September 2005, Volume 35 Number 9 , p 24 - 24
SARVIS, CONNIE M. RN, CON,C, CWS, IIWCC, MN
SARAH TRESLAN, 28, comes into your wound clinic with two large wounds above her left outer ankle that she says “just won't heal.” Her medical history is unremarkable. She can't remember any trauma or other incidents that could have caused the wounds, which have developed slowly over about a year.
Assessing the wounds, you find that they're moist and covered with yellow slough, and they have a scant amount of serous exudate. They measure 1.2x0.8 inches (3x2 cm) and 1.6x1 inches (4x2.5 cm) and are each 0.3 inch (0.75 cm) deep. Ms. Treslan has no signs of venous stasis and you find no hyperpigmentation, varicose veins, or dermatitis on her legs or feet.
Looking at the wounds closely, you note that they appear punched out (similar to arterial ulcers), yet her vascular status is normal, as confirmed by an ankle-brachial index and palpable distal pulses.
As you examine the rest of her skin, ...