An 80-year-old male is admitted from a nursing home to the surgical intensive care unit following the onset of respiratory and renal failure. Physical examination reveals a cachectic male on mechanical ventilation. He is on a pressure redistribution surface. A urinary catheter has been placed and he is being turned every two hours. Which of the following would be the most appropriate next step in minimizing his risk for skin breakdown?

Removable cast walkers may offer advantages over the total contact cast for all of the following reasons EXCEPT:

Which of the following provides the best non-invasive vascular assessment of a diabetic patient with calcified arteries?

Which of the following statements is most accurate regarding pyoderma gangrenosum?

Which organism is the cause of most diabetic foot ulcer infections?

Diabetic foot ulcers are most commonly classified as:

A 48-year-old obese female with a BMI of 36 presents for care of an ulcer located at the midcalf region. The patient reports this as being her first ulcer, but has had swelling in both legs for several years. The ulcer started 2 months ago following minor trauma and is shallow and moist. ABI testing was performed based on a history of diabetes and smoking, with bilateral ABI of 0.9. What is the best initial treatment?

Which of the following is the most common initiating factor resulting in the formation of avenous ulcer?

Infection is directly related to which of the following:

What type of debridement is achieved by the utilization of semi-occlusive or occlusive dressings to contain wound fluid?

During the initial consultation and evaluation of a patient with a venous leg ulcer, a detailed history is likely to be positive for one of more of the following factors EXCEPT:

Which of the following statements is INCORRECT regarding custom made ankle-foot orthosis (CROW)?

Platelet activation and degranulation signals the initiation of which phase of wound healing?

Which of the following statements is MOST accurate concerning basal cell carcinoma?

Which of the following distinguishes a wound colonized with bacteria from one that is infected?

A split thickness skin graft (12 x 20 cm) is harvested from the thigh to cover a traumatic wound on the lower leg of a healthy 18-year-old patient. The most appropriate management of the donor site is:

The gold standard for diagnosing osteomyelitis is a positive bone biopsy. Which of the following statements is MOST accurate regarding non-invasive diagnostic modalities?

Inaccurate ankle brachial pressure index may be associated with all of the following conditions EXCEPT:

Bioengineered skin substitutes enhance wound healing by several mechanisms. Which of the following is the primary mechanism of action?

All of the following are vascular assessments which suggest the presence tissue hypoxia and lower extremity ischemia EXCEPT:

A diabetic patient presents with fever and a small first webspace ulcer. The patient's caretaker reports copious amounts of malodorous purulent drainage. The patient has little pain but does have a fever. The foot is non-painful but extremely edematous, red and warm. An MRI of the foot obtained in the ED will likely show:

During the initial wound care consultation, assessment of the wound bed of an untreated arterial ulcer would be expected to demonstrate one or more of the following characteristics EXCEPT:

A patient with biopsy confirmed calciphylaxis has undergone repeated surgical debridement of the wound. Which of the following additional surgical procedures may be of benefit in the management of this patient?

A patient with arterial insufficiency is seen for a calcaneal pressure ulcer. The wound is covered with a dry eschar. There is no evidence of drainage or fluctuance or other signs of infection. Which of the following would be inappropriate for the management of this patient?

All of the following are characteristics commonly associated with the diagnosis of calciphylaxis EXCEPT:

Chronic arterial occlusion may result in the development of ischemic lower extremity ulcers.All of the following clinical features are commonly associated with these ulcers EXCEPT:

All of the following statements concerning patients with arterial ulcerations in the lower extremity are true EXCEPT:

Which of the following bandages provides nonelastic (support) compression therapy?

A 27-year-old patient underwent a radial forearm free flap to close a complex lower extremity traumatic wound. Surgical follow-up on postoperative day 3 finds the flap cool and dusky. The most appropriate management wound be:

The accuracy of the Ankle-Brachial Index (ABI) is dependent on which of the following characteristics of arteries?

The therapy that demonstrates the fastest healing times and greatest percentage of healed diabetic foot ulcers in a 12 week time period is:

A 59-year-old woman has long standing, poorly controlled diet and diabetes. She has been on dialysis for three years. She presents with large patches of skin and fat necrosis on the flanks, abdomen, and thighs. These began as purple discolorations two months ago, progressing to dry black eschar. She was otherwise not acutely ill, and her physicians, unaware of the diagnosis or treatment, did nothing until drainage and odor became problematic. On consultation, the black eschars are about 20% separated. There is scant periwound erythema or edema, but pain and tenderness are severe. The patient has good pulses in the popliteals. Laboratory and histologic confirmation of the expected diagnosis will have which of these features?

