Skin repair: delayed healing or chronic wounds
When managing wound care, there are two types of wounds that can occur, acute wounds that usually heal within 2 – 4 weeks, or chronic wounds that are delayed in healing and stay around from 6 weeks or so to several years.
There are many factors that may delay wound healing
If the person with the wound does not have effective blood circulation, or if there is a recurrent infection, there could also be an underlying disease that hasn’t been detected or controlled well. This will also cause a delay in wound healing.
It is extremely important to speak to a health professional if you have a wound that’s not healing within an expected time frame as it could be a result of many different things.
Consider why the healing may be delayed. It is more appropriate to consider the “whole” person rather than just what to put over the “hole”.
There has been a revolution in wound management products since the early 90’s so you may hear all sorts of solutions and remedies about what is best thing to cover the wound. The important point is always to find out what caused the wound in the first place and why it may not be following the predicted path to healing.
Once that is sorted out then choosing a dressing that suits the conditions of the wound is the next step. Sometimes the wound conditions can change so the dressing choice needs to change as well. Seek professional help to get on the right track, because it could also be an inappropriate dressing that is causing a delay in healing. The modern dressings are complex and will interact with the wound bed so clear guidance is needed.
There are many things that can cause delayed wound healing. In diabetes, a blood sugar reading over 8mmols/L will affect the healing capacity. If the body is trying to repair tissue then nutrition is very important. Skin hygiene or just keeping the wound clean by changing bandages and dressings when they are wet is necessary to avoid an infection.
If these things are taken care of and the wound is still not healing then it is important to seek professional help to investigate why the healing is delayed.
Protein intake is important because it provides the building blocks for tissue repair. Protein sources can be found in meats, fish, nuts, lentils or in a nutritional supplement. If a wound is not continuing to show signs of healing, and there is weight loss from a hospital stay or trauma, then a nutritional supplement may be needed to help the recovery.A good multivitamin and at least 1,000 mg a day of Vitamin C may help speed up the healing process. A GP can arrange for a blood test to see if a supplement or extra iron is needed to aid wound repair, or refer a dietician to help with meal plans. Alternatively, making an effort to eat well could have a surprising result.
The wound must be kept clean at all times to control bacteria and promote healing. In acute wounds, inflammation is normal for a few days but if this is continues then it can lead to infection. Increasing pain, excess fluid from the wound, redness, swelling, odour from the wound or a temperature are all symptoms of an infection. Seek medical advice as antibiotics may be needed to fight the infection.
Protecting the wound is imperative so securing the dressings is important and ensuring it is the right size for the wound. Keeping the area dry is also worthwhile and keeping the wound bed undisturbed so it has a chance to heal is just as important as changing it often enough. Seek help or make an effort to protect the dressing under the shower. Some dressings are waterproof but it doesn’t take much to have water leak in.
Once the wound has healed then providing protection with a barrier cream or moisturizer is also worthwhile because the area will be fragile and take a while to recover and regain strength again.
The elderly or frail or those without sensation, it may be worthwhile providing a protective sleeve to prevent reoccuring injury.
Wound management is complex particularly if the healing is delayed and the wound has become “chronic”. By understanding the nature and cause of the wound and eliminating the things that can be controlled, for example hygiene, diet, protection then healing can be achieved.
If the wound is not healing then consider what your doctor could do to help investigate or assist with those things that cannot be easily controlled.
By Mim Gunn
Clinical Nurse Consultant
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