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Around 6.5 million people in the U.S. live with a chronic, or non-healing, wound, most often on the legs or feet. Patients with neuropathy from diabetes, for instance, may lack sensation in their feet. Something as small as a pebble in the shoe could result in a wound that may break open and get infected before the person notices the injury.
Non-healing, or chronic, wounds can cause serious complications, including infection, pain, and tissue damage. In rare cases, a non-healing wound leads to amputation—removing part or all of a limb.
Non-healing wounds require specialized care. In some cases, amputation is the most effective treatment. But in far more cases, expert care can help patients avoid amputation and provide the knowledge to prevent future injuries.
At MedStar Health’s Wound Healing Institute, our team of experts uses the latest medical and surgical limb salvage techniques to help reduce the need for amputation, heal challenging wounds, and return patients to a healthy and more active life.
What can stop a wound from healing?
Some of the most common reasons why a wound might not heal include:
- Infection: When a wound gets infected, the immune system prioritizes clearing the contamination over healing the wound, and bacteria can slow healing, too.
- Circulation challenges: People with peripheral vascular disease, high blood pressure, or diabetes can have poor blood circulation. Blood is critical to healing, so disruption can cause a wound to heal slowly or not at all.
- Condition of the wound: Healing is impaired if the wound is repeatedly traumatized, too much pressure is applied, or the wound gets dehydrated or overhydrated.
- Medications: Some drugs reduce inflammation, like corticosteroids that can be used to treat allergies, asthma, arthritis and more. Some types of chemotherapy or radiation may increase the risk of non-healing wounds.
- Aging: The skin becomes fragile with age, and older patients are more likely to have chronic diseases that cause poor circulation, such as diabetes or heart disease.
Medical limb salvage treatments.
Depending upon the cause, location, and size of a wound there are several techniques we can employ to aid in healing. These include:
- Basic wound care: Regular cleaning, changing dressings, and ensuring no further damage occurs to the wound.
- Debridement: Providers remove dead tissue to promote the growth of new cells and improve healing.
- Hyperbaric oxygen therapy: Patients breathe pure oxygen for two hours per day for up to eight weeks in a pressurized chamber. HBOT technology helps wounds heal by increasing the oxygen in the blood to help build new blood vessels and tissues at a microscopic level.
- Medications: Doctors may prescribe drugs that support the immune system and antibiotics to aid in healing.
- Negative pressure wound therapy: A vacuum device can be used to create negative pressure around the affected area, reducing swelling and promoting blood flow to the wound.
- Topicals: Wound gels and antibiotic ointments can help prevent infection and support healing.
Surgical limb salvage procedures.
For challenging or advanced wounds, surgery can help heal the wound and save the limb. These can include:
- Angioplasty: Doctors improve circulation with this procedure to push plaque against the walls of a nearby artery.
- Atherectomy: Doctors remove plaque removed from a narrowed artery, restoring circulation.
- Flap surgery: In this procedure, a plastic surgeon moves a section of healthy tissue and its blood supply from a healthy area of the body to cover the non-healing wound.
- Skin grafts: The surgeon transplants healthy skin from another part of the body or a donor to cover the wound and help it heal.
- Stenting: Our experts implant a small tube in the narrowed artery, which expands to open the blood vessel and improve circulation.
- Wound closure methods: We use surgical techniques such as stitches, staples, or adhesive strips to help keep the wound closed, assist in healing, and prevent complications.
When a non-healing wound is life-threatening, we consider amputation of the affected limb. The choice to have an amputation is difficult, so our team works closely with patients to consider all their options. We offer comprehensive services, including prosthetics, rehabilitation, and counseling to our patients adjust and return to their lives.
After any surgery, patients need to follow physical, occupational, and care instructions to fully heal and regain function. Our Patient Care Coordination Team can help patients connect with community resources, home health aides, and rehabilitation facilities to promote healing.
Related reading: Diabetic Foot and Limb Loss Prevention
Advances in limb salvage technology and wound care.
Over the last decade, advances in technology and in our understanding of wound care have helped save more patients’ limbs. One of the most impactful changes has been the adoption of a team approach to limb salvage.
As we focus on centering patients and their circumstances at the heart of our team-based care, we see outcomes improve. The team at MedStar Health Wound Healing Institute includes specialists with expertise in every aspect of wound management, including:
- Diabetes management
- Occupational and physical therapy
- Plastic surgery
- Podiatric surgery
- Radiology
- Rheumatology
- Vascular surgery
- Advanced practice providers (APPs) like physician assistants, advanced practice registered nurses, and certified registered nurse practitioners with wound care experience.
Digital health solutions like telemedicine, wound imaging, and remote monitoring are helping us keep in close contact with our patients, many of whom require multiple treatments or surgeries and extensive rehabilitation. A few of the other leading-edge techniques and innovations that we use include:
- New wound dressings: Innovative materials like hydrogels, foams, and films can help create a moist environment to promote wound healing.
- Growth factors and biologics: Biologic agents such as platelet-derived growth factors and tissue-engineered products can stimulate tissue repair and regeneration.
- Negative pressure and hyperbaric oxygen therapies: As discussed above, these technologies can support healing in effective and powerful ways for patients who are eligible.
- Genetic therapies: Research into the use of stem cells, skin substitutes, and genetically modified cells to promote healing are showing promise.
Watch our Facebook Live broadcast below to learn more about limb salvage:
Prevention and taking action.
The only thing better than seeing our team before a wound becomes problematic is preventing wounds in the first place.
For patients with diabetes, controlling blood sugars can help reduce the chances of a wound forming and improve healing when a wound does occur. Because foot wounds can be difficult to notice, it’s important for people with diabetes to check their feet for injuries every day.
We recommend that patients speak with a doctor if a wound is not healing after two weeks. Ignoring non-healing wounds can quickly lead to complications, so it’s important for patients who notice a wound that won’t heal to reach out right away.
As we age and our lives become more medically complicated, the chances of developing a non-healing wound increase. Yet these challenging conditions don’t have to mean automatic amputation like in the past. The longer a wound is open, the harder it is to heal, so don’t hesitate to talk with your doctor if you have a stubborn wound.
