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Overview of treatment of chronic wounds

Karen Evans, MD
Paul Kim, DPM, MS
Section Editors
Charles E Butler, MD, FACS
Russell S Berman, MD
Eduardo Bruera, MD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Diane MF Savarese, MD


A chronic wound may be defined as one that is physiologically impaired due to a disruption of the wound healing cycle as a result of impaired angiogenesis, innervation, or cellular migration, among other reasons [1]. Normal wound healing is described separately. (See "Wound healing and risk factors for non-healing", section on 'Impaired wound healing' and "Wound healing and risk factors for non-healing", section on 'Risk factors for non-healing'.)

The precise timeline for complete epithelialization varies depending on numerous factors including comorbidities (eg, diabetes, autoimmune disease, peripheral artery disease), increased body mass index, anatomic location, and medications. However, regardless of etiology, wound healing normally progresses at a sustained, measureable rate. Some suggest that the lack of approximately 15 percent reduction weekly or approximately 50 percent reduction of the surface area of the wound over a one-month period indicates a chronic state [2].

Examples of chronic wounds include nonhealing or infected surgical or traumatic wounds, venous ulcers, pressure ulcers, diabetic foot ulcers, and ischemic ulcers. Chronic wounds related to malignancy require appropriate treatment of the malignancy, but in some cases, palliation may be all that can be offered [3,4]. The clinical assessment and differentiation of these wounds is reviewed elsewhere. (See "Clinical assessment of wounds".)


As with acute wounds, local care of chronic wounds includes debridement and proper wound dressings. Frankly necrotic debris should be aggressively removed. Proper local care is an important element of preparing the wound bed to accept a skin graft or flap, or for closure, when indicated. (See "Basic principles of wound management", section on 'Wound debridement' and "Basic principles of wound management", section on 'Wound dressings' and 'Wound bed preparation' below.)

Local treatment should also be directed toward dealing with the most troublesome chronic wound problems that affect the patient physically and emotionally, such as odor, bleeding, itching, excess exudate, pain, and also toward minimizing infection.


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Literature review current through: Sep 2016. | This topic last updated: Mar 7, 2016.
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