Causes of non-healing wounds
The immediate cause of non-healing wounds is insufficient activity of restoration processes in the body, slow tissue regeneration. Moreover, the conditions under which regeneration slows down can be varied.
Among the general factors (i.e., affecting the state of the body as a whole), the following can be identified:
• weakened immunity due to concomitant disease or chronic immunodeficiency state;
• chronic intoxication of the body;
• metabolic disease;
• diabetes; this condition can be considered a severe form of metabolic disorder, namely glucose metabolism. Disturbances in the normal absorption of glucose lead to increased tissue fragility and a slowdown in the regeneration process;
• circulatory disorders - both general and local. The cause may be atherosclerosis, deformation of vascular walls, and diseases of the cardiovascular system. Local circulatory disorders can be caused by prolonged compression of tissues and pinching of small blood vessels (an example of a chronic wound against the background of constant compression of tissues - bedsores);
• hypo- or avitaminosis of vitamins A, C, K and group B, which play an important role in the process of tissue regeneration;
• lack of calcium or zinc in the body;
• exhaustion – nutritional (due to insufficient or malnutrition) or senile;
• presence of cancer.
A specific factor in the appearance of chronic wounds is poor circulation in the legs, most often due to varicose veins. Against the background of impaired blood circulation, trophic ulcers develop on the legs (usually in the shins) - difficult-to-heal tissue defects.
Local factors affecting the wound itself and the area around it include:
• infection;
• the presence of necrotic tissue in the wound (they increase the risk of suppuration and, accordingly, the duration of healing);
• presence of foreign bodies in the wound;
• the presence of bleeding in the wound (also increases the risk of infection);
• repeated damage to an unhealed wound.
The risk of a wound becoming chronic increases if, in addition to the skin, other tissues are damaged - subcutaneous tissue, nerves, muscles, tendons, bones.
Symptoms of non-healing wounds
•constant pain;
•converging edges of the wound;
•constant bleeding;
• “stuck” wound at one of the stages of healing for more than three weeks;
•often – unpleasant odor;
•conventional treatments do not help or help little.
These signs indicate that the regeneration processes in tissues are disrupted for one reason or another. For the treatment of chronic wounds, local treatment is not enough; comprehensive measures are required.
To achieve progress in healing, it is necessary to provide conditions for restoring the normal rate of regeneration. They largely depend on the cause of the chronic wound, but there are recommendations that are common to all situations.
The body needs to provide:
•balanced nutrition - in particular, the diet should be enriched with vitamins A and B, which stimulate tissue regeneration, and vitamin C, which promotes the production of collagen - a substance involved in the formation of connective tissue that closes the wound in the first stages;
•normal sleep mode – during sleep the regeneration process occurs more actively;
•protecting the wound and the area around it from external influences, such as rubbing, squeezing, etc.;
•wound ventilation – without air circulation, the wound will quickly fester.
More specific recommendations depend on the origin and nature of the wound.
How to care for the suture after surgery?
Once the edges of the incision tighten, there will be no need for additional support. Removal of sutures in the head, face and neck area occurs already on the 5th day after the operation. If they were applied in the area of the torso or limbs, then it will take at least 10 days for the wound to heal. Daily dressings are necessary for the first few days. The patient usually spends this time in the hospital. After discharge, tight bandages are usually no longer needed. But if necessary, you can always change the dressing at the nearest hospital or medical center.
Caring for the suture after surgery consists of daily treating the incision area with an antiseptic and taking medications that accelerate tissue regeneration. All medications for home therapy are used strictly according to the doctor’s recommendation!
Treatment of sutures is usually carried out with ready-made pharmaceutical preparations or homemade antiseptics, such as solutions of iodine, potassium permanganate, brilliant green or hydrogen peroxide. To avoid getting a chemical burn when performing such procedures, the liquid for disinfection should be prepared only according to a prescription issued by a doctor.
