Why Non-Healing Wounds Need a Different Treatment Approach

DMCA.com Protection Status
Blog Category: 
Doctor meeting with nurse

by Aletha Tippett MD

If we let the body alone, can it take care of a healing a wound? In general, yes, leaving the body alone will get you further than some procedures because the body knows what to do, such as allowing autolytic debridement. If you look at the body, it is designed to heal, and it knows much more about that than we clinicians do. It is important to know what a wound looks like and how it should progress. If you know this, you can follow the progress of the wound and know healing is taking place.

Investigating the Reason Behind a Non-Healing Wound

Now, what if there is a wound that won’t heal? Maybe the wound has been there three years, has had multiple therapeutic interventions such as hyperbaric oxygen therapy, and negative pressure wound therapy and still won’t heal. If you have a wound like this that is not responding to treatment and adjunctive therapies, then you have to think, maybe there is something going on different than a usual wound, and you need to find out just what it is.

There are several things to evaluate for a recalcitrant wound. Is it infected? First, assess the wound for signs of infection. A culture will help you to determine if infection is present and reveal the reason why the wound is not progressing. Is it a Marjolin's ulcer? A biopsy will provide you with the answer to this question. If you feel good pulses, but the patient appears to have poor circulation? A laser Doppler or a CT angiogram will help you determine what the underlying issue is. A wound that will not heal should not be left alone. A non-healing wound needs every evaluative and treatment effort you can give it. Is the wound not healing due to pyoderma gangrenosum? A biopsy might help, but simply looking at the wound and giving it a thorough assessment would help more.

Treatment Interventions for Non-Healing Wounds

Sorting through these options may give you a different view of the wound and a different way to approach it. If you discover a wound is infected, the right antibiotic needs to be selected. If you determine a wound is an Marjolin's ulcer, then an oncologist can help provide specialized treatment interventions. If in find in your investigation of the cause behind the non-healing wound that your patient has poor circulation, then a vascular surgeon needs to become involved to help revascularize. If determine that you are managing a case of pyoderma gengrenosum, treatment is with cyclosporine and prednisone and is not dependent on a wound dressing.

So, for a typical wound, letting the body do what it can is going to be best, but for an unusual wound that fails to heal, you will need to investigate the reason(s) why the wound has become recalcitrant and adjust your treatment approach to put the wound on the path to healing.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

WoundSource ENEWS


Perhaps the geko device should be considered in many situations like this.

Excellent post! I agree 100%. As you rightly point out, as clinicians, we need to have the humility to recognize that we do not heal wounds: only the patient's own body can do the healing. We simply provide supports and remove barriers. After addressing the cause of the wound and supporting healing with pain and inflammation control, improved nutrition, and appropriate compression to improve circulation, we can remove barriers by addressing the three Ds: Dirt, Dry, and Damage. Dirt includes that necrotic tissue (which will be removed by autolytic debridement) and remnants of dressings that may be hidden deep in the wound bed. Damage is often caused by inadequate offloading.

In my experience, most often wounds fail to heal because there is so much fear of maceration that the wound is kept too dry. At the initial visit I flush the wound with large amounts of saline. I dry only the periwound and then dress the wound with a moisture retentive dressing such as a PMD. When PMDs are not available, I use a plastic bag to hold in the wound moisture. Providing a truly moist wound bed has proven to be a very effective way to support the body's ability to clean up and heal the wound.

As this article so rightly points out, when all of these measures are in place and the wound still doesn’t heal, look for an underlying problem such as a deep tissue infection, Marjolin’s Ulcer, or arterial insufficiency.

Linda Benskin, RN, SRN (Ghana), CWCN, CWS
Independent Nurse Researcher and Ferris Mfg. Corp.

Add new comment

Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use.