Patient Education Guide
A comprehensive guide to help you understand what chronic wounds are, why they happen, and how they can heal with proper treatment.
A chronic wound is any wound that has not healed within the expected timeframe—typically 4 to 12 weeks—despite receiving standard wound care treatment. Unlike acute wounds (cuts, scrapes, or surgical incisions) that heal predictably, chronic wounds become "stuck" in the healing process and may persist for months or even years without proper intervention.
While chronic wounds can be frustrating and challenging, most chronic wounds CAN heal with the right specialized treatment approach. Advanced wound care therapies and regenerative treatments have dramatically improved healing outcomes.
Chronic wounds can develop for various reasons. Understanding the type of wound helps determine the best treatment approach.
Open sores or wounds that develop on the feet of people with diabetes, often due to nerve damage (neuropathy) and poor circulation.
Common causes: Neuropathy, pressure, poor footwear
Risk factors: High blood sugar, smoking, foot deformities
Wounds that occur on the lower legs when veins don't properly return blood to the heart, causing pooling and pressure buildup.
Common causes: Venous insufficiency, varicose veins
Risk factors: Age, obesity, previous blood clots
Wounds caused by prolonged pressure on the skin, typically over bony areas, cutting off blood flow to the tissue.
Common causes: Immobility, friction, moisture
Risk factors: Wheelchair/bedbound, malnutrition
Wounds resulting from poor blood flow (arterial insufficiency), often affecting the feet, ankles, and lower legs.
Common causes: Peripheral artery disease, atherosclerosis
Risk factors: Smoking, diabetes, high cholesterol
Surgical incisions that fail to heal properly, becoming dehiscent (reopening) or developing complications.
Common causes: Infection, poor blood flow, diabetes
Risk factors: Obesity, malnutrition, smoking
Injuries from accidents, burns, or trauma that fail to heal due to tissue damage, infection, or underlying health conditions.
Common causes: Severe tissue damage, burns, crush injuries
Risk factors: Infection, foreign bodies, poor circulation
Normal wound healing progresses through predictable stages. Chronic wounds become "stuck" in one of these stages due to various factors that disrupt the healing process. Understanding these barriers is key to effective treatment.
Chronic wounds often harbor bacterial biofilms—protective communities of bacteria that are resistant to antibiotics and the body's immune system. These biofilms prevent healing and must be physically removed through debridement.
Adequate blood flow delivers oxygen and nutrients essential for healing. Conditions like diabetes, peripheral artery disease, and venous insufficiency reduce circulation, starving wounds of what they need to heal.
While some inflammation is necessary for healing, chronic wounds often get stuck in a prolonged inflammatory state. This creates a hostile environment with destructive enzymes that break down healthy tissue faster than it can regenerate.
Dead or damaged tissue (called slough or eschar) covers many chronic wounds, creating a barrier that prevents healthy tissue growth and provides a breeding ground for bacteria. This tissue must be removed through debridement.
Diabetes, autoimmune disorders, malnutrition, and other systemic conditions impair the body's natural healing mechanisms. Managing these conditions is essential for wound healing success.
Ongoing pressure, friction, or repeated injury to the wound prevents healing. Offloading pressure (removing weight from the wound) and protecting the area are critical components of treatment.
Understanding how wounds normally heal helps you recognize when a wound has become chronic and needs specialized care.
Timeline: Seconds to minutes after injury
Blood vessels constrict and platelets form a clot to stop bleeding. This creates a temporary seal and releases growth factors that signal the next phase of healing to begin.
What you see: Bleeding stops, scab forms
Timeline: 1-4 days after injury
White blood cells arrive to fight infection and clear debris. The wound area becomes red, warm, and swollen as immune cells work to clean the wound. This is a normal and necessary part of healing.
What you see: Redness, warmth, swelling, some clear or yellow drainage
Timeline: 4 days to 3 weeks after injury
New tissue (granulation tissue) fills the wound bed. Blood vessels regrow, bringing oxygen and nutrients. New skin cells (epithelial cells) multiply and migrate across the wound surface to close the gap. Collagen fibers form to strengthen the new tissue.
