Defining a Chronic Wound

Chronic wounds are a major cause of worldwide physical pain and economic woes. They are typically complex wounds, ones that do not heal in the predicted amount of time and continue to cause discomfort and medical bills for patients. Often caused by constant, unrelieved pressure or diseases such as diabetes, these wounds, if not healed properly, lead to increasing amounts of pain and in some cases amputation (Improving Chronic Wound Healing). The factors that contribute to this delayed or non-existent healing process vary; the University of Virginia Health Care System lists a few of the top culprits in chronic wounds:

  • Vascular disease
  • Infection
  • Diabetes or other metabolic disorders
  • Immunosuppression
  • Unrelieved Pressure
  • Radiation Injury
  • Malnutrition

Assessing a Chronic Wound

As the frequency and cost of treatments for chronic wounds increases due to the aging population and the rise of obesity and diabetes increases both in the U.S. and throughout the world, assessing chronic wounds and new therapies becomes fairly critical. The most prevalent chronic wounds are ulcers, caused by persistent pressure, neurological impairments, arterial issues, etc. The most current methods for chronic wound assessment rely largely on physical examinations of the wound; the wound surface appearance and the measurements of wound surface dimensions. The following list from Assessment of Chronic Woundsdetails the most common physical traits associated with a short selection of chronic wounds.

  • Pressure Ulcer: Generally located over bony prominences, Stage I of these ulcers are characterized by persistent redness in light pigmented skin, or red, blue or purple in darker colored skin. Stage II is often accompanied by breaking of the skin to result in a blister-like appearance. Stage III presents itself as a crater in the skin, with or without undermining of adjacent tissue.
  • Chronic Venous Insufficiency: Also called CVI, this ailment is characterized by a hardening of soft tissue, edema, hemosiderin staining, dermatitis or varicosities.
  • Neuropathic Ulcers: Often resulting from diabetes, these are caused by decreased blood flow to the appendage and result in redness, callouses, cracks, with sharp wound edges on the plantar surface.

Treatment

Cleansing of the wound should be performed using non-irritant and non-toxic solution. According to the PubMed article Evidence-based Management Strategies for Treatment of Chronic Wounds, many current dressings combine “components of wound bed preparation, that is, debridement and antimicrobial activity, with moisture control.” A moist environment is generally accepted as the best topical treatment for open wounds, such as Stage III ulcers. The wound dressing should minimize pain by preventing friction, be easy to move in, and protect the exposed tissue and skin.

There is increasing evidence that negative pressure therapy performed two to three times a week is helpful in promoting healing of chronic wounds. Negative pressure therapy (applying a vacuum through a special sealed dressing) after removing the unhealthy tissue, is helpful in decreasing the localized edema by drawing out excess fluid, increasing peripheral wound perfusion, promoting tissue development, and decreasing the overall size of the wound.

Further Reading

A Reliable Method of Determining Wound Healing Rate – Three hundred wounds were analyzed to find a measure of wound healing rate that is independent of initial wound extent and to present a method of wound healing rate prediction.

Pressure Ulcers: Prevention, Evaluation, and Management – This article examines the prevention, assessment, and treatment of this common ulcer that can severely threaten the well-being of patients with limited mobility.

Secret to Healing Chronic Wounds Might Lie in Tiny Pieces of Silent RNA – The Ohio State University Researchers present promising discoveries in their new experiments of targeting different RNA segments.

Do Topical Antibiotics Improve Wound Healing? – This evidence-based article examines the difference in using use of topical triple-antibiotic ointments compared with a petrolatum control ointment to see which method decreases infection in minor contaminated wounds.

In the World: Better wound treatment for all – Massachusetts Institute of Technology reports on a more basic and streamlined version of negative-pressure wound therapy. Put to the test in Haiti, this treatment could prove invaluable to the developing world.

Electrical Stimulation for the Treatment of Chronic Wounds – This extensive report examines electrical stimulation as a direct current, pulsated current, and alternating current, and its many different therapeutic applications as a possible therapy for wound healing.