I sorted out the precautions for changing the medication for chronic wounds and wrote my own experience in the past few years to patients who need help. Because there are too many points, it is impossible to say everything in the general outpatient clinic. If you can really operate against these entries, you should be able to solve most of the patient's problems.
Causes of difficult healing of chronic wounds:
- Internal worries: decreased willingness to promote healing, poor systemic condition, insufficient local blood supply, and poor anti-infection ability.
- External: Bacterial infection.
Topical treatment:
(1) Debridement The main point of treatment of chronic wounds is not what medicine to use, but how to wash, and to fully drain the exudate and bacteria
- Thin tubes flush the sinus tract
The irrigation of the sinus passage must be flushed from the inside out, the hydrogen peroxide flushing effect is better, and the inner wall of the sinus tract is dirty and dirty, and it must be rinsed
- Hydrogen peroxide + iodine
Foaming with hydrogen peroxide can carry iodine to deeper tissues to function
- Soak and wet compress
Through capillary action and liquid flow, the bacteria on the wound surface are drained to the outside of the body as much as possible, and the wet compress requires multiple layers of wrung-out gauze, the capillary effect is stronger, and it takes a period of wet compressing, and drainage takes time.
- bath
Rinse with flowing water, drainage effect is better, in addition to the dilution of bacteria, flowing water also has mechanical force, with surfactant in shower gel, can destroy the bacterial biofilm.
- Full mechanical debridement
Scraping spoon scraping, cotton swab turning, gauze rubbing, not only can remove the bacterial medium, but also restart the healing process of the wound.
- Removes necrotic tissue and foreign bodies
Foreign bodies such as scabs and knots are shelters for bacteria, and bacteria can use these places as bases, while immune cells cannot intervene here, which causes wounds to persist.
(2) Dressing change and surgery The purpose is mainly to change the chronic wound to an acute wound and restart the healing process
- Increase the frequency of dressing changes
In a race against the proliferation of bacteria, bacteria proliferate all the time, and it is necessary to ensure that the number of bacteria on the wound surface is always maintained at a relatively low level.
- Dot matrix laser
The wound repair procedure can be restarted and has a certain depth that directly stimulates the fibrous layer.
- Stitch or pull
The criterion for judging whether it can be sutured is the bacterial content in the wound, which is judged by the degree of inflammation around the wound and the amount and viscosity of the secretion, that is, the degree of infection. If the suture standard is not met, the wound can be narrowed by pulling together with a tension reduction patch first.
- Drain at the mouth and cut if necessary
Subcutaneous sneaking sinus tracts are best drained against the mouth, and the opening at the end is much better than in one direction. If the effect is still not good, the sinus tract is incised, the dressing is opened, and the second stage is sutured.
(3) Wound medication and dressing The main role is drainage, and the exudate bacteria are continuously absorbed onto the dressing after debridement
- Topical growth factors
After debridement, growth factors are applied externally for a period of time, and the results are better
- Adequate filling of sinus tracts and cavities
Both the cavity and the sinus tract should be adequately stuffed, because the inner wall will harbor bacteria in each place, and there may even be branches inside.
- Choice of dressings
Dressings are selected according to the amount and texture of the exudate: foam dressings for more and thinner, and oil yarns for less and viscous ones. The sinus tract recommends the use of microdynamic negative pressure, and its water absorption and expansion function can be close to the inner wall of the sinus tract and fully drain.
- Negative pressure drainage
This is active drainage, which is better than passive drainage, but it should be noted that it is replaced frequently, generally once every 3 days, otherwise the drainage material is easily contaminated.
- Pressurized bandage
The greater the pressure, the more fully the dressing and the wound contact, the better the drainage effect
- Hormonal ointments
The essence of hormones is to mobilize the body's future reserves to deal with the current situation, a bit like a mortgage. For wounds that cannot be healed, it is necessary to mobilize the reserves of the body and break the deadlock as soon as possible.
- Self-pharmaceutical, traditional Chinese medicine
The principle of this type of drug is to use the strong immunogenicity of the ointment to stimulate the wound and restart the wound healing process. At the same time, it promotes the chemotaxis of immune cells from the inward to the interstitial space of the blood vessels, improves the permeability of blood vessels, and plays an antibacterial effect similar to self-irrigation after acute trauma.
Systemic treatment:
(I) Increase local blood supply A good blood supply is the basis for healing
- Controls blood sugar
Even if the current blood sugar is stable, it does not mean that the wound can heal quickly, and the degree of lesions in blood vessels is directly proportional to the time of diabetes.
- Oral vasodilator drugs
Beprost sodium, diosmin tablets, salvia and other drugs
- Local infrared hyperthermia
Be careful not to burn
- Vasodilation or stents
Causes the blocked large blood vessels to pass again
- Spinal cord electrical stimulation
Dilates the arterioles of the lower extremities
- massage
Strengthens local blood circulation
(2) Avoid local congestion or ischemia
- The affected limb is immobilized, raised, and weight-bearing avoided
- Stretch bandage
Wear it when walking down the ground
- Quit smoking and alcohol
Nicotine in smoke constricts blood vessels, and PM2.5 clogs capillaries
(3) Medication support treatment
- Analgesia
Pain can cause blood vessels to constrict
- somatotropin
Promotes anabolic tissue metabolism in the body
- Control of special drugs such as immunosuppressants and chemotherapy
Systemic use of hormones also needs to be avoided or reduced
- Antibiotics are used in the acute phase
Acute infection of chronic wounds can be repeated
(4) Others
- Keep a good mood
Bad mood can lead to endocrine disorders
- Strengthens nutrition
Eat more high-protein foods while balancing other nutrients