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Guideline for the Management of Wounds in Patients With Lower-Extremity Neuropathic Disease: An Executive Summary

Crawford, Penny Ellen; Fields-Varnado, Myra

Journal of Wound, Ostomy and Continence Nursing: January/February 2013 - Volume 40 - Issue 1 - p 34–45
doi: 10.1097/WON.0b013e3182750161

This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

Penny Ellen Crawford, MSN, RN, FNP-BC, CWOCN, Atlantic Shores Wellness Clinic, Virginia Beach, VA.

Myra Fields-Varnado, BS, RN, CWOCN, LSU Health System, New Orleans, LA.

Panel Members' Disclosure: Individuals involved in developing clinical practice guidelines are charged by the WOCN Society to develop guidelines that are objective, comprehensive, and practical. To ensure the integrity of the WOCN Society and the Clinical Practice Guideline Program, prior to participating in any guideline activity, participants submit a Disclosure Form to the WOCN Society regarding any financial relationships with commercial companies that could create a conflict when the company's products or services are related to the subject of the guideline. Members of the guideline panel submitted a Disclosure Form, which was reviewed by the WOCN Executive Director, who determined that no conflict of interest exists with any individual panel member.

Source of Funding: No funding source has been identified.

Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society