A number of local and systemic factors may be associated with a delay in wound healing. Identification of these factors can help identify a patient who may require more aggressive wound management.


Systemic factors:

(1) malnutrition

(1a) protein deficiency

(1b) deficiency in vitamins (A, C, K) and trace metals (Zinc)

(2) medications

(2a) corticosteroids

(2b) chemotherapeutic agents

(2c) anticoagulants

(3) endocrine disorders

(3a) thyrotoxicosis

(3b) Cushing's disease

(3c) poorly controlled diabetes mellitus (associated with complications)

(4) advanced age

(5) hereditary defects in collagen synthesis (Ehlers-Danlos syndrome, prolidase deficiency)

(6) fever

(7) cardiovascular

(7a) heart failure

(7b) peripheral vascular disease to site

(7c) systemic vasculitis

(8) respiratory disease with hypoxemia

(9) coagulopathy

(9a) hemophilia and other factor deficiencies

(10) cirrhosis (associated with complications)

(11) malignancy (associated with complications and therapy)

(12) heavy cigarette smoking


Local factors:

(1) incomplete debridement, with retained foreign material

(2) wound infection

(3) topical treatments with soft tissue toxicity

(4) physical manipulation of the wound

(5) extensive regional irradiation at the wound site

(6) edema


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