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Author: Prasad Kilaru, MD
Specialty:
Plastic Surgery
The human body can do some really incredible things. If you think about a typical scrape or a cut, it can go from bleeding to fully healed in less than a month. That’s pretty amazing. However, some conditions can interrupt your body’s natural healing process, resulting in chronic or non-healing wounds.
Chronic wounds are ulcerations that don’t follow a predictable pattern of healing, typically showing slow or no improvement within 4 -6 weeks. Often caused by an underlying condition or conditions, these can take years to heal or may never heal completely. Without specialized medical intervention, chronic wounds put their owners at an increased risk of infection, which can lead to serious complications including loss of limb or life.
Some types of chronic wounds include:
Usually, your body heals in four fairly predictable stages: the hemostasis, inflammation, proliferation and maturation phases. In chronic, non-healing wounds one or multiple stages of this process have been interrupted.
In the hemostasis phase, your body is attempting to stop the loss of blood. Platelets in your bloodstream bond together to plug holes in the injured blood vessel.
The swelling, heat and redness you typically associate with the inflammation phase is your body flooding the injury site with water, salt and protein. This helps restrict blood flow, prevent infection, and promote healing by making the wound site more accessible for repair agents like nutrients, enzymes and white blood cells.
In the proliferation phase, granulation tissue, which is made up of new blood vessels and connective tissues, begins to form over the wound.
Finally, the maturation phase is where a wound fully heals. All of the repair agents are removed and thick, collagen-rich scar tissue is rearranged to make the skin and repaired structures stronger. This can begin a few weeks after a wound appears and last for a year or more.
This wound healing process can be disrupted by several factors, including infection, poor blood supply or shearing. Sometimes a wound can’t progress past the inflammatory or proliferative phase—that’s when increased attention is needed.
Chronic wounds can have a considerable impact on one’s quality of life. In addition to the physical pain they cause, they can cause psychological strife, mobility issues, and be expensive to treat.
Because they are often caused by underlying medical conditions like diabetes, peripheral artery disease, varicose veins or chronic immobility, they require a team of specialists to treat the wound as well as manage the cause. This may include endocrinologists, podiatrists, plastic surgeons, vascular surgeons, infectious disease specialists, pain management specialists or physical therapists and involve a variety of therapies including infection control, hyperbaric oxygen therapy, negative pressure therapy, debridement and advanced therapies such as the use of skin substitutes and finally possible surgical intervention.
To learn more about how we treat chronic or non-healing wounds at the Washington Center for Wound Healing and Hyperbaric Medicine, visit the Washington Hospital website.
Posted July, 2019