Why do stubborn wounds not heal?

In wound healing care, there is a wound that will never heal no matter what dressing is used and regular debridement. This situation often causes great distress to the patient, and may even prevent the patient from living and working normally. So, why do stubborn wounds appear? Why can't it be cured? then, let's watch it together.

What kind of wound is a stubborn wound?

Recalcitrant wounds often stall in the inflammatory phase of wound healing. This stage typically presents with increased erythema, pain, edema, and fever in the area due to the hallmark vasodilation and increased capillary permeability of this stage. These features are often mistaken for signs of wound infection, so it is important to look for other key features of non-healing wounds. These signs may include a lack of hypertrophic red granulation tissue, persistent carrion, or a pale or whitish appearance. These wounds are often full-thickness wounds and can lead to a number of complications including chronic pain, increased bleeding or infection changes, reduced mobility (particularly leg ulcers), and psychological problems, and they may have a higher chance of leading to amputation or even death.

However, for some recalcitrant wounds, these basic principles do not seem to work. It may be that the wound is too deep or too wide, or the wound is so infected that new granulation tissue cannot completely cover the wound surface. At this point, the surface of the wound may be covered with an unhealthy layer of tissue, causing pain and discomfort. In addition, intractable wounds may also be caused by severe damage to the tissue surrounding the wound, causing nerve or blood vessel rupture, causing pain and discomfort.

Effects of functional wound dressings on wound healing:

If the dressing does not balance the moisture content of the wound well, the wound may become too wet or dry for healing. Minimize the amount of time the wound is exposed to the air. Doing so will prevent the wound from drying out and hindering healing. If the wound dressing does not adequately absorb exudate, maceration, and breakdown of the peri-wound skin will result from In addition to humidity control, proper dressing can also provide temperature regulation. Exposure of the wound to air causes evaporative cooling of the moisture in the wound and can significantly reduce the temperature of the wound. According to Dr. Stephen Thomas, an ideal dressing should maintain a core wound temperature of 37°C (98.6°F) and relative humidity of 75%. The dressing should also be gentle on the wound bed. If a wound requires debridement, consider dressing types that allow autolysis or enzymatic action, which remove unwanted tissue while maintaining healthy new growth.

Current treatment for stubborn wounds:

For intractable wounds, the current treatment methods mainly include drug therapy, physical therapy, and surgical treatment. Drug treatment mainly includes the use of antibiotics, non-steroidal anti-inflammatory drugs, corticosteroids, and other drugs to reduce pain and inflammation. Physiotherapy, including treatments such as infrared, microwave, and ultraviolet rays, can promote wound healing. Surgical treatment mainly includes surgical methods such as removing the unhealthy tissue and rebuilding nerves or blood vessels to improve wound healing.

Despite what we have learned about the causes and treatments of refractory wounds, there are still many patients who cannot be treated effectively. The causes of intractable wounds can be very complex and may require a detailed examination and evaluation of the patient to determine the best treatment for them. Furthermore, for the treatment of recalcitrant wounds, a systematic approach is required to assess the patient's condition and integrate the treatment into a large medical team in order to provide the patient with the best possible care.