Chronic Wounds: When a Wound Won't Heal, Causes and Proper Care

6 days ago

3 min read

A chronic wound is a wound that has not healed within 3 months, even with standard care. It greatly affects quality of life through pain, treatment costs and the risk of serious infection. In Thailand, where many people have diabetes, chronic wounds, especially on the feet, are an important public health problem. This article explains the types of wounds, the reasons wounds fail to heal, modern wound care principles, and the warning signs that need prompt medical attention.

Common types of chronic wounds

Chronic wounds fall into 3 main groups by cause:

Diabetic Foot Ulcer (DFU) — a foot wound caused by damaged nerves and blood vessels in people with diabetes. It is a leading cause of amputation in Thailand.
Venous Leg Ulcer (VLU) — an ankle wound caused by veins that cannot return blood to the heart well. It is common in women and in people who stand for long periods.
Pressure Ulcer / Bedsore — a pressure sore in bedridden people, caused by continuous pressure over bony areas.

Why wounds do not heal

Normal wound healing depends on several body systems working together. Factors that disrupt this process include:

Diabetes — poorly controlled blood sugar suppresses the cells that repair the wound.
Infection — long-lasting bacterial infection, especially biofilm, which is hard to eliminate.
Poor blood supply — poor circulation means the wound does not receive enough oxygen and nutrients.
Nutrition — malnutrition, including a lack of protein, vitamin C and zinc.
Pressure and moisture — continuous pressure, or prolonged exposure of the wound to moisture and friction.

Modern wound care: the TIME framework

The current standard for chronic wound care follows the TIME framework:

T (Tissue) — remove dead tissue (debridement) so that healthy tissue can grow.
I (Infection/Inflammation) — treat infection and control inflammation.
M (Moisture balance) — keep the wound moisture balanced, neither too dry nor too wet.
E (Edge) — stimulate the wound edges to grow inward and close the wound.

Modern wound dressings

Dermatologists and surgeons choose among several types of dressings depending on the condition of the wound:

Hydrocolloid dressing — absorbs wound fluid and keeps the wound moist. Suitable for general chronic wounds.
Alginate dressing — absorbs a large amount of fluid. Suitable for heavily draining wounds.
Foam dressing — helps relieve pressure. Suitable for pressure ulcers.
Negative Pressure Wound Therapy (NPWT) — a vacuum device that helps stimulate tissue growth.

Specialized treatments for chronic wounds

Debridement — removal of dead tissue, which may be done by a surgeon or a specially trained nurse.
Hyperbaric Oxygen Therapy — increases oxygen delivery to the wound in cases of diabetic foot wounds.
Skin Graft — skin transplantation for large wounds.
Growth factors — such as becaplermin gel, to stimulate tissue growth.

Warning signs that need prompt medical attention

See a doctor promptly if you have any of the following:

Spreading inflammation — the wound becomes rapidly more swollen, red and warm.
Infection — a foul smell or increasing pus.
Danger sign — red streaks spreading out from the wound, which carry a risk of bloodstream infection (sepsis).
Whole-body symptoms — high fever, or a wound that keeps getting larger, especially in people with diabetes who have a foot wound.

Frequently asked questions about chronic wounds

What kind of wound is called a chronic wound? A wound that has not healed within 3 months despite standard care. It is often seen in people with diabetes, vascular disease and those who are bedridden, and should be evaluated to find out why it is not healing.

Why do wounds heal slowly in people with diabetes? High blood sugar suppresses the cells that repair the wound, and damaged nerves and blood vessels mean the wound does not get enough blood and oxygen and becomes infected easily.

Can I treat a chronic wound at home myself? A minor wound may be cared for following your doctor's advice, but a chronic wound should be assessed and planned for by a doctor, because choosing the right dressing and removing dead tissue require expertise.

Can chronic wounds be prevented? They can be prevented by keeping diabetes well controlled, protecting the skin and feet from injury, cleaning and caring for fresh wounds properly, and seeing a doctor early when a wound is slow to heal.

A chronic wound that does not heal should not be left alone, because of the risk of serious infection and loss of a limb. If you or someone close to you has a wound that is slow to heal, especially a person with diabetes, it should be cared for by a specialist doctor. Consult a dermatologist at Siam Dermatology, tel. +66 61 448 7000 or LINE @siamderm

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026