Physician Focus: April 2012
By Evan Provisor, M.D., F.A.C.S., and Susan Proulx,
B.S.N., R.N.
The human body has a wonderful ability to heal itself normally
from bumps, bruises, injuries and sores, but certain conditions can
hinder the healing process and lead to what health professionals
call chronic wounds.
A chronic wound is one that does not begin to heal from
conventional treatments within two weeks and is not completely
healed within four weeks. Anywhere from five to eight million
Americans have chronic wounds, which not only contribute to a poor
quality of life, but can also lead to more serious consequences
like infections and even amputation.
Several conditions can lead to these kinds of wounds: venous
ulcers, usually occurring in the legs; pressure ulcers or bed
sores, resulting from immobility; paraplegia and spinal cord
injuries; and injuries from radiation, such as that received in
cancer treatments. Problems with the body's circulatory system -
the organs and tissues involved with circulating blood throughout
the body - can also play a role, as does smoking, which puts carbon
monoxide into the body, impairing the delivery of oxygen to tissues
and thus slowing the healing process.
The highest incidence of chronic wounds, however, occurs among
patients with diabetes, a disease that currently affects some 26
million people in the U.S. (And it continues to grow: nearly
two million adults age 20 and older were newly diagnosed with the
disease in 2010, according to the Centers for Disease Control.)
Many patients with diabetes, for example, don't feel pain,
especially in their feet, so an injury from stepping on a nail or
even from shoes that are too tight, might go unnoticed. These
conditions can fester and form dangerous infections. (Because of
this inability to feel pain, patients with diabetes should check
their feet twice daily, as they may not be aware of a wound or
injury. It is critically important to do this, as diabetes is a
leading cause of non-traumatic lower limb amputations.)
Diabetes can affect the feet in two ways: by causing nerve
damage, a condition called diabetic neuropathy, signaled by
tingling or numbness in the feet; and by causing a narrowing of the
blood vessels in the feet. That means less blood is flowing to the
feet, which means less oxygen and nutrients are reaching the feet
to fight infection and promote healing.
Chronic wounds are best cared for in a wound care center, a
dedicated facility that treats these conditions beyond what a
physician may be able to offer in an office. Such a facility
provides ready access to physicians and nurses specializing in this
type of care, as well as services tailored to the needs of
individual patients. Many hospitals have established wound care
centers in recent years.
Among the services these centers provide are debridement, the
removal of unhealthy or dead tissue from a wound, a process that
assists in faster and better healing; advanced dressing materials;
temporary casts; temporary skin grafts with artificial skin; and
orthotic services that can provide custom footwear, temporary foot
aids, or custom inserts.
One of the state-of-the-art treatments offered at wound care
centers is hyperbaric oxygen therapy. With this treatment, the
patient lays inside a sealed, high-pressure chamber, breathing pure
oxygen. This increases the concentration of oxygen in the
bloodstream, thus promoting faster healing and lowering the risk of
amputation.
Wound centers provide a comprehensive approach to care for
chronic wounds, with health professionals examining vascular and
circulatory issues and treating inflammation, swelling, or an
infection that may need antibiotics. Further, wound center staff
work with patients individually and coordinate with other agencies
such as visiting nurses, should patients require that kind of
additional care.
Patients, especially those with diabetes, who may have a
slow-healing wound or sore should check with their primary care
physician to determine if specialized treatment is needed. Our skin
is the largest organ in our bodies and our first line of defense
against infection, and any wound or sore, however small, should
receive immediate attention.
For more information of the care of chronic wounds, including
tutorials on debridement, diabetic foot care, hand washing to
prevent infections, and treatment of sores, visit http://thewoundinstitute.com.
For a video discussion, visit the Massachusetts Medical Society's
site at www.physicianfocus.org/woundcare
Evan Provisor, M.D., F.A.C.S. is Medical Director, and Susan
Proulx, B.S.N., R.N., is Program Director of The Wound Care Center
at Harrington in Charlton, Mass., part of Harrington HealthCare
System based in Southbridge, Mass. Physician Focus is a public
service of the Massachusetts Medical Society. Readers should use
their own judgment when seeking medical care and consult with their
physician for treatment. Send comments to PhysicianFocus@mms.org
