Chronic Wounds – Treatment Options and Prevention Methods

The term chronic wound refers to any wound that does not heal within the expected period for its location and type and does not follow the normal healing process. Typically, this refers to a period of 6–8 weeks.

It is important to bear in mind that chronic wounds have not only a significant impact on health but also major socioeconomic consequences for the individual, primarily by drastically reducing quality of life. Their treatment requires considerable involvement from healthcare professionals, as well as discipline and active participation from the patient.

Most Common Causes

Although there are numerous possible causes of chronic wounds, the most common predisposing factors include peripheral arterial disease, venous insufficiency, high blood pressure, and diabetes mellitus, which are themselves chronic conditions.

Despite the many potential causes, the development of chronic wounds generally follows a similar pattern. It is primarily associated with tissue hypoxia (reduced oxygen levels in the tissues), accompanied by an increased risk of local infections due to bacterial colonisation. Swelling, redness, and increased local temperature may also occur, with progressive deterioration of the affected area if appropriate treatment is not initiated in a timely manner.

Main Types of Chronic Wounds (Approximately 95% of Chronic Wounds)

1. Ischaemic wounds – most commonly caused by peripheral arterial disease or conditions that reduce arterial blood flow to the affected area, such as diabetes. These wounds are typically very painful.

2. Martorell ulcer – a specific type of chronic wound that most commonly occurs in older women. It is associated with a combination of high blood pressure, diabetes, and peripheral arterial insufficiency and is typically very painful.

3. Neurotrophic ulcer – develops as a consequence of reduced or absent pain sensation, with diabetes being the most common underlying cause. These wounds are usually painless.

4. Venous ulcers – most commonly caused by venous insufficiency and the resulting pooling of venous blood (venous stasis).

Specific Subtypes Include:

1. Pressure ulcers – most commonly occur in immobile patients as a result of prolonged pressure on the skin and underlying tissues.

2. Diabetic foot (Charcot foot) – one of the more serious complications associated with diabetes. In severe cases, surgical treatment, including amputation, may be necessary.

Chronic Wound Treatment and Advice for Patients

Based on the above, it is clear that treating chronic wounds requires intensive care and active patient involvement due to the significant risk of complications, such as local infection or the formation of callus tissue. Proper management of the underlying conditions contributing to the development of these wounds can facilitate healing and help prevent their recurrence.

In addition to establishing an accurate diagnosis, the key elements in the treatment of chronic wounds include:

1. Timely surgical debridement – mechanical removal of damaged and devitalised tissue, as well as any other tissue or material that may interfere with wound healing.

2. Regular wound dressing using appropriate antiseptics, followed by appropriate methods to stimulate tissue healing.

3. Appropriate antibiotic therapy when indicated.

4. Effective control and treatment of the underlying condition.

5. Once the local condition has stabilised, an appropriate decision regarding further treatment should be made. Options may include continued wound dressing until complete healing, surgical closure of the wound using an autologous skin graft, or coverage of the remaining skin defect with fibrin-based dressings.

6. Following completion of treatment and stabilisation of the local condition, physical therapy is recommended whenever possible to support further recovery and restore the function of the soft tissues and musculoskeletal system in the affected area.

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