In a wound healing disorder, the natural course of wound healing is disturbed, resulting in delayed healing. Wound healing is an extremely complex process that is precisely regulated. It serves to close the wound, prevent it from drying out and counteract bacterial infections. If this complex process is disrupted, the wound will not heal for a long period of time.
Below you will find further information and selected specialists for the treatment of wound healing disorders.
A wound healing disorder is a chronic wound that has not healed within 12 weeks. Normally a wound heals within 2 weeks. Wound healing disorders are also one of the most common complications of surgery. For example, one fifth of all patients undergoing surgery suffer from wound healing disorders.
Wound healing disorders can be triggered by various deficiencies and underlying diseases. A basic distinction can be made between local (in the immediate area of the wound) and systemic (in the entire body circulation) factors. However, there is often a combination of local and systemic factors.
Systemic factors include, among others
Although we live in abundance and hunger is not a problem in civilized countries, malnutrition is a cause of wound healing disorders. Malnutrition results in a lack of nutrients such as proteins, carbohydrates, fats, minerals, trace elements and vitamins. However, these are required for the natural wound healing process, as the wound tissue is particularly metabolically active and consumes a correspondingly large number of substances.
However, overeating can also be the cause of wound healing disorders. Unhealthy, high-fat and high-sugar diets are a particular cause here.
Advanced age is also a risk factor for poorly healing wounds and can be described as a systemic factor. The older a person is, the slower the wound healing process tends to be. This has to do with a slowdown in all metabolic processes and a deterioration in tissue perfusion.
However, taking medication or chronic cardiovascular or tumor diseases can also lead to a deterioration in wound healing. This must be taken into account before surgical interventions.
Smokers are more likely to have chronic wounds, especially on the foot and primarily in the toe area. However, wounds after surgical procedures (operations) also heal much more slowly in smokers. Studies show that up to 50 percent of all smokers suffer from wound healing disorders after an operation. This figure is only around 10 percent for non-smokers. This is presumably due to the fact that smokers have poorer blood circulation. However, toxins from smoking also have a detrimental effect on wound healing and lead to an undersupply of oxygen to the tissue .
Other causes of oxygen deficiency include diabetes, vascular diseases of the arteries ( peripheral arterial occlusive disease) and veins(varicose veins and thrombosis), as well asanemia.
Another important cause of wound healing disorders is the weakness of the immune system. A weakened immune system, for example in the case of canceror chronic infectious diseases such as AIDS, impairs the healing process. The same applies to various medications such as immunosuppressants, anticoagulants and cytostatics, which are often used in cancer therapy.
Changes in the wound environment, so-called local factors, can also significantly impair wound healing. Large, deep, dry, dirty or bruised wounds are particularly prone to wound healing disorders. Pus or bruising can also delay the healing process, as can bacteria in the wound area.
In general, small and superficial wounds heal better than large and deep wounds. In general, smooth cuts heal better than bite wounds, for example. Incorrect wound care after injuries can also lead to wound healing disorders. The wound cover should protect the wound from drying out and allow a good supply of oxygen.
If the wound needs to be sutured, the suture must not be too tight. If the stitches are pulled out too early, the injury can tear open again.
The main symptom of a wound healing disorder is a wound that does not heal. The clinical picture can vary depending on the type of disorder. The wound may swell, become red and painful. If the edges of the wound become separated or the wound bursts open, this is known as wound dehiscence. This phenomenon mainly occurs after surgery. The wound may be surrounded by blood (wound haematoma = haematoma) or have dead tissue(necrosis). Such a necrotic wound appears bluish-purple or black. Some wounds also ooze or are accompanied by itching and fever.
Another wound healing disorder is cicatricial keloid, which means excessive scarring. This is where so-called fibroblasts, which are a main component of connective tissue, form. This results in a benign tumor that grows like a bulge above the skin level. Keloid is normally a purely aesthetic problem, but occasionally it can be accompanied by itching or sensitivity to touch.
After a detailed consultation (anamnesis), the wound or scar is examined and palpated. It is also checked whether blood circulation, sensitivity or motor skills are impaired and which structures are affected. The condition of the wound is also assessed, in particular whether there is any dead tissue or pus. In the case of smaller wounds, it is usually sufficient to examine them and carefully clean and dress them.
Larger wounds and pronounced healing disorders usually require further examinations. For example, a blood test can provide information about the functioning of the immune system and show whether an infection is present. Deeper and internal wounds can only be assessed using imaging techniques such as X-rays, computer tomography, magnetic resonance imaging or ultrasound. If an infection of the wound is suspected, a wound swab is taken so that the exact pathogen can be determined and, if necessary, an antibiotic effective against it can be administered.
In the treatment of wound healing disorders, a distinction can be made between local and systemic therapy. The most important success factor in local therapy is wound hygiene. The wound must be kept clean, but must not be overly irritated by disinfectants. Rinsing with salt water or wound baths with tap water at body temperature are used to clean the wound. Dead tissue, foreign bodies or coatings are removed surgically.
If possible,chronic wounds should be treated regularly by an experienced wound expert. They will select the right wound dressing to protect the wound and at the same time provide a moist wound bed for healing. If there is a major wound infection, treatment with antibiotics may be advisable. A wound swab is usually taken prior to drug therapy in order to determine any insensitivity to certain antibiotics (known as resistance) in advance.
Antibiotics are usually administered as an infusion or tablet for systemic treatment . However, to promote the healing process, it is essential to treat the underlying cause of the wound healing disorder. Despite intensive treatment, complete healing is not always possible, so amputation may be necessary as a last resort.
If the cause of the wound healing disorder can be eliminated, the prognosis is generally good. The earlier the wound is optimally treated, the better the chances of healing. However, people with advanced chronic diseases that impair wound healing in particular suffer from poorly healing wounds for the rest of their lives. Even very minor injuries need to be treated by a specialist so that no further foci of inflammation develop.
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