A number of etiologic
factors have been identified (Table 2) which impede
the normal healing process allowing a chronic wound
to develop. Systemic factors such as malnutrition
and chronic illness prevent the acute wound from
healing due to inadequate protein synthesis needed
for new tissue development. Other factors such as
impaired perfusion, hypoxia, do not allow healing to
occur because of inadequate oxygen. Other systemic
factors such as infection, diabetes, and
corticosteroids directly impede healing.
The most common local factors which allow a chronic
wound to develop are continue mechanical trauma to
the wound and or the use of wound care products
toxic to the cells of the wound bed. Repeated loss
of the new tissue synthesis will eventually lead to
a chronically inflamed wound.
Often there are several etiologic factors which are
present. Correction of these systemic and/or local
factors is needed to allow the wound to heal. The
wound microenvironment changes dramatically from
normal and the changes seem to self perpetuate,
making it extremely difficult to heal. The
characteristics which impede healing will be
described below.
