Treating Chronic Wounds 2024.

Understanding Chronic Wounds

These are chronic wounds which fail to heal within the normal and expected time frame or do not undergo a normal healing cycle. They are usually more prolonged and rarely decrease during the inflammatory phase and do not require 3-6 weeks to heal as required by other acute wounds that may take up to 8-12 weeks to heal. The patients with chronic wounds experience severe pain, and if the injury has not been treated, the patient will be restricted and the quality of life is compromised. Some key things to know about these difficult-to-treat wounds include :Several points to note about such hard-to-heal wounds are as follows

What Causes Chronic Wounds

In this article, the author shares several reasons that may hinder the healing of the wounds and make them chronic. Common causes includes

  • Pressure and Friction Any kind of constant pressure exerted or friction on an area of skin such as with the use of ill-fitting shoes or being obese or bedridden can cause ulcerations that will not heal. The regions of the body where cartilage is thin and only the bones are underneath are prone to slip and fall injuries; these include the heels, ankles, hips, and the tailbone.
  • Immobility Restricted mobility minimizes the repositioning and likewise hinders the blood supply resulting in lack of nutrition and oxygen to the affected tissue. Pressure ulcers or bedsores are common in patients as wounds. 
  • Infection In bacterial and other pathogenic organisms in wounds, toxins and inflammatory substances which are released have an undesirable effect on tissues. Infections slow recovery and increase cell injury and destruction.
  • Poor Nutrition If the body is starved of nutrition, then the body’s immunity is lowered, development in every aspect is affected and recovery slowed. Failure of some surgical wounds not to heal is consistent due to malnutrition.

By description and the type of tissues involved, the more frequent types of chronic wounds include:

There are several classifications of chronic wounds that are defined based on their causes and characteristics :There are several classifications of chronic wounds that are defined based on their causes and characteristics:

Pressure Ulcers

These lesions are also referred to as bedsores or pressure sores, and are characterized by the development of wounds where skin and the tissues underlying it are exposed to constant pressure or friction over a bony prominence, which results in the formation of damaged tissue beneath the skin. They are often located in the lower back area of the spine at the tailbone and in the hip, heel, and ankle regions.

Diabetic Foot Ulcers 

These neuropathic foot ulcers that are prevalent among diabetics are as a result of insensitivity from damaged nerves in lower limbs. The child and other vulnerable body parts like the skin or feet suffer minor injuries or deformities which do not elicit pain and continue to worsen because tissues have no protection sensation and remain prone to poor circulation. 

Venous Leg Ulcers

These painful leg ulcers are caused by venous insufficiency, whereby formation of new blood vessels or angiogenesis is triggered by poor circulation in the veins due to faulty valves in veins of the lower leg. This leakage leads to the damage of tissues that surround the red blood cells. They are often located at the ankle level and the lower regions of the leg.

Arterial Leg Ulcers

The outcome of the present research reveals that most of these ulcers are the result of peripheral artery disease that hinders blood circulation thus failing to supply oxygen and nutrients to the tissues in the legs. It often manifests in the foot and ankle part of the body and can be very painful. They also heal for a longer time than venous ulcers .

Chronic Wound Management

Management is mainly to treat the causes and related diseases with the aim of reactivating the healing phase. Common treatments include:

Wound Dressings 

As already highlighted, Sophia Advanced dressings help in preventing wound contamination hence allowing the moist wound to continue to heal. Another recommendation is the use of antimicrobial dressings, which help to prevent infection and improve healing .The dressing has to be changed frequently depending on the status of the wound present.

Compression Therapy

Wearing compression stockings improves blood circulation and reduces swelling while it also statistically significantly improves the healing rates of venous leg ulcers. Medical bandages have to be replaced by Unna boots because they offer equal weight distribution. May require clinical assessment from the patient on each occasion. If not well fitted, they can be rather uncomfortable to wear. ”

Wound Debridement

This entails the process of excision of the necrotic, affected tissue, which hinders tissue repair. Can be surgically, chemically using enzyme agents or autolyzed by placing dressings which have moisture maintaining capacity. Allows for better evaluation of a wound.

Offloading Pressure

Frees necessary to relieve pressure on wounds and requires to use total contact casts, protective and heel boots. They are especially important for diabetic foot ulcers. Ambient surfaces such as air fluidized bed and mattress also assist in the same. 

Oxygen Therapy 

It is utilized to introduce oxygen under pressure to the human body with an intention of accelerating the process of wound healing as well as combat infection. Topical oxygen therapy also enhanced the concentration of oxygen in that area.

Skin Grafts and Substitutes

In extensive or tunneling wounds, grafting with the patient’s skin or bioengineered skin substitutes serve as a covering for the wound that will hasten the healing process.

Growth Factor Therapy 

Thus, topical application of exogenous synthetically derived growth factors stimulates the body’s stem cells to respond and repair tissue. It is a recombinant human platelet derived growth factor indicated for neuropathic diabetic foot ulcers and it is FDA approved. 


Negative Pressure Wound Therapy A vacuum device applies negative pressure on a wound and this means that the margins of the wound are closed while at the same time, any excess fluid secretions and pathogenic microorganisms are aspirated for positive and intended healing of deeper and larger size of a wound.

Maggot Therapy

Maggots, which are the third instar of the Green blowfly, specifically medical grade sterile maggots are deliberately placed in non-healing necrotic ulcers to eat the dead tissues thus promoting healthy tissue growth. This age-old treatment modality perhaps can serve the purpose of debridement of wounds.

Hyperbaric Oxygen Therapy

The patient inhales oxygen that is combined with other gasses. This oxygenates blood to increase the formation of new blood vessels to fight bacterial formation within blood .This floods blood with oxygen that promotes formation of new blood vessels to counteract bacterial infection. Most effective for the treatment of arterial and diabetic ulcers of the foot.

Key Takeaways 

Chronic wounds are devastating by underlying diseases, pressure, impaired circulation, or bacterial infection that do not allow the usual timely healing of a wound. Despite this, there are more evolved treatments that can help to begin the healing process again, by eliminating such causes. Early intervention with appropriate specialized wound care can help to ensure that the wound heals without further complications or serious conditions that would require that the limb be amputated. It has also found that compliance with the treatment regimen achieves superior results. Also critical are assessments of any infection signs and management of risk factors when it comes to chronic wounds.

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