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A chronic wound is a wound that does not progress through the normal stages of wound healing—haemostasis, inflammation, proliferation, and remodeling—in a predictable and timely manner. Typically, wounds that do not heal within three months are classified as chronic. [ 1 ]
Chronic wound pain is a condition described as unremitting, disabling, and recalcitrant pain experienced by individuals with various types of chronic wounds. [1] Chronic wounds such as venous leg ulcers, arterial ulcers, diabetic foot ulcers, pressure ulcers, and malignant wounds can have an enormous impact on an individual’s quality of life with pain being one of the most distressing symptoms.
Wounds can vary greatly in their appearance depending on wound location, injury mechanism, depth of injury, timing of onset (acute vs chronic), and wound sterility, among other factors. [ 1 ] [ 2 ] Treatment strategies for wounds will vary based on the classification of the wound, therefore it is essential that wounds be thoroughly evaluated by ...
Timing is important to wound healing. Critically, the timing of wound re-epithelialization can decide the outcome of the healing. [11] If the epithelization of tissue over a denuded area is slow, a scar will form over many weeks, or months; [12] [13] If the epithelization of a wounded area is fast, the healing will result in regeneration.
Chronic ulcer symptoms usually include increasing pain, friable granulation tissue, foul odour, and wound breakdown instead of healing. [3] Symptoms tend to worsen once the wound has become infected. Venous skin ulcers that may appear on the lower leg, above the calf or on the lower ankle usually cause achy and swollen legs.
“Moral injury is a touchy topic, and for a long time [mental health care] providers have been nervous about addressing it because they felt inexperienced or they felt it was a religious issue,” said Amy Amidon, a staff psychologist at the San Diego Naval Medical Center who oversees its moral injury/moral repair therapy group.
Repeated bouts of ischemia and reperfusion injury also are thought to be a factor leading to the formation and failure to heal of chronic wounds such as pressure sores and diabetic foot ulcer. [4] Continuous pressure limits blood supply and causes ischemia, and the inflammation occurs during reperfusion.
Some troops leave the battlefield injured. Others return from war with mental wounds. Yet many of the 2 million Iraq and Afghanistan veterans suffer from a condition the Defense Department refuses to acknowledge: Moral injury.