Heel pressure wounds

[humblepie]

I recently read something about heel wounds differing from other pressure wounds and thatthey may be considered for a separate classification system. The article stated that the traditional pressure wound protocols for stage l-lV may not be applicable to heel wounds.

I can't seem to locate the article and my web research has not yeilded results. If there are any wound care nurses out there who can give me direction with this, I would greatly appreciate it.

I am an RN hospice case manager and while I would love to see my patient's wounds heal, most of the time the focus is on reduction of pain, prevention of infection and prevention of extension of the wound.

[Christie RN2006]

I recently read something about heel wounds differing from other pressure wounds and thatthey may be considered for a separate classification system. The article stated that the traditional pressure wound protocols for stage l-lV may not be applicable to heel wounds.

I can't seem to locate the article and my web research has not yeilded results. If there are any wound care nurses out there who can give me direction with this, I would greatly appreciate it.

I am an RN hospice case manager and while I would love to see my patient's wounds heal, most of the time the focus is on reduction of pain, prevention of infection and prevention of extension of the wound.

I am not a wound care nurse, but I have seen a few heel wounds... most of the heel wounds I see are in individuals with poor circulation.

I'm not sure exactly what you are asking... but about the healing wounds, do you ever use wound vacs? I am a big fan of wound vacs, I have seen a lot of wounds successfully healed using wound vacs.

[EmmaG, RN]

http://www.npuap.org/

http://www.extendedcarenews.com/article/4968

Perhaps those links will help. There is a mention of heel ulcers in the second link; I didn't search the npuap site for further info, though.

Heel Pressure Ulcers

The heel presents a problematic source of pressure due to its bony prominence, especially in the recumbent individual. Care should be taken to mobilize the immobile, provide good skin care, and off-load the vulnerable heel area with pressure relief equipment. Unlike pressure ulcers on other areas of the body, if the heel ulcer (see Figure 3) is dry, black, and intact, it should be left alone without debridement. This is considered best practice if there is a chance of compromised blood flow and if there is no edema, redness, or drainage--in other words, a "stable" heel eschar.

Figure 3

[RN1989]

My guess is that they are talking about the Wagner Scale. It is a scale for foot wounds in diabetics. With that scale used, the patient can become eligible for better wound care such as hyperbaric oxygen therapy and other new products not generally available outside of a wound center because they are expensive. If you want to know anything more in depth you can PM me.

[humblepie]

Thanks for the useful discussion. I actually found the NUAP website in a book on wound care. In Feb. 2007 NUAP issued new definitions and stages for pressure wounds. Heel wounds often will fall into the new category of (Suspected)Deep Tissue Injury - when there is a "purple or maroon area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue..." The new definition goes on to say that the wound my rapidly evolve exposing additional tissue damage even with optimal treatment.

I appreciate the common sense of leaving eschar on heel wounds as natures own protective covering.