What are chronic wounds?

A chronic wound is a break in the skin that doesn’t heal as it should and takes longer than 4 weeks. This differs to an acute wound, a sore that heals properly, usually within around 4 weeks.

Chronic wounds can happen for a range of reasons and only some can be prevented. You might get a chronic wound if you have another health problem, for example:

• obesity
• problems with your immunity (from an autoimmune disease or an infection such as HIV)
• nerve damage
• skin problems due to illness or injury

A chronic wound can affect your quality of life.

Chronic wounds are grouped into 4 types based on their causes:

• arterial ulcers (relating to problems with arteries)
• diabetic ulcers (for example, foot ulcers)
• venous leg ulcers (relating to problems with veins)
• pressure injuries (for example, bed sores)

What symptoms are related to chronic wounds?

If you have a chronic wound, your wound may:

• feel painful
• have oozing discharge
• bleed
• have a very bad smell

There may be swelling of the area around the wound, and sometimes the wound may limit your ability to walk or move.

What causes chronic wounds?

Chronic wounds happen when your body’s natural healing process is disrupted and your wound does not heal.

Certain medical conditions can slow down or prevent wound healing, such as:

• living with obesity
• living with some health conditions — heart failure, lung disease, anaemia, varicose veins or a history of deep vein thrombosis
• being immunocompromised (having a weak immune system) due to living with HIV, uncontrolled diabetes or cancer
• some skin problems — dermatitis, dry skin or having had radiotherapy
• peripheral neuropathy (nerve damage)
• swelling in your limbs (peripheral oedema)

How is the cause of a chronic wound diagnosed?

Your doctor can diagnose the cause of your chronic wound by physically examining your wound and asking you about your medical history. They may also recommend you do some tests, including an ultrasound.

If your doctor thinks your wound is infected, they may take a sample (biopsy) of it.

When should I see my doctor?

You should see your doctor if:

• you have a wound that is not healing properly
• you have diabetes and notice a foot ulcer
• your chronic wound is getting worse or you develop a fever
• you are experiencing pain, low mood or distress because of your wound

How is a chronic wound treated?

If you have a chronic wound, your doctor will treat your wound and any medical conditions that may be preventing your wound from healing properly.

You will have a team of doctors, dietitians, physiotherapists and nurses working together to care for you.

Chronic wounds are treated with the TIME principle:

• Tissue debridement — dead or infected tissue in your wound is removed with a scalpel.
• Infection control — prevent and treat infection using special wound dressings, antimicrobial washes or antibiotics.
• Moisture balance — keeping your wound moist helps it heal quicker.
• Edges of your wound — keep the skin surrounding your wound healthy.

Self-care at home

As part of caring for your wound at home, you are recommended to:

• manage your blood sugar levels if you have diabetes
• eat well — your body needs nutrients to help your wound heal. Your dietitian will support you.
• take pressure off your wound — for example, if you have a diabetic foot ulcer, avoid walking on the affected area
• wound dressings — there are many types of wound dressings made for different wounds. Your healthcare professional will choose the best dressing for you.

Medicines for chronic wounds

Your doctor may recommend:

• oral or intravenous antibiotics if your wound is infected and you have a fever
• pain-relief medicines

Other treatment options

Other treatments include:

• hyperbaric oxygen therapy and negative pressure wound therapy
• skin grafts, transplanting healthy skin to your wound to close it
• surgery

If your wound does not improve after 4 weeks, your doctor may take a sample (biopsy) of it or refer you to a specialist wound clinic.

What are the complications of chronic wounds?

If your chronic wound becomes infected, you might also develop a fever. Your symptoms will worsen and your wound will grow.

In some cases, symptoms can be severe enough to affect your quality of life.

Chronic wounds can cause serious life-threatening and life-changing complications, such as:

• amputation of your limb
• infections — osteomyelitis and cellulitis
• sepsis
• depression — chronic wounds can sometimes affect your mental health and wellbeing

Can chronic wounds be prevented?

Some chronic wounds can be prevented. Below are some strategies to prevent chronic wounds:

• prevent and treat dry skin
• prevent pressure injuries
• prevent your skin from tearing
• prevent skin irritation caused by incontinence
• keep a balanced diet

If you are in an assisted living facility, they will have programs in place to protect your skin. You can ask staff if you want to know more about it.

Read about how you can prevent leg ulcers.

Read about how you can prevent a pressure sore.

Resources and support

• Visit Wound Australia to learn more about chronic wounds.
• Diabetes Feet Australia has tips to help you look after your feet.
• Learn more about pressure ulcers at SA Health.
• You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Aboriginal and/or Torres Strait Islanders

• Central Australian Aboriginal Congress has information and an app to help you look after your feet.

Other languages

• Diabetes Australia has a range of translated multicultural diabetes resources for people with diabetes who speak languages other than English.
• Health Translations has a resource about eating to prevent pressure injuries translated into many community languages.