Wound Q&A

In this section, you can find replies to some of the most frequently asked questions by patients with a chronic/non-healing wound.

Wound Q&A for patients and relatives

A holistic approach to wound care is important to ensure appropriate treatment and management is provided. Therefore, it is recommended that you inform your General Practitioner (GP) and/or wound care nurse about other issues related to your health status (other chronic diseases, medication, etc.) and ask questions about your wound. These questions can lead to a valuable dialogue with your clinician to help your wound to heal. Working with your clinician and the treatment plan helps to ensure that potential complications are minimised.

Definitions: Primary types of chronic/non healing wounds/ulcers

Venous leg ulcer: this type of ulcer occurs around the ankle area. They are shallow and can be painful. They are caused when the veins in the legs are damaged or are not working properly and therefore do not return blood back to the heart as efficiently as they should. They are also called venous stasis ulcers or sometimes varicose ulcers.

Arterial leg ulcer: This type of ulcer usually occurs on the foot or the lower part of the leg. They can be small and sometimes deep and often quite painful. They are caused when the arterial blood flow to the area is reduced and often occur among people who have some form of heart disease.

Mixed ulcer: This ulcer is due to a combination of venous and arterial disease.

Diabetic foot ulcer: This type of ulcer occurs on the foot of a person with diabetes. There are three main types; neuropathic (due to lack of sensation); ischaemic (due to poor blood supply); neuro-ischaemic (a combination of both).

Pressure ulcer: This type of ulcer is caused by pressure and/or shearing force. These ulcers may also be re-ferred to as bed sores or decubitus ulcers.

In this Q&A, “clinician” may refer to your nurse, doctor, physiotherapist or other health care professional with expertise in wound management.

The material is produced by EWMA in collaboration with its cooperating organsiations and has been grouped into the following sections:

Causes and diagnosis

My mother had a leg ulcer, will I get one?

A number of well-known acquired and putative inherited etiological factors such as venous insufficiency, obesity, and deep vein thrombosis can contribute to the development of venous leg ulcer. These factors can be prevented. Your clinician can give you advice.

Why did my mother develop a pressure ulcer/bed sore?

Pressure ulcers are developed because the mechanical load (pressure) on the tissue is higher than the tissue can resist. You can feel the mechanical load on the tissue while sitting or sleeping in the same position for a long time. This causes pain and you can feel so uncomfortable that you need to change your position. However, someone who is very ill, has loss of sensation or who cannot move, cannot change their position and thus are at an increased risk of developing a pressure ulcer. The main risk factors for pressure ulcers are immobility, increased skin moisture (incontinence, sweating, highly exudating wound) and poor nutritional status. Other factors also increase risk but these are the main ones.

Are pressure ulcers/bed sores inevitable when someone is confined to bed?

No. In most cases, pressure ulcers can be prevented. The risk factors need to be recognised before the pressure ulcer develops and to do this clinicians are recommended to use a risk assessment scale. It is also important that the individual at risk changes positon in bed by him/herself or with help to relieve pressure. For individuals who are confined to bed it is very important to inspect the skin at least daily, have a strategy to re-position and if necessary to use a special mattress to relieve the pressure.

I have diabetes. Is developing a diabetic foot ulcer inevitable?

No. Individuals who develop a diabetic foot ulcer usually have a long history of diabetes or very poorly controlled diabetes. As a progressive disease, diabetes causes complications, like neuropathy (reduced sensation in the feet) and/or arterial-vascular disease that disturbs normal arterial blood flow in the foot. Together with trauma, these changes could mean that even a minor break in the skin may lead to the development of a diabetic ulcer.

It is very important that you manage your diabetes well, so that the risk of developing complica-tions is reduced. The daily care and inspection of your feet is important to ensure that any changes in the skin are noticed and that the skin is kept healthy.

My doctor says I suffer from venous insufficiency. Is it inevitable to develop a leg ulcer?

