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Clearing up common misconceptions about wound healing

Patient and health care provider

People living with heart disease, diabetes or other health issues can be at risk for ulcers, often hard to heal lesions that can be painful and increase the risk of infection and amputation. At the latest Speaker Series event, An Evening Discussion on the Heart, Dr. Ahmed Kayssi, a vascular surgeon with the Schulich Heart Program, cleared up some common misconceptions about wound healing.

It’s a simple question, but generally, how do wounds heal?

There are four stages to wound healing, which include:

  1. Hemostasis: When the skin is cut, or the integrity of the skin is disrupted, you likely bleed. Hemostasis causes a blood clot to form and stop this bleeding.
  2. Inflammation: This is the red hot, painful stage where the body is reacting to the wound. There can be swelling at the site of the wound, and it’s tender to the touch. I treat a lot of patients who are stuck at this stage.
  3. Proliferation: This stage happens when the body is actively repairing the wound and replacing it with other products, a process that can take several weeks.
  4. Remodeling: This refers to your body forming a scar, a process that can take up to two years. Keep in mind that even with optimal healing, the damaged skin will never be as strong as it was before the wound happened.

Should you expose ulcers exposed to air?

No! The most important thing to keep in mind when healing an ulcer wound is maintaining proper moisture balance. If you are drying a wound out by exposing it to air, or putting iodine or other substances on it, you are essentially forming a scab. And just because you scab over a wound doesn’t mean you’ve healed it. Scabs actually get in the way of your skin bridging over a wound and forming a new cover.

Here is the take away: just because your wound is dried out doesn’t mean you’ve healed it. In fact, the ulcer might sometimes still be there underneath the scab. This is a really important concept for people to understand.

So moisture is key?

Moist wound healing is by far the better approach, and something you should talk to your doctor about. Generally, to heal an ulcer properly, it needs the proper balance of moisture and oxygen, meaning it needs to have the right blood supply. To check for that, your doctor may arrange for you to have an ultrasound or other tests.

If your blood supply is the problem, there are some surgical solutions. With angioplasty, we can open up the blood vessel in the leg with a tiny balloon to improve blood flow.  Bypass is another option, where we create an alternate route for the blood to flow by implanting a vein or a prosthetic graft around the blocked blood vessel.

How quickly should wounds heal?

Most wounds should reduce in size by 40% or more after four weeks of a given therapy. If a wound is older than three months, or not responding to wound care after four weeks of therapy, a biopsy should be considered. And if a wound bed is worsening despite treatment, or is excessively painful, it could be infected. Make sure you talk to your health care team to determine the best treatment path for you.

Any other things to consider?

Think about the big picture, your overall health. By the time you have a wound, there are other health issues that got you there. So if you are diabetic, you need to optimize your blood sugars. Also, have your feet inspected regularly by a specialist.

Moisturizing your skin daily is also important. A very effective and affordable option is petroleum jelly. It doesn’t cost a lot and works wonders!

If you are on your feet a lot, wear compression socks. They are available in stores, and can also be prescribed by your doctor. Also, wear the proper footwear. Certain manufacturers make shoes that are specifically made to cater to those at high risk for ulcers.

Watch the whole Speaker Series event:

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About the author

Dr. Ahmed Kayssi