To speed up regeneration processes, external agents with wound healing and antibacterial effects are used. These include balsamic liniment (better known as Vishnevsky ointment), levomekol, ichthyol ointment and many others.
Pain of varying intensity after surgery is absolutely normal. If discomfort is severe, analgesics approved by your physician may be used.
Treatment of non-healing wounds taking into account their cause
When starting to treat injuries of this kind, it is necessary to understand the cause of their occurrence. Further actions will depend on this.
1. First of all, it is necessary to examine the wound for foreign bodies, necrotic tissue, and bleeding and, if necessary, clean it. Please note that it is strongly recommended not to remove foreign bodies yourself! Such attempts may cause additional tissue damage and increase the risk of infection. You need to seek help from a doctor.
2. If local blood circulation is impaired, it is necessary to eliminate the source of pressure on the tissue (change the position of the patient’s body with bedsores, wear looser clothes/shoes for “diabetic” wounds).
3. When treating trophic ulcers on the legs, it is necessary to use compression stockings or bandages - they will help “support” the blood vessels and normalize blood circulation, as well as “pull” the edges of the wound towards each other for faster healing.
4. In case of exhaustion and vitamin deficiencies, it is necessary to provide a normal balanced diet in order to provide the body with the necessary substances for tissue regeneration and the production of collagen - a substance that is actively involved in the early stages of the healing process and helps tighten the edges of the wound.
5.If you have diabetes (of any type), you need to monitor your blood glucose levels.
After creating optimal conditions for wound healing, you can begin to treat and treat it.
Principles (stages) of treatment
Actions when treating a wound depend not only on the conditions and causes of its appearance, but also on the stage at which the wound process has stopped in it.
The first stage of the wound process is acute. During it, vascular changes occur caused by a reaction to damage, and the process of blood clotting is actively underway. If the wound is infected, pus is formed and toxic substances are simultaneously absorbed into the tissue.
At this stage, it is necessary, first of all, to clean the wound - remove dead tissue from it, remove foreign bodies (with the help of a doctor), drain it - remove pus and exudate from the wound. It is also necessary to prevent infection from entering the wound. It is best to wash the affected area with saline solution, as caustic disinfectant liquids can harm surrounding healthy tissue.
The second stage of the wound process is granulation. At this stage, a thin layer of connective tissue begins to form on top of the wound. The edges of the wound begin to tighten, and it closes itself. The thinnest capillaries are formed in the connective tissue layer, providing nutrition to regenerating tissues. Often chronic wounds stop at this phase, and the healing process does not proceed further; This is most often what happens with trophic ulcers.
At the granulation stage, it is important, firstly, to protect the newly formed tissue from mechanical damage, secondly, to stimulate further regeneration, and thirdly, to prevent the development of the inflammatory process - despite the fact that the wound is closed, the risk of infection and inflammation remains. To stimulate tissue regeneration, methyluracil ointment is used (you can use a ready-made Voskopran dressing with methyluracil ointment); to protect the surface of the wound, atraumatic dressings should be used that do not stick to the wound surface and do not injure it.
We should not forget about maintaining a maintenance diet and sleep schedule - this will help speed up the healing process.
At the first aid stage
The process of its healing in the future largely depends on how effectively and competently first aid is provided when receiving a wound. Therefore, as first aid you need:
- stop the bleeding,
- wash the wound, clean it of dirt and foreign bodies.
To stop bleeding, a tourniquet is used (when applied, be sure to indicate the time when it was applied) or a pressure bandage. It is advisable to wash the wound with an antiseptic solution, hydrogen peroxide (which, by the way, helps stop bleeding) or, in extreme cases, with clean water. It is important to remove any foreign particles from the wound surface - each of them can subsequently become a source of purulent inflammation and, as a consequence, complications of wound healing. Large debris, slivers, and fragments are removed using tweezers.
Dressings for the treatment of non-healing wounds
When treating wounds of any nature, including chronic ones, the correct selection of dressing material plays an important role.
