Marcia Spear

Acute and chronic wounds heal and behave differently. An understanding of these differences is imperative to the practitioner in providing and planning appropriate wound care and management. The purpose of this article is to present some of the major differences and enable the practitioner in developing and modifying an appropriate plan of care to enhance healing and manage patient expectations.

Leg ulceration can be defined as any chronic ulcer of the lower leg excluding those on the forefoot or toes (Lees & Lambert, 1992). Venous or stasis ulcers account for 80%-85% of all leg ulcers with an overall prevalence of approximately 1% in the United States (Collins & Seraj, 2010; O'Meara, Al-Kurdi, & Ovington, 2008). Venous ulcers are more common in women and the older population (Abbade & Lastoria, 2005; Bergqvist, Lindholm, & Nelzen, 1999). Venous ulcers are often recurrent and chronic and can persist from weeks to even years. Severe complications include cellulitis, osteomyelitis, and malignant changes (Collins & Seraj, 2010). This column discusses the pathophysiology of venous insufficiency and ulcerations, presentation, diagnosis, and current treatment.

Exudate consists of fluid and leukocytes that move to the site of injury from the circulatory system in response to local inflammation. This inflammatory response leads to blood vessel dilatation and increased permeability, resulting in increased production of exudate. The nature and quantity of exudate depend on the nature and severity of the tissue damage. The exact amount of wound exudate and moisture to promote moist wound healing is unknown. This moisture balance is essential to promote healing and is oftentimes a major challenge to the wound care provider. This article will explore the benefits of wound fluid as well as the detrimental impact on wound healing. Assessment and management will also be briefly discussed.