The silver cation, Ag+, is a very potent antimicrobial agent because it can do all of the following, EXCEPT:

A 60-year-old female presents with an acutely infected diabetic foot ulcer. Which of the following organisms is most likely to be cultured from her wound?

A 72-year-old diabetic patient has undergone endovascular revascularization for the treatment of non-healing ulcer of the great toe. The patient is referred to the wound clinic 8weeks post revascularization procedure. Examination finds fibrin and slough, with a paucity of granulation. The wound size is similar to prior documentation. Which one of the following options is the best next step?

Which of the following is a component of the Braden Scale?

The most abundant type of collagen in normal dermis is:

A patient presents with a 4 month history of an enterocutaneous fistula which drains 700-1000 cc’s daily depending on oral intake. The skin around the fistula has broken down and is painful. Appropriate management strategies include ALL of the following EXCEPT:

When talking with a patient about the strength and durability of the tissue at the site of a healed wound once complete maturation has occurred, the patient can be advised that tensile strength of a wound approaches what percent of the original strength?

Which of the following is most important for the regulation of matrix metalloproteases?

As a diagnosis of exclusion, chronic wounds of a factitial etiology are typically:

Which of the following describes the erroneous practice of changing the wound stage in order to reflect the changing depth noted as the wound heals?

Which of the following is associated with high mortality and is characterized by progressive cutaneous necrosis occurring more commonly in patients with end stage renal disease on dialysis?

A 53-year-old Caucasian male from Florida presents with a raised pearly lesion on his left shoulder that has not changed much in appearance over the last several years. Which of the following malignancies is most likely?

An elderly, bedridden patient is evaluated for a dry, gangrenous, non-infected calcaneal ulcer. The most appropriate initial primary dressing is:

The half shoe should NOT be used for unloading of fore foot wounds in patients:

A 54-year-old male presents with an ulceration at the DIP joint of his right 1st toe. Medications include HCTZ, Simvastatin, and Allopurinol. Physical examination reveals an erythematous 1st toe exquisitely painful with an ulceration at the DIP joint. A thick white substanceis expressible from the ulcer. He admits to frequent consumption of shellfish and beer. Microscopic exam revealed negative birefringence. What is the thick white substance?

Which of the following strategies is considered the primary therapy for achieving optimal outcomes in the management of a patient with venous insufficiency ulceration?

Apligraf® is a skin substitute therapy best defined as being comprised of:

Gram negative bacteria capable of causing an infection in a diabetic foot ulcer include ALL of the following EXCEPT:

A ten-year-old child presents with blistering and redness of her right arm. Four days ago, she fell and sustained an abrasion of forearm. Yesterday she became febrile to 103 and developed painful swelling of her arm. Her mother stated that the redness has spread quite rapidly in the past 24-48 hours. The most probable organism causing this infection is?

The use of crutches as an effective off-loading therapy for foot ulcerations is limited and often not implemented due to all of the following reasons EXCEPT:

Preventative measures for surgical site infections include all of the following EXCEPT:

A 45-year-old paraplegic presents with a stage IV pressure ulceration. Exposed bone and muscle is noted. She has a low grade fever and there is purulent drainage but no frank cellulitis. Appropriate initial management includes all of the following EXCEPT:

The most common lower extremity ulcer in the general population is:

Sufficient amounts of essential nutrients (such as arginine, cysteine, Vitamin A) maintain cytokine (Th1) status of the immune system. Deficiency of these important regulator molecules would be expected to result in:

Common findings in patients with lower extremity arterial insufficiency include all of the following EXCEPT:

For a patient with a prior history of a stable arterial ulcer, the onset of which symptom should prompt urgent vascular consultation for consideration of angiography and revascularization?

