Even if you’re not a warrior or risk taker, you’ve undoubtedly suffered many wounds in your life–a scraped knee from a fall off a bike, a bad burn or a cut on the finger from chopping vegetables.
And the wound often looks downright nasty–weeping at first, then crusting over and eventually getting better. You were probably unsure about how to treat the wound, and the advice you got from friends and family was not always consistent.
You might be even more concerned if you knew that some wounds–4.5 to 5 million each year–fail to heal or take an excessively long time to do so. Some of these occur to younger adults who suffer severe burns, automobile accidents or other traumatic injuries, but the majority occur in older persons with chronic diseases such as diabetes, heart failure, lymphedema, peripheral artery disease (PAD), venous hypertension or a compromised immune system.
Diabetics are particularly vulnerable to non-healing ulcers on the legs and feet, and these result in about 86,000 amputations each year. Any slow-healing wound, of course, is reason for serious concern, and it’s important for both patients and their health care professionals to know how to recognize and care for them. Many hospitals, in fact, are establishing dedicated wound healing centers.
Basic Wound Care
In the majority of cases, there is little to worry about. The first step is to clean the wound with running water. Don’t worry about a little bleeding because it helps to flush out dirt and other contaminants. Use soap to clean the skin around the wound; it will sting if you get it in the wound, but otherwise, there is no harm.
Rinse it thoroughly and use tweezers, if necessary to remove any debris. You may have heard about applying hydrogen peroxide or antibiotic ointment, but neither is necessary nor recommended. Some kind of ointment or salve, though, may ease the pain and keep the wound moist for quicker healing.
If the wound is deep and has jagged edges or if you have not had a tetanus shot in the past five years, you should see a doctor. Any time you can see layers of tissue along the sides of a cut, it’s deep enough to seek treatment. Other signs include tenderness, numbness and draining pus.
Normal wound healing follows a typical pattern.
The initial stage involves inflammation. Blood vessels at the site of the wound constrict to prevent blood loss, and platelets gather to form a clot. During this stage, the wound may feel warm and have a red appearance.
White blood cells rush to the area to kill bacteria. And skin cells multiply in an effort to grow across and cover the wound.
The next stage is known as the fibroblastic stage. Collagen starts to grow within the wound, forming a structure on which the new skin will grow. This causes the edges of the wound to close in and shrink. Meanwhile small blood vessels form to make sure the area is nourished with blood.
During the final maturation stage more collagen is added, eventually causing the scar to heal. This may take months or even years, and it’s important to take care of the wound throughout this period.
The wound healing process can be slowed by a number of factors, including:
too much dead skin or foreign matter;
a bacterial infection,
persistent bleeding,
continual pressure or irritation,
poor food choices that lead to deficits of vitamin C, zinc or protein;
medical conditions that restrict blood flow;
age;
smoking;
varicose veins that inhibit blood flow; or
dryness.
Although you may have been told that a wound needs exposure to the air, this practice tends to dry the area and slow the healing process.
Redness in the area does not necessarily mean that the wound is infected. A doctor must determine if there is an infection and adjust treatment accordingly. In most cases, infections should be treated with systemic rather than topical antibiotics. Prolonged use of topical antibiotics can upset the bacterial balance at the site and inhibit healing. It can also promote the growth of resistant organisms.
A wound or sore is defined as chronic when it shows no sign of healing after one month or has not completely healed in two months.
Most chronic or hard-to-heal ulcers in older adults are associated with medical conditions such as diabetes, heart failure or peripheral artery disease. Patients who are bedridden or confined to a wheelchair for an extended period are at risk of pressure sores. One factor common to all of these is poor circulation.
Uncontrolled blood sugar causes blood vessels to harden and narrow, limiting blood flow. With loss of feeling associated with diabetic neuropathy, a patient may not notice the irritation from a small cut on the leg or a blister on the foot until the ulcer poses a serious problem.
Once a chronic sore has developed, prompt, professional attention is crucial. Debridement involves surgically removing dead tissue that may be inhibiting the healing process.
Proper healing requires oxygen. Most wound centers today are equipped to provide hyperbaric oxygen therapy (HBOT). Patients lie inside a chamber filled with a higher than usual level of oxygen for about 90 minutes at a time. The treatment is painless and, some say, even relaxing. The patient can sleep, talk, watch television or listen to music while breathing in pure oxygen that improves circulation and speeds the healing process.
Several studies have demonstrated the effectiveness of HBOT in healing ulcers associated with diabetes and other chronic diseases. All of these chronic wounds have a high rate recurrence, however.
Long-term prevention focuses on treating the underlying causes–keeping your blood sugar, cholesterol and blood pressure under control. Choose your footwear carefully and don’t ignore a blister or any seemingly minor sore.
The other wounds you sustain–the cuts, burns, scrapes and scratches–require prompt treatment and constant monitoring.
REFERENCES:
Laura L. Bolton, Ph.D., FAPWCA, “Benchmarking chronic wound healing outcomes,” Wounds, February 20, 2012.
Rod Brouhard, “How to dress a wound,” About.com First Aid, updated October 8, 2010.
Jason P. Hodde, M.S., ATC/L, and Reynald Allam, M.D., M.B.A., “Submucosa wound matrix for chronic wound healing,” Wounds, August 22, 2007.
Kenneth R. Jones, RN, Ph.D., FAAN, et al, “Chronic wounds: factors influencing healing within 3 months and nonhealing after 5-6 months of care,” Wounds, May 1, 2007.
Catherine R. Tatliff, Ph.D., APRN-BC, CWOCN, et al, “Quantitation of bacteria in clean, nonhealing, chronic wounds,” Wounds, December 9, 2008.
S. Schremi, et al, “Oxygen in acute and chronic wound healing,” The British Journal of Dermatology, September 15, 2010.
Frank Wardin, M.D., et al, “Evidence-based management strategies for treatment of chronic wounds,” ePlasty, 2009;9e19,2009, Open Science Co.
“When time doesn’t heal all wounds see a doctor,” GO San Angelo Standard Times, June 29, 2009.
01/08/2013
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