A person in bright red-orange snowpants and a turquoise t-shirt and gloves is strapped into neon green bindings on a snowboard as they fly over the snow after hitting a kicker with tall, deep green pine trees and a snowy mountain range in the background.

Wound Care at Altitude

Traveling and living at altitude can make many physiologic processes just a little harder. If you have experience in the mountains, you may have noticed that simple cuts and wounds simply take longer to heal than down at sea level. This isn’t your imagination. Wounds can take a significantly longer time to heal while at altitude. This means routine wound care is more important to observe while at altitude.

Normal Wound Healing Process

Wound healing is a well-documented and well-described process. After an injury to the skin, the first step of healing involves creating a blood clot to seal the disrupted vessels. This step involves activation of circulating proteins that promote blood coagulation. Platelets bind together in a strong collection strengthened by coagulation proteins.

The next step of wound healing involves activation of inflammation. While inflammation is generally thought of as a bad thing, it is actually a crucial step in repairing tissues. White blood cells are attracted to the injured area where they can eliminate pathogens that have gotten into the wound. These white blood cells serve other functions as they help to lay down fibrin proteins and activate fibroblasts.

Fibrin and fibroblasts operate in the proliferation stage of wound healing. This stage is when proteins are laid down in the wound to serve as scaffolding for tissues. Blood vessels are then able to heal themselves. Skin cells then start to divide and fill in the area of the wound. After these steps, the collagen that was laid down as a scaffold rearranges itself into a tight matrix that will provide a strong foundation for the healing skin. All in all, the body goes through a few days of inflammation followed by several weeks of regrowing injured tissue.

Changes in Wound Healing at Altitude

Now the question at this point is, how does living at altitude interfere with this whole process? This is an area that is not very well studied, and research is ongoing to discover the impact of altitude on wound healing. What we do know is that wounds tend to take more time healing while at altitude than at sea level. The theory behind this delayed wound healing is due to impaired oxygen delivery at the site of the wound. Individuals with circulation problems like diabetes and arterial stenosis will have similarly delayed healing at wound sites. Furthermore, wounds farthest away from the heart tend to take the longest to heal (think fingers and toes). The coagulation and inflammatory processes will carry on as normal (as these steps don’t require oxygen to function properly); however, proliferation and maturation steps require considerable amounts of oxygen. This can prolong how much time is required in these different steps.

Consequences of Delayed Healing

Prolonged wound healing can lead to some significant consequences. The longer a wound stays open, the greater a chance it has at developing an infection. If a wound becomes infected, it can prolong the healing process even more, lead to more inflammation, result in pain, and even spread of the infection throughout the body. If the maturation phase is interrupted either by an infection or low oxygen state, it can lead to more scar formation and lower tissue strength.

General Wound Care Recommendations

Luckily, the recommendations for caring for a wound do not change while at altitude. It is still important to wash all wounds in clean water. Keep the wound covered with antibiotic jelly such as bacitracin or any over the counter triple-antibiotic ointment. Keep wounds dry and clean and covered with a bandage until it closes. If cuts are deep, they may need to be closed with sutures. Be aware of signs of infection. This would include redness of the wound, warmth, increased pain, purulent discharge, or red streaks radiating away from the wound. While discussing the implications of delayed wound healing at altitude with Dr. Christine Ebert-Santos at Ebert Family Clinic in Frisco, CO, she recommended that sutures closing lacerations remain in for a little longer. For facial lacerations, she recommends leaving them in for 7 days as opposed to the typical 5, and sutures elsewhere can remain in for 10 days. Consult with your regular medical provider if you are concerned with how any wounds are healing.

Sources

Balsa IM, Culp WT. Wound Care. Vet Clin North Am Small Anim Pract. 2015;45(5):1049-1065. doi:10.1016/j.cvsm.2015.04.009

Goodson WH 3rd, Lopez-Sarmiento A, Jensen JA, West J, Granja-Mena L, Chavez-Estrella J. The influence of a brief preoperative illness on postoperative healing. Ann Surg. 1987;205(3):250-255. doi:10.1097/00000658-198703000-00006

Janis JE, Harrison B. Wound healing. Plastic and Reconstructive Surgery. 2016;138. doi:10.1097/prs.0000000000002773

Eric Meiklejohn is a second year Physician Assistant student attending Red Rocks Community College in Arvada, Colorado. He received his undergraduate degree from Colorado State University. Prior to Physician Assistant school, he worked as an EMT both in the Emergency department and on the ambulance. In his free time, he enjoys cooking and spending time with his wife, Nicole, and his dog, Julie.

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