Chronic Wounds

By Christine Miller DPM, PhD

It is an understatement to say that these are trying and uncertain times, as we ride this unpredictable wave of the COVID-19 pandemic. All of us in wound healing as part of the greater health care force are deemed essential, so we cannot "shelter in place." As health care workers, we have to balance our duty to render care with that of protecting ourselves, a tricky tightrope balancing act. The media coverage of this pandemic is constant and anxiety producing, but it has made me ponder the term essential and what that truly means to our patients.

By Windy Cole, DPM

In my recent WoundSource webinar, I discussed the topic of diabetic foot ulcers (DFUs) and using advanced therapies to encourage their healing. The webinar is still available for viewing on WoundSource.com. Chronic lower extremity wounds present significant challenges with regard to effective wound management. Ischemia, microcirculatory dysfunction and peripheral vascular disease cause limitations in blood flow that can delay the healing process.

By the WoundSource Editors

Conservative sharp debridement: Conservative sharp debridement is done outside the operating room, and although it removes necrotic tissue and debris, it is not as aggressive a procedure as surgical sharp debridement.

Eschar: Eschar is dead tissue and is found only in full- thickness wounds. It may be tan, brown, or black.

Fibroblasts: Fibroblasts have several roles in wound healing, including breaking down fibrin clots, creating new extracellular matrix and collagen structures, and contracting the wound.

By the WoundSource Editors

Advanced Treatment Modalities: Wound care interventions that are typically applied when standard of care treatments have failed to lead to significant wound closure progress. Treatments include collagen products, cellular and/or tissue-based products, negative pressure wound therapy, hyperbaric oxygen, and others.

Cellular and/or Tissue-Based Products: Cellular and/or tissue-based products (CTPs) actively promote healing by stimulating the patient’s own cells to regenerate healthy tissue.

Collagen: Collagen is the most abundant protein in the human body. In wound healing, collagen attracts fibroblasts and encourages the deposition of new collagen to the wound bed.

By the WoundSource Editors

Wound healing is a complex biological process that involves a sequence of molecular and cellular events to restore damaged tissue. These events occur within the extracellular matrix, a complex three-dimensional acellular environment that is present within all tissue and essential for life. Remodeling within this extracellular matrix is necessary for tissue repair throughout the wound healing process, including during the inflammatory phase.

By the WoundSource Editors

Wound reepithelialization is key in the goal of wound closure. Reepithelialization is a coordinated multifactorial systemic process that involves formation of new epithelium and skin appendages. The epithelialization process can be stalled by a number of factors, all of which must be resolved before wound healing can move forward.

By the WoundSource Editors

Wound chronicity is defined as any wound that is physiologically impaired due to a disruption in the wound healing cascade: 1) hemostasis, 2) inflammation, 3) proliferation, and 4) maturation/remodeling. To effectively manage chronic wounds, we must understand the normal healing process and wound bed preparation (WBP). Wound chronicity can occur due to impaired angiogenesis, innervation, or cellular migration. The presence of biofilm and infection are the most common causes of delayed healing.

By the WoundSource Editors

Wound chronicity is an ongoing challenge for patients and health care professionals around the globe. An astonishing 4.5 million people in the United States experience lower extremity wound chronicity, while an estimated 1% are affected in the Western population with all types of chronic wounds. The cascade of wound healing does not always follow suit in an orderly fashion of hemostasis, inflammation, proliferation, and remodeling.

By the WoundSource Editors

The venous leg ulcer (VLU) is the most common type of chronic leg wound, and it can be challenging to manage. VLUs account for up to 90% of all chronic leg ulcers. Proper diagnosis and treatment planning are key to wound healing outcomes. This fact is particularly true for older adults, who have an annual VLU prevalence of 1.7%.

By the WoundSource Editors

The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care system. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years old or older have venous ulcers. Identifying signs of venous disease early on while implementing surgical intervention, if warranted, can increase healing outcomes and decrease the recurrence of venous ulcers. Treatment of venous ulcers can include exercise, leg elevation, dressings, advanced wound care such as cellular and tissue-based products, compression therapy, medications, venous ablation, and surgical intervention.