Good health: Chronic wounds affect 1 in 4 family members

We all get cuts and scrapes, but for many people these injuries may not heal. And the longer the wound remains open, the higher the risk of infection. More than eight million people in the US suffer from chronic wounds each year, which cost $98 billion a year to treat.

In Bloomington-Normal, between 300 and 500 people each month are treated for sores that won’t go away. Dr. Caroline Halperin, medical director of the Center for Wound Healing and Hyperbaric Medicine at Carl Bromen Medical Center, said one in four families in the nation has a member with a chronic wound, noting that there has been a sharp increase in amputations statewide.

She said that the skin is the largest organ in the body and when you have a chronic wound, it is a sign of low life expectancy.

“The problem is growing because of our aging population as well as our patient population with diabetes,” Halperin said in the new episode of Sound Ideas. “About 2% of our population continues to have sores. There are several different types of wounds. The most common are diabetic ulcers, but there are also venous ulcers, pressure ulcers, lymphedema and surgical wounds.

“We treat radiation wounds, but the diabetic ulcer is the most common; 85% of our diabetic patients who underwent amputation were preceded by an ulcer. And the five-year mortality rate in a diabetic patient who undergoes an amputation is as high as 50%.”

She said it can be very difficult for patients who come in because they have had wounds for a year.

Diabetic ulcers and pressure sores from immobility, known as bedsores, are more common. Venous ulcers can be quite painful. When you have a problem with the venous return of blood to the body, you get swelling, which causes the skin to stretch and, as a result, less perfusion to the skin, which leads to an ulcer. Arterial ulcers are associated with reduced blood flow, usually to the legs, also because you have poor oxygen perfusion to the tissue. Tissue is a living organ and needs oxygenation to live, Halperin said.

Elderly people, people with diabetes, smokers and people with poor nutrition are more likely to have an ulcer.

Halperin said it is possible to prevent some wounds.

“If you’re diabetic, the best thing to do is control your blood sugar (and) make sure you’re eating right. The other thing is if you have venous congestion, using compression helps reduce swelling. If you have vascular disorders or poor blood flow, treat that,” Halperin said.

The Wound Center at Carle BroMenn treats ulcers in several ways: debridement, or cleaning out dead tissue and bacterial pads that can keep the wound inflamed even if they don’t cause infection, specialized dressings, bioengineered skin, and hyperbaric oxygen.

“Most patients who come to us are stuck in the inflammatory phase of wound healing,” Halperin said. “There are four phases. There is hemostasis, inflammation, proliferation and remodeling. These are all normal phases of wound healing, but what happens is when you get stuck in the inflammatory phase, which is kind of like the cleansing phase, trying to remove cells, killing bacteria, our bodies recruit these cells to to help with the injury. And when you do that, some patients can’t get past that inflammatory phase.”

If the patient has good blood flow, the center cleans away the dead tissue and makes sure there is no infection. Usually at this point they use a special dressing, maybe collagen.

“We need to continue to help with the biofilm, where the bacteria is sitting on top of the wound, causing inflammation but not infecting the wound. After about four weeks, most of the time, we can use bioengineered skin. The ones we use here range from xenografts, which come from animal tissue, to allografts, which are human tissue,” Halperin said.

Also in the toolbox of the Wound Care Center is hyperbaric oxygen therapy. Patients sit in a closed chamber exposed to an atmosphere of 100% oxygen. Normal air is about 21% oxygen. Oxygen is also at 2 to 2.5 times normal atmospheric pressure. The procedures take one to two hours, and the course of treatment is daily for about a week.

“It increases the plasma oxygen level, which leads to angiogenesis, which is the production of new blood cells. It helps with tissue repair and cell death and helps with infections,” Halperin said, adding that the center’s cure rate is 93 percent to 95 percent.

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