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What are chronic wounds?

A chronic wound doesn’t follow a predictable healing pattern. As a result, a chronic wound can be difficult to treat – and heal. The National Institutes of Health estimates that 6.5 million people in the U.S. suffer from chronic wounds.

These common questions – and answers – will help you better understand how dressings are used to help promote healing chronic wounds.


What are the phases of wound healing?

Normal wounds follow a regular pattern in healing, including stages that health care providers can monitor and treat. A simplified breakdown of the three-phase healing process includes the inflammatory phase, when the body first reacts to the wound, constricting the blood vessels and triggering blood clotting. Chemicals are given off by the cells in the area of the wound to bring in other cells to help with tissue repair. Second, during the proliferation phase the body’s cells produce new tissue and cells to replace those that were damaged. Third, in the maturation phase the wound is closed and the body makes the last repairs to the affected area.


What causes chronic wounds?

If any part of the healing process is delayed or prolonged, the body may have trouble repairing the wound. There are several reasons why the wound may be chronic, including underlying health or genetic issues, which may prevent wounds from healing


Some common causes include:

Loss of circulation or poor circulation to the affected area. Blood delivers the oxygen needed for tissues to thrive along with the cells that repair the wounded area.


Pressure of skin against bone. When bone pushes constantly against the skin it can restrict blood flow and lead to injury. Called a pressure ulcer (other names include pressure sore, decubitis ulcer or “bed sore”) these wounds are most common in people with limited movement – perhaps they’re in a wheelchair or bed – for most of the day.


Pooled, non-oxygenated blood. With poor blood circulation blood can pool in areas like ankles and legs, which makes the lower leg prone to injury (venous leg ulcers).


Lack of sensation and circulation in the feet of people with diabetes (diabetic foot ulcers). These types of wounds can take a long time to heal because of the person’s general health, the severity of the wound and possible infection.


Rare chronic wound cause:

People with EB (epidermolysis bullosa) have extremely fragile skin due to a genetic abnormality that causes their skin to blister from the slightest friction or changes in temperature. While some people with EB only experience mild symptoms, others require daily wound dressing changes, pain management and careful nutrition care. The goal in treatment is not to heal wounds, but to manage them. 


What are the types of chronic wounds?

Venous ulcers: These ulcers occur in the lower legs and account for 80% of leg ulcers, mostly affecting the elderly. The veins in the legs do not work properly, resulting in pooling of fluid and a risk for wounds.

Arterial ulcers: These ulcers are found on the feet and are less common than venous ulcers. These ulcers are due to a lack of blood supply to the legs, which results in less oxygen reaching the tissues, causing tissue death and wounding with minor trauma.

Diabetic ulcers: Diabetic neuropathy can prevent people from feeling pain, so they may not feel or notice even minor wounds to the legs and feet, which may lead to the injury becoming worse or infected.

Pressure ulcers: Usually occurs in people with conditions that inhibit movement of body parts that are commonly subjected to pressure, such as the heels, ankles, hips and buttocks.



What is the treatment for chronic wounds?

Chronic wounds can take months or even years to heal – some never fully heal. The treatment for chronic wounds varies depending on the type of wound and the underlying causes for the injury. Dressings are an important part of overall wound treatment. They aid in the healing process by protecting the wound area from outside germs along with promoting skin and tissue repair.


Related articles:
Pressure ulcer wound stages & dressings
Wound care 101
What is wound exudate?