ABOUT CHRONIC WOUND Treatment
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 towards healing in 30 days. Chronic, non-healing wounds can have serious health consequences and may adversely affect your quality of life. To treat such wounds, appropriate chronic wound management is significant.
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.
Chronic Wounds fall into two categories - open or closed
In a closed wound, tissue damage and bleeding may occur beneath the surface of the skin. Examples of closed wounds include bruises. While an open wound involves a break in the skin that leaves the internal tissue exposed. Open wounds may result from falls, trauma, and surgery.
Common Types of Chronic Wounds
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.
There are many challenges in delivering wound care such as:-
Proper wound care expertise is scarce among primary care physicians. Advanced training can be cost prohibitive for providers who don’t focus completely on wounds.
For hospitals, the risks and costs can outweigh the advantages of running your own wound care practice, and it can be tough to measure quality or offer wound-specific technologies.
To further complicate the situation, patients themselves are often ignorant of their own risks for non-healing wounds. On an average, patients have 3-4 simultaneous, chronic conditions that leads to the risk.
Chronic Wound Healing Treatment and Prevention
The best treatment for chronic non healing wounds 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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