Why Isn’t My Wound Healing? #7 Swelling

Why Isn’t My Wound Healing? #7 Swelling

Swelling is the enemy of wound healing.

Wound healing means that new tissue grows where the tissue is lost. To make new tissue, we need two building blocks: blood and oxygen. Blood provides protein and nutrition to build new tissue, while oxygen keeps the tissue alive. Oxygen also must be present to weave collagen fibers to strengthen the new tissue. Swelling at the microscopic level means that there is excessive water in between the cells. This extra water pushes the small blood vessels that supply blood and oxygen away from where they are needed. As a result, wound healing becomes impossible.

Besides many diseases that cause swelling of the body, the most common and most important cause of swelling — especially in legs — is a sedentary life style, i.e., sitting or standing too long. The heart pumps and sends blood to legs all the time through arteries. However, for all practical purposes, legs do not send the blood back to the heart easily because the pressure inside the leg vein is not high enough to overcome gravity. Instead, when we walk, our calf muscle squeezes the blood in the legs upwards and back to the heart.

For office workers, teachers or retirees who sit or stand long hours without walking, the pooling of blood in the leg veins can cause serious leg swelling, varicose veins, and eventually even leg ulcers. Imagine that the artery is the clean water supply to the house, and the vein is the sewer system. When water runs without drainage, the whole house will be filled with water and will swell up, and soon the walls will start to burst.

Most leg swelling can be prevented simply by walking frequently. If one sits too long, one needs ankle exercises. Flex your ankle up and down to activate the calf muscle pump. Do it 100 times every hour. It takes only a few minutes. If you are a TV watcher, flex your ankle up and down continuously during the TV commercials. You can easily do more than 100 flexes each hour. (This TV commercial reminder method is credited to my old friend, Chris Morris, RN.) People think shopping is like constantly walking. But when you are waiting in long line somewhere, make sure you do the ankle flexes; otherwise, your legs will swell up while you are standing and not walking.

Besides ankle flexes, you can drain water from your swollen legs by elevating legs above the heart. Lie down flat on your back with a few pillows under your calf for twenty to thirty minutes four to five times a day. Or put your legs on the arm rest of the sofa while lying on it. In order not to forget, schedule leg elevations around the clock – for instance, 10:00 AM, 12:00 PM, 2:00 PM, 4:00 PM and 6:00 PM. You can also sleep with a pillow under your calf to elevate your legs above your heart.

Many people think sleeping in a recliner is a way of leg elevation. But most of the time, the opposite is actually true. I constantly see patients developing leg swelling and wounds because their legs are lower than their body while they are sleeping on recliners. When we sleep horizontally in bed, the gravity stops pulling blood to the legs. This will naturally drain swollen legs during the night. But if you sleep in a recliner while your legs are lower than the body, gravity will continue to pull the blood down to the legs while the calf muscle pump is not working – a “double whammy”!

Sometimes ankle exercise and leg elevation are not enough to decrease leg swelling. Then we mechanically squeeze blood out of the legs with compression sleeves, stockings, wrappings or pumps. Numerous compression methods are available tailored to the degree of compression and the condition of the wounds. Unna boot, wrapping of the leg with medicated bandage, is a well-known example of a compression method that healed millions of leg wounds since it was developed more than one hundred years ago. Although Unna boot is quite effective, many patients need a different compression method for various reasons.

Certain blood pressure medications (calcium channel blockers) and pain killers such as Ibuprofen or Naprosen may also cause swelling. If your leg started swelling after taking new medications, you need to discuss it with your prescribing physicians. Taking too much salt also can lead to swelling.

Lastly, when excessive body water is the reason for swelling in cases such as congestive heart failure, a water pill will be necessary to remove body water.

Do you have a wound in your leg? Is your leg swollen? Begin with ankle exercises. Then you are on the right track for healing.

Recommended Exercises to Reduce Leg Swelling:

• Walk frequently.
• Flex your ankle up and down 100 times every hour while you are sitting. Do this whenever TV commercials are on.
• Lie down and elevate your legs above heart level for 20-30 minutes 4-5 times every day.
• Sleep with a pillow under your calf.
• Avoid sleeping in recliners if legs are lower than heart.
• Wear compression sleeves, stockings and compression wrappings whenever your legs are lower than your heart.
• Avoid medications causing leg swelling such as calcium channel blockers or pain killers (Ibuprophen or Naprosen).
• Avoid too much salt.

Written by Dr. Byoung Yang