What do you know about chronic trauma repair?

In recent years, with the prevalence of various chronic diseases, such as diabetes and cancer, year by year, and the gradual increase of car accident trauma, the number of patients with chronic trauma is also increasing. And as a long-term wasting disease, chronic trauma causes great pain to patients. Patients with chronic wounds can be divided into three categories: patients with chronic skin wounds caused by diabetes, mainly diabetic foot; patients who are bedridden due to cardiovascular diseases and skeletal nervous system diseases, mainly pressure sores (commonly known as “bed sores”); and some patients with wounds that do not heal due to medical factors such as surgery and radiotherapy. There are also patients with wounds that do not heal due to medical factors such as surgery and radiotherapy. Take diabetes as an example. In the last five years, the incidence of diabetes in the world has increased at an alarming rate of 11% per year, and now nearly 200 million people have diabetes, making it the fifth leading cause of death in the world. According to IDF (International Diabetes Federation) estimates, there are 55 million people with diabetes in China, and 1.2 million new cases of diabetes are discovered each year, and the number is increasing at a rate of at least 3,000 people per day. In the next three to five years, 15% of these diabetic patients will develop diabetic foot, and in serious cases will face amputation. In addition, as the population continues to age, the incidence of venous ulcers and decubitus ulcers in the lower extremities continues to climb. Chronic intractable wounds may not be immediately life-threatening, but if left untreated for a long time, they will seriously affect the quality of life of patients and their families, and may even lead to the spread of infection, resulting in complications such as sepsis, which can be life-threatening. Chronic wounds are different from general trauma wounds in that they are more complex and have different epidemiological and pathological characteristics in terms of pathogenesis, site of origin, bacterial infection and pathological changes, and the methods of wound repair are also different. The etiology is mostly related to trauma infection, poor local blood supply, malnutrition, diabetes, and radiation. Therefore, it is necessary to cure the root cause or control it within the normal range and to perform a comprehensive treatment before using plastic surgery techniques to create flaps to repair difficult-to-heal wounds. The treatment of chronic trauma is etiologic treatment. First, systemic treatment. Actively search for and eliminate or control the undesirable factors that affect the healing of trauma. For example, high blood glucose, malnutrition, anemia, vascular lesions, etc. If the internal diseases that cause the wound not to heal are not identified and treated, it is inevitable that the wound will be difficult to heal. Second, local wound treatment. This includes debridement and dressing change to remove necrotic tissue and control bacterial infection. Supplemented by continuous or intermittent negative pressure suction to promote the suction out of traumatic inflammatory substances, eliminate chronic edema, improve local blood supply, and promote the growth of granulation tissue; then through surgery, create a moist and clean environment, suture implants, flap repair, etc. Using this series of integrated techniques, wound healing or wound closure is promoted. For some chronic wounds that cannot be healed by months or years of medication changes, it is not simply a matter of changing the patient’s medication, but rather treating the medication change as a process of observing the condition and treating the disease, and if necessary, culturing the wound secretions to determine whether drug-resistant bacteria or special bacterial infections such as Mycobacterium tuberculosis infection are present on the ulcer surface, so that non-antimicrobial antimicrobial treatment or anti-Mycobacterium tuberculosis treatment can be targeted. treatment to control the growth of drug-resistant bacteria or Mycobacterium tuberculosis. For chronic wounds associated with inadequate local blood supply, such as diabetic foot and pressure ulcers, which are caused by ischemia and hypoxia of the trabecular tissues, improving local blood flow should be the key point of treatment. For chronic leg ulcers caused by varicose veins in lower extremities and soft tissue infection and necrosis in diabetic patients, if the skin defect is too large, it is difficult to heal the wound with regular drug changes, so skin implants or flap repair measures must be taken. For some large chronic wounds that are difficult to close due to excessive tension, such as those with postoperative incisions that do not heal, additional means to promote skin traction closure are required.