Healing chronic wounds

April 05, 2011 By Jennifer Clark, M.D.

For many of us, minor cuts or scrapes are easy to treat. We'll wash the area, apply a bandage and often within a week or two, the wound has turned into a small scar.

But for people with certain health conditions, like diabetes or circulatory problems, a little cut or scrape can turn into a big problem. These people may develop chronic wounds – those that don't improve significantly in four weeks or heal in eight. Untreated, these wounds can get bigger, cause significant pain and infection and in rare cases lead to amputation.

Fortunately, there are healthcare professionals who specialize in treating chronic wounds using techniques and technology that can help even severe wounds heal.

Chronic wounds can have a number of causes. These include conditions like venous stasis, which occurs when fluid buildup in a limb makes it difficult for blood to get in to nourish cells and remove waste. Tissue becomes thin and inflamed and breaks open, resulting in a wound. Chronic edema, fluid buildup in the extremities, can also cause ulcers. Other chronic wounds result from arterial disease, traumatic injury, non-healing surgical incisions, pressure ulcers (bed sores) and other diseases and conditions that affect the skin.
But the most common source of chronic wounds is diabetes. Because diabetes can damage leg and foot nerves, patients might injure themselves more easily and be less aware of wound severity. Additionally, high blood sugar can impair white blood cell function, making wounds susceptible to infection.

Wound care specialists have a number of options for treating chronic wounds. These include debridement, when a surgeon removes unhealthy tissue that can interfere with healing. Debridement can also be done with enzymatic treatments that dissolve unhealthy tissue over a couple weeks. Wounds won't heal if they're too dry or too moist, so specialists also use treatments to maintain optimum moisture levels for healing.

Hyperbaric oxygen therapy can be effective for advanced diabetic wounds, wounds involving bone infection and those due to previous radiation therapy treatments. Patients relax in a see-through chamber, which circulates 100 percent oxygen at two to three times atmospheric pressure (similar to what deep-sea divers experience). Pressurized oxygen has been shown to help heal wounds, preserve damaged tissues, control infection and increase blood vessel formation.

Regardless of the treatment they choose, wound care specialists must deal with patients' overall health and lifestyles. Wound care specialists use a multidisciplinary approach, working closely with patients' primary care physicians and specialists in podiatry, surgery, pain management, vascular care and other areas.

Patients also play a significant role in their healing; often they must make lifestyle changes to control blood sugar, reduce sodium intake, elevate the affected limb and ensure regular dressing changes.
Healing a chronic wound isn't fast or easy, but the results of treatment can be dramatic. In some cases, amputation can be prevented, long-standing infections cured and pain eliminated. If you have a non-healing, chronic wound, see a wound care specialist. The sooner you get treatment, the sooner you'll heal.

Jennifer Clark, M.D., is medical director of The Hospital of Central Connecticut's Wound Care Center.