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Chronic Wound – Causes, Symptoms and Treatment
A chronic wound is a wound that fails to heal within eight weeks despite proper treatment. It commonly occurs in people with diabetes, circulatory disorders, or pressure ulcers.
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A chronic wound is a wound that fails to heal within eight weeks despite proper treatment. It commonly occurs in people with diabetes, circulatory disorders, or pressure ulcers.
What is a Chronic Wound?
A chronic wound is a tissue injury that does not close within eight weeks despite appropriate medical care. Unlike acute wounds such as cuts or surgical incisions, chronic wounds become stuck in one phase of the healing process and fail to progress. It is estimated that millions of people worldwide live with chronic wounds, making this a significant public health concern that places a heavy burden on healthcare systems and the quality of life of those affected.
Causes
Chronic wounds rarely result from a single cause. They typically develop when several underlying factors interfere with the normal healing process:
- Circulatory disorders: Arterial or venous vascular disease reduces the supply of oxygen and nutrients to the tissue.
- Diabetes mellitus: Elevated blood glucose levels damage nerves and blood vessels, leading to impaired healing – particularly in the form of the diabetic foot.
- Sustained pressure: Prolonged pressure on skin areas, especially in bedridden patients, causes pressure ulcers (also known as decubitus ulcers or bedsores).
- Infections: Bacterial colonisation can inhibit healing and sustain chronic inflammation.
- Immunosuppression: Conditions or medications that weaken the immune system increase the risk of chronic wounds.
- Malnutrition: Deficiencies in protein, vitamins (e.g., vitamin C), or zinc impair tissue repair.
Common Types
- Venous leg ulcer (ulcus cruris): A wound on the lower leg most commonly caused by chronic venous insufficiency.
- Diabetic foot syndrome: Wounds on the foot in people with diabetes, caused by nerve damage and poor circulation.
- Pressure ulcer (decubitus ulcer): Tissue damage from sustained pressure, most often affecting immobile patients.
- Ischaemic wounds: Wounds resulting from insufficient blood supply due to peripheral arterial disease.
Symptoms
The clinical presentation of chronic wounds varies depending on the underlying cause. Common signs include:
- Absent or very slow healing over several weeks
- Pain in and around the wound area
- Redness, swelling, and warmth indicating infection or inflammation
- Malodorous or purulent wound discharge
- Black or yellow tissue (necrosis or fibrin slough) within the wound
- Oedema (fluid accumulation) surrounding the wound
Diagnosis
Diagnosing a chronic wound requires a thorough medical history and a combination of clinical and technical assessments:
- Wound assessment: Documentation of wound size, depth, wound edges, wound bed, and exudate.
- Microbiological swab: Identification of pathogens and antibiotic resistance (sensitivity testing).
- Doppler ultrasound: Assessment of blood flow in the leg vessels.
- Laboratory tests: Blood glucose, HbA1c, inflammatory markers (CRP, white blood cell count), albumin levels.
- Imaging: X-ray or MRI when bone or deep-tissue infection (osteomyelitis) is suspected.
Treatment
Managing chronic wounds is complex and requires an interdisciplinary team of physicians, nurses, and therapists. The goal is to address the underlying cause while creating optimal conditions for wound healing.
Wound Care
- Debridement: Removal of necrotic tissue (surgically, enzymatically, or autolytically) to stimulate healing.
- Modern wound dressings: Hydrocolloid, hydrogel, or foam dressings maintain a moist wound environment and support regeneration.
- Negative pressure wound therapy (NPWT): Promotes blood flow and granulation tissue formation using controlled negative pressure.
- Antiseptics: Substances such as polihexanide or octenidine are used to manage infected wounds.
Treatment of the Underlying Condition
- Optimal blood glucose management in diabetes
- Compression therapy for venous insufficiency
- Revascularisation for arterial occlusive disease
- Pressure relief for pressure ulcers
Supportive Measures
- Nutritional optimisation (protein, vitamin C, zinc)
- Pain management
- Physiotherapy to improve mobility and circulation
Prevention
Many chronic wounds can be prevented or their development slowed through targeted measures:
- Regular foot care and inspection in people with diabetes
- Pressure relief and regular repositioning of bedridden patients
- Consistent management of underlying vascular diseases
- A balanced diet to support tissue repair
- Avoiding smoking, as it significantly impairs circulation and wound healing
References
- Augustin M. et al. - Management of chronic wounds: diagnosis and treatment. Dtsch Arztebl Int. 2011;108(25):435-440.
- World Health Organization (WHO) - Chronic diseases and health promotion. www.who.int (accessed 2024).
- Vowden P., Vowden K. - Wound bed preparation. World Wide Wounds. 2002. www.worldwidewounds.com.
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