Doctors battling an epidemic of wounds that won’t heal

Sunday, Aug. 30, 2015 | 2 a.m.

Wound healing, particularly chronic wound healing, is a complicated and dynamic process that can require a concentrated multidisciplinary approach. While wound treatment often is left in the hands of primary care physicians, more and more wound centers are cropping up all over the country to account for an increase in hard-to-heal and chronic wounds. “Wounds aren’t healing for many people, and it’s a worldwide epidemic,” said Dr. Naz Wahab, medical director of the Outpatient Wound Center and Hyperbaric Center at MountainView Hospital. “The skin is the body’s first defense mechanism, so if it becomes damaged, it is a significant entry point to the rest of the body.”

What is a chronic wound?

A chronic wound occurs when a wound is unable to heal within a predictable amount of time and may be stuck in one or more stages of the healing process. Wounds that do not heal within three months typically are considered chronic. Chronic wounds can be painful and can last years or even lifetimes.

“We’ll see patients who have had the same wound for 30 or 40 years,” Wahab said. “And the longer it takes patients to seek treatment, the longer the wound takes to heal.”

Stages of wound healing

1. Inflammatory phase: This phase is marked by pain, swelling and loss of function at the wound side. Chronic wounds most often are stuck in the inflammatory phase.

2. Epithelialization phase: This phase occurs when the body begins to create a scab, which provides temporary protection to the wound.

3. Maturation phase: This phase is the scarring period, as the body fills in the wound with new tissue to restore the skin's integrity.

Why is the problem on the rise?

The increase in chronic wounds can be attributed to many things, but certain patients may be more susceptible than others. Patients with compromised immune systems, diabetes or poor nutrition are most likely to develop chronic wounds. Antibiotic resistance also is a contributing factor, because patients who develop infections have fewer treatment options, which could delay or prevent healing.

“What I wish more people understood is that chronic wounds are a public health concern, and they need to be addressed accordingly,” Wahab said. “At the Wound Center, our goal is to heal the wound from what caused it, not just heal the wound itself.”

How are chronic wounds treated?

Wound management typically involves the following people: vascular surgeons, primary care wound specialists, intervention cardiologists, podiatric specialists, nurse practitioners and physical surgeons. A number of advanced interventions also may be necessary depending on the wound.

Hyperbaric oxygen therapy: The patient is placed into a hyperbaric oxygen chamber filled with pure, pressurized oxygen that encourages cell renewal and discourages infection.

Skin substitutes: A skin graft is performed using skin grown in a lab, rather than taken from another part of the patient’s body.

Emergency limb salvage: A surgical procedure used for patients with serious infections, where the bone is replaced or reconstructed. This procedure is used to avoid amputation when possible.

In case of emergency, follow these steps

1. Stop the bleeding: While wearing gloves and using clean cloths, apply steady, direct pressure to the wound for 15 minutes. If the wound continues to bleed heavily after 15 minutes, seek medical attention.

2. Rinse the wound: Use clean, lukewarm water to remove any large pieces of dirt or debris. Once the wound is free of debris, wash it with a mild, antibacterial soap.

3. Apply a bandage: Once the wound is cleaned thoroughly, apply an appropriately sized bandage. It should completely cover the wound. Replace the bandage every day or every time it gets wet.

NOTE: If you have a large, deep or dirty wound, or a wound that won’t stop bleeding, seek emergency medical attention. Most wounds that require stitches will need to be treated within six to eight hours, and no longer than 24 hours to avoid infection.

Are you bandaging your wounds properly?

While many of the most serious cases handled at wound centers are exacerbated by diabetes or patients’ weakened immune systems, it’s important to bandage injuries properly and to seek medical attention when necessary.