Q&A: Why won’t my wound heal?
Wounds should show signs of healing within two weeks. If there are no signs of healing after two weeks, the wound may be chronic.
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Q: I have a wound that isn’t healing. Should I be concerned?
A: Wounds are injuries, including cuts, scrapes and scratches, that break the skin or other body tissues.
Wounds should show signs of healing within two weeks. If there are no signs of healing after two weeks, the wound may be chronic. Common signs and symptoms of a chronic wound include increasing pain, breakdown of the wound, excess of serous exudate (clear, thin, watery plasma) and foul odor.
There are four stages of wound healing:
Hemostasis: The process of the wound being closed by clotting.
Inflammation: The injured blood vessels leak transudate (made of water, salt and protein) and cause swelling. Inflammation controls bleeding and prevents infection.
Proliferation: The wound rebuilds with new tissue.
Remodeling: New tissue builds strength and flexibility.
If left untreated, chronic wounds can lead to further health complications, including increased infection, osteomyelitis (bone infection), tissue necrosis (irreparable death of body tissue) and gangrene in the extremities, muscles and organs.
Acute wounds can repair themselves and heal in a timely manner, while chronic wounds cannot.
Many chronic wounds, such as ulcers, result from minor injuries or immobility causing pressure that restricts blood flow. Some chronic wounds also occur as a result of underlying health issues, including diabetes, obesity, vascular disease, immunosuppression, renal failure and infection, among many others.
Venous ulcers occur primarily in the legs and are caused by problems with blood circulation, including hypertension, due to dysfunctional blood valves or obstructed veins.
Diabetic ulcers are open sores, often on the bottom of the foot, caused by health effects of diabetes including poor circulation, nerve damage and hyperglycemia.
Pressure ulcers (also known as bedsores) are injuries to skin and tissue caused by prolonged pressure. People unable to move due to old age or illness are most at risk.
The TIME acronym provides a simple understanding of factors contributing to proper wound healing:
Tissue: The presence of non-viable tissue or foreign bodies can prevent healing.
Infection: Identify potential infection or inflammation.
Moisture: The wound should be warm and moist, not too dry or too wet.
Edge: The edge of the wound and surrounding skin should show improved conditions.
Multiple treatments exist, depending on the severity and location of the chronic wound. Frequent cleaning and the application of topical products can optimize healing and promote skin growth. Compression therapy helps prevent blood clots, improving venous flow to speed up wound healing and limit infections. Other therapy options include hyperbaric oxygen therapy and negative pressure wound therapy.
Lifestyle changes, including limiting alcohol and tobacco intake and following a healthy diet, can reduce risk for health problems that may lead to chronic wounds. For those with diabetes, proper diabetes management can help limit risk for health complications due to diabetic ulcers.
If you are experiencing symptoms of chronic wounds, talk to your doctor.
Arthur Barnaby is a surgeon at Nazareth Hospital in Northeast Philadelphia.