When Wounds Won't Go Away...

If you get a scrape or other superficial wound, it usually heals in a week or two. But some

wounds don't go away so quickly-especially if you're an older adult, are confined to a bed or wheelchair, or have diabetes or some other condition that interferes with your blood circulation.

Latest development: New, highly effective therapies and the proliferation of wound-care centers staffed by doctors and other health-care professionals (often located at large medical centers or university hospitals) are helping to prevent amputations, life-threatening infections and other serious complications.*

Why Wounds Become Chronic

If a wound doesn't heal within six weeks, it is considered chronic and requires special care. Poor blood flow, which cuts off the supply of oxygen and nutrients that are needed for healing, is a common cause of chronic wounds.

Basic care for all chronic wounds usually involves cleansing (to remove foreign matter and bacteria-laden debris)...debridement to remove dead and damaged tissue).. and dressing often treated with a medicinal preparation, such as an antimicrobial solution, to prevent the growth of bacteria).

Common Chronic Wounds

• Diabetic foot ulcers. Among Americans with diabetes, 15% will develop a foot ulcer, and many of them will ultimately require amputation of the foot-usually because the patient has developed a life-threatening condition, such as gangrene (decay and death of tissue due to insufficient blood supply).
  

Why are people with diabetes at such high risk for foot ulcers?

The disease not only impairs healthy blood flow, but also inhibits the body's ability to fight infection. In addition, neuropathy (a type of nerve damage that often occurs in people with diabetes) can cause nerve pain and decrease sensation, so pressure and injury may go unnoticed.

Diabetic ulcers typically occur at points of prolonged or repeated pressure on the skin and underlying tissue-for example, the big toe or front part of the foot.

Self-defense: People with diabetic foot ulcers should wear properly fitting shoes. They also may need a podiatrist to check for abnormalities in their gaits, perhaps with the aid of a computerized scan of pressure points on their feet. Special shoe inserts (orthotics) can help adjust the position of the foot to relieve pressure points.

"To find a wound-care specialist in your area, consult the American Academy of Wound Management (202-4578408, www.aawm.org).

• Venous ulcers. When veins, which carry blood back to the heart, don't function properly, blood can pool in the legs, causing swelling and discoloration and disrupting the supply of fresh blood with its oxygen and bacteria-fighting immune cells. This sets the stage for venous ulcers to develop.
  

Self-defense: The main treatment for a venous ulcer is compression (wrapping the leg, under a doctor's supervision, with an elastic bandage or special stocking to reduce swelling and improve blood flow). Venous ulcerations that don't respond to standard therapy may require surgery to close off the failing veins, which improves blood flow back to the heart and reduces venous pressure in the leg.

• Arterial ulcers. Atherosclerosis, the build up of fatty deposits (plaque) that narrows the coronary arteries, also may impair circulation to the limbs. If circulation is further inhibited by a tiny blood clot, tissue may die, causing an arterial ulcer, typically on the toes or an ankle.
  

Self-defense: The most effective treatments for arterial ulcers are much like those used for coronary artery disease-the doctor may thread a catheter into the affected artery and inflate a balloon to open it up, possibly inserting a stent (tiny wire mesh tube) to keep it open.

A severe blockage may require bypass surgery as with a coronary bypass, a blood vessel (taken from elsewhere in the body) is implanted to "bypass the blockage.

• Pressure ulcers. Also known as bedsores, these afflict people who are confined to a bed or wheelchair. Immobility causes constant pressure, which cuts off circulation (for example, in the tailbone). About 9% of hospitalized patients develop pressure ulcers, usually during the first two weeks of their stay.
  

Self-defense: Pressure ulcers require the same care as other chronic wounds. Bedsores often can be prevented by regularly changing an immobile person's position (every two hours), which distributes pressure more evenly.

Breakthrough Therapies

A chronic wound is a magnet for bacteria—the dead tissue and moisture provide a hospitable environment for germs to thrive.

