Non-Healing Wounds
What is a Non-Healing Wound?
A non-healing problem wound is one that does not follow the normal timeline for wound healing. Typically, if a wound is not closed by around 4 weeks and starting its remodeling process, other factors need to be considered to determine if the wound is a non-healing problem wound. Several factors increase the risk of a wound becoming a non-healing problem wound including poor arterial circulation (blood vessels that supply oxygenated blood), poor venous drainage, excess swelling (‘edema’), excess inflammation, tissue damage, ongoing infection, and others.
What is Normal Wound Healing?
When a tissue is injured, it undergoes normal wound repair which includes four stages:
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Hemostatic: The stage where a fresh wound stops bleeding and clots
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Inflammatory: The stage where specialized cells come in to clean up the wound to reduce infection
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Proliferative: The stage where specialized cells enter and begin building the repaired tissue
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Remodeling: The prolonged stage where fine tuning of the wound repair occurs
Typically, the proliferative stage is completed by 3-4 weeks and the wound is closed and entering its prolonged remodeling phase where it builds additional strength and becomes more like the tissue before the injury.
What are examples of Non-Healing Wounds?
Wounds that don't close and persist beyond a reasonable timeframe can occur in the following types of wounds:
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Diabetic Foot Ulcers
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Peri-Anal Fistulas (patients with inflammatory bowel disease)
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Wounds in people with poor circulation (peripheral vascular disease)
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Wounds in previously damaged tissues from past trauma, infection, burns, or radiation therapy
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Wound resulting from persistent tissue compression (edema, sacral ulcers)
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Others
How are Non-Healing Wounds treated Medically?
Non-healing wounds are typically managed with a multi-specialist team approach of which hyperbaric oxygen therapy is a part of. It is important to treat all reversible causes that may be contributing to the wound. This may include addressing poor circulation with a vascular surgeon, optimizing management of underlying medical conditions like diabetes with an endocrinologist, and utilizing appropriate antibiotics if infection is a factor. Additionally, several preventative approaches need to be in place including appropriate debridement and dressings applications, orthotic use (if applicable), and lifestyle modifications.
How are Non-Healing Wounds treated with Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy works to help heal problem wounds through several mechanisms. It increases the amount of oxygen available at the wound. Oxygen is one of the critical metabolic requirements for the wound healing process to occur and wounds with poor oxygen delivery have a failure of these repair pathways. Additionally, hyperbaric oxygen therapy decreases swelling through the direct action of the increased pressure in the hyperbaric chamber. This improves circulation to the affected wound as swelling restricts blood flow into and out of the wound area. Hyperbaric oxygen therapy also mobilizes progenitor cells (‘stem cells’) through its effect on the hematologic system resulting in an increase in the amount of specialized cells needed at the problem wound to support the healing process. These progenitor cells are critical to a process called angiogenesis (the creation of new blood supplies) which is needed to improve oxygen delivery to the problem wound area long term.