Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling, improving blood flow in the veins and healing or preventing sores or ulcers. There are lots of different types of compression therapy so ask your nurse to find something that is right for you.
Compression can be a little uncomfortable when you first start treatment but should not cause you any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this. In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy.
If you have venous hypertension, intervention to your veins from a vascular specialist might help with healing and stop your wound or sore from coming back. Sometimes varicose veins can be treated by laser therapy. Ask your nurse or doctor for a referral to your local vascular team to talk about how their input might help you.
Your nurse or GP may refer you to a specialist tissue viability nurse or to a vascular service for further advice if your leg or foot condition or wound is failing to improve.
For further information about leg ulceration please review this video. It contains local NHS information but also some great patient well being advice. Thanks to Redmoor Health for this film. Dowload this page as a pdf to print.
Accelerate We have a clear vision at Accelerate — Our vision is to boldly transform chronic wound and lymphoedema care. And we do this by developing and increasing access to world-class treatments and thinking in chronic wound and lymphoedema care. Contact details hello acceleratecic. British Heart Foundation The British Heart Foundation were founded in by a group of medical professionals wanting to fund extra research into the causes, diagnosis, treatment and prevention of heart and circulatory disease.
Today they are the nation's heart charity and the largest independent funder of cardiovascular research. Bupivacaine has a slightly slower onset several minutes vs almost immediate and a significantly longer duration 2 to 4 hours vs 30 to 60 minutes. Duration of action of both can be prolonged by adding epinephrine ,, a vasoconstrictor.
Because vasoconstriction may impair wound vascularity and thus defenses , epinephrine is mostly used for wounds in highly vascular areas eg, face, scalp. Although traditional teaching has been to avoid using epinephrine in distal parts eg, nose, ears, fingers, penis to prevent tissue ischemia, complications from use on distal parts are rare, and such use is now considered safe.
Epinephrine can be particularly helpful in achieving hemostasis in wounds that are bleeding heavily. Adverse reactions to local anesthetics include allergic reactions hives Urticaria Urticaria consists of migratory, well-circumscribed, erythematous, pruritic plaques on the skin. Urticaria also may be accompanied by angioedema, which results from mast cell and basophil activation True allergic reaction is rare, particularly to amide anesthetics; many patient-reported events represent anxiety or vagal reactions.
Furthermore, allergic reactions are often due to methylparaben, the preservative used in multidose vials of anesthetic. If the offending agent can be identified, a drug from another class eg, ester instead of amide can be used. Otherwise, a test dose of 0. Using a small needle a gauge needle is best, and a gauge is acceptable; a gauge may be too flimsy.
Regional nerve blocks are sometimes preferred to wound injection. Nerve blocks cause less distortion of wound edges by injected anesthetic; this decreased distortion is important when alignment of wound edges must be particularly precise eg, infraorbital nerve block for lacerations through the vermilion border of the lip or when wound injection would be difficult because the space for injection is small eg, digital nerve block for finger lacerations.
Also, large areas can be anesthetized without using toxic doses of anesthetic. Use of topical anesthesia makes injection unnecessary and is completely painless—factors particularly desirable in children and fearful adults.
A cotton dental pledget or cotton ball the length of the wound soaked in several milliliters of the solution and placed within the wound for 30 minutes usually provides adequate anesthesia. If anesthesia is incomplete after application of a topical anesthetic, supplementary local anesthetic can be injected through the partially anesthetized wound edges, usually with minimal pain.
The full extent of the wound is explored to look for foreign material and possible tendon injury. Foreign material may also often be discerned by palpating gently with the tip of a blunt forceps, feeling for a discrete object and listening for a click characteristic of glass or metal foreign bodies.
Occasionally, contaminated puncture wounds eg, human bite wounds near the metacarpophalangeal joint must be extended so that they can be adequately explored and cleansed. Deep wounds near a major artery should be explored in the operating room by a surgeon. Laceration debridement uses a scalpel, scissors, or both to remove dead tissue, devitalized tissue eg, tissue with a narrow base and no viable blood supply , and sometimes firmly adherent wound contaminants eg, grease, paint.
Macerated or ragged wound edges are excised; usually 1 to 2 mm is sufficient. Otherwise, debridement is not used to convert irregular wounds into straight lines. Sharply beveled wound edges are sometimes trimmed so that they are perpendicular. Most wounds can be closed immediately primary closure. Primary closure is usually appropriate for uninfected and relatively uncontaminated wounds 6 to 8 hours old 12 to 24 hours for face and scalp wounds.
Many other wounds can be closed after several days delayed primary closure. Delayed primary closure is appropriate for wounds too old for primary closure, particularly if signs of infection have begun to appear, and for wounds of any age with significant contamination, particularly if organic debris is involved.
