Types & Causes of Chronic Wounds

Chronic wounds affect nearly 6 million people and contribute to about $20 billion in medical costs each year. While individuals of all ages can experience these injuries, older adults are more vulnerable due to thinning muscle mass, skin changes, a body that heals slower and an often sedentary lifestyle.

Wounds that do not progress past a certain healing stage may become infected, cause pain and increase mortality risks. For yourself or a loved one, learn how they develop.

What Are Chronic Wounds?

Wounds progress through a series of four distinct stages: coagulation, inflammation, proliferation and tissue remodeling. Small proteins called cytokines and growth factors guide each stage as new tissue emerges and the wound begins to heal.

Chronic wounds do not progress through all stages. Rather, they stall at inflammation or each stage is drawn out beyond a predictable timeline. While any type of wound can become chronic, those falling into this pattern share similar characteristics, including:

• High levels of inflammation-encouraging cytokines
• An infection
• A drug-resistant biofilm
• Tissue cells that do not begin rebuilding

People who suspect they have a chronic wound should not attempt to heal the injury themselves. If the wound remains open, inflamed or oozing fluid, contact your doctor to have it examined and potentially biopsied.

From here, most patients must follow a treatment plan involving tissue debridement, infection control, replenishing moisture and controlling the wound’s edges, limiting pressure placed on the area and controlling any underlying condition like diabetes, peripheral neuropathy or peripheral artery disease. In select cases, surgery may be needed.

Types of Chronic Wounds

Based on the location, depth and size, chronic wounds include the following types:

• Venous and Arterial Ulcers: These chronic wounds emerge after damage to a vein and possibly in response to untreated varicose veins or chronic venous insufficiency. The condition restricts oxygen to the skin and surrounding tissue, which start to die and create an open wound. Arterial ulcers affect the lower half of the body and may progress to the point a tendon or bone gets exposed.
• Diabetic Ulcers: Factors related to diabetes, like hardening arteries, narrowing blood vessels and poor circulation, restrict oxygen traveling to the extremities and an open wound may form. Patients with peripheral neuropathy, another side effect of diabetes, may not notice the wound’s development for weeks while the damage progresses. As a result, those with diabetic ulcers risk having a limb amputated.
• Pressure Ulcers: Commonly called bedsores, these injuries appear when areas of the body experience repeat pressure and friction. Common locations include the heels, ankles, hips and tailbone. The pressure applied limits blood flow to the area, causing cells and tissue to start dying within a matter of hours. Similar to other types of chronic wounds, pressure ulcers grow in size and increase their depth when ignored. Individuals are more susceptible to pressure ulcers if they lead a sedentary or immobile lifestyle, are obese, have incontinence or a bowel disorder.

Causes of Chronic Wounds

Doctors diagnose wounds as chronic when the injury has not healed within six weeks. Factors contributing to chronic wounds include:

• Diabetes
• Peripheral artery disease and other vascular diseases
• Limited or no mobility
• Trauma to the wound site
• A bacterial infection or biofilm
• Edema
• Infection
• A deeper injury
• Limited or no sensation in part of the body

Treatment for Chronic Wounds

Once a doctor examines the wound and determines it has not been healing on a standard timeline, they may recommend a treatment plan involving:

• Debridement: Removing dead skin cells and tissue from the wound bed.
• Controlling Biofilms: These contribute to infections and often prevent the wound from passing the inflammatory stage. You may need to apply dressings with an antibacterial element or take antibiotics based on the degree of infection.
• Adding Moisture to the Wound: Keeping the bed moist helps chronic injuries heal faster, yet you may need to control discharge or fluid while keeping the area moist.
• Controlling the Size of the Wound: Limit maceration and other traumatic actions that damage surrounding skin or cause wound fluid to spread over healthy skin.

Are you concerned about the development of chronic wounds? Discuss your injury with the medical team at West Hartford Health & Rehabilitation Center today.