A chronic wound is a wound that has not started to heal in two weeks or that has not healed completely in four to six weeks.
Chronic wounds in people with diabetes pose some of the greatest medical challenges. Diabetics often have related conditions such as poor circulation, obesity and kidney disease. Poor circulation means that the body is slower to heal wounds, and an infection that does not heal quickly can lead to gangrene and eventual amputation.
Other conditions make people with diabetes more prone to chronic wounds. Their skin becomes dry and cracked, which opens pathways for infection to enter the body. Circulation is weakest at the extremities, which causes the hands and feet to be most susceptible to infection. Nerve damage, known as diabetic neuropathy, adds to these threats and can lead to a loss of feeling in the feet and the inability to notice a foot wound or infection.
Immune system problems in people with diabetes increase the chances for infection. People with diabetes also tend to develop atherosclerosis, or clogged arteries, at a younger age than other people. This further reduces blood flow to the feet and impairs healing.
A “watch and wait” approach with any type of wound can endanger a patient. This applies especially to people with diabetes. Developing ulcers on the feet can be a life-threatening condition. These ulcers predict nearly a 50 percent mortality rate within five years. This mortality rate compares with that of colon cancer and is more than twice the rate of death from breast cancer and prostate cancer. So, obviously these types of wounds demand serious, prompt attention.
If you have a chronic wound, and especially if you have diabetes and a wound, you need to seek the care of a physician-driven wound care clinic. A wound care center can provide a more cost-effective and healthy environment in which new cells can grow, thereby speeding the healing process.
Specialized approaches to wound care include nutritional counseling, advanced tissue grafting, hyperbaric oxygen therapy, surgical debridement (removal of dead tissue), vascular intervention and limb compression therapy.
A successful wound care team might include specialists in primary care medicine, vascular surgery, podiatry, infectious disease, emergency physicians and plastic surgeons, plus registered nurses and technicians with the training to provide a whole-body approach to healing. The team also needs to maintain communication with the patient’s primary care physician.
Wound care involves vascular assessment to evaluate the blood flow to and from the wound. If needed, a vascular surgeon can improve blood flow to the affected area using grafts and stents to detour around a blockage in circulation.
Northern Nevada Medical Center offers northern Nevada’s first physician-directed wound care clinic. The staff also treats surgical wounds, burns and wounds associated with cancer, delayed radiation injury, trauma, infectious diseases and vasculitis. They follow sophisticated wound care protocols developed by Diversified Clinical Services, the world leader in advanced wound care.
The Diversified guidelines provide a clinical database drawn from care provided in more than 300 wound care centers in the United States. The NNMC Wound Care Center also features two hyperbaric oxygen therapy chambers.
The Wound Care Center at Northern Nevada Medical Center is located at the Vista Medical Terrace at 2345 E. Prater Way. For more information, call 352-5353.
Todd Inman, MD, is the medical director for the Wound Care Center at Northern Nevada Medical Center. Dr. Inman practices in family medicine at the Northern Nevada Medical Group. He earned his medical degree and completed his residency at the University of Nevada School of Medicine in Reno.