Brief overview
- Symptoms: Impaired healing process, bruising, bleeding, pus formation, pain, sometimes fever.
- Causes and risk factors: Inadequate wound care, preexisting conditions, age, nicotine use, malnutrition
- Examinations and diagnosis: Physical examination, blood test, sometimes imaging or biopsy
- Treatment: professional wound care and hygiene, debridement, pain management, antibiotics if necessary, treatment of pre-existing conditions
- Prevention: appropriate initial treatment of the wound, treatment of pre-existing conditions, abstention from nicotine.
What is a wound healing disorder?
A wound is a severance of contiguous tissue on the external or internal surface of the body. If a wound does not heal or heals poorly, it is called a wound healing disorder. It is characterized, among other things, by bruising, accumulation of wound secretions under a wound, wound tears and, above all, infections.
Wound healing
You can read about the complex healing process of a wound in the article Wound Healing.
What are the symptoms?
The main symptom of a wound healing disorder is the wound defect. The wound does not heal, the skin does not return to its normal state. This is often accompanied by pain and bleeding.
In the case of a wound infection, the wound is reddened, overheated and foul-smelling. The wound discharge increases markedly and (pressure) pain occurs. In some cases, surrounding lymph nodes swell painfully as a sign of the immune reaction. If fever also occurs, this is a possible indication of dangerous blood poisoning (sepsis).
What can be the cause of a wound healing disorder?
Local causes
The most important local risk factor for a wound healing disorder is unfavorable wound conditions. Especially wide, bruised, dry or dirty wounds, which may also be infected, usually heal poorly. If pus or a bruise forms, this further complicates the healing process. In addition, smooth cuts usually heal better than bite wounds, small and superficial wounds better than large and deep wounds.
Systemic causes
Systemic causes are factors that fundamentally impede wound healing. These include, for example, previous diseases or age, but also an unhealthy diet, nicotine consumption or the use of certain medications.
Pre-existing conditions
Skin diseases, chronic pain disorders, immune system disorders, severe infections, tumors and their treatment with radiation and chemotherapeutic agents as well as high bilirubin and urea levels, anemia and dehydration also impair wound healing.
Age
In old age, wounds usually heal more poorly than in younger years. This is sometimes due to the more frequent occurrence of concomitant diseases.
Smoking
Smoking is an important risk factor for poorly healing wounds. One study showed that 50 percent of smokers compared to 21 percent of nonsmokers suffer from wound healing problems after surgery.
Nutrition
Wounds heal poorly when proteins and their components, amino acids, are lacking for tissue repair. Protein deficiency sometimes also occurs when, for example, the liver does not produce enough protein or as a result of malignant tumor disease.
Medications
Caution is also advised with medications that sometimes directly or indirectly delay the healing process. These include, for example, corticosteroids, cancer drugs, psychotropic drugs and anticoagulants.
Whether a wound heals well after surgery depends not only on the skill of the surgeon but also on postoperative wound care and nursing. A wound will not heal after surgery if the patient’s positioning is neglected – if the patient is constantly lying on the wound, the sustained pressure load will lead to a wound healing disorder.
There is also a risk of wound healing disorders following tooth extraction, for example. As a general rule, particularly long operations and high blood loss during surgery favor a wound healing disorder.
How is a wound healing disorder diagnosed?
Specialists in wound healing disorders are, in particular, dermatologists for superficial wounds and surgeons for internal wounds. Initially, the doctor will usually ask the following questions, among others:
- How did the wound develop?
- Are you suffering from pain or fever?
- Has the wound healed better in the meantime?
- Have you already experienced wound healing problems?
- Do you have any known pre-existing conditions?
- Have you had any reactions to wound treatment (including allergic reactions)?
Depending on how long a wound takes to heal, the wound is referred to as acute or chronic. Asking about fever and taking body temperature are important for early detection of possible sepsis.
