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At first, chronic wounds are regularly cleaned and covered using wound dressings and bandages. If a wound still hasn’t healed after a long time despite this wound care, special treatments such as negative pressure wound therapy or skin grafts are used.
A wound is considered to be chronic if it hasn’t started to heal after 4 to 12 weeks despite treatment. These kinds of wounds usually arise as a result of poor blood circulation, diabetes or a weak immune system. Open wounds on the lower leg are also known as venous leg ulcers.
As well as treating the underlying condition and tending to the wound, pain relief is important. Some people with complex, poorly healing wounds find psychological support helpful too.
The wound is often cleaned when the dressing is changed, normally using a saline (salt) solution. Overall, though, not enough is known about the pros and cons of the various solutions that are used to clean wounds, and how they affect the healing process. It is also not yet clear whether tap water could be used for the medical cleaning of wounds.
When treating chronic wounds, doctors or nurses often remove dead or infected tissue. This is known as debridement. The tissue is removed using instruments such as tweezers, a sharp spoon-like instrument called a curette, or a scalpel. An enzyme-based gel is sometimes applied too, to help clean the wound.
The wound can also be cleaned using a high-pressure water jet. Another form of debridement involves the use of a certain species of maggots (fly larvae) that are specially bred for medical purposes. The maggots are placed on the wound, either as they are or in a pouch. They remove dead tissue and fluid from the wound.
Because debridement is often painful, a local anesthetic is used to numb the wound beforehand, for instance using an ointment. If more severe pain is expected, painkillers can be taken before treatment. Larger wounds are sometimes cleaned under general anesthetic.
Once the healthcare professional has cleaned the wound, they cover it with a new dressing. Most wounds are kept moist, for instance with moist compresses. But the following kinds of dressings can be used instead:
Hydrogel dressings Hydrocolloid dressings Dressings containing silver or alginates Foam dressingsThe dressings are used to remove excess fluid from the wound and protect it from infection. They are usually left on the wound for several days. Dressings should be changed if it’s clear that they can’t soak up any more wound secretions, if they slip out of place, or if fluid leaks out of the bandage. It is not clear whether certain types of wound dressings are better than others.
In addition, substances called growth factors can be put on the wound to help the cells grow better. One approach involves putting some of the patient’s own blood into a machine to increase the concentration of blood plasma (platelet rich plasma, PRP). The blood that is prepared in this way is then applied to the wound as a gel. Growth factors can also be made chemically. Several studies suggest that they can help chronic wounds to heal better.
Honey has traditionally been used in wound care. But applying specially prepared honey before dressing the wound probably doesn’t have any advantages. The effect of using honey in the treatment of leg wounds has so far only been tested in people with venous leg ulcers, though.
If venous insufficiency is what caused the chronic wound, then compression stockings or compression bandages can help it to heal faster. The pressure from the stockings and bandages helps the veins to carry blood back to the heart. This also relieves the pain caused by venous leg ulcers.
Wounds are even less likely to heal well if they are infected with bacteria. Depending on how severe the infection is, antibiotics may be considered. They are usually taken as tablets, but are sometimes applied to the wound in an ointment or placed on the wound using a dressing.
In hyperbaric oxygen therapy, you go into a special chamber to breathe in oxygen under high pressure. This is meant to increase the oxygen concentration in your blood and improve the blood supply to the wound area.
Research suggests that hyperbaric oxygen therapy can improve the healing of wounds in people with diabetic foot problems.
In negative pressure wound therapy (also called vacuum-assisted closure or VAC therapy), the wound is covered with an airtight dressing that is connected to a pump by a thin tube. The pump continuously sucks fluid out of the wound, creating negative pressure across the surface of the wound. The aim is to increase the flow of blood to the wound. It helps keep the wound moist too, which is also meant to improve the healing process. Research suggests that negative pressure wound therapy helps chronic wounds to heal better and can also reduce the length of the hospital stay.
The pump that is attached to the wound limits your mobility somewhat and makes noise. Some people find this annoying. Changing the dressing and tube can also be painful and cause a small amount of bleeding.
Skin grafts are considered as a treatment option if a wound is so large that it can’t close on its own. In this procedure, skin is taken from another part of your body – usually your upper leg – and transplanted to the wound. There are also grafts that are made from human cell products and synthetic materials.
Skin grafts increase the chances of poorly healing venous leg ulcers closing faster. Chronic foot wounds (ulcers) in people with diabetes also heal faster after a skin graft.
Ultrasound therapy involves treating chronic wounds using sound waves. The sound waves make the tissue warmer. But ultrasound therapy hasn't been scientifically proven to help the wound heal faster.
The same is true of electromagnetic therapy, where weak electromagnetic waves are applied to the wound using pillows or mats that have magnets in them.
Painful chronic wounds can be a burden in daily life and also prevent you from getting a good night’s sleep. Constant pain can really wear you down, making you feel quite low or even depressed after a while.
It often hurts when the dressing is changed too, particularly if the dressing is stuck to the wound. But this pain can be reduced in various ways – for instance, by using dressings that are less likely to stick to the wound. The wound can also be rinsed with a salt solution first, so the dressing comes off more easily.
Drugs like acetaminophen (paracetamol) or ibuprofen can help ease mild to moderate pain. Some dressings contain painkillers too. If they aren’t effective enough, the doctor can prescribe a stronger painkiller.
People who have chronic pain can benefit from pain management therapy and psychological support. The aim of psychological treatments for pain management is to help people cope better with the pain in everyday life.
