The food you eat plays an important role in how your body functions on a daily basis. However, many people don't consider how the food they eat affects their body's wound healing process. Eating balanced healing foods can help your body heal faster and more efficiently.
Which food necessities are good for wound healing?
A healthy diet is an essential part of healing wounds and maintaining overall health and well-being. This means you should eat a balanced diet and include all dietary essentials, especially:

• Protein;
• Micronutrients (vitamins and minerals);
• Healthy fats;
• Carbohydrates .

The role of proteins in wound healing

Protein is arguably one of the most important aspects of any diet, as it is used for nearly every function of your body. In wound healing, proteins are used to repair tissue, help transport oxygen throughout the body and help fight infection.
Therapeutic Foods Containing Protein
Many foods are good sources of protein that can aid in healing. These include:

• 3 ounces chicken breast = 21 grams of protein
• 8 ounces of yogurt = 11 grams of protein
• 1 cup of milk = 8 grams of protein
• 1 cup of dry beans = 16 grams of protein

Protein needed for wound healing

The amount of protein needed per day depends on the individual, but in general, the average inactive man needs 56 grams per day. Inactive women need to eat an average of 46 grams of protein per day. People with wounds and other medical conditions need to eat more protein each day to help wounds heal. You may consider seeing a wound care professional to help determine the optimal amount you need to heal.

Amino Acids and Wound Healing

Amino acids help build proteins and are used in every cell of our body. Many amino acids play a role in building and repairing tissue, which is important for wound healing.

Therapeutic Foods Containing Amino Acids

Arginine is an amino acid that helps increase blood flow and oxygen to wounds. This increases collagen formation and reduces inflammation. Foods high in arginine include pumpkin seeds, milk, yogurt, and cheese.
Another important amino acid in therapy is glutamine, which stimulates collagen production, regulates nitrogen metabolism, and supports the immune system. Healing foods high in glutamine include chicken, fish, cabbage, spinach, dairy, tofu, lentils, and beans.
Wound care clinics can prescribe wound care supplements that contain these amino acids to ensure you are getting enough.

Micronutrients and Wound Healing

Micronutrients required for a healthy diet include vitamins and minerals. While your body needs a variety of micronutrients, research shows that zinc and vitamins A and C are essential for wound healing. Each of these micronutrients is essential to the body's innate healing process, and when you're not getting enough, you may notice that you start to feel more tired than usual. They also aid in the body's inflammatory response and help produce collagen.
Other notable micronutrients important for wound healing include magnesium, iron, copper, vitamin E and B vitamins.

Therapeutic Foods Containing Micronutrients

While it's best to eat a variety of foods to ensure you're getting all the nutrients your wound needs to heal, some good options include:

• Foods rich in minerals: oysters, spinach, nuts such as cashews, beans such as peanuts, dairy products, black and lentils, bananas, and fish.
• Foods rich in vitamins: citrus fruits, bell peppers, whole grains, eggs, dark leafy greens, fish, lean meats, leafy greens, soybeans, almonds, sweet potatoes, and milk.

Carbohydrates and Wound Healing

When some people hear the word "carbs," they automatically think of how carbohydrates are broken down into sugars, such as glucose. However, this glucose comes into play when part of a healthy, balanced diet. Glucose is converted to adenosine triphosphate (ATP), a form of cellular energy used in the healing process.

Fat is also important for wound healing

Healthy fats such as fatty acids, lipids, phospholipids, linoleic acid, and arachidonic acid play an important role in maintaining the body and promoting normal wound healing. Research shows that these healthy fats are essential for tissue regeneration and cell metabolism, and contribute to inflammation.

Healing Foods Containing Healthy Fats

Fatty foods that help wounds heal include oily fish, avocados, nuts, seeds, and eggs.

What if healing foods are not enough to heal wounds?

When it comes to nutrition, it's important to understand that everything you eat affects your body and how it functions. Eating a balanced diet ensures that your body is functioning properly and is constantly creating the necessary cells to help carry oxygen throughout the body. If you need help with a balanced diet, especially with wound healing, you may want to consult a registered dietitian or dietitian.
Unfortunately, sometimes individuals must undergo severe dietary restrictions,  which can significantly impact their ability to heal wounds. Underlying health conditions, such as diabetes, can also affect the body's ability to heal. If this is your case, you can seek out a wound clinic to help you plan your recovery.

