Understand wounds and wound healing

Diabetic Foot Ulcer

Posted on by Steven CHEE

What is a diabetic foot ulcer?

Diabetic foot ulcers are one of the major complications of diabetes. Between 19 and 34% of all diabetics will develop a foot ulcer at some point in their lives1. Often underestimated, or even unrecognised by the patients affected, it can lead to complications such as an infection requiring hospitalisation, or even in the worst cases, amputation. After amputation, patient life expectancy does not exceed 5 years in almost 70% of cases, which is lower than that for certain types of cancer2. This outcome is not however a fatality. With proper prevention, ulcers can be avoided.

What causes diabetic foot ulcers?

Diabetes does not only cause blood sugar imbalance. It also causes two phenomena which increase the risk of occurrence of a diabetic foot ulcer:

  • Involvement of the distal nerves of the legs, especially with loss of sensitivity. As a result, the patients only rarely feel they have an ulcer (neuropathic ulcer).
  • Blocked arteries, ultimately leading to insufficient blood flow (ischemic ulcer).

In three out of four cases, diabetic foot ulcers are related to wearing uncomfortable shoes, to an injury caused when cutting the toe nails, to a burn/friction or to fissures / cracks on the soles of the feet.

The longer an ulcer remains open, the more the risk of infection increases. It can lead to amputation in extreme cases.

Types of diabetic foot ulcers

Caused by an initially minor lesion (a simple cut through to wearing uncomfortable shoes), a diabetic foot ulcer can take three forms:

 

Neuropathic ulcer

Appearing on the toes or under the arch of the foot, as a perforating ulcer of the foot, on the foot joint, this ulcer begins with a callus or corn. It comes with a loss of sensitivity (pain/heat), has clear edges and the skin is dry. In effect, diabetes causes neuropathy which affects the sensory and motor nerves, weakening the extremities of the lower limbs. Therefore, the patient’s foot becomes deformed and their nails become curved like claws. The loss of sensation in the foot can even prevent the patient feeling they have an ulcer, which can then rapidly become infected.

Ischemic ulcer

This is related to a perfusion defect. It mainly occurs on the tips of the toes, on the heel or edge of the foot. The skin breaks, and is pale or bluish in colour. The foot is cold and painful, and the patient can feel burning or itching sensations. Yellow, red, pink, or even black if it is necrotic, the ulcer can take on different colours, depending on its stage of progression.

Neuro-ischemic ulcer

It is related to neuropathy and is associated with the ulcer forming on the edge of the foot or tips of the toes, or even under the toenails. The first sign is generally a blister caused by repeated friction of the foot in shoes that are too tight or too narrow.

In adults, an infection is likely to occur in addition to the ulcer. In effect, the open wound is subject to bacterial invasion. Diabetic foot ulcer therefore makes diabetes the leading cause of amputation in the world3.

Prevention of diabetic foot ulcers

The severity of the foot involvement requires targeted prevention according to the risk. The Haute Autorité de Santé (HAS)4 has therefore defined a podiatric risk grading system in order to adapt treatment. The foot assessment is used to grade the level of risk according to the following classification:

Grade 0: no sensory neuropathy

Podiatric risk grade 0 means there is no loss of sensitivity in the feet. Therefore, the risk is the same as in the general population. It is the most common situation. Standard hygiene rules should be followed, like wearing appropriate, non-traumatic footwear or avoiding maceration (feet should be dried properly and synthetic socks should be avoided) and traumatic treatments (e.g.: use of a scalpel). It is especially important to balance the diabetes as far as possible and to control any risk factors (e.g.: smoking, arterial hypertension, cholesterol etc.).

Grade 1: isolated sensory neuropathy

In addition to the recommendations that apply for grade 0, you can also follow the advice below:

  • If the ulcer is very painful or uncomfortable, talk to your doctor about it. Certain medicines can provide relief, in addition to balancing blood sugar.

  • If the ulcer involves loss of sensation, you or a member of your family must inspect your feet daily. It will enable you to detect any ulcers that go unnoticed. It is essential to see a doctor as soon as possible if there is an ulcer, even if it is not painful.

It is especially important to not damage the feet using too abrasive and/or corrosive treatments, by wearing shoes that hurt or walking barefoot etc. Apply a moisturising cream daily if your feet are very dry. Of course, your diabetes should be controlled as effectively as possible to prevent the neuropathy worsening.

