What is the best way to care for healing wounds?

Christopher Carsten, MD

Advanced wound care

Injuries like bruises often heal largely through giving them time and resting the injured area. But what about healing from cuts, scrapes, surgical incisions or other situations where injured cells are exposed to the air? What do you do to encourage faster healing, and what does it mean if your wounds aren’t healing as fast as they should?

Advanced wound care specialist Christopher Carsten, MD, answered common questions about how to care for healing wounds, the difference between chronic and acute wounds and more.

What makes a wound chronic or acute?

“When a wound is acute, it’s a new injury, like a cut in the skin that follows the normal healing timeline and improves within a few weeks,” said Dr. Carsten.

A chronic wound, on the other hand, is one that doesn’t heal within four weeks or isn’t showing steady progress in improving. These kinds of wounds are often caused by an underlying medical condition like diabetes, venous disease, peripheral arterial disease, pressure or infection.

Chronic wounds usually require specialized care.

What are the usual stages of healing a wound?

“Wound healing happens in four phases,” said Dr. Carsten. “Now, timelines vary depending on a variety of factors, from how serious the initial injury is to how efficient your body is at recovering and whether or not you have any conditions that affect your ability to heal.”

The four stages of healing include:

• Hemostasis: Immediately after receiving the injury through about the first day. The body stops bleeding through clot formation.
• Inflammation: Days 1 through 4. The immune system removes bacteria and damaged tissue. Mild redness, warmth and swelling are normal during this phase.
• Proliferation: Days 4 through 21. New tissue, collagen and blood vessels form. The wound begins to fill in and contract.
• Maturation, or remodeling: Day 21 up through one year after the initial injury. The wound strengthens and scar tissue reorganizes over time.

Healing timelines can be delayed by factors such as infection, poor circulation, diabetes, pressure or swelling.

What is the general standard for wound care when dealing with acute or basic wounds?

“Basic wound care, the sort you usually begin at home on your own, includes cleaning the wounded area, keeping it protected and slightly moist, using correct bandages or dressings and monitoring for any signs of infection,” said Dr. Casten.

Generally, if a wound is not improving within 2–4 weeks, evaluation by a wound specialist is recommended. Signs of infection may also be a sign that more care is needed.

Signs of infection in a wound include:

• Fever or chills
• Increased pain or new bleeding from the wounded area
• Discoloration, including green, yellow or brown liquid or pus coming from the wound
• Foul smell
• Nausea or vomiting

Infection can move fast and become dangerous very quickly. Speak to your doctor as soon as possible if you experience any of these symptoms.

If you witness increasing redness around the wounded area that is spreading or dark or red ‘streaks’ in the skin around the wound, head to the emergency room right away.

What kinds of injuries or medical conditions can cause chronic wounds to develop or acute wounds fail to heal?

“The most common reasons that wounds don’t heal involve existing medical conditions that affect your body’s ability to get healing white blood cells to your injury. Think conditions like diabetes, peripheral artery disease, infection, swelling or smoking affecting your circulation,” said Dr. Carsten.

Venous insufficiency, which can lead to significant swelling or pressure injuries related to immobility, can also cause wounds to heal very slowly or to not heal at all. Treating the underlying condition is essential for healing.

Nutrition is also an important component of healing. The body must have adequate fuel to create the new tissue that is required to heal a wound. Ensuring that patients are having adequate caloric intake, especially when it comes to protein, is another element of wound healing.

How are chronic wounds diagnosed and treated?

Chronic wounds require a comprehensive medical evaluation. In addition to examining and measuring the wound, physicians and other providers may order:

• Vascular studies to assess circulation
• Blood work and laboratory testing
• Wound cultures to identify infection
• X-rays, CT scans or MRI to evaluate bone or deeper tissue
• Biopsy when indicated
• Review of medical history and risk factors

“Without identifying the underlying cause of the failure to heal within the standard timeline, we can’t effectively treat the problem and get your wound back on track to healing,” said Dr. Carsten.

Treatments may include options like:

• Hyperbaric oxygen therapy: In HBO, the wounded patient breathes 100% oxygen inside of a pressurized chamber. The increase in pressure helps the body to take in more oxygen, reaching tissues that otherwise weren’t receiving enough oxygen to heal.
  
  HBO can help not just to get more oxygen to the damaged area, but also to support new blood vessel growth, reduce swelling and help your body fight off certain infections.
• Noninvasive treatment options for wound care: Treatment may include advanced dressings, removal of nonviable tissue (also called debridement), compression therapy, pressure offloading, cellular or tissue-based products and in some cases surgical care.

When is surgical care required to help with a chronic wound?

“Surgery may be necessary if the infection is severe, blood flow needs to be restored or the wound requires closure or reconstruction,” said Dr. Carsten. “Whether or not we are able to rely on nonsurgical methods or need to move on to surgical treatment is really based on how severe the wound is and the patient’s overall health.”

Is there any way to help wounds heal faster at home after treatment?

Patients can support healing by following the care instructions they received from their medical provider, such as following instructions on how to clean and dress the wound, as well as managing their blood sugar, elevating swollen limbs if told to do, taking in adequate amounts of protein and avoiding smoking.

Make sure you don’t miss your follow-up appointments.

Why is it important not to miss follow-up appointments when dealing with chronic wounds and wound care?

“Consistency in care is so important,” said Dr. Carsten. “Chronic wounds can change quickly. Regular visits allow providers to monitor progress, adjust treatment and identify complications early.”

Missing appointments can delay healing or make it more difficult to recognize early signs of infection.

What are the potential risks if you skip follow-ups or don’t follow the treatment plan?

“Without proper care, chronic wounds can lead to hospitalization, tissue damage, infection, amputation or even risk sepsis, a condition that can be fatal,” said Dr. Carsten.

Early and consistent treatment significantly reduces these risks.