WHAT IS A WOUND?
A disruption of the tissue integrity of the skin is called a wound. Wounds on the skin are also called ulcers. Wound formation can be caused by external factors such as sharp objects, burning, and frostbite, and some chronic diseases can facilitate this process.
What Are Wound Types?
There are many classifications of wounds. The classification may be based on the duration, type and cause of the wound. Biologically, many wounds are formed and healed in our body from birth. When the wound is treated and wound care is provided, the skin returns to its normal physiological state and the wound heals as our biological structure tends to heal the wounds.
Acute Wounds
Wounds that heal completely within the expected time are called acute wounds. Healing time may vary depending on the depth and width of the wound, the localization site, and the mechanism of the wound formation. However, it is important that appropriate conditions are present or provided for wound healing. According to the general principles of wound healing, the wound should be cleansed, infection should be prevented, and if any, should be treated, and the appropriate amount of moisture should be provided.
Chronic Wounds
Wounds that do not heal within the expected time are called chronic wounds. Chronic wounds include all wounds that heal late or poorly or do not heal completely. The term chronic wound is used for wounds that show no signs of healing within 4 weeks or that do not heal after 4–6 weeks. While wounds usually heal on their own biologically, there are other reasons why the wound does not heal and becomes chronic.
Patient-related causes;
- Diabetes mellitus
- Arterial diseases
- Venous diseases
- Nutritional diseases
- Advanced age
- Rheumatic diseases
- Drugs and/or diseases related to the immune system
- Cancer
- Liver and kidney diseases
- In addition, prolonged bed confinement causes wound formation and/or delays wound healing.
The main causes of chronic wound formation;
- If there are necrotic (dead) tissues in the wound,
- If there is any foreign body in the wound (penetrated, or placed into the tissue due to treatment),
- If there is systemic infection or the wound / the near-wound site is infected,
- If there is infection in the bone tissue (osteomyelitis) at the base of the wound,
- If there is pressure in the wound,
- If the structure of the wound site is impaired,
- If the wound is large and very deep,
- If the wound is dry or excessively moist,
- If there are tissues with difficult closure, such as open bone, cartilage, and tendon at the base of the wound, the wound healing will be difficult and delayed.
What Should Be The Basic Treatment For Chronic Wound Healing?
In chronic wounds, the target is to bring the wound back to normal conditions.
Our cells, which have the potential to heal wounds biologically, will provide closure of the injured tissue that becomes suitable for healing. How to normalize injured tissue:
- Debridement is done.
- Infection is treated.
- Inflammation is controlled.
- Moisture is provided.
- Blood supply to the injured tissue is provided.
- Any unnecessary pressure on the wound should be removed.
DEBRIDEMENT : The removal of any non-living tissue from the wound site is called debridement.
TREATMENT OF INFECTION: If the wound site is infected, the infection should be eliminated with appropriate treatment.
MANAGEMENT OF INFLAMMATION: Inflammation is the body's self-defence mechanism. However, in chronic wounds, this defence mechanism does not limit itself over time and such prolonged time delays wound healing. Therefore, it is important to bring the patient’s chronic inflammation to an acute inflammatory response.
ENSURING ADEQUATE MOISTURE BALANCE: Healing is delayed in very dry or very moist, exuding (fluid discharge from tissue due to infection and/or inflammation) wounds. Therefore, ensuring optimum moisture balance is important for wound healing.
PROVIDING TISSUE NUTRITION: Any problem in the vascular structure that feeds the injured tissue, should be eliminated.
RELIEVING THE PRESSURE: The injured tissue should be prevented from exposure to any pressure.
There are various non-healing chronic wounds including diabetic foot ulcers, venous ulcers, pressure sores, wounds due to peripheral arterial disease, wounds due to Buerger's disease, burn wounds, vasculitic wounds and wounds that do not heal after trauma.
VENOUS ULCERS
Chronic venous insufficiency (CVI) is an important clinical condition that can greatly affect the quality of life of individuals through its epidemiological and socioeconomic outcomes. The factors that make this disease important are its prevalence, cost of diagnosis and treatment, significant loss of working capacity during treatment and negative effects on the patient's quality of life.
Chronic venous insufficiency results from the insufficiency or occlusion of the vessels or the combination of these two factors. As a result, venous hypertension increases. High vascular pressure and increased capillary permeability cause characteristic changes in the skin and subcutaneous tissue. Fluid, molecules and hemosiderin accumulate in the extravascular space. Edema, venous eczema and dermatitis, lipodermatosclerosis, pigmentation, and ultimately venous ulcers or wounds occur in patients. Damage to the veins, called venous insufficiency, occurs as a result of occluded veins, valve insufficiency, muscle pump dysfunction and their combinations.
Risk Factors
Age: Advanced age is the most important risk factor for venous insufficiency.
Obesity: It has been reported that there is an increased risk of 6.5 times in men and 3.1 times in women with a body mass index (BMI) >30.
Family history: Although the genetic predisposition is definitely known, the underlying genetic anomaly has not been fully determined.
The most common forms of clinical venous insufficiency include telangiectasia, and reticular or varicose veins.
Pain, swelling, burning, night cramps, tingling, itching, restless legs syndrome, increased pigmentation (colour) and ulcer-related complaints can also be observed in this disease. Thrombophlebitis and bleeding are less common, yet serious clinical findings.
Diagnosis
The diagnosis of chronic venous insufficiency is established based on patient history, physical examination and various imaging methods.
Treatment
In this disease, standard wound treatment is administered, and the target is to prevent recurrence after the closure of the wound. Therefore, patients should pay attention to their lifestyles and preventive treatments.
Reference: CHRONIC VENOUS DISEASE Peripheral Arterial and Venous Diseases - National Treatment Guide 2021
