Non-Healing Ulcers or Wounds

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We might all be familiar with ulcers in a general manner, but certain types of ulcers behave quite differently due to various contributing factors. These are nonhealing ulcers or nonhealing wounds, and if not treated with care and in good time, such wounds can pose a serious risk to the patient’s health. Severe cases may lead to amputation of the affected limbs or loss of life in the most extreme circumstances. The nonhealing ulcers cases we treat here at Pedes Orange County fall under peripheral arterial disease (PAD) and a subcategory of arterial disease.

Non-healing wounds or ulcers do not follow the usual healing process and are referred to as chronic wounds should they persist beyond 3 weeks. Such wounds can be a heavy burden to live with for anyone. Still, the board-certified vascular surgeons and specialists at Pedes Orange County are dedicated to administering effective treatment and management solutions to all patients so they may resume a healthy, productive, and pain-free life.

Types of Non-Healing Ulcers

In general, patients will present with one of three categories of non-healing ulcers, with these categories being broadly defined by the major causative factors allowing for their development. These are:

Arterial or Venous Ulcers

These are found to account for between 70% up to 90% of non-healing wounds or non-healing ulcers. Mostly occurring in elderly patients, they are believed to come about as a result of a failure of the valves in a person’s blood vessels of both arteries and veins. These valves are responsible for preventing the backflow of blood as it passes within them. The consequent outcome is a lack of nutrient and oxygen-rich blood from reaching the affected tissues and sets up the conditions favoring non-healing wounds.

Pressure Ulcers

These are ulcers that are brought about by the restriction of blood flow to certain regions of the body due to the persistent and prolonged application of pressure upon them. It is mostly encountered among patients with full or partial paralysis and those who are bedridden for extended periods.

Diabetic Ulcers

These are also highly prevalent chronic wounds, and are on the increase among patients owing to the ever-increasing cases of diabetes among the population. In fact, the prevalence of chronic wounds among diabetics makes this demographic 15% more likely to have to undergo limb amputation as a complication of the condition.

The high amputation rate among diabetics is attributable, in part, to the neuropathic effects of the ailment. Neuropathy leads to a lack of pain perception in the affected individual, meaning that they may be entirely unaware of minor wounds on their feet and legs in good time, allowing for their infection or repeat injury. It is also made more likely by the immunosuppressive effects of the condition, which makes the patient more vulnerable to infection.

Causes of Non-Healing Wounds

The underlying factors contributing to the risk of developing a non-healing ulcer or wound are widely varied. What they have in common is their ability to interfere with the way the body normally functions with regard to wounds.

Nerve Damage (Neuropathy)

Diabetes Foot Spider Vain | Pedes Orange County

This condition is prevalent in people living with certain circulatory ailments such as atherosclerosis, diabetes, alcoholism, etc. In a healthy person, the nerves will send signals to the brain whenever pain or discomfort is experienced in any body tissues. Neuropathy makes this system non-functional; tissue can be damaged without warning signals being sent to the brain. This will prompt the person to change position or remove the object, causing injury. Over time, the affected area might see the development of an ulcer.

Circulatory System Issues

A person’s circulatory system is responsible for delivering blood rich in oxygen and nutrients to all the tissues in the body that need it. Without it, tissues will begin to die. Due to their extremity (distance from the heart) and the effect of gravity, a person’s feet will often be the first problem area for a person with an impaired circulatory system. Peripheral artery disease (PAD) is a particularly culpable condition in this instance as it may lead to numbness, skin discoloration, severe pain, ulcers, or even the patient’s demise if left unchecked.

Underlying Health Conditions

The formation of non-healing ulcers will indicate that an advanced stage of certain conditions has been reached in a patient. These conditions include high blood pressure, diabetes, kidney failure, high cholesterol, or peripheral artery disease (PAD). These conditions contribute to the formation of ulcers by causing ischemia, or the interruption of oxygenated blood to all parts of the body, or by damaging the nerves in the wound areas…

Contributing Lifestyle Habits

Some various habits and lifestyles will place patients at a heightened risk of developing non-healing ulcers. Smoking, for instance, has the effect of narrowing the vessels carrying blood to body tissues, thus increasing one’s chances of developing ulcers. A sedentary lifestyle involving little to no active movement will also carry the risk of encouraging ulcer development due to the constant pressure applied to certain tissues. Old age is also a factor here, as our skins will gradually lose their ability to repair themselves as quickly and efficiently as they once did.

Symptoms of Non-Healing Ulcers

You shouldn’t allow a wound to fester for weeks on end before seeking professional assistance, especially if you fall under one or more of the risk categories we’ve outlined above. The following are some warning signs to look out for:

Darkening or bluish discoloration around the wound edges
Significant pain around the wound that persists without improvement or progressively grows worse
Foul odor or smell emanating from the wound
Swelling and redness emanating from the wound and spreading to surrounding skin and tissue
Continuous leaking, draining, or weeping from the wound.

