How To Detect And Treat Infected Wounds

By John S. Steinberg, DPM, Khurram Khan, DPM, and Jonah Mullens

In clinical practice, two of the most common types of infected wounds podiatrists see are ulcerations and postoperative incision sites. In order to resolve these infections and ultimately close these wounds, one must have a strong understanding of the etiology of infected ulcerations and post-op infections, how to assess these wounds and how to select appropriate treatment options. With this in mind, let’s start by discussing pedal ulcerations. Pedal ulcerations provide a portal for pathogen entry and therefore can lead to the development of infection in the deep soft tissues and bone.1,2 If the infective process is not addressed, it can threaten preservation of the limb and life. Early detection of an infected ulceration is imperative to a good clinical outcome. Performing a thorough examination and using appropriate diagnostic modalities are essential when it comes to differentiating between a local soft tissue or osseous infection versus an ascending and/or systemic infection. Doing so will help you determine the appropriate medical and/or surgical intervention.3 Before you begin the examination, it’s important to obtain a thorough patient history as well as a focused history of the wound. Specifically, it’s essential to document any history of recent trauma, delay in treatment, prior infections or immune deficiencies that would place the patient at an increased risk for infection. Inspection of the wound and the periphery should reveal any erythema, lymphangitis, drainage, exposed deep tissues or necrosis. Inspecting the wound will also give you clues as to the etiology of the wound site. For example, you may identify hyperkeratotic or macerated tissues to the wound periphery or perhaps note the functional position and nature of the foot type. During the examination of the wound, one should also be able to recognize induration, fluctuance (underlying abscess), crepitus (soft tissue emphysema), increased skin temperature, tenderness, bulla, edge undermining or odor. Hypotension, tachycardia, elevated temperature and altered mental status can be the first clues in determining the severity of a systemic infection and possible progression into septicemia.

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