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Wound healing disorders: causes, frequency, treatment

by Josephine Andrews
Published: Last Updated on 353 views

In the case of a wound healing disorder, the healing process of a wound is delayed and it can become infected. Such a disorder often occurs with a weakened immune system and after surgical interventions. In these cases, a special wound treatment must be initiated, otherwise there is a risk of serious complications. Read everything you need to know about symptoms, diagnostics and treatment of wound healing disorders here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

T89 T79 T81

Wound healing disorder: description

A wound is a severing of connected tissue on the outer or inner surface of the body. If a wound does not heal or only heals poorly, one speaks of a wound healing disorder. These include, among other things, the development of bruises, accumulations of wound secretion under a wound (seroma), separating of the wound edges, wound tears and, above all, infections.

In the case of a chronic wound, the cohesion of the inner or outer skin barrier and the underlying structures is, by definition, disrupted for at least eight weeks.

occurrence

Between three and ten percent of wounds do not heal over a longer period of time. Around one percent of the general population has a chronic wound. In Germany, up to three million people are said to suffer from a wound healing disorder. This is one of the most common complications of an operation. Wound healing disorders occur in up to 20 percent of all operations in vascular surgery. People over the age of 60 are three times more likely to have wound healing disorders than younger people. Around 40 percent of long-term bedridden people suffer from a so-called decubitus ulcer – a poorly healing ulcer caused by bed sores.

The problem of a wound healing disorder is also the risk of recurrence. Since it usually arises on the basis of existing underlying diseases, wound healing disorders occur repeatedly in over 60 percent of cases.

wound healing

You can read about the complex healing process of a wound in the article on wound healing .

Wound healing disorders: symptoms

The main symptom of a wound healing disorder is the wound defect, which can manifest itself in various ways. In addition, there is usually (severe) pain and bleeding. In addition to the actual wound healing disorder, other injuries such as bone, vascular or nerve damage can occur. Blood and lymph circulation disorders make the healing process even more difficult and lead to other symptoms such as lymphedema.

When a wound becomes infected, the wound is red, overheated, and smelly. The wound discharge increases significantly and (pressure) pain occurs. Surrounding lymph nodes may swell (painful) as a sign of immune response. If there is also a fever , this can be an indication of dangerous blood poisoning (sepsis).

Wound healing disorders: causes and risk factors

Poor wound healing is caused by a variety of factors. It is often due to a chronic illness that a wound does not close. A distinction is made between local (ie in the area of ​​the wound) and systemic causes of wound healing disorders.

Unfavorable wound conditions

The most important local risk factor for impaired wound healing is unfavorable wound conditions. Particularly wide, bruised, dry or dirty wounds that may also be infected usually heal poorly. The formation of pus and bruising further complicates the healing process. In addition, smooth cuts usually heal better than bites , and small and superficial wounds heal better than large and deep wounds.

sutures and bandages

The wound must be reached by sufficient oxygen. Choosing the wrong bandage or using a suture that is too tight can limit the oxygen supply. The choice of wound dressing is therefore of crucial importance for the healing process. The bandage should protect against drying out, allow a sufficient supply of oxygen and not stick to a newly developing skin layer.

If the wound has been stitched, it is important to find the right time to pull the sutures (unless self-dissolving sutures have been used). If the stitches are pulled too early, the wound can reopen. Pulling the stitches too late, on the other hand, promotes the development of infections and hinders the final wound closure.

age

In old age, wounds usually heal less well than in younger years. However, this is also due to the more frequently occurring comorbidities.

underlying diseases

The most common systemic causes of wound healing disorders are diabetes mellitus (especially diabetic foot syndrome) and vascular diseases – especially chronic venous insufficiency (CVI, chronic venous insufficiency and peripheral arterial occlusive disease (PAD).