An 88-year-old, non-ambulatory male with paraplegia and mild dementia is referred for evaluation and management of a mildly painful left calcaneal wound. Examination identifies strong femoral pulses and absent popliteal and pedal pulses bilaterally, pale feet and toes, knee contractures, and a full-thickness, dry (1.2 x 1.8 cm) ulcer that does not probe to bone. There is no evidence of wound infection or cellulitis. Bilateral Ankle-Brachial Indexes(ABIs) are 0.45. White Blood Cell count is 5.8, serum creatinine is 2.2, pre-albumin is 12. Angiography is being discussed for this patient. Your recommendation regarding angiography should:

A 40-year-old diabetic male presents to the ED with the rapid onset of right lower extremitycrepitant cellulitis, high fever and severe pain. Computed tomography demonstrates muscle and subcutaneous edema consistent with necrotizing fasciitis. The BEST management strategy is:

The "calf muscle pump" plays an important role in the pathogenesis of which of the following ulcers?

A frank wound infection is BEST characterized by which of the following descriptions?

The most common side effect of multiplace hyperbaric oxygen therapy when used for the treatment of chronic wounds is:

A 65-year-old diabetic patient is seen in an outpatient wound center one week after laparotomy via a long midline incision closed with staples. He has developed a large amount of serosanguineous drainage from the middle of the incision. The wound is probed with a sterile cotton-tipped applicator, and the fascia appears to have dehisced. Which of the following would be the best initial management?

Select the single best statement regarding brown recluse spider bite.

A 76-year-old male presents with a lower leg ulcer. He complains of claudication and rest pain. Which of the following would likely be noted during this patient’s physical exam confirming his underlying arterial insufficiency?

Which of the following statements about lymphedema is TRUE?

Which of the following statements is most accurate as related to a wound biopsy which confirmed the presence of basal cell cancer?

Causes of chronic venous insufficiency include all of the following EXCEPT:

Which of the following statements is most accurate as related to a wound biopsy which confirmed the presence squamous cell cancer?

A 62-year-old diabetic male presents with a 5 week history of an ulcer located on the distaldorsal aspect of the 2nd left toe. Physical exam finds strong femoral and popliteal pulses and absent pedal (DP and PT) pulses on left. Systolic blood pressures are:

When venous leg ulcers have failed to respond to standard protocols for greater than a 4 week period, which of the following treatments is approved for use by the Food and Drug Administration?

Which of the following factors is NOT likely to contribute to developing a postoperative complication of wound dehiscence?

In a patient with purpura, livedo reticularis, tissue necrosis and painful ulcers, and with histology showing occlusion or thrombosis of the microvasculature without vascular calcification, the most likely diagnosis is:

A 72-year-old male with a BMI of 33 presents with a 9 month history of an ulcer in the midcalf region of his right lower extremity. Trace edema with ankle flair is noted. The ulcer has an irregular shape, has slightly raised margins, and is shallow and moist. Bilateral ABIs are 0.8. He reports a negative past medical history, and this is the first and only ulcer. What is the most appropriate initial management?

All of the following characteristics are true for duplex ultrasound scanning for evaluating venous insufficiency EXCEPT:

According to the Agency for Health Care Research and Quality, which of the following strategies should be utilized in the management of pressure ulcers?

A periwound TcPO2 measurement performed inside the hyperbaric chamber at 2.0 ATA pro-vides the best single discriminator between success and failure of hyperbaric oxygen therapy using a cutoff score of:

Which of the following describes the defining element of wound infection, versus the presence of only colonization or contamination?

The role of fibroblasts in wound healing include all of the following EXCEPT:

Which of the following is a TRUE statement regarding physical findings associated with anarterial ulcer?

What is the correct calculation for determining the Ankle-Brachial Index (ABI)?

A 65-year-old diabetic woman with prior left leg amputation, coronary artery disease, and on dialysis via a prosthetic arteriovenous graft, presents with pain in all of her right toes, malaise and fever. On examination she looks ill. Temp 102 F. A palpable thrill and audible bruit is noted within her right arm dialysis graft, but there is no erythema overlying her graft or in her extremities. There is a pale ulcer on the distal tip of her right third toe and dry black eschar on the distal tips of the other four toes on the right foot. The lower extremities are cool and pale with absent right pedal pulses. There is moderate calf and foot edema. Her left leg stump is without abnormality. Regarding this patient:

Which of the following represents the strongest level of evidence in support of a given treatment strategy or therapeutic device?

