Chronic Wounds And Chronic Wound Healing

Having a chronic wound can lead to other associated health, financial and emotional issues beyond the chronic wound itself. Therefore it is critical to understand what a chronic wound is, the underlying causes and how to address chronic wounds before they contribute to additional health issues. If you have a wound that does not appear to be healing properly (through the normal stages of wound healing) despite proper wound care, it is important to promptly seek professional medical attention so that the situation can be diagnosed and a chronic wound treatment plan can be implemented to promote wound healing and prevent further complications.

Chronic Wounds

Having a chronic wound refers to a medical condition where a wound does not follow the normal stages of wound healing, or is simply difficult to heal despite normal wound care and treatment. Generally speaking, a wound would be classified as being chronic if it hasn’t started to heal within 4 to 12 weeks of treatment having been initiated.

Unlike an acute wound, which is typically caused by sudden trauma or a surgical procedure and heals through the normal healing process and within an expected timeframe, a chronic wound does follow the normal stages of wound healing and instead takes several months or years to heal, if at all. Chronic wounds often develop on their own, and are oftentimes located on the feet, toes or lower legs and are the result of diabetes, blood flow or circulatory issues and venous insufficiency.

Characteristics Of A Chronic Wound

Some of the key characteristics of chronic wounds include:

Delayed healing: Chronic wounds do not progress through the four normal stages of wound healing:
- hemostasis (initial phase focused on stopping blood loss)
- inflammation (the body’s response to injury and infection)
- proliferation (formation of new tissue to close the wound site)
- remodeling (the strengthening of the wound site and restoration to its original structure)
Disrupted healing process: Factors such as poor circulation, infection, or underlying health conditions can hinder your body's natural ability to repair the damaged tissue and promote wound healing.
Persistent chronic inflammation: Chronic wounds often remain in a prolonged inflammatory phase, which can damage healthy tissue and negatively impact the wound healing process.

Common Causes And Contributing Factors Of A Chronic Wound

As stated previously, chronic wounds usually develop on their own and oftentimes result from a pre-existing, underlying health condition. Due to this relationship, it is important to understand and treat the underlying cause or contributing factors which led to the development of the chronic condition. Some of the more common causes and contributing factors of chronic wounds include:

Poor circulation and associated insufficient blood flow to a wound site can limit the delivery of oxygen and nutrients which are necessary for proper wound healing, increasing the risk of the wound becoming chronic.
Prolonged or sustained pressure from lying in bed or sitting for extended periods can result in pressure points on parts of the body (e.g., where the bone structure is near the skin surface), which reduces blood flow in these areas and leads to the development of pressure ulcers (bed sores). Having a pressure ulcer or bed sore is especially prevalent among individuals who have limited mobility.
While generally not the primary cause, bacterial infection can significantly contribute to the development of chronic wounds and impede the wound healing process and exacerbate damage to skin tissue at the wound site.
Having a weakened or compromised immune system, for example resulting from having been treated for cancer, can impair and slow the body's internal ability to fight infection and repair damaged tissue. When the body is unable to effectively initiate the wound healing process, a chronic wound is more likely to develop and persist.
Older individuals may simply experience slower wound healing due to age-related cellular and systemic changes within their body. Simply stated, the older we get, the harder it is for the human body to self-treat health issues and medical conditions.
Underlying pre-existing medical conditions such as chronic venous insufficiency, diabetes (Type 1 or Type 2 diabetes), peripheral artery disease (PAD), and autoimmune disorders can directly contribute to the development of a chronic wound. The more prevalent of these underlying conditions include:

Chronic venous insufficiency, which is a disorder affecting the leg veins that transport blood back to the heart, can increase the likelihood of developing chronic wounds (venous leg ulcers) on your lower legs (leg ulcers), feet (foot ulcer) and toes (toe ulcer). Chronic venous insufficiency causes the veins in your leg to become enlarged, usually resulting in a condition known as varicose veins. When this occurs, the blood in your legs is unable to flow upwards towards the heart, and instead it collects in the legs, sometimes causing them to swell. The resulting pressure of the collected blood makes it even more difficult for the blood to circulate and provide the body with enough nutrients and oxygen to help wound healing.
Diabetes, whether Type 1 or Type 2 diabetes, can directly lead to chronic wounds (diabetic ulcers), especially on the feet (diabetic foot ulcer) and toes (diabetic toe ulcer) due to its negative impact on the body’s immune system (ability to fight infection), circulatory system (reduced blood flow), and nerve damage to the feet and toes, among other contributing factors. It is estimated that approximately 20 to 25% of all people who have diabetes will develop some form of chronic diabetic ulcer.
Peripheral artery disease (PAD) results in reduced blow flow to the extremities (arms and legs), resulting in lower levels of oxygen and nutrients, which are required for proper wound healing, from reaching wound sites. With the body unable to self-treat through a normal wound healing process, wounds become prone to infection and are more likely to become chronic. It is estimated that PAD affects at least 10% of the general population, with the rate of occurrence increasing with age.

