Chronic Wound Basics
A chronic wound is a wound that just will not repair itself over time. Chronic wounds are often thought to be “stuck” in one of the phases of wound healing, and are most often seen in the older adult population. Typically, if a wound is not healing as expected within 2-3 months, it is considered chronic.
There are many factors that contribute to the non-healing nature of chronic wounds including:
- Advanced age of patient
- Chronic medical conditions affecting circulation and immune functioning such as diabetes mellitus, peripheral neuropathy, peripheral arterial disease and venous insufficiency
- Poor nutrition
- Impaired mobility
- Poor health
Generally, chronic wounds can be classified into one of three types.
- Pressure Ulcers
- Also known as bedsores, these wounds are caused by prolonged, unrelieved pressure to an area of the body, typically around bony prominences such as the tailbone, heels and ankles. This constant pressure inflicts damage to the skin while other factors, such as moisture and friction, contribute to the wound formation. These wounds typically occur in individuals who are bedridden, or those with limited mobility.
- Arterial and Venous Ulcers
- Venous stasis ulcers occur due to dysfunctional valves in the veins, which cause blood to pool in certain areas of the body – particularly the lower limbs. This pooling results in poor circulation and chronic inflammation at the site. These wounds typically occur in the elderly and account for the majority of chronic wound cases.
- Arterial insufficiency ulcers are a direct result of blocked blood flow to small vascular beds in the body – such as on the top of the foot. If this area is injured due to trauma or pressure, the wound is unable to heal itself due to a lack of blood flow. While not as common as venous stasis ulcers, these wounds also occur most frequently in the elderly.
- Diabetic Ulcers
- Diabetes causes decreased nerve functioning, particularly in the lower extremities, resulting in a numbing effect. If an individual is not aware of pain in the legs or feet, any cuts or wounds can go completely unnoticed for days or possibly longer, resulting in a much larger and more complicated wound. Furthermore, diabetes decreases the body’s immune response, hindering its ability to fight infection and contributing to the non-healing nature of these wounds.
Signs and Symptoms
Any wound that is not healing, or one that is healing slowly, can be considered chronic. The most common symptom of chronic wounds is pain.
Who Is at Risk
The elderly and individuals with multiple chronic medical conditions are at greatest risk for chronic wounds. Individuals taking multiple over-the-counter or prescription medications are also at risk due to the many side effects drugs can have on sensory perception and circulation. General risk factors include:
- Decreased sensory perception
- Limited mobility (due to weakness, paralysis, sedation, bed rest or use of a wheelchair)
- Decreased mental awareness
- Poor nutrition
- Medical conditions that affect circulation
- Cigarette smoking
Chronic wound treatment is aimed at trying to reverse or improve the root cause of the wound itself. Chronic wounds may last for several years, and in some individuals, may never fully heal. In all cases, pain management is an important part of the treatment process. Some treatment options for chronic wounds include:
- Routinely cleaning the wound and ridding it of dead tissue via debridement and irrigation
- Vacuum assisted wound dressings, also called Wound Vacs, create negative pressure to the wound, which can be particularly helpful in wounds with large amounts of drainage.
- Warming the area to increase blood flow
- Antibiotic regimen
- Oxygen therapy
- Specialized dressings that provide healing factors or enzymes that help break down dead tissue
Chronic wounds are much easier to prevent than to treat. The best way to prevent a chronic wound is to actively and appropriately manage chronic medical conditions such as diabetes, high blood pressure, venous insufficiency and peripheral neuropathy. Skin should be routinely inspected in these individuals. Steps should be taken to prevent trauma to the skin of the legs and feet, such as wearing shoes, ensuring clothing is not wrinkled or bunched over bony areas and maintaining proper hygiene and nutrition. If a cut or wound does occur, immediate care and attention should be provided.