Advanced treatments heal chronic wounds
By Richard M. Basile, MD

The aging of the Baby Boom generation and a sharp rise in the incidence of diabetes and obesity in the larger population have literally opened a stubborn wound – a dramatic increase in the prevalence of chronic wounds that resist basic treatments to heal them.  The good news is that a steady evolution of advanced treatment technologies, including biologically-derived topical gels, natural and artificial skin replacements and hyperbaric oxygen chamber therapy, have provided highly effective healing solutions.

Chronic wounds, those which take three months or much longer to fully heal, are rarely seen in people who are otherwise healthy. For the vast majority of us, if we suffer some type of relatively minor cut, scrape or wound, it should heal quite quickly, providing we follow the basic steps of keeping it clean, moist and covered, without creating pressure.  But for those of us with conditions like diabetes, obesity, arteriosclerosis and other circulatory issues, the specter of chronic wounds can be very real, particularly as we age. A simple cut on the leg or foot can become a lengthy, painful ordeal. Often, these skin wounds simply appear as a direct result of those conditions. 

MOST COMMON CHRONIC WOUNDS 

Diabetic Foot Ulcers.  A common complication of diabetes, they form when skin tissue breaks down and exposes the layers beneath. They account for 20 percent of the nearly 3 million hospitalizations every year related to diabetes. An estimated 12 percent of patients with untreated foot ulcers eventually must undergo amputation. 

Venous Leg Ulcers. The veins in your legs have one-way valves that keep blood flowing up toward your heart. When these valves become weak, blood can flow backward and pool in your legs. This is called venous insufficiency. The excess fluid causes the blood pressure to build, preventing healing nutrients and oxygen from getting to those tissues. 

Arterial Ulcers. These wounds also appear on the feet and legs due to poor blood flow, causing cells to die and damage tissue. Clogged arteries (atherosclerosis) are the most common cause of these ulcers. 

Pressure Ulcers. These sores are areas of skin damaged by staying in one position for too long. They commonly form where bones are close to the skin, such as the back, ankles, elbows, heels and hips.  Vulnerable patients include those who are bedridden or in wheelchairs, as well as stroke victims, patients with diabetes and those with dementia. 

MOST COMMON ADVANCED TREATMENTS 

Growth Factor Therapy. Growth factors are natural substances secreted by the body whose function is to stimulate the growth and proliferation of cells involved in wound healing. This treatment uses human cells (derived in laboratories) to promote healing, usually applied topically in the form of a gel. 

Skin substitutes. Available in both natural and synthetic form, skin substitutes are used to aid in wound closure, control pain and replace skin function to promote healing. Natural substitutes are bio-engineered from living human cells. Synthetic substitutes mimicking natural skin have proven to be an effective alternative. 

Hyperbaric Oxygen Therapy. For patients with low tissue oxygen, this treatment involves breathing 100 percent oxygen at increased atmospheric pressures to increase the amount of oxygen delivered to body tissues. The patient sits or lies down in a special hyperbaric chamber for several hours over the course of several outpatient visits. 

WOUND PREVENTION 

Lifestyle changes can help prevent the onset of chronic wounds. Taking these steps can improve blood flow and aid healing:

• If you smoke, quit.
• If you have diabetes, keep your blood sugar level under control and follow proper foot care.
• Exercise as much as your doctor advises. Staying active helps with blood flow.
• Eat healthy foods and get plenty of sleep at night.
• Lose weight if you are overweight.
• Manage your blood pressure and cholesterol levels.

Richard M. Basile, MD, FACS, is medical director of the Center for Wound Care and Hyperbaric Medicine at Berkshire Medical Center.