Grade 2: sensory neuropathy with arteriopathy of the lower limbs and/or foot deformation

Grade 3: history of ulcer or amputation

These very high risk feet (grade 2 and grade 3) require both increased vigilance on your part and/or by your family, but also active ulcer prevention measures. Podiatrists or nurses can remove the hyperkeratosis (callus). Podiatrists/chiropodists/orthotists can make ortheses or insoles to correct abnormal weight bearing areas. Sometimes, if your foot is very deformed, you may even have to wear specially-made shoes. If there is arterial involvement, revascularisation may be essential.

Treatment of Diabetic Foot Ulcers

First of all, diabetic foot ulcers require rapid and comprehensive treatment to minimise the risk of complications. Regardless of its size, the ulcer must then be closely monitored by a multi-disciplinary team. The team includes the diabetes specialist, the general practitioner, the nurse, the podiatrist-chiropodist and the surgeon who will all closely monitor the more or less rapid progress of the ulcer.

Wearing a pressure relief device is also compulsory. It means the foot does not press on the ulcer and more effectively distributes pressure on walking, so as not to aggravate the wound.

It is essential to apply a dressing after careful ulcer cleansing and removal of denervated tissue. Its aim is to promote healing.

The diabetes, comorbidities and nutritional status must also be managed at the same time.

Prevent relapse of Diabetic Foot Ulcers

70% of healed diabetic foot ulcers relapse within 5 years5 . Diabetic patients must therefore take special care of this part of their body, by following some basic recommendations:

  • Wear shoes suited to the shape of the foot, and always with socks. 

  • Never walk barefoot

  • Show their feet to a chiropodist on a regular basis

  • Monitor the general foot condition (use a mirror to inspect the sole)

  • Continue to closely monitor blood sugar levels and follow a diabetes-reducing diet.

  • Ask a podiatrist or chiropodist to look after their feet and nails (cutting/filing) and not use corn remover (product to remove corns)

  • Wash their feet daily with soap and water, not forgetting to dry between the toes and user a moisturiser to keep them supple.

  • Not warm their feet using a heat source (e.g. Hot water bottle)

1- Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med 2017; 376: 2367-75
2- Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med 2016; 33:1493–98.
3- Whiting, D. R., Guariguata, L., Weil, C., and Shaw, J. 2011. “IDF Diabetes Atlas: Global Estimates of the Prevalence of Diabetes for 2011 and 2030.” Diabetes Res. Clin. Pract. 94 (3): 311-21.
4- Evaluation of the acts performed by the pedicure-podiatrist for the prevention of grade 1 risk foot injuries in the diabetic patient. French Health Authority. (Évaluation des actes réalisés par le pédicure-podologue pour la prévention des lésions des pieds à risque de grade 1 chez le patient diabétique. Haute Autorité de Santé)
5- Connor H, Mahdi OZ. Repetitive ulceration in neuropathic patients. Diabetes Metab Res Rev. 2004 May-Jun;20 Suppl 1:S23-8. doi: 10.1002/dmrr.446. PMID: 15150809.

Venous Leg Ulcer

Posted on by Steven CHEE

What is a leg ulcer?

Leg ulcers are skin lesions arising from bad blood circulation into the veins and/or the arteries. They affect 1 in 1001 people, mainly women, and up to 3% of the over 65s2. These ulcers can take a long time to heal and need to be taken seriously as soon as they appear in order to prevent them from worsening.

Located on the lower third of the leg (under the knee), leg ulcers are chronic wounds that have not healed after 6 weeks. The wounds may be caused by a knock, by scratching, and sometimes can appear on their own.

  • Venous leg ulcers (comprising 70% of cases3): related to poor venous circulation. They are superficial in most cases, with inflamed, uneven edges. Venous leg ulcers are painful and usually located around the ankle.
  • Arterial leg ulcers (comprising 10% of cases3): related to poor arterial circulation. They start out as a small cut with uneven edges on the leg or foot. Gradually becoming deeper, arterial leg ulcers can even go on to reveal the tendons or the bones, as they become progressively necrotic (can turn black). They are generally very painful.
  • Mixed leg ulcers: related to poor arterial and venous circulation. Signs of a venous ulcer and an arterial ulcer are present at the same time.

How does a venous ulcer form?

