Chronic Wound Care
What is Chronic Wound?
A chronic wound is one that does not progress through regular and timely stages of healing and does not show significant progress towards healing within 30 days. Factors that contribute to the chronicity of the wound may include:
Pressure, trauma and/or lower extremity wounds
Increased bacterial load
Excess proteases: impaired growth factors, matrix metalloproteinases (MMPs), impaired cell surface structures
senescent/abnormal cells
Inappropriate treatment
Symptoms of Chronic Wounds
Chronic wounds are typically defined by an elevated, hyperproliferative, but non-progressive scar margin. The area around the wound becomes inflamed and this inflammation can adversely affect healing.
etiology
Types of chronic wounds may include, but are not limited to, the following etiologies: venous ulcers, diabetic ulcers, and pressure ulcers.
Venous ulcers occur primarily on patients' legs and are caused by problems with blood circulation due to dysfunctional blood valves or clogged veins.
Diabetic ulcers often begin as small scratches or bruises that patients with diabetes may not notice because of nerve damage and limited sensitivity. Damaged immune systems and damaged capillaries cause these formerly small and benign wounds to become dangerously infected.
Pressure ulcers primarily affect patients who are bedridden or with limited mobility. The constant pressure on the tissue strengthens the pressure of the capillaries, affecting blood flow. The areas at greatest risk for pressure ulcers are the sacrum, shoulder blades, and heels. Accurately identifying the cause of a chronic wound and local and systemic factors that may contribute to poor wound healing is critical to successful wound management.
Risk factors
There are several factors that can increase a patient's risk of developing a chronic scar. Bariatric patients and those with diabetes or venous insufficiency are at increased risk, as are elderly patients.
Treatments and Interventions for Chronic Wounds
Treatment of chronic wounds also varies according to the type of wound. Often, underlying causes must be addressed before wound healing progresses. Individuals with diabetes will need to improve their diet and vascular health, and both diabetic and pressure ulcers will require draining for the affected area. Arterial ulcers will require revascularization, while venous ulcers will benefit from compression therapy.
What are the treatment options for chronic wounds?
At first, chronic wounds are cleaned regularly and covered with wound dressings and bandages. If a wound has not healed after a long time despite this wound care, special treatments such as vacuum assisted closure or skin grafting are used.
If someone has a wound for more than eight weeks without any signs of healing, it is considered a chronic wound. These types of sores often occur as a result of poor circulation, diabetes, or a weakened immune system. Open sores on the lower leg are also known as venous leg ulcers.
In addition to treating the underlying condition and tending to the wound, pain relief is also important. Some people with complex, poorly healing wounds also find psychological support helpful.
cleaning the wound
The wound is usually cleaned when the dressing is changed, normally using a saline (salt) solution. In general, however, there is not enough information about the advantages and disadvantages of the various remedies used to clean wounds and how they affect the healing process. It is also unclear whether tap water can be used for medical cleaning of wounds.
debridement
When treating chronic wounds, doctors or nurses often remove dead or inflamed tissue. This is known as debridement. The tissue is removed using tools such as tweezers, a sharp spoon-like instrument called a curette, or a scalpel. An enzyme-based gel is also sometimes applied to help clean the wound.
The wound can also be cleaned using a high pressure water jet. Another type of debridement involves using a specific type of maggot (fly larva) specially bred for medicinal purposes. Maggots are placed on the wound as they are or in a pouch. They remove dead tissue and fluid from the wound.
Because debridement is often painful, a local anesthetic is used to numb the wound before, for example, with an ointment. If more severe pain is expected, pre-treatment pain relievers can also be taken. Larger wounds are sometimes cleaned under general anaesthetic. There is not enough good research on the advantages and disadvantages of various debridement techniques to say how effective they are.
wound bandages
After the wound is cleaned, it is closed with a dressing. Most wounds are kept moist, for example, with moist compresses. However, the following types of dressings can be used instead:
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