Welcome to Wound Clinical Solutions Investigation (CSI). See if you can make the diagnosis.
Q. This is a young patient with a history of spina bifida resulting in paralysis of both legs. He spends most of his time in a powered wheelchair and continues to enjoy a very busy social life. The wound care team was asked to examine this wound that developed on the ankle area. What is the cause of this wound?
What is your diagnosis?
A. The wound is linear in shape with smooth, even edges, which suggests this is most likely caused by external trauma, such as an abrasion or laceration. He was recently prescribed with compression bandages to control pedal edema due to the loss of calf muscle pump function and the extended time he spent in a chair with his legs in a dependent position. A short-stretch compression bandaging system was applied daily with a figure 8 wrap-style around the ankle. After investigating, the wound care team concluded that the wound was caused by the compression bandage. The following recommendations were made:
1. Provide education and training to staff to ensure safe application of compression.
2. Document a plan of care and application method to ensure consistency and discourage “personal” modification.
3. Use appropriate tension to apply the short-stretch bandage: Snug, no tug, to avoid the excessive pressure to the area.
4. Ensure dorsiflexion of the foot while the bandages are applied to prevent slippage.
5. Use an ankle-foot orthosis to keep his feet in a normal position and prevent excessive passive movements due to weakness of the feet.
6. Apply an atraumatic dressing to cover the open lesion.
7. Customize a piece of foam to the ankle area to reduce friction.
8. Pad the ankle to reduce the angle of flexion between the leg and the foot. This will help distribute pressure evenly to minimize trauma to the skinfold and the Achilles tendon.