Wound Care


 1.Phases of Wound healing? Inflammatory phase
Proliferative phase
Remodeling phase
 2.Phases of inflammation? Inflammatory response
Repair and Regeneration

 3.Stages of bone healing? Inflammation
Soft Callus
Hard Callus
 4.Types of neuropathy (3)? 1. Sensory Neuropathy
2. Motor Neuropathy
3. Autonomic Neuropathy
5.What is Charcot neuroarthropathy?  A patient thas loss of sensation causing fractues and dislocaiton of bone
6.What is the neurotraumatic theory? Repetitive trauma causing bony destruction since the patient has no sensation
7.What is the neurovascular theory? Trauma and vascular reflex that causes hyperemia and osteopenia
8.What are the types of ulcers formed?
  1.  Neuropathic,
  2. arterial,
  3. venous insufficiency, and
  4. decubitus

Arterial Ulcers

9.Describe appearance of arterial ulcers: The ulcer has punched-out appearance. It is intensely painful. It has gray or yellow fibrotic base and undermining skin margins.

Pulses are not palpable. Associated skin changes may be observed, such as thin shiny skin and absence of hair.

10.Location of arterial ulcers?  located on the lateral surface of the ankle or the distal digits. They are commonly caused by peripheral artery disease (PAD)
11.Treatment of arterial ulcers?  Do NOT  perform debridement. These ulcers are difficult to heal by basic wound care and require advanced therapy, such as hyperbaric oxygen therapy or bioengineered skin substitutes. Depending on the patient’s condition, the physician may recommend invasive testing, endovascular therapy or bypass surgery to restore circulation
12.What causes arterial ulcers? Arterial insufficiency occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis
13.What is Gangrene? Insufficient blood supply leading to necrosis, or tissue death. This may occur after an injury or infection.
14.Dry gangrene? The death of tissue from lack of blood supply. May be caused by PAD or acute limb ischemia.
15.Wet gangrene? Gas gangrene? Infected gangrene seen as “wet” by thriving bacteria. High risk for sepsis. Gas gangrene  has a foul odor and spreads quickly. Both treated as medical emergency.
16.treatment of gangrene? Maggot therapy, debridement, antibiotics, oxygen therapy, angioplasty, amputation

Venous Ulcer

17.Describe a venous stasis ulcer Wound bed is approximately 85% adherent yellow slough, with approximately 15% granulation tissue,  with irregular borders.
18.Location of venous ulcer? Near medial malleolus, following path of Saphenous vein.
19.Venous ulcer treatment? Compression of the leg to minimize edema or swelling. Compression treatments include wearing compression stockings, multi-layer compression wraps, or wrapping an ACE bandage or dressing from the toes or foot to the area below the knee
20.What is CVI? Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs.

21.Describe neuropathic ulcer?Well defined margins, often seen with undermining caused by loss of sensation or neuropathy

Neuropathic Ulcer

22.Location of neuropathic ulcer? Plantar aspect of the metatarsal heads at increased pressure points
23.Neuropathic ulcer treatment? Debrided down to healthy, bleeding tissue. Often there is infection underneath the superficial layer of necrotic tissue, even extending down into the bone and bone marrow.
24.What can cause neuropathy? Diabetes, alcoholism, leprosy, spinal cord injury, syringomyelia, renal disease

Decubitus Ulcer

25.Decubitus ulcer location? (AKA pressure ulcer)  pressure to dermis and vascular structures typically over a boney area: lateral mallolus, calcaneus, etc.
26.How many hours before a pressure ulcer forms? Superficial skin can tolerate pressure 2-8 hours before breakdown.
27.Stages of decubitus ulcer? Stage I: Skin is intact and red
Stage II: Loss of skin integrity in epidermis and dermis
Stage III: Loss of skin integrity into subcutaneous tissue
Stage IV: Involvement of all layers of skin plus muscle, bone and tendon
28.What is sensory neuropathy? Patient unable to sense pain/pressure
Mechanical/Repetitive stress most common cause
29.What is mechanical neuropathy?

