Skin wounds that do not heal, heal slowly, or heal but tend to recur are called chronic wounds. Many causes of chronic (persistent) skin wounds can include trauma, burns, skin cancer, infection, or underlying conditions such as diabetes. Wounds that take a long time to heal require special care.
Causes of chronic wounds
Many causes of chronic skin wounds may include:
Inability to move (pressure wounds or bedsores), continuous local pressure restricting blood flow
major trauma to the skin
Surgery incisions (cuts made during surgery) can become infected and heal slowly
underlying medical conditions, such as diabetes or certain types of vascular disease
Certain types of infections, such as Bairnsdale or Buruli ulcers (M. ulcerans)
Nutritional ulcers, a lack of sensation can lead to everyday trauma leading to ulcers - such as diabetic neuropathy and leprosy.
process of skin wounds follows a predictable pattern. If one or more stages of healing are interrupted, the wound may not heal. Normal wound healing phases include:
Inflammatory stage - The blood vessels at the site constrict (tighten) to prevent blood loss, and platelets (specialized blood clotting cells) clump together to form a clot. Once the clot is complete, the blood vessels dilate to allow maximum blood flow to the wound. This is why a healed wound feels warm at first and looks red. White blood cells flood the area to destroy microorganisms and other foreign objects. Skin cells multiply and grow on the wound.
Fibroblast stage - Collagen, a protein fiber that gives the skin its strength, begins to grow inside the wound. Collagen growth prompts the edges of the wound to contract and close together. Small blood vessels (capillaries) form at the site to supply blood to the new skin.
Mature stage - the body is constantly adding more collagen and refining the injured area. This can take months or even years. This is why scars fade over time, and why we must take care of wounds for a period of time after they heal.
Factors that may slow the wound healing process include:
Dead skin (necrosis) - Dead skin and foreign objects can interfere with the healing process.
Infection - Bacterial infections can occur in open wounds. The body fights the infection instead of healing the wound.
Bleeding - Continued bleeding can separate the edges of the wound.
Mechanical injuries - for example, people who are immobile due to constant pressure and friction are at risk for pressure ulcers.
Diet - Poor food choices can deprive the body of nutrients it needs to heal wounds, such as vitamin C, zinc, and protein.
Medical conditions - such as diabetes, anemia and some vascular diseases that restrict blood flow to the area, or anything that blocks the immune system.
Age - Wounds in older adults tend to take longer to heal.
Medications - Certain medications or treatments used to treat certain diseases may interfere with the body's healing process.
Smoking - Smoking can impair healing and increase the risk of complications.
Varicose veins - restricted blood flow and swelling can cause skin breakouts and persistent ulcers.
Dryness - Air-exposed wounds (such as leg ulcers) are less likely to heal. Various cells involved in healing, such as skin cells and immune cells, require a moist environment.
The cause of chronic wounds must be determined so that underlying factors can be controlled. For example, if a leg or foot ulcer is caused by diabetes, your doctor will check your blood sugar level control and may recommend that you see a podiatrist to prevent future ulcers from recurring. In the case of ulcers caused by varicose veins, surgery on the veins may be necessary. Diagnosis of chronic wounds may include:
Physical examination including examination of wounds and assessment of local nerve and blood supply
Medical history, including information about chronic illnesses, recent surgeries, and medications you regularly take or have recently taken
blood and urine tests
The wound is cultured for any (pathogenic) pathogenic microorganisms.
Guided by your doctor, but self-care suggestions for slow-healing wounds include:
If possible, do not take medications that interfere with the body's natural healing process. For example, anti-inflammatory drugs, such as over-the-counter aspirin, can block the action of immune system cells. Ask your doctor for a list of medications to avoid in the short term.
Make sure to eat right. Your body needs good food to facilitate the healing process.
Include foods rich in vitamin C in your diet. The body needs vitamin C to make collagen. Eating fresh fruits and vegetables every day also provides your body with other nutrients essential for wound healing, such as vitamin A, copper, and zinc. It may help supplement your diet with extra vitamin C.
Keep the wound bandaged. Wounds heal faster if kept warm. Change dressings as quickly as possible. Exposing a wound to air will lower its temperature and may slow healing for a few hours.
Do not use antiseptic creams, lotions or sprays on chronic wounds. These preparations are toxic to cells involved in wound repair.
Exercise regularly, as it increases blood flow, improves overall health, and speeds wound healing. Ask your doctor for advice on appropriate exercise.
Manage any chronic disease, such as diabetes.
do not smoke.
go to the doctor
Check your wound regularly. See your doctor right away if you have any symptoms, including:
wound pus or discharge
If you have any concerns about the wound, be sure to see your doctor.