When Skin Injuries or Wounds Won't Heal

Most of us take for granted that cuts, nicks, and scrapes resulting from falls or kitchen carelessness will heal up without incident. But for some people, chronic wounds that resist healing pose a major health threat. These wounds require special treatment and care to avoid serious infection, amputation, or even death.

In the U.S., chronic wounds affect 6.5 million people, according to a study published in Wound Repair and Regeneration. Chronic wounds cost more than $25 billion annually to treat, and this figure is expected to balloon as the population ages, health care costs rise, and the incidence of diabetes and obesity continues to grow.

Local Wound Care Available

Long Beach Memorial Medical Center and Miller Children's Hospital Long Beach are served by Wound Healing Centers and offer comprehensive care.

The opening of the Wound Care Center at Los Alamitos Medical Center makes advanced wound care available locally in that city as well. “Any wound can become chronic if it doesn’t heal properly,” says Elise Parsons, R.N., manager. For example, a surgical wound can become difficult to heal for certain patients due to nutritional problems, certain medications, or other health issues such as high blood pressure, high cholesterol, or sickle cell anemia. A wound is considered chronic if it takes longer than normal to heal, doesn’t heal completely, or recurs.

Vulnerable Populations

People with diabetes and vascular disease are particularly prone to chronic wounds. Diabetes can lead to nerve damage, or neuropathy, that results in a loss of sensation in the feet. People who have neuropathy may not feel a crack, callus, or other wound on the foot, which can become ulcerated. An estimated 2 to 3 percent of people with diabetes develop a chronic wound annually, with up to 15 percent developing this type of hard-to-heal wound over their lifetime, according to a study in the journal Wounds.

Peripheral artery disease, blood clots, or other vascular problems can also produce chronic wounds in the legs or feet. Slow or insufficient circulation makes it harder for wounds to heal. In addition, those who are bedbound or who use a wheelchair risk developing pressure wounds. These wounds are caused by lying or sitting on an area for too long, compressing the skin against the bone so that the skin dies. The National Nursing Home Survey of 2004 reported that approximately 11 percent of nursing home patients develop pressure wounds.

Accident, Trauma Can Produce Chronic Wounds

A crush injury, which occurs when a part of the body is subjected to extreme force or pressure, may require advanced wound care. A finger caught in a door is an example of a minor crush injury—more serious crush injuries severely damage the tissues, organs, muscles and bones beneath the skin, and must be carefully treated to avoid permanent damage.

Multidimensional Treatment

Treatment for a chronic wound may involve several approaches, one of which is cleaning the wound and removing dead skin in a process called debridement. Special antimicrobial dressings can clear chronic wound infection, promote healing, and reduce scarring. Other chronic wound treatments include total contact casts, often used to take the weight off foot ulcers that occur in people with diabetes. “The cast offloads the weight and allows much better healing,” Parsons notes. Preemptive wound treatment helps preserve limbs, she says, reducing the need for amputation due to a wound that will not heal.

Tissue engineering and biotechnology advances have led to the development of skin substitutes, which may also be used to treat certain types of chronic wounds. “For wounds that meet certain criteria, we can use these substitutes to help the wound close faster,” Parsons says.

Oxygen Heals

Hyperbaric oxygen therapy, or HBOT, is also used to treat and manage chronic wounds. With HBOT, patients breathe 100 percent oxygen in a pressurized chamber. Under pressure, the oxygen dissolves into all body fluids, not just red blood cells, and is diffused throughout the body.

HBOT is used to treat complex diabetic foot ulcers, bone infections, and radionecrosis, which is damage to bone or tissue caused by radiation therapy. In cases of necrotizing fasciitis, a rare bacterial infection sometimes called “flesh-eating bacteria,” HBOT can inhibit the spread of the potentially deadly bacteria. Muppets creator Jim Henson died in 1990 when a strep infection led to necrotizing fasciitis.

Take Care of Your Skin

Parsons says she reminds patients that their skin is the body’s largest organ. Every medication taken and every bit of food eaten impacts the skin, she observes. “Treating chronic wounds involves more than just the wound,” she says. “We look at all impediments to healing. Sometimes that can be nutritional factors. In other patients we need to look at their lifestyle and see if we can get them moving more.”