The New Times (Kigali)

Rwanda: Reasons Why Wound Healing Can Delay

Normally wound healing is a normal biological process in the human body and is achieved through homeostasis, inflammation, proliferation, and remodeling. For a wound to heal properly, all four phases must occur in the proper sequence and time frame.

Now there are factors that can interfere with one or more phases of wound healing and this leads to improper or impaired wound healing.

One of the most common factors that affect wound healing is poor circulation. Delayed wound healing and tissue breakdown is frequently associated with poor circulation. This can be caused by local pressure, vascular disease or diabetes disease.

For example in cases where diabetes affects the peripheral circulation, skin layers such as the epidermis and dermis become compromised and therefore prone to injuries and persistent infections.

Diabetic ulcers usually develop following simple abrasions, contusions and lacerations. Normally diabetic ulcers are difficult to treat.

Poor nutrition or malnutrition has a significant impact on wound healing. Lack of protein will result in insufficient building blocks for cell regeneration. Vitamin C is essential for collagen synthesis and its deficiency can result in delayed wound healing.

Delayed wound healing can also be caused by local or systemic infection that inhibits the healing mechanism. People who are carrying chronic infections or disease tend to take longer time to recover from injuries than those who have good health conditions.

This is because resistance to infection is related to the physiological ability and the patient's physical health. For diabetic patients, anaerobic bacteria such as the bactericides, clostridium and streptococcus can become active and infect deeper levels of the dermis that is insulated from the healing influence of oxygen.

Most aerobic bacteria such as the staphylococcus and corynebacteria are closely associated with the infection of the superficial epidermis layer of the skin and are involved in infective processes.

Most of these bacteria discharge toxins that are potent inhibitors of the healing process. However some bacteria have more devastating effects than others.

Another important factor to mention is the psychological condition involved. Some people with persistent stress and anxiety tend to have increased hormonal levels especially glucocorticoids that may suppress the inflammatory phase and affect healing in both acute and chronic wound infection. Some scientific studies have shown quick recovery from postoperative wound infection on reduced stress or anxiety.

Environment at which the wound is exposed also contribute to its degree of healing. A moist environment has been found to have a positive healing progress on most surgical wounds. This is because without moist condition epithelial cells will migrate over living tissue and this process can be delayed by dehydration.

Sometimes a wound surface that has been exposed to air for a long period suffers cellular dehydration, tissue necrosis or death and this results in increase of wound depth. However when a wound has to be exposed for examination by health care providers, cling film can be used to prevent dehydration and help protect and maintain temperature. Most modern dressings have been designed to allow the required moist environment for healing.

The use of most appropriate dressing will maintain a moist environment at the wound surface without causing maceration of the surrounding skin. It is important to understand that the wound exudate that forms under occlusive dressings is highly bactericidal and this prevents infection but in some wounds can be detrimental to healing.

Poor surgical technical procedures such as over use of diathermy or poor choice of suturing material are among factors that can delay wound healing of a surgical wound.

Poor assessment or some wound care practices such as inappropriate choice of wound dressing, use of fiber shedding materials like cotton wool or gauze swabs, tight bandaging can all lead to deterioration of the wound condition.

Older people have been found to have decreased wound healing capacity as compared to young people. This is because the physiological changes that occur with aging normally place the older people at higher risk of poor wound healing.

Reduced skin elasticity and collagen replacement in elderly people influence reduced wound healing. The immune system also declines with age, making older patients more susceptible to infection. Older people can also present with other chronic diseases that affect their circulation and oxygenation at the wound bed.

Some medications such as cytotoxic drugs, immunosuppressive drugs, and anticoagulant drugs all reduce healing rates by interrupting cell division or the clotting process.

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