NON-HEALING WOUNDS
Wounds which have not healed by 12 weeks are referred to as chronic wounds. They cause much distress and prevent individuals from leading active lives. Pain at the affected site is very common among individuals with nonhealing wounds.
Wound healing progresses from injury to scar formation. In chronic wounds, this progress is arrested in the early stages.
What are the causes of nonhealing wounds?
Nonhealing wounds result from factors which prevent normal wound healing. These factors can be localized at the wound or systemic. The commonly associated causes include:
How are chronic wounds managed?
History and clinical examination help us ascertain the factors which contribute to the nonhealing status of the wound. Additional information is obtained with the help of investigations to assess the vascularity and perfusion of tissues. Bacteriological examination reveals the predominant microbes and the sensitivity pattern to antibiotics. Imaging techniques such as CT and MRI help delineate the extent of pathology and the presence of devitalized tissues in the wound. Tissue diagnosis is done in cases where malignancy or connective tissue disorders are a possibility.
These tests are customized depending on the clinical findings in the patient.
Steps are taken to improve the conditions favorable to wound healing. Nutritional parameters are monitored and if necessary nutritional supplements are recommended.
Additional interventions may be performed to improve the perfusion abnormalities.
The presence of devitalized tissues in the wound bed impair healing. Wounds are cleaned and kept covered with dressings. Sometimes operative debridement is carried out in the presence of significant contamination. Treatment modalities to achieve closure of the wound include,
Wound healing progresses from injury to scar formation. In chronic wounds, this progress is arrested in the early stages.
What are the causes of nonhealing wounds?
Nonhealing wounds result from factors which prevent normal wound healing. These factors can be localized at the wound or systemic. The commonly associated causes include:
- Ischemia
- Diabetes
- Venous insufficiency
- Malignancy
- Vasculitis
- Trauma
How are chronic wounds managed?
History and clinical examination help us ascertain the factors which contribute to the nonhealing status of the wound. Additional information is obtained with the help of investigations to assess the vascularity and perfusion of tissues. Bacteriological examination reveals the predominant microbes and the sensitivity pattern to antibiotics. Imaging techniques such as CT and MRI help delineate the extent of pathology and the presence of devitalized tissues in the wound. Tissue diagnosis is done in cases where malignancy or connective tissue disorders are a possibility.
These tests are customized depending on the clinical findings in the patient.
Steps are taken to improve the conditions favorable to wound healing. Nutritional parameters are monitored and if necessary nutritional supplements are recommended.
Additional interventions may be performed to improve the perfusion abnormalities.
The presence of devitalized tissues in the wound bed impair healing. Wounds are cleaned and kept covered with dressings. Sometimes operative debridement is carried out in the presence of significant contamination. Treatment modalities to achieve closure of the wound include,
- Conservative management, with regular dressing changes.
- Surgery. This includes coverage with skin grafts or flaps.
- Negative pressure wound therapy (NPWT).
Non-healing wound overlying the tendoachilles
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Following debridement and coverage with a distally based fasciocutaneous flap
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Postoperative image which shows healed wounds
Postoperative image with contraction of tendoachilles
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