"As a wound expert I appreciate the web-based activities of Coloplast, and we will use part of the information in our in-house learning system. The assistance for selection of wound dressings on the basis of wound-related problems under attention of the phases of wound healing (wound selection wheel) is a powerful practical tool. The evidence website supports us with scientific background information we need for choosing the right product. The Coloplast College Program provides structured, up-to-date seminars given by outstanding wound experts."

Jan Forster, Head Nurse Wound Competence Center Bremen, Germany

“We appreciate the learning modules in the S.A.F.E programme put out by Coloplast in Canada. We have used them for our advanced practice nurses and also to supplement some of our own in-house learning. The topics covered by Dr. Sibbald and Laurie Goodman were very clear and concise. The Coloplast website is always given to our employees for their own self-directed learning. Whenever we have student nurses come for clinicals to our company, this website is also given to them and they are able to use the S.A.F.E. CD’s that we have in-house. Thanks again for all your support with our on-going educational needs.”

Theresa Henderson, RN, BScN, CWOCN, CETNc President Partners In Community Nursing, Canada

The three most common types of leg ulcers are:

• Venous leg ulcers (70%)
• Arterial leg ulcers (10%) 
• Mixed venous and arterial leg ulcers (10–15%) 

Venous leg ulcers

Venous leg ulcers are caused either by dysfunction of the venous valves or an inadequate calf muscle pump. In both cases, blood isn’t sufficiently returned to the heart. This leads to higher venous pressure, which can cause edema. And an increased fluid level between cells can result in cell death, leading to ulcers. This is why compression therapy is an essential part of treating venous leg ulcers.

Venous leg ulcers are often located in the gaiter area of the leg and characterized by:

• Irregular shape
• Brown pigmentation in the peri-ulcer skin area (often with eczema)
• Normal foot pulse

Venous leg ulcers are often painful, especially during daytime. Elevation of the leg can relieve some of the pain.

Arterial ulcers

Arterial leg ulcers are caused by insufficient blood supply to the leg or feet due to arteriosclerosis. The condition reduces the supply of oxygen and nutrients to the cells, resulting in tissue death and, eventually, ulcers.
Patients with arterial ulcers should not be treated with compression therapy, but will often need vascular surgery.

Arterial ulcers are often located in the gaiter area and on the feet, and are characterized by:

• Fairly regular shape
• Atrophic, pale peri-wound skin
• Weak foot pulse 

Arterial ulcers can be very painful, especially at rest.

Mixed venous and arterial leg ulcers 

Mixed venous and arterial leg ulcers are ulcers caused by both venous and arterial disease. The majority of patients diagnosed with mixed venous ulcers have ulcers of venous origin and develop arterial insufficiency over time.

Treatment needs

Venous leg ulcers should normally be treated with graduated compression therapy. However, not all patients can tolerate full compression. Mixed aetiology ulcers are likely to require a reduced level of compression. Arterial leg ulcers should not be treated with compression therapy.

Wound dressings for leg ulcers should offer superior absorption and exudate management properties that enable them to absorb and retain exudate under compression bandages (venous leg ulcers). Suitable dressings include Biatain Silicone, Biatain Non-Adhesive and Biatain Super.

A silver-releasing dressing, such as Biatain Ag or Biatain Silicone Ag, can help prevent or resolve wound infection.

Up to 15% of diabetics are likely to develop a foot ulcer at some stage in their lives. Diabetic ulcers have a considerable negative impact on patients’ lives, and are highly susceptible to infection that all too often leads to amputation. This makes infection control of paramount importance in diabetic foot ulcer management. 

Successfully managing a diabetic foot ulcer requires a comprehensive understanding of the wound: its cause, progression, risk, and treatment.

The main causes of diabetic foot ulcers are: 

• Neuropathy
• Poor blood supply (ischemia)

Neuropathy

Neuropathy is the most common diabetic foot condition and is caused by damaged nerves in the lower extremity. The condition is permanent and can lead to loss of sensation, which increases the risk of accidental injuries, and painful feet. Treatment involves attention to feet, self-care and custom-made footwear. 

