The definition of a problem wound is one which fail to respond to established medical/surgical management in an appropriate timeframe. Depending on the wound size, an appropriate time to heal would be approximately 1 month. These wounds usually present in compromised hosts with multiple local and systemic factors which inhibit tissue repair.
Vascular and circulation problems affect almost all people with diabetes. Prolonged high levels of sugar in the blood cause changes on a cellular level that affect all organs in the body including the skin. In diabetes blood becomes thicker with higher affinity to clot and stick deposits to the wall of blood vessels making them narrower and less flexible. Eventually, the smallest vessels, the capillaries, will close down, shutting the supply of blood and oxygen to the surrounding tissue.
Poor circulation deprives organs of needed oxygen and can cause their malfunction. Left undetected and uncontrolled this may lead to damage of nerve endings with symptoms like pain or numbness in feet or hands. Many people with diabetes have these symptoms for years before more serious conditions occur like leg ulcers and non-healing wounds. More than half of diabetic leg ulcers end up with amputation.
Similar to monitoring and controlling blood sugar and blood pressure, circulation can be assessed. Circulation monitoring is non-invasive, pain free and can be done regularly, every six months. This close monitoring allows for early detection of circulation problems and prevention of further damage.
The Wesley Centre for Hyperbaric Medicine uses the latest equipment to accurately assess the status of circulation and tissue ability to heal.
Compromised Amputation Sites/Non-healing Traumatic Wounds/Vascular Insufficiency Ulcers
Regardless of etiology, the basic mechanism of non-healing wounds is an interplay between varying degrees of tissue hypoperfusion and infection. All have the underlying problem of tissue hypoxia and its sequela as common denominators. Tissue oxygen tensions in or near such wounds usually measure below 20 mmHg. If tissue becomes hypoxic, wound healing is slowed or halted through several mechanisms including: decreased fibroblast proliferation, decreased collagen production and reduced capillary angiogenesis. Hypoxia also impairs oxygen-dependent intracellular leukocyte bacterial killing of the most common aerobic organisms found in wound infections and creates the ideal environment in which anaerobic and microaerophilic organisms flourish.
Hyperbaric Mechanisms in Problem Wounds
Hyperbaric oxygen (HBO2) treatment provides a significant increase in tissue oxygenation in the hypoperfused, infected wound. This elevation in oxygen tension induces significant positive changes in the wound repair process.
HBO2 promotes wound healing by directly enhancing fibroblast replication, collagen synthesis, and the process of neovascularization. Providing oxygen at the cellular level also increases leukocyte bacterial activity and has a direct lethal effect on anaerobic organisms.
HBO2 elevates oxygen tensions in ischemic and infected wound tissue. Tissue oxygen tension influences the rate of collagen deposition, angiogenesis, and bacterial clearance in wounds. Hypoxia is deleterious and hyperoxia will enhance the wound healing process. The greatest benefits are achieved in tissues with compromised blood flow and oxygen supply.