True about chronic wound

Chronic wounds are defined as those that do not follow the normal healing process and show no signs of healing in 4 weeks. It fails to progress through the normal phases of healing but with prolonged inflammatory phase. Diabetes, venous/aerial diseases, nutritional deficiencies are the causes. Hypoxia initially is a potent stimulus for fibroblast activity and angiogenesis; persisting hypoxia impedes fibroblast and collagen activity and also allows bacterial invasion to make wounds chronic. Chronic wounds are chronically infected with biofilms which interfere mainly with the inflammatory phase of healing, contributing to the non-healing. A biofilm is a complex structure of microorganisms contained in an extracellular matrix of proteins and polysaccharides that adhere to a surface, creating a protected environment for the organisms. Chronic ulcers are unrespon- sive to dressing treatment; it requires biopsy, culture study, definitive treatment like wound debridement, VAC (Vacuum Assisted Closure) therapy, skin grafting or flap. Specific conditions like tuberculosis if present should be treated. Malignancy if confirmed is treated by wide local excision and skin graft. Ref: SRB 6th edition.