Health Matters: Don't ignore non-healing wounds

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Chronic wounds (defined as wounds that won't heal within 30 days using conventional treatments) are becoming more prevalent in our aging society. In Windham County, home of our nation's most rapidly expanding population of senior citizens, it is estimated that over 1,200 people have a chronic wound of some type.

A wound is a breach of the skin, the human body's largest and most important barrier to infection. Wounds need to be repaired as quickly as possible, so if a wound is slow to heal, or worsening, it is imperative that a person go to their primary care provider to determine the cause and plan a treatment strategy.

Chronic wounds are usually associated with underlying issues such as Type 2 diabetes or cardiovascular disease. In a healthy person, the body heals wounds by supplying the area with ample blood and oxygen, known as perfusion. A person with diabetes or vascular disease may not be able to adequately supply the affected area with blood and oxygen on their own, which can prolong or prevent the normal healing process.

Another issue, known as neuropathy, may further compound the problem of poor blood and oxygen supply. Neuropathy, another side effect of diabetes and other diseases, is nerve damage that causes tingling or numbness in affected areas of the body, usually the extremities. Due to the numbing effect of neuropathy, wounds located in hard to see areas such as the heel or bottom of the foot may go undiscovered for a period of time. If a person is unaware of the wound, they may continue walking on and using the affected area, making the wound worse.

As part of the healing process, a wound healing center can assist a primary care provider in evaluating and treating a non-healing wound. The Brattleboro Memorial Hospital Center for Wound Healing has a 93 percent success rate in healing wounds over a median of 30 days. The Center utilizes advanced wound therapies based on 136 clinical practice guidelines including debridement, off-loading when necessary, forming a proper wound "bed," educating the patient, and performing Hyperbaric Oxygen Therapy when appropriate.

Debridement is when a physician removes "debris" or tissue which is blocking the body's ability to provide blood and oxygen to the area that requires healing. Debridement can be either surface or subcutaneous (under the skin), depending on the depth of the wound, and is usually done in the office setting. Off-loading is done by transferring pressure from a wound (for example, a heel) to another area, usually via a cast. This allows the wound to heal by keeping pressure off of the wounded area. Forming a proper wound "bed" is done by assessing the wound to determine the proper type of dressing most conducive to healing for a specific type of wound.

Hyperbaric Oxygen Therapy involves placing a patient in a pressurized oxygen chamber in pure oxygen. This saturates the whole body, including the wound, in an environment with 15 to 20 times the oxygen level of normal air. The body's natural healing process is aided by increased oxygen flow to the wound while high levels of oxygen kill bacteria in the wound area.

The combination of one or more of these advanced therapies, plus the focus of a highly trained staff, results in the high success rate of the BMH Center for Wound Healing. Early detection is by far the best approach to chronic wounds; do not ignore a wound that will not heal over a 30 day period. A visit with your primary care provider is the first step to determine whether there is an underlying factor involved and a referral to the BMH Center for Wound Healing is appropriate.

Gregory Gadowski, MD, is the Medical Director for the Brattleboro Memorial Hospital Center for Wound Healing and a board-certified surgeon practicing at Brattleboro General Surgery. For more information call 802-275-3674 or visit online at www.bmhvt.org.


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