Poorly Healing Wounds

Poorly Healing Wounds
Poorly Healing Wounds

The human body has amazing healing capabilities. Skin, organ tissue, bone – our cells are able to repair themselves and regenerate in many cases. The process is not perfect, of course. Scar tissue often remains behind and is thicker, less sensitive, and may even be painful. Broken bones may knit back together improperly, or the break and subsequent healing may leave the bone weaker. However, in some cases, wounds may heal poorly or not at all.

What Are Poorly Healing Wounds?

Poorly healing wounds are exactly what they sound like – wounds that take an abnormally long time to close and begin healing, or do not heal at all, at least in portion. In some cases, those wounds may begin to fester, rather than healing, leading to infection and complications. Dubbed “chronic” wounds, these can lead to a wide range of problems that affect your life.

Why Are Some Wounds Slow to Heal?

Wound healing is directly related to multiple factors. One of those is age – the older you are, the slower wounds are to heal. However, healing is also dependent on the number of growth factors in the area, as well as the level of stem cells at the wound site. As we age, growth factors and stem cells naturally decrease in concentration. In addition, stem cells that remain are often less capable of healing due to accumulated mutations and damage over time.

What Causes Would to Heal Slowly or Incompletely?

Wounds that heal poorly, continually reopen, or fail to heal at all can be caused by any number of factors, with age being one of those. However, there are others that may play a role depending on your situation. Some of the most common factors that may make a wound slow to heal, or prevent healing in the first place, include the following:

  • Diabetes - If you have diabetes, your wounds will naturally be slower to heal, particularly wounds to the legs and feet. This is due to several factors, including reduced blood flow. Reduced sensation, makes it harder to notice wounds and then provide proper care. Additionally, inflammation-related cells fail to work properly, allowing small wounds to grow quickly without inflammation to withstand erosion.
  • Venous Insufficiency - Older adults, in particular, are at risk for venous insufficiency, which means that blood pools in the legs and feet. This can also lead to skin ulcers as the blood can leak out from veins and into the surrounding tissues, breaking down the skin and forming wounds that are slow to heal.
  • Immune System Problems - If you have a compromised immune system, wounds may be slow to heal or may not heal completely. This is common for patients undergoing chemotherapy for cancer, but it is also seen in other patients with weakened immune systems, as well.
  • Pressure on the Skin - Pressure on your skin can create wounds. Bedsores are a good example of this. However, long-term pressure from any position on any part of the body can create these wounds, and so long as the pressure remains, they will be very slow to heal, if healing occurs at all. In some cases, pressure-related wounds can go all the way to the bone, in which case they will not heal on their own and will require surgical intervention.

How Are Poorly Healing Wounds Treated?

Treating chronic wounds requires specific steps, although the exact steps will vary depending on the severity of the wound, the wound’s location, and other factors. Some of the most common steps to treating poorly healing wounds include the following:

  • Cleaning - Slow to heal or non-healing wounds must be cleaned to remove debris and infection. A saline or electrolyte solution is generally used for this, and then debridement occurs to remove dead tissue, allowing new tissue to grow.
  • Dressings - Slow and no-healing wounds must have their dressings frequently changed, particularly after cleaning. In some cases, special dressings will be used, such as hydrogels and films.
  • Skin Grafts - In some situations, particularly severe burns, skin grafts may be necessary to encourage the wound to heal.
  • Other Treatments:
    • Hyperbaric oxygen therapy
    • Electromagnetic therapy
    • Ultrasound therapy
    • Vacuum-assisted closure

Who Is Most At Risk for Developing Poorly Healing Wounds?

Those most at risk for poorly healing wounds are the elderly, diabetics, and patients with compromised immune systems. Patients with poor circulation, those who are bedbound, and others will also see an increased risk for poorly healing wounds.

What Role Might Stem Cells Play in Treating Poorly Healing Wounds?

Stem cells are the foundation of the body’s regenerative system. As mentioned, one reason that wounds are slow to heal, or fail to heal entirely, is due to a reduced concentration of stem cells in the area. Stem cell therapy introduces new cells to the body, boosting the concentration of stem cells in all tissue types, thereby improving the body’s ability to heal itself, even from severe wounds and at advanced ages.

In a study published in 2019, the authors note that

Stem cell therapy has emerged as a promising treatment modality, with the potential to restore tissue to its pre-injured state. Of particular interest are mesenchymal stromal cells, which have been shown to accelerate wound healing by modulating the immune response and promoting angiogenesis.

The treatment is usually provided by injecting stem cells right inside the wounds or applying a film (including amniotic membrane) seeded with stem cells over the wound.

The latter treatment is more and more accepted by medical community and is frequently covered by insurance.

Understanding Stem Cell Types

Patients should understand the difference between autologous stem cells and allogeneic stem cells. Autologous cells are sourced from the patient’s own body, which means they have low healing capabilities due to age and accumulated mutations and damage. Allogeneic stem cells are sourced from umbilical cord blood and are young, energetic, and capable of maximum healing.

Conclusion

Today, the FDA has yet to approve any stem cell therapy in the US. Any such treatment should be viewed as experimental only. In addition, patients should seek to work with a physician experienced in using allogeneic stem cells in order to ensure the best possible results from the treatment.

Source:

https://www.ncbi.nlm.nih.gov/pubmed/30900481
https://wexnermedical.osu.edu/blog/six-signs-your-wound-is-not-healing-right
https://www.facs.org/-/media/files/education/core-curriculum/nonhealing_wounds.ashx
https://www.health.harvard.edu/diseases-and-conditions/why-wound-healing-gets-harder-as-we-age
https://www.ncbi.nlm.nih.gov/books/NBK326431/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/

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