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November 11, 2019

The Causes and Treatments of Chronic Wounds

The Causes and Treatments of Chronic Wounds

To remedy chronic wounds, it's important to understand what causes them and why they are a treatment challenge.

If a wound has not healed in more than eight weeks, and does not show any progress in doing so, it is considered a chronic wound. This is as opposed to an acute wound, which is classed as an injury that heals well within a certain amount of time. 

Chronic wounds include, but are not limited to, diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals around the world, and consume a great deal of healthcare resources.

Some common features shared by each of these wounds include prolonged or excessive inflammation, persistent infections, formation of drug-resistant microbial biofilms, and the inability of skin to heal. 

Chronic wounds are a common problem for people with certain conditions, and in many cases apart from the discomfort they cause, there’s the emotional and psychological effects of the chronic wound to consider. Many people with complex chronic wounds find that psychological support is just as important as physical support, because quality of life can suffer as the ability to perform simple tasks can be hindered. 

Bedridden patients are particularly at risk of suffering from a chronic wound, as long periods of immobility can result in poor circulation. 

Bedridden patients may also experience pressure ulcers, a type of chronic wound which is sometimes known as a bedsore. They occur as a result of long term pressure being applied to certain areas of the body.

Repairs

While injuries are an unavoidable part of life, our body always works to repair the damage. However, for people with diabetes, what initially starts off as an acute wound can carry great risks and can result in serious health complications. 

People with diabetes have high blood glucose levels, which often causes stiffness of the arteries. This can also cause narrowing of blood vessels and diabetic neuropathy (nerve damage caused by diabetes). The effects of these body changes carries an increased risk of wounds and complications in healing. 

Even when acute wound does not develop into an infection, slow healing has effects on a personal quality of life. Wounds that take time to heal can make walking and exercise painful and sometimes nearly impossible. 

Foot ulcers have proven to be a very common chronic wound in people with diabetes. Reports have found that 1 in 4 people who suffer with diabetes have also suffered with a foot ulcer. If foot ulcers go untreated or take too long to heal, infection can take over, to the point where amputation is necessary. 

Immunity 

What you eat can determine your body’s ability to generate new tissue, an essential element in wound healing. When the body is injured, the immune system works to repair the damage with new tissue and prevents bacteria multiplying in the wound and causing infection. In cases of people with poor nutrition, chronic wounds tend to develop because the immune system is compromised. Conversely, obesity can also be an underlying factor in chronic wounds. 

Wounds heal in four stages:

1. Hemostasis – constriction of the blood vessels and blood clotting

2. Healing – blood platelets secrete growth factors, phagocytes remove bacteria, and growth factors start repair work

3. Formation – new tissue and blood vessels form and inflammation subsides over a period of about a week

4. Collagen replacement – tissue in the closed wound is remodelled into bundles in a process which can take 1-2 years or longer

Often, chronic wounds stall in the inflammation phase of healing, due to a range of causes including cellular senescence (cells which are too old to divide), recurrent infection, melanoma (cancer of pigment cells), or other factors. 

Treatments 

There are a number of advanced clinical treatments available for chronic wound care, such as electrical stimulation, topical oxygen therapy, low-frequency ultrasound, placental tissue treatments  and skin transplants – but before resorting to any of these, conventional wound care using medical dressings can often present a solution. There are many possibilities, including standard and super absorbent gauzes, foam, silicon and polyurethane dressings, zinc oxide dressing and ointments, hydrogels (absorbent polymers), alginates (carbohydrates derived from clinical bacterial sources), and even honey dressings (using medical grade honey, which has antimicrobial and anti-inflammatory properties).

The fight against chronic wounds can be a long one, but with proper medical advice and attention, it's one which it is possible to win. 

See Also: Why Some Wounds Won't Heal

This feature was orignally published in the winter edition of Live to 100 with Dr Hilary Jones, which you can read here