What is Chronic Wound Care?
Appropriate wound care and treatment are essential in preventing infection and stimulating healthy tissue growth for wound closure. However, not all wounds respond to the first treatment attempt.
If a wound has not shown any signs of healing after eight weeks, it classifies as a chronic wound. Chronic wounds can develop due to complications from diabetes, poor circulation, a weak immune system or other causes.
Here’s an overview of chronic wounds and how to treat them.
What Are Chronic Wound Treatment Options?
Chronic wound care treatment depends on the condition of the wound bed and the surrounding tissue, both of which will dictate the treatment you pursue.
Multiple treatment methods may need to be combined to treat a chronic wound correctly, and there may even be several effective treatment plans to consider. Nevertheless, if a treatment is not effective after two to four weeks, you must change it.
Generally, wound care and treatment will fall under one of these categories:
- Moisture donating
- Moisture absorbing
- Cavity filling
- Substrate providing
- Artificial membranes
Symptoms of Non-Healing Wounds
Characteristics of non-healing wounds include raised skin, inflammation, and ulceration. There may be discharge or drainage from the wound, as well. Chronic wounds typically do not advance beyond their initial margins and do not show any signs of improvement even after about eight weeks of treatment.
Treatment Decisions Based on What is Present
You can make several treatment decisions based on the condition of the wound and the status of the wound bed. If it appears too wet, you should aim to absorb the moisture, whereas if it’s too dry, you want to add moisture to it. Similarly, if the wound is a cavity, you want to fill it, and if it’s bleeding, you must stop it.
When an infection is present, treatment should involve killing the infection. If the wound has an odor, work on eliminating it, and if there is necrotic tissue, you will have to treat it with debridement.
What is Debridement Option?
Chronic wounds often require debridement of dead, inflamed, or necrotic tissue. Doing so counteracts infection and promotes new tissue growth.
If the wound needs debridement, you have a few options. An autolytic debridement recruits the body’s own enzymes to consume the necrotic tissue slowly. This method is the lengthiest option.
Mechanical debridement physically removes necrotic tissue using methods like whirlpool or pulse lavage.
Finally, enzymatic debridement involves chemical enzymes that eat away at necrotic tissue. This process can take days or weeks to complete.
Surgical Sharp Debridement
This type of debridement uses a surgical blade or curette to remove necrotic tissue. A trained clinician, either a doctor or nurse practitioner, must perform this procedure, but it has an excellent success rate in treating the wound and preventing infection.
Part of what makes this treatment option so effective is that it eliminates senescent cells with little visible slough. However, the patient may require repeated procedures to reach optimal healing.
Current Enzymatic Debriding Agent
Two enzymatic debridement agents used today are collagenase, or Santyl, and papain-urea.
Collagenase comes from bacteria and performs selective debridement of necrotic tissue. This agent works from the base of the wound up, healing from the inside in order to move the outer edges of the wound toward closure.
Papain-urea, from the papaya fruit, involves non-selective debridement, working from the top down to heal the wound.
Be careful not to combine either of these treatments with silver products.
An antimicrobial kills or stops the growth of microorganisms, like bacteria or fungi. They promote healing by preventing or treating infection.
Antibiotics are one kind of antimicrobial. While they have proven to be effective in treating infections, overuse of them can lead to antibiotic-resistant strains of microorganisms.
Silver, one of the most documented antimicrobials, is bacteriostatic, meaning that it inhibits bacteria from reproducing and spreading. While there is no evidence of silver resistance, the patient may develop a sensitivity to it.
If the wound is a cavity, you may have to fill or pack it. Packing a wound fills in the dead space, helps remove debris, and supports healing from the base of the wound and up.
There are several useful options for a cavity filling. The one you choose will depend on factors like the location and severity of the wound.
Calcium alginate dressings, like Maxorb, are comfortable and work well with unusually shaped wounds. Hydrofiber dressing, like Aquacel, absorbs wound secretions well, while iodoform gauze bandages offer a balance of absorbency and porousness for proper wound drainage.
SilvaSorb cavity dressing utilizes antimicrobial silver to manage wounds, whereas hydrogel impregnated gauze delivers moisture to the wound to hydrate it.
In some cases, wounds may benefit from treatment with stimulatory agents that encourage healing and normal tissue regrowth.
For example, collagen dressings quicken recovery by promoting collagen growth around the wound. Fibercol, Puracol, and Cellerate are all collagen dressings that can treat chronic wounds. Collagen dressings usually require repeated applications.
Some stimulatory agents, like Regranex and Oasis, derive from growth factors. For wound care and treatment, these dressings attract cells to the wound and encourage their reproduction for faster healing.
Xenoderm and Granulex are both stimulating agents that contain trypsin, an enzyme that removes dead tissue to allow the growth of healthy cells.
Dressing the wound is imperative to regulate moisture levels and protect from infection. Bandages need changing every few days or more frequently if they move out of position, become too moist, or if the wound is leaking out of the dressing.
For tissue dressing, Apligraf works as a skin substitute designed specifically to treat chronic wounds. It has proven to restore normal healing at the epidermal and dermal layers.
Skin grafting may be necessary for very severe or extensive chronic wounds. During a skin graft, a surgeon removes healthy skin from another part of the body and uses it to close the wound.
Similarly, a skin flap uses tissue from a different part of the body to close a wound, but it consists of not just the skin but also the underlying tissues, muscle, and bone.
Treatments to Avoid
When treating a wound, you should avoid any outdated techniques that have been proven less effective than more modern treatments.
These treatments include wet-to-dry, Dakin’s solution, betadine, and iodine. You may find rare cases where these methods are still useful, but, generally, there are more effective wound care and treatment options to consider first.
This article is a comprehensive overview of Wound Care Treatment. However, it should not take the place of speaking with a physician. If you are experiencing any of the symptoms listed above, or know someone who is, contact us today to schedule a consultation.