Why Won't My Grandfather's Wound Heal After a Fall?

Why do injuries from falls never seem to heal?

My grandfather fell and got injured over a year ago.
At that time, we didn't think much and treated the wound with standard first aid, but it never healed and continued to spread.
Later, we went to a major hospital for examination, but they couldn't determine the cause.
Blood tests showed no diabetes or hypertension, and now we are unsure which specialist to consult.
I would like to know what other conditions could cause a wound to heal poorly.
My grandfather's wound has persisted for so long that a doctor at one hospital mentioned the need for skin grafting, but they couldn't identify the underlying issue.
(Our elderly family member is currently showing signs of malnutrition, such as lack of appetite; the wound sometimes hurts and sometimes does not.) The wound keeps deteriorating from the epidermis, becoming red, swollen, and exuding fluid, eventually presenting as an open sore.

Dai Dai, 10~19 year old female. Ask Date: 2012/01/30

Dr. Liao Zhongxin reply Internal Medicine

Dear readers,
1.
First, assess whether the grandfather is of advanced age and if his diet is normal; then consider if there are any underlying diseases or medications involved.
Many factors can affect wound healing.

2.
If liver disease, diabetes, and malnutrition have been ruled out, consider seeking further evaluation and treatment at a medical facility that offers hyperbaric oxygen therapy.

Thank you!

Reply Date: 2012/01/30

More Info

The situation you described regarding your grandfather's non-healing wound after a fall is concerning and multifaceted. There are several potential reasons why a wound may not heal properly, and understanding these can help guide you toward the appropriate medical care.

1. Underlying Health Conditions: While you mentioned that your grandfather does not have diabetes or high blood pressure, there are other conditions that can impede wound healing. For instance, peripheral vascular disease (PVD) can restrict blood flow to the extremities, making it difficult for wounds to heal. Additionally, conditions like chronic kidney disease or liver disease can affect the body's ability to heal.

2. Nutritional Deficiencies: You noted that your grandfather is experiencing malnutrition. Nutritional status plays a crucial role in wound healing. Proteins, vitamins (especially Vitamin C and Vitamin A), and minerals (like zinc) are essential for tissue repair and regeneration. A deficiency in these nutrients can lead to delayed healing or even wound deterioration.

3. Infection: If the wound is red, swollen, and producing exudate (fluid), it may be infected. Chronic wounds can become colonized with bacteria, leading to persistent inflammation and delayed healing. Infections can also cause systemic symptoms, which may require antibiotic treatment.

4. Age-Related Factors: Older adults often have slower healing processes due to decreased skin elasticity, reduced blood circulation, and other age-related physiological changes. The skin's ability to regenerate diminishes with age, which can complicate wound healing.

5. Medications: Certain medications can interfere with the healing process. For example, corticosteroids can suppress the immune response and slow down healing. If your grandfather is on any long-term medications, it would be worth discussing with his healthcare provider.

6. Chronic Conditions: Conditions such as venous insufficiency, where blood does not flow properly back to the heart, can lead to chronic wounds, particularly on the lower extremities. If your grandfather has any history of leg swelling or varicose veins, this could be a contributing factor.

Given these considerations, it is crucial to seek a comprehensive evaluation from a healthcare professional. Here are some steps you can take:
- Consult a Wound Care Specialist: Many hospitals have specialized wound care clinics that can assess chronic wounds and provide targeted treatment plans. They can also perform debridement if necessary, which involves removing dead tissue to promote healing.

- Nutritional Assessment: A dietitian can evaluate your grandfather's nutritional status and recommend dietary changes or supplements to support wound healing.

- Infection Control: If there is any suspicion of infection, a healthcare provider may need to perform cultures and prescribe appropriate antibiotics.

- Comprehensive Medical Evaluation: If the cause of the non-healing wound remains unclear, a thorough evaluation by a geriatrician or a physician specializing in internal medicine may be beneficial. They can assess for underlying conditions that may not have been previously identified.

In summary, non-healing wounds can result from a combination of factors, including underlying health conditions, nutritional status, infection, and age-related changes. A multidisciplinary approach involving wound care specialists, nutritionists, and primary care providers will be essential in addressing your grandfather's situation effectively. Prompt action can lead to better outcomes and improved quality of life for him.

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