Chronic Wounds

Chronic wounds are wounds that have not healed within six weeks despite adequate treatment.

In the vast majority of cases, the underlying cause is a disease of the blood vessels, i.e. the veins and/or arteries. Chronic wounds place a heavy burden on those affected and their families due to pain, restricted mobility, unpleasant odours and impairment of social life. They noticeably reduce quality of life.

In order to achieve complete wound healing, it is crucial to treat the underlying cause. Therefore, in the case of chronic wounds, it must be clarified whether a vascular disease is the underlying cause – the sooner this is done, the better! Months or even years of unsuccessful wound treatment can usually be avoided with early clarification of the cause and causal therapy!

Symptom of a disease

In most cases, the wound is merely the visible symptom of the underlying disease. Over 70% of all chronic wounds are caused by vascular disease. 

In cases of venous insufficiency, blood components are deposited in the tissue. This ultimately leads to a reduced supply of oxygen and nutrients to the skin, resulting in the formation of a wound.

In the case of arterial circulatory disorders, the tissue and therefore also the skin are not supplied with sufficient oxygen and nutrients. The cause is usually arteriosclerosis (i.e. calcification of the arteries), which leads to narrowing or even blockages in the vessels.

Diabetic foot syndrome is a late complication of diabetes mellitus that has often been present for years and has not been treated or has been inadequately treated. This leads to malpositions of the foot skeleton, incorrect weight distribution and pressure loads, accompanied by a loss of pain sensation. Minor injuries, e.g. as a result of improper foot care, can thus lead to wounds that remain unnoticed for a long time. If an infection occurs – often accompanied by reduced blood flow – the situation quickly becomes critical: amputation may be necessary.

Diagnosis and treatment

Chronic wounds will not heal without treatment of the underlying disease. Since vascular disease is the cause in most cases, any wound that does not heal must be referred to a vascular specialist as soon as possible. All patients with a chronic wound should be examined for arterial circulatory disorders or venous insufficiency.

In most cases, a painless examination of the vascular system using ultrasound is sufficient. If vascular disease is suspected, further examinations, such as magnetic resonance angiography or angiography, are usually necessary.

In the case of arterial circulatory disorders, an improvement in blood circulation must be achieved. In many cases, this can be achieved through gentle, so-called endovascular procedures. These involve widening narrowed vessels or fitting them with stents. These procedures can usually be performed under local anaesthetic, so that even elderly people can be treated gently.

Follow-up treatment

In addition to treating the cause, stage-appropriate and guideline-compliant local therapy is also necessary to ensure wound healing. Modern dressings create an optimal wound environment for healing and usually do not need to be changed daily. 

The vascular specialists, together with specially trained wound managers, will decide which local therapy is right for you.

Your treating vascular surgeon can offer you everything from a single source: diagnostics and therapy, including all available surgical and endovascular treatment methods, and will be happy to advise you in detail about any treatment that may be necessary.