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Therapeutic Approach

Skin wounds include arterial, diabetic, and venous ulcers that commonly present at the foot, ankle, or leg. Arterial ulcers benefit from therapies that improve arterial patency and restore blood flow to ischemic tissue. Diabetic ulcers benefit from therapies that offload the wound, normalize blood sugar, and promote healing through chemical or mechanical stimulation. Venous leg ulcers benefit from therapies that improve venous drainage. Therapeutic selection should follow a comprehensive patient history and consider clinical presentation including wound dimensions, and volume of drainage. If applicable, risk factors for cardiovascular disease such as hypertension, diabetes, hypercholesterolemia, smoking, and obesity should be addressed. Anticholesterol, antidiabetic, and antihypertensive medications should be optimized, and patients should be counseled on smoking cessation and healthy eating behaviors when appropriate. Generally, in the author’s opinion, for highly exudative wounds, alginate dressings are useful, while hydrocolloids are useful for more lightly exudative wounds. Patients must be monitored for infection and treated appropriately when indicated. Routine use of topical antibiotics for uninfected wounds of low risk for infection should be avoided. See Table 134-1.

Table 134-1Wounds Treatment Table

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