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Non-Healing Wounds

FOR A PATIENT WHO WISHES TO UNDERSTAND THEIR WOUND:

A non-healing wound simply means that the wound has taken longer than expected to heal. Normally, the body repairs a wound through a series of stages where the tissue closes  by growing from the bottom up and new skin forms. Sometimes this process slows down or stops before the wound has fully healed.

There are many reasons why this can happen, but the single most important issue is that the blood supply to the area is not as strong as it should be for a variety of reasons.

  • This is particularly relevant in pressure ulceration as pinching the flesh between a bone and a hard surface prevents the blood from reaching the tissue to feed it.
  • Also, the wound may have a small amount of infection which prevents blood reaching the area
  • There may be fluid collecting under the skin (is your ankle swollen?) preventing blood supply
  • The skin may have been under tension after surgery.

It does not necessarily mean that something serious is wrong, but it does mean the wound needs a bit more specialist attention in order to restore the blood supply fully and sometimes requires further investigation to understand if there are other reasons it is not healing as expected such as a low-grade infection.

Our aim is to identify the cause of your wound and to address the blood supply there. Also to find anything that might be preventing the wound from healing properly and then treat that cause. Once the underlying issues are addressed, we can then progress the wound to healing with the appropriate dressings and care.

If you have a diagnosis of a venous leg ulcer then you must have a Duplex Scan undertaken, arranged via your GP. The NICE Guidelines make this very clear.

Consider being part of our VIRTUAL CLINIC which is designed to provide you with appropriate care and to keep the cost as low as possible. Look this up at the bottom of the screen where you will find all the information and apply via the contacts page.

FOR NURSES WITH INTEREST IN WOUND CARE:

A non-healing wound (often referred to as a chronic wound) is a wound that fails to progress through the normal stages of healing within the expected timeframe. Most acute wounds heal within 4–6 weeks, but a wound that remains open, repeatedly breaks down, or continues to discharge beyond this time is considered non-healing.

Common Types of Non-Healing Wounds

  1. Venous leg ulcers – caused by chronic venous insufficiency.
  2. Pressure ulcers – caused by prolonged pressure over bony prominences.
  3. Diabetic foot ulcers – related to neuropathy and vascular disease.
  4. Arterial ulcers – due to poor arterial blood supply.
  5. Surgical wounds that fail to close (e.g., dehisced wounds after surgery such as an apronectomy).

Common Causes

Non-healing wounds usually occur because one or more underlying factors prevent the healing cascade from progressing:

Local Factors

  • Blood supply is always poor for a variety of reasons.
  • Infection or high bacterial burden
  • Necrotic tissue or slough
  • Repeated trauma or pressure
  • Foreign body or retained sutures
  • Sinus or fistula formation
  • Poor moisture balance
  • Underlying collections or cavities

Systemic Factors

  • Poor circulation (arterial or venous disease)
  • Diabetes
  • Malnutrition
  • Smoking
  • Immunosuppression
  • Anaemia
  • Chronic oedema or lymphoedema
  • Certain medications (steroids, chemotherapy)

Surgical Complications

In long-term surgical wounds, persistent discharge can be due to:

  • chronic infection
  • retained sutures or mesh
  • sinus tract
  • fat necrosis
  • seroma
  • osteomyelitis
  • fistula
  • rarely malignancy developing in a chronic wound

Signs a Wound Is Not Healing Properly

  • Persistent discharge or exudate
  • Recurrent opening after appearing closed
  • Increasing pain
  • Malodour
  • Hypergranulation tissue
  • Rolled wound edges (epibole)
  • Persistent inflammation

Management Principles

Effective management usually follows the TIME framework:

T= Tissue: Debridement of necrotic tissue.

I = Infection/Inflammation: Control bacterial burden.

M = Moisture balance: Use appropriate dressings to control exudate.

E = Edge of wound: Encourage epithelial advancement.

Additional interventions may include:

  • compression therapy (for venous ulcers)
  • offloading (for diabetic foot ulcers)
  • vascular intervention
  • surgical revision
  • negative pressure wound therapy
  • nutritional optimisation

In Surgical Wounds

If a wound heals then repeatedly opens with discharge, clinicians often investigate for:

  • sinus tract
  • chronic seroma cavity
  • retained sutures
  • fat necrosis
  • underlying infection

This is why imaging such as MRI or ultrasound is sometimes arranged before deciding on the final wound management.