The healing of an acute wound follows a well-ordered pattern through a number of defined phases. Often, acute wounds heal themselves without coming close to a wound care specialist. Unfortunately, as all wound care practitioners know, a large proportion of wounds fail to follow this well-understood path and prove more difficult to heal. These are the ‘chronic wounds’ that command much of the wound care specialist’s time.
Don’t Focus Exclusively on the Wound
In a chronic wound, progression through the normal phases of healing is prolonged or halted due to the presence of one or more underlying condition. The best way to improve healing in these wounds is to stop focusing exclusively on the wound itself and begin to consider all underlying issues. This allows the wound to restart its normal progress through the phases of wound healing.
Wound Healing Categories
Factors that can adversely affect the rate of wound healing can be divided into four categories: characteristics of the wound itself, local factors within the wound area, systemic factors relating to the patient as a whole, and inappropriate wound management. Not all of these factors can be modified, for example, certain wound characteristics (size, location, and time since onset) and systemic factors (age and comorbidities) are what they are. However, there is still plenty of scope for the wound care specialist to improve the chances of wound closure. For example, systemic problems that can be readily addressed include poor nutrition and hydration, and use of concomitant medication, while local problems such as wound infection or presence of necrotic tissue should be dealt with as a priority. Inappropriate prior wound management should, of course, be dealt with immediately.
Our understanding of the factors affecting healing in chronic wounds is improving all the time. We now recognize the importance of looking beyond the wound itself to other systemic factors in order to create an improved environment for wound healing. To learn more about best practice for chronic wound management, and other important areas of wound management, consider becoming wound certified.
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Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.