Chronic Wounds

By Lauren Lazarevski, RN, BSN, CWOCN

Could metallic micronutrients be the missing link for your patient with a chronic wound? When we consider the nutrition required to optimize wound healing, protein supplementation is usually the star of the show. However, there are micronutrients involved in wound healing on a cellular level. Although the daily requirements may be small, they are mighty—and if deficient, they may be the missing step in healing a chronic wound.

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

A pilonidal cyst is a pocket located at the top of the cleft of the buttocks that usually results from an embedded or stiff hair. This area may remain dormant for years and cause no major issues; however, often the embedded or stiff hair may cause the cyst to become inflamed and infected, resulting in an abscess that requires an incision to drain the infected material. These abscesses can recur, causing the patient to require surgical intervention to remove the cyst. After surgery, some patients tend not to heal well, and the result is a chronic, tracking wound in an area that is difficult to heal.

By Temple University School of Podiatric Medicine Journal Review Club

Chronic wounds require an increased amount of oxygen to help with cellular function and growth. They often manifest with biofilm, slough, and necrotic tissue, all of which deprive cells of the oxygen they need to perform vital functions. Various forms of debridement are commonly employed to rid wounds of pathological tissues that negatively affect cellular communication and growth. Sharp surgical debridement is most frequently performed by physicians. Continuous diffusion of oxygen (CDO) involves the use of humidified, purified air at 3mL/hour in conjunction with moist wound therapy (MWT) dressing. A previous paper by Niederauer et al. published in 2018 in the Journal of Wound Care, described using CDO for healing DFUs. This study showed that CDO improved the healing rate of DFUs in terms of time, chronicity, and weight-bearing ability when compared to a placebo. Additionally, the previous paper described wound size, chronicity, and adverse events.

Biofilms are found in the majority of chronic wounds and pose a critical health threat, causing nearly 80% of refractory nosocomial infections. They also have a damaging virulence mechanism, which induces resistance to antimicrobials and evasion from the host’s immune system. Over 90% of chronic wounds contain bacteria and fungi living within a biofilm construct. Biofilms have been reported as major contributing factors to a multitude of chronic inflammatory diseases. Given the resistance of the bacteria, biofilms increase the risk of infection and cost the health care system millions of dollars annually. Clinicians should have practical knowledge of the role and impact that biofilms play in impeding chronic wounds, thus leading to risks of complications such as infection.

By Margaret Heale, RN, MSc, CWOCN

I had shopped before lockdown and had not needed to go to a supermarket for a while. Before my first big shopping event, I came across this online video: preventing your kitchen getting contaminated from your shopping. I smiled at the thought of people trying to use an aseptic technique in their kitchen while trying hard not to contaminate the kitchen, its contents, or themselves with imagined glitter (or coronavirus).

Paula Erwin-Toth, RN, MSN, FAAN

Hello to my wound care colleagues around the world. As I write this blog, the news relating to the results of COVID-19 continues to provide evidence of the profound impact this pandemic has had on those suffering from the disease and the negative impact shut downs and quarantines have had on the health of people with chronic illnesses. We, as health care providers, are under tremendous stress as many of us have been re-deployed to maintain and support the overwhelming challenges of front-line health care providers serving patients with COVID-19. We, too, are on the front lines helping to maintain skin integrity in critically ill patients who are often intubated and placed in the prone position. The physical, emotional, and financial strains on patients, health care providers, businesses, and governments are going to affect us for years to come.

By Temple University School of Podiatric Medicine Journal Review Club

Venous leg ulcerations (VLUs) are a common and often chronic pathology, and these wounds diminish the quality of life and increase the financial burden for affected patients. A recent article estimates that up to 3% of the U.S. population suffer from VLUs. A venous leg ulcer can be severely painful and may decrease a patient’s quality of life by affecting sleep, mobility, activities of daily living, and even result in social isolation. A 1994 paper proposed that approximately 65% of patients felt financially affected by a VLU, and this number is likely to have increased as a result of rising healthcare costs. The prevalence and chronic nature of the venous leg ulceration has motivated physicians to research novel techniques to heal ulcers successfully and in a timely manner.
Acellular dermal matrices have been utilized to treat diabetic foot ulcers with favorable outcomes.4 This study investigated the efficacy of a specific acellular dermal matrix for VLUs.

By the WoundSource Editors

Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.

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.