Most of us take for granted that everyday cuts, nicks and scrapes will heal without incident. But, for some people, wounds resist healing and pose a major health threat. These chronic wounds require special treatment and care to avoid serious infection, amputation or even death.
In the U.S., chronic wounds affect 6.5 million people, according to a study published in Wound Repair and Regeneration. Chronic wounds cost more than $25 billion annually to treat, a figure expected to balloon as the population ages, health care costs rise, and the incidence of diabetes and obesity continues to grow.
Local Wound Care Available
The opening of the Wound Care Center at Los Alamitos Medical Center makes advanced wound care available locally.
“Any wound can become chronic if it doesn’t heal properly,” says manager Elise Parsons, R.N. For example, a surgical wound may not heal properly for certain patients because of nutritional problems, medications, or other health issues such as high blood pressure, high cholesterol or sickle cell anemia. A wound is considered chronic if it takes longer than normal to heal, doesn’t heal completely, or recurs.
People with diabetes and vascular disease are particularly prone to chronic wounds. Diabetes can lead to nerve damage, or neuropathy, that results in a loss of sensation in the feet. People who have neuropathy may not feel a crack, callus or other wound on the foot, and it can become ulcerated. Each year, an estimated 2 to 3 percent of people with diabetes develop a chronic wound, with up to 15 percent developing such a wound over their lifetime, according to a study in the journal Wounds.
Peripheral artery disease, blood clots, or other vascular problems can also produce chronic wounds in the legs or feet. Slow or insufficient circulation makes it harder for wounds to heal. In addition, those who are bedbound or use a wheelchair risk developing pressure wounds. These wounds are caused by lying or sitting on an area of the body for too long, compressing the skin against the bone to the point that the skin dies. The National Nursing Home Survey of 2004 said approximately 11 percent of nursing home patients develop pressure wounds.
Accident, Trauma Can Produce Chronic Wounds
A crush injury, which occurs when a part of the body is subjected to extreme force or pressure, may also require advanced wound care. A finger caught in a door is an example of a minor crush injury. More serious crush injuries severely damage the tissues, organs, muscles and bones beneath the skin, and must be carefully treated to avoid permanent damage.
Treatment for a chronic wound may involve several approaches, one of which is cleaning the wound and removing dead skin in a process called debridement. Special antimicrobial dressings can clear chronic wound infection, promote healing and reduce scarring. Other treatments include total contact casts, often used to take the weight off foot ulcers in people with diabetes. “The cast offloads the weight and allows much better healing,” Parsons notes. Preemptive wound treatment helps preserve limbs, she says, reducing the need for amputation.
Tissue engineering and biotechnology advances have led to the development of skin substitutes, which may also be used to treat chronic wounds. “For wounds that meet certain criteria, we can use these substitutes to help the wound close faster,” Parsons says.
Hyperbaric oxygen therapy, or HBOT, is also used to treat and manage chronic wounds. With HBOT, patients breathe 100 percent oxygen in a pressurized chamber. Under pressure, the oxygen dissolves into all body fluids, not just red blood cells, and is diffused throughout the body.
HBOT is used to treat complex diabetic foot ulcers, bone infections and radionecrosis, which is damage to bone or tissue caused by radiation therapy. In cases of necrotizing fasciitis, a rare bacterial infection sometimes called “flesh-eating bacteria,” HBOT can inhibit the spread of the potentially deadly bacteria. Muppets creator Jim Henson died in 1990 when a strep infection led to necrotizing fasciitis.
Take Care of Your Skin
Parsons says she reminds patients that skin is the body’s largest organ. Every medication taken and every bit of food eaten affects the skin, she says: “Treating chronic wounds involves more than just the wound. We look at all impediments to healing. Sometimes that can be nutritional factors. In other patients, we need to look at their lifestyle and see if we can get them moving more.”