By Janet Wolfson, PT, CLWT, CWS, CLT-LANA
Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.
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. Here are 10 of the most common factors affecting wound healing in chronic wounds:
There are many overall changes in healing capacity that are related to age. Studies have shown that people over the age of 60 may have delayed wound healing due factors associated with physical changes that occur with advanced age. In addition to multiple existing comorbidities, there is decrease in the body's inflammatory response, a delay in angiogenesis and the process of epithelialization is slower. Some visible changes to the skin are related to the alteration in melanocytes, such as age spots, as well as drier skin due to a decreased function of the sebaceous glands. Decreased collagen synthesis is attributed to slower scar formation in the wound healing process, as well.
The characteristics of a wound can affect the speed of wound healing. Obviously, larger wounds take longer to heal, but the shape of the wound can also play a part in the time of healing. Linear wounds typically heal faster than rectangular wounds, and circular wounds are the slowest to heal. In addition, wound healing is slower when wounds have necrotic tissue, desiccation, and foreign bodies.
All skin breaks can allow bacteria, virus, or fungus to enter the wound site. Normally, these pathogens are overtaken and eliminated by white blood cells and other components of the immune system. When infection is present, up through the surface and create sore or lesion which requires treatment through excellent wound care and perhaps administration of antibiotics.
Patients who have diabetes or have diseases affecting their circulatory system may have inhibited wound healing. Efficient wound healing requires good blood flow and chronic conditions which have compromised blood flow to the wound site may require therapeutic intervention. Individuals with chronic wounds are advised to consult a medical professional for a comprehensive assessment to identify appropriate treatment interventions.
In a chronically ill or geriatric patient, poor nutrition can cause the body to have insufficient resources to heal the wound. Inadequate nutrition can occur because infections increase the protein and caloric needs of an individual. Moreover, wounds can exude large quantities of protein daily, especially in the case of large pressure ulcers (injuries) or leg ulcers. When calories are inefficient, the body may break down protein for energy, further depleting the body's ability to heal.
A lack of moisture at the surface of a wound can halt cellular migration, decrease blood oxygenation, and seriously delay wound healing. Dehydration caused by either a depletion of sodium or water can delay all aspects of the healing process. While most people need 64 ounces of fluid daily, a person trying to recover from a wound will need to drink more to help the process of white blood cells traveling to the injury site to supply needed oxygen and nutrients. A properly hydrated patient will have urine that is clear and generally odorless.
Since blood delivers the necessary components to tissue for the wound healing process to take place, people with low blood pressure or vascular disease can have problems with delayed healing. Blocked or narrowed blood vessels or diseases of the heart, kidneys and lungs can also cause issues in the body delivering vital wound healing components, including white blood cells and adequate oxygen, to wounded tissues.
While most traumatic injuries cause some tissue swelling, excessive edema can increase the pressure on blood vessels, resulting in poorer blood circulation in the wound area. Tissue swelling can be caused by heart conditions or blood vessel problems. Compression therapy is often effective at transporting fluids back into the circulatory system to reduce edema so proper healing can occur.
Wounds that continue to be reinjured due to shear force or pressure against a surface can have their healing process delayed or even stopped. Repetitive trauma often occurs with bed-bound patients and can be treated by careful repositioning on a regular schedule or use of offloading or protective devices under the supervision of a health care professional.
Unfortunately, some patients contribute to delayed wound healing through lifestyle choices like smoking or excessive drinking. Other patient behaviors that can affect wound healing are a lack of adequate sleep, failure to elevate the affected area, not properly cleaning the wound, using inadequate wound dressing procedures, not keeping the wound moist and not moving enough. Listening to patients and providing careful education can help create better compliance with good wound healing practices.
Ideally, the complex processes of wound healing would resolve every wound successfully. Luckily, there are a number of treatment options to aid the healing of chronic wounds such as regular cleansing, debridement, special wound dressings, negative pressure wound therapy (NPWT), or hyperbaric oxygen therapy (HBO). For best patient outcomes, health care providers need to know how to recognize the factors that prevent wound healing so that they can use these alternative treatments appropriately.