Wound care centers

Common types of non-healing wounds include:

• Pressure sores
• Surgical wounds
• Radiation sores
• Foot ulcers due to diabetes, poor blood flow, chronic bone infection (osteomyelitis), or swollen legs

Certain wounds may not heal well due to:

• Diabetes
• Poor circulation due to damage to arteries or veins
• Nerve damage
• Bone infection
• Being inactive or immobile
• Weak immune system
• Poor nutrition
• Excess alcohol use
• Smoking
• Having a foreign body (such as a piece of wood or broken glass) in the wound

Non-healing wounds may take months to heal. Surgery may be performed to speed up healing. Some wounds never heal completely.

When you go to a wound clinic, you will work with a team of health care providers trained in wound care. Your team may include:

• Providers who oversee your care
• Nurses who clean and dress your wound and teach you how to care for it at home
• Physical therapists who help with wound care and work with you to help you stay mobile

Your providers will also keep your primary care provider up to date on your progress and treatment.

Your wound care team will:

• Examine and measure your wound
• Check the blood flow in the area around the wound
• Determine why it's not healing
• Create a treatment plan

Treatment goals include:

• Healing the wound
• Preventing the wound from getting worse or becoming infected
• Preventing limb loss
• Preventing new wounds from occurring or old wounds from coming back
• Helping you stay mobile

In order to treat your wound, your provider will clean the wound and apply a dressing. You also may have other types of treatment to help it heal.

Debridement

Debridement is the process of removing dead skin and tissue. This tissue must be removed to help your wound heal. There are many ways to do this. You may need to have general anesthesia (asleep and pain-free) for debridement of a large wound.

Surgical debridement uses a scalpel, scissors, or other sharp tools. During the procedure, your provider will:

• Clean the skin around the wound
• Probe the wound to see how deep it is
• Cut away the dead tissue
• Clean the wound

Your wound may seem bigger and deeper after debridement. The area will be red or pink in color and look like fresh meat.

Other ways to remove dead or infected tissue are to:

• Sit or place your limb in a whirlpool bath.
• Use a syringe to wash away dead tissue.
• Apply wet-to-dry dressings to the area. A wet dressing is applied to the wound and allowed to dry. As it dries, it absorbs some of the dead tissue. The dressing may be wet again and then gently pulled off along with dead tissue.
• Put special chemicals, called enzymes, on your wound. These dissolve dead tissue from the wound.

After the wound is clean, your provider will apply a dressing to keep the wound moist, which promotes healing, and help prevent infection. There are many different types of dressings, including:

• Gels
• Foams
• Gauze
• Films

Your provider may use one or multiple types of dressings as your wound heals.

Hyperbaric Oxygen Therapy

Depending on the type of wound, your provider may recommend hyperbaric oxygen therapy. Oxygen is important for healing.

During this treatment, you sit inside a special chamber. The air pressure inside the chamber is about two and a half times greater than the normal pressure in the atmosphere. This pressure helps your blood carry more oxygen to organs and tissues in your body. Hyperbaric oxygen therapy can help some wounds heal faster.

Other Treatments

Your providers may recommend other types of treatment, including:

• Compression stockings -- tight-fitting stockings or wraps that improve blood flow in veins, reduce swelling, and help with healing.
• Ultrasound -- using sound waves to aid healing.
• Artificial skin -- a synthetic skin that covers the wound for days at a time as it heals.
• Negative pressure therapy -- pulling the air out of a closed dressing, creating a vacuum. The negative pressure improves blood flow and pulls out excess fluid.
• Growth factor therapy -- materials produced by the body that help wound-healing cells grow.
• Skin grafts -- a surgeon removes part of your skin and places it over your wound.

You will receive treatment at the wound center every week or more often, depending on your treatment plan.

Your providers will give you instructions on caring for your wound at home in between visits. Depending on your needs, you may also receive help with:

• Healthy eating
• Diabetes care
• Smoking cessation
• Pain management
• Physical therapy

You should contact your provider if you notice signs of infection, such as:

• Redness
• Swelling
• Pus or bleeding from the wound
• Pain that gets worse
• Fever
• Chills

Pressure ulcer - wound care center; Decubitus ulcer - wound care center; Diabetic ulcer - wound care center; Surgical wound - wound center; Ischemic ulcer - wound center

de Leon J, Bohn GA, DiDomenico L, et al. Wound care centers: critical thinking and treatment strategies for wounds. Wounds. 2016;28(10):S1-S23. PMID: 28682298 pubmed.ncbi.nlm.nih.gov/28682298/.

Woelfel SL, Armstrong DG, Shin L. Wound care. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 118.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.