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Wounds are a natural part of life, typically healing on their own with proper care and attention. However, some wounds defy the body’s natural healing processes, persisting despite treatment efforts. 

These non-healing wounds, also known as chronic wounds, pose significant challenges to both patients and healthcare providers. 

In this article, we’ll explore the tell-tale signs of non-healing wounds, delve into their causes, and discuss innovative treatments and diagnostics aimed at addressing this issue. 

What Is a Non-healing Wound?

A non-healing wound is a wound that fails to progress through the normal stages of healing within a reasonable time frame. According to Yale University, that reasonable time frame is between four to six weeks. While acute wounds typically show signs of improvement within a few weeks, chronic wounds may remain stagnant or worsen over time. 

Examples of chronic wounds include diabetic foot ulcers, pressure ulcers, venous ulcers, and arterial ulcers. These wounds can result from several factors, including diabetes, poor circulation, immobility, and trauma. 

Causes of Non-Healing Wounds

Following are some of the most common conditions that can lead to the development of non-healing wounds.

Poor Blood Circulation

Adequate blood flow is essential for delivering oxygen and nutrients to the wound site and removing waste products. Conditions such as peripheral artery disease (PAD) and venous insufficiency can impair blood circulation, hindering the body’s ability to heal wounds.

Testing blood sugar levels

Woman testing her blood sugar level at home.

Diabetes

Diabetes can lead to peripheral neuropathy (nerve damage) and peripheral vascular disease (blood vessel damage), increasing the risk of foot ulcers and impairing wound healing. Elevated blood sugar levels can also interfere with the body’s inflammatory response to immune function, further complicating the healing process.

Pressure

Prolonged pressure on the skin can cause tissue damage and lead to the formation of pressure ulcers, commonly known as bedsores. Individuals who are bedridden or confined to a wheelchair are particularly susceptible to pressure ulcers, which can be challenging to heal due to constant pressure on the affected area.

Infection

Wounds that become infected are less likely to heal properly, as bacteria can impede the body’s natural healing processes. Chronic wounds are especially prone to infection, as the compromised tissue provides an ideal environment for bacterial growth. 

Infections can lead to delayed wound healing, increased pain, and systemic complications if left untreated.

Underlying Health Conditions

Certain underlying health conditions, such as autoimmune disorders, cancer, and malnutrition, can impair the body’s ability to heal wounds. These conditions often weaken the immune system, disrupt normal physiological processes, and interfere with tissue repair mechanisms, thus prolonging the healing process. 

What Are the Stages of a Healing Wound?

Before we look at the signs of a non-healing wound, let’s look at the stages all wounds go through on their way to being healed.

There are four stages of wound healing – Hemostasis, inflammatory, proliferation, and maturation. Here are the signs that will help you recognize whether a wound is healing normally:

Bleeding or Scabbing

Typically, wounds like burns and pressure ulcers do not bleed. If it’s a cut, scrape, gash, or puncture wound, it goes through three stages – bleeding, clotting, and scabbing. This is called haemostasis, which begins within seconds of the wound occurring.

A healthy response to cuts and scrapes is that the wound will bleed and begin to clot within a few minutes. After the blood begins to dry, there will be scabbing. But if the wound is bleeding after a significant period or you can’t stop the bleeding, stitches may be required to close the wound. 

If there is no scabbing after a while, you need to seek treatment from a wound care expert.

Swelling 

After the scab formation, the body’s immune system starts healing the wound in the form of swelling, or tendering. 

The inflammation or swelling is a sign that the body’s immune system is working properly and repairing your wound. You may notice drainage from the wound. It may have a reddish or pinkish appearance, enabling sufficient blood flow, oxygen, and nutrients to the affected area. This usually occurs within 0 to 4 days of when the patient receives the wound. 

Growth of New Tissues 

In 2 to 24 days from the wound’s appearance, proliferation occurs. When the swelling is stopped, the tissues will begin forming over the wound. That can last a couple of weeks in case of minor wounds. This is when the body repairs broken blood vessels and replaces damaged tissues. In the healing process, the skin pulls the wound edges inward, and it will get smaller.

