Chronic Wounds

Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Wounds tend to follow a certain algorithm when healing, which can be summed down to three distinct phases: hemostasic/inflammatory, proliferative, and remodeling. Chronic wounds are characterized as wounds that do not follow this pattern and fail to heal within 8 weeks. They tend to occur in patients that have uncontrolled comorbidities causing the healing cycle to get "stuck" in the inflammatory phase. There are roughly 6.5 million cases of chronic wounds noted annually in the United States. Thus, the need for better products that may induce quicker healing are highly sought after.

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Thomas Serena's picture
Wound Care Clinical Trials

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

A recent article by Kaiser Health News misquoted me as saying that we enroll only "healthy" patients in our clinical trials. At moments like this, one feels that something has been overlooked. One of my research coordinators, recalling the serious adverse events (SAEs) of the previous week said, "The only patients sicker than ours are underground."

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Janet Wolfson's picture
delayed wound healing

by Janet Wolfson PT, CLWT, CWS, CLT-LANA

Delayed wound healing: how did it start, what are we doing to prevent delay, and what could we be doing differently when delay is noted?

If you have worked in wound care a long time, there are those wounds we recall that were a real puzzle. Why wouldn't they heal when we were doing everything right? Sometimes it is as simple as finding out that the client has been sleeping in a recliner instead of a bed, in which case edema and sacral wounds will suffer. Or perhaps that the patient has resumed smoking now that their mobility allowed getting outdoors.

Temple University School of Podiatric Medicine's picture
literature review

Chronic wounds are clinically defined as wounds that have failed to proceed through a healing process in a timely and biologically efficient manner. They are easily identified due to their presence of a raised, hyperproliferative, and non-advancing wound margin. They often are not responsive to initial therapy, and still continue to exist even with adequate wound treatment and sharp debridement.

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Temple University School of Podiatric Medicine's picture
literature review

Diabetic foot ulcers often present in patients with diabetes mellitus, and are a serious and challenging complication that often requires time and costly procedures to treat. Diabetic foot ulcers are very difficult to heal and often become chronic, which increases the incidence of progressing to infection. The goal of diabetic foot ulcer management is to promote reepithelization of ulcerative areas, as well as address deficits of the ulcer such as necrotic tissue, inadequate perfusion, and inflammation.

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Temple University School of Podiatric Medicine's picture
wound care journal club

While opioids are routinely prescribed for painful and chronic wounds, the effects of the medications are not well described in literature. Past studies suggest that stimulation of mu-opiate receptors on keratinocytes may induce transforming growth factor-beta (TGF-beta) and cytokeratin 16 (CK16), which are molecules that appear in wound healing environments. However, other studies suggest opioids may impede immune activation and negatively affect healing.

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WoundSource Editors's picture
factors affecting healing in chronic wounds

by the WoundSource Editors

Whether due to injury or surgery, wound healing normally progresses steadily through an orderly set of stages. Wounds that don't heal within 30 days are considered chronic. Wounds that become chronic generally stall in one or more of the phases of wound healing.

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Janet Wolfson's picture
electrical stimulation therapy in wound healing

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA

I know we have all had those patients with diagnoses that impair their wounds forming granulation tissue to fill wound depth. Perhaps there are comorbidities such as diabetes, peripheral artery disease or malnutrition. Skin flaps, cellular and/or tissue-based products for wounds, and hyperbaric oxygen therapy are alternatives, but not every patient can tolerate surgery or a hyperbaric chamber, has a shallow enough wound or enough arterial supply to make these other options successful.

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Temple University School of Podiatric Medicine's picture
wound care literature review club

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

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Paula Erwin-Toth's picture
high touch patient care

by Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN

My last blog discussed the need to be high touch in a high-tech environment. This generated a lot of discussion among readers. Everyone agreed 'high touch' is important, but wondered what can we do to actually create that environment in all clinical settings?

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