Chronic Wound

Pressure sores

The condition where the blood circulation was comprised by prolonged local pressure to the local tissue resulting in pathological changes in the skin, which might even spread to the subcutaneous tissue, muscles and bones, is referred to as pressure sores. This is a common medical condition for patients with long-term immobility [including patients with spinal injury], those requiring chronic bed-rest and those unconscious, incontinence, diabetic or with fragile skin, fatigue or malnutrition problems. Pressure sores will turn non-pale redness from redness and then to dark bruising and eventually tissue necrosis.

 

Diabetic wounds & diabetes mellitus

Long-term diabetic patients often suffer from vasculopathy and peripheral neuropathy. In addition, diabetic patients are susceptible to metabolic abnormalities and insufficient collagen production. With their hyperglycemic condition, collagen is combined with blood sugar and denatures. As collagen plays an important role in wound healing, denatured collagen will make wound healing difficult and lead to chronic ulceration. The causes of diabetic foot include neuropathy, occlusive vasculopathy and bacterial infection, which are one of the common chronic complications observed in diabetic patients. Loss of feeling at the toes tends to result in unconscious bleeding from injuries. Other than damages to the sensory nerves, both motor and autonomic nerves are also damaged, resulting in deformation of toes and arches of the foot, loss of perspiration function and dry and cracked skin, causing the feet more vulnerable to injuries.

Vasculopathy will cause chronic atherosclerosis which blocks the distal vessels and results in ischemia in the feet, compromising the wound healing result. In addition, the blood glucose level is higher in diabetic patients. Collagen in the capillary walls at the end of the extremities will bind with glucose, forming denatured collagen. The blood vessels will resultantly loss elasticity, which leads to decreased micro circulation and incomplete elimination of metabolic wastes at the end of the extremities, increasing the risk of tissue necrosis.

Long-term diabetic patients often suffer from vasculopathy and peripheral neuropathy. In addition, diabetic patients are susceptible to metabolic abnormalities and insufficient collagen production. With their hyperglycemic condition, collagen is combined with blood sugar and denatures. As collagen plays an important role in wound healing, denatured collagen will make wound healing difficult and lead to chronic ulceration. The causes of diabetic foot include neuropathy, occlusive vasculopathy and bacterial infection, which are one of the common chronic complications observed in diabetic patients. Loss of feeling at the toes tends to result in unconscious bleeding from injuries. Other than damages to the sensory nerves, both motor and autonomic nerves are also damaged, resulting in deformation of toes and arches of the foot, loss of perspiration function and dry and cracked skin, causing the feet more vulnerable to injuries.

Venous ulcer wounds in the lower extremities

Stasis dermatitis is a common manifestation of lower-extremity ulcers commonly seen in middle-aged and elderly patients with a history of prior surgery or insufficient venous function due to venous thrombosis. During the early stage, swelling and hardening can be observed in the calves which deteriorate into pigmentation, itchiness, erythema and desquamation and eczema-like changes, dilated capillaries and varicose vein. The damaged venous valves unable to close effectively will result in blood reflux due to gravity when a person stands. Veins in the lower extremities will sustain extreme pressure and thus develop chronic inflammation. This will damage the venous wall and cause blood pooling in the surrounding skin tissues. The poor reflux will lead to chronic inflammation. As inflammatory factors will diffuse into tissues surrounding the blood vessel, it will continually worsen the inflammation and damage the tissues. It is likely to cause ulcerations that may never heal.

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