Byram Healthcare

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Local Factors that Affect Wound Healing

Factors		Description
Local Factors
Pressure	Reduces blood flow
Dessication	Reduces fluid available for wound healing chemical reactions; wounds heal 3-5 times faster with less pain in a normally moist wound environment; wound dehydration can cause cell death
Trauma/edema	Supports continued inflammatory response and deprives cells of oxygen required to complete healing
Infection	Continues inflammatory response
Necrosis	Continues inflammatory response and prevents reepithelialization
Incontinence	Moisture that includes infectious substances and can alter skin integrity

The chronic wound is less predictable and timely in healing. The timeline may vary depending on wound cause, site, and the age and physical condition of the patient. Generally, anatomical and functional integrity of tissues is not fully sustained. Healing can be delayed and incomplete. Up to 70% of chronic wounds can be attributed to venous stasis, diabetes, and pressure necrosis.

Chronic wounds that stall between the inflammatory and proliferative stages may require active treatment to support healing. Healing may require more time than acute wounds because of infection, continued pressure and circulation problems, malnutrition, and existing diseases. There are six local wound factors and seven systemic factors that can delay or stall wound healing (shown here). They include pressure, dessication, trauma or edema, infection, necrosis, and incontinence.

Now let’s look at the systemic factors.

Systemic Factors that Affect Wound Healing

Older age	Older age is associated with decreases in immune function, circulation, respiratory function, hydration, and nutrition. These can impair macrophage efficiency, capillary strength, fibroblast mobility, and response to chemical mediators to contract, remodel, and reepithelialize the wound
Body build	Obese patients may have a limitation on blood flow (due to decreased blood perfusion of fat tissues) and mobility; underweight patients may have compromised nutritional status and more prominent bones that increase risk for pressure sores in those areas
Stress	Both physical and psychological stress result in increased catabolic hormone release that can contribute to continued or exaggerated inflammatory responses
Nutrition	Poor nutrition includes deficits of nutrients required for immunity and other body functions involved in the healing process
Medication interactions	Some medications can impair immune function or other vital healing processes; an example is corticosteroids that reduce the migration of neutrophils and macrophages, chemo-attracting substances, growth factor, collagen synthesis, and contraction mediators; when corticosteroids are in use, vitamin A may be supplemented or used topically to reverse some of the negative effects.
Altered vessel function or integrity	Reduces oxygen because of compression, obstruction, changes in vessel walls, or chronic vasoconstriction
Diseases	Some diseases interact to slow healing and favor continued tissue damage; an example is diabetes which is associated with osteomyelitis

These are all factors that contribute negatively to wound healing. Older patients can have the obvious decreases in immune function and circulatory functions, while individuals who are underweight are at higher risk for pressure injuries due to their more prominent bones. Stress and nutritional status both can put a strain on the immune system, while medication interactions can also strain the immune system and the healing process. Blood vessels that are constricted, compressed or obstructed can cause oxygen deprivation in areas where there is already tissue damage, and disease can cause slowed healing and continued tissue damage.