Chronic Wound
A wound that fails to heal in the expected time
Quick Facts
- Type: Skin and tissue condition
- Definition: Wound not healed in expected time
- Common types: Diabetic, pressure, venous, arterial ulcers
- Key to healing: Treating the underlying cause
Overview
A chronic wound is a sore or break in the skin that does not heal in an orderly, timely way, usually meaning it has not made meaningful progress within several weeks. Healthy wounds heal through predictable stages, but in a chronic wound this process stalls, often because of an ongoing problem such as poor blood flow, repeated pressure, high blood sugar, or persistent infection.
Common types include diabetic foot ulcers, pressure injuries (bedsores), venous leg ulcers from poor vein circulation, and arterial ulcers from reduced blood supply. Chronic wounds can be painful, raise the risk of serious infection, and affect quality of life. The key to healing is identifying and treating the underlying cause while caring for the wound itself.
Because a chronic wound is usually a sign of another health problem, treating only the surface rarely works. A sore over the ankle may point to vein problems, one on the bottom of the foot to diabetes and nerve damage, and one over the tailbone or heels to prolonged pressure. Matching the treatment to the cause is what allows healing to finally move forward.
Symptoms
A chronic wound looks and behaves differently from a healthy healing wound.
- A sore that stays the same size or grows over weeks
- Little or no sign of new pink healing tissue
- Surrounding skin that is discolored, thickened, or hardened
- Drainage that may be clear, yellow, or foul-smelling
- Pain, or in some cases numbness around the wound
- Recurrent breakdown of skin in the same area
Spreading redness, increasing pain, pus, swelling, warmth, or fever suggest infection and need prompt evaluation.
Causes
Most chronic wounds result from an underlying condition that interferes with healing.
- Poor circulation: Reduced blood flow from artery disease starves the wound of oxygen and nutrients, while poor vein drainage causes fluid buildup that damages skin.
- Diabetes: High blood sugar impairs healing and nerve damage can reduce sensation, so injuries go unnoticed.
- Pressure: Constant pressure over a bony area, common with limited mobility, cuts off blood flow and breaks down skin.
- Persistent infection: Bacteria in the wound can keep it inflamed and prevent closure.
Risk Factors
- Diabetes
- Peripheral artery disease or chronic vein problems
- Limited mobility or being bedbound
- Older age
- Obesity
- Smoking
- Poor nutrition
- A weakened immune system
Diagnosis
Diagnosis focuses on the wound itself and the underlying cause that is preventing healing.
- Wound assessment: Measuring size, depth, and appearance and checking the surrounding skin.
- Circulation testing: Pulse checks, ankle-brachial index, or ultrasound to assess blood flow.
- Blood tests: To check blood sugar, nutrition, and signs of infection.
- Wound culture: To identify bacteria if infection is suspected.
- Imaging: Used if infection of deeper tissue or bone is a concern.
Treatment
Successful treatment combines wound care with management of the underlying problem.
- Treating the cause: Improving blood flow, controlling blood sugar, and relieving pressure are essential for healing.
- Wound cleaning and debridement: Removing dead tissue helps healthy tissue grow.
- Dressings: Moisture-balancing dressings protect the wound and support healing.
- Pressure relief and compression: Special mattresses or repositioning for pressure injuries; compression therapy for venous ulcers.
- Infection control: Antibiotics when infection is present.
- Advanced therapies: Negative-pressure wound therapy, skin substitutes, or surgery for difficult wounds.
Prevention
- Manage diabetes and keep blood sugar in target range
- Inspect feet and skin daily, especially if you have diabetes or reduced sensation
- Reposition often and use pressure-relieving supports if you have limited mobility
- Wear well-fitting footwear and protect at-risk skin
- Stop smoking to improve circulation
- Eat a balanced diet with enough protein to support healing
When to See a Doctor
See a doctor for any wound that has not started to heal within a couple of weeks, that keeps recurring, or that is getting larger. Seek prompt care for signs of infection such as spreading redness, increasing pain, pus, swelling, warmth, or fever. Get emergency care if you have a high fever with chills, rapidly spreading redness, a foul-smelling or blackened wound, or feel very unwell, as these can indicate a severe, spreading infection.
Frequently Asked Questions
What makes a wound chronic?
A wound is considered chronic when it does not heal in an orderly, timely way, usually meaning it has not made meaningful progress within several weeks. This often happens because of an ongoing problem such as poor circulation, diabetes, pressure, or persistent infection.
What are the most common types of chronic wounds?
The most common are diabetic foot ulcers, pressure injuries (bedsores), venous leg ulcers from poor vein circulation, and arterial ulcers from reduced blood supply. Each has a different underlying cause that must be addressed for healing.
Why won't my wound heal?
Healing can stall because of reduced blood flow, high blood sugar, constant pressure, infection, poor nutrition, or smoking. Treating the wound alone is rarely enough; the underlying cause usually needs to be corrected as well.
How are chronic wounds treated?
Treatment combines wound cleaning, removal of dead tissue, and appropriate dressings with management of the cause, such as improving circulation, controlling diabetes, or relieving pressure. Compression, infection control, and advanced therapies are added when needed.
When is a non-healing wound an emergency?
Seek emergency care if a wound is accompanied by a high fever and chills, rapidly spreading redness, severe pain, a foul-smelling or blackened appearance, or you feel very unwell. These can signal a serious, spreading infection that needs immediate treatment.
References
- MedlinePlus, U.S. National Library of Medicine. Pressure ulcer.
- Centers for Disease Control and Prevention (CDC). Diabetes and Your Feet.
- Mayo Clinic. Bedsores (pressure ulcers) — Symptoms and causes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic foot problems.