Risk factors for impaired wound healing and wound complications
- David G Armstrong, DPM, MD, PhD
David G Armstrong, DPM, MD, PhD
- Professor of Surgery and Director
- Southwestern Academic Limb Salvage Alliance (SALSA)
- Keck School of Medicine, University of Southern California
- Andrew J Meyr, DPM
Andrew J Meyr, DPM
- Clinical Associate Professor
- Temple University School of Podiatric Medicine
- Section Editors
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Acute wounds in normal, healthy individuals heal through an orderly sequence of physiological events. Some individuals have one or more factors that contribute to impaired wound healing, which can lead to chronic nonhealing wounds and ulcers or can complicate the surgical course.
The risk factors associated with impaired wound healing due to patient factors, underlying disease, and disease treatments are reviewed here. Wound mechanisms, normal phases of wound healing, and wound classification as well as the clinical evaluation and management of wounds are discussed elsewhere. (See "Basic principles of wound healing" and "Clinical assessment of wounds" and "Basic principles of wound management" and "Overview of treatment of chronic wounds".)
Impaired wound healing — A wound is a disruption of the normal structure and function of the skin and underlying soft tissue . Acute wounds in normal, healthy individuals heal through an orderly sequence of physiological events. (See "Basic principles of wound healing".)
The overlapping intricacy of the wound healing pathway serves to prevent a single primary factor from disrupting the process. As examples, local tissue ischemia and neuropathy can impair chemotaxis during the hemostasis and inflammatory stages, tissue necrosis and infection alter the balance of inflammation and compete for oxygen, and uncontrolled periwound edema and wound instability disrupt myofibroblast activity, collagen deposition, and cross-linking. Impaired wound healing often occurs in the setting of multiple, smaller contributing issues to stall the healing process; however, infection or ischemia alone can impair wound healing.
When the healing process is stalled, a chronic wound may develop, and this is more likely to occur in patients with underlying medical disorders. Chronic ulceration commonly affects the lower extremities with a prevalence that ranges between 0.18 and 1.3 percent in the adult population [2-5]. The most common nonhealing wounds affecting the lower extremities are associated with chronic venous insufficiency, peripheral artery disease, and diabetes mellitus [1,2,6-8].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL PRINCIPLES
- Impaired wound healing
- Risk factors
- Surgical site infection
- - Risk factors
- - Surgical wound classification
- SMOKING AND NICOTINE REPLACEMENT THERAPY
- IMMUNOSUPPRESSIVE THERAPY
- VASCULAR DISEASE
- Peripheral artery disease
- Chronic venous insufficiency
- LESS COMMON FACTORS
- Sickle cell disease
- SUMMARY AND RECOMMENDATIONS