Skip to main content

Chronic Wounds and Infections

  • Chapter
  • First Online:
Local Wound Care for Dermatologists

Part of the book series: Updates in Clinical Dermatology ((UCD))

Abstract

Dermatologists are exposed to wound healing during their training. Unfortunately, only minimal time is dedicated to this important subfield of medicine. Nevertheless, solid background in dermatology provides training physicians a much easier route to expand their knowledge of wound healing. Chronic wounds are opened and have the propensity to be infected; this may stall the healing process in milder cases, but may actually have more devastating outcome if the infection is not well controlled. There are some conditions when chronic wounds may appear infected, but they are not, and it is essential to differentiate imminent infection from conditions that may merely mimic infection. Finally, we would like to shed some light and provide enablers for dermatologist in wound healing with emphasis on infection control.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hanke CW, Moy RL, Roenigk RK, et al. Current status of surgery in dermatology. J Am Acad Dermatol. 2013;69(6):972–1001.

    Article  Google Scholar 

  2. Boweler PG, Davis BJ. The microbiology of acute and chronic wounds. Wounds. 1999;11:72–99.

    Google Scholar 

  3. Gary Sibbald R, Goodman L, Reneeka P. Wound bed preparation 2012. J Cutan Med Surg. 2013;17(Suppl 1):S12–22. Review

    Article  Google Scholar 

  4. Keast DH, Bowering CK, Evans AW, Mackean GL, Burrows C, D'Souza L. MEASURE: a proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen. 2004;12(3 Suppl):S1–17.

    Article  Google Scholar 

  5. WINTER GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293–4.

    Article  CAS  Google Scholar 

  6. Berard F, Gandon J. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg. 1964;160(Suppl 2):1–192.

    CAS  PubMed  Google Scholar 

  7. Toon CD, Lusuku C, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2015;(9):CD010259.

    Google Scholar 

  8. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47(4):519–27.

    Article  Google Scholar 

  9. 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. 1995;273(9):721–3.

    CAS  Google Scholar 

  10. Lavery LA, Armstrong DG, Peters EJ, Lipsky BA. Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic? Diabetes Care. 2007;30:270–4.

    Article  Google Scholar 

  11. Sibbald RG, Mufti A, Armstrong DG. Infrared skin thermometry: an underutilized cost-effective tool for routine wound care practice and patient high-risk diabetic foot self-monitoring. Adv Skin Wound Care. 2015;28(1):37–44.

    Article  Google Scholar 

  12. Butalia S, Palda VA, Sargeant RJ, et al. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA. 2008;299:806–13.

    Article  CAS  Google Scholar 

  13. Körber A, Klode J, Al-Benna S, et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges. 2011;9(2):116–21. https://doi.org/10.1111/j.1610-0387.2010.07535.x.

    Article  PubMed  Google Scholar 

  14. Humphreys ML, Stewart AH, Gohel MS, Taylor M, Whyman MR, Poskitt KR. Management of mixed arterial and venous leg ulcers. Br J Surg. 2007;94:1104–7.

    Article  CAS  Google Scholar 

  15. Shanmugam VK, Angra D, Rahimi H, McNish S. Vasculitic and autoimmune wounds. J Vasc Surg Venous Lymphat Disord. 2017;5(2):280–92. https://doi.org/10.1016/j.jvsv.2016.09.006.

    Article  PubMed  Google Scholar 

  16. Fazli M, Bjarnsholt T, Kirketerp-Møller K, et al. Nonrandom distribution of Pseudomonas aeruginosa and Staphylococcus aureus in chronic wounds. J Clin Microbiol. 2009;47(12):4084–9. https://doi.org/10.1128/JCM.01395-09. Epub 2009 Oct 7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nakagami G, Schultz G, Gibson DJ, et al. Biofilm detection by wound blotting can predict slough development in pressure ulcers: A prospective observational study. Wound Repair Regen. 2017;25(1):131–8. https://doi.org/10.1111/wrr.12505.

    Article  PubMed  Google Scholar 

  18. Landis SJ, Zenilman JM, Strauss L, Sibbald RG, Somayaji R. Infections in chronic wounds. In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th ed. WoundPedia; 2015.

    Google Scholar 

  19. Kravitz S. Infection: are we defining it accurately? Adv Skin Wound Care. 2006;19:176.

    Article  Google Scholar 

  20. Woo KY, Sibbald RG. A cross-sectional validation study of using NERDS and STONEES to assess bacterial burden. Ostomy Wound Manage. 2009;55(8):40–8.

    PubMed  Google Scholar 

  21. Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, Woo K, Boeni T, Ayello EA, Kirsner RS. Diabetic foot ulcers: part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):1–18.

    Article  Google Scholar 

  22. Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003; focus on infection and inflammation. Ostomy Wound Manage. 2003;49(11):24.

    PubMed  Google Scholar 

  23. Kujath P, Kujath C. Complicated skin, skin structure and soft tissue infections- are we threatened by multi-resistant pathogens? Eur J Med Res. 2010;15(12):544–53.

