fapamaepod blog

By ncbi.nlm.nih.gov

Minor injuries to our skin usually heal quite quickly on their own. Larger wounds may need more time, and sometimes stitches are needed.

But some wounds close very slowly, keep on opening up, or do not heal at all. This is often a result of circulation problems or diabetes. Poorly healing wounds are more common on the lower legs or feet.

Doctors refer to a wound that that does not heal for a long time as a chronic wound. Treatment often takes a long time and can be very painful. But it is important to have good wound care and to treat the underlying condition that caused the chronic wound to develop.
Symptoms

Not all chronic wounds cause constant pain. Large and deep wounds can be very painful, though. Chronic wounds are often itchy, secrete a clear fluid (weep), or have a bad smell. The surrounding skin might be reddish or brownish in color.

The pain gets worse if the wound becomes infected or when you move. The pain and itching is often especially bad at night so people often have trouble sleeping and feel tired.
Causes and risk factors

Wounds are usually the result of an acute injury such as a cut or a bump. But chronic wounds most often result from an underlying condition that causes wounds to develop from just minor pressure, and then no longer heal. The main factors that are involved include the following:

Poor circulation: People with poor circulation – possibly as a result of peripheral artery disease (PAD) – have arteries that are narrowed. Arteries are the blood vessels that provide the body’s tissues with oxygen and nutrients. Wounds generally heal more slowly if blood cannot circulate properly. Ulcers are then more likely to develop, especially on your lower legs or feet.
Venous insufficiency: Disorders affecting the leg veins responsible for transporting blood back to the heart can also contribute to ulcers developing on your lower legs or feet. Venous insufficiency causes the veins to expand, usually resulting in varicose veins. The blood cannot flow upwards and it collects in the legs, causing them to swell. The resulting pressure makes it even more difficult for the blood to circulate and provide the body’s tissues with enough oxygen. In this case even a small injury may result in an ulcer.
Diabetes: High levels of sugar in the blood can damage blood vessels and nerves that supply the feet over time. That’s why people who have diabetes often do not feel pain in their feet and may not notice things like small injuries or pressure from shoes that are too tight. Poor circulation also affects the supply of oxygen and nutrients to body tissues and increases the risk of wounds becoming chronic.
Weakened immune system: If your immune system is weakened, for example by cancer, the wound may also heal poorly or become infected. Wounds often heal more slowly in older people as well, or in people who have a poor diet.
Accidental injuries or destroyed tissue: A severe injury or burn resulting in large and deep wounds may test the limits of the body’s ability to heal itself.
Mechanical pressure: People who have to spend a long time lying in bed or sitting in a wheelchair may develop pressure ulcers from the constant pressure put on some parts of their body by their own body weight. For the ulcers to be able to heal, the pressure needs to be taken off the affected area.

Effects

Chronic wounds are hard on the body and the immune system. This can leave you feeling tired and groggy. The pain also further limits your mobility.

If bacteria get into the wound it can become infected and tissue may die. Without treatment the germs may spread, leading to blood poisoning (septicemia).

In the worst case it may be necessary to amputate the affected part of the body.
Diagnosis

Skin injuries and poorly healing wounds do not always turn into chronic wounds. Your doctor will first ask about how long the wound has remained open and might also check for various risk factors such as diabetes, a weak immune system or circulation problems.

These are the main criteria for assessing a wound’s state:

Size and depth of the wound
Condition of the edge of the wound and the surrounding skin
Fluid from the wound
Smell
Amount of pain and itchiness

Prevention

In people who have diabetes, blood sugar levels need to be regulated so the wound can heal normally. Shoes should be large and wide enough to keep pressure off the feet. Regularly caring for your feet can also help to stop wounds from developing or help you notice them earlier.

People with venous insufficiency and varicose veins can use compression stockings or compression bandages (tight elastic dressings) to help prevent wounds. The pressure from the bandage relieves the veins and improves circulation, making it easier for wounds to heal.

There are also special pneumatic compression devices with inflatable air chambers that can be placed around your legs and then gradually pumped up from the heel to the top of your leg. The resulting pressure is meant to press the blood out of the deep veins in the legs – this is called “intermittent pneumatic compression.” But this approach has not yet been fully tested in studies.

Antibiotics are sometimes used to treat wounds that are infected with bacteria. The antibiotics can fight the infection and prevent the wound from becoming chronic.
Treatment

Chronic wounds are covered with a dressing for protection. There are other treatment options in addition to regularly changing the wound dressing:

Cleaning the wound

Medical staff will change the wound dressing and clean the wound regularly. The wound is normally rinsed with a saline or electrolyte solution, or simply with tap water. A technique called debridement is used to remove dead cells or inflamed tissue with tweezers.

Having a wound cleaned is often painful. A topical anesthetic such as a medicated ointment can be applied to the wound area to prevent pain. Larger wounds are sometimes cleaned under general anesthetic.

Wound dressings

After cleaning the wound, the doctor or nurse will put on a new dressing. Things like wet compresses, films or hydrogels are used as wound dressings. Their main purpose is to keep the wound moist, absorb excess fluid and prevent infection.

Advanced treatments

Some hospitals also use more advanced methods to help especially difficult wounds to heal:

In hyperbaric oxygen therapy, patients sit in a special pressurized chamber and breathe in oxygen.
In vacuum-assisted closure (VAC therapy), fluid is continuously drawn out of the wound.
Ultrasound therapy uses sound waves to treat chronic wounds.
Electromagnetic therapy involves the use of magnetic cushions or mats that produce weak electric currents near the wound.

Skin grafts

Skin grafts may be an option for people with wounds that are too large to close on their own. The surgeon takes skin from another part of the body, often the upper leg, and transplants it to the wound. Grafts can also be made from human cell products and synthetic materials.

Medication

Good pain management is an important part of wound care. The pain caused by chronic wounds is often underestimated.

Painkillers like acetaminophen (paracetamol) or ibuprofen tablets can help relieve mild to moderate pain. Your doctor can prescribe stronger painkillers if these do not provide enough relief. Wound dressings that contain ibuprofen are also available.

Antibiotics can be used to treat wounds infected with bacteria.
Everyday life

Pain or itching caused by a chronic wound can affect your everyday life and make it difficult to sleep. Changing the dressing is often painful too. A lot of people worry that their wound has a bad smell and that other people might find it unpleasant. Personal hygiene might generally be an issue too, for instance because it is difficult to take a shower. Constant pain and limited physical fitness can cause problems at work or in your personal life and can lead to depressive thoughts.

People with chronic wounds sometimes feel uncomfortable or embarrassed and withdraw from social situations. So support is needed on both personal and medical levels. In addition to care and support from friends and family, you can also get help from your family doctor, wound care specialist or ambulatory care nurses.

Support from family and friends or your nurses and doctors will be especially important if the treatment is not very effective. Then you might need to find a way to cope with the open wound over the longer term. Psychological treatments can also help to deal with the pain.

Source: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079406/