A pressure ulcer (decubitus ulcer) is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. This type of ulcer is the result of pressure, or pressure in combination with shear (2). The pressure prevents the blood from circulating properly, and causes cell death, tissue necrosis and the development of ulcers. Wheelchair users or people confined to a bed (for example, after surgery or an injury) are especially at risk.

Major cause of morbidity

Pressure ulcers are a major cause of morbidity and mortality, especially for people with impaired sensation, prolonged immobility, or advanced age. The most common places for pressure ulcers are over a bony prominence, such as elbows, heels, hips, ankles, shoulders, the back, and the back of the head.

Classification

Pressure ulcers are classified according to the degree of tissue damage observed. In 2009 the EPUAP-NPUAP advisory panel agreed upon four levels of injury (3):

Category/Stage I: Non-blanchable redness of intact skin

Buttocks, Stage I, NPUAP copyright & used with permission.

Intact skin with non-blanchable erythema of a localized area, usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness or pain may also be present. Darkly pigmented skin may not have visible blanching.

Category/Stage II: Partial thickness skin loss or blister

Buttocks, Stage II, NPUAP copyright & used with permission.
Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or serosanginous-filled blister.

Category/Stage III: Full thickness skin loss (fat visible)

Ischium, Stage III, NPUAP copyright & used with permission.

Full thickness tissue loss. Subcutaneous fat may be visible, but no bone, tendon or muscle is exposed. Some slough may be present. May include undermining and tunneling.

Category/Stage IV: Full thickness tissue loss (muscle/bone visible)

Sacral Coccyx, Stage IV, NPUAP copyright & used with permission.

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often include undermining and tunneling.

Category/Stage: Unstageable

Full thickness skin or tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Treatment needs (2,3)

• Pressure must be relieved or removed by appropriate measures.
• Wound care must be optimised by:

1. Debridement of necrotic tissue
2. Appropriate cleansing of wound and surrounding skin
3. Use of appropriate moist wound healing dressings

Suitable wound dressings for pressure ulcers are foam or alginate dressings with superior absorption and exudate management properties, such as Biatain Silicone or Biatain Adhesive foam dressing or Biatain Alginate dressing. A silver-releasing dressing such as Biatain Ag or Biatain Alginate Ag can help prevent or resolve wound infection.

Download our tips for preventing, assessing and treating pressure ulcers:

Pressure ulcers – prevention and treatment: A Coloplast quick guide (pdf)

An acute wound is an injury that causes a break in the skin and sometimes the tissue. Acute wounds are classified into two principal types:

• Acute traumatic wounds, such as abrasions, lacerations, penetrations or bites, and burns
• Acute surgical wounds resulting from surgical incisions

Acute wounds – signs and symptoms

• A cut or tear in the skin
• Bleeding, swelling, pain, and/or difficulty moving the affected area
• There may be dirt or foreign objects inside the wound
• Exudate is normally clear
• Large or deep, acute wounds with heavy bleeding need acute medical attention to stop bleeding and check for damage to vital organs or tissue. 

Treatment needs

Foreign objects should be removed from the wound and necrotic tissue debrided, as it can function as a base for infection and delay wound healing. Wound cleansing with SeaClens Wound Cleanser, may be appropriate.

Exudate production is part of the natural wound healing process (1), but the exudate needs to be managed appropriately. Exudate levels are often high during the inflammatory phase of wound healing, and leakage of exudate under the dressing can damage the surrounding skin. Wound exudate must be absorbed and managed by a dressing with moist wound healing properties. This supports the healing process and reduces scar formation. (2-3)

With appropriate care, smaller acute wounds will normally close within days or weeks depending on the size, depth and position of the wound.

Suitable dressings for acute wounds are dressings with superior absorption and exudate management properties that support a moist wound healing environment. These include Biatain Silicone, Biatain Adhesive or Comfeel. Where infection is present, Biatain Silicone Ag and Biatain Ag are appropriate choices.

Why do some acute wounds become chronic?

If a person has a condition affecting the circulation system and/or immune response, normal wound healing processes may be impaired, and the wound may become chronic. Chronic wounds are often defined by the underlying condition that prevents wound healing, such as venous leg ulcers, arterial leg ulcers, diabetic foot ulcers or pressure ulcers.