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PHC117 White R (2008) Delayed wound healing: in whom, what when and why? Primary Health Care. 18, 2, 40-46. Date of acceptance: 18 February 2008.
Summary
For a variety of reasons, some wounds take longer than anticipated to heal, or do not heal at all. Delayed or impaired healing may occur with wounds such as leg ulcers, but can also sometimes be seen with acute traumatic wounds such as pre-tibial lacerations. This article, using leg ulcers as an example of 'chronic' wounds, provides a guide to delayed healing and how it can be anticipated, avoided and managed.
Keywords
Chronic wound; Ulcer; Delayed healing
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Aims and intended learning objectives
The aim of this article is to introduce and define the concept of delayed wound healing, with a focus on venous leg ulceration and to describe the causes of delayed healing and interventions to overcome it. After reading this article, you should be able to:
* understand what healing rates might be expected with standard treatment.
* relate delayed or prolonged healing to treatment, medical, biological, psychological and lifestyle causes.
* be aware of guidelines available to aid prediction of wound chronicity.
* appreciate the evidence in support of interventions to overcome delayed healing.
Introduction
Many wounds that heal by secondary intent, such as leg ulcers and pressure ulcers, have historically been referred to as 'chronic', but a wound is not always inherently 'chronic' simply because of its aetiology (Harding 2000). This label is applied to wounds in which compromised healing is anticipated, usually because of complex underlying pathologies such as diabetes (King 2001), vascular disease (Grey et al 2006), malignancy (Izadi and Ganchi 2005), malnutrition (Graue et al 2008) or morbid obesity (Fife et al 2008). The published literature contains many references to such wounds, referring to them as 'stunned' (Ennis and Meneses 2000), recalcitrant (Thomson 2000) or 'difficult to manage' (Ballard and Baxter 2000). Consideration must be given to the diagnosis, and to what degree or rate of healing is anticipated, if any, before any judgement...