February 24, 2022 Author : Joana Patrício Any wound interferes, even momentarily, with the well-being and quality of life of those affected. When it comes to chronic wounds, that is, wounds do not heal within the expected period , there is more discomfort and the wound and its treatment are often a real challenge. Why wounds appear When in some area of the body the protective barrier of skin is no longer intact, a wound is formed, and the deeper tissues are exposed and unprotected from external aggressions. Wounds can have different causes, including accidents with sharp objects, trauma, burns, among other problems. These cases usually give rise to acute wounds , which, after being well cleaned and disinfected, are closed, whenever necessary, with stitches or dressings. Within a few days, the skin heals completely, regains its integrity and function, and the wound disappears. There are, however, some situations that cause wounds to heal very slowly , taking weeks, months or even years to heal, instead of days. Some of these situations are related to characteristics of the own organism which are difficult to modify, for example chronic diseases that affect the healing process , such as: Diabetes; Heart failure; Autoimmune diseases; Venous and/or arterial vascular diseases; Diseases that affect the healthy development of the skin. In addition to disease situations, there are also some habits that can contribute to aggravate wounds because they make it difficult for the body to respond to aggression. Among these stand out: Tobacco consumption; Diet low in protein and antioxidants; Stress and depression; Sedentary lifestyle, immobilization; Overweight and obesity; Taking some medications such as corticosteroids or immunosuppressants. Also, factors related to the wound itself , such as infection or the presence of devitalized tissue (dead tissue), can also stagnate the healing process or even worsen the wound. Prevent and intervene early – a teamwork! The challenge with chronic wounds is to be able to identify for each wound that is unable to heal quickly and healthily which factors can be modified so that its treatment is successful. Regarding diseases that affect healing and that cannot be eliminated, it is important to stabilize it as best as possible, so that their interference in the healing process is minimized. So: Diabetic patients should have their blood glucose controlled to avoid losing sensitivity in the skin (which protects it from injury) and also to prevent high blood glucose from inhibiting the healing process; Patients with heart failure should have their disease stabilized , to avoid edema in the lower limbs and decreased tissue oxygenation; Patients with varicose veins should control the disease through surgery or use contention elastic socks and medications that prevent veins dilation; Patients with arterial disease should take anticoagulants and/or undergo procedures that allow the arteries to be cleared so that the blood flow necessary for a wound to heal is not impaired. Among the habits that make it difficult for the body to respond correctly, their impact should be minimized as much as possible. It is important to correct any nutritional deficits, with a diet rich in proteins and nutrients that promote healing and correct hydration. And when the wound insists on not healing? A specialized treatment may be required! Once favorable healing conditions are achieved, through the control of underlying diseases, there is then room to correct local conditions that may interfere with wound closure , namely: The wound must always be clean, removing as much dead tissue and bacterial debris that prevent healthy skin growth; A dressing must be applied that is suitable for the stage of the healing process in which the wound is; The surrounding skin must be healthy, well hydrated and free of dirt; Whenever necessary, devices that help wound healing, such as elastic stockings, adapted insoles, among others, should be used. Despite its complexity, with dedication and experience, chronic wounds can be successfully managed and treated, culminating in their complete healing. The faster the situations that delay healing are identified and treated, the higher the success rate . Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
