Individualized Treatment Options for Problem Wounds

Chronic wounds often contain dead or dying tissue, which can be a breeding ground for bacteria and a barrier to healing. Doctors will often remove (debride) any dead or infected tissue in and around the wound as an initial treatment to promote healing and reduce the risk of infection. Debridement can be done using mechanical instruments and/or special dressings and ointments that soften the tissue so it can be removed more easily.

When diminished blood flow is a primary reason for the development of chronic, non-healing wounds, doctors may perform minimally invasive endovascular procedures to restore or improve blood flow. Recent advances in endovascular techniques, make revascularization a possible option for many more patients, including the elderly or more frail patients. Procedures may include:

• Complex endovascular techniques to open narrowed blood vessels
• LimFlow deep venous arterialization for no-option patients
• Alternative non-invasive therapies to save limbs

These procedures are commonly done to treat peripheral artery disease (PAD).

Some patients with hard-to-heal wounds may be prescribed hyperbaric oxygen therapy in addition to more traditional medical and surgical wound treatments.

For each therapy session, the patient relaxes in a special chamber that contains pure oxygen, pressurized at two to three times higher than normal air pressure. In this environment, the lungs can gather a great deal more oxygen than is possible when breathing at normal air pressure. The extra oxygen is carried by the blood throughout the body to stimulate healing and fight infection.

HBOT is most commonly used to treat severe burns, bone infections, diabetic foot ulcers and radiation-related tissue injuries. Multiple sessions are required over many weeks or even months to achieve optimal results.

Compression therapy refers to the use of special medical-grade compression socks or stockings, which, are designed to support the veins in your legs, improve drainage of venous blood out of the legs and back to the heart, reduce swelling and lessen pain. It is often recommended for patients who have symptoms associated with chronic venous insufficiency and to optimize results after a venous intervention. They are very important in maintaining both the health of your veins and your leg skin.

Compression stockings work by exerting external pressure on the veins and muscles of the lower legs, helping the blood to flow more efficiently and prevent blood from pooling in the legs. Increased emptying of the veins in the legs via walking and compression therapy allows the veins to loosen, decreasing venous pressure and helping to keep the blood moving towards the heart. They also reduce edema (abnormal fluid build-up) in the legs and ankles and improve the skin changes that sometimes occur with chronic venous insufficiency.

The skin and the tissues that lay beneath it are packed with millions of receptor nerve cells. When the skin is broken or damaged due to traumatic injury, disease or surgery, these receptor cells send messages along nerve pathways to the brain, which results in the sensation of pain.

In the case of acute or chronic wounds, pain sensations may occur at the time of injury, arise due to infection or inflammation and/or be present throughout the treatment and healing process. The wound care experts at University Hospitals work with a team of pain management specialists to manage the pain associated with chronic or slow-healing wounds. Therapies may include:

• Medications (oral and/or topical)
• Nerve blocks
• Behavioral health strategies
• Integrative medicine techniques like acupuncture and meditation

A wound or skin injury can occur for many different reasons. It could be due to an accident, injury, surgery, a burn, circulation problems, diabetes, or spending too much time in one position (not moving enough). Physical therapists can help prevent and heal wounds by prescribing specific exercises and activities to help you manage pain and prevent excess scar tissue from forming as you heal.

Specifically, physical therapy can help you find ways to move your body that will increase blood circulation to the injury, strengthen surrounding muscles, tendons, and ligaments and prevent joints from stiffening.

The wound care team at University Hospitals is dedicated to helping patients manage their chronic, non-healing wounds. In addition to a wide array of medical therapies, we also offer access to comprehensive support services and resources designed to hasten the healing process, prevent future wounds and enhance the overall patient experience. Supportive services include:

• Assistance in obtaining durable medical equipment (DME) for at-home use. DME for wound care may include a wide range of equipment and supplies.
• Diabetes education
• Education related to managing fluid buildup (edema) in tissues that can lead to swelling and potentially breaks in the skin
• Infection control resources and education
• Nutritional counseling