non healing wounds, chronic wounds, heart failure, kidney failure, varicose veins, wounds, injuries, accidents, ulcers, Dr Alexander, plastic surgeon, cosmetic surgeon, cochin, India+

We often feel that wounds are a surgeon’s domain. This is true to a great extent but in a number of patients there are a lot of general conditions and diseases of the body that affect the wound healing locally. In many patients the local factors in and around the wound appear not to be the cause of poor wound healing. These patients fail to realize that cause of their poor wound healing lie elsewhere. In patients with cardiac failure the heart is unable to pump the blood efficiently. The blood flow to the wound is poor and oxygen delivery to the tissue is decreased both of which impairs wound healing. Further since the heart pump is ineffective, the back pressure (increased pressure in veins) cause more swelling (edema) of the tissues (and wound area). Tissue edema can also result in patients with renal failure where the kidneys fail to excrete the body wastes and urine.
 This swelling or edema is bad because
 a) It prevents good oxygenation of wound.
 b) It prevents the smooth flow of ‘worker cells’, ‘specialist cells’, growth factors and other repair materials into the wound area.
A physician, cardiologist or a nephrologist will need to assess and help to correct these problems.
 The same mechanism is true for patients with varicose veins.  One of my patients, a healthy gentleman of 35 years, was going around with an accidental injury and wound on his leg for months. He had been on treatment for his diabetes (mild), and then treated with antibiotics, thinking it was infection till we evaluated his leg veins and found that he had underlying varicose veins without any apparent complaints, which was preventing the wound from healing. As the back pressure increases in the blood vessels some of the constituents of blood that normally does not pass through the wall (off capillaries) now filter out by pressure. This build up of fibrin, haemosiderin and fluid in the tissues cause firm swelling of the limb (induration) that is typically seen in blood outflow disorders (venous insufficiency).