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Wound Care for Elderly Patients: Advances and Clinical Applications for Practicing Physicians

      Chronic ulcers (wounds) are commonly encountered in medical practice, particularly in elderly patients who have chronic medical conditions. Health care providers must be adept at diagnosing chronic ulcers and optimizing medical treatment. We describe the best medical practice for the 4 common types of chronic ulcers: pressure ulcers, ischemic ulcers, venous ulcers, and neuropathic ulcers. We emphasize the importance of nutrition and proper wound care as a foundation for the management of all chronic ulcers. There is a unique therapeutic goal for each chronic ulcer. Pressure relief should be provided for both pressure ulcers and neuropathic ulcers. Ischemic ulcers require revascularization. Patients with venous ulcers need adequate edema control. We outline advances in each of these areas and discuss the newest developments in wound care, including growth factors, hyperbaric oxygen, and vacuum-assisted devices. Chronic ulcers in elderly patients can heal with proper diagnosis and good medical care.


      PAD (peripheral arterial disease), PRD (pressure-relieving device), R-PDGF (recombinant platelet-derived growth factor)
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        • Bergstrom N
        • Allman RM
        • Alvarez OM
        • et al.
        Treatment of Pressure Ulcers. Agency for Health Care Policy and Research, Public Health Service, Rockville, MdDecember 1994 (Clinical Practice Guideline No. 15. AHCPR publication 95-0652.)
        • Takahashi PY
        • Swagerty DL
        • Evans JM
        The physician's response to institutional mistreatment.
        Ethics Law Aging Rev. 2000; 6: 191-206
        • McGee M
        • Jensen GL
        Nutrition in the elderly.
        J Clin Gastroenterol. 2000; 30: 372-380
        • Norris JR
        • Reynolds RE
        The effect of oral zinc sulfate therapy on decubitus ulcers.
        J Am Geriatr Soc. 1971; 19: 793-797
        • Thomas DR
        Issues and dilemmas in the prevention and treatment of pressure ulcers: a review.
        J Gerontol A Biol Sci Med Sci. 2001; 56A: M328-M340
        • Carek PJ
        • Dickerson LM
        • Sack JL
        Diagnosis and management of osteomyelitis.
        Am Fam Physician. 2001; 63: 2413-2420
        • Evans JM
        • Andrews KL
        • Chutka DS
        • Fleming KC
        • Garness SL
        Pressure ulcers: prevention and management.
        Mayo Clin Proc. 1995; 70: 789-799
        • Grayson ML
        • Gibbons GW
        • Balogh K
        • Levin E
        • Karchmer AW
        Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients.
        JAMA. 1995; 273: 721-723
        • Lewis Jr, VL
        • Bailey MH
        • Pulawski G
        • Kind G
        • Bashioum RW
        • Hendrix RW
        The diagnosis of osteomyelitis in patients with pressure sores.
        Plast Reconstr Surg. 1988; 81: 229-232
        • Reuler JB
        • Cooney TG
        The pressure sore: pathophysiology and principles of management.
        Ann Intern Med. 1981; 94: 661-666
        • National Pressure Ulcer Advisory Panel
        Pressure Ulcer Prevention Points [summary of AHCPR publication 92-0047]. National Pressure Ulcer Advisory Panel, Reston, Va1993 (Accessibility verified December 29, 2003.)
        • Rehm KB
        • Vayser DJ
        • Branom R
        • Berger JA
        Decubitus ulcers: catching patients lying down.
        Podiatry Today. 1999; 12 (40-58.): 30-34
        • Richardson GM
        • Gardner S
        • Frantz RA
        Nursing assessment: impact on type and cost of interventions to prevent pressure ulcers.
        J Wound Ostomy Continence Nurs. 1998; 25: 273-280
        • Whittington K
        • Patrick M
        • Roberts JL
        A national study of pressure ulcer prevalence and incidence in acute care hospitals.
        J Wound Ostomy Continence Nurs. 2000; 27: 209-215
        • Vap PW
        • Dunaye T
        Pressure ulcer risk assessment in long-term care nursing.
