Chronic wounds: Definition
A wound that does not heal over a period of more than four weeks is described as chronic. Poor wound healing is often the result of a circulatory disorder, an immunodeficiency or diabetes mellitus. A common chronic wound is a bedsore (decubitus ulcer) or leg ulcer (ulcus cruris).
An acute wound that is not cared for properly can also become chronic. Wound healing is also worsened by smoking or obesity. Patients are often considerably restricted in their everyday lives by their chronic wounds, and the numerous visits to the doctor can also put a strain on their psyche. If the cause is not remedied, there is little chance of healing. This is why, in addition to providing optimum care for the wound, the underlying disease must also be treated in the best possible way!
Chronic wounds: Cleaning and fighting infections
A destroyed skin barrier favors the entry of pathogens. Chronic wounds are therefore particularly at risk of contamination and infection. This is why their treatment includes careful cleansing, for example with medical irrigation solutions.
If the wound is infected with bacteria, antibiotic therapy is necessary in addition to wound cleansing. This is usually administered via a venous access, but can also be taken in tablet form.
Chronic wounds: Wound dressings
As chronic wounds cannot be closed as long as they are infected, they must be securely covered. In this way, the doctor can prevent new infections and the wound edges from drying out. The right wound dressing plays a major role in wound care.
A distinction is made between inactive wound dressings, which only absorb wound secretions, interactive wound dressings, which actively support the healing process, and bioactive wound dressings, for example skin grafts.
Inactive wound dressings are very absorbent, which can also dry out the wound. They also have the major disadvantage that they often stick to the wound bed, which makes them difficult and painful to remove. Gauze dressings must therefore be soaked in saline solution and covered with a waterproof film. When changing the dressing, there is a high risk that newly formed tissue will be torn off with it.
Chronic wounds: Accompanying measures to support wound healing
In addition to the treatment of the underlying disease and wound care, various physical procedures are used. They are intended to accelerate the healing process. One example is the frequently used vacuum sealant: A sponge with a negative pressure system is placed in the open wound, which has the following effects:
- Reduction of the wound area
- Improved tissue perfusion
- Protection against pathogens
- Removal of wound secretions and blood
Whole-body pressure chamber therapy (hyperbaric oxygen therapy) also has a positive effect on chronic wounds, especially diabetic feet. In this procedure, the patient breathes pure oxygen in a pressure chamber.
Chronic wounds: Treatment of pain
Chronic wounds are usually accompanied by severe pain, which causes patients a great deal of physical and emotional suffering. Adequate pain therapy is therefore an important part of wound care. Mild pain can be treated with topical anaesthetic ointments, for example, while more severe pain can be treated with systemically effective therapy (painkillers, injections or infusions). Sometimes a trained pain therapist is involved in addition to the attending physician.
