Overview of treatment of chronic wounds
- Karen Evans, MD
Karen Evans, MD
- Associate Professor
- Georgetown University Medical Center
- Paul Kim, DPM, MS
Paul Kim, DPM, MS
- Associate Professor
- Department of Plastic Surgery
- Georgetown University School of Medicine
- Section Editors
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
- Eduardo Bruera, MD
Eduardo Bruera, MD
- Section Editor — Non Pain Symptoms: Assessment and Management
- Professor of Oncology
- University of Texas, MD Anderson Cancer Center at Houston
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 . 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 .
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".)
LOCAL CARE OF CHRONIC 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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- LOCAL CARE OF CHRONIC WOUNDS
- SURGICAL INTERVENTION
- Wound bed preparation
- - Operative debridement
- - Negative pressure wound therapy
- - Hyperbaric oxygen therapy
- Wound coverage/closure
- SPECIFIC WOUND MANAGEMENT
- Diabetic foot wounds
- Ischemic ulcers and gangrene
- Chronic orthopedic wounds
- Abdominal wounds
- Pressure ulcers
- Ulcerated and fungating malignancy-related wounds
- Venous stasis ulcers
- SUMMARY AND RECOMMENDATIONS