A non-healing or chronic wound is one that has not improved after about four weeks or closed by eight weeks, such as diabetic foot, venous or pressure ulcers. Treatment targets the underlying cause and infection with debridement, antibiotics, negative pressure therapy and moist dressings, followed by definitive cover with skin grafts or flaps.
- AnaesthesiaLocal, spinal or general, depending on the procedure
- Hospital stayOutpatient care to a few weeks
What is non-healing wounds?
A wound is considered chronic if it has not improved after four weeks or has not closed by eight weeks. Common types include diabetic foot ulcers, venous ulcers, non-healing surgical wounds, pressure ulcers, wounds linked to metabolic disease and wounds that repeatedly break down because of unstable scarring. They cause both physical and emotional strain.
The main danger is infection. Bacteria such as Staphylococcus and Pseudomonas are normally harmless on the skin but can invade an open wound, and severe infection can lead to amputation. Wounds left untreated for many years may also carry a risk of skin cancer. Signs of infection include worsening pain, redness and warmth, discharge and a foul smell.
Large wounds rarely heal well on their own because they lack the skin structures needed for good regeneration. Those that do close often heal by contraction, which near a joint can restrict movement, and immature scars may keep breaking down. Plastic surgery provides definitive cover: skin grafts need a healthy granulating base and splinting early on and can contract over time, while flaps carry their own blood supply, can cover vital structures, resist contraction and need no splinting.
Who is non-healing wounds for?
- People with wounds that have not improved in four weeks or closed in eight weeks
- Patients with diabetic foot, venous or pressure ulcers
- People with surgical wounds that have broken down
- Patients with unstable scars that keep breaking down
- Anyone with signs of wound infection
How is it done?
- Investigations: blood tests for anaemia and diabetes, arterial and venous colour Doppler, X-rays, wound biopsy and nerve conduction tests
- Local antibiotics and moist wound care; relieving pressure on the wound
- Surgical debridement to remove dead and infected tissue
- Negative pressure wound therapy (VAC) or, in selected cases, sterile maggot therapy
- Definitive cover with skin grafts or flaps
What is recovery like?
- Regular follow-up visits
- Elevation of the limb until the graft or flap is stable
- Pressure garments to reduce swelling and help the graft or flap settle
- Massage of the healed graft or flap to help it mature
- Ongoing control of the underlying cause, such as diabetes or venous disease
What are the risks?
- Persistent or spreading infection
- Graft or flap failure
- Recurrence if the underlying cause is not controlled
- Scarring or contracture
- Amputation in severe uncontrolled infection
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
When is a wound considered non-healing?
A wound is generally considered chronic if it has not shown improvement after about four weeks or has not fully closed by about eight weeks. Such wounds need assessment to find and treat the underlying cause, such as poor circulation, diabetes, pressure or infection.
What tests are done for a chronic wound?
Common tests include blood tests for anaemia and diabetes, arterial and venous colour Doppler scans to check circulation, X-rays to look for bone involvement, a wound biopsy and nerve conduction tests. The results guide treatment.
What is maggot therapy?
Maggot therapy uses sterile, medical-grade live maggots placed on the wound. They remove dead tissue and help kill bacteria, and can reduce odour and speed healing. Like VAC therapy, it is used to prepare the wound for a skin graft or flap.
Why might I need a skin graft or flap for a wound?
Large wounds rarely heal well on their own and often heal by contraction or with fragile scars that break down. A skin graft or flap provides stable, durable cover, shortens healing time and reduces the risk of further infection.
What are signs that my wound is infected?
Warning signs include pain that is getting worse, redness and warmth spreading around the wound, discharge or pus, and a foul smell. Fever can also occur. Seek medical attention promptly if you notice any of these signs.