A 95-year-old male with diabetes, paraplegia, dementia and nutritional compromise is referred to you for management of a lower extremity wound. The patient is bed bound due to severe lower extremity contractures and has not walked in four years. Physical exam identifies a dry non-infected unstageable right heel ulcer, 4 cm by 3.5 cm in size. Strong femoral pulses, but absent popliteal and pedal pulses are noted bilaterally. Bedside ABIs are 0.35 on the right and 0.5 on the left. Significant labs include WBC 7.5, Hgb 10.1, BUN 20, Creat 2.8, PAB 14. The most appropriate treatment option is:

Apligraf® and Dermagraft® are skin substitutes that are similar in that they both contain:

A young male patient presents with a new onset, small granular-based ulcer on the dorsal aspect of his foot. He is HIV positive with a CD4 count of 200. The two best probable diagnoses for the etiology of this ulcer include:

In addition to a thorough history and physical examination, the most definitive test for verifying chronic venous insufficiency (CVI) is:

Which one of the following statements is correct regarding pyoderma gangrenosum?

Detection of which of the following organisms in a chronic wound is considered an infection threat even when present at less than 100,000 organisms/gram of wound tissue?

In wound healing, the primary role of the polymorphonuclear cells (PMNs) is:

A 67-year-old type 2 diabetic male presents to the clinic with a non-healing wound, 2 months duration on the lower calf area just above the medial malleolus which he reports started from an insect bite. The wound measures 1.5 cm x 1.3 cm and is painful. Physical exam reveals 3+ pitting edema of the lower extremities with hemosiderin staining. The patient reports that his primary physician has been telling him for years that he needs to wear compression stockings. Select the most appropriate next step?

A 57-year-old female undergoes excision of a one centimeter squamous cell carcinoma of the right mid back. The wound is closed primarily. On postoperative day 5 she notes incision pain and drainage. Which bacteria is the most likely cause of this infection?

Which one of the following is the most common limitation of the Ankle-Brachial Index:

The "gold standard" for the anatomical assessment and interrogation of the arterial vascular disease is:

A 90-year-old diabetic who is a nursing home resident has developed an ischemic ulcer on her left lateral malleolus. It is dry and black. There is no evidence of infection. She is nonambulatory and has been deemed not a good surgical candidate for a distal revascularization. What is the best treatment option?

The 3-year arterial bypass patency / limb salvage rates are:

In a diabetic patient, which of the following diagnostic assessments for the evaluation of tissue ischemia is most unreliable?

The mechanism of action of hyperbaric treatments is attributed to the immediate direct physical affects of oxygen under pressure and to the delayed secondary physiologic and biochemical effects that are set into motion with each hyperbaric treatment. The primary effects of hyperbaric treatment include all of the following EXCEPT:

Which of the following statements is NOT TRUE regarding the use of the total contact casts?

An alert but confused 80-year-old patient was transferred to a nursing home following surgical treatment for a right femoral fracture. Dietary intake has consisted of minimal fluids and less than 500 calories per day during the 9 day hospitalization. Upon admission to the nursing home, the patient continued to complain of lack of appetite, measured a 12 pound weight loss since hospital admission and was found to have a Stage IV pressure ulcer of the coccyx and calcaneus. The best option for providing nutritional therapy in the current care setting to meet the nutrition requirements of this patient while minimizing the potential for secondary complications would be to:

The staging system most commonly used to stage pressure ulcers of the heel is the:

Radiation has a variety of destructive effects on tissue which can negatively impact wound healing. Which of the following is NOT considered a potential compromising side effect of therapeutic radiation therapy?

Using Wagner staging, the best classification of a 58-year-old diabetic male smoker with end stage renal disease and coronary artery disease, with a history of non-compliance, who is admitted to the hospital for the treatment of a deep ulcer which probes to bone, and with abscess formation on the plantar aspect of his right 2nd metatarsal, is:

Optimal outcomes in wound management when utilizing Negative Pressure Wound Therapy(NPWT) are more commonly achieved when treating wounds with the following characteristics:

Compression stockings are a common treatment modality and are primarily utilized to:

The most common predisposing risk factor leading to the development of a diabetic foot ulceration is:

A 67-year-old male presents to clinic with a dry necrotic superficial ulceration on the dorsal aspect of his Left Great Toe. The patient states that he believes it was caused by minor trauma 3 weeks ago. Upon examination, the foot is cold and pulses are non-palpable. The wound appears to have a desiccated base without obvious exudate but with periwound erythema. A consultant service has suggested debridement but you decide that blood flow to the wound area needs to be assessed. Which of the following tests is not considered reliable vascular assessment?

