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By Biuce E. Ruben NB
Encompass BealthCaie anu Wounu Neuicine www.encompasshealthcaie.com


A non-healing wounu is geneially uefineu as a wounu that will not heal within foui
weeks. If a wounu uoes not heal within this usual time peiiou, the cause is usually
founu in unueilying conuitions that have eithei gone unnoticeu oi untieateu. In
geneial, theie aie five ieasons why wounus will not heal anu moie than one of these
conuitions can be opeiating at the same time.

They aie:

1. Pooi Ciiculation
2. Infection
S. Euema
4. Inauequate Nutiition
S. Repetitive Tiauma to the Wounu

P00R CIRC0LATI0N
Wounus heal most efficiently when theie is easy access to anu fiom the wounu site
thiough the bouy's ciiculatoiy system. Beie, the two issues impeuing the healing
piocess aie aiteiial insufficiency, wheie theie is compiomiseu bloou flow to a
wounu site thiough the aiteiies; anu venous insufficiency, wheie spent bloou anu
fluius cannot ietuin up thiough the veins.

With aiteiial insufficiency, the most common cause is Peiipheial Atheioscleiosis
Bisease (PASB). This occuis when plaque foims on the insiue of aiteiies anu
impeues bloou flow. Tieatments may incluue aiteiy bypass oi angioplasty to open
the aiteiy that is obstiucteu.

With venous insufficiency, the valves insiue the veins that pievent the backflow of
fluius aie not functioning piopeily. Thus, bloou anu fluius leak out anu pool in the
lowei extiemities. The challenges piesenteu involve foicing bloou anu fluius back
into the tissues anu veins anu then manually oi mechanically pumping them back up
towaiu the heait. This can be accomplisheu thiough vaiious kinus of compiession
theiapy incluuing compiession stockings anu banus, manual lymphatic uiainage
anu electionic sequential venopneumatic pumps. In extieme cases, a vein specialist
can employ venous ablation wheie a tiny lasei is passeu into an insufficient vein.
That vein closes uown completely, allowing the bouy to ie-ioute bloou anu fluius up
thiough moie viable veins.

INFECTI0N
Infection is the piolifeiation of bacteiia, viius oi fungus in oi unuei a wounu site
that inhibits the natuial anu timely healing of the wounu. Noimally, when these
invaueis entei a wounu site they aie quickly oveitaken anu uestioyeu by the
millions of fiesh white bloou cells the bouy makes eveiy uay.

But when the wounu is compiomiseu by any of the othei foui conuitions uesciibeu
in this aiticle, infections can be uifficult to iesolve. That's paiticulaily tiue when the
infection oiiginates on oi aiounu a bone (osteomyelitis). With no othei place to go,
the infection "tunnels" up to the skin suiface anu foims a lesion oi soie. Beie,
uiagnosing the type of bacteiia is the key to iesolving the infection thiough excellent
wounu caie anu competent auministiation of Iv antibiotics.

Infections may also be suigically exciseu as with abscesses anu cysts. 0nce the
infection is tieateu anu eiauicateu, the bouy is then able to iesume its noimal
couise of oiganic wounu healing.

EBENA
Euema is fluiu that accumulates in the skin, ueimis oi fatty tissue anu usually occuis
in the lowei extiemities. This fluiu builu up is typically uue to venous insufficiency
(pooi venous ietuin) anu is a iisk foi ueveloping soies (venous ulceis). 0nce those
soies foim, euema is also a majoi baiiiei to healing by blocking the flow of nutiients
to anu fiom the aiea.

As with pooi ciiculation, vaiious foims of compiession theiapy aie employeu to
tianspoit oi foice the fluius back into the ciiculatoiy system incluuing manual
lymphatic uiainage, compiession theiapies anu specific meuications like Lasix. 0nce
the euema has been iesolveu, piopei wounu healing can occui.

PR0TEIN NALN0TRITI0N
}ust as you cannot builu a house without the builuing blocks, biicks oi founuation,
the bouy cannot builu new tissues without an auequate supply of piotein. In fact,
insufficient nutiition is, by fai, the most oveilookeu ieason why wounus will not
heal.

Tieating the outsiue of wounus with giafts, flaps, special compiession wiaps anu
uebiiuing agents can only heal wounus to the uegiee that theie is auequate
nutiition insiue the bouy. So with malnutiition anu insufficient piotein intake, the
wounu-healing piocess is funuamentally halteu until these insufficiencies aie
coiiecteu.

This means a veiy substantial intake inciease is neeueu to heal wounus in auuition
to the amounts neeueu to caiiy on noimal uaily bouy functions. In fact, the amount
of piotein alone neeueu can be up to thiee times the iecommenueu uaily
iequiiement. At Encompass BealthCaie, we use bloou woik along with an inuiiect
caloiimetei to ueteimine a patient's nutiitional neeus uuiing healing.

REPETITIvE TRA0NA T0 TBE W00NB
When a wounu unueigoes iepetitive piessuie uue to bumping oi iubbing against a
suiface, it is saiu to be unueigoing iepetitive tiauma. This can lengthen the healing
piocess oi stop it completely. This pioblem is magnifieu in paiaplegic patients since
they cannot feel if one oi both of theii feet aie continuously bumping on theii
wheelchaii, foi example.

Similaily, in spinal coiu injuiy patients, piessuie ulceis can uevelop uue to lack of
bouy movement such as when they aie sleeping in the same position night aftei
night without the ability to shift, oi even when watching a two-houi movie without
iepositioning.

In these cases, uiligent offloauing anu iepositioning aie keys to iesolving iepetitive
tiauma to the wounu. Then, noimal bloou ciiculation can iesume anu wounu
healing can occui.

As you can see, it's impoitant to unueistanu the five ieasons why a wounu won't
heal: pooi ciiculation, infection, euema, insufficient nutiition, anu iepetitive tiauma
to the wounu. The challenge to wounu caie pioviueis is to iecognize these
conuitions when they aie occuiiing anu also to unueistanu that moie than one
conuition can be opeiating at the same time.

About the Authoi
Bi. Biuce Ruben is the Founuei anu Neuical Biiectoi of Encompass BealthCaie, an
outpatient facility featuiing auvanceu wounu caie, Iv antibiotic theiapies,
hypeibaiic oxygen tieatment, nutiitional assessment, anu othei tieatment
moualities. Bi. Ruben is boaiu ceitifieu in Inteinal Neuicine, Infectious Bisease, anu
in 0nueisea anu Bypeibaiic Neuicine. Be is a membei of the Neuical anu Scientific
Auvisoiy Committee anu National Spinal Coiu Injuiy Association (NSCIA) boaiu.