Examples Of Chronic Wounds

The more common examples and types of chronic wounds include:

Venous leg ulcers are the result of poor circulation and blood flow in the leg veins (chronic venous insufficiency) and represent approximately 70-90% of chronic wounds. Having a venous leg ulcer is also more prevalent among the elderly population due to natural age-related circulatory impairment within the body.
Diabetic foot ulcers and diabetic toe ulcers often occur on the feet of individuals who have diabetes. Diabetes may also lead to diabetic leg ulcers as well.
Arterial insufficiency ulcers result from poor blood circulation in the arteries, resulting in reduced levels of oxygen and nutrients which help with the body’s internal wound healing process.
A pressure ulcer (bed sores or bed sore ulcer) generally develop due to prolonged, sustained pressure on the skin, especially over bony prominences near the surface of the skin. Bed sores are more common among those who have mobility issues and remain immobile for extended periods.

Side Effects Of Having A Chronic Wound

Physical pain
Increased risk of infection
Emotional stress and anxiety
Social isolation
Loss of self-esteem
Decreased mobility and inability to perform normal daily activities
Overall decrease in quality of life
Financial burden (long-term treatment and care)

Chronic Wound Treatment

Treatment And Management Of A Chronic Wound

Due to their “chronic” nature, chronic wounds often require specialized medical care and treatment to properly and effectively manage the wound healing process. In addition to applying methods that directly facilitate the healing process of the wound itself, treatment of a chronic wound will likely involve addressing the underlying causes of the wound. Chronic wound treatment can broadly be categorized as involving:

Debridement of the wound (removing dead or infected tissue at the wound site).
Use and application of an appropriate wound dressing to maintain a moist wound healing environment and protect the wound site.
Infection control (use of antibiotics if necessary).
Addressing and managing underlying conditions which contributed to the chronic wound, such as diabetes or poor circulation.

Please note that you should consult with your healthcare provider for a specific, detailed plan of treatment and medical care for your particular condition.

Wound Dressings Used To Treat Chronic Wounds

There are several types of wound care dressings which may be prescribed to treat chronic wounds. Your healthcare provider will likely consider several factors to determine which wound dressing is appropriate for your particular case and will generally include wound exudate levels, wound depth and the presence of infection.

Among the available wound dressing types used to treat chronic wounds include:

Foam wound dressings - a foam wound dressing is excellent for managing moderate to heavily exudating wounds, providing cushioning and moisture balance.
Hydrocolloid wound dressings - a hydrocolloid wound dressing is suitable for shallow, low-exudate wounds, as they help maintain a moist environment and can aid in wound debridement.
Hydrogel wound dressings - a hydrogel wound dressing is ideal for rehydrating dry wounds and promoting autolytic debridement.
Alginate wound dressings - an alginate wound dressing is effective for wounds with moderate to heavy exudate, and can also help with debridement while acting as a cavity filler.
Antimicrobial wound dressings - antimicrobial wound dressings contain silver or iodine and can help control infection in chronic wounds.
Honey wound dressings - using honey on wounds offers an effective treatment option for certain chronic wounds as medical grade Manuka honey possesses antimicrobial, anti-inflammatory, and debriding properties which can promote wound healing. Read more about the benefits of treating actuate and chronic wounds with honey wound dressings.

Compression Therapy For Treating A Chronic Wound

The use of compression therapy is a well-established and commonly practiced primary method for treating venous-related chronic wounds. The use of compression involves the application of controlled pressure to the affected wound area, which helps promote healing by improving circulation and blood flow, reducing inflammation and swelling and helping to control pain. This compression is typically applied through the use of compression bandages, compression wraps or compression stockings.

Self-Care To Treat Underlying Causes Of Chronic Wounds

While it is absolutely critical to seek the advice of your healthcare provider to help treat and manage your chronic wound, there are steps that you can take individually to help facilitate the wound healing process. These self-care steps for helping to manage chronic wounds include:

Maintain a balanced and healthy diet, as proper nutrition can provide your body with what it needs to heal from a chronic wound.
Refrain from smoking as the effects of smoking impairs the body’s natural healing process.
Staying active will help your circulation and improve blood flow, contributing to your overall general health.
Stay hydrated - drinking plenty of water helps transport nutrients within and removes waste from your body, helping it heal from chronic wounds.
Keep pressure off and elevate affected wound sites which will better allow them to heal.
Follow proper wound care steps as prescribed by your healthcare provider.
Manage other chronic medical conditions that you might have:

For diabetes, maintain blood sugar levels, wash and moisturize your feet daily, keep pressure off of your feet and wear diabetic socks.
With chronic venous insufficiency and varicose veins, wear compression socks or compression wraps that provide needed compression to help contain swelling and improve circulation and blood flow.

Please note that you should consult with your healthcare provider for a specific plan of self-care in helping to manage your particular medical condition.