Chronic wounds are those that do not heal or show improvement in four weeks or more. The most common chronic wounds are:

• Venous leg ulcers
• Arterial insufficiency ulcers
• Diabetic foot ulcers
• Pressure ulcers (bed sores)
• Traumatic injuries
• Post-surgical wounds
• Burns
• Spider bites

---

Signs & Symptoms

The signs and symptoms of chronic wounds depend on the type of wound:

• Diabetic ulcers – Diabetic ulcers often develop on the bottom of the feet. They are painful and may make walking difficult. Those with diabetic ulcers may have discoloration in their feet, which can appear black, blue, or red, and they can also display signs of infection, such as fever and swelling.
• Venous ulcers – These types of ulcers are irregularly shaped and fairly superficial. The first sign is an area of skin that darkens and thickens; this is where the blood is pooling. The skin will usually appear shiny and smooth and feel dry and itchy. Venous ulcers can also cause swelling and pain.
• Arterial ulcers – Arterial ulcers, which commonly develop between the toes or on the ankle, have well-defined edges and are exceptionally deep – sometimes down to the tendon. They appear raised and shiny and are cool to the touch. These types of ulcers can be very painful, particularly after exercising and while at rest.
• Pressure ulcers – These ulcers may appear red and warm to the touch at first, later progressing to a discolored, open sore. Pressure ulcers, also called bed sores, are painful and if not treated the wound may become deeper.

---

Diagnosis

The wound care team at the James Klinghoffer Center at Deborah Heart and Lung Center provides wound evaluations, treatment, and caregiver education. Diagnostic testing and a variety of treatments are available.

Some of the standard therapies for chronic wounds include:

• Debridement
• Advanced dressings
• Compression therapy
• Nutritional support

Advanced therapies include:

• Hyperbaric Oxygen Therapy (HBOT)
• Negative Pressure Wound Therapy
• Bioengineered skin substitutes
• Arterial and venous pumps
• Angioplasty and stenting
• Wound matrix and collagen dressings
• Growth factors
• Ultrasonic debridement
• Total contact casting
• Skin grafting