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When wounds are difficult to heal
Last Updated: 10/17/2018




What do you do if you accidentally cut yourself with a knife while cooking or scrape your knees when you fall down? Usually, you clean and cover the wound with a bandage and ignore it. Within a few days, the wound heals, as the body has the ability to repair injuries.

However, in certain cases, it takes longer for a wound to heal. Wounds that do not respond to treatment after four weeks or have not healed in two months are considered chronic.

Askina Healthcare Centre Medical Director Dr. Divya Panicker says any injury can become a chronic wound if not treated appropriately. The larger the wound, the higher the risk for it to become non-healing and turn chronic.

Various factors affect the healing process. These include a lack of oxygen to the wound, bacterial infections on the wound surface, swelling due to a weak natural defense mechanism and the poor circulation of blood to affected areas.

“Chronic wounds fail to heal when they do not go through the four phases of healing—haemostasis, inflammatory, granulation, and remodeling.”

“Healing can remain stagnant in the inflammatory or granulation phases and will result in prolonged and lengthened recovery and, in some cases, the wound never completely heals. Some common examples of chronic wounds are ulcers—diabetic foot, pressure, arterial, venous—and radiation-induced wounds.”

Infection and immune-compromising conditions like diabetes, auto-immune diseases, and certain medications can predispose a person to the development of chronic wounds, as these conditions interfere with the body’s normal healing pathways.

Dr. Divya says that general conditions affecting the body can also result in chronic wounds, such as medications that depress the immune system, poor nutrition, advanced age, and diseases such as diabetes mellitus.

“Diabetes is one of the many causes of chronic wounds, as persistent high blood glucose levels can affect wound healing.

Uncontrolled diabetes causes narrowing of blood vessels, leading to poor nutrition and a lack of oxygenation to the wound. Decreased nerve sensation leads to an increased risk for trauma and neglected wounds as well as an increased risk of infection.

“The progress of infection in diabetics is also greatly accelerated, as it retards the immune system, which makes it difficult for the body’s natural infection control reactions to take place. Due to this, wound care in diabetics has to be administered early and properly to prevent complications.”


RISK OF INFECTION

The major concern for diabetic patients is always the high risk of infection and rapid spread, which generally involves deeper structures such as tendons and bones. The lack of sensation at the feet makes it hard to recognize wounds early, and this leads to neglected wounds.

“The dreaded complication of all diabetic foot ulcers is amputation. Levels of amputation vary depending on the extent and site of the wound. In some cases, especially where treatment is delayed, chronic wounds can lead to generalized infections and multi-organ failure, which leads to death.

“Patients should be aware that a non-healing wound, no matter what size, is a problem that needs expert and rapid attention. Its condition can deteriorate very quickly, especially if the patient has diabetes mellitus. If the right treatment is commenced in a timely manner, a lot of major life-threatening and debilitating complications can be avoided.”


TREATMENT

Treatment of a chronic wound is challenging because it needs personalized care focusing on wound management, compared to a simplistic approach. There is also a relatively longer management plan with the need to review and adjust plans frequently.

“Treatment for chronic wounds is complicated, and there is a need for a holistic multi-disciplinary management plan based on international guidelines. A specialist wound management center is able to provide the patient with the medical expertise and technology to maximize healing compared to general care.”

Reference:https://www.nst.com.my/lifestyle/heal/2018/09/414658/when-wounds-do-not-heal



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