Aging; Plastic Surgery
Time is tissue: Tips to manage and prevent chronic wounds and ulcers
February 6, 2020
Skin is the body’s largest organ – but unlike your internal organs, it is exposed to day-to-day damage during normal activities, which can result in cuts and scrapes. In most patients, these surface-level wounds heal quickly.
However, in patients with conditions that weaken the skin, the healing process can be delayed or sometimes doesn’t begin at all. When a minor wound doesn't heal on its own after approximately two weeks, we consider it a chronic wound. And if left untreated, it can lead to serious infections and tissue loss. In rare cases, it increases the risk of amputation.
Chronic wounds are common, with experts estimating that 1% to 2% of the population have them.
At the UT Southwestern University Hospital Wound Care Clinic, we see patients for a variety of conditions that cause skin dryness, tissue tears, loss of elasticity (stretchiness), or loss of sensitivity (neuropathy), which increases their risk of developing chronic wounds. Some of these conditions include:
- Autoimmune diseases, such as rheumatoid arthritis and diabetes
- Ongoing mobility issues or long-term wheelchair use
- Skin complications after surgery or cancer treatment
When dealing with wounds, time is tissue: the earlier you receive treatment, the better.
We approach wound care as a team of experts who cover all the bases with patients, from preventive strategies to nutrition plans that promote healing. Our patients have access to new and emerging treatments that can heal chronic wounds faster. And the process begins with addressing the nuances of the underlying condition that put them at risk in the first place.
Common conditions associated with chronic wounds
Diabetes is most often associated with the development of chronic wounds. It can alter the function of blood vessels, nerves, and surface of the skin, leading to issues such as foot ulcers, which affect up to 15% of diabetic patients. Typically, this is brought on by peripheral neuropathy, or losing sensation in your feet, which can make it more difficult to immediately notice wounds after stepping on a sharp object or developing a blister.
Patients with diabetes should check their feet regularly for wounds and skin changes. We advise patients to wear properly fitting footwear designed especially for diabetic foot health. These shoes can help reduce irritation and protect the feet from foreign objects. We also recommend using a thick lotion made specially for patients with diabetes to help keep the skin moisturized, flexible, and resistant to tearing.
Wheelchair use or limited mobility
Pressure ulcers are a common issue for those who use a wheelchair for mobility or are confined to a bed. Also called bedsores, these wounds can develop when your skin is pressed against a hard surface for extended amounts of time. If the pressure reduces blood flow to this area, the tissue can become damaged or die, leading to the formation of ulcers.
To minimize the risk, patients or caregivers should perform regular inspections to make sure abrasions are healing properly. A doctor or mobility expert can recommend cushions, padding, or a rotation schedule to reduce the risk of pressure ulcers. Pay special attention to areas such as the spine and hips that are frequently in contact with hard surfaces.
Leaky or varicose veins
Approximately 20% of adults in the U.S. have varicose veins – swollen or twisted blood vessels that can be seen under the skin and increase the risk for chronic wounds or ulcers. For some patients, varicose veins cause swelling, tension, and skin damage such as hemosiderin deposits, in which the blood leaks back into the skin, weakening it and sometimes preventing wounds from healing.
To prevent varicose veins, we frequently recommend compression socks for patients who sit or stand for long periods of time every day. Other steps include quitting smoking, getting exercise every day, and elevating your legs when resting.
Conditions or treatments that suppress the immune system
Autoimmune conditions such as rheumatoid arthritis can reduce your immune system’s ability to fight infection – and so do many recommended treatments. Immunosuppression disturbs the body’s typical healing response, slowing healing and increasing the likelihood of infection. This is also true with individuals who take anticoagulants (blood thinners), which can also decrease wound healing time.
Taking steps to manage your autoimmune disease can minimize your risk for developing chronic or long-lasting ulcerations. Talk with your specialist about symptoms to watch for and skin inspection tips for your condition.
Radiation as a treatment for cancer can make your skin fragile, which can make it harder for wounds to heal. Other cancer treatments such as removal of a tumor can lead to skin integrity issues, which can result in a slower healing process for the affected skin.
Your provider can recommend guidelines to help your skin remain healthy. In general, strategies such as washing the treated skin with warm water, avoiding harsh skin cleansers, and wearing loose clothing is a good place to start in maintaining skin health and elasticity.
Though in most cases they heal quickly, incisions from surgery can be slow to heal or become chronic if the incision opens or becomes infected. Factors such as a weakened or suppressed immune system, being overweight, and advanced age can increase your risk for incisions failing to heal. If you notice any signs of infection such as fever, drainage from the area, or increased pain around the incision line, alert your doctor right away.
Innovative treatments in wound care
Patients in our wound care clinic have access to a team of experts in plastic surgery, vascular surgery, nutrition, and wound ostomy nurses, who are specially trained to care for patients with chronic wounds. We meet regularly to review each patient's case and recommend next steps in their personalized care plans, including recommendations to help improve their underlying conditions.
Negative pressure wound therapy
This revolutionary procedure, also known as vacuum dressing, can promote healing by using suction to remove excess fluid from the wound. The technique uses a sealed wound dressing made from foam or gauze attached to a vacuum pump to create suction on the wound.
In addition to removing excess fluid from the wound’s surface, the suction pulls the edges of the wound together and can increase circulation to the affected area, helping the body naturally heal the wound. Typically, this treatment takes one to two weeks, and the dressing will be changed a few times per week.
Related reading: How VAC wound care helped fix a tortoise’s leg
Biological dressings are used to temporarily cover the wound and work to close it while preventing fluid loss and protecting the wound from contamination. The dressing is usually created from organic material such as bovine collagen or human stem cells.
In addition to shielding the wound from the outside elements, the dressing can also help activate the tissue surrounding the wound into a healing state. Recovery time depends on the severity and location of the wound, and your doctor will discuss what to expect.
Surgery can also treat chronic wounds caused by blocked blood flow. Minimally invasive procedures such as angioplasty and stent placement can open blood vessels in the lower extremities and help start the healing process.
We can enter the patient's blood vessel through the groin using a catheter, which is a thin, flexible tube. Through the tube, we inflate a small balloon to open the blocked vessel and place a stent to help keep it open. Recovery time will depend on how blocked the vessel was and the severity of the wound.
While wound care continues to evolve, standard treatments such as skin grafting and closure of the wound are still effective in many cases. Most cases require debridement – controlled removal of dead or unhealthy skin – to provide a clean, smooth surface. Removing the damaged skin "reminds" the body that it has healing to do and jumpstarts the process.
Emerging treatments and a predictive future for wound care
UT Southwestern is home to a robust research program and many clinical trials for chronic wound treatment. Our researchers are investigating technology that can detect areas with low blood flow before a wound appears. Much like the relationship between time and tissue, it’s also true that ‘blood is life’ – without proper blood flow, damaged tissues can’t repair itself and wounds or ulcerations in the affected area are prone to becoming chronic.
Another technology that shows promise is hyperspectral imaging, which works like a camera by bouncing a laser off the wound surface to measure oxygen saturation in the tissue. Low oxygen is an early indicator of at-risk tissue. Finding these areas before they become surface wounds can help us isolate issues earlier and provide better, more effective care.
While chronic wounds can be dangerous, there are many innovative new treatment options. The most important thing to remember is that time is tissue – the sooner you’re able to receive specialized treatment, the more likely it is your wound can be effectively managed.