Most cuts and scrapes heal with basic care and time. However, some wounds linger. Weeks pass and the area still looks red, swollen or open. For many patients, this can be confusing and concerning.

When a wound does not heal within about two to three weeks, or stops showing signs of improvement, it may be considered a chronic wound. These wounds often require specialized care because an underlying health issue may be preventing the body from healing properly.

“My goal as a wound care specialist is to accelerate healing, prevent complications and help patients avoid hospitalization or amputation when it comes to their wounds,” said Ricko Rask, MSN, a provider with CU Medicine. 

Rask leads the wound care clinic located within CU Medicine Plastic and Reconstructive Surgery – Highlands Ranch Specialty Care Center. The clinic provides services such as comprehensive wound assessments, wound debridement and advanced wound dressings.

According to Rask, not all wounds are the same. The underlying cause of a wound often determines how it should be treated. Identifying the type of wound is an important first step in helping patients heal and preventing more serious complications. 

Diabetic Ulcers: When Blood Sugar Affects Healing

People with diabetes are at higher risk for wounds that heal slowly, especially on the feet. High blood sugar can damage blood vessels and reduce circulation, limiting the oxygen and nutrients needed for healing. Diabetes can also cause nerve damage, known as neuropathy, which reduces feeling in the feet. As a result, patients may not notice a blister, cut or sore until it becomes more serious.

Diabetic ulcers most often develop on the bottom of the feet where pressure from standing and walking is greatest. “Even a small wound can worsen quickly if it is not treated early,” shared Rask.

Common diabetic ulcer symptoms include:

• An open sore or wound on the foot
• Redness or swelling around the area
• Drainage on socks or shoes
• Skin discoloration or thickened skin around the wound
• Loss of sensation in the feet

Wound treatments for diabetic foot ulcers include:

• Cleaning and dressing the wound
• Removing damaged tissue to promote healing
• Reducing pressure on the foot with special footwear or devices
• Managing blood sugar levels
• Antibiotics if infection is present

Pressure Wounds: Skin Breakdown from Constant Pressure

Pressure wounds, sometimes called bedsores, develop when constant pressure reduces blood flow to the skin. Without adequate blood flow, the skin and underlying tissues can begin to break down. These injuries are most common in people who spend long periods in bed or in a wheelchair and have limited ability to change positions.

“Pressure can cut off blood flow to the skin and underlying tissue. Without adequate blood supply, tissues cannot receive the oxygen and nutrients necessary for healing,” said Rask.

Pressure wounds often appear in the following areas:

• Heels
• Tailbone
• Hips
• Ankles
• Elbows

Treatment for pressure wounds may include:

• Relieving pressure by repositioning frequently
• Using special mattresses, cushions or padding
• Cleaning and dressing the wound
• Removing damaged tissue to support healing
• Treating infection if it develops

Venous vs. Arterial Ulcers: When Circulation is the Problem

Wounds can fail to heal when blood flow to the affected area is reduced. Two common types caused by circulation problems are venous ulcers and arterial ulcers.

“Treatment for venous and arterial ulcers differs greatly, so proper diagnosis is critical in our approach to care,” said Rask.

Venous Ulcers

Venous ulcers develop when blood has trouble returning from the legs to the heart. This can cause fluid buildup, swelling and changes in skin color. These wounds often appear near the ankles and may heal slowly without proper treatment.

Common symptoms of venous ulcers include:

• Swelling in the lower legs or ankles
• Red, brown or darkened skin around the wound
• Aching or heaviness in the legs
• Shallow, open sores near the ankle

Treatment for venous ulcers may include:

• Compression therapy, such as bandages or stockings
• Elevating the legs to reduce swelling
• Cleaning and dressing the wound
• Removing damaged tissue if necessary

Arterial Ulcers

Arterial ulcers form when blood flow to the extremities is reduced, often due to narrowed arteries. These wounds are usually painful and commonly appear on the toes or feet. They may require a vascular evaluation before wound care treatment can succeed.

Common symptoms of arterial ulcers include:

• Pain, especially when walking or elevating the foot
• Pale skin around the wound
• Deep sores with well-defined edges
• Slow-healing wounds that may become infected

Treatment for arterial ulcers may include:

• Improving blood flow through vascular procedures or lifestyle management
• Cleaning and dressing the wound
• Protecting the area from further injury
• Managing underlying conditions such as diabetes or peripheral arterial disease

Why Some Wounds Do Not Heal

Even with proper care, some wounds fail to improve. Several factors can prevent healing and make wounds chronic. Understanding these reasons can help patients and caregivers take steps to support recovery.

Common reasons wounds don’t heal are:

• Poor circulation, which limits oxygen and nutrients needed for tissue repair
• Infection that damages tissue and slows healing
• Repeated pressure or trauma to the wound area
• Uncontrolled diabetes that affects circulation and immune function
• Poor nutrition, including insufficient protein, vitamins or minerals
• Smoking, which reduces blood flow and interferes with the body’s healing process

Rask shared, “Early intervention often dramatically improves healing outcomes and reduces the risk of serious complications.”

Healing Wounds is Possible with the Right Care

Chronic wounds can be challenging, but with the right care, healing is possible.

“Each wound is unique, and treatment plans are tailored to the patient’s specific needs and underlying health conditions,” said Rask. “Also, advanced treatments are now available, including specialized dressings, biologic therapies, negative pressure wound therapy and regenerative technologies that can significantly accelerate healing.”

If you or a loved one has a wound that is not healing, contact the wound care clinic at CU Medicine Plastic and Reconstructive Surgery – Highlands Ranch Specialty Care Center by calling (720) 516-4085.