Hyperbaric wound care and healing foods can help heal wounds

Some people may have trouble balancing essential nutrients to help get oxygen where it's needed. Hyperbaric Wound Care Therapy  delivers oxygen to the body through inhalation and absorption. This ensures your body gets the oxygen it needs to help improve your body's ability to heal wounds. When used in conjunction with a nutritional plan, they can ensure you receive optimal health benefits and help your body heal.

 

Mouth ulcers, also known as oral ulcers, aphthous ulcers, or canker sores, are breaks in the tissue lining of your mouth, often along the base of the gums or inside the cheeks or lips, but can form in the floor of the mouth or on the tongue. (Very rarely a mouth ulcer may be the early sign of a cancer.)
They can be painful, annoying, and sometimes embarrassing, interfering with eating, drinking, brushing, and even talking. They are also very common. The pain from a mouth ulcer is caused because the nerves just below the surface of the lining of the mouth become exposed. Luckily most mouth ulcers are easy to treat.
Mouth ulcers are usually temporary, healing on their own within one to two weeks, and harmless (except for pain and inconvenience). If you get mouth ulcers that last longer than three weeks, or they recur regularly, you should seek medical attention as it may be a sign of a more serious problem.

Causes

The exact cause of oral ulcers is not known, but there are several factors that are suspected of contributing to their appearance.²

• Trauma or tissue damage:Damage to the mouth lining is common. Damage from vigorous brushing, orthodontic braces, ill-fitting dentures or biting the inside of your mouth can cause a mouth ulcer to form.
• Infections:Bacterial, viral or fungal infections may cause mouth ulcers.
• Stress-related mouth ulcers, aphthous ulcers:Most common in teens, stress-related mouth ulcers will heal within a couple of weeks. Prevention is by resolving stress-related problems or using stress-busting relaxation strategies. Hormonal changes and allergic reactions may also cause mouth ulcers.
• Foods and drinks:Mouth ulcers may be triggered by acids in certain foods, including oranges, lemons, pineapples, strawberries, tomatoes, and others.
• Toothpaste or oral rinses:Pastes or rinses that contain sodium lauryl sulfate may contribute to the appearance of mouth ulcers.
• Vitamin deficiencies:A deficiency of vitamins such as B-12, iron, folate or zinc could also be a cause of mouth ulcers.

Disease-Related Mouth Ulcers

There are some serious causes of mouth ulcers. Mouth ulcers can be symptoms of herpes infection, sex-related infection, inflammatory bowel disease, leukoplakia, gingivostomatitis, oral cancer, oral thrush, celiac disease, and immune disorders.
If mouth ulcers are a symptom of a disease they are usually accompanied by other symptoms in the body, but not always.² Most mouth ulcers last between one to two weeks. If mouth ulcers do not heal it could be a sign of disease that needs medical attention.

When to See a Healthcare Provider

If mouth ulcers do not heal within two to three weeks it could be a sign of disease that you need medical attention and treatment for. If mouth ulcers recur frequently, are large in size, continue to develop or are painless, see your healthcare provider for advice and a health check-up.

Treatment

Some treatments will require the removal of the source of the mouth ulcer, such as the treatment of those caused by the disease.
For most mouth ulcers treatment is somewhat effective.¹

• Pain relief creams or ointments such as Orajel or Anbesol
• Rinsing the mouth with salt water and baking soda
• Cooling mouth rinses with cold water or applying ice to the ulcer
• Cool chamomile tea—swish it in your mouth and then swallow

Tips for Prevention

To prevent getting mouth ulcers, use these tactics:

• Practice good oral hygiene.
• Eat a healthy diet.
• Employ gentle brushing for your teeth and gums
• Get a good intake of vitamin B, C, and zinc
• Avoid very hot drinks and food
• Reduce stress

Chronic and non-healing wounds are those that do not progress through the healing process in a timely or predicted manner. They are a global problem and are becoming harder to treat. Medicare estimates that over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion dollars annually.1
Most wound care protocols recommend standard wound care treatments, including debridement when indicated, the application of dressings, and periodic reassessment. However, non-healing wounds often require advanced treatment to enable these wounds to progress through the stages of healing.

