There are a broad spectrum of wounds that individuals develop. For most people, injury to the skin (the largest protective organ of the body) is followed promptly by a wound response process that ultimately leads to wound closure within 1-2 weeks. In the presence of chronic diseases like diabetes, kidney failure, lupus or scleroderma or when systemic medications like coumadin or steroid agents are being taken-wound healing may require a longer time. In my experience, wounds that have failed to heal within 2-3 weeks following their onset should be referred to a wound care specialist for evaluation. There is a critical window when advanced local wound care measures including debridement, skin grafting and edema control can be maximally effective to heal wounds. With time, wounds develop bacterial colonization which is an additional factor that must be addressed.
It is quite unusual for most outpatient primary care doctors to have access to the numerous wound care products which are most helpful in select circumstances. Furthermore, active debridement and reducton of bio burden is a hallmark of the effort to optimize the wound environmnet
Unfortunately, wounds can develop in elderly people as a function of their bedridden or nonambulatory state. In these cases, the wounds often need offloading and their may be an underlying component of ischemia which requires treatment. Cases like these benefit fully from the involvement of a multidisciplinary team that may consist of a vascular surgeon, podiatrist, plastic surgeon and woundcare nurse specialist