Notice that these symptoms are mostly indicative of infection. This is a good measure as it often indicates a failure of the body’s natural mechanisms to deal with the wound through its normal processes. The rapid and timely intervention will be called for to forestall further tissue damage and complications.

Treatment of Non-Healing Wounds

As we’ve seen, there is a very wide range of causes that may contribute to the formation and persistence of non-healing ulcers. It follows that the methods or treatment options at the disposal of healthcare professionals will also be varied. Doctors will discuss the available options with their patients in order to arrive at the best possible options, but the type and severity of the wound will be the decisive point of consideration. These measures include:

Compression Wrapping

This involves the application of tightly bound wraps to the affected limbs or regions in order to provide support to the vascular system, which might be operating under lower pressure than it should due to the wearing out of the vascular walls and muscles that support the efficient flow of blood to and fro the tissues that need it.

Specialized Dressings and Topical Medication

Technological progress has made it possible to develop special dressing materials made out of smart polymers that work by adjusting their absorptive qualities depending on the hydration levels of the wound area, among other specialized positive actions. Antibiotics may also be employed topically to non-healing ulcers and these help by reducing the bacterial levels present in the wounds in question while maintaining the optimal levels of environmental moisture suitable for wound repair.

Patient Self-Care and Education

There are plenty of measures that patients will be able to implement in the treatment and management of non-healing ulcers if armed with the proper knowledge and aids where required. Regular cleaning and disinfecting of wounds, proper bandage care, manual repositioning of paralyzed limbs, and avoidance of habits that contribute to the incidence or severity of these types of ulcers will be of significant benefit to many.

Negative Pressure Therapy (NPWT)

This treatment method works by pulling away the fluid in the wound that nourishes bacteria by the application of negative pressure. It is also known as vacuum-assisted wound closure for this reason. This action will also reduce tissue swelling and bring up fresh blood and nutrients to the problem area, which assist in the healing processes.

Surgery

In many cases, surgical procedures may be called for to rectify any underlying conditions that might be remedied in this way. Patients with atherosclerosis or blood clots in their vascular system, for example, might undergo surgical procedures to remove these clots or clear built-up cholesterol plaques in their system, thus removing the condition that encourages the formation and persistence of non-healing ulcers.

Growth Factor Therapy

Growth factors refer to the biomaterials generated naturally in our bodies that play the role of replacing tissues as they are damaged or degraded, as in the case of wounds and infections. These factors include epidermal growth factor, insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and more. What your medical practitioner will do is introduce or stimulate these factors directly onto the wound in order to speed up the healing and re-growing processes.

Skin grafts taken from donors (cadaver, usually) are another option here referred to as allografts. These grafts provide a covering to the wound without integrating with the host body and work by encouraging and providing a structure for the growth of epithelial cells. Severe cases might not be suitable for this intervention, however, and will do better with grafts taken from elsewhere on the patient’s own body.

Debridement (removal of dead tissue)

Debridement more simply refers to the removal of dead or dying (necrotic) tissue from the site of a non-healing wound. The goal is to minimize the risk or opportunity for infection by eliminating the necessary medium for bacterial growth and proliferation, which such tissue provides. This is an especially relevant measure undertaken in the fight against diabetic non-healing ulcers, as amputation will usually be carried out in cases where infection has progressed past a certain limit.

This is the idea behind the rather outlandish yet scientifically sound application of maggot therapy in the management and treatment of chronic wounds. Here, live, disinfected maggots will be introduced to the wound by a medical professional. Maggots will happily devour necrotic tissue while not touching healthy tissue. This directly leads to a reduction in the bacterial presence in the wound, thus encouraging rapid healing as well as pain and odor mitigation.

Pedes Orange County Treatments for Non-Healing Ulcers

The treatment for PAD has two main goals. One is to manage the symptoms, including leg pain, allowing you to resume your normal physical activities. The second one is to top the progression of atherosclerosis in the body…

Non-Healing Ulcers Treatments

Patient Story

Why Choose Pedes Orange County

The treatment of vascular conditions and ailments requires extensive expertise, experience, and discernment if the outcome is positive. The professionals of Pedes Orange County are constantly updating their medical knowledge to be at the forefront of new techniques and technology to facilitate the very best outcomes that human knowledge and ingenuity are capable of in the challenging world of vascular surgery, therapy, and treatment. Contact us today and schedule a screening for comprehensive care you can trust.

What to Expect from Your Visit to Pedes

ULTRASOUND

Your treatment will begin with an ultrasound examination of your veins, arteries, or both, in your legs to diagnose the presence and extent of the disease. Your test results will be immediately available to review with the doctor.

CONSULT

Once we review the results of your diagnostic tests, our physicians will help you develop a plan to provide you with the best treatment for your disease.

TREATMENT

Depending on the extent of disease in your arteries or veins, our specialists may recommend minimally invasive intervention and/or prescribe medications to help your symptoms.

FOLLOW UP

It is important to make sure that you return for every scheduled follow-up appointment to ensure that your disease is appropriately monitored. If you ever have any questions or concerns, please call or schedule a follow-up appointment with our staff.