CONCLUSION Embrace the Call to Wound Prevention and Care A challenging career Be part of an interprofessional team Help patients, families, communities Commit to lifelong learning To cure occasionally, To relieve often, To comfort always. ~Hippocrates CHRONIC WOUND CARE: The Essentials e-book 341
Plate 1. Venous leg ulcer. Chapter 1, p2. Plate 2. Exquisitely painful pressure ulcer of the lateral malleolus. Chapter 1, p2. Plate 3. Sacral and trochanteric pressure ulcers with slough and eschar. Chapter 1, p2. Plate 4. Deep tissue injury. Chapter 1, p2. Plate 5. Unstageable. Chapter 1, p2. Plate 6. Nonhealing surgical wound with infection in a person with a diabetic neuropathic foot. Chapter 1, p2. 342 CHRONIC WOUND CARE: The Essentials e-book
Plate 7. The International Interprofessional Wound Caring Model 2012. Chapter 2, p7. CHRONIC WOUND CARE: The Essentials e-book 343
Plate 8. Sequence of wound healing. Normal skin wound healing proceeds through the 4 phases of hemostasis, inflammation, repair, and remodeling. Most chronic wounds get stuck in a prolonged inflammatory phase that prevents the wound from moving into an effective repair phase. Adapted from Schultz GS, Ladwig G, Wysocki A. Extracellular matrix: review of its roles in acute and chronic wounds. Available at: http://www.worldwidewounds.com/2005/august/schultz/extrace- Matric-Acute-Chronic-Wounds.html. Chapter 3, p17. Plate 9. Neutrophils and macrophages perform critical functions in acute wounds by engulfing and killing bacteria and fungi by generation of ROS in endosomes and by releasing proteases that debride the acute wound bed. Chapter 3, p18. 344 CHRONIC WOUND CARE: The Essentials e-book
Plate 10. Biofilms in chronic wounds. Planktonic bacteria typically convert into biofilm communities when the levels of quorum molecules reach a threshold and change the pattern of bacterial gene expression. In the spectrum of bacterial bioburden, the concept of critical colonization probably reflects the presence of biofilms, which are not detected by standard clinical microbiology laboratory measurements. Reprinted from Phillips P, Sampson E, Yang Q, et al. Bacterial biofilms in wounds. Wound Healing S Africa. Available at: http://www.woundhealingsa.co.za/index.php/whsa/article/view/17. Chapter 3, p20. Plate 11. Imbalanced molecular and cellular environments of healing and chronic wounds. The molecular and cellular environment of acute healing wounds is dramatically different than that of chronic wounds and must be rebalanced to approximate the environment of healing wounds before healing can progress. Adapted with permission from Mast BA, Schultz GS. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair Regen. 1996;4(4):411. Chapter 3, p23. CHRONIC WOUND CARE: The Essentials e-book 345
Plate 12. Intact heel eschar on ischemic foot. Chapter 6, p64. Plate 13. Infected LE wound. Note eschar liquefying in center. Chapter 6, p64. Plate 14. Acutely infected heel ulcer requiring debridement. Chapter 6, p64. Plate 15. Use of currette to debride ulcer. Chapter 6, p65. Plate 16. Use of high powered waterjet. Chapter 6, p67. Plate 17. Pulsed lavage with suction. Chapter 6, p67. Plate 18. UAW therapy. Chapter 6, p70. Plate 19. Crosshatching. Chapter 6, p73. 346 CHRONIC WOUND CARE: The Essentials e-book
Plate 20. Electron scan of a maggot. Chapter 36 p74. Plate 21. Hydrocolloid border with skin cement. Chapter 6, p75. Plate 22. Application of maggots. Chapter 6, p75. Plate 23. Sealing wound area with veil dressing and taping edges. Chapter 6, p75. Plate 24. Removal of dressing after 72 hours. Chapter 6, p75. Plate 25. Nonhealing Stage IV sacral pressure ulcer, cleared of candidiasis and ready for reconstruction. Chapter 21, p285. Plate 26. Acute wound following ulcer excision and ostectomy. Chapter 21, p285. Plate 27. Left gluteal rotation and right gluteal V-Y myocutaneous flap reconstruction. Chapter 21, p285. CHRONIC WOUND CARE: The Essentials e-book 347
Plate 28. NPWT on thigh wound. Chapter 16, p200. Plate 29. NPWT on debrided heel ulcer bridged to dorsum of foot. Chapter 16, p200. Plate 30. NPWT bridged axilla to axilla s/p excision for hidradenitis suppurativa. Chapter 16, p200. Plate 31. VAC ATS pump and VAC Freedom pump (KCI ). Chapter 16, p200. Plate 32. Infected dehisced surgical wound s/p bowel resection. Chapter 16, p200. Plate 33. Granufoam Silver (KCI ) dressing applied to wound from Plate 32. Chapter 16, p200. Plate 34. Granufoam Silver (KCI ) at 120 mmhg pressure. Chapter 16, p200. Plate 35. Wound from Plate 32 with infection clear and wound granulating. Chapter 16, p200. 348 CHRONIC WOUND CARE: The Essentials e-book