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Wound chronicity is defined as any wound that is physiologically damaged as a result of a disturbance in the wound healing cascade, which includes 1) hemostasis, 2) inflammation, 3) proliferation and 4) maturation/remodeling. To manage chronic wounds properly, we must first understand the natural healing process and wound bed preparation (WBP). Chronic wounds can develop as a result of poor angiogenesis, innervation, or cellular migration.
Chronic Wounds That Are Common
A comprehensive examination of the patient is required to determine if a patient's wound is likely to become chronic. Patients with several comorbidities, particularly diabetes or obesity, as well as those on specific drugs (immunosuppressants) or who smoke, are more prone to undergo delayed healing. 4 Certain wounds are more likely than others to develop chronic; doctors should learn to detect these wounds and take necessary preventative measures.
- Venous ulcers form when vein valves fail to function correctly, allowing blood to pool in the veins and cause swelling and ulcer formation.
- Arterial ulcers are produced by a lack of nutrient-rich blood flow to the lower limbs, causing oxygen-deprived tissue to become destroyed. These are often full-thickness wounds.
- Diabetic foot ulcers are caused by repeated stress to the foot, frequently over regions of deformity or, in those with neuropathy, reducing feeling in the foot.
- Pressure injuries occur when bone prominences are subjected to prolonged pressure, shear, or friction.
What has considered standard of care varies depending on the etiology of the wound, however, all wounds should be debrided if necessary, monitored for infection, off-loaded as needed, and have a moist wound bed.
Wounds should be assessed for the presence of non-viable tissue before selecting an appropriate debridement treatment. Sharp/surgical debridement is commonly referred to as the gold standard, however various treatments may be selected based on the patient, the degree of non-viable tissue, and the wound's aims. Non-viable tissue limits healthy tissue formation and increases the risk of wound infection.
Options for Advanced Wound Care in Chronic Wounds
Using a patient-centered approach, select therapies that are appropriate for the wound. Because of the variety of products available, treatment selection might be difficult. Always consider wound depth, exudate quantity, wound size, wound location, and treatment availability, as well as payer source. Because advanced wound care solutions come in a variety of shapes and sizes, health care practitioners should take the time to choose the most appropriate dressing. Bacterial balance and an appropriate, moist wound healing environment are the goals of wound therapy selection.
The following are some therapeutic options:
- Transparent films
- Super absorbents and collagen foams
- Wound treatment using negative pressure
- Skin replacements – goods derived from cells and tissues
- Factors of Growth
Chronic wounds place a strain on the healthcare system, healthcare workers, and patients. Implementing a multimodal treatment strategy early in the healing process can enhance wound healing results. Health care providers should identify possible risk factors and assist their patients in managing variables that contribute to chronic wounds. Using various wound care dressing technologies can aid in the healing of chronic wounds.