The skin defect of the wound surface is too large, which is more common in surgery, such as second-degree burn, necrosis of large skin flap after incision and drainage of neck carbuncle and back carbuncle, chronic leg ulcer caused by varicose veins of lower limbs and soft tissue infection and necrosis of diabetic patients. If the skin defect is more than 5 cm, it is difficult to make the wound heal by conventional dressing change, and only by taking the measures of point skin grafting can the wound heal.
Wound infection Wound infection is the most common reason that affects wound healing. In addition to the common infections of Staphylococcus aureus, Streptococcus and Escherichia coli, there may also be infections of Pseudomonas aeruginosa, Mycobacterium tuberculosis and fungi. Therefore, for wounds that are difficult to heal for a long time, the wound should be cleaned, the necrotic tissue should be removed, the wound secretion should be cultured with bacteria, and then antibiotics should be used locally or systematically according to the drug sensitivity test to promote wound healing.
There is a foreign body in the wound. When the body is debrided after being injured by sharp nails, wooden thorns, glass, etc. (especially in emergency dressing change treatment), small foreign bodies are likely to remain in the wound. This kind of wound with foreign body is difficult to heal. Although the dressing was changed repeatedly, the swelling and pain of the wound did not improve and the secretion did not decrease. If the foreign body in the wound can be removed in time and treated with antibiotics, the wound can heal quickly.
Repeated dressing changes for granular edema, especially irregular dressing changes, can easily lead to granulation edema. Edema granulation is pale white or reddish, and there are many secretions, which are higher than the skin and make the wound heal. Unhealthy granulation above the skin is removed, and then 33% magnesium sulfate (magnesium ions can dehydrate granulation and promote skin cell regeneration) is applied externally, and skin grafting is carried out locally if necessary. Under normal circumstances, the wound can be healed in about 2-4 days 1 time or 1 month.
Systemic malnutrition Most patients with chronic consumptive diseases such as cancer, diabetes and tuberculosis suffer from systemic malnutrition and weak collective resistance, which affects wound healing. Especially after chemotherapy and radiotherapy, it is more difficult for tumor patients to heal wounds. On the basis of local treatment, this kind of patients should be treated with systemic nutritional support to improve their nutritional level and enhance the regeneration ability of tissue cells, so as to promote wound healing.
In addition, factors such as hematoma in the wound, poor drainage and poor skin alignment at the suture mouth are also the reasons why the wound is difficult to heal. Therefore, it is necessary to correctly analyze the causes of delayed healing wounds, carefully examine them, and then carry out targeted treatment to make them recover as soon as possible.
References:
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