Elements affecting wound healing time: An evidence based analysis

Abstract

The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups--factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.© 2015 by the Wound Healing Society.

Factors associated with complications in total laryngectomy without microvascular reconstruction

“…This is likely due to an increase in serious wound infections, which may in turn increase other major complications given the need for more intensive and prolonged hospital stay . Both chronic steroid use and class III wounds are known to increase postsurgical wound infections and alter surgical healing . Class III contaminated wounds are defined as either a major break in sterile technique, gross spillage from the gastrointestinal tract, or acute nonpurulent inflammation .…”

“…12 Both chronic steroid use and class III wounds are known to increase postsurgical wound infections and alter surgical healing. [13][14][15] Class III contaminated wounds are defined as either a major break in sterile technique, gross spillage from the gastrointestinal tract, or acute nonpurulent inflammation. 16 In the context of total laryngectomy, which is defined as a clean-contaminated surgery, we speculate that class III wounds are likely secondary to acute inflammation.…”

“…The finding of increased age as a risk factor for complications is concordant with the head and neck literature, as older patients have higher risk of postdischarge complications, longer wound healing times, higher hospital costs, and are more likely to be admitted to the intensive care unit. 15,17,18 However, the relatively low odds ratio of 1.24 for overall complications and the lack of association with major complications suggests that patient age does not confer an overwhelming risk to older patients when controlling for other factors. Given this, age alone should not preclude oncologic resection.…”

The contribution of interleukin-2 to effective wound healing

“…2,12 Wound infections, which occur following roughly 0.3% of surgeries and can also complicate non-surgical injuries, also delay wound healing. 2,13,14 Wounds can reopen following a surgical closure, a process called dehiscence, which often occurs due to an infection of the wound. Thus, a myriad of factors including infection, debris at the wound site, and patient comorbidities, can lead to a delay in wound healing.…”

“…The occurrence of chronic wounds, which affected upwards of 6.5 million Americans as of 2009, is increasing in the United States due to the increasing age of the population and prevalence of comorbidities. [1][2][3] Recent reports concerning commercial opportunities in medicine indicate that spending on chronic wound care exceeds a billion dollars annually. On the other end of the spectrum, scar formation due to excess extracellular matrix (ECM) deposition and overzealous cell proliferation is also undesirable.…”