We’ve all experienced a painful ingrown toenail or papercut. Most minor wounds heal themselves so efficiently that you don’t have to give them much attention. But what happens when a wound fails to heal altogether?
Instead of fresh, healthy skin taking the place of your burn or blister, red and infected skin develops and becomes worse with each passing day. After 30 days, these non-healing wounds are considered chronic wounds, and they require specific treatment to heal successfully.
What Is a Chronic Wound?
Whether you slam your finger in a door, cut your foot on a piece of glass, or burn yourself on the stove, wounds are an unavoidable part of life. It’s easy to assume your injuries will heal and disappear on their own, but as many as 4.5 million Americans find themselves dealing with chronic wounds that never improve.
Once a wound persists for more than a month with minimal improvement, it’s officially considered a chronic wound that requires specific medical attention.
Common Types of Chronic Wounds
Chronic wounds occur in many different forms, areas, and sizes, but the following types of chronic wounds are most common.
Since diabetes interrupts the body’s natural healing process, it’s common for people with diabetes to develop extreme ulcers on their lower extremities, especially on the feet. Diabetic foot ulcers begin as common cuts, blisters, and scrapes, but they gradually deteriorate into deep wounds with severe infection.
Since nerve damage may prevent you from feeling the pain of your diabetic foot ulcer, it’s important to visually inspect your feet every day. If you notice any of the following signs of a chronic diabetic ulcer, call your doctor right away:
- Drainage from your foot is staining your socks or leaking from your shoe
- Unusual swelling
- Irritation and redness
- Strong, irregular odor from one or both feet
- Black tissue surrounding a wound on the foot
Surgery can save your life, but unfortunately surgical incisions are vulnerable to bacteria and infection. If your surgical wound fails to undergo the normal healing process, a chronic wound may develop.
Watch closely for signs of redness, streaking, throbbing, and fluid retention around the surgical site. A strong odor and moderate fever also indicate problems with your post-surgical wounds.
Any type of severe trauma or injury to the body, such as an aggressive burn, has the potential to result in damage that can’t be reversed using the body’s natural healing functions. This occurs because major trauma causes prolonged and excessive inflammation, continuous infections, and even drug-resistant bacteria that cripple the normally healthy reparative response of cells and tissues.
Arterial ulcers are chronic wounds that can be easily recognized by their round shape. They’re caused by poor circulation through the legs and feet. If you experience pain in the legs after exercising or when your legs are elevated, it could signal an arterial ulcer.
What’s the Difference Between a Chronic and Acute Wound?
Chronic and acute wounds are both injuries on the bodies, but their healing times set them apart. Chronic wounds fail to heal over a normal or predicted time frame, but acute wounds are able to move through the stages of healing and resolve themselves in a timely manner.
In general, any wound that remains longer than 30 days without improvement is chronic, while any wound that improves or heals in less than 30 days is acute.
Open Wound Healing Stages
From the time a wound develops to the time a wound heals, four physiological stages of healing occur: hemostasis, inflammation, proliferation, and maturation. If these four stages fail to occur properly, a wound becomes “stuck” in the inflammatory phase and develops into a chronic wound.
Hemostasis occurs immediately after an injury. Blood clots to prevent excessive blood loss and to create a scab that protects the underlying tissues from bacteria. This complex and essential process involves the interplay of platelets, fibroblasts, and proteins.
Hemostasis gives way to the inflammatory phase. A surge of inflammatory cells enters the area and triggers common signs of inflammation like redness, warmth, swelling, pain, and loss of function.
Early inflammation is actually a good sign, since it’s meant to control bleeding and prevent infection in the wound. Inflammation of less than seven days indicates that platelets, white blood cells, and other cells are working hard to stimulate healing.
During the proliferative phase, which can last two to three weeks in a properly healing wound, the wound regenerates with new tissue made of fresh, healthy collagen. New blood vessel networks are constructed to keep this new tissue fully nourished with oxygen and nutrients.
The proliferative phase also helps the wound to become smaller and less noticeable. Pink and red tissue signals successful, healthy wound healing.
The maturation phase oversees the conclusion of proper wound healing. New type III collagen transforms into type I collagen to help the wound close completely with new tissue. Any extra cells used to help repair the wound are removed while collagen fibers reorganize themselves into more efficient cross-links.
Cross-linking reduces scarring and helps the skin across an old wound remain strong. It’s best if this remodeling takes place three weeks after a wound is sustained, but it can continue for as long as a year.
What Can Lead to a Chronic Wound Infection?
Acute wounds heal efficiently through the hemostasis, inflammatory, proliferative, and maturation phases, but not all wounds proceed through the healing process in an orderly and timely manner.
