Wound healing is a complex process that uses specific cellular and biochemical actions to achieve wound closure. These processes (homeostasis, inflammation, proliferation, and maturation) occur over defined periods of time. They are often taken for granted as the wound innately granulates, contracts, and epithelializes under optimal conditions.
A wound begs the clinician’s attention when the healing processes stall and the wound does not progress to closure. This type of wound is deemed chronic; it is defined as an insult or injury that has failed to proceed through an orderly and timely process to produce anatomic and functional integrity or that has proceeded through the repair process without establishing a sustained anatomic and functional result.
Despite advances in wound care over the last few decades, many chronic wounds continue to be affected by local and systemic factors that impair the healing process. Local factors include bacterial load and infection, trauma, edema, pressure, and moisture. Systemic factors include age; chronic medical conditions, such as anemia, diabetes mellitus, and renal or hepatic dysfunction; stress; medications; tissue oxygenation; and nutrition status, such as vitamin, protein, or fluid deficiencies.
Clinicians commonly evaluate and manage the typical chronic wounds, such as pressure, vascular, and diabetic ulcers. However, many unusual wounds mimic these common chronic wounds. Because these unusual wounds are often incorrectly assessed, they can be easily misdiagnosed. Examples include pyoderma gangrenosum, calciphylaxis, toxic epidermal necrolysis, epidermolysis bullosa, polyarteritis nodosa, antiphospholipid antibody syndrome, cryoglobulinemia, cholesterol emboli, disseminated intravascular coagulation/purpura fulminans, bullous pemphigoid, and necrotizing fasciitis.
Misdiagnosis of a wound prolongs the patient’s suffering by delaying healing; increasing the emotional and financial toll on the patient, caregiver, and facility; and increasing medical liability. It also leads to improper medication delivery and topical treatments, which can further exacerbate the patient’s condition, mask symptoms, prolong accurate diagnosis, and increase morbidity or mortality.
Read previous articles in “Advances in Skin & Wound Care” by Cathy Thomas Hess in the link.
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Cathy is Chief Clinical Officer for WoundExpert® and Vice President at Net Health, and in addition to being the MIPS Clinical Consultant for WoundExpert. She gained over 30 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. Cathy is the author of Clinical Guide to Skin and Wound Care (also translated into Italian and Portuguese) – Eighth Edition published in September of 2018.