What are the factors contributing to delayed wound healing?

Local Factors Contributing to Delayed Wound Healing

Local factors, inherent to the wound condition, contributing to delayed wound healing are as follows:

  1. Excessive edema involving the wound site: Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Excessive edema with fluid accumulation involving the wound site can increase the local pressure at the wound site. This increased local pressure can disrupt the healthy blood flow to the wound site. Compromised blood flow to the wound site can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
  2. Wound contamination with excreta: Contamination of wounds, especially pressure ulcers on the hips in bedbound patients, with urine and stool can lead to recurrent infections and contribute to poor healing. Continuous exposure of skin to body excreta in bedbound & incontinent individuals can result in further maceration of skin surrounding the wound. This can result in enhanced compromise to the skin integrity, increase in the wound size, and poor healing.
  3. Presence of necrotic tissue in the wound: Necrotic tissue in the wound can present itself as slough or eschar. Slough is the yellowish white moist tissue often found in the wound, adhered to the wound bed as a thin coating or in patchy distribution. Eschar is often black in color, dry in appearance and found adhered to the wound bed. Both slough and eschar are dead tissue cells and increasing deposition of dead tissue inside a healing wound can slow down the progress on healing front. Periodical debridement of the wound to remove the deposited necrotic tissue from the wound surface can help faster healing.
  4. Increased pressure at the wound site: Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Undue amount of pressure involving tissue at the wound site, such as, in individuals with foot ulcers wearing tight compression stockings, in individuals with torso wounds wearing tight corsets, and in bedbound individuals with pressure ulcers on dependent body parts can result in disrupted blood flow to the wound site. Disrupted blood flow to the wound site can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
  5. Infection in the wound site: Presence of infection in any wound site as evidenced by local elevation of temperature, unresolving erythema of the wound site, foul smelling drainage, undue swelling of the wound site can contribute to poor healing of the wound and result in further complications. Obtaining a culture of the wound site can help identify the infecting bacteria and start the patient on appropriate antibiotics that the bacteria are sensitive to. Timely diagnosis of the infection with appropriate management measures can promote healing of the wound.
  6. Dry environment inside the wound: Excessive dry environment inside the wound can typically dehydrate the cells and result in increasing cell death, which can slow down healing. The dry environment also promotes formation of scab, which can further slowdown the wound healing. Maintaining the right amount of moisture inside the wound can promote comfort and pace up the wound healing. Choosing appropriate wound dressing materials that can retain a healthy moisture inside the wound proper can assist with healing. Encouraging the individual to keep up with the fluid intake recommendations can contribute to improved healing.

 

Systemic Factors Contributing to Delayed Wound Healing

Overall systemic factors contributing to delayed wound healing are as follows:

  1. Poor nutritional status: Adequate nutrition intake, especially protein intake, is needed for timely wound healing. Protein is essential for development of granulation tissue, resulting in quickening of the healing process. Individuals with history of malnutrition can present with poor protein intake, which can compromise growth of granulation tissue, thus contributing to delayed wound healing.
  2. Poor hydration status: Proper hydration status is very important to promote wound healing. Some individuals, especially senior citizens, could be poorly sensitive to thirst sensation and thereby, can be often noncompliant with daily fluid intake recommendations. Individuals with debilitating illnesses, such as, congestive heart failure or dialysis dependency, could be recommended limitation on daily fluid intake, and thus are limited on this front. So, all these individuals, irrespective to the reason for poor fluid intake, can present with compromised hydration status, resulting in delayed wound healing.
  3. Chronic anemia: Red blood cells have iron containing pigment heme that binds to the oxygen, transports, and helps deliver oxygen to all the body tissues. Optimum functioning red blood cell count is needed for the required oxygen binding and transport to the body tissues. Oxygen and nutrients carried in the blood are highly essential elements for wound healing. Wound tissues always have an increased demand for these elements to help healing. Individuals with poorly treated or untreated chronic anemia have a low red blood cell count, which results in reduced oxygen supply to all the tissues. Compromised oxygen supply to wound tissues thus result in delayed wound healing.
  4. Immunosuppression: Individuals with serious debilitating illnesses, such as, cancer or chronic kidney disease, can present with compromised immune status. Also, individuals with chronic inflammation of tissues could be prescribed high dose of steroids to control the inflammation and steroids carry the side-effect of compromising immunity. Individuals with compromised immune status inherently have reduced ability to fight against infections and thus are more prone for the same. Thus, wounds in immunocompromised individuals can have a hard time healing and get delayed on the healing front. Co-existing factors, such as, smoking and diabetes in these individuals can contribute to furthering the delay.
  5. Chronic smoking history: Individuals with chronic smoking history can be at increased risk for disrupted peripheral circulation and thereby develop peripheral artery disease in the extremities. Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Compromised blood flow in the extremities of individuals with PAD can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
  6. Poorly managed cardiac conditions: Poorly managed cardiac conditions, such as, coronary artery disease (CAD) and congestive heart failure (CHF) contribute significantly to poor wound healing. Individuals with poorly controlled coronary artery disease and heart failure can present with progressively reduced heart function and consequently, result in reduced volume of blood pumped out of the heart into the circulation. Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Compromised blood flow in the extremities of individuals with poorly managed chronic health conditions, such as, CHF & CAD can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
  7. Poorly managed diabetes: Individuals with poorly controlled diabetes mellitus can present with high blood sugar numbers, which can result in inflammation of smaller blood vessels, especially in the distal extremities. Progressive unresolved inflammation of the smaller blood vessels leads to them becoming swollen and thick, which reduces the caliber or lumen of blood vessels. This results in reduced capacity to accommodate blood flow, thus contributing to reduced blood flow. Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Compromised blood flow in the extremities of individuals with poorly managed diabetes can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.