CHRONIC WOUNDS

A chronic wound is a wound that fails to progress through the normal stages of wound healing. The wound may have been present for only a month, or may have been present for several years. Regardless of the type of wound, chronic wounds typically do not heal on their own and often do not improve with routine treatment.

It is known that there are some common reasons why chronic wounds fail to heal. One of the most important is lack of adequate blood flow(add link to arterial and venous wounds) to the wound. Infection within the wound and poor general nutrition are other important factors. Underlying illnesses, such as cancer (add link to cancer article) or diabetes,(add link to diabetes article) can cause a general impairment in the body’s ability to heal wounds. Certain medications, most notably steroids, can also negatively affect wound healing ability. Other reasons include a history of prior radiation (hyperlink to cancer article)exposure or unrelieved pressure on the wounded area.

The treatment of chronic wounds is complex, often requiring the input of multiple trained specialists. In general, care of a chronic wound will involve treatment of underlying infection, removal of any dead tissue in the wound (debridement), and maximization of blood flow to the area of the wound. Adequate nutrition should be maintained, and the patient should stop smoking. If pressure is a causative factor, then that pressure must be relieved as much as possible. Other important issues include control of tissue swelling (edema), optimal glucose control for diabetics, and medical management of underlying chronic illnesses. If the wound does not heal with the above interventions, advanced therapies including cultured tissue grafts or hyperbaric oxygen therapy may be required. Very resistant wounds may eventually require surgical repair or reconstruction to achieve ultimate healing.

Most chronic wounds are easily preventable. In most cases, treatment of a chronic wound is much more difficult than preventing the wound from forming in the first place. Wearing well-fitting, supportive footwear, for instance, will help prevent the formation of ulcers on the toes and foot. This is especially important for those people who have diabetes or vascular disease (link to arterial/venous article). People who are immobilized or bedridden as a result of stroke, spinal cord injury or advanced age can develop pressure ulcers (bedsores) on the buttocks, hips, heels, and other areas. Avoidance of constant pressure through frequent turning and change of position along with pressure-relief mattresses or cushions can help prevent these problems. Proper nutrition, regular exercise, and avoidance of smoking can also help make the body more resistant to wound formation.

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