Conway McLean, DPM, Journal columnist

Has anyone ever mentioned, in casual conversation, amongst acquaintances or business associates, their chronic skin wound? Not exactly a hot topic in social circles, is it? Most sufferers of this too-common condition are embarrassed about their non-healing or slowly healing skin injury. Let’s face it, most would say it’s a pretty disgusting subject, and these openings in the skin can be. But it is a huge problem and under-represented in the media.

These wounds of the skin can occur for myriad reasons. They are often disguised as part of some other disease, like the diabetic who develops a foot ulcer. The foot problem becomes a sub-story of their diabetes. As it is with heart disease and gangrene of a toe due to blood vessel disease (like the ones going to the heart). It has become clear this approach is inappropriate and downright flawed. And it has led to the death of too many Americans.

Chronic wounds represent a silent epidemic that affects a large percentage of the world population. 6.5 million Americans have these painful lesions. Many experts claim it is significantly higher than the 2% of the population as listed in the journals. In the years to come, our aging population will contribute to this figure, and the diabetic epidemic could result in that number exploding. More than $25 billion each year is already spent by the healthcare system on treating these wounds and their related complications.

A lengthy discussion appeared in these very pages many months ago, examining the different causes for these non-healing ulcers. My intention here is quite the opposite, concentrating on the progress made in healing these stubborn injuries to the skin. New technologies and techniques have paid off in our on-going battle to heal these chronic wounds. We have learned much about the mechanisms of these wounds and what is occurring when they won’t close in a timely fashion.

One essential component of our new-found skills concerns the basics: how best to keep a wound clean, uninfected, free of dead tissue. These techniques are referred to as “standard wound care” practices. Surprising to many (including many health care providers) is the importance of keeping the surface of a wound moist. This is not to say it should be kept wet nor that a wound should be allowed to dry out. These are now taken as fact, having been proven decades ago.

Perhaps the craziest technique that has surfaced recently entails the application of….are you ready?….fish skin. Yes, you read that correctly. Obviously the material has been processed but surprisingly, only minimally, preserving its structure. Fish skin is rich in omega3 fatty acids, apparently of benefit in recruiting new skin cells to the area. The fish skin graft seems to elicit minimal reaction by the recipient of the product and very importantly, there are no concerns of disease transmission. They are too alien! Having used this product on various types of ulcers, I can attest to its effectiveness.

Some exciting new technologies have allowed us to heal wounds we once thought unsalvageable, especially those due to inadequate blood flow. For several years, I have utilized a unique form of electric stimulation which causes tiny blood vessels to open up, delivering more blood to some body part deprived of sufficient quantities. This condition occurs generally to those regions farthest from the heart, that being the feet and toes. Treatments with this technology, performed over several weeks, can produce new tissue growth “before your eyes,” an exciting development to all parties involved.

The removal of dead, diseased, or infected tissue from a chronic ulcer is vital to healing, another practice in wound care established beyond question. Every study on the topic reveals the more often the wound is cleaned up, a procedure called debridement, the faster it will heal. Unfortunately, this can be an exquisitely painful procedure. A new device produces an ultrasonically charged mist that achieves this painlessly, while also improving blood flow to the area and, in addition, killing bacteria.

One of the most successful new techniques utilizers the principles of regenerative medicine, involving the use of amniotic tissues from a placenta (following a planned C-section). These provide abundant and authentic growth factors, which recruit stem cells to the area. These are cells capable of forming any kind of tissue, including new skin. These products have been a tremendous addition to our tool bag of therapies for closing non-healing wounds.

Statistically, the most common type of chronic ulcer occurs on the lower leg, just above the ankle. These are nearly always due to swelling problems, generally secondary to a vein condition. The traditional recommendation to prevent these open sores is the use of compression stockings. For most seniors, these are nearly impossible to get on, and should they have assistance in donning them, they are too uncomfortable to leave on. A new sleeve-like garment has been consistently gratifying in its benefits, effectively reducing the swelling and improving both skin health.

Chronic wounds can have a tremendous impact on the health of patients, as well as their quality of life. They cause pain, both physical and emotional, to patients and their families. Normal everyday functions and activities may be limited, at home or the workplace. Mobility issues are typical, as is depression and anxiety. The financial burden can be prodigious, especially if insurance is inadequate or lacking. Chronic wounds can lead to dangerous complications, even death.

The choices of dressing materials and medicines for wound care is staggering, a billion dollar market. Nearly every day, I see new medicines, techniques, therapies, all directed at some aspect of wound healing. It’s a gratifying time for wound care specialists. To those afflicted with a foot or leg ulcer that won’t heal, these injuries are both disheartening and confusing. Who to turn to, who best to consult? Physician-only board certification in wound healing is a sure sign of interest and knowledge.

Despite the frustration experienced by many of those afflicted with these difficult lesions, there is usually some medicine, technique, or therapy that will lead to healing, changing a wound in which healing has stalled to one moving progressively towards closure. If you or a loved one has a chronic wound, find out why and what can be done. This is an injury you don’t want to live with, and chances are excellent, you don’t have to.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.