Non healing wounds are horific to manage. It takes time, resources are utilized more and more and sometimes dismal results and failure of treatment. Different modes of intervention are promoted for healing. So, personal experience in the background of accepted knowledge is invited in this forum to show an acceptable mode of intervention in chronic non healing wounds.
Cause to be evaluated and dealt with promptly,infection to be eradicated by conventional treatment strategies,wound care and application of modern methods of chronic non-healing wounds to be adopted.
please follow the following link to the full text version of a publication on a very promissing treatment of chronic wounds with Autologous full-thickness skin substitutes,
http://www.a-skin.nl/nl/images/askinwebsite/bjd_tiscover-pretrial-article.pdf
or visit my profile page
Some approaches are
Hypoxia
http://www.sciencedirect.com/science/article/pii/S0168365912004403
http://www.dradio.de/dlf/sendungen/forschak/1820557/
Bone marrow cells and HMGB1
http://www.eurekalert.org/pub_releases/2011-04/kcl-bmc040111.php
Plasminogen
http://idw-online.de/pages/de/news479887
Simvastatin
http://www.eurekalert.org/pub_releases/2012-11/ehs-tss112712.php
Silver nanoparticles
http://www.impactlab.net/2011/04/07/healing-wounds-with-nanoparticle-rubber-stamps/
Plasma
http://medicalxpress.com/news/2011-11-platelet-rich-plasma-chronic-wounds-veterans.html
Peptides
http://www.eurekalert.org/pub_releases/2010-12/tuhs-bpf120710.php
Higher social status
http://phys.org/news/2012-05-social-status-faster-wound-wild.html
Friends
http://www.scienceblog.com/community/older/2004/7/20046305.shtml
Other
http://www.eurekalert.org/pub_releases/2011-12/gumc-ril121511.php
http://www.eurekalert.org/pub_releases/2011-02/thuo-ddb020711.php
http://www.eurekalert.org/pub_releases/2010-01/bu-edo010410.php
http://www.eurekalert.org/pub_releases/2005-06/nyum-rsn062005.php
Regards,
Joachim (not a medic)
Exact evaluation of the cause. Ischemia? Poorly managed diabetes? Infection? The first step to sucessfully ending a long-term wound healing is the fundamental basement of diagnostics, otherwise most probably any attempt will fail.
Dear Satyendra, you might be interested in some of my publications...feel free to sneek and download. If you experience any difficulties, please let me know! Dieter Mayer, MD, FEBVS, FAPWCA and Head of Wound Care, University Hospital of Zurich, Switzerland
This question is too broadly expressed to provide more than a generic answer, but clearly the most important factor is a complete initial assessment looking for the usual etiologies as outlined above by "deleted".
You can find a couple of publications when visiting my profile page (1.Castana O et al, The International Journal of Lower Extremity Wounds; 12:18-21
2. Ramadhinara A and Poulas K Adv Skin Wound Care; 26(1):1-4.) about a new technology for treating chronic wounds with WMCS (wireless microcurrent stimulation). The results are very interesting indeed.
Although there are many remedies for the treatment of chronic wounds, but not all are effective for all cases of chronic wounds, as the there are many etiology for the occurance of chronic wounds. From my personal poit of view, most of the chronic wounds are stick to inflammatory phase. This phase is weak in chronic wounds and wound healing cannot proceed to next phase i.e. proliferation. So, wound debridement is beneficial in chronic wound and apply some inflammatory drug, which is also having wound healing properties (i.e increase the proliferation of fibroblasts, blood vessels, collagen synthesis, epithelial regeneration etc... ). This will definitely lead the healing of chronic wound via proper regulation of all phases of healing.
This is multi-factorial.... finding out cause and treating it easier to say and difficult to do/prectice....
still the one most important is the assessment.... finding out the cause will be most important thing if that can be eliminated then any wound will naturally heal (taking its own time depending on nature and size).. with normal interventions like offloading, rest with elevation of part, moist environment and controlling bacterial proliferation.
Other than the normal etiologies like lack of sensations( trophic ulcers), and lack of vascularity (PVD), few things commonly missed are condition of underlying bone (get an X ray), exposed bone (it will not granulate even with VAC), exposed tendon (needs debridement even of the unexposed part of it for early and proper healing), vasculitis (especially in chronic wounds when the inflammation is long standing)..leading to decreased oxygen delivery... (can be managed with either hyperbarric O2, or steroids with physicians/preferably rheumatologists advise), so going into details of what can be causing problem will help.
For some patients it is simply impossible to avoid recurrent trauma (eg in some bedsore patients/ patients with trophic ulcers) due to lack of support and resources) and it is near impossible for them to comply with the r=treatment.
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