Wound healing disorder
Clemens Gödel is a freelancer for the medical team.
More about the experts All content is checked by medical journalists.If the wound is not healing properly, the healing process of a wound is delayed and it can become infected. Such a disorder often occurs with a weakened immune system and after surgical interventions. In these cases, special wound treatment must be initiated, otherwise the most severe complications threaten. Here you can read everything you need to know about symptoms, diagnosis and treatment of wound healing disorders!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. T89T79T81
Wound healing disorder: description
A wound is a severing of contiguous tissue on the outer or inner surface of the body. If a wound does not heal or only heals poorly, one speaks of a wound healing disorder. These include, among other things, the formation of bruises, accumulations of wound secretion under a wound (seroma), divergence of the wound edges, wound cracks and, above all, infections.
In the case of a chronic wound, the cohesion of the inner or outer skin barrier and the underlying structures is, by definition, disrupted for at least eight weeks.
Occurrence
Between three and ten percent of wounds do not heal over a long period of time. Around one percent of the total population has a chronic wound. In Germany up to three million people are said to suffer from wound healing disorders. This is one of the most common complications of an operation. In vascular surgery, wound healing disorders occur in up to 20 percent of all operated on. People over the age of 60 are three times as likely to have wound healing disorders as younger people. Around 40 percent of long-term bedridden people suffer from a so-called decubitus ulcer - a poorly healing ulcer caused by bedsores.
The problem of a wound healing disorder is also the risk of recurrence. Since it usually arises on the basis of existing underlying ailments, wound healing disorders occur repeatedly in over 60 percent of cases.
Wound healing
You can read about the complex healing process of a wound in the article Wound Healing.
Wound healing disorder: symptoms
The main symptom of a wound healing disorder is the wound defect, which can show itself in various ways. In addition, there is usually (severe) pain and bleeding. In addition to the actual wound healing disorder, other injuries such as bone, vascular or nerve damage can occur. Blood and lymph circulation disorders make the healing process even more difficult and lead to further symptoms such as lymphedema.
If the wound is infected, the wound is red, overheated and smelly. The discharge from the wound increases significantly and pain (pressure) occurs. Surrounding lymph nodes can swell (painfully) as a sign of the immune reaction. If there is also a fever, this can be an indication of dangerous blood poisoning (sepsis).
Wound healing disorder: causes and risk factors
Poor wound healing is caused by a variety of factors. Often it is because of a chronic illness that a wound does not close. A distinction is made between local (i.e. in the area of the wound) and systemic causes for wound healing disorders.
Unfavorable wound conditions
The most important local risk factor for impaired wound healing is unfavorable wound conditions. Particularly wide, bruised, dry or dirty wounds, which may also be infected, usually heal poorly. The development of pus and a bruise makes the healing process even more difficult. In addition, smooth cuts usually heal better than bite wounds and small and superficial wounds heal better than large and deep wounds.
Seams and bandages
Sufficient oxygen must be able to reach the wound. A wrong choice of dressing or a seam that is too tight can restrict the oxygen supply. The choice of the wound dressing is therefore of crucial importance for the healing process. The bandage should protect against drying out, allow a sufficient supply of oxygen and not stick to a newly emerging skin layer.
Once the wound has been sutured, it is important to find the right time to pull the thread (unless self-dissolving sutures have been used). If the sutures are pulled too early, the wound can tear open again. If the thread is pulled too late, however, it favors the development of infections and hinders the final wound closure.
age
Wounds tend to heal more poorly in old age than in younger years. However, this is also due to the more frequent accompanying illnesses.
Underlying diseases
The most common systemic causes of wound healing disorders are diabetes mellitus (especially diabetic foot syndrome) and vascular diseases - especially chronic venous insufficiency (CVI, chronic venous insufficiency) and peripheral arterial occlusive disease (PAD).
