Wound Care
Wound healing consists of a cascade of interrelating reactions triggered by an injury. Any disruption to the cascade could lead to delay or non-healing. A chronic wound frequently has multiple etiologies.
It is estimated that 1-2% of the U.S. population will have a chronic wound at some time during their life. The number of these wounds, the cost of their treatment, and their impact on an individual’s quality of life and independence is almost certain to grow with aging and the increasing incidence of obesity in our population.
Comprehensive Wound Management: The Functional Lifestyle Approach
At Rochester Clinic, our physicians treat the whole person, not just the disease, ensuring comprehensive care for wound management. Identifying systemic comorbidities is crucial to properly treating ulcers, particularly diabetic foot ulcers. The functional lifestyle approach provides a holistic framework for optimal wound healing.
Etiology
Accurately identifying the etiology, or immediate cause of the ulceration, is essential to initiating the proper wound management protocol. Correct classification ensures that underlying causes and contributing factors are effectively addressed.
Systemic Comorbidity
A wound will not heal in a timely manner without adequate blood flow or if it is compromised by systemic issues such as high blood sugar and edema. Managing these comorbidities through lifestyle modifications, including a whole food, plant-based diet, regular physical activity, and stress management techniques, is vital. These changes help control blood sugar levels, reduce inflammation, and improve overall health.
Types of Most Common Chronic Ulcers
Chronic ulcers can be classified based on the etiology (cause), however, many people have multiple systemic conditions and the chronic ulcers frequently have multiple causes.
Arterial ulcers are developed due to compromised circulation and are frequently a result of acute wounds that do not heal.
Venous ulcers occur secondary to edema (swelling). They are commonly located at the inside of the ankle.
Neuropathic ulcers are sometimes called diabetic ulcers since diabetes is the most common cause of neuropathy. The ulcers are usually located on the pressure points of the foot due to repetitive microtraumas. Diabetic foot ulcers result in the most non-traumatic amputations and proper diabetic foot care is an important part of ulcer prevention.
Pressure ulcers are also called bedsores that are injuries to the skin and tissues due to prolonged pressure. The most common areas to develop pressure ulcers are coccyx (tailbone), hips, heels and ankles. Besides pressure, friction from moist and reduced circulation from the pressure are contributors.
Other ulcers can develop secondary to other systemic conditions, such as gout and inflammatory diseases. Some chronic ulcers develop cancer but some cancers manifest as ulcers.
Infection
The skin serves as the first line of defense against infections. However, a wound inhibits this defense mechanism, making it prone to infection. Timely detection and treatment of infections are critical to ensuring proper healing of ulcers. Infections are one of the leading causes of chronic ulcerations. Addressing systemic inflammation through dietary modifications, anti-inflammatory treatments, and lifestyle changes is essential. A healthy GI microbiome, supported by probiotics and prebiotics, can enhance immunity and reduce infection risk.
Offloading
Repetitive trauma continues to injure chronic wounds, particularly in pressure and neuropathic/diabetic ulcerations. Offloading is crucial to remove pressure and repetitive trauma from the ulcer. This includes using orthotic devices, corrective exercises, and manual therapies to restore optimal biomechanics. Compression therapy can also reduce pressure applied to the ulcer by edema, promoting healing.
Inflammation
Inflammation is essential in initiating the wound healing process. However, chronic inflammation can delay the healing process and exacerbate pain. Addressing inflammation involves both local and systemic approaches, such as anti-inflammatory medications, dietary modifications rich in anti-inflammatory foods, and supplements like omega-3 fatty acids and turmeric. Therapies like cryotherapy and laser treatments can also help reduce localized inflammation.
Gut Microbiome
The gut microbiome plays a critical role in overall health and wound healing. A healthy gut microbiome reduces systemic inflammation and supports immune function. Dysbiosis, or an unhealthy gut microbiome, can impair healing and increase infection risk. Dietary interventions to support a healthy microbiome, such as increasing fiber intake and consuming probiotics and prebiotics, are essential.