Dressing material for non-healing wounds should be:
•hygroscopic;
•"breathable";
•elastic and flexible – the bandage will have to be worn for a long time, so it should not interfere with movements.
Biotekfarm company offers a wide selection of dressings for the management of wounds of any complexity and at any stage. So, for wounds in which there are fragments of necrotic tissue or hemorrhage, a Parapran dressing with chymotrypsin is suitable - the drug included in the dressing helps to break down necrotic tissue, helping to cleanse the wound.
To moisturize “dry” chronic wounds (bedsores, trophic ulcers) and accelerate their healing, it is recommended to use the “GelePran” dressing with miramistin or colloidal silver. This soft transparent dressing, consisting of 70% water, moisturizes the surface of the wound, and the medicine it contains (miramistin or silver) disinfects and promotes regeneration.
For the treatment of infected wounds, bactericidal dressings Voskopran with Povidone-iodine ointment, antimicrobial dressings Voskopran with Dioxidin ointment, and anti-inflammatory dressings Voskopran with Levomekol ointment are suitable. Polipran dressings with Dioxidin are excellent for preventing infection of wounds at the granulation stage.
The Chitopran dressing based on chitosan nanofibers will help stimulate regeneration. It provides optimal conditions for healing - sufficient humidity, breathability and protection from damage, and promotes the rapid growth of its own cells. It is worth paying attention to the fact that this bandage does not need to be removed - it resorbs on its own as the wound heals.
The importance of the granulation phase for tissue repair
The granulation stage of the formation of new tissue is a complex process in which several groups of cells take part. It includes:
- Plasmocytes are cells that synthesize antibodies, which, in turn, are responsible for the body’s immune response.
- Histiocytes. They perform a protective function by inactivating foreign objects that enter the newly formed layer of tissue.
- Fibroblasts responsible for secreting the precursor protein collagen.
- Leukocytes - protect the body from any pathogenic agents.
- Mast cells are one of the components of formed connective tissue.
The entire maturation cycle of granulation tissue takes 20-30 days.
It should be remembered that this is a temporary formation that will be replaced by dense scar tissue. Most of it consists of newly formed capillaries. Over time, the thin walls of the vessels are covered with new cells, which continue to divide, forming a dense layer that covers the site of damage.
Wound healing time and consequences
Healing a chronic wound is a long and complex process that can take from 1 to 3 months, depending on the depth and size of the wound. It should be borne in mind that epithelization of chronic wounds is very slow - no more than 1 cm per month. After complete epithelialization, the “new” skin increases its strength for another 6 months.
Recommendations for caring for the problem area are quite simple:
•protect the wound from compression and mechanical damage;
•change the bandage regularly (depending on the stage of healing and type of bandage);
•at the granulation stage - use dressings that accelerate healing.
Home first aid kit
However, if we are talking about a universal remedy, which is better to have in a home medicine cabinet and which is suitable for all family members, then preference should be given to dexpanthenol preparations, which are approved for use in children from the first days of life, in pregnant women and women during lactation. Since at each stage of the wound process different forms of release of this drug are recommended, it would be optimal to have an ointment and a cream or gel combined with an antiseptic in the first aid kit.
Sources
- Abaev Yu. K. Biology of acute and chronic wound healing // Medical news. - 2003. - T. 6. - P. 3–10.
- Afanasyev V.V. // Solcoseryl: results and prospects. Collection of scientific and practical works. articles. St. Petersburg - 1997. - pp. 4–9.
- Butko Ya. A., Drogovoz S. M., Deeva T. V., Lyapunov N. A. Study of the reparative properties of creams with dexpanthenol and ceramides // Scientific bulletins of BelSU. Series: Medicine. Pharmacy. - 2013. - No. 18 (161).
- Zhilyakova E. T., Ivashchenkova A. O. Analysis of the Russian pharmaceutical market of drugs for the treatment of thermal burns // Young scientist. - 2022. - No. 39 (8).
