Study Questions: Chapter 21 Chapter 21: Leg Ulcerations and Wound Care MARK D.P. DAVIS, MD Study Questions: Chapter 21 * 1.) A patient presents with a painful leg ulceration that has been going on for 3 years and has not responded to numerous wound care interventions and leg compression, including 3 trials of Unna boots. The edges of the ulceration are raised, violaceous, and overhanging. Which of the following should be obtained next? Wound Gram stain and culture Plain film radiograph Wound biopsy from the ulceration edge Sedimentation rate Show answerThe correct answer is 3, Wound biopsy from the ulceration edge.With the recalcitrant nature of this leg ulceration and the clinical description of raised, violaceous, overhanging edges, the possibility of pyoderma gangrenosum has to be considered, and the option of starting systemic corticosteroids has to be considered. But many conditions can imitate pyoderma gangrenosum.(30) Therefore, a skin biopsy should be obtained to help rule out conditions that mimic pyoderma gangrenosum, such as vasculitis or squamous cell carcinoma. Skin biopsies of the edge of an ulcer are most helpful: this should be sent for both regular histology (H&E stain) and culture. * 2.) Which of the following statements is correct regarding debridement of wounds? Enzymatic debridement is harmless to surrounding healthy tissue. Maggots are FDA approved in the United States. Autolytic debridement is the liquefying of fibromembranous debris and necrotic material by the body’s own fluids. Debridement of wounds has been shown in multiple studies to accelerate wound healing. Show answerThe correct answer is 3, Autolytic debridement is the liquefying of fibromembranous debris and necrotic material by the body’s own fluids.Debridement of chronic wounds is commonly accepted as an essential component in their management. However, there have been no studies that convincingly demonstrate that wound debridement accelerates healing. There are many forms of debridement. Surgical debridement involves the use of an instrument to remove debris from a wound. Autolytic debridement is the liquefying of fibromembranous debris and necrotic material by the body’s own fluids. Enzymatic debridement involves the use of externally administered chemicals to “dissolve” fibromembranous debris and necrotic material overlying a wound; unfortunately, these chemicals do not distinguish between necrotic debris and healthy tissue and can therefore be harmful to surrounding healthy tissue. Biologic debridement with the use of maggots has not been approved by the FDA. * 3.) For an exudative wound, which of the following is the most effective, absorbant dressing class? Gauze Hydrocolloids Alginates Collagen Show answerThe correct answer is 3, Alginates. Alginates and foam dressings are the most absorptive dressings available, and are most appropriate for exudative wounds. The other classes listed are nonabsorptive (hydrocolloids) or minimally absorptive (gauze, collagen). * 4.) Which of the following is the most appropriate dressing class for a dry wound? Gauze Foam Silver Hydrogel Show answerThe correct answer is 4, Hydrogel. Hydrogels are most appropriate for a dry wound— they add moisture to a wound (“hydro”). The other classes listed are absorptive (gauze, foam) or antimicrobial (silver). * 5.) Pyoderma gangrenosum is most often associated with which of the following diseases? Inflammatory bowel disease Hematologic disorders Liver disorders Neurologic disorder Show answerThe correct answer is 1, Inflammatory bowel disease. Pyoderma gangrenosum is associated with underlying systemic diseases in up to 70% of cases, including inflammatory bowel disease, seropositive or seronegative arthritis, multiple myeloma, paraproteinemia (particularly IgA), diverticulitis, pulmonary disease, malignancies (particularly leukemia), and other conditions. In the majority of studies, inflammatory bowel disease is the most common association.