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What are Chronic and Non-Healing Wounds?
A chronic wound can be defined as a wound that has failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result.9 Literally, the word chronic as it pertains to disease means, lasting a long time, lingering, inveterate, continuous or constant. For hundreds of years, the word chronic was also commonly used as a synonym for the word invalid. Individuals with chronic wounds not only have to deal with being wounded, but they also have to face the unfulfilled expectation of healing and its sequels, e.g., pain, social isolation, odor.10 They have to come to terms with a (seemingly) failing body, or a body that has betrayed them - a body that behaves like a terrorist.7,11 This in turn may cause a loss or negative alteration of body image or a serious limitation in their ability to function in society. Both can be extremely traumatic and stressful. Indeed, the need to be physically whole and to be a contributing member to society is strongly associated with remaining mentally and emotionally intact.12

7 van Rijswijk L, Gottlieb D. Like a terrorist. Ost/Wound Management 2000;46(5):25-6.
9 Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol 1994;130:489-93.
10 Neil JA, Munjas BA. Living with a chronic wound: The voices of sufferers. Ost/Wound Management 2000;46(5):28-38.
11 Krasner D. Preface. In: Krasner D (ed). Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. King of Prussia, PA: Health Management Publications, 1990.
12 Drench ME. Changes in body image secondary to disease and injury. Rehab Nursing 1994;19(1):31-6.

Van Rijswijk. Chronic Wound Care, Third Edition, The Language of Wounds, 2001; 21

What is Chronic Wound Care?

Wound care professionals are usually called to care when it has been determined that the wound in question is not healing the way it should. Care in the context of "to care for" is defined as "take thought for, provide for, look after." In general, the word care means a lot more than looking after. It means to "grieve, feel concern or trouble oneself for someone or something." Why do people in general, and healthcare professionals in particular, care? Louis Berman gives eight meanings of being called to care including these four: entering into a relationship with the other, suffering with the other, responding to, the needs of, and hoping with another person.13 When we perform wound care, we not only physically manage and cover the wound, we respond to a need and bring hope for healing by caring and dressing ("making it all better").

13 Lashley ME, Neal MT, Slunt ET, Berman LM, Hultgren FH(eds). Being Called to Care. Albany, NY:State University of New York Press, 1994.

Van Rijswijk. Chronic Wound Care, Third Edition, The Language of Wounds, 2001; 21

What is an Acute Wound?

Acute wounds can be from a surgical procedure, or can result from trauma or an accident. They can range from a small paper cut to a third-degree burn. They heal normally, and show signs of healing early on, without complications.

What are Pressure Ulcers?

Many wounds result from excessive pressure that is put on bony prominences, or areas where bone is close to the skin's surface. Examples include the heel, tailbone or sacrum, and the elbow. These types of wounds are known as pressure ulcers, bedsores and decubitus ulcers.

Pressure ulcers are categorized into four stages:

Stage I pressure ulcers are noticeable changes of the skin and may include changes such as skin temperature, tissue consistency, and/or pain and itching. The affected area may appear red, blue or purple.

Stage II pressure ulcers involve the epidermis, dermis or both. These are superficial wounds and may look like an abrasion, blister or shallow crater.

In Stage III pressure ulcers, the wound may extend into the subcutaneous level but not through underlying fascia. These may appear to be deep craters.

Stage IV pressure ulcers involve muscle, bone or other supportive structures.

Stage III and IV pressure ulcers usually present with necrotic or dead tissues.

What are Venous Stasis Ulcers?

Venous stasis ulcers are shallow wounds that develop when the leg veins do not move blood back toward the heart normally. These wounds typically develop on either side of the lower leg, between the ankle and the calf. When veins are damaged and allow some blood to back up in the vein, reduced circulation causes fluid to seep out of the overfilled veins into surrounding tissues. This causes the tissue to break down, and may lead to ulcers. These wounds are treated with multiple layer compression to decrease the swelling and allow the wound to heal.

What is a Diabetic Foot Ulcer?

Diabetic foot ulcers are caused predominantly by the lack of sensation to the foot. Because of this lack of feeling (neuropathy), excessive callus builds up, eventually causing a wound. Diabetics also have a higher incidence of peripheral arterial disease. The treatment may include treating infection, controlling blood sugars, assess arterial circulation and provide wound offloading. Our treatment of choice to take the pressure off a diabetic foot ulcer is total contact casting. We are currently the only practice in central florida providing this service.

What are the stages of the wound healing process?

The Inflammatory Phase. This phase begins with the injury itself. The wound may bleed, the blood vessels narrow, clots form and various chemicals are released to begin the healing process. Specialized cells clear the wound of debris over the course of several days.

The Proliferative Phase. New skin cells and blood vessels form. The new blood vessels supply the rebuilding cells with oxygen and nutrients to help them continue to grow, and to support the product of proteins (mostly collagen). New tissue builds on the collagen.

The Remodeling or Maturation Phase. The collagen becomes more organized to make the tissue stronger. At this stage, the wound can resist normal stress, but is still not as strong as uninjured skin. Finally, new skin cells are produced across the surface of the wound, restoring the protective barrier between the body and the environment.

How do I get help for my chronic or non-healing wound?

You may call one of our Practice Locations directly, or be referred by your doctor. Some insurance plans require that you be referred by your Primary Care Physician.

Phone: 407.339.4499
FAX: 407.339.4903
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