What causes non healing sores and how are they treated?

According to one study of Medicare data, chronic non-healing wounds and related complications affect nearly 15% of Medicare beneficiaries. Non-healing wounds, also known as chronic ulcers, can be a sign of a deeper health issue and require specialized medical attention to address the underlying causes.

Quick Summary

Several underlying factors can prevent wounds from healing, including poor blood circulation, infections, and chronic diseases like diabetes and vascular conditions. A non-healing wound may also be the result of a weakened immune system, persistent pressure, or inadequate nutrition, all of which hinder the body's natural repair process.

Key Points

• Common Causes: The main culprits behind non-healing sores include poor circulation, uncontrolled diabetes, infection, constant pressure, a weakened immune system, and poor nutrition.

• Underlying Health Issues: Chronic wounds often signal a deeper, underlying health problem that needs to be addressed, such as peripheral artery disease or chronic venous insufficiency.

• Advanced Treatments: Specialized care, including debridement, negative pressure wound therapy, hyperbaric oxygen therapy, and bio-engineered skin grafts, can help persistent wounds heal.

• Seek Medical Help: If a wound doesn't improve within four weeks or shows signs of infection like increased redness, swelling, or odor, it’s critical to see a doctor or wound care specialist.

• Serious Complications: Ignoring a non-healing wound can lead to severe health problems, including sepsis, gangrene, bone infection, and amputation.

• Types of Wounds: Different types of chronic ulcers—like venous, arterial, diabetic, and pressure ulcers—each have distinct causes and require specific treatment approaches.

The complex process of wound healing

Under normal circumstances, the body’s healing process is a dynamic and complex series of four stages: hemostasis, inflammation, proliferation, and maturation. Each stage has a specific role, from stopping blood flow and clearing debris to rebuilding tissue and strengthening the skin. When this intricate process is interrupted, a wound can stall in the inflammatory phase and become a chronic or non-healing sore. A wound is typically classified as non-healing if it fails to show significant improvement within four weeks or fully heal within eight weeks.

The primary culprits behind non-healing sores

Several systemic and local factors can interfere with the body's ability to heal:

• Poor circulation: Inadequate blood flow is one of the most common reasons for chronic wounds. Blood delivers the oxygen, nutrients, and immune cells needed for repair. Conditions like peripheral artery disease (PAD) and chronic venous insufficiency can significantly reduce blood flow, especially to the legs and feet, starving the wound of what it needs to heal.
• Infection: An infection introduces bacteria that compete with the healing process, causing a prolonged inflammatory response. If the body is busy fighting bacteria, it can’t focus on rebuilding tissue. Chronic wounds can harbor biofilms—complex bacterial communities—that are resistant to traditional antibiotics and further impede healing.
• Diabetes: High blood sugar levels characteristic of uncontrolled diabetes damage blood vessels and nerves (neuropathy), particularly in the feet. This leads to poor circulation and a diminished immune response, making a person with diabetes more susceptible to non-healing foot ulcers.
• Pressure or trauma: Consistent, unrelieved pressure on a specific area of the body can lead to a pressure ulcer (bedsores), a common issue for individuals with limited mobility. Repetitive trauma or friction can also constantly disrupt the fragile new tissue and prevent a wound from closing.
• Compromised immune system: Autoimmune diseases, certain medications (like corticosteroids or chemotherapy drugs), and other conditions that suppress the immune system hinder the body's ability to fight infection and manage inflammation, which is critical for healing.
• Nutritional deficiencies: Healing is a calorie-intensive process that requires sufficient protein, vitamins (especially A and C), and minerals (like zinc). Malnutrition or inadequate nutrition deprives the body of the building blocks needed to repair tissue, weakening the immune response.

Comparison of common chronic wounds

Type of Ulcer	Primary Cause	Typical Location	Appearance and Characteristics
Venous Ulcer	Poor venous blood flow due to weakened leg veins.	Usually around the ankles or lower legs.	Irregular, shallow, and weepy, with reddish-brown skin discoloration and surrounding edema.
Arterial Ulcer	Blocked or narrowed arteries, leading to poor blood supply.	Often on feet, toes, and heels, especially in bony areas.	Has a “punched out” appearance, can be red, yellow, or black, with minimal bleeding and cool skin.
Diabetic Foot Ulcer	Nerve damage (neuropathy) and poor circulation from uncontrolled diabetes.	Bottom of the feet or on pressure points.	Can be painless due to neuropathy; may be surrounded by hardened skin (callus); often deep and prone to infection.
Pressure Ulcer	Prolonged, uninterrupted pressure on the skin.	Heels, hips, coccyx, or other bony prominences.	Can range from a red patch of skin to a deep, open wound involving bone and muscle.

