What Is a Chronic Wound?
According to WoundCareCenters.org, a chronic wound is one that has failed to progress through the phases of healing in an orderly and timely fashion and has shown no significant progress toward healing in 30 days.
What Causes a Chronic Wound?
Failure of any wound to heal can be due to a lack of one or more of the main requirements of healing, including a good supply of blood, oxygen, and nutrients, and a clean and infection-free environment. An important aspect of caring for wounds is to remove the causing agent, as in cases of wounds caused by weight bearing or wounds that are under constant pressure. When wounds do not get relief from constant pressure, there can be a cumulative breakdown of the tissue.
Types of Chronic Wounds
Some of the most common types of wounds and their specific causes are as follows:
Whether it is bacterial, fungal, or viral, if the cause of the infection is not treated with the proper medication, the wound will not heal properly within the expected time.
Ischemia means that the wound area is not getting sufficient blood supply. Limiting the blood supply, as well as the oxygen and nutrients it carries, can delay the healing process or even prevent it.
Regardless of whether the source of radiation is therapeutic (gamma rays or x-rays) or accidental (exposure to radioactive materials from nuclear plant accidents or radioactive devices that detonate), excessive exposure to ionizing radiating materials can weaken the immune system, cause damage to exposed tissue, and delay the healing time of all wounds.
Wounds caused by incisions made during surgery can progress to chronic wounds if the blood supply to the surgery area is accidentally damaged or if wound care is inadequate. Both can delay the healing time of a wound.
(the most common type of chronic wound):
- Arterial ulcers: These can occur due to hypertension, atherosclerosis (plugging), or thrombosis (clotting), where the reduced blood supply leads to an ischemic state.
- Venous ulcers: These account for more than half of ulcer cases, especially in the lower limbs (mainly the legs), as associated with deep vein thrombosis, varicose veins, and venous hypertension. Venous ulcers can lead to stasis, where the blood fails to circulate normally.
- Diabetic ulcers: These are a common complication in uncontrolled diabetes mellitus, resulting in impaired immune function, ischemia (due to poor blood circulation), and neuropathy (nerve damage), which eventually lead to breakage of skin and ulceration.
- Pressure ulcers: The constant pressure and friction resulting from body weight over a localized area for prolonged duration can lead to breakage of skin and ulceration (also known as bed sores), especially on the back and on the ankles and feet.
Treatment and Prevention of Chronic Wounds
The best treatment is to prevent the wound from progressing to a chronic state by avoiding all the risk factors. Preventive measures include maintaining proper hygiene and wound care as instructed by the doctors while complying with the prescribed medications. Regular inspection of wounds to track healing progress is also a primary part of the treatment plan.
In general, treating and removing the underlying cause of any chronic wound should be the primary focus of the treatment. In some cases, a surgical debridement (removing any accumulated dead tissue) is needed to improve the blood flow and supply of nutrients to the wound. In other cases, applying proper wound care by changing wound dressings frequently, keeping the wound clean, applying local antibiotics, taking anti-inflammatory medications when needed, and maintaining a healthy lifestyle is sufficient to prevent chronic wounds and encourage proper healing.
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