Prophylaxis — Wounds and ulcerations

  • Chapter: Wounds and ulcerations

    Article: 6 of 7

    Update: Mar 10, 2021

  • Author(s): Ott, Hagen

As the basis of all further measures in wound prophylaxis, underlying causative diseases which are known risk factors for the development or persistence of wounds (e.g., diabetes mellitus, peripheral arterial occlusive disease, thromboses) must be avoided or identified and treated.

Timely and causative treatment of chronic venous insufficiency in patients with venous or arteriovenous malformations by the treatment of the underlying vascular anomaly can prevent the occurrence of lower extremity wounds in many cases. Attention should be paid to signs of particularly vulnerable skin appearing, especially whitish skin atrophy.

In addition, affected patients should be encouraged to eat a balanced diet to prevent malnutrition, especially in cases of vitamin, iron and protein deficiencies. Medications that may be responsible for delayed wound healing, such as cortisone or other immunosuppressants, should also be given in the lowest possible dosage or, if possible, discontinued.

Particularly for patients with restricted mobility, e.g., after surgery, or for patients who cannot perceive a pressure load on the skin and underlying soft tissue structures, measures must be taken to relieve pressure in affected areas (pressure sore prophylaxis).

Another decisive preventive measure is stage-appropriate skin care. Thus, moisturizing basic therapy with lotions, creams or ointments free of active ingredients prevents skin dryness, which can contribute to the development of non-bacterial inflammation (eczema). Without appropriate basic care of dry and/or eczematous skin areas, frequent scratching can cause skin lesions that promote infection with bacteria or fungi. These infections must be recognized at an early stage and treated immediately to prevent the development of larger skin defects. The treatment of existing wounds under strictly sterile conditions also contributes to this.

In patients with combined or exclusive lymphatic malformations, interdisciplinary care is particularly relevant to the prophylaxis of wound formation. In this group of patients, physiotherapy, occupational therapy, lymphatic drainage, and compression therapy, among others, should be used to prevent functional limitations and immobility from arising. Skin hygiene or, depending on the location oral hygiene, in patients with lymphatic malformations can also help to prevent wound infections such as erysipelas (“wound roses”). In this patient group, consistent and early treatment of bacterial skin infections is also of great importance, especially in the area of lymphatic vesicles on the skin surface. In some patients, antibiotic prophylaxis is even required after recurrent infections and erysipelas.