Scar from a recent wound.

Scar indicate the final stages of wound healing.

Scarring 

Scaring typically happens within 24 days to 1 year from the wound occurring. This is the last stage of wound healing. This can last anywhere from a few weeks to a whole lifetime. There will be a scar in the place of the initial scab. 

If the injury is minor, the scar will slowly fade away. You may also experience itching during this stage. If the wound is significant and is in a visible location, some seek plastic surgery to repair scar tissue.

5 Signs of a Non-Healing Wound

Now that we know what a properly healing wound looks like, here are the five main warning signs that a wound isn’t healing.

Sign #1: Thick Discharge of Yellow or Green Pus. 

Excessive pus or drainage from a wound can indicate infection, particularly if the discharge is thick and yellow or green in color. Pus is a sign that the body is fighting off bacteria present in the wound, and its presence may delay the healing process if not addressed promptly. 

Sign #2: Redness or Warmth Around the Wound

Persistent redness or warmth in the skin surrounding the wound can indicate inflammation and infection. Inflammatory mediators released by the body in response to infection can cause the skin to appear red and feel warm to the touch. This inflammatory response may impede wound healing and require targeted intervention.

Sign #3: Unpleasant Odor

A foul or malodorous smell emanating from the wound is often indicative of bacterial infection and tissue necrosis. The breakdown of tissue by bacteria produces volatile organic compounds (VOCs) that contribute to the characteristic and unpleasant odor of infected wounds. Addressing the underlying infection is essential. 

Sign #4: Swelling

Swelling, or edema, around the wound site can impede blood flow and hinder the delivery of oxygen and nutrients to the tissues. Chronic inflammation and impaired lymphatic drainage contribute to fluid accumulation in the affected area, further exacerbating the swelling. Managing edema is crucial for optimizing wound healing outcomes and preventing complications.

Sign #5: Darkening of the Skin Around the Wound

Darkening or discoloration of the skin surrounding the wound, known as periwound maceration, can occur due to prolonged moisture exposure and impaired tissue oxygenation. Macerated skin is more susceptible to breakdown and infection. Proper wound dressing selection and moisture management are essential for preventing periwound maceration and promoting healing. 

In addition to these signs, systemic symptoms such as fever, chills, and malaise may indicate a severe infection or systemic inflammatory response requiring urgent medical attention. 

Factors Affecting Wound Healing

Factors affecting wound healing can be extrinsic or intrinsic. Wound care teams must address all of these factors to see success in healing chronic wounds.

Extrinsic Local Factors

  • Wound management and moisture balance (e.g. wound dehydration or maceration)
  • Stable temperature (approximately 37oC)
  • Neutral or acidic pH
  • Presence of infection
  • Wound location
  • Mechanical stress, pressure, or friction
  • Presence of foreign bodies
A Healthy Plate

Good nutrition plays an important role in healing chronic wounds.

Intrinsic Systemic Factors

  • Nutrition
  • Underlying or chronic disease
  • Limited mobility
  • Impaired perfusion
  • Medications (including immunotherapy, chemotherapy, radiation, or NSAIDs)
  • Mental health (including stress, anxiety, or depression)
  • Patient understanding and compliance
  • Age of patient

Best Wound Care Practices

Improving the healing rate and patient outcomes for non-healing wounds requires a comprehensive approach to wound care. Here are some of the best practices to consider.

Debridement

Debridement is the process of removing necrotic tissue, foreign material, and biofilms from the wound bed to promote healing. Sharp debridement, mechanical debridement, enzymatic debridement, and surgical debridement are among the techniques used to facilitate wound healing. Debridement helps create a clean wound environment conducive to tissue repair and reduces the risk of infection. 

IV Antibiotics

IV antibiotics can help treat bacterial infections in non-healing wounds.

