Wounds | Causes & Treatment

What is a wound?

A wound is any damage or break in the surface of the skin. Skin is the largest single organ in the body. It acts as a protective barrier to the external environment, keeping out harmful agents such as bacteria and viruses; maintaining the internal environment (temperature regulation and body hydration). Skin damage therefore results in a beach through which harmful substances can enter to cause inflammation and infection locally and systemically. 

Wounds can be caused by several reasons, such as:

• Accidental – abrasion, cut, skin tear, burn, puncture, avulsion
• Surgical – post surgical intervention (operation)
• Complication of underlying disease  – diabetes ulcer, vascular ulcer
• Complication of some skin condition – excoriation from eczema or psoriasis

Wounds can be superficial or deep, depending on the extent of injury, some may involve deeper tissues including muscle, tendons, bones.

Wounds generally can be divided into two categories:

1. Acute
2. Chronic

Acute wounds are wounds that happen suddenly and follow the expected rate of healing. Examples of acute wounds are surgical wounds and traumatic wounds.

Chronic wounds are acute wounds that have not proceeded through the phases of healing orderly and timely and have shown no significant healing progress in 30 days.  These chronic wounds are usually associated with underlying disease which affect the blood supply and cell functions for wound healing, some are even implicated by heavy bacteria infection. Examples of chronic wounds may include diabetic ulcers and venous ulcers.

Wound healing

It is a series of complex events consisting of four highly integrated phases:

1. Hemostasis
2. Inflammation ( 0 – 3 days)
3. Reconstruction ( 2 – 24 days)
4. Tissue maturation ( 24 days – 1 year)

Types of wound closure: Primary, Secondary, Tertiary (delayed primary closure)

1. Primary closure intention

• Immediate closure of a clean wound
• Minimal tissue loss
• Edges of wound held in close opposition 
• Using sutures, clips, adhesives tapes o glue (synthetic adhesives)
• Done under sterile conditions
• Minimal scarring results
• Fast healing process

2. Secondary closure intention

• Implemented when primary intention is not possible
• Usually when there is significant tissue loss or damage
• Occurs by a process of granulation, contraction and epithelialization
• Scarring results 
• Healing process can be slow, requires more time and energy 
• Majority of wounds closure intention

3. Tertiary healing intention (Delayed primary closure)

• Combination of healing by primary and secondary intention
• Usually instigated by wound care specialist to reduce risk of infection
• When wound is infected or contain foreign bodies, requiring intensive cleaning and monitoring before primary closure days later
• Example : dog bites traumatic injury, laceration with foreign bodies

Why is my wound healing slower than others?

While dressings and antibiotics do their part, several factors affecting wound healing can make the treatment process different for each patient. Some of these factors are unavoidable, while others can be controlled or evaded with conscious effort.

Here are some of the important factors that can promote or inhibit wound healing:

1. Age

Wounds in older patients may heal more slowly than those in younger patients. Older patients may have altered hormonal responses, poor hydration,  inadequate nutritional intake, and compromised  circulatory, immune, and respiratory systems, any of which can increase the risk of skin breakdown and delay wound healing. Comorbidities as we age too would affect the wound healing rate.

2. Weight

Overweight patients typically experience slower wound healing with poor blood supply to fat tissues. This is due to a higher risk of skin breakdown and strained cardiovascular function that comprises tissue oxygenation, which is common in overweight people.

3. Nutrition

Our bodies need an adequate amount of resources to support wound healing, which is why patients should maintain a healthy, balanced diet. Foods high in protein, zinc, copper and vitamins can especially promote faster healing. 

4. Lifestyle

Patient behaviours and lifestyle choices, such as excessive smoking and drinking, getting poor quality of sleep and failing to clean and dress wounds can significantly delay healing.

5. Medical history

Patients with chronic diseases should be followed closely through their course of care to provide the best management plan. Coronary artery disease, peripheral vascular disease, cancer, and diabetes mellitus are a few of the chronic diseases that can compromise wound healing. 

6. Infection

If bacteria, virus or fungus reach the wound site, there’s a high chance that an infection will develop. This complication can stall overall healing until antibiotics or other medical interventions treat the infection.

7. Wound care

With so many factors at play, following the best wound care practices is key to staying on the road to recovery. For instance, regular cleaning and dressing changes can protect the affected area from infection and other complications. An optimal level of moisture at the wound site also facilitates proper healing. With the help of modern wound care and advanced technologies, wound healing rate can be significantly accelerated, duration needed for wound healing is much shorter, shortened hospital stay, cost efficient, and improves one’s quality of life.

Next read: Platelet-Rich Plasma (PRP) For Wound Treatment