Chronic Wounds

What are Chronic Wounds?

Chronic wounds, also known as ulcers, are wounds that have a biological or physiological reason for not healing. The fact that a wound is chronic has nothing to do with the amount of time the wound has been present. If unrecognized and untreated, chronic wounds — such as a leg ulcer from a vein problem, a foot ulcer in a person with diabetes, a bed sore, or an infected wound — can have severe health complications.

Chronic wounds can be recognized by the loss of skin and/or tissue surrounding the wound. Once a wound has become chronic, intensive medical intervention is required to make the wound heal. There are a variety of types of chronic wounds and each has its own causes and treatment regimens. To learn more about a specific chronic wound and its treatment, please see below.

Types of Chronic Wounds:

Diabetic Wounds

Another major cause of chronic wounds, diabetes, is increasing in prevalence. Diabetic Wounds also known as (foot ulcers) refer to any break in the top layer of the skin (epidermis) on the foot of a person who has diabetes. The formation of ulcers may be caused by a loss of sensation (neuropathy) and/or inadequate blood flow (ischemia). For example, pressure or a cut from poorly fitted shoes can lead to a diabetic foot ulcer. A callus should be considered an ulcer. Infection is likely to arise if a wound does not receive early treatment. Since people with diabetes are less able to fight infection, early treatment is beneficial.

People with diabetes are at increased risk for neuropathy, or nerve damage affecting the motor, sensory, and autonomic nerves. Motor neuropathy can cause muscle weakness, reduction of muscle, and paralysis. Sensory neuropathy can lead to a loss of the protective sensations of pain, pressure, and heat. Autonomic neuropathy can cause the blood vessels to swell, impairing the ability to sweat and resulting in warm, overly dry feet with the skin at risk of breaking down.

The loss of sensation associated with neuropathy can make a person with diabetes unaware of the constant trauma to the feet caused by poorly fitting shoes, improper weight bearing, hard objects such as pebbles in the shoes, or infections such as athlete's foot. By preventing the detection of pain and pressure, neuropathy can make individuals with diabetes unable to adjust their gait to avoid walking on an area of the foot where pressure is causing trauma to cells and tissue.

Venous ulcers

Venous ulcers, which usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly. Venous ulcers are most commonly found in the area above the ankle but can include any area below the knee. The leg may become swollen, causing the skin surrounding the ulcer to become dry, itchy, and sometimes brownish in color. Dermatitis (eczema) may occur. Venous ulcers are caused by venous reflux. Venous reflux means that the blood flows backward through the circulatory system. When the veins are not working properly, the blood backs up into the superficial veins, increasing pressure and causing the veins to become elongated and dilated. The tissue surrounding those veins no longer receives a good supply of fresh blood, including the infection-fighting white blood cells. As a result, toxins remain in the tissue and the site may become ulcerated.

Testing & Treatment

Topical treatments may decrease the rate of infection and promote a moist environment, which stimulates healing. The creams and dressings may be used jointly with compression garments and compression therapy. Well-conducted studies have shown that this combination of topical and compression therapies promotes the healing of venous ulcers.

After you heal, it is critically important to wear a compression stocking to help prevent recurrence.

Oral and intravenous (IV) antibiotics are specifically chosen based on the patient's medical condition and the type of bacteria growing in and around the wound. (Bacteria are identified through deep cultures or tissue samples.) To prevent the bacteria from becoming resistant, antibiotics are used selectively for finite periods of time.

Used correctly, antibiotics can promote a clean wound bed that will stimulate wound healing. If an infection is present, oral antibiotics are initially given. If cellulitis (redness) or other signs of infection have not improved after a week of oral antibiotics, intravenous (IV) antibiotics will be administered.