What are the local wound care recommendations for wound dehiscence in the setting of ischemic foot (Peripheral Artery Disease, PAD)?

From the Guidelines

For wound dehiscence in an ischemic foot, local wound care should prioritize gentle cleansing, conservative debridement, and maintenance of a moist wound environment, with a focus on optimizing blood flow through vascular assessment and potential revascularization, as emphasized by the most recent guidelines 1.

Key Components of Local Wound Care

• Gentle cleansing with normal saline or commercial wound cleanser
• Conservative debridement limited to clearly non-viable tissue, as aggressive debridement can cause further tissue damage in an already compromised blood supply
• Application of a non-adherent dressing, such as a hydrogel or alginate, to maintain a moist wound environment while absorbing excess exudate
• Use of a protective secondary dressing like foam or gauze, with daily or more frequent dressing changes if heavily soiled

Importance of Vascular Assessment and Revascularization

• Vascular assessment and potential revascularization are crucial for improving blood flow, which is essential for wound healing, as highlighted in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1
• Revascularization should be prioritized alongside wound care to address the underlying ischemia

Additional Considerations

• Offloading pressure from the wound using specialized footwear, casts, or walkers is essential to prevent further breakdown
• Topical antimicrobials, such as silver-containing dressings, may be used if infection is present, but systemic antibiotics should be reserved for clinical signs of infection
• Regular monitoring for signs of infection, such as increasing pain, erythema, or purulent drainage, is necessary
• Patients should be educated about elevation of the extremity when possible and strict glucose control if diabetic, as emphasized in the IWGDF 2023 update 1 and the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1

From the Research

Local Wound Care Recommendations for Wound Dehiscence in Ischemic Foot

• The management of wound dehiscence in the setting of ischemic foot involves a comprehensive approach, including debridement, off-loading, and the use of advanced wound therapies 2, 3.
• Debridement is a crucial step in wound management, and nurses should adopt an evidence-informed approach to care, understanding the importance of wound bed preparation and the different debridement options available 4.
• Mechanical negative pressure wound therapy (mNPWT) has been shown to be an effective wound care option for promoting wound healing, decreasing edema, and removing tissue debris and exudate 2.
• Off-loading is also essential in the management of diabetic foot wounds, and techniques such as the use of total contact casts can be effective in reducing pressure and promoting healing 3.
• In cases of infected wound dehiscence, a combination of surgical debridement, antibiotic therapy, and plate preservation may be beneficial in eradicating infection and promoting wound closure 5.
• Restaging of the Wound, Ischemia, and Foot Infection (WIfI) classification system after initial vascular and podiatric intervention can provide valuable information on the clinical implications of treatment and influence outcomes such as amputation-free survival and freedom from major adverse limb events 6.

Key Considerations

• A holistic approach to wound management is essential, taking into account the patient's overall health and the specific needs of the wound.
• The use of advanced wound therapies, such as mNPWT, should be considered in conjunction with traditional wound care practices.
• Regular monitoring and restaging of the wound is crucial in assessing the effectiveness of treatment and making adjustments as needed.
• A multidisciplinary approach to care, involving nurses, surgeons, and other healthcare professionals, is essential in providing optimal care for patients with wound dehiscence in the setting of ischemic foot.