About Wound Care

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There are numerous causes and types of wounds.  The most common type are: 

  • Diabetic Wounds
  • Traumatic wounds
  • Pressure injuries
  • Arterial Ulcers
  • Venous Stasis Ulcers
  • Non-Healing Surgical Wounds
  • Fluid overload from lymphedema 
  • Infected Wounds

No matter the cause of the wound, there are 4 overlapping stages of wound healing that must occur for the successful closure of the wound.  The phases are: Bleeding, Inflammation, proliferation, and maturation/remodeling.

Each stage of wound healing has a distinct physiological process that must occur before the next stage.  Any wound that has not begun to heal in 2 weeks, or has not healed completely in 6 weeks, is considered a “stalled” wound in any of the  stages of healing.   These wounds may benefit from advanced wound healing.  

The depth of tissue involvement will also help determine the treatment needed.  Wounds are classified by the extent of tissue damaged as either superficial, partial thickness, or full thickness. 

Diabetic Ulcers

Wounds on the bottom surface of a foot

Diabetic ulcers most often occur on the feet, however, can develop other places also.   There are several reasons why having diabetes makes a person more susceptible to developing wounds.  The main reason is that high blood sugars can damage your nerves and blood vessels.  Chronically high blood sugars will harden blood vessels, which will lessen blood flow, usually to hands and feet, which makes it harder for sores and cuts to heal.   Diabetes will also make you more likely to get an infection.  In addition, nerve damage can occur with Diabetes, also known as neuropathy,  which makes it harder for you to feel pain or other symptoms of ulcers or infections. 

For example, neuropathy could prevent a person with diabetes from feeling their shoes rubbing on their feet.  In addition, this rubbing of their shoes causes tissue damage in an area where there is decreased blood flow.   The result is a wound on the foot, which is more prone to infection and poor healing outcomes.  This is when getting proper fitting shoes and advanced wound healing techniques are necessary.

Vascular Ulcers

The circulatory system includes your heart, arteries, veins, and lymphatics.  The heart pumps and circulates blood throughout the body to transport nutrients and oxygen to all of your cells and organs.   The heart moves blood through the arteries to your capillaries, keeping all of your tissue healthy. This blood then returns to the heart from every part of your body through the veins or the lymphatic system.   There are two different types of vascular ulcerations, Venous and arterial.  

Venous Ulcers

When the veins are damaged, they can no longer get the blood back up to the heart.   For a time, the lymphatic vessels will help the veins by bringing the fluid back to the heart. When patients have poor functioning veins, blood collects in the lower legs, causing high pressure in the veins. This high pressure can force the fluid and proteins to filter out of the blood vessels and into surrounding tissue. The lymphatics responsible for removing this fluid may not be able to keep up with the extra fluid or become damaged, so swelling occurs.   This failure of the lymphatics will lead to decrease in wound healing and also increase the risk of infection. 

Venous ulcers form on the leg when enough fluid and pressure build in the tissues, the skin can break down and result in opening of the skin. 

Arterial Ulcers

Arterial ulcers occur when the capillaries are no longer able to get oxygenated blood to the skin.    The overlying skin and tissues are then deprived of oxygen, killing these tissues and causing the area to form an open wound.  Arterial wounds usually develop on the tips of the toes or around the ankle.  However, minor cuts and scrapes can fail to heal if there are underlying arterial insufficiencies.  A consultation with a vascular specialist is always the first step in the treatment of arterial wounds.    

 

Pressure Injuries

4 stages of pressure injuries

Similar to arterial ulcers, pressure injuries result from the skin being deprived of oxygen-rich blood.  However,  they are caused by too much pressure on an area of the body, usually over bony prominences, i.e. poor fitting shoes, prolonged bed rest, sitting in a wheelchair without moving, etc.  The first step in dealing with pressure injuries is to relieve the pressure off the wound and then treat the wound with proper wound dressings to help aid in healing.       

Lymphatic Wounds

These wounds are due to extensive damage to the skin and/or fluid overload on the skin that causes blistering.   As a result, the fluid from the lymphatic dysfunction will begin weeping out of the skin.  The primary focus with these wounds is controlling moisture on the skin and reducing lymphedema to regain healthy skin again.