Assessment and management of chronic wounds

The prevalence of chronic wounds is rising, partly due to the increase of longevity in the population but also they can occur in younger people also. Chronic wounds are more prevalent in adults over 65 years, and have a significant burden on both the NHS and the patient. A recent study extrapolated that there are 2.2 million people with wounds in the UK with an overall cost of £5.3 billion of which £3.2 billion was spend on chronic wounds.¹

Chronic wounds are described as those that fail to heal within a predicted timeframe, they are also known as hard-to-heal, non-healing, recalcitrant, challenging or complex wounds.² It is thought that during the process of normal healing, there is a balance of healthy proteins and enzymes in the wound that promote healing.

Any disruption in this balance can lead to the development of a chronic wound.³ In addition, any intrinsic factors, such as age or comorbidities, or extrinsic factors, such as lifestyle, smoking, excessive alcohol or medication, can affect the chemical balance in the wound bed, leading to a prolonged inflammatory response, a defective extracellular matrix (ECM) and a failure to re-epithelialise. One study suggests that chronic wounds are more complex than acute wounds, due to this prolonged inflammatory response and therefore are more difficult to heal and last many months or years.⁴ Another suggests that a wound that has not exhibited any signs of progression within first 2–3 weeks could be demonstrating chronicity.⁵