Dr. Paul Skudder, MD FAC
Open wounds on the body, particularly the legs, are common and troublesome. Some are difficult to heal, particularly as we age. Some wounds grow worse or become infected. Pain and disability can then result.
Healing wounds involves several considerations. When underlying tissue is healthy and the wound is not large, healing is usually straightforward. Underlying problems can cause even minor wounds to fail to heal or become more severe. Treating wounds often requires a team effort involving patients, families, physicians, and others.
You may want to consider the following factors if you have a wound that is not healing properly:
- Test for circulation problems. There are simple non-invasive tests that can be done in outpatient settings to see if you have adequate blood flow for healing. Slow healing can happen despite poor circulation, but such wounds often recur. Underlying circulation problems usually need to be treated or repaired before some wounds can be expected to heal. Circulation problems are now most often treated with minimally invasive repair of both arteries or veins. These can be accomplished on an outpatient basis in vascular surgery offices or hospitals. One procedure may include an angioplasty, or ballooning, of a blocked artery that is restricting blood flow to the limb so there is not enough oxygen and nutrition for the wound to heal. In other cases, the problem involves a leaking valve in a vein of the leg. This can be treated with a simple catheter procedure under local anesthesia in the physician’s office.
- Diabetes can cause a reduction in the ability to fight infection and to grow and heal tissue, especially with high blood sugar or an elevated Hemoglobin A1C. Controlling blood sugar will help heal your wound.
- Neuropathy causes a reduced sensation and sometimes associated with discomfort, burning sensations or “pins and needles” sensations. This allows minor injury, pressure points, or open areas to go unrecognized and contributes to diminished wound development.
- Wounds under pressure or with weight-bearing heal poorly. Wounds must therefore be “offloaded” or unweighted.” Podiatrists or foot specialists help immensely with this problem. Prescriptions may include footwear inserts, a “metatarsal bar” inside issue, “donut” dressings, special boots, or custom shoes. Some pressure points (bunions for example) may require a medical procedure to reduce pressure.
- Appropriate Moisture. Wounds heal best when kept moist so dressing with products which foster this are helpful. Too much moisture can cause the wound to become macerated and inhibit healing.
- Infection. Wounds need to be clean. Accumulated residue of unhealthy tissue, slough, or slime should be removed (“debrided”) at regular intervals to aid in this. Antibiotics shouldn’t be prescribed for all wounds. They can have real side effects of nausea, diarrhea, rash, or allergy. Antibiotic overtreatment can be detrimental to the wound, causing resistant bacteria like MRSA and pseudomonas. In addition, treatment with antibiotics doesn’t usually heal a wound which requires treatment of the underlying cause such as poor circulation. X-rays can be used to assess possible deep infection at the bone (osteomyelitis). Treatment of osteomyelitis can require lengthy tedious treatment with many weeks of intravenous antibiotics and removal of infected bone.
- Nutrition. Eating a healthy diet with good protein will help wound healing.
- Smoking. It is well known that smoking inhibits wound healing. Consider smoking cessation. 9. Negative pressure wound therapy. (Wound Vac) involves a special dressing over a wound connected to a device which applies constant suction to the wound. This accelerates filling in wounds that are clean, deep and meet certain other criteria. It can be used in the home with good results.
- Bioengineered skin substitutes. These products don’t replace the patient’s skin and shouldn’t be confused with real skin grafts which can result in very rapid healing. “Skin substitutes” are bioengineered products from living tissues like placenta or infantile skin that can accelerate healing of certain wounds.
- Hyperbaric oxygen therapy (HBOT) was developed for divers with the “Bends” after too rapidly re-surfacing. Patients enter a clear plastic pressure chamber for 1-2 hours five days a week, usually for about two months. HBOT is inconvenient and costly, but there are certain wounds for which this treatment is advantageous.
Not all patient with wounds require special attention. Wounds from minor injuries that are not deep, with little bleeding and low concern for infection, poor circulation, diabetes will usually heal nicely if kept clean and free from further injury. When concerns are present, or the wound is not behaving as expected, evaluation by a vascular specialist or other individual skilled in wound care is appropriate.
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