Chronic Wound Care

What is a chronic wound?

A wound is an injury that causes a break in the skin. There may also be damage to nearby tissues. Chronic wounds are wounds that do not heal completely in 6 weeks. Examples of wounds that can become chronic are deep ulcers (open sores), large burns, and infected cuts.

What leads to a chronic wound?

Conditions that slow or stop the healing process may lead to a chronic wound. These may include any of the following:

  • Poor blood supply or low oxygen can be caused by low blood pressure, or blocked or narrowed blood vessels. This is more likely if you smoke or have heart or blood vessel disease. Blood, heart, kidney, and lung disease can also decrease the oxygen supply to tissues.

  • An infection occurs when bacteria get into your wound. Objects in the wound, such as glass or metal, may bring bacteria into your wound. Dead tissue in your wound may give bacteria a place to grow. Diseases such as diabetes can also increase your risk for infection.

  • A weak immune system may lead to a chronic wound. Radiation treatments, poor nutrition, and certain medicines, such as steroids, weaken the immune system. Diseases, such as cancer and diabetes, can weaken your immune system and make it hard to fight an infection.

  • Tissue swelling may happen with traumatic injuries. It can also happen with conditions that cause decreased blood flow to the area, such as heart failure or blood vessel problems. The swelling increases pressure that decreases blood flow to the area.

What are the signs and symptoms of a chronic wound?

  • Milky, yellow, green, or brown pus in the wound

  • Bleeding, swelling, or pain in the affected area

  • Trouble moving the affected area

  • Wound has become larger or deeper

  • Dark or black skin around the wound that is warm to the touch

  • Fever

How is a chronic wound diagnosed?

Your caregiver will ask about your injury. He will ask about your health, the medicines you take, and any past surgeries. He will examine the injury and the area around it. He will check to see how deep the wound is and look for signs of infection. You may need any of the following:

  • Blood tests are done to see if you have an infection and to find its cause.

  • A wound culture is a test of fluid or tissue used to find the cause of your infection.

  • An x-ray is a picture of your bones and tissues in the wound area. You may need to have an x-ray if the wound is near a joint or bone. Caregivers look for broken bones, or foreign objects such as glass or metal.

How is a chronic wound treated?

Your treatment depends on where your wound is located and how severe it is. If a medical problem such as diabetes is delaying wound healing, it is important to treat this problem. Caregivers may change your treatment over time if your wound still does not heal. You may need any of the following:

  • NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.

  • Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.

  • Antibiotics may be given to prevent or treat an infection caused by bacteria.

  • Wound care:

    • Cleansing is done by flushing the wound with sterile water. Caregivers may use a large syringe with a needle or catheter (tube) tip. They may also use a liquid that kills germs.

    • Debridement is done to remove anything from the wound that can delay healing and lead to infection. This includes dead tissue, and objects such as small rocks and dirt. Your caregiver may cut out the damaged areas in or around the wound. He may also drain the wound to clean out pus. Moist bandages may be placed inside the wound, or bandages that contain enzymes may be used. Hydrotherapy (whirlpool treatment) uses water to clean wounds. It may be used to clean and debride burn wounds.

    • Wound dressings are used to protect the wound from further injury and infection. They also maintain moisture in the wound area to promote and speed healing. An elastic bandage may be wrapped around the wound area to put light pressure on it. The light pressure helps to decrease swelling in tissues around the wound area. Dressings may be in the form of bandages, gauze, films, gels, or foams. They may contain substances to help you heal faster. Skin taken from another part of your body may be used to close a large wound. Caregivers may instead use artificial skin that contains cells needed to repair damaged tissues.

    • Negative pressure wound therapy (NPWT) may also be done. This therapy is also called wound vacuum, or wound vac therapy. A vacuum device uses suction to remove fluid and waste from your wound and pull the edges closer together. NPWT may also increase blood flow and new tissue growth in the wound.

  • Hyperbaric oxygen therapy (HBO) is used to get more oxygen into your body. The oxygen is given under pressure inside of a tube-like chamber called a hyperbaric or pressure chamber. You may need to have this therapy more than once.

How can I care for my wound?

  • Do not stop using the bandage on your wound unless your caregiver says it is okay. Keep the bandage clean and dry.

  • Clean the wound as often as directed by your caregiver.

  • Wash your hands before and after you take care of your wound.

  • Your wound may need to be packed with gauze each time you change the bandages. Write down how many pieces of gauze are placed inside your wound. Be sure the same number comes out each time you replace the packing.

What can I do to help my wound heal?

  • Eat healthy foods and drink liquids as directed. Healthy foods give your body the nutrients it needs to heal your wound. Liquids prevent dehydration that can decrease the blood supply to your wound. Healthy foods include fruits, vegetables, grains (breads and cereals), dairy, and protein foods. Protein foods include meat, fish, nuts, and soy products. Protein, calories, vitamin C, and zinc help wounds heal. Ask your caregiver for more information about the foods you should eat to improve healing.

  • Do not smoke. If you smoke, it is never too late to quit. Smoking delays wound healing. Smoking also increases your risk for infection after surgery. Ask your caregiver for information if you need help quitting.

  • Prevent pressure damage. If you have a chronic wound, you may be at risk for pressure damage to your wound and other places on your body. Pressure sores can develop when blood flow to an area is blocked. For example, you sit or lie in the same position without moving and put pressure on your legs.

    • Prevent pressure sores by changing your position every 15 minutes while you are sitting. Prop your legs on pillows to lift your heels while you are lying down.

    • Check your skin daily for signs of pressure sores. Common signs are swelling, open sores, blisters, a rash, or changes in color or temperature. Tell your caregiver if you have any of these signs.

When should I contact my caregiver?

  • You have a fever.

  • You have increased or new pain, swelling, redness, or bleeding in or around your wound.

  • You have pus or a foul odor coming from your wound.

  • Your skin itches or has a rash.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You have muscle or joint pain, body aches, or sweating, with a fever.

  • You have a headache with diarrhea, nausea or vomiting, or a sore throat.

  • You are confused, or feel dizzy or faint when you stand up.

  • You have trouble breathing or sudden chest pain.

  • You see blood in the NPWT tubing or container, or on your bandages.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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