        J Gerontol Nurs. 2000; 26: 37-45
        • Krasner D
        • Kane D
        Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 2nd ed. Health Management Publications, Wayne, Pa1997
        • Day A
        • Leonard F
        Seeking quality care for patients with pressure ulcers.
        Decubitus. 1993; 6: 32-43
        • Burgos A
        • Gimenez J
        • Moreno E
        • et al.
        Cost, efficacy, efficiency and tolerability of collagenase ointment versus hydrocolloid occlusive dressing in the treatment of pressure ulcers.
        Clin Drug Invest. 2000; 19: 357-365
        • Hooi JD
        • Kester AD
        • Stoffers HE
        • Overdijk MM
        • van Ree JW
        • Knottnerus JA
        Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study.
        Am J Epidemiol. 2001; 153: 666-672
        • Andersson E
        • Hansson C
        • Swanbeck G
        Leg and foot ulcer prevalence and investigation of the peripheral arterial and venous circulation in a randomised elderly population: an epidemiological survey and clinical investigation.
        Acta Derm Venereol. 1993; 73: 57-61
        • Leng GC
        • Lee AJ
        • Fowkes FG
        • et al.
        Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population.
        Int J Epidemiol. 1996; 25: 1172-1181
        • Hooi JD
        • Stoffers HE
        • Kester AD
        • et al.
        Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusive disease: the Limburg PAOD Study.
        Scand J Prim Health Care. 1998; 16: 177-182
        • Criqui MH
        • Langer RD
        • Fronek A
        • et al.
        Mortality over a period of 10 years in patients with peripheral arterial disease.
        N Engl J Med. 1992; 326: 381-386
        • Newman AB
        • Naydeck BL
        • Sutton-Tyrrell K
        • Polak JF
        • Kuller LH
        The role of comorbidity in the assessment of intermittent claudication in older adults.
        J Clin Epidemiol. 2001; 54: 294-300
        • Newman AB
        Peripheral arterial disease: insights from population studies of older adults.
        J Am Geriatr Soc. 2000; 48: 1157-1162
        • Eccles M
        • Freemantle N
        • Mason J
        • North of England Aspirin Guideline Development Group
        North of England evidence based guideline development project: guideline on the use of aspirin as secondary prophylaxis for vascular disease in primary care.
        BMJ. 1998; 316: 1303-1309
        • Mannick JA
        Remembrance of things past—New England surgeons and infrainguinal reconstruction.
        J Vasc Surg. 1996; 24: 1-5
        • Wolf GL
        • Wilson SE
        • Cross AP
        • Deupree RH
        • Stason WB
        • Principal Investigators and Their Associates of Veterans Administration Cooperative Study Number 199
        Surgery or balloon angioplasty for peripheral vascular disease: a randomized clinical trial.
        J Vasc Interv Radiol. 1993; 4: 639-648
        • Baumgartner I
        • Pieczek A
        • Manor O
        • et al.
        Constitutive expression of phVEGF165 after intramuscular gene transfer promotes collateral vessel development in patients with critical limb ischemia.
        Circulation. 1998; 97: 1114-1123
        • Dillon RS
        Fifteen years of experience in treating 2177 episodes of foot and leg lesions with the circulator boot: results of treatments with the circulator boot.
        Angiology. 1997; 48S: 17-34
        • Vella A
        • Carlson LA
        • Blier B
        • Felty C
        • Kuiper JD
        • Rooke TW
        Circulator boot therapy alters the natural history of ischemic limb ulceration.
        Vasc Med. 2000; 5: 21-25
        • Valencia IC
        • Falabella A
        • Kirsner RS
        • Eaglstein WH
        Chronic venous insufficiency and venous leg ulceration.
        J Am Acad Dermatol. 2001; 44: 401-421
        • London NJ
        • Donnelly R
        ABC of arterial and venous disease: ulcerated lower limb.
        BMJ. 2000; 320: 1589-1591
        • Cullum N
        • Nelson EA
        • Fletcher AW
        • Sheldon TA
        Compression for venous leg ulcers.
