What are chronic wounds?

What are chronic wounds?

A chronic wound is any type of wound that does not heal in a timely manner. Wounds that are slowly healing or not progressing within 30 days can be considered chronic wounds. These wounds often persist for more than three months. These wounds can be caused by various factors and can affect people of all ages, although they are more common in older adults with contributing factors that increase risks of delayed healing.

A chronic wound is any type of wound that does not heal in a timely manner. Wounds that are slowly healing or not progressing within 30 days can be considered chronic wounds. These wounds often persist for more than three months. These wounds can be caused by various factors and can affect people of all ages, although they are more common in older adults with contributing factors that increase risks of delayed healing.


Chronic wounds are a significant medical problem and can lead to significant morbidity and mortality, especially in patients with underlying medical conditions. They can also cause psychological distress, decreased quality of life, and increased healthcare costs. Days of hospitalization are often extended, then the need for aftercare, including rehab stays, home care services and outpatient clinics are often part of caring for a chronic wound in addition to the cost of supplies to treat the wound itself.


There are many possible causes of chronic wounds. Diabetes is a leading cause of chronic wounds. High blood sugar levels cause damage to blood vessels and nerves. This leads to poor circulation, decreased sensation in the feet and legs, and diminishing eyesight. These factors can delay identification and effective early treatments. When early interventions are delayed, healing may be prolonged with a higher risk of deeper tissue damage and infection. For people with diabetes, early identification and treatment is of utmost importance because diabetic foot ulcers are the leading cause of surgical amputations.


Venous Insufficiency is a condition where the veins in the legs are not able to pump blood back to the heart properly. This leads to bulging veins, progressive swelling and open wounds that are often slow to heal. Pain, leaking legs and risk of infections eventually lead to decreased mobility, further delaying healing. A hallmark treatment for venous insufficiency wounds includes compression, which can be difficult for patients to comply with and will compound issues.


Arterial disease is a condition where the arteries of the legs become narrowed or blocked. Lack of blood flow is will cause dark black wounds in the lower legs and feet. Arterial disease can be present in people with venous disease and diabetes, which further complicates healing issues. Open foot wounds are at high risk for infection which also needs to be constantly monitored and treated when present.


Pressure injuries have been known by many names including bedsores, pressure ulcers, decubitus ulcers etc. Pressure, friction and shearing affect the skin between support surfaces and bony prominences which can lead to skin breakdown. Pressure injuries are most common in frail elderly and people with decreased mobility and sensation. These individuals are at risk for chronic wounds when they do develop as their ability to improve their overall health may be diminished.


Traumatic injuries, such as burns, cuts, and abrasions, can lead to chronic wounds if they are not properly treated. Certain infections, such as cellulitis and osteomyelitis, can cause chronic wounds. Some types of cancer, such as melanoma and squamous cell carcinoma, can cause chronic wounds. Untreated cancer lesions can also be fungating and protrude from the surface of the skin and will continue to proliferate.


The symptoms of chronic wounds can vary depending on the underlying cause. Common signs will include a lack of wounds decreasing in size, continued significant drainage, persistent redness, pain and swelling. These persistent issues with chronic wounds will continue to be strong and persistent. Chronic wounds may eventually heal but can also reoccur in the same location due to changes in normal changes to skin strength after a wound.


The treatment for chronic wounds will depend on the underlying cause and the severity of the wound. In most cases, treatment will involve a combination of wound care, medication, and lifestyle changes. The first step in treating a chronic wound is to keep it clean and protected. It is likely that traditional wound care of gauze and saline will be insufficient to heal a chronic wound. Topical treatments to address current wound presentation may include topical prescription ointments and treatment for any infection present. Debridement of any non-viable tissue will need to be removed and serial debridement may be needed. Compression therapy involves applying pressure to the affected area to help improve circulation and reduce swelling. Surgical interventions may be required beyond debridement to restore blood flow to distal chronic wounds.

 

Patient compliance and lifestyle changes can help improve the healing process and prevent reoccurrence. Nutrition can play a huge factor in wound healing and working with a registered dietician can greatly improve further skin integrity concerns and help to manage or reverse diabetes and further risk factors.

 

Compression wear long-term will be needed to prevent further edema issues for people with venous disease and lymphedema. Fitness is an important factor for overall health and maintaining mobility and independence. Working with physical therapists and personal trainers can be useful for individuals to progress physically and maintain a healthy lifestyle.


Chronic wounds are a common issue for many people, particularly for those who are bedridden, wheelchair-bound, or suffer from conditions that limit their mobility. These wounds can be quite challenging to manage and may take weeks, months, or even years to heal completely. As a caregiver, it is important to understand what chronic wounds are, their causes, and how to manage them effectively.


Caregivers can use strategies to help promote healing and prevent further complications. The most effective strategies can include the following. Seek advanced wound care from certified wound specialists which can often be found in outpatient wound clinics. This can be essential for promoting healing and preventing infection accessing advanced wound healing options. Clinic treatments may include frequent debridement to remove devitalized tissues, obtaining differential diagnoses and cultures as needed. Good nutrition is essential for promoting healing, particularly for people with chronic wounds. A diet that is rich in protein, vitamins, and minerals can help to promote tissue repair and healing. Improving mobility and pressure relief is very important for wound healing and physical therapy may be a key component for improving functional status to improve wound healing.

©2020 Human Biosciences, Inc. The content presented here is for your information only. It is not a substitute for professional medical advice.