No. Venous insufficiency cause oedema (fluid) in the tissue and this increases the risk of developing an ulcer. Thus it is very important to use the prescribed compression therapy and exercise to strengthen the muscles in the calf. The exercise will also support the venous circulation and help decrease and prevent oedema. The general practitioner can assess the seriousness of venous insufficiency or refer to a clinician with expertise in venous leg ulcer assessment. Surgical treatment may be needed in some cases.

I heard my nurse talk about pressure sores/bed sores categories/stages. Do I need to worry?

The pressure ulcer categories are used to assess the severity of a pressure ulcer. The categories explain how deep the ulcer is and provide important information for professionals concerning the treatment plan. The categories which are typically used are the EPUAP/NPUAP pressure ulcer categories (www.epuap.org ):

“Stage 1: Non blanchable erythema” means that there is no ulcer, but the skin is red in colour. The ulceration can be prevented by good skincare and positioning, and pressure releasing mattresses are recommended.

“Stage 2: Partial Thickness Skin Loss” means that the skin is broken, but the damage is superficial and the healing prognosis is good if appropriate wound care, positioning and use of a pressure releasing mattress are applied.

“Stage 3: Full Thickness Skin Loss” means that the wound is deeper than in Stage 2, extending to the subcutaneous layer which is also called fat tissue. The risk of infection is high and the ulcer may need examination by a surgeon.

“Stage 4: Full Thickness Tissue Loss” means that the ulcer extends into the muscle or even into the bone or joint. Consultation with a surgeon is needed and often these Stage 4 pressure ulcers are treated by a plastic surgeon.

I heard my nurse/physician talk about stage/classification of my wound. What does that mean?

Staging/classifying of a wound means to categorise your wound. The categorisation is based on the etiology, such as diabetic foot ulcer, pressure ulcer or venous leg ulcer. The categorisation is only part of the total assessment of your wound, which includes other factors such as surrounding skin and presence of exudate, to name a few. Details about pressure ulcer categories are provided in the answer to the above question.

Lifestyle and prevention

There are many different risk factors and lifestyle choices which may influence the development of and healing of chronic wounds. In this section we list some of the primary risk and lifestyle factors which you should pay attention to.

What food would help my wound to heal?

A well balanced diet is essential for keeping your skin healthy and assist in the wound healing process. Your diet should include (in particular) the following: Vitamins A, B, C & E, iron and zinc, proteins and carbohydrates.

Can food/nutritional supplement help my wound to heal?

Yes, there is clear evidence in the professional literature indicating that the use of supplements incorporating protein, iron, zinc and vitamin C will enhance both a patient’s cognitive (mental) status as well as his/her wound healing potential. This is especially important for those over 70 years of age.

Should I expose my wound to air?

No. There is clear evidence that covering wounds up with an appropriate dressing product will enhance the wound healing potential by helping to create the ‘ideal’ wound healing environment. Exposing a wound to the open air will both reduce the temperature of the wound surface and dry out the wound. Neither of these help healing.

An appropriate dressing is one that helps to create an ideal wound healing environment (warm and moist) maintaining a constant temperature (around 37^oC) at the wound surface and keeping the wound moist but not soggy. However, in some specific cases your clinician may advise to keep the wound open or choose a different treatment option.

Does smoking influence my wound healing?

Yes. Smoking reduces the amount of oxygen arriving at the wound. In addition any scar tissue laid down when the wound heals will be of poorer quality. If you need further information, ask your clinician for advice.

I have a wound. Do I need to alter my alcohol consumption/will it influence my wound healing?

Alcohol consumption should always be in moderation as the excess consumption of alcohol will adversely delay the wound healing process. If you need further information, ask your clinician for advice.

Are there other options to bandages? I would like to wear my own shoes.

Your clinician can advise you about the variety of materials that can be used to enable you to wear your own shoes. If you have a venous leg ulcer, you will need bandages to heal it, but you can use stockings afterwards that will enable you to wear your own shoes.

