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 complications. If you have a wound that does not appear to be healing properly despite proper care, it is important to promptly seek professional medical attention so that the situation can be diagnosed and a health treatment plan can be implemented to promote healing and prevent further complications.

Chronic Wounds

Having a chronic wound refers to a medical condition where a wound does not follow the normal healing process, or is simply difficult to heal. 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 not heal within a normal healing process, instead taking 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 Chronic Wounds

Some of the key characteristics of chronic wounds include:

Delayed healing: Chronic wounds do not progress through the four normal stages of 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 hinder your body's natural ability to repair the damaged tissue and promote healing.
Persistent chronic inflammation: Chronic wounds often remain in a prolonged inflammatory phase, which can damage healthy tissue and negatively impact the healing process.

Common Causes And Contributing Factors Of Chronic Wounds

As stated previously, chronic wounds can 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, leading to the development of pressure ulcers (bedsores). This condition is especially prevalent with 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 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 healing process, chronic wounds are 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 venous insufficiency, diabetes, peripheral artery disease (PAD), and autoimmune disorders can directly contribute to the development of a chronic wound. The more prevalent of these conditions include:

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 ulcers) on your lower legs, feet and toes. 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 wounds heal.
Diabetes can directly lead to chronic wounds (ulcers), especially on the feet and toes 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.
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 healing process, wounds become prone to infection and are more likely to become chronic.

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 (venous insufficiency) and represent approximately 70-90% of chronic wounds. Venous leg ulcers are also more prevalent among the elderly population.
Diabetic foot ulcers and toe ulcers often occur on the feet of individuals who have diabetes.
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.
Pressure ulcers (bed sores) 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.

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)

Treatment And Management Of Chronic Wounds

Due to their “chronic” nature, chronic wounds often require specialized medical care and treatment to properly and effectively manage and heal. 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. This “healing process” can broadly be categorized as involving:

Debridement of the wound (removing dead or infected tissue at the wound site).
Use and application of the appropriate wound dressings 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 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 types of wound dressings used to treat chronic wounds include:

Foam dressings - excellent for managing moderate to heavily exudating wounds, providing cushioning and moisture balance.
Hydrocolloid dressings - suitable for shallow, low-exudate wounds, they help maintain a moist environment and can aid in debridement.
Hydrogel dressings - these dressings are ideal for rehydrating dry wounds and promoting autolytic debridement.
Alginate dressings - effective for wounds with moderate to heavy exudate, they can also help with debridement and act as a cavity filler.
Antimicrobial dressings - these dressings contain silver or iodine and can help control infection in chronic wounds.
Honey dressings - honey wound dressings can be an effective treatment option for certain chronic wounds as honey possesses antimicrobial, anti-inflammatory, and debriding properties which can promote wound healing . Read more about honey wound dressings and compression for effective chronic wound healing.

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 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 venous insufficiency and varicose veins, wear compression socks or compression wraps that provide 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.