Chronic wounds

The definition of a chronic wound is not clearly outlined in the literature. Chronic wounds develop when there is a disruption in the normal healing process. They fail to heal within a "normal" period of time when similar wounds would otherwise have healed. Wounds that have failed to progress through a normal sequence of repair in 4 to 8 weeks are generally presumed to be chronic. Chronic wounds can be a challenge to the patient, the health care professional, and the health care system. Venous leg ulcers, pressure sores, ischemic ulcers, and diabetic foot ulcers are examples of chronic wounds. There are over 4 million Americans afflicted with these types of wounds, with an annual treatment cost of 9 billion dollars. A large percentage of these wounds occur in the growing elderly population. This becomes a large burden to society because of the loss of productivity and escalating health care costs [1]. Many factors can impair wound healing. Some of the local or intrinsic factors that impair wound healing include foreign bodies, tissue maceration, ischemia, and infection [2]. Medical disorders that are known to negatively affect wound healing include malnutrition, diabetes, and renal disease [2]. The pathophysiology of chronic wounds is not fully understood, and this incomplete understanding of the process results in many treatment failures. The ideal healing environment can be easily disrupted. This article describes the many processes that may inhibit or retard wound healing and some of the ways that the clinician may alter those processes to optimize healing. To facilitate healing, clinicians must be current on the physiology of wound healing and have in their armamentarium all the accepted and proven technologies that are available.