1. Primary Care Approach to Wound Management
Kevin Taffe, MD, PhD

5. Objectives
Evaluate and diagnose wounds that are commonly seen in primary care
Provide basic wound management in the office setting
Properly triage and refer patients with wounds to the appropriate provider(s)

6. Evaluation of wounds

7. Goals of evaluation

8. Goals of evaluation (cont’d)

9. Overview of evaluation
“I need a Wound Center referral for a
sore on my backside”
Chief complaint
History
History of trauma, pressure, therapies, etc.
Physical

10. Description of wound: general approach

11. Description of wound: Size

12. Tunneling and Undermining

13. Examination of Wound Bed

14. Wound Drainage

15. Wound Edges Raised edge- pressure, trauma, malignancy
Rolled- stagnation, chronicity (epitherlial cells can’t migrate at wound edges)
Contraction- healthy, re-epithelialization taking place

16. Periwound Skin: Primary Dermatologic Lesions
Pyoderma gangrenosum

17. Periwound Skin: Infection
Periwound inflammation
Periwound infection
Rubor
Calor
Dolor
Rubor
Calor
Dolor

18. Wound Location

19. Other exam findings

20. Assessment of Wounds: History

21. Assessment of Wounds: History
HPI: Location, quality, severity, duration, timing, exacerbating/ relieving factors, associated symptoms.
Ask about dressings and other treatments.

22. History: Risk factor assessment

23. Basic Wound Care Managment

24. Treat the underlying cause

25. Treat contributing factors

26. Dressing basics Remove dead tissue Reduce bacterial burden
Support/ create moist wound environment
Protect wound bed

27. Dressings: Debridement

28. Types of debridement

29. Reduce bacterial burden

30. Reduce bacterial burden

31. Treat infection

32. Maintain or create a moist wound environment

33. Maintain or create a moist wound environment

34. Protect wound bed

35. Wound triage and referral

36. Triage

37. Triage

38. Triage

39. Triage

40. Triage

41. Dermatology referral
Squamous cell carcinoma of the foot (raised, lobulated, ulcerated)

42. Rheumatology referral
Can see ulcerations in rheumatologic disease such as RA (incl Felty’s syndrome); usually long standing but in one series this was first manifestation in 3/366 patients (Shanmugam, Victoria K et al. “Lower extremity ulcers in rheumatoid arthritis: features and response to immunosuppression.” Clinical rheumatology vol. 30,6 (2011): )

43. Key take-home points
A detailed history is essential for the diagnosis and treatment of wounds.
The examination of wounds should include a description of all wound characteristics, location, and important supplemental exam findings.
Treatment should be focused on managing the underlying cause, contributing factors, and goal-directed dressing selection.
Chronic wounds do not require urgent referral; consider urgent referral to a Wound Center, ER, dermatologist, or rheumatologist in select cases.