Which offloading method has consistently demonstrated the fastest healing rate for plantar ulcerations?

A quantitative biopsy of a non-healing wound reveals greater than 100,000 colony forming units of bacteria per gram of tissue. The wound has stalled and shows increased drainage and odor. There is no fever, cellulitis or local tenderness. The most appropriate treatment is:

An oral agent shown to be effective in the treatment of venous ulcers is:

All of the following factors can adversely affect normal wound repair EXCEPT:

Platelet derived growth factor (PDGF) has all of the following characteristics EXCEPT:

A 92-year-old non ambulatory diabetic nursing home resident with severe peripheral arterial insufficiency manifested by rest pain has a black eschar covering most of the right heel that shows no evidence of inflammation or infection. Pressure redistribution efforts and nutritional therapy have been initiated. What is the most appropriate next step in therapy?

The term that best describes the characteristic of pyoderma gangrenosum in which the lesion extends into the periwound tissue following trauma is:

For patients with chronic venous ulcers that are poorly responsive to compression therapy and greater than six months duration, which one of the following would be the best next step?

CMS has approved the utilization of HBOT in the management of the diabetic foot ulcer. All of the following criteria must be met EXCEPT:

In a diabetic patient who presents with a non-healing foot ulcer due to compromising factors including protein energy malnutrition (recent unintended weight loss of 5-10%), the best way to manage the nutritional status is by:

Which of the following is LEAST likely to be a risk factor for the development of a diabetic foot ulcer?

Skin and skin structure infections that occur within twenty-four hours of surgery are most likely caused by which bacteria?

In a patient with lymphedema, the therapeutic transition from the reductive phase to the maintenance phase of decongestive therapy includes initiation of:

What is the lowest transcutaneous oxygen (TcPO2) value in a diabetic that is sufficient for wound healing with standard wound care, grafting, or application of products such as growth factors?

A 54-year-old diabetic female presents with a Wagner 3 ulcer over the right 1st metatarsalphalangeal joint. Which of the following plain film radiograph findings is LEAST likely to be interpreted as osteomyelitis?

Which of the following inflammatory conditions is LEAST likely to be associated with the onset of pyoderma gangrenosum?

Regarding the use of Dakin's solution in wound care, the active substance is:

A 68-year-old previously healthy female becomes acutely depressed following the death ofher spouse. She spends the next several days in bed, with little to eat. She is found in bed lethargic but arousable by her children after she does not answer her phone. They call 911 and she is taken to the hospital ED via ambulance. The most common correctible risk factor for development of a pressure ulcer during her first few hospital days is:

Following arterial vascular evaluation and intervention (Ankle-Brachial Index of 0.75), the most appropriate management of a patient with a diagnosis of mixed arterial and venous ulcer would be:

In bed bound adults, the most common location for pressure ulcer formation is:

Which of the following is NOT a known etiologic factor in the development of a pressure ulcer?

The Panton-Valentine leukocidin (PVL) gene is characteristic of which organism?

A 34-year-old male presents with a history of chronic ulcers of leg and ankle, accompanied by edema, dermatoliposclerosis, pigment changes, and venous ectasia. Management for venous hypertension has failed and at the time of consultation, the wound margins show persistent inflammation and progressive ulceration. Prior workup includes venous imaging, which confirms old venous thrombosis and reflux, and a wound biopsy which is negative for malignancy. Which of the following profiles is most apt to imply an underlying hypercoagulopathic disorder (rather than incidental non-specific post-phlebitic venous hypertension)?

A 62-year-old insulin-dependent diabetic male with chronic renal failure presents with a painful lateral ankle ulcer one month in duration. Doppler Ankle-Brachial Index (ABI) in the affected limb is 1.0 and 1.1 in the asymptomatic limb. The next step in the management ofthis patient is:

Qualities of a good diabetic shoe for the use of offloading inlays and custom molded orthoses include all of the following features EXCEPT:

Which of the following factors identified in a patient's past medical history most strongly correlates with the development of venous insufficiency and the onset of venous ulceration?

The first immune cells to arrive at a wounded site are:

SEPS (subfascial endoscopic perforator surgery) is most appropriate for which type of patient in the treatment of venous leg ulcers?

