Chronic Wounds
Wounds that fail to heal in the normal time
Quick Facts
- Type: Skin and wound condition
- Definition: A wound that has not healed as expected
- Common types: Pressure, venous, arterial, diabetic
- Key to healing: Treating the underlying cause
Overview
Most wounds heal in an orderly way over a few weeks. A chronic wound is one that does not follow this normal path and fails to heal in the expected time, often persisting for many weeks or months. The wound seems to get stuck in the healing process, frequently because something is interfering, such as poor blood supply, ongoing pressure, infection, or an underlying condition like diabetes.
Chronic wounds are common on the lower legs, feet, and bony pressure points. They can be painful, become infected, and significantly affect quality of life. The key to healing is not just dressing the wound but identifying and treating the underlying reason it will not close. With the right care, many chronic wounds can heal, though it may take time and ongoing attention.
Symptoms
A chronic wound is, by definition, a sore that is not healing. Other features depend on its cause and whether it is infected.
- An open wound or ulcer that has not improved over several weeks
- Surrounding skin that may be discolored, swollen, hardened, or itchy
- Drainage that may be clear, cloudy, or blood-tinged
- Pain, although some wounds, such as diabetic foot ulcers, can be painless
- A wound bed that looks pale, dark, or covered with dead tissue
Signs of infection, such as increasing redness, warmth, swelling, pus, foul odor, increasing pain, or fever, need prompt medical attention, as infection prevents healing and can spread.
Causes
Chronic wounds usually result from one or more factors that block normal healing. The main types include:
- Pressure ulcers: From sustained pressure over bony areas in people with limited mobility.
- Venous ulcers: From poor return of blood in the leg veins, usually near the ankle.
- Arterial ulcers: From reduced arterial blood flow, often on the toes or feet.
- Diabetic foot ulcers: From nerve damage and poor circulation related to diabetes.
- Infection and other factors: Ongoing infection, repeated injury, swelling, and poor nutrition all impair healing.
Risk Factors
- Diabetes, particularly with nerve damage
- Poor circulation from artery or vein disease
- Limited mobility or being bedbound
- Smoking, which reduces blood flow and slows healing
- Older age and a previous chronic wound
- Obesity, leg swelling, and poor nutrition
Diagnosis
Evaluation focuses on identifying the wound type and what is preventing healing:
- Examination: The location, appearance, and surrounding skin help identify the cause.
- Circulation tests: Checking pulses and blood flow, sometimes with ultrasound, assesses artery and vein function.
- Blood tests: To check for diabetes, infection, nutrition, and other contributing conditions.
- Swabs or biopsy: Used if infection is suspected or if an unusual or persistent wound needs further evaluation.
Treatment
Successful treatment combines good local wound care with correcting the underlying problem.
- Wound care: Cleaning the wound, removing dead tissue, and using appropriate dressings to maintain a healthy healing environment.
- Addressing the cause: Compression for venous ulcers, improving blood flow for arterial wounds, relieving pressure for pressure ulcers, and offloading for diabetic foot ulcers.
- Treating infection: Antibiotics when infection is present.
- Supporting healing: Controlling diabetes, improving nutrition, stopping smoking, and reducing swelling.
- Specialist care: Persistent wounds may benefit from advanced therapies and wound clinics.
Healing can take weeks to months, and ongoing care helps prevent recurrence.
Prevention
- Manage diabetes and check the feet daily for new sores
- Treat poor circulation and use compression stockings if advised
- Reposition regularly and use pressure-relieving cushions if mobility is limited
- Keep skin clean, moisturized, and protected from injury
- Stop smoking and eat a balanced diet to support healing
- Seek care early for any wound that is slow to heal
When to See a Doctor
See a doctor for any wound that does not begin to heal within a couple of weeks, that recurs, or that is linked to diabetes or poor circulation. Seek prompt care if a wound shows signs of infection, such as spreading redness, warmth, swelling, pus, foul odor, or fever. Seek urgent care if you have severe pain, the skin around the wound turns dark or black, or you feel generally unwell, as these can signal a serious infection or loss of blood supply.
Frequently Asked Questions
What makes a wound chronic?
A wound is considered chronic when it fails to heal in the expected time, often persisting for many weeks or months. This usually happens because something is interfering with healing, such as poor blood supply, ongoing pressure, infection, or an underlying condition like diabetes.
Why won't my wound heal?
Common reasons include poor circulation, repeated pressure, nerve damage, infection, swelling, poor nutrition, smoking, and poorly controlled diabetes. Treating the underlying cause, not just dressing the wound, is essential, which is why persistent wounds need medical evaluation.
How are chronic wounds treated?
Treatment combines local wound care, cleaning, removing dead tissue, and appropriate dressings, with correcting the cause. That may mean compression for venous ulcers, restoring blood flow for arterial wounds, relieving pressure, treating infection, and managing diabetes and nutrition.
When should I worry about a wound?
Seek prompt care if a wound is not healing after a couple of weeks, or shows signs of infection such as spreading redness, warmth, swelling, pus, odor, or fever. Get urgent care for severe pain, darkening or black skin around the wound, or feeling generally unwell.
References
- MedlinePlus, U.S. National Library of Medicine. Leg and foot ulcers.
- Mayo Clinic. Bedsores (pressure ulcers).
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic foot problems.
- Centers for Disease Control and Prevention (CDC). Diabetes and your feet.