How to care for a wound that won’t heal

How quickly any wound heals depends on a number of factors, including your age, diet, medications and health status. There’s also the wound itself: Where on your body was it sustained? How deep is it? How severe is it?

Generally speaking, most wounds—known as acute wounds—are expected to heal within a certain timeframe, following a relatively predictable process. But what happens when a wound doesn’t heal, or when the process stalls in an unexpected way?

In these cases, the wound is considered to be chronic. The best treatment for chronic wounds will vary from one person to the next, depending on your medical history, any current health conditions and the unique features of the wound itself.

In general, if your wound has not started to heal after two weeks, or has not healed completely within six weeks, you should consider making an appointment with an outpatient-based wound care expert. HCA Houston Healthcare’s outpatient centers take a multidisciplinary and comprehensive approach to wound care, and provide standard and advanced therapies to accelerate the wound healing process, and can permanently resolve your injury.

“Dealing with chronic wounds can not only affect your quality of life and prevent you from doing the things you enjoy, but they also have very serious consequences if left untreated,” said Aimee Wisnoski, director of advanced wound care, ostomy and hyperbaric medicine at HCA Houston Healthcare Clear Lake and HCA Houston Healthcare Southeast. “The longer a chronic wound goes untreated, the greater the risk of infection, further tissue loss, amputation or loss of life.”

What to expect from treatment for chronic wounds

Treatment for chronic wounds is typically multi-layered. It involves:

• Caring for the wound itself, making sure that it is cleaned and dressed while managing any related infections.
• Managing any underlying health conditions that are contributing to the delayed healing. This could involve helping patients with diabetes better manage their blood sugar levels, helping smokers quit and helping people with poor diets eat more healthfully.
• Possibly introducing more advanced wound healing therapies such as debridement, compressions, vacuum-assisted closure, hyperbaric oxygen therapy and/or cellular and tissue based products.

Chronic wound treatment should include managing the factors that can contribute to a wound becoming chronic in the first place. With the help of your healthcare team, you may need to make some changes to your habits and lifestyle, including:

• Controlling your blood sugar levels: If you have diabetes, keeping your blood sugar levels in check can help improve your circulation and blood vessel function. This can promote healing while decreasing your risk for infection.
• Improving your diet: Malnutrition is a factor that can stall wound healing. Eating healthfully, such as consuming adequate amounts of protein, not only improves your overall health but also bodily functioning, including wound healing.
• Quitting smoking: If you smoke, talk to your doctor about safe and effective ways to kick the habit.

Other factors that can contribute to stall wound healing that your healthcare team will help you address include edema (swelling caused by excess fluid in the body’s tissues) and circulatory problems.

Cleaning and dressing chronic wounds

Another key part of a chronic wound treatment plan is making sure that your wound is properly cleaned and dressed, which may ease pain while helping to prevent infection.

Properly dressing a chronic wound also:

• Reduces the risk of infection
• Helps relieve itching
• Stops the wound from drying out
• Absorbs excess fluid that may come out of the wound
• Protects the wound from further damage

Most chronic wounds require regular cleaning, which should be done by a doctor, nurse or other healthcare professional. They’ll typically rinse the wound with a saline solution and remove dead cells or inflamed tissue with a surgical instrument called a curette or a scalpel. It can be a painful process, so a topical numbing agent may be applied to the wound before the cleaning begins. The wound then gets a new dressing. Wound dressings may include foams or hydrogels. Some wounds that become infected may require more frequent cleaning and dressing, along with antibiotics.

Managing pain and discomfort

Living with chronic wounds—and tending to their cleaning and dressing—can be painful. However, it’s important to discuss your pain with your wound care provider, as it can also be an indicator of a more serious wound complication such as an infection or dressing sensitivity.

It’s also important to speak with your provider about ways you can manage your pain in order to improve your quality of life and reduce the extent to which a chronic wound interferes with your day-to-day life and healthy habits, like getting adequate sleep, socializing and exercising.

Over-the-counter (OTC) pain relievers like acetaminophen can help with mild to moderate pain. Non-steroidal anti-inflammatory drugs (NSAIDs, including aspirin and ibuprofen) may also be used in the short term, but be sure to check with your doctor about whether or not they are safe for you to take. If OTC formulas don’t provide enough relief, speak with your wound care doctor for other alternatives that offer pain relief.

Requiring extensive treatments

“For most people, wound care is a straightforward process: clear the wound at home, dress it with a bandage, and allow your body to do the rest of the work," said Wisnoski. “But for some people the healing process is far more complicated.”

Chronic wounds that have failed to respond to the conventional therapies within a couple of weeks should be treated by a specialty trained wound care provider who will address the problem comprehensively and consider the introduction of more advanced wound healing therapies.

Debridement

Debridement is the most common treatment for stubborn to heal wounds, and involves the removal of unhealthy tissue within a chronic wound to promote the growth of healthy tissue, reduce complications of infection, and speed up the healing process. Debridement is performed in few different ways, depending on the wounds characteristics and patient’s medical history. The most common methods include:

• Sharp debridement: Performed by a wound care specialist and the most common method of debridement. This type of debridement involves removal of the unhealthy tissue with a surgical instrument.
• Autolytic debridement: A specialized dressing is applied to assist in breaking down the unhealthy tissue
• Enzymatic debridement: Sometimes called chemical debridement, and often used in conjunction with sharp debridement where a prescribed medication is applied to break down the unhealthy tissue within the wound

Compression therapy

Compression dressings or specialty made garments helps wounds heal faster by limiting swelling, maximizes the tissues ability to receive the oxygenated blood, and helps to reduce pain.

Vacuum-assisted closure

Also known as “negative pressure wound therapy,” this method uses suction to draw excess fluid out of a wound and to stimulate the growth of new tissue.

Hyperbaric oxygen therapy (HBOT)

HBOT involves increasing the delivery of oxygen to specific areas of tissue to improve wound healing. Hyperbaric oxygen therapy aids the healing of chronic ulcers in people with diabetes, as well as chronic wounds with bone infection, and injuries that result from radiation therapy.

Total contact casting

The gold standard in treatment for patients with diabetic foot ulcers or chronic wounds on their feet. A specially designed fiberglass cast is applied to completely alleviate pressure and damage from walking.

Skin grafts and cellular- or tissue-based products

A skin graft is a procedure in which a surgeon removes skin from one part of the body (usually the upper leg) and transplants it onto the wounded area. This may be a helpful solution for chronic wounds that are large or located in places that make applying a dressing difficult.

Cellular- or tissue-based skin substitute products provide temporary or permanent coverage for wounds and can help the body regenerate tissue and resolve the injury.