A 72-year-old female presents for evaluation of a medial ankle ulcer of over 1 year duration. She doesn’t remember how it started but states that the wound has been treated with many different topical dressings and ointments but cannot tolerate many as they cause a burning sensation. Petrolatum based dressings are the only ones that do not cause stinging. The wound has not changed appearance but has been slowly increasing in size. Which of the following diagnoses is the LEAST likely to be the correct etiology?

Which of the following risk factors is the LEAST likely to be implicated in the causal pathway leading to diabetic foot ulceration?

Which of the following tissues does NOT contribute to the composition of Lean Body Mass?

A 70-year-old male patient presents with an irregular foul smelling plantar ulcer on his left foot. Which procedure would be most appropriate to diagnose and distinguish a diabetic ulcer from an atypical or malignant ulcer?

Which of the following is the most important reason to properly diagnose and distinguish squamous cell carcinoma from basal cell carcinoma?

Which of the following is NOT a benefit of sharp debridement?

Mature extracellular space is composed primarily of what protein?

In the management of patients with venous insufficiency and ulceration, all of the following are predictive of poor healing EXCEPT:

A 62-year-old female presents with a 3cm x 2.5cm shallow ulcer with smooth regular margins just distal to the left lateral malleolus that developed 10 weeks ago. Her history is negative for diabetes. There is a family history of rheumatoid disease. The patient is a smoker with a 45 pack-year history. She also admits to leg pain and cramping when walking less than 100 feet. ABI's are 0.5 bilaterally. Transcutaneous evaluation finds several periwound leads with values less than 20mmHg on room air. Which of the following is the best management option?

An 84-year-old patient with dementia presents with a foul smelling ulceration in the sacral region. During the prior three weeks the nursing home staff has been treating the wound application of a hydrocolloid changed every 3 days. The ulcer is now covered with a soft and boggy black eschar and is draining a malodorous yellow-brown fluid. Which of the following would be the BEST approach for general management?

Computed tomography findings that are typically seen in patients with necrotizing fasciitisinclude all of the following EXCEPT:

There are several indications for tissue biopsy to evaluate a wound for an atypical etiology. Which of the following is NOT an appropriate indication for wound biopsy?

Which of the following BEST describe the Recommended Daily Allowances (RDAs) which apply to daily dietary nutritional intake of protein, vitamins and minerals?

Patients that have ischemic leg ulcers can relieve their ischemic pain in the toes or forefoot at rest by:

Which of the following is TRUE regarding ischemic claudication in the lower extremity?

Which of the following offloading methods is the LEAST effective treatment for submetatarsal head ulcerations?

During the inflammatory phase of wound healing, the primary role of macrophage is:

Use of a pneumatic compression device is contraindicated for patients who have:

Secondary lymphedema can result from which of the following?

Which of the following statements related to enterocutaneous fistula is TRUE?

Compression therapy is a primary therapy for the management of patients with venous insufficiency as it most efficiently achieves the following direct effects:

Which of the following compression therapies would typically be CONTRAINDICATED in the initial management of a patient presenting with their first venous ulcer?

A 68-year-old patient is evaluated for a 2.5cm foot ulcer which is covered with a dry black eschar. Vascular examination finds no palpable popliteal or pedal pulses. Bedside Doppler detects monophasic signals in the posterior tibial and dorsalis pedis arteries. Which of the following is the most appropriate initial approach to the management of this patient?

Which of the following is NOT one of the cardinal signs of clinical wound infection?

Which cellular entity matches with the appropriate basic energy unit which together are responsible for production of the main source of metabolic energy that power cellular reactions critical for wound infection?

A 45-year-old female who is otherwise healthy is being treated for a venous leg ulcer with moist wound healing and multilayer compression wraps. After four weeks, the wound is 65% of the original ulcer size. There are no signs or symptoms of infection. What is the most appropriate course of action?

A 74-year-old patient presents with a three year history of progressive bilateral lower extremity pain exacerbated by exercise and walking. Recently he has developed left lower extremity pain at rest and a shallow, painful two centimeter ulcer over the right lateral malleolus. The most likely diagnosis is:

A patient presents with a chronic lower extremity wound that has shown increasing drainage without frank infection. Bacterial colonization is suspected. The best method of decreasing wound bioburden is:

Which of the following characteristics is NOT typical of venous ulcers?