Other diseases that can lead to impaired wound healing are skin diseases, chronic pain disorders, tumors (and their treatment with radiation and chemotherapeutic agents), high bilirubin and urea levels, anemia and dehydration. Furthermore, disorders of the immune system and severe infections (such as tuberculosis , syphilis , HIV and other viral infections) also promote wound healing disorders.

Overall, imbalances in almost all systems of the human body lead to wound healing disorders, including hormonal (such as Cushing’s disease ) and psychological disorders (such as dementia , drug addiction). A wound will not heal unless such imbalances are corrected.

tuxedo

Smoking is an important risk factor for poorly healing wounds. A study showed that 50 percent of smokers compared to 21 percent of non-smokers suffer from a wound healing disorder after surgery.

nutrition

Diet also plays a major role, as proteins, vitamins, minerals and trace elements are important for the healing process. Both insufficient calorie intake and severe obesity promote wound healing disorders. Wounds heal poorly if proteins and their components, the amino acids , for tissue repair are missing. A protein deficiency can also occur, for example, if the liver does not have enough protein. Protein deficiency situations also occur in malignant tumor diseases.

Postoperative wound care

Whether a wound heals well after an operation depends not only on the skill of the surgeon but also on postoperative wound care and care. A wound does not heal after an operation if the positioning of the patient is neglected – if the patient lies constantly on the wound, the sustained pressure load leads to wound healing disorders.

If foreign bodies such as prostheses are installed during an operation, the body’s defense reaction can also impede the healing process. In general, particularly long operations and high blood loss during the operation promote wound healing disorders.

medication

Caution is also required with drugs that can directly or indirectly delay the healing process. These include, for example, corticosteroids, cancer drugs, psychotropic drugs and anticoagulants.

cooperation of the patient

Last but not least, the cooperation of the patient also plays a decisive role. Only consistent compliance with the prescribed therapy can prevent a wound healing disorder or make its treatment successful.

Wound healing disorders: investigations and diagnosis

Specialists in wound healing disorders are skin doctors (dermatologists) in the case of superficial wounds and surgeons in the case of internal wounds. If the wound occurs after an operation, the first thing to do is to contact the surgeon. First, the doctor will usually ask the following questions, among others:

  • How long has this wound existed?
  • How did the wound come about?
  • Do you suffer from pain or fever?
  • Has the wound healed better in the meantime?
  • Have you already experienced wound healing disorders?
  • Do you have any previous illnesses?
  • Have you reacted (also allergically) to a wound treatment?

With the help of the temporal delimitation of the duration of the wound, the wound can be classified as acute or chronic. Asking about fever and measuring body temperature are important in order to detect possible blood poisoning (sepsis) as early as possible.

After the conversation, the doctor will assess and examine the wound. He checks whether blood circulation, motor functions and sensitivity around the affected area are intact. A closer inspection of the wound healing disorder requires an assessment of how deep the wound extends and which structures are affected. For example, if the wound has reached the bone, there is a risk of bone inflammation . This so-called osteitis or osteomyelitis can have serious consequences.

Assessing the condition of the wound is also important. The doctor must pay attention to pus, redness and dead tissue, among other things. This enables him to assess whether the wound is aseptic (germ-free), contaminated or septic (infected). Finally, he will roughly determine the phase of wound healing for therapeutic and prognostic purposes.

In the case of larger and more severe wound healing disorders, further investigations are necessary.

blood test

blood test can show an infection and allows you to evaluate red blood cells, white blood cells, and platelets.

imaging

In the case of deeper and internal wounds and suspected foreign bodies or broken bones, imaging should be carried out as part of the diagnosis of wound healing disorders: an ultrasound examination can help at first. If the wound is not superficial, the extent must be estimated using computed tomography (CT), magnetic resonance imaging (MRI) or X-ray.

Wound swab/biopsy

If there is a suspicion of a wound infection, it is essential to take a swab from the wound. This is used to determine the exact type of pathogen and to clarify whether it is resistant to certain antibiotics. A possible antibiotic treatment should only be started after a wound swab has been taken, otherwise the result will be falsified.

