Infection is a major factor that restricts proper wound healing. A wound can become septic, if bacteria grow within the damaged skin of a wound. Appropriate management of injuries is important to prevent wounds from becoming septic. Chronic wounds can be the result of surgery incisions, major trauma injury to the skin, deep burns, or even underlying medical conditions such as diabetes or some types of vascular disease. Infection of the wound triggers the body’s immune response, causing inflammation and tissue damage, as well as slowing the healing process. Podiatrists are experienced in managing different types of wounds. With reliable Concierge Wound Care Solutions, they can dispense and bill wound care kits electronically, avoiding paperwork and enhancing care.
Risk Factors and Symptoms of Wound Infection
Even a simple wound can become septic, if not treated properly. The wound healing process includes three distinct phases – the inflammatory phase, the proliferative phase, and the remodeling phase. Infection disrupts this process. The risk of infection is higher if the wound –
- is large, deep, or open
- has dirt or any foreign particles in it
- is caused by a bite from an animal or human
- is not cleaned or treated within 8 hours
- occurs in a person with diabetes, a weak immune system, obesity or reduced mobility
Key symptoms of wound infection are – foul-smelling drainage from a wound, increased pain and swelling or redness in or near a wound, a change in the color or size of a wound and more. More severe infections may lead to nausea, chills, or fever.
Diabetic wounds and foot ulcers require special care, as they present increased risk for complications. While treating a diabetic foot ulcer, the main need is to prevent infection. Prior to initiating wound care, the podiatrist will perform a thorough examination using appropriate diagnostic modalities and obtain a health history, including a focused history of the wound.
Understanding and addressing the challenges in the treatment of chronic wounds is crucial for a better clinical outcome. It may also happen that these podiatrists will have to spend several weeks on a complex wound, which may improve or even worsen.
Key steps in wound care
Proper wound cleansing and dressing to reduce bioburden
For deep wounds, dead skin will be removed surgically under local anesthesia. Depending on the type and severity of the wound, the right dressing will be chosen. For chronic wounds, a moist dressing will be used. Wound cleansers will be used to remove contaminants, foreign particles and exudate from the wound surface, or to irrigate a deep cavity wound. Dirt and debris will be removed from a fresh wound, often in the shower. To prevent sepsis, the dressing will be changed daily using sterile gloves. Antibiotic ointments will be applied to help prevent bacterial infection in minor cuts. Large wounds will be closed with stitches or staples. Medications will be recommended to relieve pain, as pain can cause the blood vessels to tighten.
Perform wound toilet and debridement as soon as possible (within 8 hours if possible)
Wound toilet and surgical debridement will be done to promote healing by secondary intention. Debridement refers to the removal of unhealthy tissue from a wound to promote healing. Tissue removal can be surgical, chemical, mechanical, or autolytic. Managing with surgical wound toilet involves cleaning the skin with antiseptics, irrigation of wounds with saline, surgical debridement of all dead tissue and foreign matter. Wound debridement involves gentle handling of tissues to minimize bleeding and control residual bleeding with compression. During debridement process, the podiatrist will remove only a very thin margin of skin from the wound edge. Dead tissue does not bleed when cut. For deep wounds, antibiotic prophylaxis will be provided to avoid infection.
Tetanus vaccine for traumatic injury
Wounds caused by animal bites or from rusty objects may be at risk of tetanus. According to the World Health Organization (WHO), wounds are tetanus-prone if they are sustained either more than 6 hours before surgical treatment of the wound or if it is a puncture-type wound with significant degree of devitalized tissue and clinical evidence of sepsis. For tetanus-prone injuries, WHO recommends TT or Td and TIG. A foot doctor will clean the wound and give the person a shot of the tetanus toxoid vaccine to protect against tetanus infection if necessary. Separate syringes and separates sites will be used when tetanus vaccine and tetanus immunoglobulin are administered at the same time.
Treatment for underlying medical conditions that hinder proper wound healing
During treatment, a podiatrist will examine for signs and symptoms of other underlying conditions that can impact wound healing and the patient’s health, and make timely referrals to the appropriate specialists. A podiatric physician will take steps to identify the cause of the chronic wound to control the underlying factors. For instance, if a foot ulcer is the result diabetes, podiatrist will review patient’s blood sugar levels and will provide treatment options to prevent recurring ulcers in future. A thorough history and physical examination will be done which supports patient’s wound healing.
As podiatry practices deal with wound care challenges, they also need to manage patient insurance verification and podiatry medical billing. Partnering with an experienced podiatry billing company is a feasible option to overcome these concerns and get appropriate reimbursement for services rendered.