Frequently asked Questions
What is a Chronic Wound?
A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds, this balance is lost and degradation plays too large a role. Acute and chronic wounds are at opposite ends of a spectrum of wound-healing types that progress toward being healed at different rates.
Do you treat chronic wound and burns for the entire body?
What locations on the body are chronic wounds typically found?
What Insurance do you accept?
We accept Medicare and Blue Cross & Blue Shield; please call for an updated list.
What are the causes of chronic wounds?
The vast majority of chronic wounds can be classified into three categories: venous ulcers, diabetic, and pressure ulcers. A small number of wounds that do not fall into these categories may be due to causes such as radiation poisoning or ischemia.
Venous ulcers, which usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly. They are thought to be due to venous hypertension caused by improper function of valves that exist in the veins to prevent blood from flowing backward. Ischemia results from the dysfunction and, combined with reperfusion injury, causes the tissue damage that leads to the wounds.
Another major cause of chronic wounds, diabetes, is increasing in prevalence. Diabetics have a 15% higher risk for amputation than the general population due to chronic ulcers. Diabetes causes neuropathy, which inhibits nociception and the perception of pain. Thus patients may not initially notice small wounds to legs and feet, and may, therefore, fail to prevent infection or repeated injury. Further, diabetes causes immune compromise and damage to small blood vessels, preventing adequate oxygenation of tissue, which can cause chronic wounds. Pressure also plays a role in the formation of diabetic ulcers.
Another leading type of chronic wounds is pressure ulcers, which usually occur in people with conditions such as paralysis that inhibit movement of body parts that are commonly subjected to pressure such as the heels, shoulder blades, and sacrum. Pressure ulcers are caused by ischemia that occurs when pressure on the tissue is greater than the pressure in capillaries, and thus restricts blood flow into the area. Muscle tissue, which needs more oxygen and nutrients than skin does, shows the worst effects of prolonged pressure. As in other chronic ulcers, reperfusion injury damages tissue.
What are complications of chronic wounds?
Most often infection, which is also the most common cause of delayed healing in chronic wounds. Microbial contamination of wounds can progress to colonization, to localized infection, then to systemic infection, sepsis, multi-organ dysfunction, and subsequent life and limb-threatening infection.
What is the best way to treat a chronic wound?
The following which also includes treating the underlying cause:
Wound debridement which can be conservative sharp wound debridement, mechanical, biological/larval, enzymatic or autolytic
Offloading for neuropathic or diabetic foot ulcers, such as Total Contact Casting
Compression therapy for venous leg ulcers
Infection control which at times requires advanced antimicrobial wound dressings that penetrate and eliminate the bacterial biofilm
Appropriate wound dressings changed at appropriate intervals to maintain the proper moisture balance within the wound
Restoring blood flow for arterial ulcers caused by arterial insufficiency
Skin Substitutes for diabetic foot ulcers or venous leg ulcers
Foot Reconstruction to correct the mechanical dysfunction causing the abnormal pressure/shearing
Negative Pressure Wound Therapy to maintain the proper moisture balance and accelerate the body’s formation of collagen and healing
Tight glycemic control in diabetics
Smoking cessation therapy
Adequate nutrition with a higher caloric intake, especially Vitamin C and protein, and occasionally Vitamin A and zinc
Do you have same day appointments?
How to avoid developing a Chronic Wound?
See a wound care specialist. Is the wound acute or chronic? Acute wounds go through the normal phases of healing and close. Chronic wounds fail to heal and remain open. Persistence of redness, little or no evidence of healing after a reasonable amount of time, granulation tissue that appears pale rather than a robust reddish color, and granulation tissue that forms initially but fails to increase in amount.
- Establish a Diagnosis – diabetic, venous, and pressure
- Keep the wound moist
- Adequate dressing changes
- Follow your suggested treatment plan provided by your wound specialist
What diseases are associated with Chronic Wounds?
