Non-healing wound: what to do?

If your wound is not improving, do not hesitate to consult a vascular doctor or a specialist in chronic wounds. Treatment typically begins with a physical examination that includes an inspection of the wound and gathering information about the patient's medical history (information about chronic health problems, recent surgical procedures, and current medication) in order to identify any underlying condition that could affect the body's ability to heal.

In many cases, it will first be necessary to address the underlying causes of the wound before healing can begin. The patient may undergo blood and urine tests, a wound biopsy, and/or a wound culture to search for potential pathogenic microorganisms. That being said, here are some approaches a doctor might use to improve wound healing which depend on the patient's age, health status, and the nature of the wound.

• Wound Debridement: This is a process under local anesthesia that involves removing dead, devitalized, and necrotic tissues using surgical instruments (tweezers, curette, scalpel). An enzyme-based gel is sometimes also applied to help clean the wound. This helps a wound heal faster and ensures the growth of healthy tissues.

• Dressing the wound: Dressings can be particularly important for preparing the area for healing, removing excess fluid from the wound, protecting it from infections, and controlling humidity levels.

• Prescription of Pain Relievers: Pain can cause a constriction of the blood vessels, which slows down the healing process, in addition to deteriorating the patient's quality of life. Therefore, the doctor may find it necessary to prescribe pain relievers (acetaminophen, ibuprofen) to alleviate mild to moderate pain. However, if these are not sufficiently effective, the doctor may prescribe a more potent analgesic.

• Antibiotics: If a wound is infected, it has less chance of healing. Antibiotics can be prescribed to prevent and treat infection in cases of ulcers. They can either be applied to the wound using an ointment, or placed on the wound using a dressing.

• Nutritional Support: Patients suffering from significant chronic wounds may be predisposed to chronic malnutrition. Studies both experimental and clinical support that the administration of dietary supplements (zinc, arginine, glutamine, vitamin A, vitamin B5, vitamin C, vitamin D) may have beneficial effects on chronic wounds. However, further research is needed to better define the mechanisms of action, potential side effects, and the overall risk-benefit ratio of human application.

• Compression Therapy: If venous issues are the cause of the chronic wound, compression stockings can help it heal more quickly. The pressure applied by the stockings helps to decrease venous pressure, reduce swelling, and improve circulation to promote wound healing.

• Hyperbaric Oxygen Therapy: in the context of chronic and complicated wounds, this type of treatment may be necessary. The patient is exposed to a high concentration of pure oxygen (2 to 3 times higher than normal) for 90 to 120 minutes in a pressurized chamber. This type of therapy helps to increase the concentration of oxygen in the blood, which improves blood supply to the injured area, helps to destroy harmful bacteria responsible for infection, stimulates the formation of new blood vessels and increases the rate of collagen deposition, promoting healing. It is particularly useful for people suffering from diabetic ulcers, chronic bedsores, venous ulcers, or radiological wounds.

• Negative Pressure Therapy (Vacuum-Assisted Closure system): In this therapy, an airtight dressing, connected to a suction device, is placed over the wound. The pump continuously draws exudates out of the wound, creating negative pressure across the wound. This form of therapy promotes angiogenesis, helping to increase blood flow to the wound site, and enhances cellular proliferation and migration within the wound. In this therapy, the wound remains moist, which improves and accelerates the healing process.

• Ultrasound Therapy (Ultrasonotherapy): This treatment utilizes ultrasonic waves, which are high-frequency mechanical vibrations (beyond 20,000 Hz) that are imperceptible to the human ear. It involves covering the wound area with a hydrogel film and emitting ultrasound, which warms the tissues promoting blood circulation and encourages tissue regeneration.

• Skin grafts: In this procedure, skin is taken from another part of your body, usually your thigh, and transplanted onto the wound, increasing the chances for chronic wounds to close more quickly. There are also grafts made from human cellular products and synthetic materials.

• Adjuvant Therapy: available in gel form or impregnated on dressings, growth factors are important for wound healing. This includes platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), keratinocyte growth factor (KGF), epidermal growth factor (EGF), and granulocyte-macrophage colony-stimulating factor (GM-CSF).