    Article  CAS  Google Scholar 

  24. Tantigate D, Jang E, Seetharaman M, et al. Timing of antibiotic prophylaxis for preventing surgical site infections in foot and ankle surgery. Foot Ankle Int. 2017;38(3):283–8. https://doi.org/10.1177/1071100716674975. Epub 2016 Oct 24

    Article  PubMed  Google Scholar 

  25. Bader M, Somayaji R. Infection control and antibiotic-resistant organisms (AROs). In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th edn. WoundPedia; 2015. Electronic version.

    Google Scholar 

  26. Omar AM, Wright JB, Nadworny PL, Schultz GS, Burrell RE. Microbial biofilms and chronic wounds. In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th edn. WoundPedia; 2015. Electronic version.

    Google Scholar 

  27. Malone M, Bjarnsholt T, McBain AJ, et al. The prevalence of biofilms in chronic wounds: a systematic review and meta-analysis of published data. J Wound Care. 2017;26(1):20–5.

    Article  CAS  Google Scholar 

  28. Schultz G, Bjarnsholt T, James GA, et al. Consensus guidelines for the identification and the treatment of the biofilms in chronic -healing wounds. Wound Repair Regen. 2017;25(5):744–57. https://doi.org/10.1111/wrr.12590. Epub 2017 Dec.

    Article  PubMed  Google Scholar 

  29. Ramsay S, Cowan L, Davidson JM, Nanney L, Schultz G. Wound samples: moving towards a standardised method of collection and analysis. Int Wound J. 2016;13(5):880–91. https://doi.org/10.1111/iwj.12399.

    Article  PubMed  Google Scholar 

  30. Sibbald RG, Goodman RG, Alavi A, Woo YK, Persaud R, Meyer D. Venous leg ulcers. In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th ed. WoundPedia; 2015. Electronic version.

    Google Scholar 

  31. Carter MJ. The evidence base for management of leg ulcers. In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th ed. WoundPedia; 2015. Electronic version.

    Google Scholar 

  32. Alavi A, Mayer D, Hafner J, Sibbald RG. Martorell hypertensive ischemic leg ulcers: an under diagnosed entity. In Sibbald RG, Ayello EA, Elliott JA, editors. WoundPedia: wound care updates 2015: a textbook for healthcare professionals & the IIWCC, vol 2. 5th ed. WoundPedia; 2015. Electronic version.

    Google Scholar 

  33. Alavi A, Mayer D, Hafner J, Sibbald RG. Martorell hypertensive ischemic leg ulcer: an underdiagnosed. Entity Adv Skin Wound Care. 2012;25(12):563–72; quiz 573–4

    Article  Google Scholar 

  34. Alavi A, French LE, Davis MD, et al. Pyoderma gangrenosum: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol. 2017;18(3):355–72.

    Article  Google Scholar 

  35. Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and management of lower-extremity ulcers. N Engl J Med. 2017;377(16):1559–67. https://doi.org/10.1056/NEJMra1615243.

    Article  Google Scholar 

  36. Carter MJ, Tingley-Kelley K, Warriner RA 3rd. Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: a systematic review and meta-analysis. J Am Acad Dermatol. 2010;63(4):668–79.

    Article  CAS  Google Scholar 

  37. Rodriguez-Arguello J, Lienhard K, Patel P, et al. A scoping review of the use of silver-impregnated dressings for the treatment of chronic wounds. Ostomy Wound Manage. 2018;64(3):14–31.

    Article  Google Scholar 

  38. Storm-Versloot MN, Vos CG, Ubbink DT, Vermeulen H. Topical silver for preventing wound infection. Cochrane Database Syst Rev. 2010;(3):CD006478.

    Google Scholar 

  39. Coutts PM, Ryan J, Sibbald RG. Case series of lower- extremity chronic wounds managed with an antibacterial foam dressing bound with gentian violet and methylene blue. Adv Skin Wound Care. 2014;27(3 Suppl 1):9–13.

    Article  Google Scholar 

  40. Jurczak F, Dugre’ T, Johnstone A, et al. Randomized clinical trial of hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds. Int Wound J. 2007;4:66–76.

    Article  Google Scholar 

  41. Lo SF, Chang CJ, Hu WY, et al. The effectiveness of silver-releasing dressings in the management of nonhealing chronic wounds: a meta-analysis. J Clin Nurs. 2009;18:716–28. Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008;(4):CD005083.

    Article  Google Scholar 

  42. Jull AB, Walker N, Deshpande S. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2013;(2):CD005083.

    Google Scholar 

  43. Sibbald RG, Coutts P, Woo K. Reduction of bacterial burden and pain in chronic wounds using a new polyhexamethylene biguanide antimicrobial foam dressing: clinical trial results. Adv Skin Wound Care. 2011;24:79–84.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shavit, E., Schultz, G. (2020). Chronic Wounds and Infections. In: Alavi, A., Maibach, H. (eds) Local Wound Care for Dermatologists. Updates in Clinical Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-030-28872-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-28872-3_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28871-6

  • Online ISBN: 978-3-030-28872-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics