They may be chronic or acute, and open or closed. The patient presented with a full thickness ulcer measuring 8 mms in diameter of approximately 6 months duration and the tissues around the ulcer are acutely inflamed. Patients with rheumatoid arthritis may develop leg and foot ulcers of varied aetiologies, including venous disease, infection and inflammation. The foot ulcers in rheumatoid arthritis patients may involve several of these aetiological factors and are often difficult to heal (Sunita). Both the ulcers and the treatments are often painful, and these ulcers may be present for years. Chronic wounds plague more than 10 million people in the world today. But even more troubling is the fact that these wounds may persist for months and even years without any healing or sign of improvement (Morgan 25). The problem is usually, if not always, not the wound itself; and therefore treating the wound will not, in chronic cases, resolve the issue. Chronic wounds have underlying causes that must be addressed in order for the wound to heal properly. Because normal skin and wound care is not enough to heal these wounds they usually remain for extended periods of time. As a rule, only 50% of leg ulcers heal within 4 months of appearing, 20% remain open at 2 years and 8% remain open at 5 years (World Wide Wounds). So we see that to effectively treat a chronic wound you must treat the cause and not simply treat the symptom.
There are several factors that affect wound healing. These include the age of the patient, hydration status, presence of infection, presence of underlying conditions, medications, obesity, oxygenation and tissue perfusion, personal hygiene and nutrition (Bowler 499). In the case of Mrs. Freeman, these factors can be very well correlated. The physiological changes that occur with ageing place older patients at higher risk of poor wound healing. The age of the patient places her in a relative state of immune deficiency. The immune system also declines with age making older patients more susceptible to infection. Older people can also present with other chronic diseases, which affect their circulation and oxygenation to the wound bed. Dehydration leads to an electrolyte imbalance and impaired cellular function. The presence of infection can significantly alter the rate of wound healing. Infection has been defined as the deposition and multiplication of organisms in tissue with an associated host reaction (Dealy 56). In the given case, infection is rather evident in the patient's ulcer. The presence of unhealthy granulation, thick, bloody, and malodorous exudates indicate the presence of infection. Wound infection is a problem because, at the most fundamental level, infection stops a wound from healing by prolonging the inflammatory phase, disrupting the normal clotting mechanisms and promoting disordered leukocyte function and ultimately preventing the development of new blood vessels and formation of granulation tissue. Chronic diseases like diabetes mellitus, rheumatoid arthritis, and lupus can delay the process of healing. The patient has been diagnosed with rheumatoid arthritis of 10 years duration and this has markedly affected wound healing in her case. She also has secondary hypertension and iron deficiency anemia. The presence of chronic diseases weakens the immune system, dampening its ability to counteract the pathogens attacking the