Non Infected Lower Extremity Wound
Diagnosis/Definition
- A non-infected lower extremity wound is described as any slow or non-healing wound of the distal leg or foot not due to infection.
Initial Diagnosis and Management
Lower extremity ulceration/wounds that are not responding to standard therapy as anticipated and/or complicated by one or more of the following conditions:
- Neuropathy
- Immunosuppressive drug therapy
- Diabetes
- History of amputation (partial foot or partial lower extremity)
- History of foreign body
- History of autoimmune processes (rheumatoid arthritis, scleroderma)
- Foot deformity
- History of neuromuscular disease processes
- Arthropathy affecting lower extremity
- Deep vein thrombosis (DVT)
- Vascular compromise
- End stage renal disease
- Compromised skin integrity
- Compromised nutritional status
- Disability affecting normal lower extremity movement, balance, transfer, etc.
- Charcot foot deformity (see CHARCOT FOOT REFERRAL GUIDELINE)
Acute Treatment:
In addition to have the patient properly clean the wound and extremity, consider the following:
- Offload with post-op shoe and padding (recommend coordinating with orthotic / prosthetic dept.
- Weight bearing x-ray
- Consult Limb Preservation Services
Ongoing Management and Objectives
- To decrease the rate of toe, foot and lower extremity amputation with prompt referral of active ulceration/wounds that have failed to resolve with standard therapy.
- To manage each patient’s condition with a combination of mechanical, medical and surgical therapies tailored specifically for the unique characteristics of the wound being treated
Indications for Specialty Care Referral
- All patients with non-healing lower extremity wounds not responding to standard therapy and/or complicated by significant morbidity should be referred for evaluation to the Limb Preservation Service/Wound Care Clinic. The patient will require an approved consult to be seen.
Criteria for Return to Primary Care
- All patients should be followed by the primary care provider for treatment of all co-morbid conditions and routine care with the goal of optimal health and wellness for the whole patient.