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 individual traits and the unique features of the wound itself.

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.

Underlying problems need to be addressed

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:

• 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. It's important to manage that 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, ask your doctor about stronger painkillers or a referral to a pain specialist.

When more extensive treatments are called for

Some chronic wounds require more aggressive therapies, such as surgery or skin grafts.

• Skin grafts: 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. Skin substitutes—which can provide temporary or permanent coverage for wounds and can help the body regenerate skin—may be an option in some cases.
• Hyperbaric oxygen therapy (HBOT): HBOT involves increasing the delivery of oxygen to specific areas of tissue to improve wound healing. There's evidence it aids the healing of chronic ulcers in people with diabetes, as well as chronic wounds that result from radiation therapy.
• 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.
• Other surgical interventions: For wounds with deep infections, bone deformities and foreign bodies—or for injuries that involve blood vessels and that require stents—additional surgical approaches may be necessary.