Chronic Wound

Liping Tang's picture

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

Emily Greenstein's picture

By Emily Greenstein, APRN, CNP, CWON, FACCWS

After attending the Spring Symposium for Advanced Wound Care and hearing many great lectures, I got to thinking, “What are the pillars of chronic wound care?” We have all heard of the concept “look at the whole patient and not the hole in the patient.” Heck, I have even written about it. But we also need to have a good foundation for how to implement this phrase or where to even start. I did a quick Internet search and came up with some interesting articles that talked about the basics of wound care and management. I found discussions on everything from maintaining a moist wound environment to being financially responsible. All of this information leads me to the concept of developing easy-to-understand pillars or categories to consider when caring for a patient with a chronic wound.

Becky Naughton's picture

By Becky Naughton, RN, MSN, FNP-C, WCC

I’m sure we’ve all hit that point in our wound care careers where we’ve had that one patient who’s wound just doesn’t seem to respond to any treatment. You’ve tried everything that you can think of—state-of-the-art dressings, advanced cellular products, regular debridement, and even hyperbaric oxygen. But despite all of this, the wound seems stuck. This is what’s known as a recalcitrant wound, a wound that fails to progress through the phases of wound healing in a typical timeline and becomes “stuck.” A wound that does not decrease in size by 30% in 3 weeks or by 50% in 4 to 5 weeks is considered recalcitrant. This is significant because wounds that don’t show improvement in size by 50% in 4 weeks have a 91% chance of not healing in 12 weeks.

WoundSource Editors's picture

By the WoundSource Editors

Debridement is the process of removing nonviable tissue and foreign objects (such as glass or shrapnel) from a wound bed to help the wound heal. Decaying tissue can trap bacteria and lead to a harmful infection such as gangrene, which is the death of body tissue resulting from a lack of appropriate blood flow or in response to a severe bacterial infection. Debridement is thus critical to effective wound management.

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Alex M. Aningalan's picture

By Alex M. Aningalan, MSN, RN, CWON, WCC

Fellow wound care specialists may agree that interdisciplinary clinical teams often seek their expertise when a patient presents with a “chronic-appearing wound with an unknown or indeterminate etiology.” As in any other discipline, a comprehensive wound assessment begins with a thorough exploration of possible underlying etiologies—the main causative factors for wound development. Moreover, chronic, nonhealing wounds may warn clinicians to explore possible unaddressed underlying complex etiologies.

Christine Miller's picture

By Christine Miller DPM, PhD

The human body possesses an amazing ability to heal itself, if given the right nutrients to carry out the necessary biologic processes involved. The need for nutritional assessment and support is critical for both acute and chronic wound healing and prevents an impaired immune defense that results in infection. Dietary intake must meet the increased demands of the body for recovery from the break in skin integrity. Nutrition in general is often overlooked when assessing healing potential in a patient’s plan of care.

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Jeffrey M. Levine's picture

For years I was the only medical doctor doing inpatient wound consults in my hospital. I was continually amazed at the variety of wounds that reflected a wide gamut of human disease. Each wound was unique, and beyond the many pressure injuries and venous stasis lesions there were wounds from cancer, substance abuse, vasculitis, trauma, surgical dehiscence, and hematologic disorders. Most doctors viewed these as an unrewarding burden, requiring extended time unwrapping and rewrapping lesions that were malodorous, painful, and sometimes unhealable. The nurses and medical residents were puzzled at my enthusiasm and dubbed me “The Wound Man.”

Cheryl Carver's picture

For the past two decades, I've had a deep interest in wound care, but my son's wound care experience in 2020 shifted my attention to a largely overlooked population. As a mother, as I prepare to face his third incarceration, I am an even stronger advocate for transforming families and the lives of those who have been incarcerated. I have recently become a Prison Fellowship Justice Ambassador. In my perspective, we must never lose sight of the fact that the prison population is a subset of the general population.

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WoundSource Practice Accelerator's picture

Abscess: Inflamed tissue surrounding a localized gathering of pus, often caused by infection.

Antimicrobial resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antimicrobial stewardship: Collective measures that are taken to slow the evolution of multidrug-resistant organisms.

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Holly Hovan's picture

By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Refractory wounds comprise a significant worldwide health problem, affecting 5 to 7 million people per year in the United States alone, as discussed in previous blogs. Wounds that fail to heal not only impact quality of life, but also impose a significant physical, psychosocial, and financial burden. Additionally, individuals with refractory wounds often experience significant morbidity, and sometimes mortality. Wound infections and amputations are common in this population, and chronic conditions often exist as well.