Management of the Wound Bed

During normal wound-healing, a balance of healthy proteins and enzymes promotes healing in the wound bed. Disruption to this balance can cause the wound to become chronic. Such disruption can take many forms, although a common type of disruption is elevated protease activity, which contributes to chronic inflammation. In addition, intrinsic factors, such as age and comorbidities, and extrinsic factors, such as lifestyle and polypharmacy, can impact the delicate chemical balance in the wound bed.2
The first step for moving a chronic wound to an acute status is adequate wound bed preparation, which can be achieved with various strategies, including debridement, maintaining a proper moisture balance, and reducing the bacterial bioburden and inflammation.3 For non-healing diabetic foot and pressure injuries, offloading is also a crucial strategy. For venous ulcers, compression can be beneficial.2
The road to healing for many wounds starts with management of the wound bed. Moreover, the effectiveness of many advanced therapies relies on proper wound bed preparation that promotes healing.2 Even with the introduction of advanced wound therapies, including dressings, negative pressure wound therapy (NPWT), and cellular and/or tissue-based products, less than half of wounds heal after 12 weeks of treatment. However, the combination of proper wound bed preparation and advanced therapy can lead to greater success in helping these wounds achieve healing.3

Advanced Therapies for Non-Healing Wounds

Cellular and Tissue-Based Therapies

This type of advanced therapy consists of several therapies based on cells, including3:

• Stem cells, including bone marrow stem cells, keratinocytes, and fibroblasts

• Scaffolds, including carrier systems

• Skin substitutes

• Tissue-based therapies, including autologous blood derivatives for wound care and advanced cell therapy

• Epidermal substitutes, dermal substitutes, and dermoepidermal substitutes

• Melanocytes, vessels, and genetic manipulation

Stem cells derived from a variety of sources induce immunomodulation in the wound bed and facilitate healing by resolving inflammation, thus making them attractive cell therapeutic agents to treat chronic wounds.4
Negative Pressure Wound Therapy
NPWT has been described as an effective treatment for wounds of many etiologies, including complex non-healing wounds.5 With NPWT, subatmospheric pressure is applied to the surface of a wound sealed off by a film dressing and connected to a suction pump and drainage collection system with a tube. The use of NPWT is becoming increasingly popular because it can reduce the number of dressing changes required. It can be readily applied at the bedside,6 and it can result in improved healing and better patient outcomes.7
Antimicrobial Dressings
There are numerous innovative wound care dressings specifically developed to treat chronic wounds. These dressings contain a variety of antimicrobial agents, such as silver,2 polyhexamethylene biguanide, medical-grade honey, povidone-iodine, dialkylcarbamoyl chloride, and chlorhexidine gluconate.8 These dressings can work to manage bioburden levels in the wound and inhibit protease activity.2

Conclusion

Chronic wounds remain a significant challenge in clinical practice and can have a detrimental impact on patients’ quality of life. Understanding the biological processes occurring in the wound bed can help clinicians optimize these conditions and select compatible advanced therapies to overcome the challenges that delay healing of complex and chronic wounds.
References
1.Nussbaum SR, Carter MJ, Fife CE, et al. (2018). An economic evaluation of the impact, cost, and Medicare policy implications of chronic on-healing wounds. Value Health. 2018;21:27-32.
2.Chamanga ET. Clinical management of non-healing wounds. Nurs Stand. 2017;32(29):48-62.
3.Armstrong DG, Bauer K, Bohn G, et al. Principles of best diagnostic practice in tissue repair and wound healing; an expert consensus. Diagnostics (Basel). 2020;11(1):50. https://doi.org/10.3390/diagnostics11010050. Accessed February 15, 2021.
4.Nuschke A. Activity of mesenchymal stem cells in therapies for chronic skin wound healing. Organogenesis.2014;10(1):29-37.
5.Apelqvist J, Willy C, Fagerdahl A, et al. EWMA document: negative pressure wound therapy. J Wound Care.2017;26(Suppl 3):S1-S154.
6.Robert N. Negative pressure wound therapy in orthopaedic surgery. Orthop Traumatol Surg Res. 2017;103(1 Suppl):S99-S104.
7.El-Sabbagh AH. Negative pressure wound therapy: an update. Chin J Traumatol. 2017;20(2):103-107.
8.Mana TSC, Donskey C, Carty N, Perry L, Leaper D, Edmiston CD Jr. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incision wound model. Am J Infect Control. 2019;47:1048-1052.

Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

Contact us for more details: [email protected].

 

Wound healing can stall for a number of reasons. Wounds that have not healed or significantly reduced in size after four to six weeks are considered chronic. They are characterized by a multitude of impeding factors including biofilm, excess matrix metalloproteinases (MMPs) and extracellular matrix degradation, inflammation, fibrosis, unresponsive keratinocytes and fibroblasts, and atypical growth factor signaling.
The vast majority of chronic wounds contain biofilm, which delays or stalls progression in the inflammatory phase of wound healing.1 Molecular and cellular abnormalities in chronic and hard-to-heal wounds lock in chronic inflammation, which plays a major role in suspending the normal healing process. The ultimate aim is to transform chronic wounds back into acute wounds to enable them to heal.2,3
Monitoring healing progress by checking wound status every two to four weeks can help determine what the stalling factors are, as can knowing what signs to look for within the wound — specifically, biofilm, granulation tissue and wound pain.

Biofilm in Chronic Wounds

If the wound is not smaller after four to six weeks, biofilm may be present in the wound, signaling that the clinician should review the treatment plan. Identifying biofilms early on and adjusting the plan of care as necessary are both essential in optimizing wound healing outcomes.4
Clinicians should know how to effectively identify devitalized wound tissue types and the signs of bacterial imbalance. Devitalized tissue (slough, eschar) impairs wound healing and should be removed as appropriate. Biofilm formation triggers a chronic inflammatory response in the wound that results in a high number of neutrophils and macrophages, which in turn leads to higher levels of reactive oxygen species and proteases ([MMPs] and elastase) that will then damage normal healing tissues, proteins and immune cells.
Biofilm formation follows a common pattern of bacterial cell attachment, microcolony formation, maturation and dispersion. During the initial attachment, biofilm is reversible; if not reversed, the attachment becomes stronger, and cells begin to multiply rapidly. They also begin to mutate so that they can compete in this now intensely crowded environment. At this point, the bacteria begin using quorum sensing, a communication process that enables the bacteria to regulate what genes they express as the cell population density increases.4-6
There is no fix-all solution or gold standard test for identifying or treating biofilm in a wound.5Evidence suggests that physical removal (debridement) and continuous, vigorous cleansing are the best ways to reduce biofilm colonies.6 These strategies not only help prevent and manage biofilm, but also reduce antibiotic usage, thereby supporting antimicrobial stewardship.
Using a combination of debridement methods is one way to battle biofilm in chronic wounds and accelerate healing.7 Sharp debridement is the most aggressive approach. The clinician uses a scalpel, forceps, scissors and other surgical instruments to remove biofilm and devitalized tissue, stimulating platelets to release growth factors key to tissue repair and move chronic wounds into an acute state.
Wound cleansers and solutions used in chronic wounds help decontaminate the wound, disrupt biofilm and promote healing. Cleansing the wound bed surface, periwound and surrounding skin with non-cytotoxic solutions is essential. Various delivery methods make them user-friendly for both the patient and clinician.
Advanced wound care dressings can be used in chronic wounds to prevent and manage biofilm. The wide array of impregnated dressing technologies includes antimicrobial formats in collagens, alginates, foams, hydrogels, gauzes and topical agents. Antimicrobial or bacteriostatic dressings may be impregnated with silver, cadexomer iodine, copper, methylene blue, gentian violet, polyhexamethylene biguanide (PHMB), etc. Used appropriately, these dressings and products have been found to be effective in chronic wound management.
Once biofilm and infection have been resolved, clinicians should look for methods of encouraging wound closure. Cellular and/or tissue-based products (CTP) can be one method of encouraging closure. CTPs come in a variety of formats, and may include collagens or antimicrobials such as silver or PHMB. They encourage wound closure by providing elements such as extracellular matrices, collagen, and other vital components that act as a scaffold for the healing wound. Encouraging rapid wound closure can ensure better outcomes for the patient, such as reduced costs, reduced pain, and better quality of life. CTPs that contain an antimicrobial component can provide a barrier against bioburden.

