What if the wound is difficult to heal?

What are Chronic Refractory Wounds (CRW)?

Many wounds do not heal for a long time, which is academically called refractory wounds, also known as chronic wounds (Chronic Refractory Wounds, CRW). It can be caused by various causes, such as pressure ulcers, vascular ulcers, infectious ulcers, diabetic ulcers, diabetic foot ulcers, metabolic skin ulcers, trauma wounds, radiation ulcers, and other refractory wounds that cannot be cured for a long time. Long-term, high treatment costs significantly reduce the quality of life of patients. Chronic wounds generally cannot heal independently and usually require human intervention to achieve routine healing.

Internal factors of CRW:

1. Decreased willingness to heal: If the wound cannot recover for a long time, the body's desire to heal begins to decline, manifested as a decrease in the secretion of growth factors at the wound and a decrease in anabolism.

2. The body's nutritional status is related: it lacks nutrients, and it is difficult for the wound to grow well.

3. Local blood circulation: After the injury, the blood supply of local tissues will be blocked. Restricted qi and blood circulation prevent nutrition from repairing the wound in time.

4. Hyperglycemia: The higher blood sugar status of diabetic patients will increase the sugar content of exuded body fluids, and wounds are more likely to be infected. In addition, people with diabetes for many years are usually accompanied by vascular disease, which is not conducive to wound healing.

5. Age: The younger the age, the stronger the cell regeneration ability, the faster the metabolism, and the faster the wound healing. Conversely, the older the period, the slower the wound healing.

6. Psychological factors: Excessive stress affects neuroendocrine-immune system function and slows wound healing.

External factors of CRW:

1. Wound infection is aggravated: the wound does not heal for a long time, the granulation tissue is increasing, and the bulge is higher than the surrounding skin. This physiological mechanism fills the wound, but it also causes bacteria to accumulate in it. Bacteria deep in the wound are challenging to remove.

2. Bacteria gradually become familiar with the wound environment and form drug-resistant bacteria: These deep-rooted bacteria are often difficult to remove. Bacteria have been on the wound for a long time, and they will gradually adapt to the environment and can also fight against the immune system. Bacteria multiply rapidly and can iterate tens of thousands of times in a month. In the future, the bacteria on the wound will be its descendants, and removing them will be more challenging.

3. Foreign bodies: Most foreign bodies in the wound caused by trauma are thread ends, steel plates, and glass. Bacteria can also hide in foreign bodies, and immune cells can't enter the foreign body to kill bacteria. The threat to the surrounding healthy tissue is excellent, so the wound with foreign bodies needs to be cleaned and removed in time.

4. Cavities and sinus tracts: Many chronic wounds are accompanied by the formation of cavities and sinus tracts, and the inner walls of such damages are all granulation tissue—examples: pressure ulcers, sinus tracts after trauma, poor healing of surgical incisions, etc. The treatment of this situation is entirely different from that of a flat wound, and it needs to be treated by flushing and packing.

5. Smoking: The combination of carbon monoxide and hemoglobin in the blood circulation reduces the ability to transport oxygen. Nicotine constricts peripheral blood vessels and affects wound healing.

6. Drugs and radiotherapy

Immunosuppressants, cytostatic, hormone drugs, can inhibit cell regeneration and negatively impact wounds. Radiation-treated wounds are complicated to heal, and some injuries will not heal over and over again for decades.

How to treat CRW?

1. Supplementary nutrition: The healing of wounds requires albumin in the blood, so the diet recommends eating high-protein foods such as fish, meat, and eggs to provide sufficient raw materials for wound healing.

2. The wound can be adequately touched with water: Many patients think the damage should not be connected with water. This is not only incorrect but also harmful. If the wound does not heal for more than three weeks, it is necessary to take a bath. Otherwise, the damage will worsen, and the normal skin around the wound may have eczema.

3. Thorough debridement: For a wound with a foreign body, large area, and dark color, the debridement should be carried out in the hospital to minimize the number of bacteria on the wound.

4. Use correct and effective dressings:

In recent years, with the continuous progress of medical level, new wet healing dressings are commonly used clinically to treat the wounds of patients with refractory wounds. New wet healing dressings include hydrocolloid dressings, alginate dressings, silver ion dressings, foam dressings, etc. Compared with dry dressings, the new wet dressings have the following advantages: 1) It will not cause the patient's wounds to form crusts, which can prevent the epidermal cells of the wounds from migrating subcutaneously, thereby shortening the healing time of the wounds; 2) The dressings are compatible with patient's wounds will not stick together, which can reduce the pain and facilitate dressing changes; 3) reduce the number of dressing changes and keep the wound temperature. [6] Provide a slightly acidic healing environment, which is more conducive to wound healing.

Foam dressings are preferred for chronic wounds. Foam dressing is a kind of medical material similar to a sponge. It is a new composite dressing widely used, absorbing exudate and smoothing granulation.

5. Elevation, massage, and pressure therapy to promote lymphatic return:

Many patients with chronic wounds need to stay in bed for a long time. At this time, muscle movement will be reduced, and the local blood supply will be less. Therefore, it is recommended that the way of lymphatic return can prevent thrombosis.

How to choose the proper dressing?

First, assess the healing of the patient's wound and clean the necrotic tissue on the wound surface. After disinfecting the patient's injury, if the patient's wound has slough and black scab, after cleaning the patient's wound, apply 5 mm of hydrogel to the wound surface, and cover the damage with a foam dressing or a hydrocolloid dressing every other time. Change the medicine once every 2 to 4 days. If the slough and black scab on the patient's wound is separated from the muscle tissue, remove the slough and black scab from the injury. If the patient's wound has a lot of exudates, an alginate dressing can be used to cover the damage. If the patient's wound is shallow and flat, a sheet-like hydrogel dressing can be used to cover the injury. If the patient has a deep wound, an alginate filler can be used to cover the damage. If the patient has fresh granulation tissue in the wound, a hydrocolloid dressing can be used to cover the injury.

For more information on Innomed® dressings please refer to the previous articles. If you have customized needs, you are welcome to contact us; we will serve you wholeheartedly.

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Editor: kiki Jia
Date: June16,2022