Chronic wound

A chronic wound is a wound that does not progress through the normal stages of wound healing—hemostasis, inflammation, proliferation, and remodeling—in a predictable and timely manner. Typically, wounds that do not heal within three months are classified as chronic. Chronic wounds may remain in the inflammatory phase due to factors like infection or bacterial burden, ischaemia, presence of necrotic tissue, improper moisture balance of wound site, or underlying diseases such as diabetes mellitus.

In acute wounds, a regulated balance of pro-inflammatory cytokines (signalling molecules) and proteases (enzymes) prevent the degradation of the extracellular matrix (ECM) and collagen to ensure proper wound healing.

In chronic wounds, there is excessive levels of inflammatory cytokines and proteases, leading to excessive degradation of the ECM and collagen. This disrupts tissue repair and impedes recovery, keeping the wound in a non-healing state.

Chronic wounds may take years to heal or, in some cases, may never heal, causing significant physical and emotional stress for patients and placing a financial burden on healthcare systems. Acute and chronic wounds are part of a spectrum, with chronic wounds requiring prolonged and complex care compared to acute wounds.

Chronic wound patients often report pain as dominant in their lives. It is recommended that healthcare providers handle the pain related to chronic wounds as one of the main priorities in chronic wound management (together with addressing the cause). Six out of ten venous leg ulcer patients experience pain with their ulcer, and similar trends are observed for other chronic wounds.

Persistent pain (at night, at rest, and with activity) is the main problem for patients with chronic ulcers. Frustrations regarding ineffective analgesics and plans of care that they were unable to adhere to were also identified.

In addition to poor circulation, neuropathy, and difficulty moving, factors that contribute to chronic wounds include systemic illnesses, age, and repeated trauma. The genetic skin disorders collectively known as epidermolysis bullosa display skin fragility and a tendency to develop chronic, non-healing wounds. Comorbid ailments that may contribute to the formation of chronic wounds include vasculitis (an inflammation of blood vessels), immune suppression, pyoderma gangrenosum, and diseases that cause ischemia. Immune suppression can be caused by illnesses or medical drugs used over a long period, like steroids. Emotional stress can also negatively affect the healing of a wound, possibly by raising blood pressure and levels of cortisol, which lowers immunity.

What appears to be a chronic wound may also be a malignancy; for example, cancerous tissue can grow until blood cannot reach the cells and the tissue becomes an ulcer. Cancer, especially squamous cell carcinoma, may also form as the result of chronic wounds, probably due to repetitive tissue damage that stimulates rapid cell proliferation.