        Cochrane Database Syst Rev. 2000; 3 (CD000265)
        • Whitmore JJ
        • Burt MM
        • Fowler Jr, RS
        • Halar E
        • Bernie R
        Bandaging the lower extremity to control swelling: figure-8 versus spiral technique.
        Arch Phys Med Rehabil. 1972; 53: 487-490
        • van Geest AJ
        • Veraart JC
        • Nelemans P
        • Neumann HA
        The effect of medical elastic compression stockings with different slope values on edema: measurements underneath three different types of stockings.
        Dermatol Surg. 2000; 26: 244-247
        • Windebank AJ
        Diabetic control and peripheral neuropathy.
        Mayo Clin Proc. 1983; 58: 344-346
        • Sterman AB
        Toxic neuropathy.
        Mayo Clin Proc. 1985; 60: 59-61
        • Mantey I
        • Hill RL
        • Foster AV
        • Wilson S
        • Wade JJ
        • Edmonds ME
        Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients.
        Commun Dis Public Health. 2000; 3: 288-290
        • Khatri G
        • Wagner DK
        • Sohnle PG
        Effect of bone biopsy in guiding antimicrobial therapy for osteomyelitis complicating open wounds.
        Am J Med Sci. 2001; 321: 367-371
        • Mulder GD
        Evaluating and managing the diabetic foot: an overview.
        Adv Skin Wound Care. 2000; 13: 33-36
        • Prabhu KG
        • Patil KM
        • Srinivasan S
        Diabetic feet at risk: a new method of analysis of walking foot pressure images at different levels of neuropathy for early detection of plantar ulcers.
        Med Biol Eng Comput. 2001; 39: 288-293
        • Dahmen R
        • Haspels R
        • Koomen B
        • Hoeksma AF
        Therapeutic footwear for the neuropathic foot: an algorithm.
        Diabetes Care. 2001; 24: 705-709
        • Armstrong DG
        • Nguyen HC
        • Lavery LA
        • van Schie CH
        • Boulton AJ
        • Harkless LB
        Off-loading the diabetic foot wound: a randomized clinical trial.
        Diabetes Care. 2001; 24: 1019-1022
        • Embil JM
        • Papp K
        • Sibbald G
        • et al.
        Recombinant human platelet-derived growth factor-BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label clinical evaluation of efficacy.
        Wound Repair Regen. 2000; 8: 162-168
        • Smiell JM
        • Wieman TJ
        • Steed DL
        • Perry BH
        • Sampson AR
        • Schwab BH
        Efficacy and safety of becaplermin (recombinant human platelet-derived growth factor-BB) in patients with non-healing, lower extremity diabetic ulcers: a combined analysis of four randomized studies.
        Wound Repair Regen. 1999; 7: 335-346
        • He H
        • Levitzki A
        • Zhu HJ
        • Walker F
        • Burgess A
        • Maruta H
        Platelet-derived growth factor requires epidermal growth factor receptor to activate p21-activated kinase family kinases.
        J Biol Chem. 2001; 276: 26741-26744
        • Wunderlich RP
        • Peters EJ
        • Lavery LA
        Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot.
        Diabetes Care. 2000; 23: 1551-1555
        • Bakker DJ
        Hyperbaric oxygen therapy and the diabetic foot.
        Diabetes Metab Res Rev. 2000; 16: S55-S58
        • Faglia E
        • Favles F
        • Aldeghi A
        • et al.
        Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: a randomized study.
        Diabetes Care. 1996; 19: 1338-1343
        • Boykin Jr, JV
        The nitric oxide connection: hyperbaric oxygen therapy, becaplermin, and diabetic ulcer management.
        Adv Skin Wound Care. 2000; 13: 169-174
        • Evans D
        • Land L
        Topical negative pressure for treating chronic wounds: a systematic review.
        Br J Plast Surg. 2001; 54: 238-242
        • Greer SE
        • Duthie E
        • Cartolano B
        • Koehler KM
        • Maydick-Youngberg D
        • Longaker MT
        Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy.
        J Wound Ostomy Continence Nurs. 1999; 26: 250-253