Slow-Healing Wounds: Why a Cut or Sore Will Not Heal and When to Be Seen

What it involves

MedlinePlus says a non-healing wound is one that has not started to heal in 2 weeks or has not completely healed in 6 weeks. Common types include pressure sores, surgical wounds and foot ulcers caused by diabetes, poor blood flow or swollen legs.

Who this is for

• Adults with a sore, cut or ulcer that has not improved in about two weeks
• Patients with diabetes who notice a blister or sore on the foot
• People with poor circulation or swollen legs and a wound near the ankle or foot
• Caregivers of a person who spends a lot of time in bed or a chair and has red or broken skin

What to expect

• Questions about how the wound started, how long it has been there and whether it is draining or painful
• A look at the wound and the skin around it, a check of the pulses in the area and a review of your health conditions
• Blood tests such as blood sugar, and a referral for circulation or wound specialist care when needed
• Instructions for keeping the area clean and protected, and a time to come back and recheck it

How a wound is supposed to heal

The MedlinePlus patient instruction on how wounds heal describes stages. Bleeding stops as a clot forms, then the immune system protects the area for roughly 2 to 5 days, with mild swelling, redness and clear fluid. New tissue grows over about 3 weeks, and a scar forms and can fade for up to 2 years. Smaller wounds heal quicker than larger or deeper ones. A wound that skips ahead or stalls, or becomes more painful, red or swollen after the first days, is the one to have looked at.

Why some wounds stall

MedlinePlus lists diabetes, poor circulation from damaged arteries or veins, nerve damage, bone infection, being inactive or immobile, a weak immune system, poor nutrition, excess alcohol, smoking and a foreign body in the wound as reasons wounds may not heal well. Several often combine. The peripheral artery disease guide explains how narrowed leg arteries starve a wound of oxygen, and the leg swelling guide covers swelling that keeps a sore wet and irritated.

Diabetes and the feet

MedlinePlus says people with diabetes are more likely to develop foot sores because nerve and blood vessel damage can numb the feet, so injuries may go unnoticed and heal poorly. Diabetic ulcers are often painless, and it may take weeks or months for them to heal. Wearing shoes that spread pressure across the foot and not walking barefoot unless your provider says it is OK are among the habits it lists, and the diabetic foot care guide walks through foot care. Our diabetes management page describes ongoing care.

Pressure sores and skin that stays moist

MedlinePlus says a pressure sore forms when skin is pressed or rubbed too long, reducing blood flow, and that it is more likely in people who stay in bed or use a wheelchair, are older, have fragile skin or have poor nutrition. Stage I is a red area that does not turn white when pressed. Relieving pressure and changing position often are the first steps, and a provider should look at anything beyond a red patch. The cellulitis guide explains when skin infection is the concern.

What a visit can and cannot do

A primary care visit can look at the wound, check for infection, review blood sugar, circulation and nutrition, and send you to the right specialist. The practice lists wound closure and sutures and incision and abscess drainage among its services, but a long-standing ulcer may need a wound care team. MedlinePlus describes wound clinics as places with providers and nurses who measure the wound, check blood flow and create a treatment plan. A referral is the right step when a wound is not improving.

Warning signs that should not wait

Seek prompt care for spreading redness, warmth, swelling, pus, a bad smell, red streaks, fever or chills, and for wounds that are black or dark, very deep or exposing tendon or bone. Wounds on the feet of someone with diabetes deserve a visit even when they do not hurt. For a wound with heavy bleeding that will not stop, call 911. For a stubborn sore on the skin, the skin lumps and cysts guide describes other skin problems a provider sorts out.

Sources

• MedlinePlus: How wounds heal (patient instructions)
• MedlinePlus: Wound care centers (patient instructions)
• MedlinePlus: Diabetes, foot ulcers (patient instructions)
• MedlinePlus: How to care for pressure sores (patient instructions)