Edges may be the problem

Have you heard the saying, "Healing happens from the bottom up and the outside in"


If your wound has a mostly red base but just is not making any progress, it may be because of the edges; the outer rim border of the wound.


The edges can tell you a lot about what is happening in the wound.

  • Too dry and the edges have a flaky, cracked appearance and may bleed easily.

  • Too wet and the edges can be white and macerated.

  • They can roll over themselves which is called epiboly.

  • Or they can just have a silvery look and be stalled out.


This is one for example. A mostly healthy wound bed with just a little bit of slough. It should be improving, but it's not.

The edges are part of the problem; thin, silvery starting to roll at the top and lacking stimulation to close.


When a wound is lacking in any major changes like decrease in size, wound bed or drainage and is open longer than 30 days, it is now a chronic wound.


This wound had become chronic and needed a jumpstart in the healing process. In this case, we recommended "roughing up the edges" while cleansing and before applying ointments and dressings. By taking sterile gauze and lightly rubbing the edge of the wound we are restimulating the wound bed into an active state to reinvigorate the healing process. The technical term is "mechanical debridement" and it can help prevent sloughy tissue, biofilm and epibole from developing. In this particular wound, there is no need to scrub the base of the pink tissue and cause bleeding. The light rub should be only around the outer rim and maybe the yellow speck. It should be only during cleansing and should not produce profuse bleeding or pain. Just a light rub to wake things up a bit. Then apply the dressings as advised.


If you are already doing, wet-dry dressings, this is a form of mechanical debridement and would not be appropriate. If you have been being very gentle and barely touching the wound, then it may be a option. Learn more about debridement types


If you try roughing up the edges at home, follow these tips:

Make sure your hands are clean or use gloves

Cleanse the wound.

Use sterile gauze or a sterile qtip and lightly rub the edge or sloughy tissues.

Go light, you can always do a little more tomorrow.

Cleanse the wound again with an wound cleanser.


Stop if:

If you notice any bleeding or pain, stop and apply a bandage with some pressure.

If the bleeding doesn't stop, seeking immediate medical attention.


 

This is not appropriate for every stalled-out wound. I always suggest you find a local wound specialist for an in-person assessment. However, we can accomplish a lot through a virtual visit while you wait for your in-person appointment.


Reach out today to schedule a video call especially if you can not get into an appointment with a specialist for 2 weeks or more.




 

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