A venous leg ulcer is a sign of chronic venous insufficiency, which prevents the blood flowing normally in the leg veins. Blocked along its usual path, the blood stagnates in the leg veins, and goes on to damage the tissue and break the skin.

This is why treatment should come with an in-depth diagnosis, to identify the cause of the venous failure.

Various factors can increase the risk of developing leg ulcers:

  • History of varicose veins or deep vein thrombosis
  • Lack of physical exercise
  • Arterial hypertension or diabetes
  • Being overweight
  • Smoking and alcohol abuse

How is venous leg ulcer treated?

The sooner the ulcer is treated the faster it will heal.

Venous leg ulcers or predominantly venous leg ulcers must be treated by a doctor. Treatment generally begins with careful wound cleansing with soap and water or saline solution, without it needing disinfecting (using an antiseptic may imbalance the skin’s flora and slow down the healing process, or even cause an allergy). It is also essential to apply an appropriate dressing. Healthcare professionals should prescribe patients a dressing to reduce the healing time, based on the available clinical evidence.

The treatment should include the use of suitable compression bandages during the healing process, followed by lifelong use of compression socks. The good news is that with compression, venous leg ulcer relapse can be avoided by up to 90%; in contrast, without it, the relapse rate can reach 97%*.

In the event of a mixed leg ulcer (both venous and arterial), compression can be indicated but it will be looser than for a venous ulcer. It will depend on the degree of associated arteriopathy.

Compression is not indicated in arterial ulcers.

Avoiding relapse

Taking care of general health is the best way of preventing a leg ulcer from recurring:

  • Taking regular walks to stimulate blood flow
  • Wiggling, curling and pointing the toes while seated
  • Rotating the ankle in both directions
  • Avoiding sitting cross-legged
  • Avoiding hot baths
  • Wearing compression socks
  • Wearing comfortable, non-slip shoes
  • Regularly moisturising the skin
  • Adopting a balanced diet and a healthy lifestyle (drink plenty of water, stop smoking)
  • Preventing weight gain
* URGO disease wound care training.
(1) B. Noël. Management of a venous leg ulcer. Revue Médicale Suisse No. 16 published on 20/04/2005)
(2) Jones JE, Nelson EA, Al-Hity A. Wounds Group. January 2013
(3) Moffat, 2001 and 2014

Burns

Posted on by Steven CHEE

Contact with hot drinks, food, fats and cooking oils was the most common cause of thermal injuries however explosions, chemical burns, contact with fire, smoke or flames and exposure to light and radiations can also cause burns. All burns require immediate first aid treatment. Burns can lead to functional, aesthetic and psychological effects. If there is significant skin loss there is risk of infection.

What is a burn?

A burn is a skin lesion which sometimes affects underlying tissue. There are four types:

  • Thermal – occurs due to contact with a solid (eg embers, hot iron, oven), liquid (boiling water/oil/burning hydrocarbon), or an explosion. Biting cold can also cause burns.
  • Chemical – caused by a caustic product (eg. acid)
  • Electrical – caused by contact with an electric current or arc.
  • Radiation – caused by solar UV radiation, XRay or nuclear radiation.

Types of burns

The severity of a skin3 depends on three main criteria: depth of burn, extent over the body and location on the body.

How is the depth of a burn evaluated?

There are three levels of burns:4

  • Superficial – these burns cause damage to the first or top layer of skin only. The burn site will be red and painful.
  • Partial thickness – these burns cause damage to the first and second skin layers. The burn site will be red, peeling, blistered and swelling with clear or yellow-coloured fluid leaking from the skin. The burn site is very painful.
  • Full thickness – involves damage to both the first and second skin layers, plus the underlying tissue. The burn site generally appears black or charred with white exposed fatty tissue. Very deep burns may damage the underlying muscle or bone. The nerve endings are generally destroyed and so there is little or no pain at the site of the full-thickness burn. However, surrounding partial thickness burns will be very painful.

  

Les degrés de la brulure

It can be difficult to tell the difference between partial and full-thickness burns. The depth of a burn is not critical in the initial treatment of burns. An assessment of the extent of the burn is more important initially.

 

How is the extent of a burn evaluated?

The extent of burn is estimated as a percentage of total body surface area.

Location

Burns to some areas such as the face, hands, feet and perineum are taken particularly seriously.

Other factors to be considered include the person’s age (children under 5 or adults over 60) and coexisting chronic diseases (eg heart failure, respiratory failure, diabetes).

First Aid for burns

Remove the person from danger and further injury. Hold the burn under cold running water for 20 minutes. If necessary, prevent heat loss by covering unburnt areas.

Burnt clothing should only be removed if it does not stick to the burn. Do not remove clothing that is stuck to the burn as this carried a risk of skin detachment. Any chemicals, such as acids and alkalis, must be washed off with running water for at least 20 minutes. A cool shower is ideal.

Superficial burns required pain relief, dressings and regular review to make sure they don’t become infected.

A major burn is defined as a burn of any depth that involves more than 20% of the total body surface area for an adult (and more than 10% of total body surface area for a child).

Major burns are a medical emergency and require urgent treatment. Immediately apply cold water to all affected areas and then cal triple zero (000) for an ambulance. A cool or lukewarm shower is ideal.

Partial thickness burns will require a non adherent dressing to promote healing and reduce the risk of infection. If the body is not able to heal the injury by itself, skin grafts may be needed.

 

(1) Australian Government. AIHW. injury in Australia: burns and other thermal causes.Updated 10 Mar 2020 Available at: http://www.aihw.gov.au/reports/injury/burns-and-other-thermal-causes
(2) Annual report on burns epidemiology in France. 2008. http://www.sfb-brulure.com/index.php/documentation/epidemiologie.html
(3) Assurance Maladie. How to rapidly assess the severity of a burn? Website Ameli-sante.fr 2015. Available at: http://www.ameli-sante.fr/brulures/comment-reconnaitre-rapidement-la-gravite-dune-brulurenbsp.html.
(4) Victorian Department of Health. Better Health Channel. Burns and scalds. Available at:  http://www.ameli-sante.fr/brulures/comment-reconnaitre-rapidement-la-gravite-dune-brulurenbsp.html..

Epidermolysis Bullosa

Posted on by Steven CHEE

What is epidermolysis bullosa?

In patients with EB the skin blisters and peels at the slightest touch. Living with EB has been likened to living with third degree burns. when the blisters, which are often on the feet and hands and sometimes mucous membranes (mouth, genital areas) burst they leave raw skin which is difficult to heal.

EB can be categorised into four major categories:

– Epidermolysis bullosa simplex, where the epidermal skin (most superficial layer of the skin) detaches. It is the most common form.

– Junctional epidermolysis bullosa, where the dermis and epidermis detach.

– Dystrophic epidermolysis bullosa, where the dermis (deepest layer) detaches. It is the least common form.

– Kindler Syndrome

As the skin surface area is uncovered, there is risk of infection.

Treatment of epidermolysis bullosa

There is no curative treatment for EB and therefore current management focusses on relieving patient pain, stopping infections and providing dressings.

Urgo’s commitment to epidermolysis bullosa

Since its creation, the URGO Foundation supports projects to improve the quality-of-life of patients suffering from epidermolysis bullosa, and the quality of their treatment. It also supports DEBRA , the global advocacy network for this disease.

Working in countries with the highest prevalence and where treatment for this disease is limited, the URGO foundation supports initiatives treating this disease, of which little is still known:

  • Organisation of training for nursing staff with the help of experts.
  • Support for families in treating wounds and teaching them how to care for them.
  • Financing of equipment for improving patient care.

To find out more about this disease and support research please visit DEBRA Australia

Surgical Wounds

Posted on by Steven CHEE

What is a surgical wound?

A surgical wound is classified according to two different types. They are easily identifiable and relate to the size of the incision and its location:

  • Surgical wound closed by simple suture (primary intention healing). This is a wound of which the edges are closed in the operating theatre using suture, staples or skin adhesive. It stands out visibly by the absence of loss of substance (skin or flesh); it heals rapidly (epidermis reconstituted in 7 days / scar consolidated after one month / permanent scar in 12 or 18 months).
  • Surgical wound with directed healing (secondary intention healing). This is a wound which comes with significant loss of cutaneous tissue and the edges of which cannot be brought together. The wound, left deliberately open, thus requires the appropriate care to help it to heal. In the event of a deep wound, a drain can also be placed to facilitate the evacuation of certain fluids (blood or pus especially).

Causes and complications

Whether it results from a minor operation or more major surgery, the surgical wound still represents rupture of the cutaneous layer. Post-operatively, certain situations may however halt the normal healing process, the stages of which are the same as for an acute wound.

Among the factors causing delayed surgical wound healing are:

  • Wound-related factors (infection, lack of oxygen supply to the tissue, haematoma etc.)
  • Factors related to the patient’s general condition (smoker, malnourished, stressed, diabetic etc.)

During the healing phase, it is necessary to closely monitor the closed surgical wound and to see a doctor or nurse in the following cases:

  • If the scar bleeds
  • If you develop a fever
  • If the scar gives off an unpleasant smell
  • If the scar is painful or hard to the touch after a week

Surgical wound treatment

Treatment of this type of wound consists of both minimising the risks of infection and rapidly achieving an aesthetically-acceptable scar. Wound care differs according to the type of wound.

  • Wound closed by simple suture (primary intention healing). The wound is covered with a protective dressing and cleaned with soap and water or saline solution. The sutures or staples are removed after 5 to 15 days.
  • Surtureless wound (secondary intention healing). After removing dead or denervated tissue, the nursing staff use dressings which promote healing in a moist wound environment. They are changed regularly, under optimal aseptic conditions.

And afterwards?

Some essential precautions must be taken for surgical wounds, especially healing time:

  • A surgical wound should be covered with a water-resistant dressing in the shower
  • A person should not undertake intense physical exercise in the days after surgery
  • It should be ensured the person has a healthy lifestyle (no smoking, no drinking, and a healthy diet)
  • The scar should not be exposed to the sun.

Wound Healing

Posted on by Steven CHEE

Regardless of the level of damage to the various skin layers, each wound, acute or chronic, requires appropriate care and management. In effect, the slightest breakage in the skin exposes the human body to bacterial contamination and therefore to a risk of infection.

How to manage a wound?

To help you manage your wound, follow this advice:

  • First clean the wound with water, which should preferably be warm. Remove any foreign bodies at the surface or even in the wound (gravel, soil, pieces of glass, metal splinters etc.)
  • If the tissue is particularly red around the edges of an acute wound, or there is a sensation of heat (sign of local inflammation) or it is yellow/green (sign of the presence of pus), if the wound is weeping considerably, if the wound gives off an unpleasant smell, or if fever is also present, see a doctor immediately, as it is probably infected.
  • You should see your doctor if you have a chronic wound of any type, which occurs or persists.

 

 
(1) Report for the Minister of Social Security and the French Parliament on the progression in health insurance expenditure and revenue in 2014 (Law of 13 August 2004) – July 2013.

How does the skin function?

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The skin is made up of several layers placed one on top of the other:

  • The epidermis: the outermost layer of the skin, the epidermis is covered by the stratum corneum, similar to a pile of flat, resistant cells. It serves as a protective envelope, sheltering the body from microbes. It is studded with pores from which sweat escapes to cool the skin. It is also home to tiny receptors linked to the brain, including pain receptors. Finally, an oily, aqueous and invisible film, called the hydrolipidic film, ensures the skin remains impermeable and moisturised. The epidermis also acts as sun screen and produces melanin, the pigment which gives the skin its colour.
  • The dermis: Highly vascularised, the dermis is a tissue rich in elastin and collagen fibres, which confer it its elasticity and strength. At the heart of its fibres and cells, this tissue is home to sebaceous glands, sweat glands and hair follicles. It also contains a multitude of nerve endings and blood vessels, and sensors which react to pressure or to touch. With age, the dermis slackens and creases, which is how wrinkles form.
  • The hypodermis: Serves as an interface between the dermis and the mobile structures located below it, such as the muscles and the tendons. It also protects the body from physical shocks, temperature variations and serves as an adipose tissue store.

The skin therefore functions like an actual ecosystem. It requires special care as it is essential to the body.

DID YOU KNOW? The skin, a living organ

The skin of an adult human being represents a surface area of around 2 square metres! Its weight is around 3.5 kilos in women and varies between 4.5 and 5 kilos in men, making it the largest organ in the body. It undergoes specific cycles and is able to tell the difference between day and night, and even reacts to certain components and fragrances (according to its pH) – the skin is permanently changing. In order to be able to play its role of a protective screen, it sheds 2 layers of dead cells daily. This explains why the epidermis is renewed more than 1,000 times over 70 years of life!

