Download Wounds are Neither Created, nor Healed Equally Karl R. Stark, MD

Wounds are Neither Created, nor Healed Equally
Karl R. Stark, MD, FACS
Medical Director
The Center for Wound Care and Hyperbaric Medicine
St. Mary’s Medical Center
The old saying “Some wounds never heal” is often heard in connection with emotional injury and loss. But
the same adage can also be used quite literally in the case of certain physical wounds that can become chronic in
nature, and may not close, or stay closed without very specific treatment.
While the body has an amazing capacity to heal itself, there are a number of physiologic and mechanical
factors that impair the healing response. This results in chronic wounds that fail to close in the normal body’s
mechanism. Local infection, hypoxia (lack of oxygen getting to the wound), trauma, foreign bodies, or systemic
problems such as diabetes, malnutrition, immunodeficiency, or medications are often responsible for lack of wound
healing. Radiation treatment and crush injuries can also contribute to chronic wounds.
The key is to determine the type of wound, and then develop a therapy to close the wound as quickly as
possible, and prevent it from returning.. Patients undergo a thorough diagnostic examination to identify the type of
wound and the underlying problems causing the wound. After this determination, a program is specifically tailored
to the patient’s needs based on the most effective treatment options. A multi-specialty strategy typically provides the
maximum benefits in wound care. The longer a wound is open, the longer the healing time, and the bigger the
chance of infection.
Some common chronic wound conditions are:
Diabetic foot ulcers
Diabetic ulcers are responsible for most foot and leg amputations in the United States. Patients with
diabetes develop these ulcers with an incidence of 2 percent per year, costing an average of $7,000-$10,000 each.
But, while diabetes patients often have ulcers of the foot there are other causes of foot ulcers. In some patients, the
foot ulcer is the initial time that diabetes is discovered. . Treatment includes debridement (removal of a
patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue),
maintaining a moist wound environment (moist wounds heal faster than dry wounds) and, if bacterial infection is
present, treatment of the infection. Hyperbaric oxygen therapy aids in closure of some diabetic wounds, as does
negative pressure devices, and biologic active agents.
Pressure ulcers
Inadequate blood flow to due to prolonged pressure over a bony prominence can be serious for those
confined to sitting or lying down. Pressure ulcers typically occur in patients who are unable to reposition
themselves. Preventive measures include frequently assessing high-risk patients, scheduled repositioning, special
bedding, moisture barriers, and adequate nutritional status. Many wounds may require surgical removal of bone
material to manage.
Venous leg ulcers
Approximately 70 percent of all leg ulcers are venous ulcers. Most of venous leg ulcers occur because the
valves connecting the superficial and deep veins don’t function properly. Compression hose or boots, along with
debridement, are mainstays of therapy. Skin grafts and bioengineered skin equivalent have both been shown to be
effective. Patients needs appropriate therapy to heal and prevent recurrances.
Therapies:
Negative pressure wound therapy has revolutionized wound care in both civilian and military wounds.
They create negative pressure (vacuum) at well-sealed wound sites that can help remove fluids and infectious
materials and draws wound edges together. This treatment appears to be very useful for diabetic ulcers.
Biologically active products, including human-cultured tissue as well as other species may find more clinical
applications in the future.
Hyperbaric oxygen therapy uses a special chamber, sometimes called a pressure chamber, to increase the
amount of oxygen in the blood.
Chronic wounds represent a significant burden to patients, health care professionals, and the US health care
system, affecting 5.7 million patients and costing an estimated 20 billion dollars annually.
At the Center for Wound Care and Hyperbaric Medicine at St. Mary’s, we utilize the most up-to-date
approaches to wound healing and remain current on new scientific advances in wound care. The family atmosphere
in the group, I feel is directly responsible for their ability to help patients remain comfortable during their treatment.
Our goal at the wound center is to help patients heal their wounds and allow them to achieve a normal life
as fast as we can.