Chapter 40: Failure of Wounds to Heal

Description of the Symptom

This chapter describes pathology that may lead to wounds that fail to heal. Chronic wounds are defined as wounds that "fail to progress through a normal, orderly, and timely sequence of repair or wounds that pass through the repair process without restoring anatomic and functional results."¹ Without adequate treatment of the wound etiology and comorbidities, the composition of the wound tissue and fluid (called chronic wound fluid) will develop certain properties that inhibit healing. The length of time a wound exists is less important in determining if it is chronic than are the characteristics of the wound tissue.

Special Concerns

• Sinus, undermining, or fistula formation

• Bone involvement that may lead to osteomyelitis

• Friable granulation tissue

• Contractures

• Deformities of adjacent joints

• Malignant changes

• Systemic amyloidosis

• Calcification²

• Failure to respond to standard care

Overview of Wounds That Fail to Heal

A chronic wound can have any of the following characteristics:

• Necrotic and unhealthy tissue

• Impaired hemodynamics (for example, hypoxia, ischemia, or edema)

• Collagen degradation resulting in unhealthy extracellular matrix

• Rolled edges without epithelial migration as a result of senescent fibroblasts and keratinocytes that are unresponsive to normal facilitating factors

• Overgrowth of epithelium due to the lack of underlying connective tissue

• Recurrent wound deterioration as a result ...