Patient Education

Below is information describing how you can take care of your wounds. You are a vital member of the team who is responsible for ensuring that your wound heals in a safe and effective manner. Along with the care you receive from your physicians and nurses, it is important for you to take the time to follow their instructions at home so you can have the best outcome.

Along with the care you receive from your physicians and nurses, it is important for you to take the time to follow their instructions at home so you can have the best outcome.

General Wound Care

  1. Wash your hands.
  2. Use non-sterile gloves if you are touching the wound or wound drainage. Change gloves after you touch old dressings or drainage, or if they are visibly soiled.
  3. If the dressing sticks, you may moisten it with saline to loosen it. Clean the wound with saline and a piece of gauze. Pat dry with a clean piece of gauze.
  4. Throw away old dressings in a plastic bag and throw the bag in the regular trash.
  5. Check wound for signs of infections which may include redness, swelling, warmth/heat, pain, or foul odor. Contact your doctor's office or wound care center if you notice these symptoms or have worsening pain or fevers.
  6. Apply solution, ointment, or dressings to the wound as directed. If you are using a wound packing, do not over-pack the wound. Make sure you love a long "tail" so the packaging can be easily removed at the next dressing change.
  7. Cover the wound with a secondary dressing, such as a rolled gauze, as needed. Secure with tape, avoiding taping the skin if possible.
  8. Wash your hands.

Skin Care

Skin is our body’s largest organ and it has protective and adaptive properties. It is constantly being renewed. Its functions are preventing fluid loss, temperature regulation, production of vitamin D, sensation (touch, pressure, temperature, and pain), absorption (drugs such as steroids or hormones), and prevention of allergic reactions.

Factors that influence skin include: age, disease, trauma, nutrition, physical limitations, and hygiene. These affect the appearance, condition, integrity and suppleness of skin. The aging process causes skin to become thinner, less elastic, more like "tissue paper", and easily damaged.

Some medications or medical conditions such as diabetes, kidney or liver problems, heart, blood vessel or lung disease may increase the risk of bruising, trauma, injury, splitting or cracking, and peeling.

This fragile skin can be injured simply by bumping against an object, scratching, or rubbing itchy skin. Dry, chapped skin in the same area can then result in an open sore.

Consult your doctor for the following skin problems:

  • Wounds that develop on the lower leg or foot
  • Dry, cracked peeling skin or blisters
  • Weeping skin over legs or feet
  • Multiple or large skin tears
  • Fissures on the feet, especially the heels.

Keep the skin supple and intact by cleansing with a gentle PH balanced cleanser, and using moisturizer after bathing or at bedtime. Bathe in warm, not hot, water. Dry skin folds and between toes carefully. Check your skin daily for any redness, sores, or cracked, peeling skin.

Smoking and Wound Healing

Many factors are involved in wound healing. Some of these factors will also play a role in forming new wounds and includes: poor nutrition, high blood pressure, obesity, uncontrolled diabetes and smoking. All tobacco products contain nicotine, which is a drug that causes vasoconstriction.

Vasoconstriction is a narrowing of the vessels that carry nutrient-rich blood to your tissues and organs.When this happens, organs and cells don’t get the oxygen and nutrients they need so, the cells die and the organs work poorly.

The good news is if you quit smoking, the vasoconstriction will reverse, causing carbon monoxide and oxygen levels to return to normal in 8-24 hours.

Ready to quit?

Contact the American Lung Association at 1-800-LUNGUSA.

Locally, you can reach the Council on Chemical Abuse at 610-376-8669.

Taking Care of Your Feet

Foot care is essential for people with diabetes. Proper foot care and footwear can prevent many complications. How can you protect your feet?
  1. Inspect your feet daily. Use a mirror, if needed, to look for cuts, sores, red areas, swelling, warm areas, pain, blisters, cracks or fissures, corns or calluses.
  2. Basic care: Wash feet with gentle soap and lukewarm water and dry well, especially between toes. Do not get soap into wounds. Do not use antiseptic solutions on your feet. Apply powder as directed by your physician. Apply moisturizer, such as Gold Bond Skin Healing to feet but, avoid applying it between the toes or on any open wounds. Keep feet warm and wear clean cotton socks. Never use heating pads or ice packs. Never trim corns or calluses - see a podiatrist for this.
  3. Nail care: Keep toenails trimmed and smooth. Patients with diabetes should see a podiatrist for nail cutting and trimming, but can file nails until smooth on their own.
  4. Wear shoes and socks at all times. Make sure shoes fit properly and do not have pointed toes, or are too tight. You may need to see a podiatrist to see if you need special footwear. If you have any bony deformities, such as hammertoes or bunions, you may need extra wide/extra depth shoes or custom molded footwear. If you have loss of sensation, inspect the inside of your shoe for foreign objects before putting them on. Protect your feet against sunburn, hot pavement or sand, hot bathing water, car heaters and space heaters.

Offloading

Offloading means avoid putting weight on a particular area. If you have been instructed to offload pressure, this means that you should not walk or put your weight on an area that has a wound, including your bottom or hips if you are bed or chair-bound. The weight of your body puts pressure on certain areas, especially your feet when you walk. This pressure prevents blood flow from getting to the area and prevents new tissue from growing. For wounds on your hips, tailbone, bottom, or “sitting bones,” you should not sit or lie on the area. If you put your body weight on an area with a wound, it will not heal and could worsen.

The easiest way to offload legs and feet is to stay in bed or in a chair. This is not always possible, so sometimes a special shoe, boot or cast will be prescribed to help offload your feet. Sometimes a walker, wheelchair or crutches can be used as well.

