Wound - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Normally the skin is capable of healing wounds in a remarkable process that begins with clotting of the blood. This clot generates signals for inflammatory cells to come and help “clean up” and fight potential infections. Very quickly after that skin cells start rebuilding and come together to close the wound leaving behind a scar which can take months and even years to reach its final size.[1]

However, in a chronic wound, this process does not work properly leading to wounds that are very slow to heal or do not heal at all. 

Symptoms

Simply put, a wound is a break in the skin. Wounds can be very superficial or extend as deep as muscle and bone. Wounds are typically caused by unintentional injury (falling, car accidents, bullets, etc.) or by intentional injury (such as a surgical wound). Less often, wounds are caused or worsened by various diseases (such as diabetes and poor circulation). 

Causes

Many factors can slow down and worsen wound healing and here are a few common reasons: 

  • Infection: many bacteria reside on our skin and are practically all around us. If the number of bacteria increases in the wound, it may lead to an infection and that will significantly slow down healing.
  • Poor blood supply: decreased blood to the wound means decreased oxygen and without oxygen normal healing cannot occur. For example, blood supply can be disrupted by unhealthy arteries and by diabetes. 
  • Poor nutrition: people who are chronically malnourished and lack certain proteins simply lack the building blocks that are used to regenerate the skin.
  • Reduced immunity: if the immune system is reduced because of disease or medication, it cannot effectively clear infections and send over the cells that are crucial for wound healing. 
  • Older age: with time our skin changes in a way that slows down the normal process of wound healing.[2]
  • Smoking: smoking leads to slow wound repair.[3-5]

Treatments

 In a healthy person, wounds should normally heal without any problem within a few days to weeks. Here are a few strategies that your skin practitioner may use to help avoid complications. In general if your wound does not seem to be healing correctly, you should seek the advice of a medical professional.

Reduce infection:  there are a variety of over the counter and prescription based ointments that can reduce the likelihood of infection at the wound site.  Some of these ointments can increase the chance of developing an allergy and must be used carefully. For example, neomycin and polymyxin containing ointments have a higher chance of causing an allergy. 

Keep a moist environment: covering the wound with a dressing and an ointment will typically keep the wound moist. Frequent changes (at least daily) are needed to avoid infection. Certain wounds may be more wet and will require special absorbent dressings (such as alginate) if your wound is weeping and drains a lot of fluid.

 Take care of yourself: since a healthy body can heal a wound by itself, it is important to stay healthy by maintaining a healthy diet and taking your medications as instructed by your doctor. 

1.    Gurtner GC, Werner S, Barrandon Y, et al. Wound repair and regeneration. Nature.2008;453(7193):314-321; PMID: 18480812.

2.    Wicke C, Bachinger A, Coerper S, et al. Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized Wound Care Center. Wound Repair Regen.2009;17(1):25-33; PMID: 19152648.

3.    McRobert J. Smoking and its effects on the healing process of chronic wounds. Br J Community Nurs.2013;Suppl:S18, S20-13; PMID: 23682498.

4.    Sorensen LT, Zillmer R, Agren M, et al. Effect of smoking, abstention, and nicotine patch on epidermal healing and collagenase in skin transudate. Wound Repair Regen.2009;17(3):347-353; PMID: 19660042.

5.    Silverstein P. Smoking and wound healing. Am J Med.1992;93(1A):22S-24S; PMID: 1323208.