When wounds do not heal
Uncontrolled diabetes results in chronic wounds which require urgent attention, writes Kasmiah Mustapha
What do you do if you accidentally cut yourself with a knife while cooking? Or scrap your knees when you fall down? Usually, you will clean and cover the wound with a bandage and ignore it. Within a few days, the wound will heal as the body has the mechanism to repair injury.
However, in certain cases, it takes longer for a wound to heal. Wounds that do not respond to treatment after four weeks or have not healed in two months are considered chronic.
Askina Hyperbaric Healthcare Centre medical director Dr Divya Panicker says any injury can become a chronic wound if not treated appropriately. The larger the wound, the higher the risk for it to become non-healing and turn chronic.
Various factors affect the healing process. These include a lack of oxygen supply to the wound, infections due to the presence of bacteria on the wound surface, swelling due to a weak natural defence mechanism and the poor circulation of blood to affected areas.
“Chronic wounds fail to heal when they do not go through the four phases of healing — haemostasis, inflammatory, granulation and remodelling.”
“Healing can remain stagnant in the inflammatory or granulation phases and will result in prolonged and lengthened recovery and in some cases, the wound never completely heals. Some common examples of chronic wounds are ulcers — diabetic foot, pressure, arterial, venous — and radiationinduced wounds.”
Infection and immuno compromising conditions like diabetes, auto-immune diseases and certain medications can predispose the person to the development of chronic wounds as they interfere with the body’s normal healing pathways.
Dr Divya says general conditions affecting the body can also result in chronic wounds such as medications that depress the immune system, poor nutrition, advanced age and diseases such as diabetes mellitus.
“Diabetes is one of the many causes of chronic wounds as persistent high blood glucose levels can affect wound healing. Uncontrolled diabetes causes the narrowing of blood vessels leading to poor nutrition and a lack of oxygenation to the wound. Decreased nerve sensation leads to an increased risk for trauma and neglected wounds as well as increased risk of infection.
“The progress of infection in diabetics is also greatly accelerated as it retards the immune system which makes it difficult for the body’s natural infection control reactions to take place. Due to this, wound care in diabetics has to be administered early and properly to prevent complications.
RISK OF INFECTION
The major concern for diabetic patients is always the high risk of infection and rapid spread which generally involves deeper structures like tendons and bones. The lack of sensation at the feet makes it hard to recognise wounds early and this leads to neglected wounds.
“The dreaded complication of all diabetic foot ulcers is amputation. Levels of amputation vary depending on the extent and site of the wound. In some cases, especially where treatment is delayed, chronic wounds can lead to generalised infections and multiorgan failure which leads to death.
“Patients should be aware that a nonhealing wound, no matter what size, is a problem that needs expert and rapid attention. Its condition can deteriorate very quickly especially if the patient has diabe- tes mellitus. If the right treatment is commenced in a timely manner, a lot of major life-threatening and debilitating complications can be avoided.”
Treatment of a chronic wound is challenging because it needs personalised care focusing on wound management compared to a simplistic approach. There is also a relatively longer management plan with the need to review and adjust plans frequently.
“Treatment for chronic wounds is complicated and there is a need for a holistic multidisciplinary management plan based on international guidelines. A specialist wound management centre is able to provide the patient with the medical expertise and technology to maximise healing compared to general care.”
Askina Hyperbaric Healthcare Centre’s services are tailored to assist patients with a comprehensive advanced wound management portfolio, with a personalised combination of treatment options for optimal outcomes.
The services include advanced wound care, hyperbaric oxygen therapy and ultrasound assisted wound debridement.