Chronic Wound Care

What is a chronic wound?

A wound is a type of injury where there is a break in the skin and may 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: Blood flow may be decreased due to 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.
  
  
• Infections: Infection happens when a large number of bacteria (germs) get into the wound. Objects in the wound, such as glass or metal, may bring bacteria into the wound. Dead tissue in the wound may give bacteria a place grow. Diseases, such as diabetes, can increase your risk for bacteria to grow in your wound.
  
  
• Weak immune system: Your immune system fights infection. Radiation treatments, poor nutrition, and certain medicines, such as steroids, weaken the immune system. Diseases can weaken your immune system and make it hard to fight an infection. Some common examples are cancer and diabetes.
  
  
• Tissue swelling: 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?

• The wound drains milky, yellow, green, or brown fluid that smells bad.
  
  
• The wound bleeds, and is swollen and painful.
  
  
• You have trouble moving the wounded area.
  
  
• The wound has become large or deep.
  
  
• The skin around the wound is dark or black and feels warm to the touch.
  
  
• You have a fever.

How is a chronic wound diagnosed?

Your caregiver may check your health history, including diseases, medicines you are taking, and past surgeries. He will also need to know when and how your wound occurred. You may need any of the following:

• Physical exam: Your caregiver will look closely at your wound and the area around it. He will check to see how much skin was broken and how deep the wound is. He will also look for other problems or signs of infection.
  
  
• Blood tests: Blood tests are done to see if you have an infection and what may be causing it.
  
  
• Wound culture: A wound culture is done to help caregivers learn more about your infection and decide the best medicine to treat it.
  
  
• X-ray: This 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 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:

• Medicines: Your caregiver may give you an antibiotic to fight infection. You may take this medicine as a pill, get it through an IV, or apply it to the wound. You may also be given medicines to decrease pain, swelling, and fever.
  
  
• Wound care:
  
  
  • Cleansing: Caregivers flush the wound with sterile (germ-free) water. They may use a large syringe with a needle or catheter (tube) tip. They may also use a fluid that kills germs.
    
    
  • Debridement: Debridement is done to remove anything from the wound that can delay healing and lead to infection. This includes dead tissue, objects such as small rocks, and dirt. Your caregiver will choose the best method of debridement for your wound. He may cut out the damaged areas in or around the wound. Caregivers 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 mechanically clean wounds. It may be used to clean and debride burn wounds.
    
    
  • Wound dressings: 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: Your caregiver will decide if you need negative pressure wound therapy (NPWT). 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: This is also called HBO. HBO is used to get more oxygen into your body. The oxygen is given under pressure to help it get into your tissues and blood. You may be put into a tube-like chamber called a hyperbaric or pressure chamber. You will be able to see your caregivers and talk with them through a speaker. You may need to have this therapy more than once.

What can I do to take care of my wound and help it heal?

• 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 more liquids: 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. Eat a variety of healthy foods including fruits, vegetables, breads, dairy products, meat, and fish. Protein, calories, vitamin C, and zinc help wounds heal. Ask caregivers for more information on wound healing and healthy foods.
  
  
• Stop smoking: Smoking delays wound healing. Smoking also increases your risk of infection after surgery. If you smoke, ask caregivers for information about how to stop.
  
  
• 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. Check your skin daily for signs of pressure sores. Common signs are swelling, open sores, blisters, a rash, or changes in color or temperature. Report these findings to your caregiver. You can help prevent pressure sores. Change your position every 15 minutes you are sitting. Prop your legs on pillows to lift your heels while you are lying down. Ask caregivers for more information on how to prevent pressure damage.

When should I contact my caregiver?

Contact your caregiver if:

• You have a fever.
  
  
• You have increased or new pain, swelling, redness, or bleeding in or around your wound.
  
  
• You have new or different pus or a foul odor coming from the wound.
  
  
• Your skin itches, swells, or has a rash.
  
  
• You have questions or concerns about your medicines or treatment.

When should I seek immediate help?

Seek care immediately or call 911 if:

• 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.

Learn more about Chronic Wound Care