It is also important to assess the condition of the wound. To do this, the doctor looks for pus, redness and dead tissue, among other things. In this way, he assesses whether the wound is aseptic (germ-free), contaminated or septic (infected). Finally, for therapeutic and prognostic purposes, he will roughly determine the phase of wound healing.
In the case of larger and more severe wound healing disorders, further examinations are necessary.
Blood examination
Imaging
For deeper and internal wounds, as well as suspected foreign bodies or bone fractures, imaging is performed as part of the wound healing disorder diagnosis. For superficial wounds, an ultrasound examination is usually sufficient. If the wound is not superficial, its extent is estimated using computed tomography (CT), magnetic resonance imaging (MRI), or X-ray.
Wound swab/biopsy
If it is suspected that the wound is a tumorous process, the physician removes wound material for (histo-) pathological examination (biopsy).
Differential diagnosis
An important alternative diagnosis to a wound healing disorder is pyoderma gangrenosum, which often occurs in connection with rheumatoid arthritis, chronic intestinal diseases, diseases of the hematopoietic system, and when the immune system is suppressed with medication. Most often it is located on the legs.
How is a wound healing disorder treated?
A wound healing disorder requires specific treatment to avoid serious consequences. Care for complicated wound healing disorders is ideally provided in a specialized wound center.
Tackling the cause
A number of causes of wound healing disorder can be at least partially eradicated. For example, if diabetes mellitus leads to wound healing disorders, it is important to control it optimally with medication.
Wound hygiene
The decisive goal of local therapy is to enable a problem-free healing process and to prevent damaging influences. Wound hygiene plays a very important role, not only in the wound itself, but also at the wound edges and in the immediate surroundings.
To prevent local reactions, aggressive irrigation solutions should be avoided. Only preparations approved for direct wound application are suitable. When iodine is used, there is a risk of it causing cell death. It must therefore be used with caution, especially in the initial treatment.
Debridement
This is particularly indicated in cases of strong signs of inflammation, systemic infections and large plaques as well as a lot of dead tissue. Everything is then removed until healthy tissue is on the surface. Among other things, this leads to a better oxygen supply to the wound.
Surgical interventions due to a wound healing disorder include clearing out cavities with wound secretions or larger bruises and, in severe cases, the (partial) amputation of body parts, such as a toe. In cases of wound infection, it is sometimes necessary to reopen the wound.
Wound coatings can also be dissolved by artificial enzymes, for example in the form of collagenase ointments.
Wound dressing
Modern interactive dressing materials such as hydrogels, alginae or foam dressings provide a favorable, moist microclimate, which allows connective tissue and skin cells to proliferate. At the same time, adhesion of the new skin cells to the dressing is usually prevented. In severe cases, a wound healing disorder is additionally treated with wound drains or vacuum sealing.
Antibiotics
Pain treatment
A wound healing disorder is sometimes accompanied by considerable pain, which in severe cases requires treatment with opiates. Surface anesthesia is sometimes used in the wound area to numb the skin and tissues.
Other procedures
Accelerate wound healing
The healing process of a wound can be supported. To find out how, read the article on wound healing.
What is the course of a wound healing disorder?
If an optimal wound environment is achieved and the cause is eliminated, the prognosis for a wound healing disorder is good. Often, however, the cause cannot be completely eliminated, which worsens the prognosis.
Complications
Infection in the context of a wound healing disorder is particularly feared, leading in some cases to an abscess and blood poisoning. The latter is potentially fatal and requires immediate treatment.
Vascular, nerve, tendon, muscle and bone damage are also among the complications of a wound healing disorder.
How can a wound healing disorder be prevented?
To prevent a wound healing disorder, it is important to always care for a wound properly. After gentle cleaning, cover the wound with a dressing. Perform disinfection exclusively with antiseptics intended for this purpose and only in the case of severe contamination. In more severe cases, a visit to the doctor is advisable, who may stitch the wound.
