Fundamentals of ulcer and wound management

Patients with chronic or recurrent ulcers or wounds have a health condition that reduces quality of life, and that may progress to serious medical complications and hospital admission. The prevalence of ulcers and wounds in older patients has been estimated between 1% and 5%. For patients with diabetes or peripheral arterial disease, complications include limb amputation and life-threatening infection.

Prevention is the best strategy. Undertake a thorough history and examination at least annually to identify and minimise risk factors for a first wound or for wound recurrence. Some patients require more frequent review based on their risk profile; for example, patients with a high-risk foot need to be reviewed every 3 months. Interventions to prevent a wound include improving skin integrity, optimising the patient’s general health and referring a patient with chronic venous insufficiency to a vascular surgeon.

If a wound does occur, the aim of management is to promote healing, minimise the likelihood of recurrence, and reduce the impact on the patient’s quality of life. Successful treatment is predicated on an accurate diagnosis; collaboration between the patient, healthcare professionals (including between hospital- and community-based clinicians) and other carers is critical.

The ability to heal diminishes with age, so minor injuries in an older person have a higher risk of delayed healing, infection, and progression to serious injury, threatening limb or life. Proactive management is required for a person with risk factors for delayed healing (see Factors affecting wound healing).

A general framework for ulcer and wound assessment and management is provided in A framework for ulcer and wound management.

After implementing a wound management plan, early review—usually within a week—ensures patients can tolerate and adhere to the plan. The duration between reviews can thereafter be extended according to wound characteristics and progress, interventions required and patient characteristics. If patients have difficulty adhering to a wound management plan, explore the basis for this without judgement. Patient and carer education is essential to facilitate optimal management.