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Wound Q&A

In this section, you can find replies to some of the most frequently asked questions by patients with a chronic/non-healing wound.

Resources for patients and private carers

Wound Q&A for patients and relatives

A holistic approach to wound care is important to ensure appropriate treatment and management is provided. Therefore, it is recommended that you inform your General Practitioner (GP) and/or wound care nurse about other issues related to your health status (other chronic diseases, medication, etc.) and ask questions about your wound. These questions can lead to a valuable dialogue with your clinician to help your wound to heal. Working with your clinician and the treatment plan helps to ensure that potential complications are minimised.

This Q&A section is developed as a reliable source of information, as there exists a significant risk of receiving unreliable information on the internet which might have an impact on the wound care.

The Internet (websites and social media) offers a vast amount of information about wound care. This information may serve very different purposes: some content aims to provide scientific knowledge, while other material is driven by commercial interests or personal promotion.

Be aware that not all the information available online is reliable or accurate. In many cases, the content is not based on scientific evidence or well-established clinical experience. Sometimes, advice, so-called “miracle” treatments, or recommendations that have not been properly verified are shared, and these can be ineffective or even harmful to health. This can happen even when the information comes from individuals who present themselves as healthcare professionals.

Following incorrect advice may cause a wound to take longer to heal, become infected, worsen, or leave avoidable complications or scars. For this reason, it is very important to be cautious and critical about what you read or watch online, especially when it concerns your health.

  • Websites of scientific societies.
  • Websites of recognised healthcare or educational institutions.
  • Scientific publications or educational materials based on research evidence.
  • Information provided by healthcare companies that meet quality and transparency standards.

Please note that general information can never replace an individual medical assessment. Every wound is different and requires a personalised approach.

Therefore, if you have any doubts, notice changes in the wound, or feel concerned about information you have found, as a general rule, always consult the healthcare professional responsible for your wound care who can recommend the safest and most appropriate treatment.

In this Q&A, “healthcare professional” may refer to your nurse, doctor, physiotherapist or other healthcare professional with expertise in wound management.

The material is produced by EWMA in collaboration with its cooperating organsiations and has been grouped into the following sections: 

Definitions: What are the primary types of chronic/non healing wounds/ulcers

This type of ulcer occurs around the ankle area. They are shallow and can be painful. They are caused when the veins in the legs are damaged or are not working properly and therefore do not return blood back to the heart as efficiently as they should. They are also called venous stasis ulcers or sometimes varicose ulcers.

This type of ulcer usually occurs on the foot or the lower part of the leg. They can be small and sometimes deep and often quite painful. They are caused when the arterial blood flow to the area is reduced and often occur among people who have some form of heart disease.

This ulcer is due to a combination of venous and arterial disease.

This type of ulcer occurs on the foot of a person with diabetes. There are three main types; neuropathic (due to lack of sensation); ischaemic (due to poor blood supply); neuro-ischaemic (a combination of both).

This type of ulcer is caused by pressure and/or shearing force. These ulcers may also be referred to as pressure sores or decubitus ulcers.

Causes and diagnosis

Diagnostic

Having a family member with a leg ulcer does not mean you will definitely get one. Most leg ulcers happen because of blood flow problems in the legs (veins, arteries, or both). Risk is higher with varicose veins/venous insufficiency, previous blood clots (deep vein thrombosis), swelling (oedema), reduced mobility, obesity, and smoking. Many risks can be reduced with early assessment and prevention. Talk to your healthcare professional if you have leg swelling, skin changes, or varicose veins.

Your healthcare professional will look at: where the ulcer is, how it looks, your symptoms (pain, swelling), your medical history and medicines, and the skin around it. They may also do blood-flow tests (for example an ankle/toe pressure test) and often ultrasound to check the veins and/or arteries. Sometimes other tests such as X-rays or blood tests are needed if infection or bone involvement is suspected. Finding the cause is important because treatment depends on it (for example, compression helps many venous ulcers but is not suitable in the same way for severe arterial disease).

Classifying a wound means identifying the main cause (for example venous, arterial, mixed, pressure-related, or diabetic foot ulcer). Some ulcers are caused by both vein and artery problems at the same time (mixed ulcers), which is why careful blood flow assessment is important. This is only one part of assessment— healthcare professionals also look at pain, infection signs, the skin around the wound, swelling, and how well the wound is healing.