Other diseases that can lead to impaired wound healing are skin diseases, chronic pain diseases, tumors (and their treatment with radiation and chemotherapeutic agents), high bilirubin and urea levels, anemia and dehydration. Furthermore, disorders of the immune system and severe infections (such as tuberculosis, syphilis, HIV and other viral infections) also promote impaired wound healing.
Overall, imbalances in almost all systems of the human body lead to wound healing disorders, including hormonal (such as Cushing's disease) and psychological disorders (such as dementia, drug addiction). A wound will not heal if such imbalances are not corrected.
smoking
Smoking is an important risk factor for poorly healing wounds. One study showed that 50 percent of smokers compared to 21 percent of non-smokers suffered from a wound healing disorder after surgery.
nourishment
Diet also plays a major role, as proteins, vitamins, minerals and trace elements are important for the healing process. Both too little calorie intake and severe obesity favor a wound healing disorder. Wounds do not heal well if proteins and their constituents, the amino acids, are missing for tissue regeneration. A protein deficiency can also occur, for example, if the liver does not produce enough protein. Protein deficiency situations also occur with malignant tumor diseases.
Post-operative wound care
Whether a wound heals well after an operation depends not only on the skill of the surgeon but also on postoperative wound care and care. A wound does not heal after an operation if the patient's position is neglected - if the patient lies constantly on the wound, the sustained pressure load leads to impaired wound healing.
If foreign bodies such as prostheses are installed during an operation, a defense reaction of the body can additionally hinder the healing process. The general rule is: Particularly long operations and high blood loss during the operation favor a wound healing disorder.
Medication
Caution is also advised with drugs that can directly or indirectly delay the healing process. These include, for example, corticoids, cancer drugs, psychotropic drugs and anticoagulants.
Cooperation of the patient
Last but not least, the cooperation of the patient also plays a decisive role. Only a consequent adherence to the prescribed therapy can prevent a wound healing disorder or bring its treatment to success.
Wound healing disorder: examinations and diagnosis
Specialists in wound healing disorders are dermatologists (dermatologists) for superficial wounds and surgeons for internal wounds. If the wound hits after an operation, you should first contact the surgeon. Initially, the doctor will usually ask, among other things, the following questions:
- How long has this wound existed?
- How did the wound come about?
- Are you suffering from pain or fever?
- Has the wound healed better in the meantime?
- Have you already experienced wound healing disorders?
- Do you have any previous illnesses?
- Have you reacted (also allergic) to a wound treatment?
With the help of the temporal delimitation of the wound duration, the wound can be classified as acute or chronic. The question of fever and the measurement of body temperature are important in order to detect possible blood poisoning (sepsis) as early as possible.
After the interview, the doctor will examine and examine the wound. He checks whether blood flow, motor skills and sensitivity are maintained around the affected area. Upon closer inspection of the wound healing disorder, it must be assessed how deep the wound is expanding and which structures are affected. For example, if the wound has reached the bone, there is a risk of bone inflammation. This so-called osteitis or osteomyelitis can have serious consequences.
Assessing the condition of the wound is also important. The doctor must pay attention to pus, redness and dead tissue, among other things. In this way he can assess whether the wound is aseptic (germ-free), contaminated or septic (infected). Finally, he will roughly determine the wound healing phase for therapeutic and prognostic purposes.
Further examinations are necessary for larger and more severe wound healing disorders.
Blood test
A blood test can indicate an infection and will allow an assessment of red and white blood cells and platelets.
Imaging
In the case of deeper and internal wounds as well as suspicion of foreign bodies or bone fractures, imaging should be carried out as part of the wound healing disorder diagnosis: First of all, an ultrasound examination can help. If the wound is not superficial, the extent must be estimated using computed tomography (CT), magnetic resonance imaging (MRI) or X-rays.
Wound swab / biopsy
If a wound infection is suspected, a swab must be taken. This is used to determine the exact type of pathogen and to clarify whether it is resistant to certain antibiotics. Any antibiotic treatment should only be started after a wound swab has been taken, otherwise the result will be falsified.