My wound has closed. What precautions should I take?

Your wound is closed on the outside, but it may take months before the inside is completely healed. Hydrate your skin so your skin stays moist and smooth. If your clinician prescribed preventive interventions like special stockings, please follow these instructions. If in doubt, ask your clinician for further advice.

I have a wound, can I take a shower?

It will differ, depending on the type of wound, so you need to discuss this with your clinician. There are waterproof dressings available on the market.

Are there any special hygiene precautions I should be aware of?

If you or your caregiver is changing your wound dressing, good hand hygiene, including the use of alcohol-based hand rubs and handwashing with soap and water is critical to reduce the risk of spreading bacteria. If in doubt or for further special hygiene precautions, ask your clinician for further advice.

Does my body weight influence my wound healing?

Yes, your body weight can influence the healing of your wound. Significant weight loss or weight gain, as well as inadequate intake of proteins, fluids, energy and vitamins do influence the process of wound healing. For further advice, ask your clinician.

Can I go swimming when I have a wound ?

It will differ, depending on the type of wound, so you need to discuss this with your clinician. There are waterproof dressings available on the market.

Treatment and wound status

I have a venous leg ulcer (See definition). My clinician says to exercise but my family and friends tell me to rest. Which is better?

If your wound is treated by a clinician and compression therapy is part of the treatment, exercise will be beneficial for wound healing. If no compression therapy is provided, please ask your clinician for specific advice. Rest could be appropriate in this case.

I have an arterial leg ulcer. My clinician says to exercise but my family and friends tell me to rest. Which is better?

With an arterial ulcer, exercise is recommended as part of the wound treatment. If the ulcer is under pressure during the exercise, ‘off-loading’ (See Wound glossary) is essential. For further advice, please ask your clinician.

I have a pressure ulcer (may also be referred to as pressure sore or decubitus). My clinician says to exercise, but my family and friends tell me to rest. Which is better?

With a pressure ulcer, exercise has no negative effect on the wound healing except if the wound is under pressure during the exercise. In that case exercise should be avoided. For further advice, please ask your clinician.

I have a burn wound. My clinician says to exercise, but my family and friends tell me to rest. Which is better?

With a burn wound, exercise has no negative effect on the wound healing, except if the wound is under pressure during the exercise. In that case, exercise should be avoided. For further advice, please ask your clinician.

I have an acute wound. My clinician says to exercise, but my family and friends tell me to rest. Which is better?

With an acute wound, exercise has no negative effect on the wound healing except if the wound is under pressure during the exercise. In that case, exercise should be avoided. For further advice, please ask your clinician.

I have a diabetic foot ulcer. My clinician says to exercise, but my family and friends tell me to rest. Which is better?

With a diabetic foot ulcer, exercise is often recommended as part of the wound treatment. Nevertheless, if your ulcer is under pressure during walking or during the exercise ‘off loading’ (See glossary) is essential. For further advice, please ask your clinician.

There is a smell from my wound. Why is that and what can I do to get rid of it?

Wounds can produce specific odours. This can be related to the dressing, the healing process or infection. If you are worried and/or the odour is present with more wound fluid and/or pain, please contact your clinician. These symptoms can be related to an infection, and specific treatment is recommended in that case. To diminish the odour, some commercial products are available, and these options should be discussed with your clinician.

Is it ok to change the dressing myself? / Can I ask a family member or friend to change the dressing?

Many patients or family members are actively involved in wound care, but you need to discuss and plan the wound care/dressing changes with your clinician.

How often should the dressing be changed?

This will depend on the type of wound and type of dressing. Some dressings are designed to stay on for up to a week. If liquid leaks out of the dressing, or if the wound is much more painful than before without specific reason, it is strongly suggested you contact your treating clinician.

The wound healing process: re-occurrence, medications, etc.