Debridement is the process of removing necrotic or dead tissue that occurs during wound healing. This tissue inhibits the body’s ability to recover and develop new tissue during the healing process. This makes debridement critical in preparing a wound for quick and efficient healing.
Offloading refers to removing pressure from the affected appendage. Offloading is achieved through a variety of methods including:
- Shoes / socks that disperse pressure points
- Wheelchair, scooter, or any device to minimize weight on the foot
- Removable cast
- Total contact cast
All of these offloading methods are effective and the best option for any patient will be decided by the clinician and patient together.
Compression Therapy involves the use of specialized stockings to reduce swelling and increase blood flow in lower limbs. Compression stockings attempt to apply gentle pressure and strengthen vein support. The stockings slowly stretch out vein walls which in turn helps eliminate swelling.
Infection control is a critical element of any wound treatment, and can only be effective if both patient and care providers are dedicated to proper infection control practices. Proper clinical infection control practices require the existence of an official Infection Control Program which should include:
- Proper hand hygiene
- Use of gloves, gowns, mask and face/eye shields when necessary
- Safe injection practices
- Proper handling of contaminated material.
Patient best practices should include:
- Keeping draining wounds covered with clean/dry bandages
- Keeping hands clean with soap and alcohol-based gels
- Maintain good general hygiene including regular bathing
- Do not share items that can come in contact with the wound such as towels, clothing, bedding, bar soap, razors, etc.
- Avoid skin to skin contact with other individuals
There are many other precautions that could be detailed but following good hygienic practices will eliminate the majority of infection risks.
Restoring Blood Flow
Poor circulation is a primary contributor to complications with wound healing, restoring blood flow to areas showing signs of reduced circulation is critical to proper wound care and avoiding amputation. There are various ways patients can assist in restoring blood flow, such as:
- Stop tobacco use
- Maintain a healthy weight
- Control blood glucose levels
- Control blood pressure
- Eat a diet low in sodium and added sugar
- Keep physically active. If restricted by limited mobility or chronic pain, seek additional options from your care provider
In severe cases, your provider may recommend surgical treatments, and in any case, early diagnosis is key to patient success.
Advanced Wound Dressings
When caring for wounds, clinicians have a wealth of options for bandages and dressings. These options are considered superior to the basic gauze and tape and are referred to as Advanced Wound Dressings. Advanced dressings reduce healing time and have less risk of infections.
Skin substitutes have been used to aid in wound closure for centuries. They also help to control wound pain and replace the skin functions to promote proper wound healing. Skin substitutes come in two varieties, temporary and permanent. Temporary substitutes function as a wound covering and primarily serve to protect a wound from bacteria and additional trauma while providing a moist, clean and healthy environment for wound healing. Permanent substitutes are used to fully replace all layers of the skin and are most common with severe burns.
There are many structural conditions of the foot and ankle that cause complex deformities, which can cause pain and difficulty walking. They may also cause calluses and wounds or ulcerations. Deformities may be due to flat feet, high arch feet, Charcot deformity (collapse of joints of the foot), rheumatoid arthritis deformities, and post-traumatic deformities.
These sorts of deformities may cause significant disability and change in lifestyle. Foot reconstruction surgery is often a last resort when conservative treatment such as orthotics, shoe gear modifications, braces, and other modalities are ineffective. Reconstructive surgery may include shifting of bones, tendon lengthening or transfers, fusions, and external fixation.
Negative Pressure Wound Therapy
Negative pressure wound therapy also known as “NPWT” is an option for treating burns, various types of ulcers and other chronic wounds. NPWT uses a dressing that creates a seal over the wound and around tubing which is attached to a pump which will draw out fluid and infection from a wound to help it heal. NPWT is a great option for some, but not all, patients. Based on your wound and medical situation, your provider will decide if you are a good candidate for this method of wound treatment.
Total Contact Casting
Your first step towards an active, pain-free lifestyle starts here.
165 Rowland Way Ste. 208
Novato, CA 94945
P: (415) 449-8580
F: (415) 202-6228
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