Wound Healing

Most cuts or wounds heal in a few days or weeks. A chronic wound is one that has not healed in four weeks. People with wounds that do not heal usually have one or more underlying conditions. The most common of these are peripheral arterial disease, chronic venous insufficiency, diabetes with or without neuropathy or people with abnormal pressure areas who are very immobile. Poor nutrition and some medications (steroids, some immunity suppressing drugs, etc) can also play a significant part in slowing the healing process.


A patient is initially evaluated with a full medical history and physical examination. Particular attention is paid to factors that can predict why the wound is not healing. Some that are important, include assessment of risk factors for arterial disease (smoking, high cholesterol, high blood pressure, diabetes, lack of exercise) and venous disease (varicose veins , previous blood clot, leg swelling, prolonged standing, leg skin color changes); assessment of type, duration and severity of diabetes and mobility. Nutritional status is evaluated. The patient’s pulses as well as assessment for leg swelling and circulation in the feet are evaluated. Abnormal leg color, swelling or varicose veins are also evaluated. Abnormal sensation called neuropathy; prominent bony areas and immobility are assessed. The wound and surrounding skin are examined in detail; the wound is measured and photographed (this allows me to monitor progress at future visits).


A plan of care is then determined based on these findings.   Wounds require a moist environment in which to heal. The underlying risk factors if severe should also be treated. A range of products is available to heal wounds depending on the location of the wound, the amount of drainage and the presence or not of underlying conditions and/or infection. Surgery is rarely required; if it is deemed necessary a small procedure is usually sufficient.


Below are some examples of different types of wounds as well as before and after pictures. Some of the pictures are graphic.