Main principles of healing

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Acute wounds and chronic wounds have different healing times.  Acute wounds heal faster in around 2 to 4 weeks.  Some examples of acute wounds include burns, cuts and scratches.  Chronic wounds take longer to heal with the average healing time being 210 days or almost 7 months1.  Chronic wounds include ulcers and are often related to an underlying medical conditions such as diabetes and vascular disease which need to be treated at the same time.

The normal wound healing stages include:

The 3 healing phases:

1. The inflammatory stage

After a wound occurs blood vessels at the site constrict (tighten) to prevent blood loss and platelets (special clotting cells) gather to build a clot. Blood vessels expand to allow maximum blood flow to the wound. White blood cells flood the area to destroy microbes and other foreign bodies. Skin cells multiply and grow across the wound.

2. The budding phase

The repair process continues. Collagen, the protein fibre that gives skin its strength starts to grow within the wound. The growth of collagen encourages the edges of the wound to shrink together and close. Small blood vessels (capillaries) forn at the site to service the new skin with blood. This skin appears red and shiny.

3. The maturation stage

Gradually the body adds more collagen and and finally closes. The new skin appears pinkish and thin. This scar often stays lighter than the skin around but scars tend to fade over time. We must take care of wounds for some time after they have healed. For the first weeks following healing , the new epidermis should not be exposed to the sun at all.

DID YOU KNOW? Scars, fans of moisturisation

After the long process of reconstruction, the skin deserves to be spoiled a little. Keeping it out of the sun (SPF 50 at all times), scars like being moisturised. Daily application of a moisturising cream nourishes the skin and “relaxes” the scar. No need to press too hard. A repeated, light, circular movement until the cream is absorbed is enough to be able to get the beneficial effects.

 
1- Report for the Minister of Social Security and the French Parliament on the progression in health insurance expenditure and revenue in 2014 (Law of 13 August 2004) – July 2013.

Risk factors

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Several factors can cause a wound,  compromise its healing, or even cause an acute wound to become a chronic wound, with all the risks of complications that brings, including the risk of recurrence.

Some of the risk factors that can cause a wound or slow the wound healing process include:

Disease-related risk factors

  • Vascular disease: Restricts blood flow to the area delaying healing

  • Diabetes: Causes a high blood sugar level, damages the arteries and nerves, especially in the feet

 
Lifestyle-related risk factors
  • Smoking: Can damage the arteries, reducing oxygen supply to the wound and impairing healing

  • Mechanical damage: Wearing ill-fitting shoes may cause pressure and friction resulting in a wound or delaying healing of an existing wound

  • Mobility: Low mobility increases risk of cardiovascular disease and diabetes, a person who is immobile is at risk of bedsores

  • Diet: Poor food choices may mean the wound is not getting the nutrients it needs to repair and heal

  • Hygiene: Not observing basic hygiene like washing daily and ensuring skin is kept dry (especially between toes) and toenails cut short

 
Other risk factors 
  • Age: Wounds tend to take longer to heal in as we age.Older people’s skin is less hydrated and has less elasticity which can slow the healing process.

These factors can extend the healing time of a chronic wound and increase the risk of a chronic wound recurring.  It is not uncommon to feel depressed or anxious about the time it is taking for a chronic wound to heal and it’s important to discuss this with your healthcare professional.

What is a wound?

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Regardless of the level of damage to the various skin layers, each wound, acute or chronic, requires appropriate care and management. In effect, the slightest breakage in the skin exposes the human body to bacterial contamination and therefore to a risk of infection.

How to manage a wound?

To help you manage your wound, follow this advice:

  • First clean the wound with water, which should preferably be warm. Remove any foreign bodies at the surface or even in the wound (gravel, soil, pieces of glass, metal splinters etc.)
  • If the tissue is particularly red around the edges of an acute wound, or there is a sensation of heat (sign of local inflammation) or it is yellow/green (sign of the presence of pus), if the wound is weeping considerably, if the wound gives off an unpleasant smell, or if fever is also present, see a doctor immediately, as it is probably infected.
  • You should see your doctor if you have a chronic wound of any type, which occurs or persists.

DID YOU KNOW? / Under the skin, there is …

Each square centimetre of human skin contains 2.4 metres of blood vessels, mainly found in the dermis and the hypodermis. These layers are the deepest layers of the skin (read our article on “The Skin” HERE).

 
(1) Report for the Minister of Social Security and the French Parliament on the progression in health insurance expenditure and revenue in 2014 (Law of 13 August 2004) – July 2013.