Why some wounds won’t heal?

As we all know, sometimes things don’t go according to plan and wounds are no exception to this.
Wound healing is dependant on many different factors.

Some factors that might stop or slow down wound healing include:

• Infection
• Poor immunity
• Poor nutritional status
• Some health problems (also known as ‘co morbidities’) which include:
• Peripheral vascular disease (poor arterial blood supply to the lower legs and feet)
• Poorly controlled diabetes
• Smoking
• Chronic renal (kidney) disease
• Rheumatoid arthritis, Inflammatory bowel disease, Lupus
• Some medicines (also known as drugs or medications) which include:
• Oral steroids
• Anticoagulants (commonly known as ‘blood thinners’)
• Chemotherapy for cancer treatment
• Inadequate or inappropriate dressings or topical therapies.

Note: This is not an exhaustive list. There may be other factors that can stop or slow down wound healing. Do not stop taking any medicines prescribed for you without discussion with your doctor or health practitioner. If you are concerned about any of the factors listed above please discuss these with your doctor or health practitioner.

When wounds won’t heal

A wound should decrease in size and improve in appearance from week to week. A wound which does not heal or show improvement for any time greater than six (6) weeks, is considered a ‘Chronic wound’ (also known as an ulcer) (AWCN, 2007).

Signs that indicate need to seek professional advice

When a wound doesn’t heal, there are often a range of factors that may be preventing the wound from healing. If a wound doesn’t heal it is strongly advised that you consult your doctor or health practitioner.

Specific signs that require professional assessment and advice from a doctor or health professional:

Infection
Infection is the most common complication of having a wound. Infection can be localised to the area immediately around the wound or can spread more widely. If infection enters the bloodstream this can be very serious. The following symptoms might indicate wound infection:

• The area around the wound becomes red, swollen and hot.
• The wound becomes painful.
• Fluid from the wound becomes thick or there is pus from the wound.
• Fluid from the wound becomes discoloured (for example: brown, grey or green).
• The amount of fluid from the wound (exudate) increases or is excessive.
• The wound smells offensive.

It is recommended you seek advice from a doctor or health professional if you experience the signs of infection.

The following symptoms might indicate severe infection and you should seek the advice of a health professional immediately:

• There is considerable, spreading redness and possibly swelling extending out around the wound.
• You feel unwell (symptoms might also include feeling hot, cold, sweaty or shivering).
• You develop a high temperature.
• You become confused or disoriented.

Other problems

The following symptoms might indicate a wound that is hard to heal or other problems. It is recommended you seek advice from a doctor or health professional if these issues develop.

• The wound has not noticeably decreased in size over 4-6 weeks (even a small wound).
• The wound has increased in size.
• The wound bleeds regularly or profusely.
• The area around the wound becomes white and soft or spongy.
• The wound becomes black or yellow.
• If you have any other concerns regarding your wound.

Where to seek advice for wounds that won’t heal

Not all doctors and health professionals have specific training and expertise in treating wounds that don’t heal. Your doctor or health professional might need to refer you to another practitioner for further investigations, tests or specialist treatment.

When you seek advice or treatment for a wound that won’t heal you are entitled to receive the best quality care.

To achieve the best possible outcome for you and your wound you have the right to:

• Have your wound assessed and treated by a practitioner with specific training and experience in managing wounds that don’t heal. This might mean you need referral to another health practitioner.
• Know what experience and qualifications your practitioner has in treating hard to heal
wounds.
• Know what different treatment options are available for your and your wound.
• Know the benefits and any risks of wound treatments offered to you and your wound.
• Know the costs of any wound dressings or treatments offered to you prior to accepting
treatment.
• Know the consequences if you decide not to follow the advice given to you.
• Ask any questions and receive an adequate answer.
• Have your wound treated with products and therapies approved for use on wounds.
• Have your wound re-assessed regularly by a practitioner who is able to determine its
progress.
• Seek an opinion from another health professional if you so desire.
• Be referred to another health professional if you so desire.

(Adapted from the Association for the Advancement of Wound Care 2006)
SAWMA has provided this information as a service to consumers. SAWMA hopes this information has provided you with some practical guidance that will help you achieve the best outcome for you and your wound.