Advanced treatments for persistent wounds

If a sore is not healing, a specialized wound care provider may recommend advanced therapies beyond basic cleansing and dressings. These treatments help remove barriers to healing and stimulate tissue repair:

1. Debridement: This is the process of removing dead, damaged, or infected tissue from the wound to promote new tissue growth. It can be done surgically, mechanically (with dressings), or with special enzymes.
2. Negative Pressure Wound Therapy (NPWT): Often referred to as a “wound vac,” this therapy uses a vacuum to create a negative pressure environment over the wound. This helps draw out excess fluid, reduce swelling, and stimulate blood flow to the area.
3. Hyperbaric Oxygen Therapy (HBOT): The patient breathes pure oxygen in a pressurized chamber, which increases the amount of oxygen in the blood. This oxygen-rich blood is delivered to the wound, helping to kill bacteria and accelerate the growth of new tissue.
4. Bio-engineered Skin Grafts and Substitutes: For severe or extensive wounds, materials like bio-engineered skin or collagen matrices can be applied to aid in closing the wound and promoting natural healing.
5. Compression Therapy: Used primarily for venous ulcers, compression bandages or stockings improve blood flow and reduce swelling in the legs, helping the wound heal more effectively.

Why ignoring a non-healing sore is dangerous

A persistent, non-healing sore is more than just a nuisance; it is a sign that something is wrong. Ignoring the problem can lead to serious and life-threatening complications:

• Worsening Infection: An untreated wound provides an entry point for bacteria, which can spread from a localized infection to the bloodstream, causing sepsis.
• Tissue Necrosis and Gangrene: Poor circulation can lead to tissue death (necrosis). If left untreated, this can progress to gangrene, which may require amputation of the affected limb.
• Bone Infection (Osteomyelitis): An infection can spread from a deep wound into the underlying bone, a painful condition that is difficult to treat and can also necessitate amputation.
• Increased Morbidity and Reduced Quality of Life: Chronic wounds can cause persistent pain, limit mobility, and significantly impact a person's mental and emotional well-being, leading to a reduced quality of life.

When to see a specialist

If a wound does not show signs of healing within a month or exhibits any symptoms of infection, it is crucial to seek professional medical advice. A wound care specialist can provide a comprehensive evaluation and create a targeted treatment plan to address the root cause of the non-healing sore. For individuals with chronic conditions like diabetes or poor circulation, it is especially important to monitor wounds closely and seek immediate care when problems arise to prevent serious complications.

Conclusion

Understanding what causes non healing sores is the first step toward effective treatment. From underlying conditions like diabetes and vascular disease to issues like infection and poor nutrition, many factors can stall the healing process. Modern wound care provides a range of advanced therapies and treatments to address these barriers, but early intervention is key to avoiding potentially severe complications. For more information on the stages of wound healing, visit MedlinePlus Medical Encyclopedia.

Frequently Asked Questions

What is considered a non-healing wound?

A wound is generally considered non-healing or chronic if it fails to show significant signs of improvement within four weeks, or if it doesn't fully heal within eight weeks. Chronic wounds typically stall in the inflammatory phase of the healing process.

Can diabetes cause wounds that won't heal?

Yes, diabetes is a major cause of non-healing wounds, particularly foot ulcers. High blood sugar damages blood vessels and nerves, leading to poor circulation and reduced sensation, which allows injuries to go unnoticed and hinders the healing process.

How does poor circulation affect wound healing?

Poor circulation restricts the flow of oxygen, nutrients, and immune cells to the wound site, all of which are essential for tissue repair. Without adequate blood flow, the wound cannot progress through the normal stages of healing and becomes stuck.

Are all non-healing sores infected?

Not all non-healing sores are infected, but infection is a very common contributing factor. Bacterial contamination can prolong inflammation and prevent the wound from healing, and chronic wounds can develop difficult-to-treat bacterial biofilms.

What is the role of debridement in wound care?

Debridement is the medical procedure of removing dead, damaged, or infected tissue from a wound. This is a crucial step in treating chronic wounds, as necrotic tissue provides a breeding ground for bacteria and prevents healthy tissue from growing.

Can malnutrition cause non-healing sores?

Yes, malnutrition, especially a lack of protein, vitamins A and C, and zinc, can severely impact the body's healing ability. Repairing tissue is a calorie and nutrient-intensive process that requires proper nutritional support.

When should I see a wound care specialist?

You should see a wound care specialist if a wound has not started to heal after four weeks, if it shows signs of infection (fever, increased pain, pus), or if you have an underlying condition like diabetes or vascular disease. Early intervention can prevent serious complications.