Chronic Wounds

Injuries That Do Not Heal Properly

A chronic wound is simply a wound that doesn’t heal properly. All injuries go through a process from the initial injury through redness, swelling, scarring, and finally healing. In a chronic wound, something happens to interrupt the process so that the scarring and healing never occur.
Some types of illnesses make you prone to injuries that refuse to heal. Diabetes, cancer, kidney and heart disease, and advanced age can all lead to conditions that result in chronic wounds in the skin.
Chronic wounds leave the body open to infection and fluid loss. They are extremely painful. Untreated chronic wounds can lead to further tissue loss, ulceration, amputation, and even death.

Types of Chronic Wounds

There are several kinds of non-healing wounds, classified by what causes them and how they affect the body. Different chronic wounds have different methods of treatment.
Also called pressure sores, bedsores, or decubitus ulcers, these injuries are a result of tissue damage due to blood loss. These injuries are most common in elderly or bedridden patients and found in bony areas where there is limited cushioning for the skin.

Pressure injuries have four stages, based on the degree of tissue damage. Stage 1 is characterized by redness and pain and itching at the wound site. Stage 4, the most serious, is characterized by deep tissue damage, infection, and sepsis.

Pressure injuries become chronic for several reasons:

  • Location of the wound. They are most common in areas with poor circulation, such as feet, elbows, tailbone, and skull.
  • Immobility. Patients who cannot easily move or are paralyzed cannot relieve the pressure on existing wounds.
  • Conditions like diabetes, heart disease, and kidney disease compromise the capillaries, making healing difficult.
Venous ulcers occur due to an insufficiency of the veins and resulting edema (swelling) in the extremities, usually the legs. As blood and other fluids pool in the lower legs, it leaks out of the veins and into the surrounding tissues, eventually resulting in an ulcer.
Before the ulcer can be fully treated, the cause of the venous insufficiency must be treated and the edema reduced. Venous ulcers are very common, especially in overweight individuals, pregnant women, and those with diabetes.
Venous ulcers can be treated with absorbent dressings and topical antibiotics, but the best treatment is to ensure they don’t occur by preventing swelling.
Ischemic or arterial ulcers are extremely painful non-healing wounds caused by a loss of arterial blood flow to an area. Unlike other chronic wounds, these wounds are due to death of the tissue from within. They are often caused by peripheral artery disease (PAD) and are extremely difficult to treat.
Arterial ulcers most often occur on the outside edges of the feet or ankles. They have a black or dark red appearance and look sunken or “punched out.” Arterial ulcers require deep debridement to remove the dead tissue. They may take many months to heal, and because there is restricted blood flow to the area they may not heal.

Treating Chronic Wounds

Treating chronic wounds is essential because breaks in the skin provide open access to germs and toxins from the outside. The best treatment is a sterile covering that retains moisture and seals the wound completely.