A chronic wound develops when any acute wound fails to heal in the expected time frame for

that type of wound, which might be a couple of weeks or up to six weeks in some cases.

Causes of Chronic Wounds

Failure of any wound to heal can be due to a lack of one or more of the main requirements of
healing, including a good supply of blood, oxygen and nutrients, and a clean and infectionfree environment. An important aspect in caring for wounds is to remove the causing agent,
as in cases of wounds caused by weight-bearing or wounds that are under constant pressure.
When wounds do not get relief from constant pressure, there can be a cumulative breakdown
of the tissue.

Types of Chronic Wounds

Some of the most common types of wounds and their specific causes are as follows:

Infectious wounds: Whether it is bacterial, fungal or viral, if the cause of the infection
is not treated with the proper medication, the wound will not heal properly in the
expected time.

Ischemic wounds: Ischemia means that the wound area is not getting sufficient blood
supply. Limiting the blood supply, and the oxygen and nutrients it carries, can delay
the healing process or even prevent it.

Radiation poisoning wounds: Regardless of whether the source of radiation was

therapeutic (gamma rays or x-rays) or accidental (exposure to radioactive materials
from nuclear plant accidents or radioactive devices that detonate), excessive exposure
to ionizing radiating materials can weaken the immune system, cause damage to
exposed tissue and delay the healing time of all wounds.

Surgical wounds: Wounds caused by incisions made during surgery can progress to
chronic wounds if the blood supply to the surgery area was accidentally damaged or if
wound care was inadequate. Both can delay the healing time of a wound.

Ulcers (the most common type of chronic wounds):

Arterial ulcers: These can occur from hypertension, atherosclerosis (plugging) and
thrombosis (clotting), where the reduced blood supply leads to an ischemic state.

Venous ulcers: These account for more than half of ulcer cases, especially in the lower
limbs (mainly the legs) as associated with deep vein thrombosis, varicose veins and
venous hypertension. Venous ulcers can lead to stasis, where the blood fails to
circulate normally.

Diabetic ulcers: These are a common complication in uncontrolled diabetes mellitus,

resulting in impaired immune function, ischemia (due to poor blood circulation) and
neuropathy (nerve damage), which eventually lead to breakage of skin and ulceration.

Pressure ulcer: The constant pressure and friction resulting from body weight over a
localized area for prolonged duration can lead to breakage of skin and ulceration (also
known as bed sores); especially on the back and on the ankles and feet.

Signs and Symptoms of Chronic Wounds

Infectious wounds: These typically have a bad odor, pus drainage, debris (yellowish to
greenish) or dead tissue, and ongoing symptoms of inflammation (fever, pain, redness,
hotness and swelling).
Ischemic wounds: Usually the wound area will be pale and cold. There might also be a
decrease in the hair growth and a weak pulse sensation in the area.
Radiation poisoning wounds: These can present with redness, blistering, itching,
inflammation and other unspecified symptoms that include nausea, vomiting, abdominal pain
and fever.
Surgical wounds: Typically occur at the site of a surgical incision, but instead of a clean
appearance, the tissue around the incision appears red, hot, and swollen, which can be
infected or inflamed.
Ulcers:

Arterial ulcers: Usually involve the full thickness of skin, having a punched out
appearance with smooth edges and occasionally pain that subsides when the legs are
lowered below the heart level. In some cases, ischemia is present (poor circulation to
area).

Venous ulcers: The skin is usually shiny and smooth with minimal to no hair. These
ulcers are superficial, shallow, and irregularly shaped with pain and edema. These can
sometimes be associated with infection or inflammation.

Diabetic ulcers: These can be either of neuropathic (secondary to nerve damage)

origin, where the lack of sweat makes the skin dry and easy to crack and scale,
forming callus (accumulation of dead skin layers). The callused area, mostly
occurring on the foot, can eventually break down and form an ulcer. Diabetic ulcers
can also occur from neuropathy with ischemic origin; where the ulcer area is cool
with no pulse, in addition to the other signs of ischemia described above.

Pressure Ulcers: These present with redness that doesnt go away when pressed upon,
and includes itching, blistering, hotness, swelling and discoloration of the area.