The threshold for using delayed primary closure is lowered for patients with risk factors for poor healing. At initial presentation, anesthesia, exploration, and debridement are done at least as thoroughly as for other wounds, but the wound is loosely packed with moist saline-soaked gauze. The dressing is changed at least daily and evaluated for closure after 3 to 5 days. If there are no signs of infection, the laceration is closed by standard techniques.
Loosely closing such wounds initially may be ineffective and inappropriate because the wound edges nonetheless typically seal shut within 12 to 24 hours. Small bites Wound care Human and other mammal mostly dog and cat, but also squirrel, gerbil, rabbit, guinea pig, and monkey bites are common and occasionally cause significant morbidity and disability.
Traditionally, sutures have been used for laceration repair, but metal staples, adhesive strips, and liquid topical skin adhesives are now used for certain wounds, mainly linear lacerations subject to only small amounts of tension. Whatever the material used, preliminary wound care is the same; a common error is to do cursory exploration and no debridement because a noninvasive closure not requiring local anesthesia is planned.
Staples are quick and easy to apply and, because there is minimal foreign material in the skin, are less likely to cause infection than sutures. However, they are suited mainly for straight, smooth cuts with perpendicular edges in areas of low skin tension. Improper wound edge apposition sometimes causing wound edges to overlap is the most common error. Topical skin adhesives usually contain octyl cyanoacrylate, butyl cyanoacrylate, or both. They harden within a minute; are strong, nontoxic, and waterproof; form a microbial barrier; and have some antibacterial properties.
However, adhesive should not be allowed into the wound. Infections are very unlikely, and cosmetic results are generally good.
Adhesive is best for simple, regular lacerations; it should not be used for wounds under tension unless tension is relieved with deep dermal sutures, immobilization, or both.
In wounds requiring debridement, deep dermal suturing, or exploration under local anesthesia, the advantages of decreased pain and time are minimized. However, patients do not require follow-up for suture or staple removal. With long lacerations, skin edges can be held together by a 2nd person or with skin tapes while the adhesive is applied. Generally, only one layer is applied as recommended by the manufacturer.
The adhesive sloughs spontaneously in about a week. Excess or inadvertently applied adhesive can be removed with any petrolatum-based ointment or, in areas away from the eyes or open wounds, acetone. Adhesive strips are probably the quickest repair method and have a very low infection rate.
They are useful for wounds not subject to tension. Use on lax tissue eg, dorsum of hand is difficult because wound edges tend to invert. Adhesive strips cannot be used on hairy areas. Adhesive strips are particularly advantageous for lacerations in an extremity that is to be casted thus blocking appropriate suture removal. Adhesive strips can also be used to reinforce wounds after suture or staple removal. Skin must be dry before application. Many clinicians apply tincture of benzoin to boost adhesion.
Improper application may result in blister formation. Adhesive strips may be removed by the patient or eventually will fall off on their own.
Because sutures can serve as an entry site for bacteria and there is a significant amount of foreign material under the skin, they have the highest rate of infection. Suture materials can be monofilament or braided and absorbable or nonabsorbable. Characteristics and uses vary see table Suture Materials Suture Materials Lacerations are tears in soft body tissue. Updates in emergency department laceration management.
Clin Exp Emerg Med. Treatment strategy for a penetrating stab wound to the vertebral artery: a case report. Acute Med Surg. Cleveland Clinic. Does your cut need stitches? Find out how to tell. July 10, Animal and human bite wounds. Dtsch Arztebl Int. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data.
Blog Category:. Wound Care By Bruce E. Ruben MD A non-healing wound is generally defined as a wound that will not heal within four weeks. They are: Poor Circulation Infection Edema Inadequate Nutrition Repetitive Trauma to the Wound Poor Circulation Wounds heal most efficiently when there is easy access to and from the wound site through the body's circulatory system.
Infection Infection is the proliferation of bacteria, virus or fungus in or under a wound site that inhibits the natural and timely healing of the wound. Edema Edema is fluid that accumulates in the skin, dermis or fatty tissue and usually occurs in the lower extremities. Protein Malnutrition Just as you cannot build a house without the building blocks, bricks or foundation, the body cannot build new tissues without an adequate supply of protein. Repetitive Trauma to the Wound When a wound undergoes repetitive pressure due to bumping or rubbing against a surface, it is said to be undergoing repetitive trauma.
Related patient condition:. Arterial Ulcers. Nutritional Support. Skin Graft Donor Sites. Properties of Moist Wound Healing. July 30th, By the WoundSource Editors Studies have shown significant value in moist wound healing as opposed to treatment of wounds in a dry environment, and clinical evidence has supported this view for many years.
February 11th, Preventing Post-Operative Complications. September 30th,
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