February 11, 2014
Sometimes a person develops a wound that just won't heal. He keeps the area clean and bandaged, maybe uses some antibiotic ointment...but time goes by, and it doesn't get better. It's painful, it's inconvenient, it's ugly—and it's potentially very, very serious. That's because infection can set in and, in some cases, it even becomes necessary to amputate the affected limb.
You may already know that people with diabetes are at high risk of developing such wounds, but they are not the only ones. Poor circulation, high blood pressure, cardiovascular disease, kidney problems and smoking also increase the risk. That's why everyone needs to be aware of the danger that chronic wounds present...and the unfortunate fact that such wounds often are quite difficult to treat.
The good news: There's exciting new information about a way to help chronic wounds heal better. The key lies in good blood sugar control. Here's why...
SCARY COMPLICATIONS
Chronic wounds most often form on the foot or lower leg where circulation is poor, though they can form anywhere. When other treatments fail, doctors generally performsurgical wound closure. However, postsurgical complications are common—and when the operation doesn’t work the first time, the likelihood of needing amputation rises. That’s why it is so important for patients to do everything in their power to prevent such complications.
Researchers at Georgetown University Hospital in Washington, DC, studied the records of patients who’d had operations to close wounds that wouldn't heal on their own. All the patients had been at risk for poor wound healing due to one or more ailments—for instance, 72% had diabetes…51% had peripheral vascular disease…30% had kidney problems…and 13% had congestive heart failure. What the researchers scrutinized was the patients' blood sugar levels during the five-day periods before and after the surgery—and what they found was startling...
• Dehiscence (splitting open or separation of the layers of a surgical wound) occurred in 44% of patients with high blood sugar (above 200 milligrams per deciliter, or mg/dL)…compared with just 18% of patients who had not had high blood sugar.
• Reoperation was required for 24% of patients with high blood sugar…but just 15% of the other patients.
• Infection developed in 11% of patients with high blood sugar…versus 6% of those without it.
Researchers also looked at how much the patients' blood sugar levels changed in the time surrounding the operation. They found that patients who had wider swings—meaning a difference of more than 200 mg/dL between their highest and lowest blood sugar levels—were four times more likely to need another operation to repair the wound than patients who had tighter control over their blood sugar levels.
This study also showed that the hemoglobin A1C test, which gives a person's average blood sugar level over the previous six to 12 weeks, should not be used to determine whether a patient’s blood sugar control is adequate to provide optimal chances for recovery after wound closure surgery. Although hemoglobin A1C frequently is used as a marker of long-term blood sugar control, the researchers determined that more than halfof the patients with normal hemoglobin A1C levels did have high blood sugar at least once during the period immediately before or after their operations—putting them at increased risk for complications.
Why wounds won’t heal when blood sugar is high: Cells called fibroblasts and stem cells, which are vital for collagen formation and wound healing, cannot function properly when they have been exposed to high blood sugar for more than 24 hours. This explains why controlling glucose during the entire period surrounding an operation—and not just on the day of surgery—is so critical for recovery.
Self-defense: If you are anticipating wound-closure surgery, work closely with your doctor to keep your blood sugar under tight control in the days before and after your operation. If the day of your surgery approaches and you have not achieved good blood sugar control, talk with your doctor about the pros and cons of postponing the operation until your blood sugar level improves.
Source: Study titled “The Role of Chronic and Perioperative Glucose Management in High-Risk Surgical Closures: A Case for Tighter Glycemic Control,” published in Plastic and Reconstructive Surgery.
