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The presence of a non-healing wound can be a very debilitating problem for a patient. The wound itself usually represents the “tip of the iceberg” with regards to the underlying problems that a patient possesses that are preventing normal healing. The ability of wounds to heal properly is determined by many factors which include 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—this is where physicians specializing in wound care can be of great benefit.
How Does Blood Supply Effect Wound Healing?
In order for wounds to successfully heal there must be a good blood supply to the wound. This will allow all of the appropriate cells that are responsible for healing to be delivered to the wound. In addition, a normal blood supply will allow the necessary oxygen to travel to the wound. Oxygen is very important in wound healing as it helps reduce the bacterial count in the wound bed. A high bacterial count in the wound is a common reason that wounds fail to heal. In order for all of these cells and oxygen to be transported to 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 (i.e. atherosclerosis), the transport of these cells and antibiotics cannot reach the wound and wound healing is impeded.
Do Vein Problems Impede Wound Healing?
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Yes, a common cause of nonhealing wounds occurs in patients with a history of venous disease in their lower extremities. Whereas arteries in the body are responsible for bringing oxygenated blood to the wound, it is the veins that carry blood away from the wound and back to the heart to pick up more oxygen. 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. These problems with veins are usually long standing ones in which the patient will initially present with leg swelling, followed over time by progressive discoloration (browning) of the lower parts of their legs. This swelling and discoloration makes it very difficult for wounds to heal. Patients with this type of problem often require some form of limb compression therapy to aid in 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
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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 many new products and treatment modalities available today to treat wounds. However, the hallmark of therapy involves the constant monitoring of the wound with serial mechanical cleaning (debridement) which allows for the removal of devitalized tissue from the wound base. The frequency of dressing changes varies from wound to wound, depending on the etiology of the wound as well as those factors that are mitigating against successful healing. Those patients that are suffering from a non-healing wound are usually best treated in a Wound Care Center.
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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 |
care—including a thorough initial history and physical examination, laboratory assessment (including tissue cultures and non-invasive vascular examination), measurements, photographs and serial debridements—are absolutely mandatory to deliver high quality wound care.
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