Factors Affecting Chronic Wound Healing
Many factors and causes are associated with slow healing or chronic wounds, and sometimes a combination of factors are involved in interrupting one of the phases of wound healing. Let’s look at the leading causes of chronic wounds:
Diminished ability to heal from wounds, or chronic wounds requiring wound care, as well as chronic diabetic foot ulcers, are common effects of the diabetic condition. The phenomenon of chronic diabetic wounds is based on a complex interplay of physiological mechanisms. Deficiency of oxygen at the wound site, known as hypoxia, is caused by hyperglycemia. Excess sugar in the bloodstream causes cell walls to thicken, thereby inhibiting blood flow to the wound site. The hemoglobin insufficiency results in lack of oxygen, white blood cells and proper nutrients. Wound healing and wound care complications are sizeable factors in morbidity rates among diabetics.
When the seven-layer barrier of skin is broken, bacteria and other micro-organisms can enter below the dermis. There, they can colonize and spread rapidly. Infections can either be the result of a chronic wound, or be the cause of a chronic wound. Micro-organisms may enter a chronic wound and cause complications with healing. Similarly, the spread of infection at a fresh wound site may severely limit the ability of the wound to heal normally, resulting in a chronic wound that requires wound care.
Advanced age has been shown to be a major risk factor for slowed or inhibited wound healing. While diminished wound healing ability is predominately due to decreased hormone levels in the elderly population, reductions in t-cell production and inflammatory response are also key contributing factors.
With regard to hormone levels, we attribute higher estrogen levels in women (specifically estradiol, for its cell growth capabilities) to studies showing better wound healing statistics for elderly women, as opposed to elderly men.
Obesity, as a condition, correlates with impaired wound healing, as well as chronic wound infection, especially with regard to post-surgical wound healing. Poor perfusion (circulation) through excess tissue results in lack of necessary oxygenation and nutrition at the wound site. Additionally, increased pressure caused by excess body weight places further burden on circulation.
Without getting too technical, chemotherapy drugs are designed to prohibit the growth of cancer cells, and as a result, also prohibit necessary cell growth, collagen formation, and tissue regeneration at the wound site. Chemotherapy drugs also stifle the body’s immune response, resulting in significantly increased rates of infection and chronic infection. Chemotherapy drugs may also restrict healthy blood clotting at the incision, leading to excessive bleeding.
The health consequences of frequent tobacco smoking have been documented for decades. Specific to wound healing, tobacco use restricts oxygen delivery to the wound, which, as we discussed earlier, greatly affects the body’s ability to heal. Nicotine use alters the consistency and chemical make up of the blood, with lowered levels of oxygen in the bloodstream in general, in addition to decreased circulation. Long-term smoking is linked to thickening of the arteries (atherosclerosis), which limits blood flow and subsequent oxygenation and nutrition. The process of burning tobacco creates carbon monoxide as a by-product, which, when inhaled, also suppresses proper oxygen levels in the blood.
In addition to the above-mentioned causal factors of chronic wounds, poor diet, stress and frequent alcohol consumption can also affect wound healing.
Chronic wounds should be treated holistically, taking all factors of a patient’s health into consideration, in addition to any diseases or medications they may be taking. Vascular surgeons treat and dress wounds, often with compression, to improve circulation and nutrition to the wound site, in a sterile environment. Proper cleansing of the wound site is also routine. Sophisticated analysis would lead a vascular surgeon to determine if curettage is required to remove damaged tissue, or if tissue is healthy enough to recover.
The San Diego Vascular Center is Ssan Diego’s foremost vascular treatment center. Whether you are looking for spider vein removal in San Diego, or need a reliable, highly-qualified staff to care for chronic wounds or vascular disease, you are in good hands with our team of board-certified doctors.