Increase in life expectancy and aging population have led to the fact that most of us have encountered or will encounter a chronic wound, both personally and as a phenomenon that affects one of our relatives. In order to know how to deal with this phenomenon, Healing Wounds answers two main questions regarding chronic wounds: What are chronic wounds, and how do you deal with them?
What is Chronic Wound?
A wound that does not heal naturally within three weeks or more. Causes of chronic wounds may be divided into two main categories.
External factors: can affect skin such as outer pressure, friction forces and shearing forces, lack of movement, diabetic ulcers, radiotherapy induced wounds, and wounds caused by trauma or infection.
Internal factors: urinary or fecal incontinence, aging, blood flow disorders, nutritional deficiencies, immune disorders, and even sores due to cancer.
Chronic wound must be treated as soon as possible from the moment of its detection, as it can deteriorate, grow, penetrating inner skin layers and turning into chronic ulcer, becoming infected and ultimately lethal.
Chronic Wound
Wound bed and the wound itself should be free of exudate (excess fluid). There should be no pressure on the wound bed, except of the bandages. The person, who has the wound, must be complexly treated in accordance with wound type and overlaying medical condition disease in an appropriate clinical setting.
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Wound Types
Venous ulcers or ulcers due to venous disease
There are some diseases, like venous thrombosis (VT), which cause veins blockage due to various reasons, such as prolonged recumbence, blood clotting disorders or malignant diseases. Sometimes venous thrombosis may cause superficial veins to widen, protrude and eventually rupture the vein wall. Vein wall rupture leads to formation of deep, and painful ulcer that will usually be on the inside part of the leg.
What should I do?
Doppler ultrasonography of veins followed by consultation with wound or vascular specialist likes of which we have in Healing Wounds – most likely they will have the necessary knowledge and experience dealing with such wounds.
Arterial ulcers
Are generally formed due to inadequate blood supply, usually as a result of old age or obesity, and lead to atherosclerosis, which causes narrowing of arteries leading to circulation disorders. As a result, tissues are not nourished with essential substances. An arterial ulcer is most likely to be found on the outer part of the leg and may cause extreme pain upon walking and lying down.
What should I do?
Doppler ultrasonography of arterial blood vessels followed by consultation with relevant physician specialist.
Diabetic ulcer or wound
Diabetes affects blood vessels and neurons of various organs. As a result, arterial and venous lesions are caused simultaneously. In some cases, due to neuronal damage, numbness and pain insensitivity may occur. It is even possible that a person will step on a sharp object or get injured and will not feel it. For example, wounds can start as suspicious black spots at fingertips and spread to the entire leg. In extreme cases, the aforementioned may lead to leg amputation. Treatment of these wounds is systemic, as it would be with other wound types, and therefore will combine local treatment of the wound itself and, in addition, complex whole-body treatment with medications and nutrition.
What should I do?
Data collection on the course of the disease, Doppler ultrasonography, consultation, with neurologist, orthopedic specialist and diabetic foot specialist. It is important to provide diabetic patient with comfortable footwear.
Trauma wound
A trauma wound is a wound that causes damage to skin and mucous and is caused by physical trauma such as injury, accident, burn and even wound surgical wound. Sometimes after surgery (any operation, even a cesarean section) the wound does not heal properly and becomes infected. Trauma wounds are tend to be very painful, but recovery is usually faster than with other wound types.
What should I do?
Local treatment depending on wound type, stitches, if necessary, and sometimes even pain relief medication. In some cases, protective bandage may be needed as well, to protect against infection and for moisture retention, so the wound can heal faster.
A trauma wound is a wound that causes damage to the skin and mucous membranes caused by physical trauma such as: injury, accident, burn and even wound due to surgery. Sometimes after surgery (any operation, even a cesarean section) the wound does not heal properly and is infected. Trauma wounds are usually very painful, but recovery is usually faster than the other wounds.
Bedsores (pressure ulcers)
A wound that results from pressure due to direct and prolonged pressure on the skin. Pressure sores tend to occur, when soft tissue is pressed for a long time between bone protrusion and outer surface such as bed, armchair, plaster and more. It is important to know that there are several risk factors, which increase the risk of pressure ulcers, like older age, existing vascular disease and diabetes, urinary or fecal incontinence and lack of movement (in patients with rheumatic disorder or nursing care).
Unlike healthy people, who can change positions from time to time once they feel uncomfortable, patients who are numb, bed confined, nursed or unconscious cannot alter their position by themselves. In this case, prolonged pressure on the skin will lead to pressure ulcers. Pressure lesions usually appear in tailbone area, femur, heel, buttocks and other areas such as nose, and ears.
What should I do?
Take a preventive action against pressure wound formation by changing your position frequently, always checking the skin and by lying down or sitting on high quality mattress or cushion, adapted to the patient by an expert.
If pressure wound is formed, treatment should be immediate. It is important to remove any pressure on wound area, cleaning the wound thoroughly, and seeing a doctor or nurse.
In addition, a position change must be performed every two hours to allow proper blood flow, along with passive or active movement of the patient, in accordance with his or her ability. It is important to use preventive devices such as dynamic active air mattresses, air cushions for sitting and heel lifts. Care must be taken for personal hygiene and keeping of dry and clean environment, nutritional adjustment, and cleaning of sitting and lying down area.
