Essentials of Wound Care and Promotion of Healing

Health & Wellness for Wound Care

Maximize Your Health to Promote Wound Healing

Conditions must be right for wound healing. Grass won’t grow in a desert: it requires fertile soil, nutrients, adequate water circulation, the right amount of sunlight and protection from weeds. Similarly, wound healing requires good nutrition, an adequate blood supply, protection from the environment and avoidance of injurious substances.

Nutrition

A well-balanced diet that supplies the right amount of proteins, vitamins and minerals is necessary to rebuild tissue. Many individuals with chronic diseases, such as diabetes or cancer, do not have enough protein to support wound healing. Daily balanced multivitamins with minerals may be beneficial but do not replace the need for a healthy diet. Your Primary Care Manager or the Wound Care Nurse may recommend a full nutritional evaluation with a dietician.

Anemia

Anemia reduces the amount of oxygen that is carried to the wound. Fibroblasts that build the framework for new tissue and white blood cells that fight infection both require oxygen to function. If you are significantly anemic (hematocrit less than 33%), you should work with your Primary Care Manager to evaluate and treat the anemia to maximize your chances of wound healing.

Stabilization of underlying disease

Many chronic disease such as diabetes, peripheral vascular disease, uncontrolled high blood pressure and heart disease can reduce your blood circulation; which in turn decreases the flow of nutrients and oxygen to the wound. It is essential that your Primary Care Manager optimizes your diabetic control and circulation.

Stop smoking

Tobacco use is probably the single most destructive agent for wound healing. Smoking decreases circulation and impairs oxygen delivery. Long term smoking causes blood vessel damage and narrowing. It is essential that you stop smoking to help your wounds heal. Ask the Wound Care Nurse and/or your Primary Care Manager for advice on tobacco cessation programs if you need assistance.

Minimize alcohol consumption

Chronic alcohol use often results in malnutrition, decreasing protein and vitamins necessary for wound healing.

Types of Wounds

Bacterial Burden

All chronic wounds contain bacteria. This does not necessarily lead to an infection. Most of the time, the body keeps the bacteria in check. In patients with poor local defenses, such as those with poor circulation or diabetics, the bacteria may get out of control leading to an infection.

Perfusion/Oxygenation

The body's natural redundancy of tissue perfusion of healthy arterial bed allows for quick increase in oxygenation to meet increased in metabolic demand. Tissue aging, chronic disease and arthrosclerosis results in decrements of this reserve. Perfusion/oxygenation needs to be expeditiously addressed and managed, either through appropriate referrals, maximizing existing perfusion and removing what can be an "oxygen" sink.

Necrotic Tissue

Remove debris when appropriate to increase the rate of wound healing. Leaving dead tissue in the wound enables bacteria to grow and penetrate deeper into the wound. This may be as simple as removing a crust or scab or may require mechanical removal by your doctor.

Edema

Often overlooked, ignored or underestimated, edema has a powerful, negative effect on the body's ability to heal all wound types. Under chronic conditions, this edema becomes inflammation which initiates enzymatic cascades , leads to peri-capillary cuffing and increasing the distance from the arterial bed to the skin and tissues creating a relative hypoxia.

Pressure/Trauma

Three main types of pressure/trauma are friction and shear, static pressure and repetitive trauma. While concept of avoiding this is appears basic, it can be one of the most difficult to achieve as it involves strict patient compliance and often assistance of family or healthcare providers.

Infection

All chronic wounds contain bacteria. This does not necessarily lead to an infection. Most of the time, the body keeps the bacteria in check. In patients with poor local defenses, such as those with poor circulation or diabetics, the bacteria may get out of control leading to an infection. Deep infections may require oral or intravenous antibiotics.

Dressing Selection

Wounds require a moist environment to allow cells to grow. Too much moisture, however, weakens skin and decreases its resistance to infection. Different dressing materials are used to provide the right amount of moisture to the wound.

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