Chronic wounds require timely care

Dr. Troy Griffiths
Dr. Troy Griffiths

Chronic wounds constitute a significant burden to patients, health care professionals and the entire health care system, affecting 5.7 million patients and costing an estimated $20 billion annually. Potential complications associated with chronic wounds further increase the stress and cost of treatment.

Chronic lower extremity wounds are those that have failed to proceed through an orderly and timely process of anatomic and functional integrity in a predictable amount of time. Typically, wounds that don’t heal within three months are considered “chronic.”

With a normal healing process, there are predicable phases through which wounds progress. Chronic wounds stall in one or more of those phases and often remain in the inflammatory stage too long. Overcoming a stalled wound can only be achieved when a number of factors are addressed — lowering the bacterial burden, removing non-viable tissue, balancing the moisture in and around the wound and implementing other treatments to jump start the healing process.

Because of the complexity of each case, the care of chronic wounds has evolved into its own specialty. Specialists now use a variety of advanced treatment techniques, including amniotic membranes, engineered skin substitutes, extracellular matrices, growth factors, hyperbaric oxygen, negative pressure, stem cells and topical oxygen.

If not addressed in a timely manner, chronic wounds can last for a year or longer and, once eventually healed, have a much higher recurrence rate than a wound that went on to heal in a normal manner. Chronic wounds often require surgical removal of devitalized tissues to promote a healthy wound bed. Oral or intravenous antibiotics can be used to control infections.

Individuals with the one or more of the following medical problems or factors are at risk for developing chronic wounds, including the elderly and smokers as well as those with AIDS, anemia, atherosclerosis, cancer, chronic corticosteroid use, diabetes, deep venous thrombosis, heart disease, high blood pressure or cholesterol, malnutrition, neuropathy or nerve damage, obesity, paralysis, peripheral vascular disease, prolonged bed rest, severe burns and varicose veins. The list isn’t exclusive, but offers an understanding of the conditions associated with chronic wounds.

Chronic wounds are often classified based on their causes. Categories include diabetic, neuropathic and pressure ulcers as well as surgical and traumatic wounds. The underlying pathologies must be addressed and stabilized to treat chronic wounds and achieve lasting results.

Chronic lower extremity wounds can lead to amputation of the limb if not addressed properly and in a timely fashion. The five-year survival rates of individuals who have a non-traumatic, below-knee amputations can be as low as 40 percent and even lower if the patient also has kidney disease.

If your wound is healing more slowly than you were told to expect, contact a medical professional. It’s imperative patients receive proper and aggressive treatment for chronic wounds to prevent more complications from arising.

Stabilizing and overcoming the underlying factors that contribute to delayed healing is a part of comprehensive approach to wound care and presents the primary challenges to treating chronic wounds.