In many people with leg ulcers, a simple, painless test is done to check the blood flow to the feet. This may include measuring blood pressure at the ankle or toes (often called ABI or toe pressure).

These tests help your healthcare professional make sure that compression bandages or stockings are safe for you. Compression is very helpful for ulcers caused by vein problems, but if the blood flow in the arteries is too low, compression may need to be adjusted or avoided. The test helps choose the safest and most effective treatment.

 

Main causes

No, but venous insufficiency can cause swelling and skin changes that increase risk. Treatments that reduce swelling and improve circulation (often compression and movement/exercises) can lower the risk. Your healthcare professional may also check whether treating the veins (for example, procedures for venous reflux) could be helpful in your situation.

No. The main reasons foot ulcers happen in diabetes are loss of sensation (neuropathy), reduced blood flow (PAD), foot deformity/pressure points, and small injuries that go unnoticed. Risk is higher if you had a previous ulcer or amputation. Prevention includes daily foot checks, not walking barefoot, well-fitting protective footwear/insoles, and contacting your healthcare professional quickly if you notice a blister, cut, crack, colour change, or swelling.

Pressure ulcers happen when skin and deeper tissue are under pressure or rubbing (shear) for too long, often over bony areas (heels, tailbone, hips). People are at higher risk if they cannot change position, have reduced sensation, have moist skin (incontinence/sweating), poor nutrition, or are very unwell. Some pressure injuries can also be caused by medical devices (for example tubing, masks, casts).

No. Many pressure ulcers can be prevented with a prevention plan: regular repositioning, checking the skin every day, keeping skin clean and dry, managing incontinence/moisture, good nutrition, and using pressure-relieving mattresses or cushions when needed. Healthcare professionals may use a risk assessment tool, but prevention also relies on clinical judgement and daily care.

“Staging” (or “categories”) describes how deep the pressure ulcer is. Early stages may be red skin without an open wound; deeper stages mean deeper tissue damage. Staging helps healthcare professionals plan treatment and monitor healing. If you are worried, ask your healthcare professional to explain what the stage means for your care plan.

Complications & safety

A wound is called infected when bacteria are causing harm, not just when they are present on the skin. Signs that may suggest infection include:

  • Increasing pain
  • Redness spreading around the wound
  • Swelling or warmth
  • Pus or a change in the wound fluid
  • Bad smell
  • Fever or feeling unwell

 

Of note, not all wounds with fluid or smell are infected, but changes over time are important. Also, not all bacteria seen on a swab mean infection; doctors look mainly at clinical signs and symptoms.

In people with diabetes or pressure ulcers, infection may sometimes cause less obvious redness but more pain, swelling, or general illness. If you notice these changes, you should seek medical advice promptly.

You should contact a doctor or nurse quickly if you notice any of the following:

  • Sudden, severe pain in the leg or foot
  • A foot or toes that become very cold, pale, blue, or black
  • Rapidly spreading redness, swelling, or fever
  • Black tissue in the wound
  • New loss of feeling or sudden numbness

 

These signs may mean a serious problem with blood flow or infection and need urgent medical assessment.

Most leg and foot ulcers are caused by circulation problems, pressure, or diabetes. Very rarely, a wound that does not heal as expected may be due to another condition, including skin cancer or inflammatory diseases.

If a wound looks unusual or does not improve despite good care, your healthcare professional may suggest taking a small skin sample (biopsy) to be sure of the diagnosis. This is a routine procedure and helps make sure you receive the right treatment.

Lifestyle and prevention

There are many different risk factors and lifestyle choices which may influence the development of and healing of chronic wounds. In this section we list some of the primary risk and lifestyle factors which you should pay attention to.

If you need further information about any of the items below, ask your healthcare professional for advice.

A well balanced diet is essential for keeping your skin healthy and assist in the wound healing process. Your diet should include (in particular) the following: Vitamins A, B, C & E, iron and zinc, proteins and carbohydrates.

Yes, there is clear evidence in the professional literature indicating that the use of supplements incorporating protein, iron, zinc and vitamin C will enhance both a patient’s cognitive (mental) status as well as his/her wound healing potential. This is especially important for those over 70 years of age.

No. There is clear evidence that covering wounds up with an appropriate dressing product will enhance the wound healing potential by helping to create the ‘ideal’ wound healing environment. Exposing a wound to the open air will both reduce the temperature of the wound surface and dry out the wound. Neither of these help healing.