If the wound is suspected of being a tumorous process, wound material should be removed for a (histo) pathological examination (biopsy).
Differential diagnosis
An important alternative diagnosis to a wound healing disorder is pyoderma gangrenosum, which often occurs in connection with rheumatoid arthritis, chronic intestinal diseases, diseases of the hematopoietic system and also with (medicinal) suppression of the immune system. Most often it is located on the lower extremity. Pyoderma gangrenosum can resemble a wound healing disorder, but it is a deep inflammation that also affects adipose tissue and blood vessels. Since there are no clear diagnostic markers, pyoderma gangrenosum is a diagnosis of exclusion (pyoderma gangrenosum can only be assumed if all other diseases with similar symptoms have been excluded).
Wound healing disorder: treatment
A wound healing disorder requires specific treatment to avoid serious consequences. Complicated wound healing disorders should be cared for in a special wound center.
Fighting the cause
A number of causes for a wound healing disorder can be at least partially combated. With this in mind, it is important to identify the underlying cause of the delay in the healing process. For example, the therapy of diabetes mellitus should be better stopped. A wound does not heal or heals with difficulty if the underlying problem persists.
If there is malnutrition or malnutrition, nutritional therapy must be initiated in addition to local wound care in order to compensate for deficits. So-called supplement food is also suitable for wound healing disorders.
Wound hygiene
The decisive goal of local therapy is to make a problem-free healing process possible and to prevent damaging influences. Wound hygiene plays a very important role, not only on the wound itself, but also on the wound edges and in the immediate vicinity. On the one hand, wounds should be kept clean, but on the other hand they should not be cleaned or disinfected too intensively. Rinsing with sterile (salt) water or wound baths (with tap water at body temperature) are often recommended. To prevent local reactions, aggressive rinsing solutions should not be used. Special means should only be used in consultation with the doctor. Only preparations that are approved for direct wound application are suitable. Iodine can cause cell death and must therefore be used with caution, especially in the initial treatment.
Debridement
So-called debridement is a very important part of wound care in order to create an optimal wound bed for wound healing. Debridement is the cleansing of the wound and the associated (surgical) removal of dead tissue (necrosis), plaque and foreign bodies from the wound.
This is particularly indicated in the case of severe signs of inflammation, systemic infections and large plaque as well as a lot of dead tissue. Everything is then removed until there is healthy tissue on the surface. Among other things, this leads to a better oxygen supply to the wound.
After this intensive wound cleaning, the non-healing wound must be cleaned again and again, but not with the same intensity. Often the wound is simply rinsed with sterile (salt) water for this purpose.
Surgical interventions due to a wound healing disorder also include the clearing of cavities with wound secretions or large bruises and in severe cases the (partial) amputation of parts of the body, such as a toe. In the event of a wound infection, it may also be necessary to (re) open a wound.
Artificial enzymes (e.g. in the form of collagenase ointments) can also dissolve wound coverings.
Wound pad
The choice of the wound dressing should be made individually by an experienced wound expert and is not easy due to the large number of options. Criteria include the healing phase, the infection status and the presence of dead tissue. Wound dressings with a wound healing disorder should in any case offer protection against drying out, guarantee a moist wound bed and not release fibers into the wound. At the same time, the oxygen supply should be ensured. Many dressing materials contain antimicrobially active ingredients such as iodine, polihexanide or octenidine.
There are roughly three types of wound dressings. Passive bandages only provide protection. Dressings with interactive properties influence the wound directly (e.g. hydrocolloidal dressing, vacuum therapy). Cultivated epidermis cells or an autologous transplant are so-called active wound dressings.
Conventional wound dressings such as gauze bandages and fleece are usually characterized by their particular absorbency, tear resistance and air permeability. However, they carry the risk of sticking to the newly formed skin layer - an ointment bandage can help against this. Conventional dressings primarily serve as an initial dressing.
