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Wound Care
This is a web site dedicated to wound care education at the Ralph H. Johnson Veterans Affairs Medical Center. Use this site to learn about wound care and what resources are available.
    We are looking for real patients with real problems to place on this site. Send messages or call Elizabeth Jones @ 3-299 or Vince Baccari @ 7449 All suggestions are appreciated.

February 2012
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Members List:

Wound Care Expert:
Elizabeth, ANP CWCN Jones
Wound Care:
Brad Solomon
Photographer:
Chris Baroody
Web Master:
Vince Baccari

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Heel Ulcer 
    HISTORY
      .78 year AA Male Admitted with Fever, UTI
        .Discharged to rehab facility 3 weeks prior for 20-days physical therapy S/P elective knee Surgery
          .Contractured knees and severe ulcers bilateral feet
            .Poor appetite
 
Left Heel Ulcer


DOCUMENTATION

Left Foot: .Patient has dry, stable eschar, no drainage or erhthema. This is a sign of pressure necrosis that is stable and covering / protecting open areas.

 Right Heel Ulcer


DOCUMENTATION

Right Foot: (measurement (head to toes/ Left to Right Depth)

    .7x10cm deroofed blister, flush withskin, soft, draining thick, yellow.
      .10x10 cm heel ulcer covered with hard black eschar
        .7x7 cm hard black eschar proximal to heel
          .Toes black, edematous, cold
 
Nutrition Labs and Consult
    Albumin (3.5-5.5) will measure PO over past month
      Prealbumin (15-25) will measure PO over past 2-days
        This patient has a albumin of 2.1 and a prealbumin of 9 indicating malnourishment over both long and short term.
          Patient needs to see Dietitian and have prealbumins q3-5days to track changes
 Skin Care Consult
    A Skin Care Consult demonstrates the following information:
      ABI's (the actual BP in the lower extremities) show very poor perfusion. This is a good sign that patient's problems were NOT neglect but rather some unforeseen physiological problem that conpromised circulation.
        Treatment for each foot is VERY different
 

TREATMENT

Left Foot
    Patient has dry, stable eschar, no drainage or erythema.
    This is a stable covering/protecting open areas. Paint eschar with betadine, cover with dry dressing. Keep Pressure Free with heel protectors.
DO NOT cover with hydrocolloid, opsite/tegaderm, wet to dry, or wound gel. DO NOT remove the eschar as this now creates an open lesion that will lead to infection, gangrene, and possibly amputation.
Right Foot
    Patient has soft eschar with pus. This is a sign of ongoing gangrene that need to be corrected immediately.
Urgent Consult to Vascular Surgery. Cover with DRY GAUZE and KERLIX to absorb drainage and decrease odor. This patient underwent AKA to remove infected tissue.

 
 RALPH H.JOHNSON VA MEDICAL CENTER
Charleston, SC

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