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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.
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
• Traumatic Injuries
• 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:
- Revascularization
- 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.
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
- Bite
- 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.
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.
“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.
“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.
“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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255 Third Avenue, Suite 10
Long Branch, NJ 07740
Phone: 732-923-6060
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