Hyperkeratotic Wound Edges

Hyperkeratotic wound edges are a sign that a disruption has occurred and the wound is not healing properly. Wound healing is a complex and multi-stage process that normally results in the affected area being re-covered with well-organized skin tissue. A number of factors can disrupt this complex process. While there are some treatments that can help wounds heal more normally, non-healing wounds remain a challenging medical problem.

Normal Wound Healing: Primary Intention

• Wound healing is typically divided into primary intention and second intention. Healing by primary intention occurs in a classical surgical incision in healthy skin. The two sides of the wound can be brought and held closely together using sutures. Wounds such as these rarely have difficulty healing properly unless there is an underlying condition preventing the wound from remaining closed, such as infection or excessive swelling.

Normal Wound Healing: Secondary Intention

• Healing by secondary intention occurs when skin is destroyed over so wide an area that the sides of the wound cannot be brought closely together. In secondary intention, a layer of special cells forming granulation tissue must first build up over the wound and skin is then organized on top of this tissue. Granulation tissue forms from the outside of the wound and moves in, as does the layer of new skin that is forming over it. Wounds healing by secondary intention are much more likely to experience problems than those healing by primary intention.

Hyperkeratosis

• Normal skin is a complex structure consisting of several different layers. The topmost layer consists largely of dead cells filled with a tough protein called keratin, which form a protective outer layer for the skin. In a poorly healing wound, the skin that is forming along the outer edge of the granulation tissue does not have this well organized structure, and keratin is distributed in large amounts through all the layers. Wound edges containing this abnormal skin have a characteristic pearly-grey appearance, and are said to be hyperkeratotic.

Causes of Poor Wound Healing

• The most common cause of non-healing wounds is poor circulation, usually as a long-term effect of smoking. Chronic infection is another cause, since inflamed tissue cannot heal properly. In addition, the elevated blood sugar from uncontrolled diabetes can disrupt the normal function of the cells involved in wound healing. Also, certain medications, such as corticosteroids, can cause general thinning of the skin and disrupt normal healing.

Treatment for Non-Healing Wounds

• Getting chronic wounds to heal is still an unsolved medical problem. Special dressings are often used, including those employing a vacuum effect, but often are of minimal benefit. Various skin growth factors have been investigated, but the results have been mixed. The most effective treatment usually involves fixing the underlying cause. While it's sometimes possible to do this in the case of diabetes or infection, poor circulation resulting from the extensive vascular damage of smoking usually cannot be corrected.