Many different physiologic and mechanical factors can interfere with the healing process, resulting in a chronic wound that fails to graduate from the inflammatory phase. Some of the most common issues known to impair the normal healing process include diabetes, immunodeficiency, trauma, and malnutrition.
To make matters worse, a chronic wound can become infected if you face other risk factors like improper wound cleaning or imbalanced blood sugar.
Improper Wound Cleaning
Wound cleaning is a simple, yet essential component of infection prevention, especially in chronic wounds. If your wound is not properly cleaned on a daily basis, bacteria will quickly take the opportunity to breed and spread infection. Failing to follow your prescribed wound-cleaning protocol will most likely lead to chronic wound infection:
- Run clean, warm water over your wound and wash with gentle soap
- Gently dab or swipe wound with gauze pad or soft washcloth
- Use a clean cloth to pat skin dry
- Cover wound in fresh, sterile dressing
- Stay away from sources of bacteria like public pools and hot tubs
Imbalanced Blood Sugar
Imbalanced blood sugar is a clear sign of diabetes. Diabetes develops when your body cannot properly produce or use insulin, the hormone that transforms sugar into usable energy. When insulin can’t do its job, glucose builds up in the blood and causes severe health complications.
High blood sugar stifles your body’s natural healing functions in serious ways:
- Triggers inflammation throughout the body
- Weakens the immune system’s protections
- Blocks nutrients and oxygen from strengthening and energizing injured cells
- Prevents white and red blood cells from traveling to the wound
Inefficient healing mechanisms don’t stand a chance against out-of-control infection. This is especially true since bacteria thrive on the excess sugar available in the bloodstream of a person with diabetes.
If you don’t take steps to balance your blood sugar and minimize the impacts of diabetes, chronic wound infection is more likely to develop.
How Long Do Chronic Wounds Need to Heal?
Unfortunately, chronic wound healing can’t always be predicted. The amount of time your chronic wound needs to heal is dependent upon the age and condition of the wound, treatments you’re using to support healing and many other factors.
If you’re dressing your wound each day, but you’re not receiving any treatment for your chronic wound, healing will occur slowly, if at all. However, if you choose to undergo an effective treatment like hyperbaric oxygen therapy (HBOT), you can expect a more rapid healing process.
How to Speed Up Chronic Wound Healing With Hyperbarics
Many patients have come to R3 Wound Care and Hyperbarics feeling frustrated and discouraged by chronic wounds they’ve unsuccessfully been trying to heal for years. Using the simple power of HBOT, our team is frequently able to heal their chronic wounds in less than eight weeks.
HBOT is a safe and natural alternative therapy that uses the power of pressurized oxygen to stimulate your body’s innate healing process to move out of the inflammatory phase and into the proliferative and maturation phases.
Depending on your unique chronic wound, you may need to see a vascular doctor in conjunction with your HBOT treatments. Vascular doctors specialize in the circulatory system, so they can provide treatments that open up your veins and arteries to support proper blood flow.
If you’re truly committed to speeding up your chronic wound healing with HBOT, make sure you stop smoking. Every time you smoke a cigarette, your circulatory system raises your blood pressure, narrows the arteries and veins responsible for blood flow, and makes it much more difficult for oxygen and nutrients to travel through your body. Smoking cessation is a critical component of successful and long-lasting chronic wound healing with HBOT.
The Bottom Line
Chronic wounds are painful, dangerous, and frustrating, but HBOT offers a safe and effective technique for chronic wound healing. By addressing the root causes of your chronic wound infection, like poor blood flow and white blood cell function, HBOT makes it possible to push your body through the open wound healing stages into recovery.
Instead of coping with the costs and limitations a chronic wound places on your life, you can visit a practice committed entirely to hyperbaric medicine, like R3 Wound Care and Hyperbarics. The team at R3 Wound Care and Hyperbarics offers state-of-the-art HBOT treatments designed to address your unique medical needs and improve your quality of life.
1. Jorge I de la Torre, MD, FACS.
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4. Frykberg, R. G., & Banks, J. (2015). Challenges in the Treatment of Chronic Wounds. Advances in Wound Care, 4(9), 560-582. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528992/
5. Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. What Are the Treatment Options for Chronic Wounds? 2006 Oct 17 [Updated 2018 Jun 14].Available from: https://www.ncbi.nlm.nih.gov/books/NBK326436/.
6. Smoking and Your Heart. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart.
Jaimi Stockstill is a nurse practitioner with experience caring for critically ill, cardiac cath lab, post-operative, psychiatric, and wound care patients. Jaimi received her Master’s of Science in Nursing from The University of Texas at Arlington. She currently manages wound care and hyperbaric oxygen therapy for the patients at R3.