Modern interactive dressing materials (such as hydrogels, alginae, foam dressings) ensure a favorable, moist microclimate, which allows connective tissue and skin cells to multiply. At the same time, the new skin cells are usually prevented from sticking to the bandage. In the case of moist dressings, the balance between a moist wound environment and the absorption of wound fluid through the wound dressing must be maintained. Silver active compresses are not only absorbent and act against microorganisms, they also reduce the wound odor. In severe cases, wound healing disorders can also be treated with wound drainage or vacuum sealing.
Antibiotics
If there is a major wound infection, antibiotic treatment (antibiosis) can be carried out. A wound swab should be taken beforehand in order to determine the exact pathogen and any resistances. The antibiotic chosen should cover the common causes of wound infection such as staph, streptococci, Pseudomonas and Escherichia coli. If resistant pathogens (such as MRSA) are detected in the wound, they should at least be combated with regular irrigation.
The antibiotics are usually used systemically, for example as a tablet. Local antibiosis for a wound healing disorder is controversial, since locally given antibiotics reach the wound tissue only unreliably, contact sensitization often occurs and the selection of multi-resistant germs is promoted.
Wound infections are potentially life threatening and should therefore be treated consistently.
Pain management
A wound healing disorder can be associated with considerable pain, which in severe cases can also require treatment with opiates (very strong painkillers). Surface anesthesia (superficial local anesthesia) can be performed in the area of the wound.
Other procedures
In addition to the treatment methods for wound healing disorders described above, there are also a large number of more or less controversial therapies such as electrical stimulation, shock wave, infrared or magnetic field therapy. In addition, specially prepared maggots in a tight, but not airtight bandage can contribute to the healing process. Your saliva contains enzymes that help remove plaque and diseased tissue.
amputation
Despite intensive and multidisciplinary treatment, in some cases amputation is the last therapeutic option for chronic wound healing disorders. For this reason, around 30,000 smaller and larger amputations are performed in Germany every year.
Accelerate wound healing
The healing process of a wound can be supported. You can find out how to do this in the article Accelerating wound healing.
Wound healing disorder: disease course and prognosis
If an optimal wound environment can be achieved and the cause can be eliminated, the prognosis of a wound healing disorder is good. Often, however, the cause cannot be completely eliminated, which worsens the prognosis.
A wound healing disorder after surgery leads to a longer hospital stay (with the associated risks) and can also result in surgical wound care.
In the long term, for aesthetic reasons, after healing has taken place, scars and wounds can be corrected by a plastic surgeon or dermatologist.
Complications
An infection in the context of a wound healing disorder, which in turn can lead to an abscess and blood poisoning (sepsis), is particularly feared. The latter is potentially fatal and requires more intensive treatment methods.
Wound healing disorders can also lead to vascular, nerve, tendon, muscle and bone damage.
The dreaded compartment syndrome is an emergency. In addition to an acute onset after trauma, it can also develop chronically as part of a severe wound healing disorder. The cause of the compartment syndrome is the compression of vessels and thus a restriction of blood flow due to increased tissue pressure in a delimited area, especially in the area of the lower leg. Typically, those affected complain of severe (new) pain. In addition, there are sensitivity and motor skills disorders. The diagnosis can be made, among other things, by an ultrasound examination. Compartment syndrome usually requires acute surgical treatment.
Prevention of a (renewed) wound healing disorder
To prevent wound healing disorders, a wound should always be properly cared for. First of all, it and the surrounding area should be cleaned gently. The wound should be disinfected with the antiseptics provided for this purpose and only if it is heavily soiled, as otherwise more damage can occur in the wound. Then the wound can be covered with a wound dressing. In more severe cases, you should see a doctor who may sew up the wound. With every wound, especially dirty wounds, it should also be checked whether there is adequate tetanus protection through vaccination.
Since many sufferers of a wound healing disorder get similar wound problems again, preventive measures must be taken. This includes that existing underlying diseases are optimally treated, the patient quits smoking if necessary and the doctor explains to him how he can recognize a wound healing disorder at an early stage.
Tags: desire to have children news first aid
