Delayed wound healing

The required time for the complete healing of chronic wounds (leg ulcers, pressure ulcers, diabetic foot ulcers) remains extremely variable according to various clinical studies.

Nevertheless, it was observed that for certain wounds, this time may be abnormally prolonged and despite of an aetiological appropriate wound management. In some chronic wounds, complete healing can never be achieved.

Factors which can " delay wound healing " have a negative effect on the evolution of the wound healing process and can lead to the risk of infection.. They can also be responsible for the deterioration of patient's quality of life and cause huge expenditure for the healthcare community.

A certain number of local and general factors have now been identified, which allow an understanding of which type of wounds may present with a risk of delayed healing and which patients present with unfavourable conditions which can also delay the healing process.

Risk factors of delayed healing have been shown to have a negative influence on the wound healing process potentially resulting in a poor outcome. These factors can be modified to varying degrees and can be defined in two categories:

  • Wound-related risk factors: Wound surface area, depth, location, duration of the wound, recurrence, appearance of the wound bed (fibrin content > 50%, necrosed tissue content, presence of calcification), medical history (venous disease, DVT, varicose vein surgery, phlebitis, thrombosis, tissue hypoxia, arterial disorders (ABPI < 0.8), previous local treatments: lack of compression, inability to weight-bear, poor healing rate at 3-4 weeks.
  • Patient-related risk factors: concomitant conditions (hip or knee surgery, poor joint mobility, ankylosis, difficulty walking, oedema of the lower limbs, etc.), general condition of the patient (Peripheral Arterial Occlusive Disease (PAOD), poor nutrition (obesity / malnutrition), sedentary lifestyle, poor hygiene, diabetes, immunodeficiency, etc.), age, sex.

And there are maybe other factors, such as infection, non-concordance with previous treatment, depression.