Wound Care/Skin Ulcers

Each year in the United States, 2.2 million individuals experience diabetic foot ulcers, 2.5 million develop pressure sores, and more than 500,000 experience a burn to the skin. Family physicians are often the first to see individuals with these wounds. Initial treatment can determine whether the wound will heal properly or be complicated by infection, poor healing, or scarring. This FP Essentials^TM monograph will address the recent advances in general wound care, and the management of three wound conditions: diabetic foot ulcers, pressure sores, and burns.

The FP Essentials^TM monograph should be approximately 10,000 words in length, divided into four sections of approximately 2,500 words each, plus a preface, key practice recommendations, a maximum of 15 tables and figures, recommended readings, and references. The monograph should focus on what’s new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to the examples provided, with modifications to emphasize key points. The references listed below include information that should be considered in preparation of this edition of FP Essentials^TM. However, these references are only a useful starting point that should be used to identify additional information to review.

Example case: Blair, a 5-year-old boy is brought to your office for acute care following a dog bite on the hand; the dog belongs to his neighbor. Blair has a 3-cm ragged, non-bleeding laceration on the middorsum of hand with no obvious tendon involvement. What is the appropriate approach to managing this wound?

Key questions to consider:

Example case: Dionne, a 58-year-old woman, has type 2 diabetes, hypertension, elevated cholesterol level, and peripheral vascular disease. She is obese and smokes one pack of cigarettes daily. She has difficulty adhering to the treatment regimen. When examining the feet, you find a large callus with surrounding cellulitis at the base of the left great toe. Dionne was unaware of this condition. What is the best approach to managing this foot condition?

Key questions to consider:

Example case: A 42-year-old, Raef, presents for a physical examination. He has been confined to a wheelchair for the past 14 years following a diving accident that resulted in a partial C7-C8 spinal injury. You notice a full-thickness loss of tissue with exposed subcutaneous fat at the base of the sacrum. No bone or muscle is visible. The area is surrounded by redness and warmth. What is the best approach to managing this pressure sore, and what can be done to prevent such sores from developing in the future?

Key questions to consider:

Example case: Lindsey, a 21-year-old college student, presents to your office soon after spilling boiling water on the left forearm and left leg. Several burned areas are visible, each about 5 cm in diameter. These burns are painful and pale pink with small blisters. Capillary refill of these areas is normal. What is the best immediate treatment for these burns, and how should they be managed in subsequent visits?

Key questions to consider: