Chronic (Non-healing) wound

A chronic wound is a lesion that does not heal in a specific time, but shows delayed wound healing. A wound is considered as a “chronic (non healing) wound” when the process is not completed between 4 weeks to 3 months. The patient has tissue damage and for this reason, the wound can be painful. Some wounds, like venous ulcers or diabetic foot ulcers, may also present the risk of recurrence.

A wound may occur for a lot of reasons, such as a pressure injury, venous insufficiency, arterial vascular disease, neuropathy, vasculitis, rheumatoid arthritis and immune disease, and so on. 

Many factors could lead an acute wound to become a chronic wound, for example, diabetes with its complications (neuropathy and narrowing of the arteries), low blood flow, soft tissue infection, pressure injuries, repeated trauma, immune suppression disease, overuse of drugs (steroids).

According to the stage of tissue damage, the wound can involve the epidermis and dermal layer or involve the deepest tissues, reaching the muscular fascia or the bone.

Care of a chronic wound should consider, first of all, the reasons that caused the wound through proper investigations (blood tests, Doppler study, MRI, and so on), with an appropriate plan of treatment to heal it and avoid the recurrence. 

Once the diagnosis is acquired, it is possible to start with the right treatment. The phrase “Wound bed preparation” means the first management of a wound that has the target to accelerate the healing processes; this is called Debridement and is one of the most important steps, involving the removal of the necrotic tissue.

The treatment of chronic wounds involves different approaches that include:

• advanced dressings
• negative wound therapy (NPWT)
• surgical procedures which include advanced therapy such as platelet-rich plasma (PRP), bioactive tissue matrix allograft composed of dehydrated human amnion/chorion membrane (dHACM), hyaluronic acid ester matrix, naturally-occurring urinary bladder matrix (UBM), a porous matrix of fibers of cross-linked bovine tendon collagen and so on.