If you are bed-bound or chair-bound, a special seating cushion and a special mattress could be ordered to take the pressure off your bottom, hips, tail bone and “sitting bones.” You may also use pillows and wedges to reposition your body off the pressure points. You should shift your weight every 15 minutes and change your position completely every 2 hours. There are special boots, socks and cushions made to keep the pressure off heels while in bed.

Inspect skin often, especially over bony areas for redness and discoloration. Make sure to keep pressure off any areas that look red or pink in lighter skin and brown or purple in darker skin. Be sure to show your health care provider any areas of concern. It only takes about 2 hours for damage to happen to your skin from too much pressure!

Preventing Ulcers and Bedsores

Take care of your skin

  • Check bony areas of your body, such as heels, elbows, back of the head, shoulders, buttocks, hips and tailbone, at least every few hours for redness or blistering
  • If any red, discolored, bruised or blistered areas appear, remove pressure from the area and call your doctor. Do not rub or massage the area!
  • Make sure skin is well hydrated with moisturizer since dry skin breaks down faster (no lotion between toes)
  • If you have an area of skin that is too moist or subject to large amounts of moisture (such as urine with incontinence), protect the skin with a skin sealant or ointment as prescribed by your doctor or provider.

Repositioning

  • Change body position every 2 hours and shift weight every 15 minutes to minimize pressure on any one area.
  • Use bed pillows (or you can purchase a "wedge" pillow at a medical supply store) between knees and ankles and under heels (so they are "floating").
  • Use a wheelchair cushion and/or specialty mattress as directed by your doctor or provider. Avoid using donut cushions.
  • When changing positions, lift your body weight rather than dragging it to prevent shearing forces from tearing the skin.

Call the wound healing center at 484-628-3939 if you have any questions.

Arterial Disease

Arteries are the part of the circulatory system that provides blood, which carries oxygen and nutrients from the heart to all parts of the body.

In arterial disease, these arteries become narrowed, and blood is not able to flow to all parts of the body, especially the legs and feet.

Causes of arterial disease include atherosclerosis, or hardening of the arteries, a condition which allows cholesterol and plaque to narrow or block the arteries. Additional arterial problems include: aneurysms, damaged or weakened blood vessels, or blood that clots too easily.

Common risk factors for arterial disease include: smoking, high cholesterol, high blood pressure, diabetes, heart disease, obesity, and family history.

Symptoms can include:

  • Pain while at rest
  • Pain with walking, often relieved by rest
  • Decreased or absent hair growth on legs
  • Purple discoloration to feet
  • Numbness and tingling of feet
  • Cool temperature of feet
  • Absent pulses in feet
  • Sore or wound on feet or legs that will not heal
Treatment for arterial disease includes a diet low in saturated fats, moderate exercise, medicine to dilate blood vessels, and possible surgical repair.

Osteomyelitis

Osteomyelitis is an infection of the bone and bone marrow. It can be caused by skin infection, an open fracture, or any infection in the body.

At risk are people with diabetes, individuals with chronic or open wounds, those with lowered immune resistance, or children in a rapid phase of growth.

Symptoms may include fever, pain, warmth, redness, swelling, tenderness, skin abscess with draining pus, or a chronic wound (a wound that does not heal, or that heals and returns) over the infected bone.

Osteomyelitis is diagnosed by medical history, physical exam, blood or bone cultures, X-rays, MRI or CT scans, and/or bone biopsy.

Treatment includes:

  • Possible surgical removal of infected bone
  • Antibiotics, oral or intravenous
  • Nutrition, vitamin and mineral supplements as needed
  • Hyperbaric oxygen therapy, if indicated

Venous Disease

Veins are the vessels in your body that carry blood back to the heart and lungs. They have valves in them to help prevent the backflow of blood, however, sometimes problems arise with how the venous system functions. Some of these common problems include varicose veins, clotting issues (thrombophlebitis/deep vein thrombosis), problems with the functioning of the valves (reflux), and venous ulceration.

There are certain risk factors associated with venous disease. These include: obesity, hereditary factors, injury, pregnancy, surgery, sedentary lifestyle, standing for long periods of time and previous clot in the leg.

Signs of Venous Disease

  • Bulging, squiggly veins (varicose veins)
  • Swelling in the legs and feet
  • Dry, itchy, rashy blistering skin
  • Brown discoloration of the skin
  • Leg pain that may improve with walking
  • Sores on your legs

How to Prevent Venous Ulcerations

  1. Take care of your skin.
  2. Wash regularly with mild soap and water and apply lotion liberally (never between toes).
  3. Elevate your legs above your heart 3-4 times a day for a half hour each time to help with swelling.
  4. Wear your prescription strength (usually 20-30 mmHg) compression stockings. Apply them first thing in the morning after waking and remove at night before bed (ask your nurse how to care for your stockings properly).
  5. Decrease salt by taking time to read food nutrition labels.
  6. If you have been prescribed compression pumps, continue to use them as directed.

You may need to consult with a vascular doctor to see if there are any problems with your veins. They may be able to provide treatment that may help prevent ulcers in the future.

Diabetes

In a person with diabetes, the body does not produce enough insulin to regulate the blood sugar. The sugar remains in the bloodstream and can cause harm to the body.

Risk factors include heredity (family history) and obesity.

Signs of diabetes are thirst, excessive urination, excessive hunger, fatigue, and elevated blood sugar levels.

Diabetes is a chronic disease that requires medical supervision and ongoing management. Uncontrolled diabetes can cause numerous problems, including nerve and blood vessel damage. Numbness and tingling or pain in the lower legs or feet could be a sign of diabetic nerve damage. Often, poor circulation caused by damage to blood vessels results in wounds that become infected, are slow to heal, or do not heal.

Treatment of diabetes includes exercise, weight control, and blood sugar management. Insulin or oral medications may be required. Regular visits to a health care provider are necessary to supervise blood sugar and prevent complications.