Chronic Wounds: How to Recognize and Treat Them

Dr. Bill Releford
March 8, 2022

A chronic wound does not heal in a standard, orderly fashion. The wound either fails to heal, recurs, or healing takes longer than expected. A chronic wound is likely a symptom of an underlying condition such as diabetes and other chronic diseases.

Types of Chronic Wounds

The types of wounds may include, but are not limited to the following etiologies:

  • Venous ulcers: Often occur on the legs and account for about 70% - 90% of all chronic wounds. This type of chronic wound mostly affects the elderly who have poor blood circulation due to aging blood valves or obstructed veins.
  • Diabetic ulcers: Majorly experienced by diabetic patients due to nerve damage, compromised immunity, damaged capillaries, and limited sensitivity
  • Pressure ulcers: Mostly seen in bedridden patients or people with limited mobility. The greatest risk areas for pressure ulcers are the sacrum, shoulder blades, and heels

Signs and Symptoms of Chronic Wounds

Most patients with chronic wounds experience pain throughout their lives. The wounds can be identified by raised, hyperproliferative, yet non-advancing wound margins. Here are some of the classic signs and symptoms associated with chronic wounds:

  • Erythema
  • Edema
  • Delayed ulcer healing
  • Foul odor
  • Wound breakdown
  • Purulent exudate and serous exudate

Causes of Chronic Wounds

Chronic wounds may be caused by:

  • Immobility
  • Malignant tumor as a result of repetitive tissue damage
  • Old age
  • Trauma injury to the skin as a result of an accident 
  • Surgery – incisions may become infected and slow to heal
  • Deep burns
  • Underlying medical conditions such as diabetes or some types of vascular disease
  • Poor blood circulation
  • Trophic ulcers, where a lack of sensation allows everyday trauma to lead to an ulcer – such as in diabetic neuropathy and leprosy

Treatment of Chronic Wounds

The choice of treatment for chronic wounds depends on the wound type. Typically, the underlying causes must be dealt with before wound healing can start. The doctor should first identify and treat the infection to determine the cause of treatment.

Hospital Treatment of Chronic wounds

For Patients with underlying conditions such as diabetes, the doctor will need to check their blood sugar levels and nutrition before treatment begins. 

Wound Cleaning and Dressing

The healthcare provider may begin by cleaning the wound to remove any dirt and foreign objects using a saline solution. An enzyme-based gel is sometimes applied to help clean the wound.

Debridement may be done in addition to wound cleaning whereby the doctor or nurse removes dead or inflamed tissue using instruments such as a curette, tweezers, or a scalpel. Another form of debridement involves the use of a certain species of maggots specially bred for medical purposes. The maggots are carefully placed on the wound either as they are or in a pouch. They remove the dead tissue and fluid from the wound. Debridement is often a painful ordeal and therefore, a local anesthetic is administered to numb the wound beforehand. 

Chronic wounds are dressed once cleaning is completed. The dressing helps remove excess fluid from the wound. Dressing doctors prefer moist dressings when dealing with chronic wounds. If the chronic wound was caused by poor blood circulation, you may be required to wear compression stockings or bandages to help it heal faster. Antibiotics can also be administered depending on the severity of the infection.

Skin Grafts

Skin grafts are used to treat chronic wounds if the wound is too large to close on its own. In this procedure, skin is taken from one part of your body – usually the thigh - and transplanted onto the wound. There also exist grafts made from human cell products and synthetic materials.

Wound Therapies

The use of wound therapies such as Platelet-rich plasma (PRP), negative pressure, and hyperbaric oxygen wound therapy in chronic wound healing is becoming popular. PRP therapy is a form of regenerative medicine that uses the body’s self-healing capabilities for effective wound healing.

Negative pressure wound therapy involves covering the wound with a special dressing connected to a gentle vacuum pump. The pump continuously draws out fluid from the wound ultimately increasing blood flow in that area. This type of therapy keeps the wound moist and improves the healing process. 

In hyperbaric oxygen therapy, the patient goes into a special chamber to breathe in oxygen under high pressure to increase oxygen concentration and blood supply to the wound area.

Self-Care Treatment

Some self-care treatment options that help in quick wound recovery include keeping your wound warm, clean, and dressed, avoiding alcohol and smoking, and management of chronic diseases. Eating a balanced diet rich in vitamin C such as fruits boosts the production of collagen which hastens chronic wound healing. It is crucial to avoid over-the-counter medication such as aspirin which compromises your immune system. Consult with your doctor on the types of medication to avoid.

Bottom Line

A chronic wound can heal when proper care and management are given, and early detection is key. Persons with chronic disease such as diabetes need to consult their doctor when they develop a wound that does not heal promptly. This way, doctors can consider the various treatment options for the best outcome.