Not every wound is chronic. However, unlike normal wounds that often heal naturally, these chronic or traumatic open wounds show no sign of healing. If unrecognized and untreated, especially foot sores of a diabetic patient, serious complications such as infection, gangrene or loss of a limb can occur. When situations like these present themselves, the wound needs special attention. Our physicians focus on the source of the wound so that the best plan of treatment can be determined.
Common Chronic Wounds
Some of the most common chronic wounds occur as complications of a host of conditions, including:
• Arterial/Venous Ulcers
• Diabetic Ulcers
• Chronic Infections
• Unrelieved Pressure Sores
• Post-operative Complications
• Radiation Injuries
A venous skin ulcer is a shallow wound caused by venous insufficiency, a condition in which the valves in the blood vessels are damaged and allow some blood to back up in the veins. The slowed circulation causes fluid to seep out of the overfilled veins into surrounding tissues, causing tissue breakdown and ulcers.
Venous skin ulcers, also called stasis leg ulcers, typically develop on either side of the lower leg, above the ankle and below the calf.
The first sign of a skin ulcer is an affected area of skin that turns dark red or purple. It may also become thickened and dry and itchy. Without treatment, an open wound (ulcer) may form. Venous skin ulcers often weep clear fluid and are covered with yellowish film.
The most effective treatment for venous skin ulcers is frequent elevation of the legs above the level of the heart and use of compression stockings during waking hours.
Arterial skin ulcers are caused by arteriosclerosis which leads to insufficient oxygenation of the skin and underlying tissues. This kills the affected tissues and causes wounds.
Characteristics of arterial ulcers are:
- Pale base color when the legs are elevated; red base color when the legs are dependent
- Surrounding skin is shiny, taut, thin, dry, hairless
- Deep Depth
- Even wound margins
- Minimal exudates
- Variable amounts of edema
- Skin temperature is cold to the touch
- Granulation tissue is rarely present
- Infection is frequent
- Pain during exercise, at night or even at rest
- Peripheral pulse is diminished or absent
- Located between toes, on toe tips, outer ankle, or where there is trauma
- And/or friction from walking
Standard treatment protocols include:
- Avoid Caffeine
- Avoid constrictive garments
- Topical therapies would include the use of non-occlusive dressings to control the exudates and maintain a moist wound healing environment.
A chronic wound is defined as one in which the healing cascade has been disrupted at some point, leading to prolonged inflammation and failure to re-epithelialize and allowing for further breakdown and infection.
There are a variety of types of chronic wounds and each kind requires it’s own treatment plan.
Unrelieved Pressure Sores
A pressure sore (bed sore) is an injury to the skin and nearby tissue. Constant pressure on an area of skin reduces blood supply to the area and eventually causes cell death, breakdown of the skin, and development of an open sore (ulcer). Pressure sores are more likely to develop if you or a person you are caring for is hospitalized or confined to a chair or bed.
Pressure sores most often develop on the skin over bony areas where there is little cushion between the bone and the skin. The majority of pressure sores develop on the lower part of the body, including over the tailbone and on the back along the spine, on the buttocks, and on the heels. Other commonly affected areas are the back of the head, the backs of the ears, the shoulders, elbows, and ankles, and between the knees where the legs rub together.
Pressure sores can range from mild reddening of the skin to severe tissue damage that extends into muscle and bone. These sores are difficult to treat and slow to heal. Complications, such as bone, blood, and skin infections, can develop when pressure sores do not heal properly.
The most common type of wound is a traumatic wound. These are categorized into several types:
- Abrasion – the surface of the skin is scraped away
- Contusion – the surface of the skin is not broken, but the underlying tissues are damaged
- Incision – made with a sharp instrument which produces a clean cut, as a scalpel
- Laceration – the skin is irregularly torn and a penetration results, like a stab or gunshot
- Cuts – where there is only a minor break in the integrity of the skin
- Thermal – include heat injuries such as burns, electrical injuries
Surgical wounds include:
- Post surgical incisions
- Suture site wounds
- IV site wounds
- Skin graft wounds
- Peri-ostomy wounds
- Peri-tracheotomy wounds
This type of injury is tissue damaged caused by the use of high energy particles to treat conditions such as cancer. Even normal and acceptable amounts of radiation required for treatment can create undesirable side effects.
Repair of the wound:
The process of repair following tissue injury is one of the most fundamental defense mechanisms of an organism against the environment. Wound healing generally occurs over a reasonable amount of time. Immediately after the injury, the wound fills with blood and a clot forms. The clot contains fibrin, which is a threadlike protein that causes the bleeding to stop. Wound healing then occurs in stages.
Stage 1 of Healing “The Inflammatory Phase”. The wound starts a natural inflammatory response with heat, redness, pain and swelling. During this time the patient may develop a mildly elevated temperature and general malaise. The wound should be monitored for swelling and redness outside the edges of the wound possibly indicating infection.
Stage 2 of Healing “The Proliferative Phase” This stage begins three to four days after the wound occurs and may last approximately 21 days. During this stage, the wound starts to get smaller and new tissue begins to grow.
Stage 3 of Healing “The Remodeling Phase”. This begins around day 21 and can continue for as long as one to two years post injury.
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