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What You Need to Know About Wounds

By Dr. Andre Willaims

What You Need to Know About WoundsWhat is a wound?
A wound may be described in many ways; by its etiology, anatomical location, or by whether it is acute or chronic. A wound is defined as an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. An ulcer is defined as an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal. The words wounds and ulcers are synonymous and can be used interchangeably.

What causes wounds?
Wounds are caused by a break to the skin by pressure. This pressure could be internal or external forces on the skin.

Venous wounds are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major occurrence of chronic wounds, occurring in 70% to 90% of leg ulcer cases.

Diabetic or neuropathic wounds are one of the most significant and devastating complications of diabetes, and is defined as an ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Diabetic ulcers are commonly located on the bottom of the foot.

Arterial wounds, also known as ischemic ulcers or ischemic wounds, are mostly located on the lateral surface of the ankle or the distal digits. They are commonly caused by peripheral artery disease (PAD). The ulcers are caused by lack of blood flow to the capillary beds of the lower extremities. The ulcer has a punched-out appearance. It is intensely painful.

Decubitus or pressure ulcers also known as pressure sores, decubitus ulcers, and bedsores, are referred to as pressure injuries that are localized damage to the skin and/or underlying tissue. These usually occur over a bony prominence as a result of pressure or pressure in combination with shear and/or friction. The most common sites are the skin overlying the sacrum, coccyx, heels or the hips, but other sites such as the elbows, knees, ankles, back of shoulders, or the back of the cranium can be affected.

Pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear force is also a cause, as it can pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in individuals who are not moving about, such as those bedridden or confined to a wheelchair. It is widely believed that other factors can influence the tolerance of skin for pressure and shear, thereby increasing the risk of pressure ulcer development. These factors are protein-calorie malnutrition, skin wetness caused by sweating or incontinence, diseases that reduce blood flow to the skin, such as arteriosclerosis, or diseases that reduce the sensation in the skin, such as paralysis or neuropathy.

When to seek care of a wound?
If a wound has been present for 7-10 days without signs of improvement then seek medical attention in your normal healthy person. In a diabetic or immunocompromised individual, wounds should be evaluated as soon as possible. In additon, medical attention is needed if signs of an infection are present:expanding redness around the wound, yellow or greenish-colored pus or cloudy wound drainage, increased swelling, tenderness, or pain around the wound, or fever.

How do we treat wounds?
Many home remedies that we used years ago are no longer appropriate. These treatments would be the use of alcohol, peroxide, or mercurochrome on wounds. It’s true that they are bactericidal, killing surface bacteria, but they are also cytotoxic. Cytotoxic means these agents kill good tissue and bad tissues indiscriminately. If a wound is “dirty” it is best to cleanse the wound with copious amounts of saline.

The mainstay of wound care is debridement. Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. There are different types of debridement; mechanical, sharp, autolytic and chemical. Mechanical debridement is done through the use of wet and dry dressings that are regularly changed throughout the healing process. Dressings most often used start off as wet, slowly drying with the tissue so that, when the dressing is removed, the necrotic tissue is removed along with it. Autolytic debridement is using your body’s own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Chemical or enzymatic debridement using enzymes that are fast acting products that slough off necrotic tissue. Surgical or “sharp” debridement and laser debridement are the fastest methods of debridement. Surgical debridement can be performed in the operating room or bedside, depending on the extent of the necrotic material and a patient’s ability to tolerate the procedure. The benefits of wound debridement include reducing the amount of bacteria on the wound surface, converting a “chronic” wound to an “acute wound”, and faster healing times.

There are numerous topical wound care products to help heal wounds. The ideal wound environment is a moist wound bed, using wet agents if the wound bed is too dry and drying agents if the wound bed is too wet. Care must be directed at the underlying cause as well. Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency. Compression therapy reduces edema, improves venous reflux, enhances healing of ulcers, and reduces pain. Leg elevation when used in combination with compression therapy is also considered standard of care. Leg elevation requires raising lower extremities above the level of the heart. Treatment of arterial ulcers focuses on improving blood flow to the affected area. And includes quitting smoking, managing blood pressure, cholesterol, triglyceride and glucose levels, and ensure that footwear is properly fitted to avoid points of rubbing or pressure. The management of diabetic foot ulcers requires offloading the wound by using appropriate therapeutic footwear, daily dressings to provide a moist wound environment, debridement when necessary, antibiotic therapy if an infection is present, optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency. Treatment of decubitus ulcers can include some or all of the following: cleaning the ulcer, reducing pressure on the area by repositioning and using supporting surfaces, and diet changes and increased fluid intake for faster recovery.

When wounds fail to respond to conventional treatment modalities, advanced wound care therapies are available. These can include the use of negative pressure wound therapy, growth factors, bioengineered skin replacements, and the emergence of stem cell therapy. Advances in wound care research and development is a growing industry that has made significant achievements in the past few years.

The average time for wounds to heal is twelve to sixteen weeks. There are an estimated six million wounds in the United States. The average cost is $3,927 per wound to heal. Wound care has evolved and our team of doctors is available for all your lower extremity wound care needs.

Foot and Ankle Center of Charlotte County
352 Milus Street, Punta Gorda, FL 33950
3406 Tamiami Trail, Suite 1, Port Charlotte, FL 33952
941-639-0025 | www.ccfootcare.com

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