Granulation Tissue in Chronic Wounds

Irregular or unhealthy granulation tissue indicates poor healing and/or infection and requires a wound culture and appropriate treatment based on the culture results. Absent infection, chemical cauterization with silver nitrate or a topical steroid can be used to facilitate healing.8

Wound Pain

Numerous factors can cause wound pain, including underlying pathology/etiology, skin damage, nerve damage, blood vessel injury, infection and ischemia. Psychological and emotional factors can also trigger wound pain. Clinicians need to listen to their patients to help identify the type of pain, its cause(s) and the best treatment options. Because chronic pain impacts patients’ quality of life, appropriately managing the pain is paramount to achieving the best possible outcomes for patients.9
Practical knowledge of prognostic indicators and risk factors in chronic and hard-to-heal wounds — including biofilm, granulation tissue and wound pain — is essential to early identification, treatment and successful healing outcomes.
References
1. Murphy C, Atkin L, Swanson T, et al. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care. 2020;29(Suppl 3b):S1-S28.
2. Hayes, Skin Substitutes for Chronic Foot Ulcers in Adults with Diabetes Mellitus: A Review of Reviews, November 2018; Nicholas et al., 2016.
3. Liu Y, Panayi AC, Bayer LR, Orgill DP. Current Available Cellular and Tissue-Based Products for Treatment of Skin Defects. Adv Skin Wound Care. 2019 Jan;32(1):19-25.
4. Vowden P. Hard-to-Heal Wounds Made Easy. Wounds International. 2011;2(4):1-6. Available from: www.woundsinternational.com
5. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 2009;18(2):54-56.
6. World Union of Wound Healing Societies (WUWHS), Florence Congress, Position Document. Management of Biofilm. London: Wounds International 2016.
7. Ayello EA, Cuddigan JE. Debridement: controlling the necrotic/cellular burden. Adv Skin Wound Care. 2004;17(2):66-75.
8. Alhajj M, Bansal P, Goyal A. Physiology, Granulation Tissue. [Updated 2020 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: www.ncbi.nlm.nih.gov/books/NBK554402/
9. Frescos N. What causes wound pain?. J Foot Ankle Res. 2011;4(Suppl 1):22.
10. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 2009;18(2):54-56.
11. World Union of Wound Healing Societies (WUWHS), Florence Congress, Position Document. Management of Biofilm. London: Wounds International 2016.
Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.
Contact us for more details: [email protected].

Refractory wounds comprise a significant worldwide health problem. Wounds that fail to heal not only impact quality of life but also impose a significant physical, psychosocial, and financial burden. Additionally, individuals with refractory wounds often experience significant morbidity and sometimes mortality. Wound infections and amputations are common in this population, and chronic conditions often exist as well.

