A chronic wound is one that, despite correct local and causal treatment, shows no tendency to heal after 8 weeks of treatment. Chronic wounds can develop at any time from an acute wound, because of an undetected persisting infection, or inadequate primary management. In the majority of cases however, chronic wounds represent the final stage of progressive tissue destruction, produced by venous, arterial or metabolic vascular disorders, pressure injuries, radiation damage or tumours.
Although the appearance of ulcers is varied, the underlying pathophysiological mechanisms are very similar. All underlying vessel damage results in disorders of nutrition of skin tissue with increasing hypoxia and ischaemia, resulting in cell death. This creates a very poor basis for healing.
In the case of chronic wounds, healing can only occur when the cycle of persisting inflammation is interrupted. This requires: • normalisation of blood supply and micro-circulation to the affected area of skin • thorough cleansing of the woundbed.
