Causes of poor wound healing

DR MAXWELL ADEYEMI

The human skin is a remarkably elastic organ that sustains insult and injury throughout life. The skin generally is under constant stress, from sun, smog, friction, tension, temperature, and a heap of other external factors. When there is sufficient stress to cause injury, the skin breaks down and we get a wound.

Wounds can be classified in a number of ways:

1) Open wound: wounds with exposed underlying tissue, open to the outside environment.

2) Closed wounds: damage occurs without exposing the underlying tissue and organs.

3) Acute wounds: wounds are classified as acute or chronic depending on how long they take to heal. Acute wounds heal without complication in a relatively predictable amount of time.

4) Chronic wounds: these take longer to heal and often involve some complications.

5) Clean wounds: these have no foreign materials or debris inside.

6) Contaminated or dirty wounds: these might contain dirt, bacteria or other foreign materials.

Stages of wound healing

Wounds generally go through three stages as they repair, however, wound healing is not linear and wounds can progress both forwards and backwards through the phases on the road back to health.

Inflammatory phase: during this phase, the body produces a natural response (inflammation) to the injury and forms a clot to stop the bleeding. Blood vessels dilate to allow essential cells (eg antibodies, white blood cells, growth factors, enzymes, and nutrients) to reach the wounded area. These cells create swelling, heat, pain, and redness, or the “inflammation” for which the phase is named.

Proliferation phase is when the wound is rebuilt. The wound contracts as a new network of blood vessels are constructed so that the tissue can receive sufficient oxygen and nutrients. In healthy stages of wound healing, the tissue is pink or red and uneven in texture and does not bleed easily. Dark tissue can be a sign of infection. Near the end of the proliferative stage, new skin cells resurface the injury.

Maturation phase is when the wound fully closes and the scar begins to fade. This “remodelling” generally begins about 21 days after an injury and can continue for a year or more, however the healed wound area will always be weaker than the uninjured skin, generally only regaining 80 per cent of the original tensile strength.

Factors that affect wound healing

Wound healing is not a straight line between two points as wounds can progress both forwards and backwards on the road back to health, and how they do so will depend on several outside factors.

Age

Ageing affects everything in the body and that includes the structure and function of the skin. Everything slows down during the ageing process, including the phases of wound healing. Skin gets thinner and the body shows a decreased inflammatory response meaning that, as you get older, your skin is predisposed to injury and will heal slower when injury occurs.

Nutrition

Proper nutrition is vital to optimal healing. A wound is unable to heal properly if you lack the necessary nutrients for cell repair and growth This is more profound in the elderly as this stage of life may be characterised by poor nutrition which may have negative effects on wound healing.

Obesity

Anyone surpassing their ideal body weight by 20 per cent or more has a greater risk of infection when dealing with a wound. Obesity is a serious disease that occurs when you have an excessive amount of body fat. While a lot of people have been moving toward the mentality of loving your bodies, regardless of size, obesity is still dangerous and can cause serious medical problems. While there’s no reason for self-hate, it is important to address obesity and work towards losing weight. Obesity contributes to a myriad of problems that can be life threatening. It also severely hinders your body’s ability to heal wounds, which can increase your risk of infection.

Poor circulation

An increase in body fat also contributes to poor blood circulation, which can slow the wound healing process. If you have vascular disease, whether it’s due to weight or not, you’ll experience delayed healing and may need additional wound care supplies to avoid acute wounds from turning chronic. Additionally, low blood count or anaemia also retards wound healing.

Repeated trauma

If you have multiple wounds or have undergone a severe trauma (eg surgery) your body’s defence mechanisms will be limited and slow wound repair. Repeated trauma and pressure to the wound or ulcer will also retard wound healing.

Skin moisture

Skin needs an adequate amount of fluid and moisture to be viable. If you’re prone to dry skin (especially common in the elderly) you may be at risk for skin lesions, infection, and thickening, which will all impair wound healing. On the flip side, if the skin is too wet, you’re at risk for developing maceration and/or infections, so maintaining an optimal level of skin moisture is imperative for healing wounds.

Chronic conditions

Chronic diseases have a direct impact on the body’s natural ability to heal. Cardiovascular conditions are among the most detrimental, diabetes, and immunodeficiency conditions can also slow wound healing.

Medication

Prescription medications can have a negative effect on healing. For example, non-steroidal anti-inflammatory drugs often prescribed for arthritis and found over the counter as aspirin, olfen, voltaren and ibuprofen, can interfere with the inflammation stage of the healing process. Anticoagulants have the capacity to disrupt blood clotting, while immunosuppressants may weaken the immune system and enhance the risk of infection.

Wound care

Finally, how you take care of your wound has a direct impact on how well it heals. When you don’t properly care for your wound, you can increase your risk of infection or complications. Using the correct dressings, creams, and any cleaning procedures will greatly enhance your wound healing process and allow you to facilitate healthy healing.

If you have a poorly healing wound, contact your doctor for further evaluation and wound care management.

Contact Dr Maxwell on 363-1807 or 757-5411.