Recent development: A treatment available at many wound-care centers uses low-frequency ultrasound to break up biofilm la microscopically thin layer of film containing bacteria) on the wound. This stimulates the production of cells that fill in the wound with new tissue and help keep the area clean.

Caution: Notify your physician promptly if your wound shows signs of infection, such as pain, odor, redness, pus or streaks along the affected limb, or if you have a fever (above 99°F). Infections require antibiotic treatment.

Wounds that refuse to heal despite treatment may require one of the other latest therapies typically available at wound-care centers…

• Cell therapy involves placing a bioengineered skin substitute over the wound. This film-like material secretes substances that stimulate your own cells to grow tissue that will close the wound. Cell therapy is often used for resistant diabetic or venous ulcers.
  
• Hyperbaric oxygen therapy, which is mainly used for diabetic ulcers, involves sitting or lying for about 90 minutes in a room or chamber that contains 100% oxygen at two to three times normal air pressure. Breathing this supercharged air promotes wound healing by raising oxygen levels in the blood.
  
• Negative pressure wound therapy, which is used for diabetic and arterial ulcers, involves placing a sponge or foam dressing over the wound and attaching a device that suctions off waste fluids and infectious material, thus stimulating the growth of new tissue.
  

New Technique Reduces Risk For Diabetic Foot Ulcers by 30%

For patients with diabetes, open sores on the I feet heal slowly, due to impaired sensation and circulation. In a recent study, 225 patients with type 2 diabetes did a daily foot inspection for 18 months and received education and therapeutic footwear. Half the patients also used an infrared skin thermometer (a probe that is placed on the skin) to measure foot temperature twice daily. Whenever a difference of more than 4'F was detected between the right and left foot, patients curtailed physical activity until temperatures normalized.

Result: Temperature-taking patients were 30% less likely to develop ulcers.

My view: Measuring skin temperature is a noninvasive way for diabetes patients to identify inflammation-a warning sign of an impending ulcer-so they can allow time to heal. The thermometer the study used, Diabetica Solutions' Temp Touch Thermometer, is available without a prescription (800-246-3395, www. temptouch.com) for $99 and is covered by some insurance plans.

Older Treatment Better at Saving Eyesight

Several years ago, early reports of success suggested that injection of steroids into the eye was a promising new treatment for diabetic macular edema (retinal swelling).

Surprising study: After two years of treatment, vision had worsened substantially in 28% of patients treated with steroids...but in only 19% of patients given the traditional laser therapy. Steroid users also had more side effects, including cataracts and increased eye pressure.

Easy Eye Scan Detects Diabetes

An experimental test uses specialized photographs of the eye to detect tissue damage caused by diabetes. The test is noninvasive and faster than blood-glucose testing and could allow an earlier diagnosis.

Does Diabetes Cause Hearing Loss?

When researchers recently analyzed hearing test results and related questionnaires for about 5,000 Americans, they found that hearing loss was about twice as common in people who had diabetes than in those without diabetes.

Theory: Diabetes may cause hearing loss by damaging nerves and blood vessels in the inner ear.

If you have been diagnosed with diabetes: Ask your doctor to refer you to a hearing specialist (audiologist), so you can receive a hearing test.

Get a Fatty Liver in Shape With Exercise

Excess fat in the liver can lead to cirrhosis and liver failure, especially in diabetes patients, necessitating dialysis or a transplant. Liver fat was reduced by an average of 34% among type 2 diabetes patients who did 45 minutes of moderate aerobic exercise (walking, cycling) plus 20 minutes of weight lifting three times weekly for six months. Waistlines shrank an average of two inches.

Diabetes Linked to Colon Cancer

In a recent analysis of data for 45,000 women, those with diabetes were 1.5 times more likely to develop colorectal cancer during an eight-and-a-half-year period than women without diabetes.

Theory: Elevated levels of insulin (a hormone that helps regulate blood sugar) may stimulate cancer-cell growth. These findings are believed to apply to men as well.

If you have diabetes: Control your blood sugar levels, and ask your doctor how often you should have a colonoscopy.