There are 6.5 million people suffering from chronic wounds in the United States, according to the National Institutes of Health (NIH). A chronic wound is a wound that will not heal in a usual amount of time. If a wound has not healed within eight weeks, it is determined to be chronic. An aging population, the number of people living with diabetes and obesity are among causes cited for the amount of chronic wounds. A variety of treatment options are available.
Types of Chronic Wounds
There are three main types of wounds on the lower extremities: venous stasis ulcers, neurotrophic ulcers, and arterial ulcers. In diagnosis, a thorough examination of the wound is completed by a physician and other diagnostic testing may be done to determine any underlying problems that need to be corrected.
Venous stasis ulcers are usually found below the knee on the inner part of the leg just above the ankle. They usually have irregular borders, are red in color, are often covered with yellowish tissue, and drainage may be present. The skin around this type of ulcer is discolored and swollen with a shiny, tight appearance.
Neurotrophic ulcers are generally found at areas of increased pressure points on the bottom of the feet, but can occur anywhere on the foot. The base appears pinkish red or brownish/black, with punched out borders and callouses on surrounding skin.
Arterial ulcers are most often found on the feet, particularly on the heels or toes and nail bed. The coloration can be yellow, brown, grey, or black, with irregular borders. The surrounding skin is often swollen and red. The entire leg will turn red when dangled and pale white when elevated due to the lack of blood flow. These wounds are very painful.
Proper blood flow, adequate amounts of oxygen and nutrients are necessary for wounds to heal properly. In addition to diabetes and obesity, other factors may impede these healing elements. They include advanced peripheral artery disease, kidney failure, venous insufficiency, and hypertension. Additionally, lymphedema, inflammatory diseases, such as vasculitis, lupus, or scleroderma can exacerbate healing. Smoking, inactivity, resulting in pressure from lying in one position for too long, cancer and infection are also contributing factors.
Treating chronic wounds could involve several methods including debridement. During this procedure, the dead or infected tissue of a wound is removed to reduce the number of microbes and substances that may be inhibiting healing. Antibiotics may be prescribed to treat an infection in a wound if present. These may be in topical or oral form.
There are many applications to help heal a wound heal from the inside out. The topical therapies recommended will depend upon the type of wound, location, and extent of damage. They include moist to moist or moist to dry dressings, hydrogels/hydrocolloids, alginate and collagen wound dressings. Topical debriding agents, antimicrobial dressings, composite dressings, and synthetic skin substitutes are other options.
Compression dressings that involve wearing multi-layer compression wraps or wrapping an ACE bandage may also be employed. These are generally used for venous stasis ulcers to minimize swelling. Prosthetics or orthotic devices may also be required to help restore someone back to their normal lifestyle and level of functioning.
Skin graft procedures allow healthy skin from one part of the body or synthetic material to cover open wound areas. This can promote faster healing of a wound and help in restoring a more normal appearance.
Beyond treating the chronic wound itself, attacking the underlying problem that caused it results in more effective healing. Diagnosis and treatment of the originating condition also accelerates the healing process. To learn more about chronic wound treatment and management, log on to vascularhealthclinics.org and visit the Wound Care Treatment Program.