Compression garments may help heal chronic lower extremity wounds.

Although chronic wounds are a side effect of many different diseases and certain disabilities, there are several causes that can be easy to overlook. However, clinicians that are faced with a wound that continues to resurface may find that the patient has one of these ailments. Here are a few to look out for, and possible treatment options:

Small vascular wounds

Wounds that are an after-effect of poor circulation can be an easy issue to overlook. When the wound site isn’t receiving enough blood (due to chronic decreased pressure in that part of the body) the area will take longer to heal, which can make it more susceptible to infection. When the wound site is small, it can be even easier to overlook – when you do not see patients on a daily basis, a small wound could easily resemble the remnants of a larger wound that is now healing. Most small vascular wounds are located in the lower extremities, and many are a side effect of conditions like diabetes.

If a patient alerts you to a small wound that hasn’t healed, compressing the wound site might be helpful. Venous ulcers and other vascular wounds need graded compression to heal, with the highest pressure at the lowest part of the extremity, with the compression tapering off as you move up the extremity. You can also suggest compression stockings for clients to wear.

Bacterial biofilms

Although this could be considered a side effect of a wound, chronic wounds that do not heal could be caused by a bacterial biofilm that has formed over the wound site. These biofilms are created when bacteria – likely from an infected wound – attaches itself to a nearby solid surface and then enclose themselves into a polysaccharide, which keeps the bacteria in the layer, and can subsequently cause new bacteria to be added to the layer, building it up over time.

Unfortunately, traditional chronic wound treatments often do not work with biofilms. Some clinicians have found success with treating chronic wounds with biofilms by using highly concentrated oxidizing agents in combination with extremely hot water, while others have used very abrasive materials to completely remove the biofilm from the wound surface, according to Dr. Harriet Burge.

Allergy-induced wounds

Certain allergic reactions to dressings or salves that are put on wounds may exacerbate a wound or cause it to show up time and time again.

Make sure that all patients’ allergies are well-documented, and patients that have not had an allergy test in several years should be considered for a re-test. Some individuals do not develop allergies until they are well into adulthood, so things that may have not caused a reaction – like latex or certain creams – may now cause irritation, inflammation and other reactions.

How to identify a chronic wound

If you are unsure as to whether or not a wound is chronic, here are some steps you can take to make sure you are not overlooking a potentially harmful wound:

With new patients, create logs that track how long different wounds last. Mark the site and date that the wound (ulceration, venous wound) first began, and how long it took to heal. For some patients, this will help you distinguish between individuals that take longer to heal and those that have truly chronic wounds.
Keep track of the treatments that are used on each patient, along with the duration and type of wound. Look at the types of dressings, compression garments and other treatments used, and see if one is routinely more effective for a particular patient or type of wound in an individual.