Non healing wounds, chronic wounds, ‘why wounds fail to heal’, wound debridement, slough, foreign body, bone infection, osteomyelitis, Dr Alexander plastic surgeon, cosmetic surgeon, cochin India +

we often come across some wounds that fail to heal. There are number of factors that hamper the normal wound healing process. It is important for us to recognize this so that we can address the problem. 

A large number of patients go around from doctor to doctor with chronic nonhealing wound though their diabetes and other contributing factors are corrected. A look at this wound may show dead and devitalized tissue (slough, necrotic tissue) that releases endotoxins, which hamper the healing process (decreases epithelisation and fibroblast activity). Further a large number of traumatic wounds have some foreign bodies- like sand, dirt, glass pieces and others that get embedded within the wound during the accident. The presence of foreign bodies in the wound has been scientifically shown to increase the incidence of wound infection- which again hampers wound healing as we have already seen. Therefore it is logical that all the dead tissue and foreign bodies must be removed from the wound to help the healing process. Sometimes the cause of a non healing wound is an underlying bony infection (osteomyelitis) or infected fracture site that is constant discharging material (pus, serous fluid) that prevents the overlying wound from healing.

In all these cases the body can do nothing to heal the wound and needs external aid. A surgeon will debride (remove all dead tissue) and clean up the wound using his knife. He will manage the underlying bone problem and treat the bone infection or the dead bone which prevents the wound from healing. If the blood flow to the limb or wound area is decreased or stopped due to diseased blood vessels, one has to evaluate (Doppler study / angiogram- will help to find if the blood vessels are patent and functioning) and repair these blood vessels to increase the blood flow (angioplasty or arterial bypass grafting) thereby removing the blockage and increasing the lumen of blood vessels or replacing the damaged or blocked blood vessels by a new blood vessel from the person’s own body or by using an artificial graft. The same is true for peripheral vascular diseases of the blood vessels that result in the poor blood supply to the wound.

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