- Chronic wounds are wounds which have failed to proceed through an orderly and timely reparative process, usually within a period of 3 months.
- The Wound Healing Society (WHS) notes that chronic wounds affect an estimated 1 to 2% of the population.
- As people age, wound closure becomes more difficult.
Chronic wounds aren’t something most people have to think about, although those that do know how difficult they can be. With health complications on the rise, we must ask ourselves as healthcare professionals: are chronic wounds a growing problem in our world?
It’s estimated that about 6.5 million Americans suffer from a chronic, non-healing wound of some sort. The annual cost of treating chronic wounds in the US is estimated to be $25 billion, signifying a huge, and potentially even growing, chronic wound care industry.
Chronic wounds are wounds which have failed to proceed through an orderly and timely reparative process, usually within a period of 3 months. Chronic wounds are also those that have proceeded through the repair process without establishing a sustained, anatomic, and functional result.
The Wound Healing Society (WHS) notes that chronic wounds affect an estimated 1 to 2% of the population, and the group classifies chronic wounds into the four following categories:
- pressure ulcers
- diabetic ulcers
- venous ulcers
- arterial insufficiency ulcers
What the Numbers Tell Us
Numbers like those referenced above reflect an increasingly large percentage of elderly people in the general population. As people age, wound closure becomes more difficult, and the decline of the overall health becomes more likely, further complicating wound closure.
Studies have found that as age increases and susceptibility to chronic wounds increases, quality of life also declines. Specifically, health-related quality of life has been shown to be lowest for physical pathologies, especially for patients with chronic wounds and for those with wound-related amputations.
Chronic wounds also have a significant impact on patients’ mental health, often resulting in depression, shame, anxiety, and social isolation. These added stresses can extend to patients’ families, where prolonged hospital stays can lead to financial burden, as does coping with long-term care.
In one example, the cost for leg amputation for a patient with comorbid diabetes ranged from $12,851 to $16,267. Further, chronic wounds impose a significant and often underappreciated burden to the healthcare system and to society as a whole.
The Underlying Factors
The wound-healing process can be quite complex, and even more so for patients with chronic conditions. Chronic diseases impede the body’s natural ability to recover, and in the case of cardiovascular conditions, they also impair the flow of blood, oxygen, and nutrients to the wound site.
Diabetes is another condition that significantly interrupts wound healing. It’s estimated that close to 15 percent of those with diabetes also suffer from a chronic wound. Similar to cardiovascular disease, diabetes causes restricted blood flow to the wound. High glucose levels can also restrict blood vessels and stiffen arteries, increasing the likelihood of chronic wounds. As one expert notes about diabetic wounds, “A small foot blister can quickly become a chronic open sore. Without early intervention and effective treatment, the patient may be at risk of amputation.”
People with poor circulation – for instance, as a result of peripheral artery disease (PAD) – also have difficulty supplying enough oxygen to the wound site to promote healing. Similarly, venous insufficiency, which causes the veins to become enlarged and varicose, can also increase the likelihood of developing wounds on the lower legs or feet. As blood collects in the legs, pressure makes blood circulation more difficult, and the result is that not enough oxygen is available to promote wound healing.
Another underlying factor that can contribute to poor wound healing is a weakened immune system, or autoimmunity. This can occur from diseases like cancer, liver, or kidney disease, or due to poor nutrient status.
Bed or Wheelchair Confinement
People who are confined to a bed or wheelchair may develop pressure ulcers (bedsores) from the constant pressure put on some parts of their body by their own body weight.
What Can Be Done About Chronic Wounds?
For people with chronic wounds, treatment is typically aimed at treating both the underlying condition as well as the wound itself. For those with diabetes, for example, blood sugar levels need to be regulated so the wound can heal normally. For those with a weakened immune system, nutritional status and diet should be addressed to improve the immune system and the body’s ability to heal. Venous insufficiency is often treated with compression stockings or compression bandages (tight elastic bandages) to improve blood circulation, making it easier for existing wounds to heal.
The treatment of chronic wounds involves the application of the TIME principle.
- Tissue debridement
- Infection control
- Moisture Balance
- Edges of the wound
Before debridement, the wound must be cleaned fully with a saline or electrolyte solution. Following this, dead cells or inflamed tissue can be carefully removed with tweezers or a scalpel. This can also be achieved through surgical or autolytic/enzymatic mechanisms. The goal of debridement is to expose healthy, well-perfused tissue that is able to proliferate and populate the wound bed.
As debridement can be painful, a topical anesthetic such as a medicated ointment can be applied to the wound area to prevent pain. When pain is severe, medication can also be taken before debridement.
Wound dressings are typically employed to control infection. For example, a moist occlusive dressing helps support the inflammatory phase of healing by creating an environment with enough oxygen to promote wound healing. When bacteria or persistent infection is present, antibiotics can be used to further prevent and control infection.
Keeping the wound moist is often achieved through the use of hydrocolloids and hydrogels which are hydrophilic and promote a moist environment. Wound dressings and bandages can also help maintain moisture balance and prevent dryness from impairing wound healing.
Promoting wound closure, or attending to the edges of the wound, involves the use of negative pressure wound therapy, or vacuum-assisted closure. By maintaining a moist environment, optimizing blood flow, removing exudates, and applying pressure to promote wound closure, vacuum-assisted closure or negative pressure treatment has shown a high degree of efficacy in treating chronic wounds.
Caring for Chronic Wounds in a Wounded World
With seniors representing a large percentage of the population and increasing rates of diabetes, heart disease, and immunity impairment, chronic wounds are considered a growing problem. While that may seem intimidating, it doesn’t have to be. Through understanding and treatment of underlying conditions, and by employing techniques to treat chronic wounds, patient outcomes can be dramatically improved, and together we can make chronic wound care as painless as possible.