Definition of Refractory Wounds

By definition, refractory wounds are chronic wounds that do not respond normally to treatment. A wound is considered refractory if there is no improvement within two to four weeks of implementing an evidence-based plan of care. Wound size and duration are predicative factors for wound healing. Ninety percent of all non-healing wounds have been identified as diabetic or neuropathic wounds, pressure injuries, or wounds of venous etiology, and they are often multifactorial.
Identifying Wound Etiology and Causative Factors
We’ve all seen and cared for wounds that just won’t heal. When developing an evidence-based plan of care for wound management, it is important first to determine wound etiology. We cannot effectively heal something if we don’t know the cause. Wound etiology guides treatment, and determining the cause of a wound is an important first step in putting together an evidence-based plan of care for treatment and prevention of wound recurrence.
Once wound etiology is determined, we must try to correct the identified causative factor. If it cannot be fully corrected, the plan of care will need to be adjusted. Supportive, evidence-based topical treatment with an individualized plan of care is key to successful wound management. An inability to correct etiologic factors will lead to impaired healing. A bedbound patient with an inconsistent turning schedule and a diabetic patient with inconsistent offloading of the plantar surface are examples of patients in whom healing would be impaired and the etiologic factor is not fully corrected. It is important to remember that a biopsy should be considered whenever a wound is non-healing and the reason for failure to heal is unclear.
Systemic factors affecting repair are commonly categorized into four parts: intrinsic, extrinsic, iatrogenic, and adherence. In this blog, we will focus on intrinsic factors affecting repair and thereby contributing to a refractory wound.

Intrinsic Factors in Wound Healing

Intrinsic factors are those belonging to the patient, and they include both modifiable and non-modifiable factors. The patient’s comorbidities and physical and physiologic conditions that impact wound healing are classified as intrinsic factors. Some examples include age, the presence of chronic illness, tissue perfusion and oxygenation (also related to chronic disease), immunosuppression (autoimmune diseases and medications that can suppress the immune system), and neurologic impairment (spinal cord injuries are common here).
As discussed in prior blogs, older adults are at risk for a multitude of skin issues, skin breakdown, and impaired healing related to aging changes both internally and specifically within the different layers of the skin (thinning epidermis, dermal atrophy, dryness, and reduced elasticity). Additionally, the increased prevalence of chronic illness among older adults contributes to recognizing age as an intrinsic factor affecting wound healing.
Chronic illnesses also contribute to refractory wounds as an intrinsic factor. Diabetes, heart disease, cancer, vascular disease, and neuropathic diseases are all examples of chronic illnesses that may cause a delay in healing for a multitude of reasons. Blood flow and tissue perfusion, sensory perception, and adequate oxygenation are all important factors to consider when looking at the healing process.
Perfusion and oxygenation are significant factors in the healing process as well; inadequacies in either will likely result in a failure to heal or delay in the healing process. Chronic illnesses can often lead to impairments in perfusion and oxygenation.
Immunosuppressive conditions (cancer, diabetes) and treatments (chemotherapy, whether for cancer or autoimmune reasons, and corticosteroid therapy leading to immunosuppression) cause impairment of the initial inflammatory response required for healing to occur and therefore usually result in delayed wound healing.
Finally, neurologic conditions often result in refractory wounds as well. Spinal cord injury (SCI) patients are known to have delayed healing below the level of injury for many reasons: persistent inflammation, edema, and changes in perfusion and oxygenation.1 Additionally, SCI patients are at a high risk for pressure injury development given their impaired sensory perception, impaired mobility, and often altered weight-bearing status. SCI patients are often identified as at risk for pressure injuries according to the Braden Scale.

Conclusion

It is important to piece together all of the systemic factors impacting healing when looking at reasons that a wound is not improving within two to four weeks of evidenced-based topical therapy and a comprehensive plan of care. Additionally, it is always important to remember to treat the WHOLE patient, not just the HOLE in the patient—a common theme among many of my prior blogs.
In future blogs, we will be exploring and defining the remaining three common factors affecting tissue repair: extrinsic factors, iatrogenic factors, and adherence.

Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.
Contact us for more details: [email protected].

An injury to the human body initiates a wound healing chain reaction that occurs in four sequential but overlapping phases: hemostasis, inflammatory, proliferative and maturation. This post focuses on the second (inflammatory) phase, which begins after blood flow stops (i.e., hemostasis) and defender white blood cells, or leukocytes, migrate to the site of the injury — a process known as chemotaxis.1