Who Is at Risk
People with the one or more of the following are at risk for developing chronic wounds:

Chronic medical conditions, such as diabetes, high cholesterol, severe burns, cancer
or AIDS

Vascular disease, including heart disease, hypertension, atherosclerosis, anemia,

varicose veins or deep venous thrombosis

Elderly, immobile or obese people are at a greater risk

Unhealthy lifestyle or habits like smoking, poor diet and hygiene or lack of exercise

Previous history of ulcers, multiple surgeries or prolonged periods of bed rest

Weak immune system, as in patients taking corticosteroids, chemotherapy or

radiotherapy

High-risk occupations with radiation exposure or long periods of sitting

Treatment and Prevention of Chronic Wounds

The best treatment is to prevent the wound from progressing to chronic state by avoiding all
the risk factors. Preventative measures include maintaining proper hygiene and wound care as
instructed by the doctors, while complying with the prescribed medications. Regular
inspection of wounds to track healing progress is also a primary part of the treatment plan.
In general, treating and removing the underlying cause of any chronic wound should be the
primary focus of the treatment. In some cases a surgical debridement (removing any
accumulated dead tissue) is needed to improve the blood flow and supply of nutrients to the
wound. In other cases, applying proper wound care by changing wound dressings frequently,
keeping the wound clean, applying local antibiotic, taking anti-inflammatory medications
when needed and maintaining a healthy lifestyle is sufficient to prevent chronic wounds and
encourage proper healing.
A chronic wound is a wound that just will not repair itself over time. Chronic wounds are
often thought to be stuck in one of the phases of wound healing, and are most often seen in
the older adult population. Typically, if a wound is not healing as expected within 2-3
months, it is considered chronic.
http://www.woundcarecenters.org/article/wound-types/chronic-wounds

Causes of Chronic Wounds

There are many factors that contribute to the non-healing nature of chronic wounds including:

Advanced age of patient

Chronic medical conditions affecting circulation and immune functioning

such as diabetes mellitus, peripheral neuropathy, peripheral arterial
disease and venous insufficiency

Poor nutrition

Impaired mobility

Stress

Poor health

Types of Chronic Wounds

Generally, chronic wounds can be classified into one of three types.

Pressure Ulcers
o

Also known as bedsores, these wounds are caused by prolonged,

unrelieved pressure to an area of the body, typically around bony
prominences such as the tailbone, heels and ankles. This constant
pressure inflicts damage to the skin while other factors, such as
moisture and friction, contribute to the wound formation. These
wounds typically occur in individuals who are bedridden, or those
with limited mobility.

Arterial and Venous Ulcers

o

Venous stasis ulcers occur due to dysfunctional valves in the veins,

which cause blood to pool in certain areas of the body particularly
the lower limbs. This pooling results in poor circulation and chronic
inflammation at the site. These wounds typically occur in the elderly
and account for the majority of chronic wound cases.

Arterial insufficiency ulcers are a direct result of blocked blood flow

to small vascular beds in the body such as on the top of the foot. If
this area is injured due to trauma or pressure, the wound is unable
to heal itself due to a lack of blood flow. While not as common as
venous stasis ulcers, these wounds also occur most frequently in
the elderly.

Diabetic Ulcers
o

Diabetes causes decreased nerve functioning, particularly in the

lower extremities, resulting in a numbing effect. If an individual is
not aware of pain in the legs or feet, any cuts or wounds can go
completely unnoticed for days or possibly longer, resulting in a
much larger and more complicated wound. Furthermore, diabetes
decreases the bodys immune response, hindering its ability to fight
infection and contributing to the non-healing nature of these
wounds.

Signs and Symptoms

Any wound that is not healing, or one that is healing slowly, can be considered chronic. The
most common symptom of chronic wounds is pain.
Who Is at Risk

The elderly and individuals with multiple chronic medical conditions are at greatest risk for
chronic wounds. Individuals taking multiple over-the-counter or prescription medications are
also at risk due to the many side effects drugs can have on sensory perception and circulation.
General risk factors include:

Decreased sensory perception

Limited mobility (due to weakness, paralysis, sedation, bed rest or use of a

wheelchair)

Decreased mental awareness

Poor nutrition

Medical conditions that affect circulation

Cigarette smoking

Treatment Options for Chronic Wounds

Chronic wound treatment is aimed at trying to reverse or improve the root cause of the wound
itself. Chronic wounds may last for several years, and in some individuals, may never fully
heal. In all cases, pain management is an important part of the treatment process. Some
treatment options for chronic wounds include:

Routinely cleaning the wound and ridding it of dead tissue via

debridement and irrigation

Vacuum assisted wound dressings, also called Wound Vacs, create

negative pressure to the wound, which can be particularly helpful in
wounds with large amounts of drainage.

Warming the area to increase blood flow

Antibiotic regimen

Oxygen therapy

Specialized dressings that provide healing factors or enzymes that help

break down dead tissue

Prevention of Chronic Wounds

Chronic wounds are much easier to prevent than to treat. The best way to prevent a chronic
wound is to actively and appropriately manage chronic medical conditions such as diabetes,
high blood pressure, venous insufficiency and peripheral neuropathy. Skin should be
routinely inspected in these individuals. Steps should be taken to prevent trauma to the skin
of the legs and feet, such as wearing shoes, ensuring clothing is not wrinkled or bunched over

bony areas and maintaining proper hygiene and nutrition. If a cut or wound does occur,
immediate care and attention should be provided.
http://www.woundcarecenters.org/article/wound-basics/chronic-wound-basics