Doris Obinna

There have been cases when injuries on the body refuse to heal. This can be as a result of many factors, like: infection, nutrition, diabetes, medication, poor circulation in the body, alcohol and ulcer.

However, it must be stated that healing of wounds is a process. But when healing becomes prolonged, it is expedient to find out why and what to do.

When a wound refuses to heal, it turns to ulcer, which experts define as a break in the skin, which allows air and bacteria to get into the underlying tissue. It is usually caused by an injury, often a minor one that breaks the skin.

Most common ulcers are on the leg. When they get worse, it becomes venous ulcers, which occur due to improper functioning of venous valves, usually of the legs, hence leg ulcers). They are major occurrence of chronic wounds, occurring in 70 per cent of leg ulcer cases.

Venous ulcers develop mostly along the medial distal leg, and can be very painful with significant effects on quality of life.

According to an expert, “the veins in your leg are tubes that carry the blood back from the foot towards your heart. The veins in your legs have one-way valves that make sure the blood flows up the leg and not back down. In some people, these valves are not very effective or can be damaged by thrombosis (clots) in the veins. If the valves are damaged, blood can flow the wrong way down the veins, which results in a very high pressure in the veins when standing up. This abnormally high pressure in the veins damages the skin and leads to the ulcers.”

A Lagos doctor, Gabriel Omonaiye, said chronic leg ulcer (CLU) is a sore below the knee, persisting longer than six weeks and not showing the tendency to heal after three months or more.

He said: “Epidemiology, at any time, one per cent of the population will be nursing CLU and up to 10 per cent of those above 65 years of age will have it. Between two to three million Americans are diagnosed yearly with CLU. The increasing cases of CLU are not unrelated to the increasing life span (longevity) and lifestyles of cigarette smoking, obesity, which tend to lead to arteriosclerosis.

“Chronic leg ulcer impact negatively on several aspects of the life of the sufferer, namely: reduced mobility, sleep disturbances, economic crisis as work capacity is reduced, reduced social activity because of the fear of injury and negative body image.”

 

Causes of CLU:

The most common underlying problem causing chronic leg ulcers is disease of the veins of the leg. Indeed, venous disease is the main reason for over two thirds of all leg ulcers. It must be noted that venous disease (caused by veins not working) is responsible for about 80 per cent of leg ulcers, while arterial disease (caused by the arteries not working) accounts for about 15 per cent of leg ulcers.

Other causes includes diabetes and rheumatoid arthritis as well as some rare conditions, about five per cent of leg ulcers.

In some cases, two or more conditions may be causing damage at the same time. Your doctor will examine you and do some tests to see what sort of ulcer you have.

 Dr. Omonaiye said CLU causes pain, inability to use the limb well, inflammation, fever, discharges from the wound, friable/ fragile granulation, wound break down.

 

Management of CLU

The medical doctor said this is usually interdisciplinary, adding that adequate history taking to get information about the onset/duration of the sickness, lifestyle practices, symptoms complex is necessary.

He noted that physical examination, thoroughly done, is a must, as, according to him, “different diagnostic investigations such as full blood count, fasting blood sugar, haemoglobin genotype, erythrocyte sedimentation rate (ESR), quantitative wound culture and sensitivity tests, biopsy for histological studies are important.

 

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Treatment

Treatment of a venous leg ulcer comes in two ways: controlling the high pressure in the leg veins and treatment of the ulcer.

The mainstays of treatment are compression bandaging or stockings and elevation of the limb.

However, proper care can never be ignored in the healing process of wound.  In an article, Dr. Manny Alvarez, Fox News Channel’s senior managing health editor, stated that to stop wounds from developing to ulcer, the American Academy of Dermatology suggested ways of staving off infection. It recommended the following: Gently wash the area with mild soap and water; Keep the wound moist to prevent scabbing, which prolongs healing (It suggested petroleum jelly); Keep the wound bandaged and clean every day. With this, there is no need for antibacterial ointments.

When to Get Help

Normal wound healing takes up to three weeks. If therefore,  a wound has not healed after a month seek professional help.

Elevation of the limb:
The higher the leg, the lower the pressure in the leg veins. If the foot is elevated above the heart, then the pressure in the foot drops to a normal level. Put your legs up whenever you can and as high as you are able. The arm of the sofa is good. Elevate the lower end of your bed (6 inches or so) so that when in bed your feet are a little higher than your head. You can use some old books for this.

Compression bandaging or stockings:
In order to keep the pressure in the leg veins at the ankle low when you are standing up, you will be treated with compression bandaging or stockings. Several layers of bandages may be required to get the necessary pressure to control the veins. Once the ulcer is healed, compression stockings are usually necessary to prevent the ulcer from returning.

These stockings need to be specially fitted and are much stronger than ordinary “support tights.” If you have difficulty putting on your stockings, then you can buy a special stocking applicator.

“The treatment normally involves the treatment of the underlying sickness(es), wound detriment and care, analgesic, antibiotics, symptom management, skin graft, compression therapy, preventative care, health education, surgery, modifications of lifestyles.

New modalities of treatment include allogenic neonatal keratinocytes and regenerative medicine using stem cells for skin growth,” Omonaiye said.

The nature’s remedies

Betsredemies.net offered some remedies for wounds that refuse to heal. It listed such remedies as aloe vera, agrimony leaves, honey, sugar and calendula.

Aloe Vera: Aloe vera is natural skin care remedy for multiple skin problems and wound care. It has potent antibacterial, anti-inflammatory and healing properties that make it ideal for tissue repair in case of open wounds, deep cuts and bruises.

To use it, extract the gel from Aloe Vera leaf. Apply it all over the irritated skin. You can even use store-brought aloe vera lotions or creams.

Agrimony leave: This is a renowned wound healer. It can be made into a tea to wash wounds. You can drink the tea to strengthen the body internally so it can heal wounds without antibiotics. Agrimony belongs to the rose family.

Brew agrimony leaves in water; steep it for 5-10 minutes; cool the tea completely; then pour the cooled tea on the wound, laceration or cuts.

Honey: Honey is a wonderful healing, soothing, anti-septic and anti-microbial remedy. It takes care of wound that refuses to heal.

Sugar: Believe it or not, sugar can heal bad sores and wounds that do not heal quickly.

To use it, make a paste of antiseptic ointment and sugar and apply a layer of the mixture to the bedsores or open wounds.

Calendula: Calendula is a classic wound healer. It is rich in tannins that create protective layer on the wounds to prevent infections. Calendula ointment is readily available in the market.