Chronic wounds are managed by treating the underlying cause, assessing the wound regularly, and caring for the wound bed using a framework called TIME: Tissue, Infection or inflammation, Moisture and Edge. Because these wounds have stopped healing on a normal timeline, care usually involves a team and a plan that changes as the wound does.
This article covers how chronic wounds are managed. If you are trying to work out whether a wound is becoming chronic, start with What Makes a Wound Chronic? How to Spot the Signs Early.
Why does the underlying cause come first?
A chronic wound usually has a reason for stalling, and the wound will rarely improve until that reason is addressed. Venous ulcers, arterial ulcers, diabetic foot ulcers and pressure injuries are the most common types.
Typical underlying problems include poor circulation, diabetes, immobility and a weakened immune system. Infection, poor nutrition or unsuitable wound care can make things worse. Depending on the cause, management may include controlling blood sugar, improving venous return with compression, or relieving pressure.
What does a wound assessment include?
A thorough assessment guides every decision about care. Providers typically record:
- Size and depth, measured over time to track progress
- The wound bed: how much healthy tissue, dead tissue or slough is present
- Signs of infection and the amount and type of drainage
- Location and duration of the wound
- The person's overall health, including circulation, blood sugar, nutrition and medications
Chronic wounds change, so assessment is repeated regularly and the plan adjusted. A wound that becomes infected, for example, may need antibiotics or different dressings. To see what this looks like in practice, read What to Expect at a Wound Care Clinic Visit.
What is the TIME principle?
TIME is a widely used framework that breaks wound bed care into four areas. Clinicians work through each one at every review.
- Tissue management: removing dead or devitalized tissue (debridement). Methods include surgical, autolytic (the body's own enzymes, supported by moist dressings), enzymatic and biologic debridement, chosen according to the wound.
- Infection or inflammation control: chronic wounds often harbor bacteria, sometimes as a biofilm. Care may involve cleansing, topical treatments or systemic antibiotics when prescribed, and techniques to disrupt biofilm.
- Moisture balance: wounds that are too dry or too wet both heal poorly. Dressings are chosen to add moisture to a dry wound or absorb excess drainage from a wet one.
- Edge of the wound: healthy edges should advance inward. Edges that are rolled, undermined or not moving suggest the plan needs review.
How does care differ by wound type?
Each type of chronic wound has its own priorities:
- Venous ulcers: usually managed with compression therapy, leg elevation and exercise to improve blood return from the legs, as advised by a clinician. See Venous Ulcers: What They Are and How to Care for Them at Home.
- Diabetic foot ulcers: need careful wound care, blood sugar management, offloading pressure from the foot, and regular foot checks.
- Pressure injuries: rely on regular repositioning, pressure-relieving surfaces, managing moisture and infection, and good nutrition.
- Arterial ulcers: depend on assessing and, where possible, improving blood supply. Compression may be unsafe, so a vascular assessment comes first.
What role do nutrition and lifestyle play?
Healing tissue needs building blocks. A diet with enough protein, vitamins A and C, and minerals such as zinc supports repair, and a dietitian can help when appetite or weight is a concern.
Stopping smoking, keeping blood sugar in range if you have diabetes, and staying as active as your provider advises all make a real difference.
What advanced treatments are available?
When standard care is not enough, specialists may consider negative pressure wound therapy, skin substitutes or growth factor therapies. Research into cell-based and other new therapies continues.
Who is on the care team?
Chronic wound care usually involves physicians, nurses, dietitians and physical therapists, and sometimes vascular surgeons, podiatrists or endocrinologists. The patient is part of the team too: understanding the plan and following it between visits is essential.
How Lavior's Multipurpose Wound Gel fits in
For the moisture part of TIME, a hydrogel can help. Lavior™ Multipurpose Wound Gel helps maintain a moist wound environment when used for the indications described on its label. Follow the product instructions and your healthcare professional's wound care plan. Like every Lavior formula, it is built around Inula AGS-RIED, Lavior's proprietary extract of the Mediterranean plant Inula viscosa. For chronic wounds, use it only as part of a plan agreed with your healthcare provider.
Sources
- Schultz GS, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(Suppl 1):S1–S28. doi:10.1046/j.1524-475X.11.s2.1.x
- Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560–582. doi:10.1089/wound.2015.0635
- Nussbaum SR, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21(1):27–32. doi:10.1016/j.jval.2017.07.007