If there is a suspicion that the wound could be a tumorous process, wound material should be removed for a (histo)pathological examination ( biopsy ).

differential diagnosis

An important alternative diagnosis to a wound healing disorder is pyoderma gangrenosum, which often occurs in connection with rheumatoid arthritis, chronic intestinal diseases, diseases of the hematopoietic system and also with (drug) suppression of the immune system. Most often it is located on the lower extremity. Pyoderma gangrenosum can resemble a wound healing disorder, but it is a deep inflammation that also affects fatty tissue and vessels. Since there are no clear diagnostic markers, pyoderma gangrenosum is a diagnosis of exclusion (only if all other diseases with similar symptoms have been ruled out can pyoderma gangrenosum be assumed).

Wound healing disorder: treatment

A wound healing disorder requires specific treatment to avoid serious consequences. Complicated wound healing disorders should be treated in a special wound center.

addressing the cause

A number of causes of wound healing disorders can be at least partially combated. With this in mind, it is important to identify the underlying cause of the delay in healing. For example, the therapy of diabetes mellitus should be better adjusted. A wound will not heal or will heal only with difficulty if the underlying problem persists.

If there is malnutrition or malnutrition, nutritional therapy must be initiated in addition to local wound care in order to compensate for deficits. So-called supplement food is also suitable for this purpose in the case of a wound healing disorder.

wound hygiene

The decisive goal of local therapy is to enable a problem-free healing process and to prevent damaging influences. Wound hygiene plays a very important role, not only for the wound itself, but also at the edges of the wound and the immediate vicinity. On the one hand, wounds should be kept clean, but on the other hand they should not be cleaned or disinfected too intensively. Rinsing with sterile (salt) water or wound baths (with tap water at body temperature) are often recommended. To prevent local reactions, aggressive rinsing solutions should not be used. Special funds should be used only in consultation with the doctor. Only preparations that are approved for direct wound application are suitable.

debridement

A very important part of wound care is the so-called debridement, in order to create an optimal wound base for the wound to heal. Debridement is the cleaning of the wound and the associated (surgical) removal of dead tissue (necrosis), plaque and foreign bodies from the wound.

This is particularly indicated in the case of strong signs of inflammation, systemic infections and large plaques as well as a lot of dead tissue. Everything is then removed until healthy tissue is on the surface. Among other things, this leads to better oxygen supply to the wound.

After this intensive cleaning of the wound, the non-healing wound has to be cleaned again and again, but not with the same intensity. For this purpose, the wound is often simply rinsed with sterile (saline) water.

Surgical interventions due to a wound healing disorder also include the evacuation of cavities with wound secretion or larger bruises and in severe cases the (partial) amputation of body parts, such as a toe. In the case of a wound infection, it may also be necessary to (re)open a wound.

Wound coverings can also be dissolved by artificial enzymes (eg in the form of collagenase ointments).

wound dressing

The choice of wound dressing should be made individually by an experienced wound expert and is not easy due to the large selection. Criteria include the healing phase, the infection status and the presence of dead tissue mass. Wound dressings for wound healing disorders should definitely offer protection against drying out, ensure a moist wound bed and not release any fibers into the wound. At the same time, the oxygen supply should be ensured. Many dressing materials contain antimicrobial ingredients such as iodine, polyhexanide or octenidine.

There are roughly three types of wound dressings. Passive bandages only provide protection. Dressings with interactive properties affect the wound directly (e.g. hydrocolloidal dressing, vacuum therapy). Cultured epidermis cells or an autologous transplant are so-called active wound dressings.

Conventional wound dressings such as gauze bandages and fleece are usually characterized by special absorbency, tear strength and air permeability. However, they carry the risk of sticking to the newly formed skin layer – an ointment bandage can help against this. Conventional wound dressings are primarily used as an initial wound dressing.

