Chronic wounds

Most minor everyday injuries heal quickly. However, a wound can be very slow to close or keep re-opening. A wound is referred to as chronic if it does not heal within eight weeks. In most cases treating this type of wound is a lengthy and painful process.

At a glance

  • A wound is referred to as chronic if it does not heal within eight weeks.
  • Treating chronic wounds can take a long time and is often painful.
  • Difficult to heal wounds are frequently caused by circulatory disorders or diabetes mellitus.
  • Chronic wounds often develop on the feet or lower leg.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

What is a chronic wound?

Whereas most minor everyday injuries heal quickly, it can take longer for larger wounds to heal. These types of wounds sometimes require stitches.

It can also happen that wounds close very slowly, continually recur or do not heal at all. In most cases this is due to circulatory disorders or diabetes mellitus. Difficult to heal wounds often occur on the feet or lower leg.

A wound is referred to as chronic if it does not heal within 8 weeks.

A wound is referred to as chronic if it does not heal within eight weeks. Treating chronic wounds can take a long time and can be painful. Getting the right wound care is very important here. The underlying condition that favored the wound should also be treated.

What are the symptoms of a chronic wound?

Chronic wounds can be, but are not necessarily very painful. The size and depth of a wound determines how painful it is. If a wound stays open for a long period the skin around the wounds may turn a reddish or brownish color. The wound may also itch, weep or have an unpleasant odor.

The pain may be exacerbated if the wound becomes inflamed or the affected body part is moved. Many people with chronic wounds sleep badly at night because they feel the pain and itching more intensely.

What are the causes of chronic wounds?

Wounds are often the result of an injury such as a cut or hard knock. People who develop a chronic wound often have an underlying condition, however. They are more prone to wounds which are difficult to heal. These underlying conditions or health problems include, for example:

Circulatory disorders

People with narrowing of the arteries (blood vessels that supply body tissue with oxygen and nutrients) generally find that their wounds heal more slowly than those with good circulation. Peripheral artery disease (PAD) is a typical underlying condition.

Venous insufficiency

Wounds on the lower leg or foot also tend to be difficult to heal in people who have problems with the veins in their legs. The veins in the legs transport the blood back to the heart. If the venous valves are not working properly the veins become distended. The blood accumulates in the legs and they swell up. This leads to an increase in pressure which stops blood circulating properly, cutting the supply of oxygen to the body’s tissue. It may also lead to varicose veins. Under these adverse conditions a minor injury can turn into a chronic wound. A difficult to heal wound on the lower leg is commonly referred to as a leg ulcer. The technical term is ulcus cruris venosum.

Diabetes

Typical signs of the advanced stages of diabetes are damage to the blood vessels and nerves in the feet. This is why people with diabetes often do not feel pain in their feet. As a result they may fail to notice minor injuries or pressure points caused by shoes that are too tight. Poor circulation also interferes with the supply of blood to the feet. This also increases the risk of chronic wounds.

Immune deficiency

People with severe diseases such as cancer, older people or people who are malnourished have weak immune defenses. This may mean wounds can take longer to heal.

Soft tissue damage and injuries due to accidents

Large, deep wounds caused by a severe injury or burns are a challenge for the body’s process of self-healing.

Mechanical pressure

When people are bed-bound or sitting in a wheelchair their own body weight exerts a constant pressure on certain areas of the skin. This can cause a pressure sore (bed sore or decubitus ulcer). Pressure must then be removed from the affected area of the body to allow the pressure sore to close.

How can chronic wounds be prevented?

It is important for people with diabetes mellitus to maintain good blood sugar levels to allow a wound to heal normally. People who are at risk should wear shoes that are the right size and width to prevent pressure points arising. Regular foot care will also help to prevent wounds occurring or detect them at an early stage.

Compression stockings or elasticated bandages (compression bandages) reduce the risk of chronic wounds in people with venous insufficiency and varicose veins.

Devices with inflatable cushions can also be used to relieve pressure on veins in the leg. The cushions are gradually pumped up starting at the ankles and ending at the groin. The pressure then pushes the blood out of the deep veins of the leg, a process known as “intermittent pneumatic compression”. There are no reliable results of studies for this technique as yet.

If a wound becomes infected by bacteria antibiotics are sometimes prescribed for the inflammation. They should also help stop it turning into a chronic wound.

How is a chronic wound diagnosed?

Superficial wounds or difficult to heal wounds do not necessarily become chronic wounds. So doctors will first of all check how long the wound has been open. They will also identify the risk factors such as a diabetes, immune deficiency or circulatory disorders.

Important: The size and color of the wound, as well as the severity of the pain, are helpful for assessing the state of the wound.

How is a chronic wound treated?

Potential treatments of a chronic wound: wound cleaning, wound dressings, change of dressing, skin transplants, medication, moisturizers

A dressing is draped over chronic wounds for protection. It is helpful to apply moisturizer to the edge of the wound and the area around it. This relieves itching and stops the skin from drying out. The dressing should be changed regularly. Other treatment options include:

Wound cleaning

When healthcare professionals change the dressing they also clean the wound. “Simple” wound cleaning involves rinsing the wound with a saline or electrolyte solution. This is followed by wound debridement where devitalized (dead) cells or inflamed tissue is carefully removed with tweezers or a scalpel.

The wound site is generally numbed, for example with a special ointment, to prevent pain during debridement. Patients may be given medication before the next debridement if the pain is severe. Anesthesia is also an option for major wounds.

Wound dressings

The doctor or nurse will apply a new dressing after the wound is cleaned. Wound dressings help to keep the wound moist, absorb excess fluid from the wound and protect against infection. Wet compresses, films or “hydrogels” are used here.

Technical aids

Technical equipment is sometimes used in hospitals to promote wound healing.

  • Hyperbaric oxygen therapy: patients breathe in oxygen in a special chamber at a high atmospheric pressure.
  • Vacuum assisted closure: fluid is drained from the wound by a permanently installed pump.
  • Ultrasound therapy: chronic wounds are treated with sound waves.
  • Magnetic field therapy: magnetic cushions or mats generate weak electric voltages at the wound site.

Skin transplants

Skin transplants (grafts) are another treatment option. They are mainly considered if the wound is very large and cannot close without treatment. Skin is removed from one part of the body, usually the upper leg, and transplanted (grafted) onto the wound. However grafts can also be made of human cell products and synthetic materials.

Medication

The pain caused by chronic wounds is often underestimated. But effective pain relief is very important.

Oral analgesics such as paracetamol or ibuprofen are effective against mild to moderate pain. Many wound dressings also contain ibuprofen. Doctors or specialists may prescribe other drugs for more severe pain.

Antibiotics are an option if a wound is infected with bacteria.

More detailed information on chronic wounds and how they are treated can be found at gesundheitsinformation.de.

What’s everyday life like with a chronic wound?

A chronic open wound that hurts and itches can make everyday life difficult and cause sleep disturbances. People with chronic wounds also experience pain during wound cleaning and restrictions relating to physical care, for example whilst taking a shower. Persistent pain and limited physical endurance have negative effects on work and private life and may also have a psychological impact. People with chronic wounds are occasionally concerned that people will notice an unpleasant smell from their wound.

Persons affected by a chronic wound can feel very uncomfortable and may be ashamed. So many of them tend to isolate themselves. That is why it is particularly important to give them the personal and medical support they need. Family and friends are important here, as well as general practitioners, outpatient care services and experts specializing in the treatment of wounds.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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