A sore that fails to heal can be a source of concern. While minor cuts and scrapes typically mend quickly, some wounds persist. This article explains why a wound might not heal and what steps to take.
Defining a Chronic Wound
A wound is considered chronic, or non-healing, if it has not shown improvement within four weeks or has not fully closed within eight weeks. These wounds often remain stuck in the inflammatory phase of healing, unable to progress through the healing stages, which prevents closure and regeneration. Chronic wounds differ from acute wounds, which follow a predictable healing process.
Characteristics of a chronic wound include persistent inflammation, a lack of new tissue growth, or repeated skin breakdown. They may also show signs like a foul odor, excessive discharge, or pain that does not improve. Unlike acute wounds, chronic wounds often stall, requiring targeted intervention.
Factors Contributing to Non-Healing
Several factors impede the body’s natural wound healing process, leading to a sore that won’t heal. These are categorized as systemic factors, which relate to overall health, and local factors, which directly affect the wound itself.
Systemic conditions affect wound healing. Poor circulation, for instance, reduces the delivery of oxygen, nutrients, and immune cells to the wound site. Conditions like peripheral artery disease (PAD) or venous insufficiency impair blood flow, making it difficult for wounds, especially on the lower legs and feet, to heal. Diabetes also contributes to poor healing due to damaged blood vessels and nerves (neuropathy) and an impaired immune response, increasing infection susceptibility.
A compromised immune system, whether due to illness or medications like corticosteroids and other immunosuppressants, hinders the body’s ability to fight infection and repair damaged tissue. Nutritional deficiencies, particularly in protein, vitamins (like Vitamin C), and minerals (like zinc), impair collagen synthesis and immune function. Age also plays a role, as older adults may experience slower healing rates. Stress, obesity, and lifestyle choices such as smoking and alcohol consumption further delay healing by affecting immune function, blood flow, and oxygen supply to tissues.
Local factors directly at the wound site also prevent healing. Infection, caused by bacteria, viruses, or fungi, disrupts the healing cascade and leads to prolonged inflammation and tissue damage. The presence of foreign bodies in the wound bed or repeated trauma, such as bumping or rubbing, continuously irritate the wound and prevent it from closing. Imbalances in wound moisture, with either too much or too little, or excessive pressure on the wound area, create an unfavorable environment for healing.
When to Seek Medical Attention
Recognizing when a non-healing sore requires medical evaluation is important for preventing complications and ensuring appropriate treatment. While minor wounds may resolve with home care, a persistent or worsening sore often signals an underlying issue requiring medical attention.
You should seek medical attention if a wound shows signs of infection, such as increasing pain, redness, swelling, or warmth around the wound. The presence of pus, excessive clear fluid, or a foul odor emanating from the wound also indicate potential infection. If you develop a fever or chills in conjunction with a non-healing sore, this suggests a serious systemic infection.
Consult a healthcare professional if a wound has not shown improvement within two to four weeks, or if it continues to worsen in size or depth. Numbness around the wound or a bluish discoloration of the wound edges indicates poor circulation. If the wound is bleeding continuously or if you have chronic health conditions like diabetes, consult a doctor promptly.
Medical Evaluation and Treatment Approaches
When a sore fails to heal, a healthcare professional will conduct a medical evaluation to determine causes and develop a treatment plan. This process begins with an assessment of the wound itself, including its size, depth, appearance, and any discharge. The doctor will also review your medical history to identify systemic conditions or medications impeding healing.
Diagnostic tests include blood work to check for underlying conditions such as diabetes, nutritional deficiencies, or signs of infection. A wound culture is taken to identify specific bacteria or other pathogens present, guiding antibiotic therapy. Imaging studies, like ultrasounds or angiograms, may be performed to assess blood flow to the affected area, especially if poor circulation is suspected. A biopsy of the wound tissue may also be considered to rule out other conditions.
Treatment approaches for non-healing sores are diverse and often involve a multidisciplinary team. One common intervention is debridement, which involves removing dead or infected tissue from the wound bed to promote healthy tissue growth. This can be done surgically, enzymatically with topical agents, or through autolytic debridement using the body’s own enzymes. Advanced wound dressings are frequently used to maintain an optimal moist environment, absorb excess fluid, and protect the wound from infection. These include hydrocolloid, foam, or antimicrobial dressings.
Managing infection is a focus, often involving antibiotics based on wound culture results. Addressing underlying conditions is also important; this includes better blood sugar control for diabetic patients, improving circulation through medication or surgical procedures for those with vascular disease, or managing immune system disorders. Specialized therapies are also employed. Negative pressure wound therapy (NPWT) uses controlled suction to remove fluid, reduce swelling, and promote blood flow and new tissue formation. Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber, increasing oxygen delivery to the wound, stimulating new blood vessel growth and enhancing healing. For certain wounds, skin substitutes or grafts, derived from bioengineered materials or natural tissues, are applied to support cell regeneration and wound closure.