Reasons for Nonhealing Wounds

For patient wounds that do not have the ability to heal, the approach is different. These individuals with the inability to heal (nonhealing wound) may be due to inadequate blood supply and/or the inability to treat the cause or wound-exacerbating factors that cannot be corrected. There may be systemic disease, nutritional impairments or medications that delay or inhibit healing.

When a healable wound does not progress at the expected rate, a chronic and stalled wound results.

These wounds are more prevalent in older adults and are attributed to the aged skin and comorbidities, such as neuropathy, coexisting arterial compromise, edema, unrelieved pressure, inadequate protein intake, coexisting malignancy, and some medications.

Persistent inflammation may be the cause of a stalled wound and in some cases may not be correctable. The presence of multiple illnesses in some older adult patients implies that healing is not a realistic end point.

The second category, a maintenance wound, is when the patient refuses the treatment of the cause (eg, will not wear compression) or a health system error or barrier (no plantar pressure redistribution is provided in the form of footwear, or the patient cannot afford the device). These may change, and periodic re-evaluation may be indicated.

Expected Healing Time for Wounds

Chronic wounds are often recalcitrant to healing, and they may not follow the expected pathway that estimates a wound should be 30% smaller (surface area) at week 4 to heal in 12 weeks.

Impact of Nonhealing Wounds

Chronic, nonhealing wounds are disabling and constitute a significant burden on patients’ activities of daily living (ADLS) and the healthcare system. Of persons with diabetes, 2% to 3% develop a foot ulcer annually, whereas the lifetime risk of a person with diabetes developing a foot ulcer is as high as 25%.

It is estimated that venous leg ulcers affect 1% of the adult population and 3.6% of people older than 65 years. As our society continues to age, the problem of pressure ulcers is growing. Each of these common types of chronic wounds will require accurate and concise diagnosis and appropriate treatment.

Chronic Wounds: Medical Legal Assumptions

In the medical legal world, there may be an assumption that most if not all wounds can be healed with proper care. In the medical world, what percentage of wounds are considered nonhealing? In a study of 173 wounds, 70% were considered healable, 25% were considered maintenance, and 5% were considered nonhealing including skin changes at life’s end.

Dr. Diane Krasner

Modified with permission from Dr. Diane Krasner, coauthor of Special Considerations in Wound Bed Preparation 2011, an Update, Advances in Skin and Wound Care, September 2011

Get in on the shifting thinking about pressure sores by learning from one of the experts in the field. Dr. Krasner explores these and other controversies in an all new multimedia course. Get the on-demand recordings for Pressure Sore Case Analysis and Reports here.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.