Decreased/loss of intrinsics,
Hammer-toe/claw toe,
Foot drop

30.What is a wet-to-dry dressing? what does it do? Wet gauze applied to wound bed and allowed to dry on wound.
Removal of dressing debrides the wound.
Removes necrotic tissue but also endogenous fluids, fibrin and other cells critical to healing process.
31.Patient presents to ED with foot pain, discharge, foul mal odor, and crepitus, what do you do? Suspicion for gas gangrene, confirm with xrays. Plan emergency I&D that day!
32.What are indications for hyperbaric oxygen therapy?
  • Hypoxic ulcers
  • Chronic osteomyelitus
  • Necrotizing fascitis
  • Burns
  • Crush injuries
33.Most common organism seen in Osteomyelitis with sickle cell disease? Salmonella
34.What is the most common form of OM seen in pt’s  with sickle cell? Hematogenous, contigous, Neuropathic, Vascular insufficiency? Vascular insufficiency
35.A German shepard bites you, what antibiotic would you take for safety measures? Augmentin (amoxicillin/clavulonic acid). Think “dogmentin”
36.Most common form of osteomyelitis seen in patients with sickle cell? Vascular insufficiency
37.A patient presents with a red, hot , swollen foot on day #5. What stage of wound healing are they in? Inflammatory phase; inflammatory 1-7 days, remodeling 5-20 days, remodeling 3 weeks-2 yrs
38.Honey crusted lesion on the foot, diagnosis?  Impetigo
39.What is pyoderma gangrenosum? Treatment? Necrotic circular deep ulcers that occur secondary to disorder of the immune system such as Ulcerative colitis or RA.



1.What is the WIFI classification? Wound
0: No ulcer
1: Small ulcer
2: Deep ulcer or local gangrene
3: Extensive ulcer or gangrene
Ischemia (Toe Pressure)
0: >60mmHg
1: 40-50
2: 30-39
3: <30
Foot Infection
0: No infection
1: Mild (2cm)
3: Severe (SIRS criteria)
With the score add the points and rank 1-5, with 5 being unsalvageable foot
2.What is the Wagner classification? Stage 1 – partial or full thickness ulcer
Stage 2 – extends to ligament, tendon, or deep fascia
Stage 3 – Deep ulcer with OM or abscess
Stage 4 – local gangrene
Stage 5 – extensive gangrene
unstagable – eschar or callus
3.Name the UTSA wound classification? It utilizes four grades of ulcer depth (0 to 3) and four stages (A to D), based on ischemia or infection, or both. Wounds of increasing grade and stage are less likely to heal.
4.What is the PEDIS classification? stands for Perfusion, Exent, Depth, Infection, and Sensation. It is a scoring system used in Europe.
5.Brodky Classification for Charcot neuropathy Stage 1 – Lisfranc joint
Stage 2 – Chopart’s joint
Stage 3A – Ankle joint

Stage 3B – Posterior calcaneus tuberosity
Stage 4 – Multiple compilations
Stage 5 – Forefoot
6.What are the Eikenholtz stages to Charcot Neuropathy? Stage 0 – Pre-Charcot Neuropathy
Stage 1 – Fragmentation/Development
Stage 2 – Coalescence
Stage 3 – Remodeling/Reconstruction
7.What is the LRINEC score? Laboratory Risk Indicator for Necrotizing Fasciitis. Made to distinguish necrotizing fasciitis from severe cellulitis or abscess
8.What are the points of the LRINEC score?
  • C-reacive protein >15 mg/dl (+4)
  • WBC 15-25µL (+1), >25(+2)
  • Hgb 11-13.5 g/dL (+1), <11(+)
  • Sodium <135 (+2)
  • Creatinine >1.6 mg/l (+2)
  • Glucose >180 mg/dl (+1)

A score >6 is suspicious for nec fasc

 9.Stages of decubitus ulcer? Stage I – Skin is intact and red
Stage II – Loss of skin integrity in epidermis and dermis
Stage III – Loss of skin integrity into subcutaneous tissue
Stage IV – Involvement of all layers of skin plus muscle, bone and tendon
 10.Waldvogel and Lew Classification?  -Periostitis: Inflammation of the periosteum
-Osteitis: Inflammation of the cortex
-Osteomyelitis: Inflammation of the medullary canal
-Sequestrum: piece of dead bone floating in pus/inflammation
-Involucrum: sheath of bone surrounding pus/inflammation
-Cloaca: tract through an involucrum