Chronic wounds are wounds that do not heal in an orderly and timely manner within a 4-6 week period. Healing is delayed due to patient, wound and/or environmental factors.
There are different types of chronic wounds and these are primarily:
- Foot Ulcers
- Leg ulcers
- Malignant Wounds
- Pressure Injuries
Foot Ulcers often occur in people who have other medical conditions such as diabetes or peripheral vascular disease. In patients with diabetes foot ulcers may be classified as either:
- neuropathic – where there is loss of protective sensation, however, foot pulses may still be felt
- neuro-ischaemic – where there is both loss of protective sensation and ischemia or lack of blood supply
Foot Ulcers can be superficial, involving only the top layer of skin or they can be deep wounds extending into the foot involving tendons, bones and other structures.
Leg Ulcers are wounds that occur below the knee, which may be categorised as:
- Venous Leg Ulcers – where there is evidence of chronic venous disease (insufficiency)
- Arterial Leg Ulcers – where there is evidence of arterial disease
- Mixed Venous/Arterial Leg Ulcers – where there is evidence of both arterial and venous disease
- Neuropathic Leg Ulcers – where there is loss of protective sensation
Malignant wounds are evidence of the progression or remission of an underlying malignant disease. Malignant wounds may present primarily as fungating or ulcerating lesions. Malignant tumours are those that can invade and destroy nearby tissue and may spread (metastasise) to other parts of the body. Symptom management is the main goal of care for malignant wounds.
A pressure injury is a localised injury to the skin and/or underlying tissue usually over a bony prominence as a result of pressure, shear and/or friction, or a combination of these factors (NPUAP and EPUAP, 2009).
Pressure injuries may be small superficial wounds or large deep wounds the depth of which may extend down to bone. Pressure injuries are classified according to the degree of tissue damage that occurs.