an inherited hemoglobinopathy most common among African Americans. The disease is associated with pathological changes in the blood and blood vessels that in turn lead to ulceration—including blood vessel occlusion, vascular infarcts, and impaired blood flow. Ulcers often begin as small, elevated, crusting wounds on the lower third of the leg and may be mistaken for venous reflux disease. Chronic leg ulceration is a major cause of morbidity in homozygous sickle cell disease. Patients with chronic leg ulcerations should be evaluated as well for more common systemic complications. Please click here to learn about our standard treatment protocol for sickle cell ulcers.
• Venous leg ulcers may initiate as small breaks in the integument and so are often not perceived as a serious pathological condition. With continued neglect, a venous ulcer can progress to a more advanced stage and require substantially more expenditure for treatment than if the wound had been initially recognized and treated promptly. Once a venous leg ulcer has progressed, the wound may be characterized by scaling, edema, pain, dermatitis, discharge, swelling, erythema, cellulitis, and lipodermatosclerosis. If no treatment or inappropriate treatment continues, sepsis may occur, significantly compounding the seriousness of the wound. It is important to note that venous leg ulcers have the highest recurrence rate of all chronic wounds. Please click here to learn about our standard treatment protocol for venous leg ulcers.