Modern interactive dressing materials (such as hydrogels, alginae, foam dressings) ensure a favorable, moist microclimate, which allows connective tissue and skin cells to multiply. At the same time, the adhesion of the new skin cells to the bandage is usually prevented. In the case of moist dressings, the balance between a moist wound environment and the absorption of wound fluid by the wound dressing must be maintained. Active silver compresses are not only absorbent and effective against microorganisms, they also reduce the odor of wounds. In severe cases, a wound healing disorder can also be treated with wound drainage or vacuum sealing.

antibiotics

If there is a larger wound infection, antibiotic treatment (antibiosis) can be carried out. A swab should be taken before hand to determine the exact pathogen and possible resistances. The antibiotic chosen should cover the common causes of wound infection such as staphylococci, streptococci, Pseudomonas and Escherichia coli. If resistant pathogens (such as MRSA) are detected in the wound, they should at least be combated with regular rinsing.

The antibiotics are usually used systemically, for example as a tablet. A local antibiosis in a wound healing disorder is controversial, since locally administered antibiotics only reach the wound tissue unreliably, contact sensitization often occurs and the selection of multi-resistant germs is promoted.

Wound infections are potentially life-threatening and should therefore be treated consistently.

pain management

A wound healing disorder may be accompanied by considerable pain, which in severe cases may also require treatment with opiates (very strong painkillers). Topical anesthesia (superficial local anesthesia) can be applied to the area of ​​the wound.

Other procedures

In addition to the treatment methods for wound healing disorders described above, there is a large number of more or less controversial therapies such as electrical stimulation, shock wave, infrared or magnetic field therapy. In addition, specially prepared maggots in a tight but not airtight bandage can aid in the healing process. Your saliva contains enzymes that aid in the removal of plaque and diseased tissue.

amputation

Despite intensive and multidisciplinary treatment, in some cases amputation is the last resort in chronic wound healing disorders. For this reason, around 30,000 smaller and larger amputations are carried out in Germany every year.

accelerate wound healing

The healing process of a wound can be supported. You can find out how to do this in the article Accelerate wound healing .

Wound healing disorders: course of the disease and prognosis

If an optimal wound environment is achieved and the cause can be eliminated, the prognosis of a wound healing disorder is good. Often, however, the cause cannot be completely eliminated, which worsens the prognosis.

A wound healing disorder after surgery leads to longer hospital stays (with the associated risks) and can also result in surgical wound care.

In the long term, for aesthetic reasons, scars and wounds can be corrected by a plastic surgeon or dermatologist after healing has taken place.

complications

Infection is particularly feared as part of a wound healing disorder, which in turn can lead to an abscess and blood poisoning (sepsis). The latter is potentially fatal and requires more intensive treatment methods.

Wound healing disorders can also lead to vascular, nerve, tendon, muscle and bone damage.

The dreaded compartment syndrome is an emergency. In addition to an acute onset after trauma, it can also develop chronically as part of a severe wound healing disorder. Compartment syndrome is caused by the compression of vessels and thus the blockage of blood flow due to increased tissue pressure in a defined area, especially in the lower leg area. Those affected typically complain of severe (new) pain. There are also sensory and motor impairments. The diagnosis can be made, among other things, by an ultrasound examination. Compartment syndrome usually requires acute surgical management.

Prevention of a (renewed) wound healing disorder

In order to prevent wound healing disorders, a wound should always be properly cared for. First of all, it and the surrounding area should be cleaned gently. The wound should be disinfected with antiseptics provided for this purpose and only if it is very dirty, otherwise more damage can be caused to the wound. Then the wound may be covered with a wound dressing. In more severe cases, you should go to the doctor who may stitch the wound. With every wound, especially dirty wounds, it should also be checked whether there is sufficient tetanus protection through vaccination.

Since many people affected by a wound healing disorder get similar wound problems again, preventive measures must be taken. This includes that existing underlying diseases are treated optimally, that the patient stops smoking if necessary and that the doctor explains to him how he can recognize a wound healing disorder at an early stage. 

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