Wound Management

Management of chronic wounds

Recognise the early signs of chronic wounds and discover the benefits of hydrotherapy during the healing process

One of the consequences of increasing life expectancies in the population is the distinctive increase in chronic diseases, which also include chronic wounds.
A nurse is treating the wound of a woman’s foot

A wound is considered to be chronic if there is little or no sign of healing, despite appropriate therapy, within an acceptable timeframe. These wounds are not usually caused by external forces, like abrasions or burns, but are more likely to relate to underlying disorders and negative influences. These culminate in the development of tissue damage as a result of disturbed metabolism. These disturbances can delay or completely prevent the normal wound healing process.

The most frequent types of chronic wounds are: pressure sores (decubital ulcers/bed sores), lower leg sores (also called ulcerated legs/leg ulcers and Ulcus cruris) and the diabetic foot syndrome.

The earlier a chronic wound is diagnosed, the better the chances of healing. Therefore it is important that the person affected interprets the initial signs correctly and obtains medical assistance at an early stage.

What early signs may be observed in individuals with such wounds?

What early signs may be observed in individuals with such wounds?

Pressure sores
Prevention requires continuous monitoring of the skin condition and immediate and appropriate reaction to change. Signs of skin damage may be discolouration and hardening (induration), increased local temperature and discomfort. Blistering may also be observed.

A number of diverse factors can be linked to the development of pressure ulcers including: advanced age, immobility, incontinence, disturbances in sensation, obesity or malnutrition and underlying disorders affecting blood circulation and cell metabolism.

Ulcers of the lower leg
Chronic wounds frequently occur on the lower leg, around the ankle (malleolar region) although they can – depending on their cause -- occur at any location on the lower extremity.

Weaknesses in the venous circulation of the legs may cause congestion or complete stasis of blood flow. This, in turn, can lead to tissue damage and subsequent ulceration. Venous ulceration doesn’t happen overnight. The following are just a few of the signs of disturbances in venous circulation that may be observed in affected individuals as the disorder develops: swelling (edema) of tissues, hyper- and/or hypopigmentation of the skin, stasis eczema, and a subjective sensation of pressure or blockage in the leg (especially toward the evening).

A surgical team is operating a chronical wound

Diabetic foot syndrome 

 Diabetic foot syndrome occurs as a result of long-term damage to blood circulation and/or nerve damage caused by complications with diabetes mellitus. The term – diabetic foot syndrome – refers to clinical symptoms observed in the foot.
The loss of protective perception of pain and pressure is one of the main triggers for ulceration in diabetic patients. Preventive measures to protect the foot from injury are essential as ulceration can rapidly occur from the smallest of injuries. A multidisciplinary approach to care is crucial.


Special attention must be paid to diabetic feet and nails as even small abrasions or pressure points can lead to the beginning of a chronic wound development.

How can chronic wounds be prevented?

Pressure ulcers can – as the word infers – be prevented by reducing, removing or redistributing the source of pressure and friction. At risk individuals should, for this reason, be correctly identified and appropriate pressure-relieving interventions carried out. These include regular turning and repositioning of immobilised individuals and the use of pressure-relieving devices.

Venous ulceration requires two decisive interventions: compression therapy and mobilisation. Patient education and empowerment play a crucial role in making these therapy regimes work so, as well as understanding the importance of applying compression, patients must learn to keep their legs moving.

Self-empowerment is equally important for diabetic patients. Those affected should ensure that their feet are inspected on a daily basis. They must be kept warm and dry and walking barefoot is an absolute taboo. Negative outcomes can be reduced by regular visits to a physician, for monitoring and assessment purposes.

A holistic approach to care is vital for successful treatment and healing of chronic wounds. It is vital that the underlying disorder, for example diabetes mellitus or arterial disease, is addressed.
Two doctors performing operation

All wounds, regardless of their cause, go through phases of healing which can be divided into three general stages:

1. Cleansing Phase
During the initial period of healing the wound attempts to cleanse itself of impurities. Wound exudate is frequently present and signs of infection may occur (redness, swelling, pain, heat, reduced function). Localised wound care serves to support these processes and accelerate cleansing.

2. Granulation Phase
A wound defect is filled with new tissues and exudate levels drop. Wound cleansing must continue and new tissues must be protected.

3. Epithelisation Phase
Wound edges draw together. The wound surface is covered with epithelial cells and wound closure can conclude. During this phase exudate levels may be minimal or non-existent and fragile epithelial cells must be cared for.

How are problematic wounds treated?

Modern wound dressings support the specific physiological process in each stage of healing. Dressings keep the wound moist, provide protection against external influences and actively support the healing process.

HydroTherapy, by PAUL HARTMANN AG, is a treatment concept especially developed for the treatment of chronic and poorly healing wounds. It consists of only two wound dressings - HydroClean plus and HydroTac - which are used one after the other during the healing process..

HydroClean can be used in all three stages of the healing process but is most effective during the cleansing and granulation phases. Due to its special absorbing and rinsing mechanism, necrosis, slough and bacteria are removed from the wound and firmly bound in the wound-dressing pad. In the core of the dressing bacteria are killed by the antiseptic polyhexanide (polyhexamethylene biguanide or PHMB) and remain enclosed there.

HydroTac is used as a follow up to HydroClean, predominantly in the granulation and epithelisation stages. It not only absorbs but actively provides moisture when needed, thereby regulating the moist wound environment. Its top film promotes healing while protecting the wound from bacteria and infection.