Antibiotics

Antibiotics may be prescribed to treat bacterial infections associated with non-healing wounds. Topical antibiotics, oral antibiotics, or intravenous antibiotics may be used depending upon the severity of the infection and the patient’s overall health status. However, antibiotic stewardship is essential to prevent the development of antibiotic resistance and minimize adverse effects.

Advanced Wound Care Procedures and Diagnostic Tools

Advanced wound care procedures such as amnion allografts, near-infrared spectroscopy, low-frequency ultrasound, and fluorescence imaging offer innovative solutions for promoting wound healing and monitoring treatment progress. These technologies enable clinicians to assess wound characteristics, optimize tissue oxygenation, and target interventions effectively.

The most advanced wound care tools and treatments available include Negative Pressure Wound Therapy (NPWT). Also known as vacuum assisted closure, the provider applies controlled negative pressure to the wound using a specialized dressing and vacuum system. This is particularly useful for large, deep, or complex wounds.

Biological and cellular therapies like autologous skin grafts, allografts, xenografts, bioengineered skin substitutes, and growth factors work to provide a scaffold for cellular activities. 

Some of the most advanced diagnostic tools available in wound care today include the Mimosa multispectral near-infrared spectroscopy for low-frequency ultrasound which promotes healing through dilating blood vessels and speeds healing. 

Another innovative tool is MolecuLight, a device that provides highly accurate real-time information on harmful bacteria that are often present in wounds. 

XSONX is a vibrating mechanical debridement tool (VMDT) which uses low sonic level frequency vibrations to scrub and debride wounds often with less pain and better results.

Wound dressing

Nurse applies a bandage to help ensure a moist environment for the wound.

Proper Wound Dressing

Choosing the appropriate wound dressing is crucial for maintaining a moist wound environment, managing exudate, and protecting the wound from contamination. A wide range of wound dressings is available, including hydrocolloids, foams, hydrogels, and alginates, each offering unique benefits depending on the wound type and nature of the wound. Regular assessment and reassessment of the wound and dressing are essential to ensure optimal healing outcomes. 

Compression therapy is ideal for managing venous leg ulcers or edema-related wounds. It involves the application of graduated compress through compression bandages, compression stockings, or compression wraps to improve venous return, reduce swelling, and encourage healing. 

Surgical Interventions

In some cases, skilled wound care surgeons conduct wound debridement, closure with sutures or staples, skin grafts or flaps, or the removal of non-viable tissue. 

Mobile Care Clinic

Heal Precisely can treat even the most stubborn wounds in the comfort of a patient’s home or care facility.

Mobile Wound Care

Clinics like HealPrecisely™ have mobile care clinics that can be bring treatments directly to the patient. A perfect option for people with mobility challenges, mobile care clinics are staffed by a wound care team, the latest in diagnostic tools, and able to allow our clinicians to deliver a superior care experience wherever our patients need us.

Consultation With a Wound Care Specialist

For complex, non-healing wounds that do not respond to conventional treatments, consultation with a wound care specialist or multidisciplinary team can help resolve even the hardest-to-heal wounds. Wound care specialists have expertise in managing challenging wounds and can recommend advanced treatment modalities tailored to the individual patient’s needs.

Non-Healing Wounds Represent a Significant Health Challenge, but They Can Be Healed With the Right Tools and Expertise

By understanding the signs of non-healing wounds, addressing underlying causes, and implementing best wound care practices, healthcare providers can improve patient outcomes and enhance the quality of life for individuals suffering from chronic wounds.

Through ongoing research and innovation, the field of wound care continues to evolve, offering hope for those grappling with this complex and debilitating condition. 

At HealPrecisely™, we are pioneers in making breakthrough therapies and diagnostic tools available to our patients faster than other wound care clinics. That’s why we have healing rates of 98.05%, which is 6% higher than the national average, according to EHR Healthnet.

If you, someone you’re treating, or someone you’re caring for has a chronic wound that won’t heal, we can help. To learn more, visit www.HealPrecisely.com