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The
ability of wounds to heal properly is determined by adequate blood supply, proper wound
care techniques and control of coexisting medical problems. Attention to detail is of
paramount importance in getting wounds to heal—most especially in terms of techniques
of wound management. How
Does Blood Supply Effect Wound Healing? The
body has a natural ability to heal wounds; however, there are specific cells that must
``travel" to the wound area for them to be effective. Substances emitted from certain
cells in the body also aid in wound healing, but, again, these cells must be present in
the area of the wound. In order for cells to
be transported to the area of the wound, an intact blood supply must exist. That is, blood
flow to that area must be unobstructed (or only minimally so.) If there are blockages in the arteries
(atherosclerosis), the transport of these cells and antibiotics cannot reach the wound and
wound healing is impeded. Do
Vein Problems Impede Wound Healing? Yes,
a common cause of nonhealing wounds is poor “venous `outflow." Simply explained,
arteries bring blood to the wound and veins carry it away.
If there are problems with veins, the pressure in these vessels increases and
prevents toxins and other products from being carried away from the wound. Additionally, vein problems can cause leg swelling
(edema), which is a deterrent to wound healing. What
About Diabetes and Other Medical Problems? Certainly,
concurrent medical problems (diabetes, heart failure, and immunosuppression) can adversely
affect the ability of a wound to heal. Diabetes
mellitus has long been recognized as a major impediment to wound healing. Since many wounds carry with them an
infection—infections tend to impair the control of blood sugar—a vicious cycle
is begun that can produce dramatic problems of limb-threatening infections. It is of utmost importance that glucose levels in
those with diabetes be well controlled, most especially during a time when one is
attempting to heal a wound. Patients
who suffer from heart failure (congestive heart failure or CHF) also represent a difficult
problem in wound healing. The primary problem in these cases is related to the leg
swelling (edema) that develops as a result of the heart failure. Leg edema makes wound healing extremely difficult
and allows infection to develop and spread readily. Immunosuppression
due to acquired diseases or a result of medications also contributes to wound healing
problems. The inability of the body to
utilize all of its ``normal mechanisms" is evident in this situation. What
is the Best Method of Wound Care? There
are numerous ointments, solutions and products currently marketed for the care of wounds. The utility of each one notwithstanding, there is
conflicting scientific data to proving one's supremacy over another. The most important aspect of wound care is
constant attention to the wound with frequent dressing changes and mechanical cleansing as
needed. The dressings must be changed regularly and wound progress assessed on a steady
and routine basis. If one particular type of solution does not work, another should be
tried; however, this mandates an accurate system of assessing wounds. What
About Wound Care Centers? Just
as in any situation, the quality of wound centers varies immensely. A good wound center will have a multidisciplinary
approach to wound care and understand the value of a ``team concept" in wound
healing. The appreciation of the need to
assess the vascular supply to the area of the wound is a hallmark of a good wound care
center. Additionally, a methodic approach to
wound assessment—including measurements, photographs and grading systems—is
absolutely mandatory to deliver high quality wound care.
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