Anne McNamara, DPM - Plymouth, NH

Services

Wound Care

There are several types of wounds that can damage the skin including: abrasions, lacerations, rupture injuries, punctures, and penetrating wounds. Many wounds are superficial requiring local first aid including cleansing and dressing. Some wounds are deeper and need medical attention to prevent infection and loss of function, due to damage to underlying structures like bone, muscle, tendon, arteries and nerves. The purpose of medical care for wounds is to prevent complications and preserve function. While important, cosmetic results are not the primary consideration for wound repair.

Wounds occur when the skin is broken or damaged because of injury. The skin can be damaged in a variety of ways depending upon the mechanism of injury. Inflammation is the skin's initial response to injury.

Superficial (on the surface) wounds and abrasions leave the deeper skin layers in tact. These types of wounds are usually caused by friction rubbing against an abrasive surface. Deep abrasions (cuts or lacerations) go through all the layers of the skin and into underlying tissue like muscle or bone.

Puncture wounds are usually caused by a sharp pointed object entering the skin. Examples of puncture wounds include a needle stick, stepping on a nail, or a stab wound with a knife. Human and animal bites can be classified as puncture wounds, abrasions, or a combination of both. Most wounds can be treated at home with routine first aid including thorough washing and dressing.

What are wounds?

Also known as "sores or ulcers". Wounds are where the outer skin is missing and the deeper layers are exposed. Sometimes they are draining or have an odor. Many times wounds are red and infected. Sometimes they have been present for weeks, months or years. Sometimes wounds are painful, but not always.

What type of wounds do we treat?

  • Diabetes
  • Vascular disease (poor blood flow to the feet)
  • Venous insufficiency (swelling of the leg/ ankle/ foot)
  • Lack of sensation in the skin (peripheral neuropathy)
  • Deformity of the foot or ankle
  • Radiation burns
  • Trauma or injury
  • Infections
  • Bone infections (Osteomyelitis)
  • Poor healing surgery

How do we treat wounds?

  • Check for infection in the skin and bone. Sometimes antibiotics are needed (by mouth or intravenous)
  • Check the blood flow to the leg/ ankle/ foot. Sometimes blood flow must be restored through surgery.
  • Check the health status of the patient. Elevated blood sugars slow or prevent healing.
  • If the patient is diabetic - they need to be counseled on appropriate nutrition for improved healing.
  • Pressure needs to be taken off the wound.

Swelling must be controlled. Compression hose or other compression devices may be required to heal the wound or ulcer. Lymph pumps may be required when lymphedema is present. Wounds have different phases and must be treated differently at each phase. Therefore, many different wound healing products are used.

Hyperbaric Oxygen Therapy (HBO) is used when appropriate. HBO is where you enter a clear chamber and that is pressurized. This increases the oxygen in the deeper layers of skin and improves healing. Surgery is sometimes needed to complete healing. A large variety of surgery is utilized to resolve wounds and prevent new ones.

Diabetic shoes or braces are needed sometimes to prevent the wounds from returning after wound healing.

To prevent infection. Some of the following are reasons podiatrist or medical professional should be obtained for a wound:

  • If the wound is due to significant force or trauma and other injures are be present.
  • If bleeding cannot be stopped even with persistent pressure and elevation.
  • If there is concern that wound requires repair with sutures (stitches). The size and location of the wound are important considerations.
  • If the wound is caused by an animal bite.
  • If the wound is very dirty and cannot be easily cleaned.
  • If there is evidence of infection including redness, swelling, increased pain, and pus at the wound.
  • If tetanus immunizations are not up to date, then a booster is needed within 48 hours. If the patient has never been immunized, the initial tetanus prevention with immunoglobulin should be given immediately.


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