What counts as a chronic wound?
A normal, "acute" wound — a cut, scrape, or surgical incision — follows a predictable pattern. Within hours the body controls bleeding and starts cleaning the area. Over the next few days, new tissue forms. Most acute wounds are well on their way to being closed within two to three weeks.
A chronic wound is different. The widely used clinical definition is a wound that has not made meaningful progress toward healing in 30 days. The body has stalled somewhere in the healing process — often because of an underlying issue like poor circulation, diabetes, ongoing pressure, or infection. Without specialty care, a chronic wound can stay open for months or even years, and the longer it stays open, the higher the risk of complications.
Why some wounds don't heal
Blood flow problems. Healing tissue needs oxygen and nutrients delivered through small blood vessels. When circulation is poor — from peripheral artery disease, venous insufficiency, or both — wounds simply can't get the supply they need to close.
Diabetes. High blood sugar damages nerves and small blood vessels, weakens the immune response, and dulls the sensation of pain that would normally warn you about a developing wound. Even a small foot wound in someone with diabetes deserves prompt, specialized attention.
Pressure. Sustained pressure on the skin — from being in bed, in a wheelchair, or from a poorly fitting shoe — cuts off blood flow to the tissue underneath. The damage often starts beneath the surface before an open wound appears.
Repeated trauma. A wound that gets re-injured every day — by walking on it, by friction from a brace, by a dressing that's too tight — never gets the stable environment it needs to heal.
Infection. Bacteria living in or around a wound can quietly stall healing without obvious redness or pus. Identifying and treating infection is often the turning point for a stalled wound.
Nutrition. Healing requires protein, vitamins, and adequate calories. Patients who are under-nourished — including many older adults — heal more slowly, and addressing nutrition is part of the plan.
Certain medications. Steroids, some chemotherapy agents, and a number of other common medications can suppress the body's healing response. Knowing your full medication list helps us understand what you're working against.
The most common chronic wound types
Venous leg ulcers
These open sores on the lower leg or ankle are caused by veins that no longer move blood back up to the heart efficiently. Fluid pools, the skin breaks down, and the wound struggles to close without compression and the right dressing strategy. See our chronic wound care page.
Diabetic foot ulcers
Often starting as a small callus or blister, diabetic foot wounds can deepen quickly because of reduced sensation and impaired circulation. They are the leading cause of diabetes-related hospitalizations and amputations — and they respond well to early, focused treatment. Learn about diabetic wound care.
Pressure injuries
Sometimes called bedsores or pressure ulcers, these develop where bone presses skin against a surface for too long — the heels, tailbone, hips, and back of the head are common sites. Treatment combines wound care with offloading and repositioning strategies. See pressure injury care.
Post-surgical wounds that won't close
Most surgical incisions heal without trouble, but some open back up — a complication called dehiscence — or fail to close in the first place. These wounds need a different plan than the original surgical site. Read about post-surgical wound care.
How chronic wounds are diagnosed
Diagnosis starts with a careful history and physical exam: how long the wound has been there, what's been tried, and what other medical conditions are in play. We measure the wound — length, width, depth — and photograph it so we have a clear baseline. Depending on what we find, we may order labs to check for infection or nutritional issues, vascular studies to look at blood flow, or imaging to evaluate deeper tissue and bone. Every test we order has a reason, and we explain what we're looking for.
How chronic wounds are treated
Most chronic wound treatment combines a few core elements: gentle debridement to remove dead tissue, dressings that keep the wound at the right level of moisture, controlling infection when it's present, and offloading pressure from the wound so it can rest. When a wound isn't responding, we add advanced therapies — bioengineered skin substitutes, negative pressure wound therapy, and other modalities — chosen for the specific wound in front of us. Read more about our full treatment program and our advanced wound therapies.
When to see a wound specialist
If any of the following describe your situation, it's time to be seen:
- A wound that has been open for more than 30 days
- Signs of infection: warmth, spreading redness, increased drainage, or fever
- Diabetes plus any new or non-healing foot wound — even small ones
- A wound that has gotten worse, not better, over the past two weeks
- A surgical incision that opens, drains, or won't fully close
- A pressure injury at any stage, including early skin discoloration
What to expect at Nexcell
Your first visit at Nexcell is unhurried. We start with a thorough intake — your wound history, medical history, current medications, and previous treatments. Then we examine the wound, document it with measurements and photography, and check circulation and the surrounding tissue. We finish by walking through the plan with you: the dressings you'll use at home, how often we'd like to see you, what counts as progress, and what to watch for between visits. You'll leave knowing exactly what comes next.
