Gress’s wounds have healed more than once, but have a tendency to recur. Edema has been a persistent enemy of healing. His latest treatment, venous ablation [see sidebar], has improved healing by re-routing return blood flow and providing a more efficient way to drain off excess fluids.
Now, if he can get his insurance to pay for a power chair with tilt-in-space, he hopes to remain wound-free. In the meantime, he gets his care at home. “Dr. Ruben is just a caring person. He comes out to my house, he sends nurses, he re-did his whole office for wheelchair users. People say doctors don’t come to your house anymore. I tell them, ‘Oh yes they do. This one does.’”
• Encompass Healthcare, 2300 Haggerty Road, Suite 1190, West Bloomfield Township, MI 48323, 248/624-9800; www.encompasshealthcare.com
Understanding Wound Healing
Dr. Bruce Ruben of Encompass Healthcare says, “Malnutrition [protein deficiency] is probably the most common reason I see why wounds won’t heal.” According to him, there are five main reasons why a wound doesn’t heal:
• Impaired circulation
• Poor nutrition
“You need to evaluate these all at one time,” says Ruben, “because if any one of the five has not been evaluated and managed, no matter what you are doing with the other four, you are still not going to accomplish healing.”
Here is a listing of terms that are important to understanding wound healing, organized according to their relationship with each other:
Repetitive trauma. Pressure from sitting, lying, bumping, scraping or bruising.
Decubitis ulcer. A skin breakdown caused by repetitive pressure.
Cellulitis. Skin infection that begins in a localized area and spreads. More common in lower extremities, where swelling (edema) often occurs.
Osteomyelitis. Bone infection. The most difficult type of infection to overcome for wound healing.
IV infusion. Intravenous infusion of an antibiotic. Can happen in a hospital, an outpatient clinic, or with a picc line, at home.
Picc line (Peripherally Inserted Central Catheter). A small catheter with an elongated line that is implanted in an arm vein for easy hook-up when longer term (up to six weeks) IV infusion is needed.
Hyperbaric chamber. A closed chamber that increases the pressure of oxygen by a factor of 10. Used mainly when wounds won’t heal due to bone infection.
Edema. Swelling due to accumulation of fluids and/or infection. Can bring on infection and/or inhibit healing.
Manual lymphatic drainage. Massage by a trained technician to move fluids accumulating below the skin and soft tissue back into the blood vessels. Decreases edema.
Sequential compression device. Much like an elongated blood pressure cuff. A device that alternates inflation and deflation sequentially and pushes fluids and blood upwards. Decreases edema.
Venous return system. The system of veins that transports blood back to the heart. Most important in lower extremities. Spinal cord injury often disables this system since muscle contraction, which activates it, has been lost.
MRV — Magnetic Resonance Vein Imagery. An MRI that enhances evaluation of the venous return system.
Venous stasis. A condition where blood no longer effectively returns to the heart since it is static in the veins. Blood and fluid leak, accumulating in soft tissue, causing edema and red staining to the skin.
Venous ulcer. A skin breakdown that occurs when venous stasis, severe cellulitis or both are present. Blood and water blisters appear, followed by skin breakdown.
Venous ablation. A radio frequency technique for ablating (cauterizing) malfunctioning veins, thereby causing blood to seek another return route.
Arterial circulation. The system of arteries that delivers blood from the heart pumping to the entire body. It is pressure dependent.
Venous circulation. The system of veins that returns blood to the lungs for oxygen and on to the heart. It is volume dependent. Gravity can work for or against this circulatory system depending on if the vein is above or below the heart.
Peripheral artery disease. When peripheral arteries in the legs become clogged with plaque, inhibiting or blocking blood flow.
Transcutaneous oximeter. A device that determines the amount of oxygen that blood delivers to a wound area.
Pre-albumin. A marker that indicates the level of protein in blood. The first step in determining whether sufficient protein is available to heal wounds.
Protein deficiency. For wound healing, tissue building and functional maintenance, protein is the most important building block in the body. A deficiency prevents healing (analogy: a house needs to be framed before it can be bricked).
Indirect calorimetry. A method of determining the body’s total nutritional needs if one were at complete rest. Calculates the basal metabolic rate. Additional calories are required above this rate to heal wounds.
Catabolic state. When a body is severely malnourished. To get protein and additional calories for survival, the body “cannibalizes” itself (breaks down muscle and tissue).