Understanding the Inflammatory Stage of Wound Healing

The inflammatory stage typically lasts several days, but it can go on for much longer, making the wound chronic. Many cells and chemical reactions or signals keep the wound progressing in the inflammatory phase. Understanding these processes can jump-start a chronically stalled wound so that healing resumes.
The clinician’s goals in the inflammatory phase are to limit further damage, close the wound, remove cellular debris and bacteria, and encourage cellular migration.1 Following hemostasis and chemotaxis, white blood cells and thrombocytes release more mediators and signaling cytokines, which accelerates the inflammatory process. Several growth factors work in concert to promote collagen degradation, transform fibroblasts, grow new blood vessels and work toward re-epithelialization. Platelets release mediators, including serotonin and histamine, to increase cellular permeability.1 Fibroblasts are recruited and multiplied by platelet-derived growth factors. Once the fibroblasts are in place, they produce collagen, a crucial protein the body needs for building and remodeling.
During this process, a fibrin scaffold forms through platelet activation.1 
The scaffold gives the inflammatory cells a place to stick. Some of the inflammatory cells attracted to the scaffold are neutrophils, monocytes and endothelial cells.1
Neutrophils digest cellular debris and bacteria through a process called phagocytosis, which helps cleanse the wound. Monocytes fight infections and help remove dead or damaged tissues.2 Endothelial cells send signals to organize the growth of connective tissue cells that eventually form the surrounding layers of blood vessel walls.3All these cells working in concert keep the wound moving to the next healing phase, known as the proliferative or granulation phase.
Matrix metalloproteinases, or MMPs, are required for the migration of inflammatory cells. MMPs also break down proteins to allow new tissue to form. However, if MMP levels get too high or if MMPs are present for too long, they can break down proteins and growth factors and stall wound healing.4

Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation. Contact us for more details: [email protected]. References
1. Basehore, B. M., Zito, P. M., & Wallace, H. A. (2020). Wound Healing Phases. Treasure Island, FL: StatPearls Publishing.
2. Territo, M. (2020, January). Monocyte Disorders. Retrieved from Merck Manuals.
3. Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K. & Walter, P. (2002). Molecular Biology of the Cell. New York: Garland Science.
4. Cullen, B., Gibson, D., Harding, K., Legerstee, R. & Shultz, G. (2009). MMPs Made Easy. Wounds International, 1(1), 1-6.

Chronic wound care is challenging for the entire healthcare ecosystem, from clinicians to patients, and COVID-19 has only exacerbated those challenges. Patients are delaying primary care provider and wound clinician visits for ongoing guidance and therapy to reduce possible exposure to the virus. This is understandable, as many chronic wound patients are in the high-risk category if they become ill with COVID-19.1They are also putting off elective surgeries, annual physicals, and basic preventive care, which can negatively affect long-term outcomes. A survey of wound care clinicians in March 2021 reported a decrease in patient visits from pre-pandemic numbers, and 57% of respondents stated that "wound severity has either increased or significantly increased since the start of the pandemic."2 At the same time, the pandemic has accelerated patient-driven care and increased usage of interactive devices for care administered at home, rapidly increasing the use of telemedicine across demographics. In fact, one report by the research firm Frost & Sullivan says the demand for telemedicine services in the United States grew by over 60% in 2020 due to the pandemic.3 As the pandemic continues, it’s important to look at how reduced access to care might affect wound care in the future and how patient-driven and more value-based care options will come into play in daily practice.

The Trickledown Effect on Patient Outcomes and Their Wounds

While there have been improvements, access to care has not fully recovered, and continued COVID-19 surge rates suggest that delayed preventive and emergent wound care could continue to trend.4 This is a negative outcome from a public health perspective, which could prove catastrophic for wound patients as they leave themselves vulnerable to infection, sepsis, amputation, and possibly death. These problems are especially concerning in our growing senior population, whose chronic wounds are complicated by vascular disease, diabetes mellitus, and unrelieved pressure. A reduction of traditional weekly or biweekly wound care visits could increase hospitalization by a factor of 20 in the United States,5 exposing the scale and often unknown prevalence of chronic wounds and their impact on the healthcare system.
The increase in the rate of untreated wounds over the last year has led some researchers to describe the situation as a “pandemic within a pandemic.” A trauma center study in Ohio found that diabetic patients were “10.8 times more likely to undergo any level of amputation and 12.5 times more likely to undergo a major amputation during the COVID-19 pandemic.” Another study reported in the same AJMC article showed that “during COVID-19 lockdowns, patients with diabetes admitted to a tertiary care center for DFU had a more than threefold risk of amputation compared with those in 2019.”6 None of this is surprising, considering how delayed care has swept across the U.S. healthcare system, especially during the stage of rising Delta variant rates. And it’s impossible to imagine how neglected wound care rates could increase when a new variant emerges. COVID-19 has had a sustained, ongoing impact on how patients receive wound care. Or even if they will be able to receive care, because patients may remain uncomfortable visiting clinics as the pandemic lingers. Widespread staffing shortages are also a concern, and wound care treatment must adapt to meet patients where they are and where they feel comfortable receiving care.

