Bed Sores Ulcers and Wound Care Guide to Healing

Most skin wounds heal fairly quickly…in a matter of days or sometimes weeks. The body usually takes care of all the problems that can cause a wound to not heal.

But why is your wound not healing now?

There are a number of reasons for this, such as;
. Medical problems (like diabetes)
. Medication which can delay healing
. Inadequate nutrition and hydration
. Inadequate blood supply
. Bacteria
. Pressure on the area
. The changing nature of the skin as we age

But even with any or all of these issues, treatments today can overcome many of these problems, leading to a closed wound.

A bit more about wounds…

There are 3 categories of wounds that you might want to understand. The approach and treatment to each of these 3 categories can be greatly different.

1) Acute wounds
2) Chronic wounds
3) Other wounds, like skin cancers
. We are not covering burns in this booklet

Acute Wounds
An acute wound is generally thought of as a ‘new’ wound, usually from a trauma or even a surgical incision. A trauma can be something like a cut or scrape.

As you might realize, an acute wound starts from the outside of the skin and goes into deeper tissues. This is an important concept because a ‘chronic wound’ can be the reverse, starting inside the body and ultimately breaking down the skin from the inside.

Acute wounds usually heal quickly, but can turn into non-healing wounds for a variety of reasons. If your acute wound hasn’t healed or showed the usual improvement within a few weeks, it would be wise to consider it a chronic or problematic wound. You would probably benefit from expert help. Obviously, if you are seeing any signs of infection, you need immediate medical treatment.

Chronic wounds
Chronic wounds can be thought of in these 2 ways:
a) An acute wound that hasn’t healed after a certain amount of time OR
b) A wound associated with certain problems or conditions, like a pressure ulcer,
diabetic ulcer, venous stasis ulcer or arterial ulcer.
Dealing with these wounds involves a proper workup and diagnosis, followed by a flexible treatment plan which can change as the wound starts improving. The good news is that many of these wounds can be healed, no matter how tough. Your wound
clinician should have an expectation of progress and be able to spot if the wound is healing properly or not.

Other wounds
This is the category where things get tricky. Sometimes, you have a break in your skin and you don’t really know how it happened. Sometimes, you have a wound that you think is a chronic wound, but it isn’t responding to treatment. These wounds might not be the ‘typical’ wounds that we spoke about in the sections above. Maybe
a biopsy needs to be taken to make sure it isn’t a different type of wound, like a skin cancer.

What has changed in wound care recently?
What used to be the standard-of-care, is no longer the standard-of-care when it comes to wounds. New understanding of the way a wound heals has led to breakthroughs in new product development, along with an understanding of products which should no longer be used on skin wounds.

For example, keep it open to air has been replaced by a concept called moist wound healing. While topical ointments are still used, advances have led to new topical products which are superior in many ways to the older products.

The common ‘saline or Betadine wet-to-dry’ treatment is now understood to not promote healing and is reserved for specific clinical situations. Surgical procedures can now be performed to
either close the wound immediately or correct issues in the body, such as poor blood flow, that contribute to the non-healing nature of the wound.

In addition, a variety of new technologies are now on the market specific to wound care, including things like: nanocrystalline silver, growth factors, tissue engineered products, MMP inhibitors, enzymatic debriders, tissue scaffolds, topical negative pressure and collagen based products.

Is every doctor or nurse aware of these advances in wound care?

Absolutely not. As you would expect, clinicians who don’t focus on wounds might not be aware of the latest products and protocols, or how best to use them. While they are well meaning and they base their decisions on past experience, your situation might be one best
served by a wound specialist. If you or someone you know has a non-healing wound,

you most likely need to be seen by a wound specialist to stand your best chance of getting better, faster.

Wound centers typically have three things that should be important to you. Without these three things, wound closure will be difficult.

1) Up to date knowledge on wound issues
2) Easy access to the right testing equipment
3) Easy access to the right products

What can I do myself, as far as treatment?

Here’s the bad news. There is no magical cure or single product for chronic wounds.

Whatever you read on the Internet, there isn’t one simple remedy for all chronic wounds. Often, wound specialists use a certain product for a limited amount of time, switching to a completely different product as the wound starts to improve and has different requirements.

Specialists should also be looking at your blood flow, your nutrition and other factors which play a role in wound healing. If you have a non-healing wound, a chronic wound or a wound that could be put into the ‘other’ category’, you really need to see a wound specialist for an appropriate diagnosis and treatment plan.

Anything else you do will most likely be guesswork on your part, resulting in extra expense on potentially ineffective products, losing time in the process and maybe allowing the wound to get worse.

If financial issues are causing you to self-treat, it would be a good idea to speak with your local wound specialist about your financial hardship to see what can be done.

Maybe they can work with you on reduced rates?
Maybe they have some product samples that they can provide you? You’ll never know unless you ask and most wound specialists do provide a certain amount of care for which they don’t receive payment.

Where can I go for expert care?
http://www.woundcenters.com is one place to start looking. The wound centers in this database report healing rates of over 80%.
But let’s explore this question a bit closer, because this is a tricky issue.

It’s easier to understand this when you think about another medical problem. For example, if you have a heart problem, you probably go to a cardiologist. And I would expect that 9 out of 10 cardiologists will diagnose, treat and monitor you in a similar way.

But when it comes to wound care, there are many people who call themselves ‘wound experts’. Unfortunately, it’s common to see clinicians prescribe a different treatment protocol for the same wound an issue that has been discussed extensively within
the wound care community.

When it comes to wound care, you’ll find that there are legitimate wound specialists in each of the following medical fields:
. Physicians
. Surgeons
. Nurse Practitioners
. Physician Assistants
. Nurses
. Physical Therapists

As the patient, how are you to know which one to see, which one is going to give you your best chance at healing? It’s confusing to say the least.