A non-healing wound, also called a chronic wound, is a break in the skin or underlying tissue that fails to successfully progress through the normal stages of wound healing within the typical timeframe—usually about four to six weeks. Unlike acute wounds, which heal predictably, a chronic skin wound gets “stuck” in one of the stages, preventing the complete closure and restoration of the tissue.
While non-healing wounds can get stuck in any stage, the inflammatory phase of the healing process is the most common time when the factors that contribute to slow healing set in. In this phase, immune cells like neutrophils and macrophages migrate to the wound site to eliminate bacteria, foreign particles, and damaged tissue. When healing slows, bacterial infection can set in—hindering blood flow and damaging all the healthy cells involved.
What makes non-healing wounds different from normal skin wounds?
To be considered a non-healing wound, the skin injury must stay in a single healing stage for at least four weeks. The slower wound healing progresses, the more uncomfortable symptoms set in, like increased pain, swelling, and redness.
Non-healing wounds are also a more significant medical concern than an everyday open wound because they can lead to serious complications like infection, including cellulitis and osteomyelitis (bone infection), and even amputation in severe cases. Without proper wound care, these injuries become excessively painful, odorous, and can even reduce patients’ mobility. That’s what makes diagnosing non-healing wounds—and treating them as quickly as possible—such a crucial goal for wound care specialists.
These factors contribute to slow-healing wounds
The majority of everyday skin injuries, surgical wounds, and burns heal successfully on their own, or with minimal medical intervention (like stitches, wound wraps, or dressings).
When a wound fails to heal, often, one of two factors is to blame: An underlying medical condition that limits the body’s natural healing process, or the presence of an infection that blocks healthy tissue repair.
Within each category, there are a range of triggers that contribute to slow- or non-healing wounds.
Underlying medical conditions, like:
Diabetes Mellitus
In patients with diabetes, high blood sugar levels throw off the body’s ability to quickly fight off bacteria, clean up the wound site, and transport a consistent oxygen- and nutrient-rich blood supply to the injury. Diabetic neuropathy, a nerve condition that leads to numbness, especially in the feet, also raises the risk of slowed healing.
Venous insufficiency
Venous insufficiency impacts the body’s ability to move blood away from the legs. As blood and excess fluid builds up in the lower extremities, the increased pressure and swelling makes it harder for oxygen and nutrients to reach cells—and waste products aren’t removed efficiently.
Venous insufficiency can also lead to the development of venous leg ulcers, which are a common type of non-healing wound. The environment is less than ideal for healing, making the process slow and challenging, even for otherwise healthy patients.
Peripheral Arterial Disease (PAD)
PAD, when the arteries become narrow or blocked due to plaque buildup, hinders blood circulation to the extremities. Without sufficient blood supply, wounds in the legs and feet don’t get the oxygen and nutrients they need to heal properly, which delays healing. Additionally, the lack of oxygen (ischemia) can lead to tissue damage or even dead tissue, making the skin wound worse.
Chronic inflammatory conditions, like Rheumatoid Arthritis
Chronic inflammatory conditions add another layer of complexity. In rheumatoid arthritis, for example, the immune system mistakenly attacks the body’s own tissues, causing ongoing inflammation.
This persistent state of alertness diverts the body’s resources away from healing wounds, extending the inflammatory process, which is supposed to be a short-term response to injury. This can disrupt the normal progression of wound healing, which relies on inflammation subsiding after its initial role is complete.
Adding to the delay, the medications used to manage these conditions, like steroids or immunosuppressants, can further impair healing. While they reduce harmful inflammation, they also suppress the immune system’s ability to respond to new threats, like bacteria entering a wound.
Malnutrition
Nutrition is the foundation of healthy healing. Every body needs adequate proteins, vitamins like vitamin C and zinc, and minerals to repair tissues and fight infections. In individuals with less than adequate nutrition, healing can be significantly impacted—or stunted altogether.
Age
As the body ages, cell replication slows down, so replacing damaged cells takes more time. Collagen production also decreases, which causes weaker skin tissue repairs and slower recovery. Plus, because older skin is thinner and less elastic, minor wounds can become major injuries as the body struggles to close the break.
Infection and biofilm further complicate healing
The underlying factors above disrupt the body’s natural healing process from within. But infection and bacteria are external threats that also delay wound healing—even if underlying conditions aren’t present.
How do bacterial infection and biofilm cause chronic wounds?
During the inflammatory stage of wound healing—the most commonly disrupted phase of the wound healing process—white blood cells work overtime to cleanse the wound site, remove dead tissue, and stimulate wound healing.
In this phase, when bacteria enter the wound, they can establish an infection by multiplying within the tissue. Usually, the body is able to eradicate the infection itself through antibodies. But when that process is disrupted or insufficient, over time, these bacteria can organize into a biofilm—a structured community of bacteria encased in a self-produced protective matrix composed of substances like proteins, sugars, and DNA.
Biofilm is resistant, evasive, and tough to eradicate
The biofilm’s matrix of proteins and organic substances acts as a physical barrier that prevents antibiotic treatment methods from penetrating and reaching the source of the infection. Plus, the microorganisms that cause biofilm-protected bacterial infection can share genetic material, including the genes that develop antibiotic resistance, which makes them collectively more resistant to treatment.
This evasion mechanism allows bacteria to thrive in slow-healing wounds, shielded from the body’s immune system and protected from many wound care methods.
How should healthcare professionals manage non-healing wounds—and restart the healing process?
Effective wound care and management techniques—like Negative Pressure Wound Therapy (NPWT), skin grafting, hyperbaric oxygen therapy, and cleansing the wound with solutions like Dakin’s—can significantly enhance the healing process for various types of skin wounds, reducing the risk of complications. These methods reduce the bacterial infection load on the wound, stimulate blood circulation, and help wounds heal faster.
While many advanced wound care methods require specialized equipment and careful professional supervision, cleansing acute and surgical wounds with Dakin’s Solution is an approach that can be used in tandem with other in-clinic and at-home approaches.
Dakin’s wound cleansers kill a broad spectrum of bacteria, including those that have developed biofilm or antibiotic resistance. Each formulation can be used for wound debridement to break down and remove dead tissue, or as the cleansing agent in wound dressings. Dakin’s tough-on-bacteria but gentle-on-skin cleansers can also reduce the odor associated with infected wounds.
Looking for Dakin’s Solution? Here’s where to find it.
You can order Dakin’s Solution in any strength directly through our website, or purchase single bottles through Medical Monks. You can also get Dakin’s at most major pharmacies—just ask the pharmacist to put in an order for you.
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