If we let the body alone, can it take care of a healing a wound? In general, yes, leaving the body alone will get you further than some procedures because the body knows what to do, such as allowing autolytic debridement. If you look at the body, it is designed to heal, and it knows much more about that than we clinicians do. It is important to know what a wound looks like and how it should progress. If you know this, you can follow the progress of the wound and know healing is taking place.

Investigating the Reason Behind a Non-Healing Wound

Now, what if there is a wound that won’t heal? Maybe the wound has been there three years, has had multiple therapeutic interventions such as hyperbaric oxygen therapy, and negative pressure wound therapy and still won’t heal. If you have a wound like this that is not responding to treatment and adjunctive therapies, then you have to think, maybe there is something going on different than a usual wound, and you need to find out just what it is.

There are several things to evaluate for a recalcitrant wound. Is it infected? First, assess the wound for signs of infection. A culture will help you to determine if infection is present and reveal the reason why the wound is not progressing. Is it a Marjolin's ulcer? A biopsy will provide you with the answer to this question. If you feel good pulses, but the patient appears to have poor circulation? A laser Doppler or a CT angiogram will help you determine what the underlying issue is. A wound that will not heal should not be left alone. A non-healing wound needs every evaluative and treatment effort you can give it. Is the wound not healing due to pyoderma gangrenosum? A biopsy might help, but simply looking at the wound and giving it a thorough assessment would help more.

Treatment Interventions for Non-Healing Wounds

Sorting through these options may give you a different view of the wound and a different way to approach it. If you discover a wound is infected, the right antibiotic needs to be selected. If you determine a wound is an Marjolin's ulcer, then an oncologist can help provide specialized treatment interventions. If in find in your investigation of the cause behind the non-healing wound that your patient has poor circulation, then a vascular surgeon needs to become involved to help revascularize. If determine that you are managing a case of pyoderma gengrenosum, treatment is with cyclosporine and prednisone and is not dependent on a wound dressing.

So, for a typical wound, letting the body do what it can is going to be best, but for an unusual wound that fails to heal, you will need to investigate the reason(s) why the wound has become recalcitrant and adjust your treatment approach to put the wound on the path to healing.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.