Hormones
Hormonal imbalances can significantly impact wound healing. Cortisol, the stress hormone, can cause inflammation and delay healing. Cortisol is a catabolic steroid that degrades soft tissue and compromises wound healing. Sex hormones, such as estrogens and androgens, also play roles in pain regulation and healing processes. Comprehensive testing and assessment of hormonal levels can identify imbalances that may be contributing to poor wound healing. Treatments may include hormone replacement therapy, lifestyle modifications, and dietary changes to support hormonal balance.
Lifestyle
Lifestyle modifications are essential in managing chronic pain and promoting wound healing. Regular physical activity tailored to individual capabilities enhances muscular strength, flexibility, and joint stability. A whole food, plant-based diet rich in essential nutrients and antioxidants supports tissue repair and reduces inflammation. Stress management techniques, such as mindfulness meditation and relaxation exercises, help mitigate the negative impact of psychological stress on musculoskeletal health. Ensuring adequate sleep, avoiding harmful substances like tobacco and excessive alcohol, and fostering social connections further enhance overall well-being.
Mobile Wound Care Services
In addition to our in-clinic services, Rochester Clinic offers mobile wound care services to selected long-term care facilities. Our dedicated team brings comprehensive wound management directly to patients, ensuring they receive the highest quality care without the need for travel. This service is particularly beneficial for patients with mobility challenges or those requiring consistent, specialized wound care in their living environment.
Conclusion
Effective wound management requires a holistic approach that addresses the whole person, not just the ulcer. The functional lifestyle approach at Rochester Clinic integrates biomechanics, lifestyle, inflammation, neurotransmitters, GI microbiome, and hormones to optimize wound healing. By addressing these interconnected factors, we enhance patient outcomes, reduce the risk of complications, and promote long-term health and well-being.
Selected Recent Publications:
Lai, J, “Unexpected Infections in Wound Management – Case Studies,” Integr J Nurs Med Volume 5(3): 1-3, (2024).
Lai, J, “Lifestyle Medicine Approach to Wound Management,” Am J Lifestyle Med, Online April 4, (2024).
Lai, J, J. R. Basford, and M. R. Pittelkow, “Levels of Expressions of Secretory Leukocyte Protease Inhibitor in Acute Wounds,” J. Wound Care, 31 (Suppl 7): S15-9, (2022).
Upcoming Publications:
Lai, J, Y. W. Asmann, J. R. Basford, and M. R. Pittelkow, “Gene Expression Profiling in Acute Wound Healing,” In Preparation, (2024).
Lai, J, J. R. Basford, K-N An, and M. R. Pittelkow, “Effects of Matrix Properties on Intracellular Signaling,” In Preparation, (2024).
Selected Recent Presentations:
“Wound Management: The Physiological Benefits of a Lifestyle Medicine Foundation,” Mayo Clinic Vascular Center/Wound Care Center Teaching Conference, May 2024.
“The Impact of Sleep on Wound Healing,” Boswick Burn and Wound Symposium, Maui, HI, January 2024.
“Enhancing Wound Healing Through Modern Wound Culture Testing,” Boswick Burn and Wound Symposium, Maui, HI, January 2024.
“Lifestyle Medicine approach to Wound Management,” American College of Lifestyle Medicine, Denver, Colorado, October 2023.
“Lifestyle Medicine in Lower Extremity Care,” No-Nonsense Podiatry, Virtual, March 2023.
“Lifestyle Medicine in Podiatry,” Lifestyle Medicine in Lower Extremity Care, Virtual, February 2023.
“Suspicion in Wound Management – Case Studies,” Boswick Burn and Wound Symposium, Maui, HI, January 2023.
“Lifestyle Medicine Approach to Wound Management,” Boswick Burn and Wound Symposium, Maui, HI, January 2023.
Upcoming Presentations:
“Lifestyle-Driven Epigenetic Modulation in Wound Healing,” Mayo Clinic Wound Symposium, February 2025.
“Challenges in Preventing Diabetic Foot Ulcers – an Illustrational Case Study,” Symposium on Advanced Wound Care, Las Vega, October 2024
Standard of Care in Wound Management
Wound management is a complicated process and the standard of care can be summarized into six principles.
Infection Diagnosis and Management
Vascular Diagnosis and Management
Offloading Pressure
Promoting a Good Wound Healing Environment
Regular Re-evaluation of Wound and Treatment Plan
Managing Systemic Comorbidities
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