First, clean and cover chronic wounds regularly using wound dressings and bandages. If the wound does not heal after an extended period of time after this treatment, special treatments such as vacuum-assisted closure or skin grafts are used.
If someone's wound is more than eight weeks old and shows no signs of healing, it's considered chronic. Such wounds are usually caused by poor circulation, diabetes or a weakened immune system. Open wounds in the lower leg are also called venous leg ulcers.
In addition to treating underlying diseases and nursing wounds, pain relief is also important. Some people with complex and poorly healed wounds find psychological support helpful, too.
Clean the wound frequently when changing dressings, usually using a saline (salt) solution. Overall, however, little is known about the strengths and weaknesses of the various solutions used to clean wounds and how they affect the healing process. It is not clear whether tap water can be used for medical cleaning of wounds.
When treating chronic wounds, doctors or nurses usually remove dead or inflamed tissue. This is called debridement. Tissue is removed using tools such as tweezers, pointed scoop-shaped instruments called curettles or scalpels. Enzyme-based gels are sometimes used to help clean wounds.
A high pressure water jet can also be used to clean the wound. Another form of debridement involves the use of certain maggots (fly larvae) specially bred for medical purposes. Maggots are placed over the wound, either as is or in pouches. They removed dead tissue and fluid from the wound.
Because debridement is often painful, a local anesthetic, such as ointment, is used to numb the wound beforehand. Pain relievers can also be taken before treatment if more severe pain is expected. Larger wounds are sometimes cleaned under general anesthesia. There are not enough good studies on the pros and cons of various debridement techniques to show their effectiveness.Wound dressing
After the wound is clean, cover it with a dressing. Most wounds are kept moist, such as wet compresses. However, the following dressings can be used instead:
Dermlin wound healing dressings
Dressing containing silver or alginate
Dressings are used to remove excess fluid from the wound and protect it from infection. They usually stay on the wound for a few days. The dressing should be changed if it is evident that the dressing is not absorbing more wound secretions, the site of slip, or fluid from the bandage. It is not possible to determine which type of wound dressing is best for different types of wounds because there are not enough good studies on this.
And some dressings contain substances called growth factors. These hormone-like substances are designed to aid the healing process by promoting the growth of the body's cells. But there aren't enough good studies to say whether using growth factors to treat diabetic foot ulcers and other types of chronic wounds is more effective than conventional wound care.
Honey is traditionally used for wound care. But applying special honey to a wound before dressing it may not do any good. But so far, the effects of using honey to treat leg wounds have only been tested in people with venous leg ulcers.
If poor circulation is the cause of a chronic wound, a pressure sock or bandage can help it heal faster. The pressure from the stockings and bandages helps the veins send blood back to the heart and improve circulation.
If a wound is infected with bacteria, it is even less likely to heal. Antibiotics may be considered depending on the severity of the infection. They can be applied to the wound using an ointment or a compress. Preliminary results suggest that wounds in patients with diabetic foot syndrome heal faster as a result. It's not clear if this applies to wounds caused by other underlying diseases.
It's not clear whether antibiotic tablets help: Studies have shown they offer no advantage in wound healing over other treatments.
In hyperbaric oxygen therapy, a person with a wound is sent to a special chamber where oxygen is inhaled under high pressure. This is to increase the concentration of oxygen in their blood and improve blood supply to the wound area.
Hyperbaric oxygen therapy improves wound healing in patients with diabetic foot syndrome, research suggests.
Ultrasound therapy involves the use of sound waves to treat chronic wounds. Sound waves warm tissue. But ultrasound therapy has not been proven to help wounds heal faster.
Electromagnetic therapy works the same way, using a pillow or cushion with magnets to apply a weak electromagnetic wave to the wound.
Negative pressure wound treatment
In negative pressure wound therapy (also known as vacuum-assisted closure or VAC therapy), the wound is covered with an airtight dressing that is connected to a pump by a thin tube.
The pump continuously draws fluid from the wound, creating negative pressure on the wound surface. The goal is to increase blood flow to the wound. It also helps to keep the wound moist, which also helps improve the healing process.
Some hospitals use pump systems to treat chronic or large open wounds, such as after skin grafts. But they can also be used at home. Negative pressure may be applied to the wound throughout the day or at regular intervals.
However, constantly connected pumps can limit your mobility and create noise. Some people find this annoying. Changing dressings and tubes can also be painful and can cause a small amount of bleeding.
It is not possible to say whether negative pressure wound therapy can help people with chronic wounds, as there is a lack of good research. It's not clear whether shockwaves, ozone or light therapy can help.
If the wound is too large to close on its own, skin grafts are seen as a treatment option. In this process, skin is removed from another part of your body -- usually your thigh -- and grafted onto the wound.
There are also implants made from human cell products and synthetic materials. Studies have shown that these increase the chances of poorly healed venous leg ulcers closing more quickly.
The wound healed completely within six months
Of the 100 patients routinely treated with wound dressings, 40
Sixty-one out of 100 people had skin grafts.
Chronic foot wounds with skin grafts also heal faster than with standard treatment.
Painful, chronic wounds can be a burden on your daily life and prevent you from getting a good night's sleep. The constant pain can really wear you out and make you feel really low and even depressed after a while.
Drugs such as acetaminophen (paracetamol) or ibuprofen can help relieve mild to moderate pain. If they are not effective enough, doctors can prescribe stronger painkillers.
Wound dressings containing ibuprofen may also be used. There's not enough research to show how effective they are at relieving pain from chronic wounds.
People with chronic pain can benefit from psychological support. Psychotherapy for pain management aims to help people cope better with pain in everyday life.