Therapeutic Strategies For Treatment of Chronic Wounds

Introduction

Chronic wounds gradually disappear as living conditions improve, and acute wounds take their place as the most common type of wound. Chronic wounds are the type of wound which fails to improve that passes through the normal stage of wound healing. Various underlying internal and external aspects should be taken into consideration. A wound develops when the normal structure and function of skin tissue are damaged for various reasons, which opens the door for bacterial colonization. Wound infection is one of the most common and significant wound complications. The relationship between a chronic wound and a wound infection illustrates mutual causality. Proper treatment that targets the wound infection can improve the healing process, while delayed treatment may cause the wound to become larger or even worsen, such as developing a systemic infection.

What Causes Chronic Wounds?

The internal and external factors linked to the development of chronic wound infection are:

External Factors:

• Severe trauma.

• Pressure injury.

• Iatrogenic implants.

• Lack of hygiene.

Internal Factors:

• Diabetes.

• Blood disorders.

• Immunological diseases.

• Poor blood supply, nutrients and oxygen.

What Are the Various Types of Chronic Wounds?

• Infected Wounds - Whether the infection is bacterial, fungal, or viral, if the infection is not treated with the correct treatment, the wound will not heal as planned.

• Ischemic Wounds - The absence of a sufficient blood flow to the wound region is referred to as ischemia. Limiting the blood supply, oxygen and nutrients it provides can impede or even stop the healing process.

• Surgical Wounds - If the blood supply to the operation area was accidently compromised or if inadequate wound care was provided, wounds resulting from incisions created during surgery may proceed to chronic wounds. Both may impair a wound's ability to heal.

• Radiation Poisoning Wounds - Excessive exposure to ionizing radiation can impair the immune system, damage exposed tissue, and prolong the healing process for all wounds, regardless of whether the source of radiation was therapeutic (gamma or X-rays) or accidental (exposure to radioactive materials from nuclear plant accidents or radioactive devices that detonate).

Who Is at the Risk of Chronic Wounds?

People who have one or more of the following conditions are susceptible to developing chronic wounds:

• Age - Wounds of older individuals may take longer to heal compared to younger patients. Inadequate dietary intake, abnormal hormonal responses, poor hydration, and weakened immunological, circulatory, and respiratory systems are all risk factors for skin breakdown and slow wound healing in older individuals.

• Body Type - Healing of wounds may also be influenced by body type. Due to the insufficient blood flow to adipose tissue in an obese patient may delay the wound healing.

• Radiation Treatment and Immune Suppression - Age, diseases, medicine, or immune system suppression can all slow the healing process. Radiation therapy may result in skin changes or ulcers either right away following a treatment or long after the course of radiation therapy has concluded.

• Chronic Diseases - Chronic conditions include cancer, diabetes mellitus, peripheral vascular disease, coronary artery disease, and others that may delay wound healing .

• Veins Insufficiency - The lower extremities can be affected by a variety of lesions or ulcers, including arterial, diabetic, pressure, and venous ulcers. These ulcers are frequently brought on by a decreased blood flow.

What Are Different Treatment Strategies of Chronic Wounds?

The different treatment strategies applied to the patient for preventing chronic wound includes:

1. Cleaning the Wound - A saline (salt) solution is typically used to clean the wound when the dressing is changed. Nevertheless, there is still a lack of information regarding the benefits and drawbacks of the various wound-cleaning methods and how they affect the healing process. The use of tap water for the medical washing of wounds is also not yet entirely evident.

2. Debridement - Doctors and nurses frequently remove dead or inflammatory tissue from chronic wounds. This process is called debridement. Tweezers, a curette, a razor-sharp spoon-like device, or a scalpel are used to remove the tissue. Occasionally, an enzyme-based gel is also applied to the wound to aid in cleaning it. A high-pressure water jet can also be used to clean the wound. Utilizing a specific species of fly larvae (maggots) that have been specifically cultivated for medicinal use is another method of debridement. The maggots are inserted into a pouch or applied directly to the wound. From the wound, they remove fluid and dead tissue.

3. Wound Dressing - The dressings are utilized to remove extra fluid from the wound and safeguard it against infection. After the wound has been cleaned, a dressing is applied. Most wounds are kept wet, for example with moist compresses. However, the following types of dressings can be used in its place:

• Films.

• Gauze.

• Dressings made of hydrogel.

• Dressings made of hydrocolloid.

• Dressings with silver or alginates.

• Foam dressings.

4. Antibiotics - If wounds are contaminated with bacteria, they are considerably less likely to heal properly. Antibiotics might be considered, depending on how bad the infection is. To effectively treat the wound, an antibiotic must have good tissue penetration. Antibiotics can either use an ointment to apply them to the wound or a compress to cover them.

5. Hyperbaric Oxygen Therapy - In hyperbaric oxygen therapy, the patient enters a specific chamber to inhale oxygen under heavy pressure. By doing this, the blood's oxygen content will rise and the wound's blood supply will be improved. According to research, hyperbaric oxygen therapy can speed wound healing in persons with diabetic foot condition.

6. Ultrasound and Electromagnetic Therapy - Chronic wounds can be treated using ultrasound therapy by using sound waves. The tissue warms up as a result of the sound waves. However, it has not been demonstrated that ultrasonic therapy promotes wound healing. The same is true of electromagnetic therapy, in which the wound is treated with mild electromagnetic waves utilizing magnetized pillows or mats.

7. Skin Graft - If a wound is so large that it cannot heal on its own, skin grafts may be an alternative for treatment. In this treatment, skin is transplanted onto the wound from another area of the body, usually the thigh. Grafts can also be created from synthetic materials and human cell products.

Conclusion

Both endogenous and external factors are linked to the development of chronic wound infection. Exogenous factors include severe trauma, pressure injury, and iatrogenic implants, and endogenous variables include diabetes, blood disorders, immunological diseases, poor blood circulation, and so on. Patients with a high risk of non-healing wounds should be prevented as much as possible, and immediate care should be taken. After determining the underlying cause, debridement and anti-infection therapy should be used as a full-course and thorough wound therapy. Due to chronic wounds and the creation of wound dressings and supplementary modalities, there is a huge potential for the future development of chronic wound prevention and treatment. However, more effort needs to be put forward to make progress in this area.