Wound Care

A wound is an injury that breaks the skin or other body tissue.  Wounds may be open or closed (meaning that the damage has occurred under the skin). The most common complication from wounds is infection. If an infection goes undiagnosed or untreated, it can cause cellulitis – a painful bacterial skin infection – or spread to underlying tissue and bone, a condition known as osteomyelitis. Infected wounds can also lead to sepsis, which can cause organ failure and, in severe cases, death.

There are four main types of ulcers – pressure, venous, arterial and neuropathic. Venous and arterial ulcers are vascular wounds caused by problems with the circulatory system. 

Pressure ulcers occur when a person remains in the same position for too long, resulting in decreased blood circulation and tissue damage. Often the immobility is caused by advanced age or an underlying condition. Pressure ulcers that have broken through the top two layers of the skin, leaving an open wound, require specialized treatment to remove damaged tissue and prevent or treat infection. Untreated pressure ulcers can lead to a variety of complications, and in some cases can be life-threatening.

Neuropathic ulcers, which may be painless, arise from minor trauma that went unnoticed because of a loss of sensation known as peripheral neuropathy. Peripheral neuropathy interferes with the ability to sense injuries, leading patients to unknowingly place stress on a limb’s pressure points until an ulcer develops. Diabetes is the most common cause of peripheral neuropathy and neuropathic ulcers. If peripheral vascular disease is also present, there is greater risk for infection and amputation may sometimes be necessary.  

Complications following surgeries including amputations, organ transplants, or orthopedic surgeries sometimes require advanced wound care if the incision does not heal as expected due to an infection, medical conditions such as diabetes, advanced age or a weakened immune system.

Other open wounds result from severe blunt or penetrating injuries that can be life-threatening or cause long-term disabilities. These injuries require immediate medical intervention and are usually the result of a traumatic event, like a motor vehicle accident, heavy machinery accident, fall, or violent wound.

When a wound has dead tissue in the wound bed, it is called a necrotic wound. Necrotizing fasciitis is a flesh-eating disease that causes severe necrotic wounds. Necrotizing fasciitis symptoms include red or purple skin in the infected area, severe pain, fever and vomiting. Necrotic wounds are unable to heal until the dead tissue is removed in a surgical process called debridement.

Debridement is the process of removing dead tissue to promote wound healing. When wounds are not progressing past the first stage of healing, this procedure can help restart the process. Debridement is also necessary when wounds are at high-risk of becoming infected. Debridement can take many forms:

• Enzymatic debridement uses an enzymatic ointment to soften the dead tissue that is then pulled away during dressing changes
  
• Autolytic debridement utilizes moisture retaining dressings that trap in the body’s natural fluids which soften the dead skin and make it easier to separate the tissue
• Mechanical debridement uses force to remove dead skin, including shower treatment, scrubbing the wound with a special pad, or letting wet gauze dry and stick to dead tissue