What is a Chronic Wound?
A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds, this balance is lost and degradation plays too large a role. Acute and chronic wounds are at opposite ends of a spectrum of wound-healing types that progress toward being healed at different rates.
Do you treat chronic wound and burns for the entire body?
What locations on the body are chronic wounds typically found?
Legs, feet, heels, shoulder blades, sacrum, and stomach.
What insurances do you accept?
We accept Medicare, Blue Cross & Blue Shield, Hill Physicians, Brown and Toland, Jade Medical Group, MediCal, Partnership and Meritage Medical Network, Chinese Community Health Plan, and most commercial health insurances; please call for an updated list.

Also, we accept walk in patients without a referral.

Do you have same day appointments?
What are the causes of chronic wounds?

In addition to poor circulation, neuropathy, and difficulty moving, factors that contribute to chronic wounds include systemic illnesses, age, and repeated trauma. Comorbid ailments that may contribute to the formation of chronic wounds include vasculitis (an inflammation of blood vessels), immune suppression, pyoderma gangrenosum, and diseases that cause ischemia. Immune suppression can be caused by illnesses or medical drugs used over a long period, for example, steroids. Emotional stress can also negatively affect the healing of a wound, possibly by raising blood pressure and levels of cortisol, which lowers immunity.

The vast majority of chronic wounds can be classified into three categories: venous ulcers, diabetic, and pressure ulcers. A small number of wounds that do not fall into these categories may be due to causes such as radiation poisoning or ischemia.

Venous ulcers, which usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly. They are thought to be due to venous hypertension caused by improper function of valves that exist in the veins to prevent blood from flowing backward. Ischemia results from the dysfunction and, combined with reperfusion injury, causes the tissue damage that leads to the wounds.

Another major cause of chronic wounds, diabetes, is increasing in prevalence. Diabetics have a 15% higher risk for amputation than the general population due to chronic ulcers. Diabetes causes neuropathy, which inhibits nociception and the perception of pain. Thus patients may not initially notice small wounds to legs and feet, and may, therefore, fail to prevent infection or repeated injury. Further, diabetes causes immune compromise and damage to small blood vessels, preventing adequate oxygenation of tissue, which can cause chronic wounds. Pressure also plays a role in the formation of diabetic ulcers.

Another leading type of chronic wounds is pressure ulcers, which usually occur in people with conditions such as paralysis that inhibit movement of body parts that are commonly subjected to pressure such as the heels, shoulder blades, and sacrum. Pressure ulcers are caused by ischemia that occurs when pressure on the tissue is greater than the pressure in capillaries, and thus restricts blood flow into the area. Muscle tissue, which needs more oxygen and nutrients than skin does, shows the worst effects of prolonged pressure. As in other chronic ulcers, reperfusion injury damages tissue.

What are complications of chronic wounds?
Most often infection, which is also the most common cause of delayed healing in chronic wounds. Microbial contamination of wounds can progress to colonization, to localized infection, then to systemic infection, sepsis, multi-organ dysfunction, and subsequent life and limb-threatening infection.
What is the best way to treat a chronic wound?

The following which also includes treating the underlying cause:

  • Wound debridement which can be conservative sharp wound debridement, mechanical, biological/larval, enzymatic or autolytic
  • Offloading for neuropathic or diabetic foot ulcers, such as Total Contact Casting
  • Compression therapy for venous leg ulcers
  • Infection control which at times requires advanced antimicrobial wound dressings that penetrate and eliminate the bacterial biofilm
  • Appropriate wound dressings changed at appropriate intervals to maintain the proper moisture balance within the wound
  • Restoring blood flow for arterial ulcers caused by arterial insufficiency
  • Skin Substitutes for diabetic foot ulcers or venous leg ulcers
  • Foot Reconstruction to correct the mechanical dysfunction causing the abnormal pressure/shearing
  • Negative Pressure Wound Therapy to maintain the proper moisture balance and accelerate the body’s formation of collagen and healing
  • Tight glycemic control in diabetics
  • Smoking cessation therapy
  • Adequate nutrition with a higher caloric intake, especially Vitamin C and protein, and occasionally Vitamin A and zinc
How to avoid developing a Chronic wound?

See a wound care specialist. Is the wound acute or chronic? Acute wounds go through the normal phases of healing and close. Chronic wounds fail to heal and remain open. Persistence of redness, little or no evidence of healing after a reasonable amount of time, granulation tissue that appears pale rather than a robust reddish color, and granulation tissue that forms initially but fails to increase in amount.

  • Establish a Diagnosis – diabetic, venous, and pressure
  • Keep the wound moist
  • Adequate dressing changes
  • Follow your suggested treatment plan provided by your wound specialist
What diseases are associated with Chronic Wounds?
Diabetes, venous insufficiency, venous ulcers, peripheral arterial disease, peripheral neuropathy, a chronic inflammatory state, and altered cellular function.
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