Case 4: 2 patients, each with a chronic open wound- what is the difference?

by nadine on November 13, 2011

These 2 patients have what may appear to be similar wounds.  But upon close inspection, they are actually very different, with very different healing potentials.  In the table that follows, the first column lists the important issues which you must think about when examing a patient with a chronic wound.

2 wounds: similar in that they are chronic, open wounds, covered with granulation tissue.  But they are actually quite different…. 

How so?

Does it matter?

 

Describe the wound

 

Almost circumferential wound of distal leg and proximal ankle.  Bland granulation with exudate

 

Anterior surface of distal leg onto dorsum of foot.  Beefy red granulation, minimal exudate

Infection present? Probably not Probably not
Describe the tissue surrounding the wound Chronic edema, woody induration above wound, ankle with minimal range of motion Minimal edema, surrounding skin supple, good ankle active/passive range of motion
Patient’s overall health status ~30.  Looks chronically ill, but nothing diagnosed Healthy teenager
 

Etiology of wound

Small traumatic injury, that progressed Acute, traumatic degloving injury of involved area
Duration of wound Years Weeks/month
Evidence of healing? None yes
Distal pulses Present, but diminished Yes, bounding
 

What the above tells you about hopes for getting this to heal…

Options for closure.

Poor likelihood for healing.  Identify and treat any underlying medical issues (nutrition, immune disorder, etc..) 

Could try debridement and STSG, but doubt success.  This is a very difficult problem and may only heal after amputation.

Good chance for this wound to heal.  Will eventually heal secondarily, but will take at least several more weeks and could cause significant contracture at ankle. 

For best functional outcome, do a STSG.

 

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