Leading Through Patient-Centered Solutions

As the healthcare industry examines existing challenges, its leaders are finding new ways to transform outcomes. One notable shift is the acceleration of telemedicine. It is already a viable choice for healthcare professionals regarding preventive care like consultations, prescriptions, wellness checks, counseling, and more. Access is an essential reason telehealth—or telemedicine—is playing such an important role. In 2019, more than half of U.S. households used the internet for health-related activities.7 And the pandemic has escalated this shift.8 During the first quarter of 2020, the number of telehealth visits increased by 50% compared with the same period in 2019.8
Solutions
Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

See a clinical care solving chronic wounds by Dermlin on Youtube: https://youtu.be/RrQsktcYmlk
Contact us for more details: [email protected].

References
1.Oropallo A. COVID-19: issues related to wound care and telehealth management. UpToDate. September 2021. Accessed October 27, 2021. https://www.uptodate.com/contents/covid-19-issues-related-to-wound-care-...
2.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-...
3.Frost & Sullivan. Telehealth to experience massive growth with COVID-19 pandemic, says Frost & Sullivan. May 13, 2020. Accessed October 27, 2021. https://www.frost.com/news/press-releases/telehealth-to-experience-massi...
4.National Center for Healthcare Statistics. Reduced access to care: RANDS during COVID-19. CDC.gov. Updated August 6, 2021. Accessed October 27, 2021. https://www.cdc.gov/nchs/covid19/rands/reduced-access-to-care.htm
5.Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care (New Rochelle). 2021;10(5):281-292. Accessed October 27, 2021. https://doi.org/10.1089/wound.2021.0026
6.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-...
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It is well known that chronic and hard-to-heal wounds have created a global crisis. Delayed healing in these wounds is often associated with biofilm, and antimicrobial dressings can be effective in managing bioburden in chronic wounds. For the use of antimicrobial advanced wound care dressings to be successful in chronic wound care, however, clinicians must have practical knowledge of dressing formats and options, dressing indications and applications, the principles of antimicrobial stewardship, and care planning for specific wound types.
There are many antimicrobial wound care dressings on the market, and making a selection can be a challenge, even for licensed health care professionals. Antimicrobial dressings are available in a variety of formats, including foams, alginates, gauzes, and more, and selecting the format most appropriate for your patient and their wound can make all the difference in wound healing.
Goals in choosing an antimicrobial dressing should include preventing, addressing, and managing biofilm and bioburden. Evaluating different antimicrobial formats, including the antimicrobial agent incorporated, mode of delivery to the wounds, and dressing material, is essential for optimal overall healing outcomes in chronic and hard-to-heal wounds.

Solutions

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

See a clinical care solving chronic wounds by Dermlin on Youtube: https://youtu.be/RrQsktcYmlk

Contact us for more details: [email protected].

 

 

 

 

When cooking, sometimes oil inside accidentally into the water, will be splashed out of oil scald, believe that women in the early stage of cooking and I will have the same experience, was very painful after oil scald, generally I will use their own method to deal with, to prevent the scar hot.

Treatment methods after injury include:  

1. Immediately get rid of the heat source and wash the wound with running water for half an hour to reduce the temperature of the affected area and prevent further damage;  
2. If there are blisters in the scald, do not remove the blister skin to avoid infection;  
3. Mild scald can be applied in the affected area scald cream, serious scald should be timely diagnosis and treatment to the hospital.For specific medication, please combine it with clinical practice and follow the doctor’s guidance.
empyrosis