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July 19 2018

Specialized wound care promotes healing in patients with chronic conditions and injuries

By Stanley Markus, MD

Most of the time, our bodies have the capacity to heal themselves. When wounds won’t heal, specialized care may be needed.

Chronic conditions like diabetes or circulation and vascular issues often lead to wounds that don’t heal on their own. Tissue damage resulting from neuropathy or problems with blood flow, surgical wounds and sores that develop from bedrest can also resist healing. In addition, trauma from a fall or other accident can leave punctures, cuts, tears, burns or infections that require treatment.

Many people wait too long to tell their doctor about a persistent or worsening wound or sore. If an open cut or burn, or a bruise or painful area (particularly in the legs) does not heal within two to four weeks, it’s time to get medical help. The longer the area goes without treatment, the more time it will take to heal.

A comprehensive approach to care includes finding the direct cause of the issue, taking tissue cultures or biopsies if needed, treating the wound, and educating the patient about ways to prevent problems from developing and escalating.

Specialty care

Wound care teams generally include physicians who specialize in wound care and hyperbaric medicine, certified wound care nurses, medical assistants, clinical hyperbaric staff, primary care physicians, surgeons, and other physicians such as podiatrists or vascular specialists. Nursing home, home health or rehabilitation professionals may also be on a patient’s care team.

Wound therapies are designed to enable the body to develop a framework of healthy tissue, or scaffolding, to help increase blood flow, enhance the delivery of nutrients in the body to the site, and allow it to repair itself. This infrastructure creates a pathway for new cells to grow until healthy tissue fully replaces the damaged tissue and any open areas.

Advanced treatments

In recent years, medical innovations have brought new and advanced treatments that help speed the process of recovery. Physicians may recommend two or more of these therapies to maximize care. Depending on the individual, treatment may require multiple weekly visits over several weeks.

Treatment options include antibiotics, antiseptics, antimicrobial agents, gels, foams, specialty dressings and wraps. The wound care team will also consider the treatments outlined below.

  • Compression bandages, socks or hosiery, wraps and pumps can minimize pain, speed healing and prevent infection. Compression is used to reduce swelling, increase oxygenation of the tissues and minimize blood clots.
  • High-tech materials are available and can act as skin substitutes to protect the injured area and promote the development of new tissue. 
  • Hyperbaric oxygen therapy is provided in a full-body chamber filled with 100 percent pressurized oxygen. The oxygen is breathed in by the patient for delivery throughout the bloodstream and tissues. The patient can see out of the chamber and communicate with a nurse while resting comfortably and listening to music or watching a video. The treatments are painless. The increased oxygen enhances the ability of white blood cells to kill bacteria, reduces swelling and allows new blood vessels to grow more rapidly into the affected areas. 
  • Low-frequency mist ultrasound uses sound waves and a saline mist to penetrate the wound and reduce bacteria while stimulating cell growth. The therapy is painless and there is no direct contact with the ultrasound device. 
  • Negative pressure therapy involves the use of a sealed wound dressing attached to a vacuum pump. The pump stimulates blood flow and draws excess fluid from the wound. 
  • Devitalized, infected or contaminated tissue can be removed through debridement. The treatment can be performed with surgery, nonsurgical irrigation, or application of a therapeutic agent.

Millions affected

According to the medical journal Wounds, chronic wounds affect more than 6.5 million people in the U.S. and wound care costs more than $35 billion year.  Chronic lower extremity ulcers alone affect an estimated 2.4 million to 4.5 million people in the U.S., as noted in Advances in Wound Care.

Patients with diabetes can face severe consequences, such as infection resulting in amputation, if wounds are left untreated. Some cancer patients have complications with wounds after radiation or chemotherapy. Deep vein thrombosis and venous insufficiency can also lead to tissue damage in the legs. Patients with skin grafts may also require additional wound care to heal.

The need for wound care doesn’t always stem from a chronic medical condition, however. People who were previously unaware of this type of care have found treatment beneficial after experiencing infections, severe inflammation, lacerations, abrasions, burns, bites or other medical issues and emergencies.

Regardless of the specific need, wound care has one goal: to stimulate the body to turn on its own healing mechanisms. Once the process of rejuvenation gets a jump start, the patient is on the road to healing.

People who have questions about wounds that won’t heal should consult their primary care physician or medical specialist. To learn more about ProHealth Care’s Wound Healing Services, call 262-928-8899 or visit ProHealthCare.org/WoundHealing.

Stanley Markus, MD, is medical director of wound care at ProHealth Waukesha Memorial Hospital. He is a general surgeon who practices at ProHealth Oconomowoc Memorial Hospital and ProHealth Waukesha Memorial Hospital. ProHealth provides outpatient wound care services at the Oconomowoc Physician Center and Waukesha Memorial in addition to inpatient care at its hospitals, including ProHealth Rehabilitation Hospital of Wisconsin in Waukesha.

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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.