What you see: Pink/red granulation tissue, wound edges pulling together, wound getting smaller
Timeline: 3 weeks to 2 years after injury
The wound continues to strengthen and mature. Collagen fibers reorganize to increase tensile strength. The scar gradually fades and flattens. Even after the wound is closed, it continues to strengthen over many months.
What you see: Wound fully closed, scar tissue forms and gradually lightens in color
Chronic wounds get stuck in the inflammatory phase (Stage 2) and never progress to the rebuilding phase. They remain in a cycle of persistent inflammation and tissue breakdown, preventing new healthy tissue from forming. This is why specialized treatment is needed to "reset" the wound and restart the healing process.
Effective chronic wound treatment addresses the underlying barriers to healing while promoting tissue regeneration. Modern advanced wound care uses a multifaceted approach tailored to each patient's specific wound and medical conditions.
The cornerstone of chronic wound care. Debridement removes dead tissue, biofilm, and bacteria that prevent healing. This "resets" the wound environment and stimulates the growth of healthy new tissue.
Methods: Sharp surgical debridement, enzymatic debridement, biological debridement (medical-grade maggots)
Advanced biological treatments that provide growth factors, proteins, and cellular components to jumpstart healing and rebuild tissue.
Examples: Skin substitutes, amniotic membrane allografts, growth factor therapies, cellular and tissue-based products
Specialized dressings maintain optimal moisture balance, manage drainage, reduce bacterial load, and create the ideal environment for healing.
Types: Hydrocolloids, hydrogels, alginates, foam dressings, antimicrobial dressings, collagen dressings
A vacuum device that applies controlled suction to the wound, removing excess fluid, increasing blood flow, and drawing wound edges together to accelerate healing.
Best for: Large wounds, surgical wounds, wounds with significant drainage
Removing pressure from the wound area is critical. Specialized boots, cushions, wheelchair modifications, and repositioning schedules prevent ongoing trauma.
Essential for: Diabetic foot ulcers, pressure ulcers, heel wounds
Controlling diabetes, improving circulation, optimizing nutrition, and addressing other medical issues that impair healing. This holistic approach is essential for long-term success.
May include: Blood sugar control, compression therapy, vascular interventions, nutritional support
Every chronic wound is unique. Effective treatment requires a personalized approach that addresses your specific wound type, underlying health conditions, lifestyle factors, and healing goals. Our wound care specialists create individualized treatment plans that combine the most effective therapies for your situation.
Understanding the treatment process helps you know what's normal and what to expect on your healing journey.
Complete medical history, wound evaluation, photos, measurements, and vascular assessment
Blood work, wound cultures, or vascular studies to identify underlying issues
Your provider will explain your specific wound issues and outline the recommended treatment approach
Wound cleaning, debridement if needed, application of advanced dressings
Most patients require weekly or bi-weekly visits initially, then less frequently as healing progresses. Each visit typically includes:
Progress Monitoring: Measuring wound size and depth
Debridement: Removing any dead tissue or biofilm
Dressing Changes: Applying appropriate dressings
Adjustments: Modifying treatment based on response
The wound may look worse before it looks better. Debridement removes dead tissue, which can temporarily make the wound appear larger. This is normal and necessary for healing.
You should start seeing healthy pink/red tissue (granulation) filling the wound bed. The wound should begin getting smaller, less deep, and have less drainage.
The wound continues to close from the edges. New skin begins to cover the surface. You may transition to less intensive treatments.
Most chronic wounds achieve complete closure within 3-4 months with proper treatment. Some complex wounds may take longer, but should show steady progress.
Healing rates vary based on wound size, depth, location, and your overall health. Some wounds heal faster, others take longer. The key is consistent progress—your wound should show measurable improvement every 2-4 weeks.
If you notice any warning signs, contact your wound care provider immediately. Early intervention can prevent serious complications like infection or sepsis.
Call 877-545-1300Chronic wounds are challenging, but with specialized treatment and advanced therapies, healing is possible. Don't give up hope—we're here to help you every step of the way.
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