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Atypical Wound Care. LEE Wai-kuen Nurse Specialist Queen Mary Hospital. Atypical Wound. Wounds due to uncommon etiologies are called atypical wounds.

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atypical wound care

Atypical Wound Care

LEE Wai-kuen

Nurse Specialist

Queen Mary Hospital

atypical wound
Atypical Wound
  • Wounds due to uncommon etiologies are called atypical wounds.
  • The most commonly encountered etiologies for an atypical wound include inflammatory causes, infections, vasculopathies, metabolic and genetic causes, malignancies and external causes.

(Baranpski & Ayello, 2004)

potential etiologies
Potential etiologies
  • Inflammatory causes
    • Vasculitis
    • Puoderma gangrenosum
  • Infections
    • Atypical mycobacteria
    • Deep fungal infections

Araujo & Kirsner, 2004

Metabolic and genetic causes
    • Calciphylaxis
    • Sickle cell anemia
  • Malignancies
    • Squamous cell carcinoma
    • Basal cell carcinoma
    • Lymphoma
    • Kaposi’s sarcoma

Araujo & Kirsner, 2004

    • Cryoglobulinemia
    • Cryofibrinogenaemia
  • External causes
    • Bites
    • Radiation

Araujo & Kirsner, 2004

  • A widespread connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs.
alternative names
Alternative Names
  • CREST syndrome
  • Progressive systemic sclerosis
  • Systemic sclerosis
  • Localized scleroderma
Affect 300,000 people in USA
  • Female : Male = 4:1
  • Population
    • Infant elderly
    • Average age 22-55
    • Unknown
    • Not directly inherited
    • Over production of collagen in the skin and other organs
  • Risk factors
    • Occupational exposure to silica dust and polyvinyl chloride
skin symptoms
Skin symptoms
  • Blueness or redness of fingers and toes in response to heat and cold
  • Ulcerations on fingertips or toes
  • Skin hardness / thickening
  • Skin is abnormally dark or light
  • Shiny hands and forearm
  • Small white lumps beneath the skin
  • Tight and mask-like facial skin
  • Hair loss
other organs involvement
Other organs involvement
  • Bone, joint and muscle
  • Digestive system
  • Lung
  • Kidney
  • Gallbladder
  • Heart
  • Eye
  • Heart failure
  • Kidney failure
  • Malabsorption
  • Pulmonary fibrosis
  • Pulmonary hypertension
    • Decrease activity of immune system
      • Corticosteroids
      • Immunosuppressants (Methotrexate, Cytoxan)
      • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Symptomatic control
  • In most patients, the disease slowly gets worse.
  • Death may occur from gastrointestinal, heart, kidney, or lung involvement.
  • Pulmonary sclerosis - most common cause of death.
epidermolysis bullosa eb
Epidermolysis Bullosa (EB)
  • A rare inherited disease
  • The skin is very fragile and blisters formed in response to friction and to every day trauma
  • May also affect multiple systems of the body
epidermolysis bullosa
Epidermolysis Bullosa
  • Epidermolysis simplex
  • Junctional epidermolysis bullosa
  • Dystrophic epidermolysis bullosa
epidermolysis simplex
Epidermolysis simplex
  • Largest group
  • Dominantly inherited disorder
    • One copy of the gene is faulty
  • Not life threatening
  • Blistering mainly limited to the hands, elbows, knees and feet
  • Reduce in severity as the child becomes older
junctional epidermolysis bullosa
Junctional epidermolysis bullosa
  • Recessively inherited disease
    • Both copies of the gene are faulty
  • The most serious type of EB, infants usually die during the first year of life
  • Generalized lesions
  • Affect mucous membrane
dystrophic epidermolysis bullosa
Dystrophic epidermolysis bullosa
  • Can be either dominant or recessive
  • Dominant – only mildly affected
  • Recessive – severely affected
  • Continuing blistering and ulceration of the skin follows everyday trauma
Lesions heal with scarring
    • result in strictures and contractures
    • limitation in mobility and eating
  • Predispose to skin cancer
handling of the children
Handling of the children
  • Small infants should never lift up under arms as painful blisters may result.
  • Older children should be encouraged to be independent in his / her early age so as to avoid trauma by others.
aims of wound care
Aims of wound care
  • Encourage wound healing
  • Maintain daily activities
  • Social acceptability
dressing choice
Dressing choice
  • Wound contact layer dressing
    • eg. Mepitel, Urgotul
  • Non adherent dressing
    • eg. Melolin, Tricose, Mepliex
  • Alginate dressing
  • Fine material clothing
  • Can be worn inside out to avoid rough seams
  • Remove internal labels
  • Padded footwear
oral care
Oral care
  • Affect mucous membrane
    • eg. oral blistering, bleeding, oral submucous fibrosis, oesophageal strictures
  • Dental decay
    • Due to fragility of oral mucosa
    • Fluoride supplement
    • Oral hygiene
    • ?? Tooth brushing
    • ?? Dentures
  • Dysphagia - gastrostomy feeding
  • Constipation – soluble fibre supplement
  • Digital fusion
    • Results from repeated blistering and scarring
  • Plastic surgery
  • Splintage
pyoderma gangrenosum pg
Pyoderma Gangrenosum (PG)
  • An inflammatory process resulting in ulceration of unknown etiology.
  • It was an immune-mediated inflammatory condition characterized by ulcerative skin lesions.
  • Affect about 5 percent of people with ulcerative colitis

Regueiro, et al, 2003

Papageprgiou, Mathew, Kaniorou-Larai, & Yiakoumetis, 2007

systemic diseases associated with pg
Systemic diseases associated with PG
  • Associated with other conditions in up to 75% of patients.
    • Inflammatory bowel disease
    • Arthritis
    • Hemotologic abnormalities
      • Lymphoma
      • Myeloma
      • Leukemia
    • Immunologic abnormalities
      • SLEAraujo & Kirsner, 2005
Appear as a blister, red bump, or pustule
  • Appear alone or in a group
  • Pustules progress rapidly and develop into the ulcer
  • Commonly found on the extremities
  • More frequently on the legs than on the arms

Nkrumah, Addo, & Tachi, 2005

Papageprgiou, et al, 2007

  • No single diagnostic test available for PG
  • It is a clinical diagnosis of exclusion
  • Based on excluding other causes and evaluating the patient for underlying systemic disease.

Trent & Kirsner, 2001

  • Treat underlying disease
  • Corticosteroid
  • Immunosuppressant
    • Cyclosporine
  • Systemic antibiotics
  • Anaesthetic
wound management
Wound management
  • Control pain
  • Necrotic tissue
    • surgical debridement is contraindicated as it may result in even worse ulceration
  • Avoidance of trauma at dressing removal
    • disturbance can generate an even greater inflammatory response and stimulate deterioration

Araujo, & Kirsner, 2004

Negative pressure therapy
    • may be used to assist debridement when the disease is stable
  • Debridement and skin grafting
    • can be considered when condition is under controlled
    • surgery may reactive the disease

Moffatt, Martin, Smithdale, 2007