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Non-Infected Lower Extremity Wound
Diagnosis/Definition
A non-infected lower extremity wound is described as any slow or non-healing wound of the distal leg or foot not due to infection.
Initial Diagnosis and Management
Lower extremity ulceration/wounds that are not responding to standard therapy as anticipated and/or complicated by one or more of the following conditions:
- Neuropathy
- Immunosuppressive drug therapy
- Diabetes
- History of amputation (partial foot or partial lower extremity)
- History of foreign body
- History of autoimmune processes (rheumatoid arthritis, scleroderma)
- Foot deformity
- History of neuromuscular disease processes
- Arthropathy affecting lower extremity
- Deep vein thrombosis (DVT)
- Vascular compromise
- End stage renal disease
- Compromised skin integrity
- Compromised nutritional status
- Disability affecting normal lower extremity movement, balance, transfer, etc.
- Charcot foot deformity (see CHARCOT FOOT REFERRAL GUIDELINE)
Acute Treatment: in addition to have the patient properly clean the wound and extremity, consider the following:
- Offload with post-op shoe and padding (recommend coordinating with orthotic / prosthetic dept.
- Weight bearing x-ray
- Consult Limb Preservation Services
Ongoing Management and Objectives
- To decrease the rate of toe, foot and lower extremity amputation with prompt referral of active ulceration/wounds that have failed to resolve with standard therapy.
- To manage each patient’s condition with a combination of mechanical, medical and surgical therapies tailored specifically for the unique characteristics of the wound being treated
Indications for Specialty Care Referral
All patients with non-healing lower extremity wounds not responding to standard therapy and/or complicated by significant morbidity should be referred for evaluation to the Limb Preservation Service/Wound Care Clinic. The patient will require an approved consult to be seen.
Criteria for Return to Primary Care
All patients should be followed by the primary care provider for treatment of all co-morbid conditions and routine care with the goal of optimal health and wellness for the whole patient.
