Long healing wounds: causes, signs, stages, prevention

therapist at LabQuest + Q-Clinica medical company

“Human beings have a good ability to regenerate. This is especially true for the epidermis – with proper care, a large cut or wound can heal relatively quickly, as well as restore the skin after a burn. However, in some cases, abrasions may not heal for a very long time. I will tell you the reasons why the body may not be able to cope well with tissue damage”.

Inhaltsübersicht

How the wound healing process works

Wound healing is a complex process that requires many body systems to work together. The hemostasis system is the first to respond to damage. During this, the mechanism of vasoconstriction is activated, narrowing the vessels at the site of damage. At the same time, the endothelium stops producing mediators that inhibit blood clotting.

As a result, increased thrombosis begins in the wound – blood clots are trying to “patch” the damage. Subsequently, as a result of a chain of chemical reactions to the clots as a result of fibrin attached to the fibrin, which strengthens them and contributes to further stop bleeding.

The wound healing process can be divided into three partially overlapping stages:

Inflammation stage. When the immediate threat in the form of bleeding has been eliminated, the body begins to sequentially direct neutrophils, macrophages, and lymphocytes into the wound. This is necessary to protect against foreign bodies and cleanse the wound of dead tissue and cells. It also helps to prevent the spread of infection. The hemostasis system and the inflammation stage are sometimes combined into one – on average, both of these stages take up to five days, depending on the extent of the injury.

Diegranulation (proliferation)stage, in which new tissue is formed and the capillary network is restored. This process takes two to four weeks on average.

Epithelialization (differentiation)stage, during which the body tries its best to return the damaged area to its original appearance. This process is the longest of all – in some cases it can last for years.

Causes of prolonged wound healing

Wounds that do not heal for three months are often considered chronic, and we will talk about them.

The speed of wound healing depends on many factors:

the depth and size of the wound affect the healing time first, because the deeper the abrasion, the longer it takes to heal;
the location of the wound. The more it is exposed to mechanical impact, the longer it takes to heal;
age also affects healing time. The older a person is, the less elastic the skin becomes, that is, the turgor of tissues changes, respectively, wounds can heal more slowly;

nutrition. The supply of nutrients and vitamins also plays an important role in the process of tissue regeneration – protein, vitamin C, E, A, K, B vitamins, calcium, zinc. All these substances help in the formation of new tissues and in the fight against infections;
taking certain medications and treatments. (NSAID therapy, hormonal drugs – GCS, radiation therapy, chemotherapy, etc.);

chronic diseases affecting the circulatory system, immune system, which also contribute to wound healing.

Diseases that lead to prolonged wound healing

Let’s look at these diseases in more detail to have an understanding of what each of us may be facing.

Weakened immunity due to co-morbidities or chronic immunodeficiency (HIV, autoimmune diseases). The adequacy of the inflammatory response and the ability of the body to resist the attachment of secondary infection depend on this.
Metabolic disorders (obesity, metabolic syndrome). Body weight affects the metabolic processes in the body. Fat tissue does not need intensive blood circulation, so increasing its amount several times relative to the norm (obesity) leads to slower tissue regeneration and frequent complications of the course of the wound process.
Diabetes mellitus. This condition can be considered a severe form of metabolic disorders, namely glucose metabolism. Violations of the normal assimilation of glucose lead to increased fragility of tissues and slower regeneration.
Disturbance of blood circulation – both general and local. The cause may be atherosclerosis, deformation of vascular walls, diseases of the cardiovascular system. Local circulatory failure can be caused by prolonged compression of tissues and compression of small blood vessels (example of a chronic wound on the background of constant compression of tissues – bedsores).

Emaciation – alimentary (due to insufficient or deficient nutrition) or senile. At extremely low body weight there is a slowdown of metabolism in the body due to a decrease in energy, therefore, all wounds heal more slowly.
Presence of cancer. Another reason for prolonged wound healing. The tumor grows and takes over part of the circulating blood with all the nutrients and oxygen. Also in this case, there is often an intoxication syndrome that affects all processes in the body, including the process of tissue regeneration.

Chronic diseases of the respiratory system, violating gas exchange, impairing the supply of tissues with oxygen through hemoglobin.
Anemia is characterized by a deficiency of hemoglobin, causing oxygen deprivation.
Chronic heart failure can develop gradually over years. Heart function deteriorates, shortness of breath and edema appear. Blood flow slows down, the supply of oxygen and nutrition to tissues decreases, which also inhibits regeneration.
Chronic venous insufficiency often leads to prolonged recovery when it comes to tissue damage in the legs. Blood outflow and nutrition supply to the tissues are impaired, causing hypoxia and metabolic disorders. As a result, trophic ulcers appear.

Local factors

Also affect the time of wound healing:

infection;
the presence of necrotized tissues in the wound (they increase the risk of suppuration and, accordingly, the duration of healing);
the presence of foreign bodies in the wound;
the presence of spilled blood in the wound (also increases the risk of infection);
re-injury of an unhealed wound;
damage to tissues adjacent to the wound – subcutaneous tissue, muscles, nerves, bones.

Signs of prolonged wound healing

If the processes of tissue regeneration are disturbed, patients may complain of constant aching pain, bleeding from the wound, there may be an unpleasant odor from the wound (with infection), the edges of the wound do not come together for a long time.

If you notice long-healing wounds, it is necessary to consult a specialist – therapist, surgeon, endocrinologist, oncologist or infectious disease specialist, who will help to understand the cause and, accordingly, prescribe appropriate treatment to improve the condition of the body.

Prevention of inflammation

To prevent the development of inflammation in the wound, it is necessary to protect the wound from damage and secondary infection – close it with a bandage, regularly treat it with antiseptic agents, provide the necessary ventilation.

If exudate is released from the wound – to ensure its drainage with a mesh drainage dressing. When the wound is in the granulation stage – take care of it from mechanical damage and do not allow violation of the integrity of the connective tissue covering it.

In any case, it is better to immediately contact a trauma center.