Chronic Wound Care

GENERAL INFORMATION:

What is a chronic wound? A wound is an injury that causes a break in the skin. A chronic wound is a wound that has not healed completely after 4 to 6 weeks. Normally, wound healing involves a complete and efficient process of tissue repair. A chronic wound occurs when this process is disturbed and healing becomes a problem. The wound may be a deep ulcer (open sore), a large burn, or an infected wound. Muscles, blood vessels, bones, and other body parts may be affected. Sometimes, tissue loss may be seen.

What causes a chronic wound? Anything that affects one or more of the stages of healing may lead to a chronic wound. This may include any of the following:

• Diseases: Diseases, such as diabetes, liver, kidney, or lung conditions, and cancer, may slow the healing process.
  
  
• Poor blood supply or low oxygen: Blood flow may be decreased due to low blood pressure, and blocked or narrowed blood vessels. This may be a common problem in people who smoke, or have blood vessel problems or heart conditions. Low oxygen supply may be caused by certain blood, heart, and lung diseases.
  
  
• Repeated trauma: This may include swelling or increased pressure in the tissues, or constant pressure on the wound area.
  
  
• Weak immune system: The immune system is the part of the body that fights infection. This may be weakened by radiation, poor nutrition, and certain medicines, such as anti-cancer medicines or steroids. Increasing age may also decrease the body's ability to respond to injury.
  
  
• Wound infection or presence of foreign objects: Infection happens when a large number of bacteria (germs) get into the wound. Dead tissue and foreign objects, such as glass or metal, present in the wound may delay wound healing.

What are the signs and symptoms of a chronic wound? The wound may be big or deep which may have started as a simple scrape, cut, tear, or bruise. The skin may be deformed with some part lost. The skin color may change to black. You may have bleeding, swelling, pain, or trouble moving the affected area. If the wound is infected, it may have pus which may be draining out of the skin. The pus may be milky, yellow, green, or brown, and may have a bad smell. The area around the pus may be red, tender, or feel warm when touched. You may also develop a fever.

How is a chronic wound diagnosed? Your caregiver may check your health history, including diseases, medicines you are taking, and past surgeries. He will also need to know when and how you were wounded. You may have any of the following:

• Physical exam: Caregivers will look closely at the injury, including the area around it. He will check to see how much skin was broken and how deep the wound is. He will also look for other problems or signs of infection. How well you move and feel things in your injured body part may be tested. These are usually needed if the wound is deep.
  
  
• Blood tests: Different blood tests may be done to see if you have an infection and what may be causing your infection. You may need to have blood taken for tests more than once.
  
  
• Wound culture: This is a test to grow and identify the germs that may be in your wound. This helps caregivers learn what kind of infection you have and what medicine is best to treat it. This test may be needed if your wound is infected or contaminated (dirty).
  
  
• X-ray: This is a picture of your bones and tissues in the wound area. You may need to have an x-ray, especially if the wound is near a joint or bone. Caregivers use the pictures to look for broken bones, injuries, or foreign objects such as glass or metal.

How is a chronic wound treated? Treatment will depend on how severe the wound is, its location, and whether other areas are affected. If another condition is causing problems with wound healing, it is important to treat or control this problem. Your treatment may change if your wound is not improving. You may need any of the following:

• Medicines: Your caregiver may give you antibiotic medicine to fight infection. This medicine may be taken by mouth, given through the vein, or applied directly on the wound area. You may also be given medicine to ease symptoms, such as pain, swelling, and fever.
  
  
• Wound care:
  
  
  • Cleansing: This may be done by flushing the wound with sterile (clean) water. It may be done under high pressure, using a needle or catheter (tube) tip and large syringe. A solution that kills germs may also be used. If the wound is large and needs further cleaning, a whirlpool treatment or hydrotherapy may be done.
    
    
  • Debridement: Debridement is done to clean and remove objects, dirt, or dead skin and tissues from the wound area. This may be done in different ways. Caregivers may cut out the damaged areas in or around the wound. Maggots which eat dead tissues may be used. Wet bandages may be placed inside the wound and left to dry. Special dressings containing enzymes may also be used. Caregivers may also drain the wound to clean out pus.
    
    
  • Wound cover: This may also be called wound dressing. Dressings are used to protect the wound from further injury and infection. These may also help give pressure to decrease swelling. Dressings may be in the form of bandages, films, or foams. They may contain certain substances that may help promote faster healing. Sometimes, skin taken from another part of the body may be used to close a large wound. The skin may also be man-made, which contains special cells needed to repair damaged tissues.
  
  
• Additional treatments:
  
  
  • Hyperbaric oxygen therapy: This is also called HBO. HBO is used to get more oxygen into your body. The oxygen is given under pressure to help it get into your tissues and blood. You may be put into a tube-like chamber called a hyperbaric or pressure chamber. You will be able to see your caregivers and talk with them through a speaker. You may need to have this therapy more than once.
    
    
  • Negative pressure therapy: This is also called vacuum-assisted closure (VAC). A special foam dressing with an attached tube is placed inside the wound cavity and tightly covered. The tube is connected to a pump which will help suck out excess fluid and dirt from the wound. VAC may also help increase blood flow and decrease the number of bacteria in the wound.
    
    
  • Others: Creams, ointments, or medicines with special solutions which help in wound healing may be applied to the wound.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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