Non-healing Wounds – Assessment and Management

A wound is non-healing or chronic, if it does not improve even after three weeks, which is the normal healing time for wounds. The healing process for a normal wound includes three phases – Inflammation, Proliferation and Maturation. However, these three stages should progress in an orderly manner although they will overlap.

The most common hard-to-heal wounds include:

  • Diabetic foot ulcers
  • Venous-related ulcerations
  • Surgical wounds
  • Pressure ulcers
  • Wounds related to metabolic disease

Certain factors that can delay wound healing include infection, lack of nutrition, patient’s age, wound location, systemic diseases, smoking habits, impaired circulation, certain medications, diabetes, obesity, and inappropriate treatment strategies.

Common locations for non-healing wounds are the feet, ankles, heels and calves. Infection is the greatest risk from these woundsites. Some symptoms that may indicate an infection include increasing pain, redness and warmth around the wound, odor from the wound and exudates. Clinical infection can lead to chronic inflammation.

Proper wound care plays a critical role in the treatment of non-healing surgical wounds. Wounds that repeatedly break down should also be given greater care. The earlier the wound healing problems are detected, the better the outcome. Recognition of a hard-to-heal wound requires careful, detailed regular reassessment with measures taken towards healing. Nurses must carefully map and measure the wound. Documenting every step of wound management is also critical for successful wound healing. Digital photography can be used to document the wound size. With an advanced wound EMR, nurses as well as physicians can instantly record their notes into the system.

An effective strategy for wound management depends on the method and scope of the assessment. Assessment should include a detailed history and a thorough physical exam. Exudates from non-healing chronic wounds should be reviewed well, as these have destructive properties with abnormally high levels of proteases. Left unchecked, excessive protease activity in wounds destroys the extracellular matrix and damages newly formed tissue, preventing the wound from healing quickly. If necessary, debridement should be performed to promote wound healing.