An appropriate dressing is one that helps to create an ideal wound healing environment  (warm and moist) maintaining a constant temperature (around 37oC) at the wound surface and keeping the wound moist but not soggy. However,  in some specific cases your clinician may advise to keep the wound open or choose a different treatment option.

Yes. Smoking reduces the amount of oxygen arriving at the wound. In addition any scar tissue laid down when the wound heals will be of poorer quality. 

Alcohol consumption should always be in moderation as the excess consumption of alcohol will adversely delay the wound healing process. 

Your healthcare professional can advise you about the variety of materials that can be used to enable you to wear your own shoes. If you have a venous leg ulcer, you will need bandages to heal it, but you can use stockings afterwards that will enable you to wear your own shoes. 

Your wound is closed on the outside, but it may take months before the inside is completely healed. Hydrate your skin so your skin stays moist and smooth. If your healthcare professional prescribed preventive interventions like special stockings, please follow these instructions.  

It will differ, depending on the type of wound, so you need to discuss this with your healthcare professional. There are waterproof dressings available on the market. 

If you or your caregiver is changing your wound dressing, good hand hygiene, including the use of alcohol-based hand rubs and handwashing with soap and water is critical to reduce the risk of spreading bacteria. If in doubt or for further special hygiene precautions, ask your healthcare professional for further advice.

Yes, your body weight can influence the healing of your wound. Significant weight loss or weight gain, as well as inadequate intake of proteins, fluids, energy and vitamins do influence the process of wound healing. 

It will differ, depending on the type of wound, so you need to discuss this with your healthcare professional. There are waterproof dressings available on the market.

Treatment and wound status

If your wound is treated by a healthcare professional and compression therapy is part of the treatment, exercise will be beneficial for wound healing. If no compression therapy is provided, please ask your healthcare professional for specific advice. Rest could be appropriate in this case.

With an arterial ulcer, exercise is recommended as part of the wound treatment. If the ulcer is under pressure during the exercise, ‘off-loading’ (See Wound glossary) is essential. For further advice, please ask your healthcare professional.

With a pressure ulcer, exercise has no negative effect on the wound healing except if the wound is under pressure during the exercise. In that case exercise should be avoided. For further advice, please ask your healthcare professional.

With a burn wound, exercise has no negative effect on the wound healing, except if the wound is under pressure during the exercise. In that case, exercise should be avoided. For further advice, please ask your healthcare professional.

With an acute wound, exercise has no negative effect on the wound healing except if the wound is under pressure during the exercise. In that case, exercise should be avoided. For further advice, please ask your healthcare professional.

With a diabetic foot ulcer, exercise is often recommended as part of the wound treatment. Nevertheless, if your ulcer is under pressure during walking or during the exercise ‘off loading’ (See glossary) is essential. For further advice, please ask your healthcare professional.

Wounds can produce specific odours. This can be related to the dressing, the healing process or infection. If you are worried and/or the odour is present with more wound fluid and/or pain, please contact your healthcare professional. These symptoms can be related to an infection, and specific treatment is recommended in that case. To diminish the odour, some commercial products are available, and these options should be discussed with your healthcare professional.

Wounds may sometimes produce a distinct odour. This can result from the dressing, the normal healing process, or an infection. If you notice an odour accompanied by increased wound exudate and/or pain, or if you are concerned, contact your healthcare professional promptly. These signs may indicate an infection, which requires targeted treatment. To help manage odour, commercial products are available; discuss these options with your healthcare professional.

Many patients or family members are actively involved in wound care, but you need to discuss and plan the wound care/dressing changes with your healthcare professional.

This will depend on the type of wound and type of dressing. Some dressings are designed to stay on for up to a week. If liquid leaks out of the dressing, or if the wound is much more painful than before without specific reason, it is strongly suggested you contact your treating healthcare professional.

The frequency of dressing changes depends on the type of wound and the type of dressing used. Some dressings are designed to remain in place for up to seven days. If you notice fluid leaking from the dressing or if the wound becomes significantly more painful without an obvious reason, it is strongly recommended that you contact your treating healthcare professional.

The wound healing process: re-occurrence, medications, etc.

The major risk factors for a pressure ulcer are pressure with reduced mobility, excessive moisture of the skin, shearing (skin stretching) forces and poor circulation (See glossary). You should alter your position frequently in bed and when in a chair/wheelchair – the frequency of which should be dictated by your discomfort or if you have any neurological impairment as advised by your healthcare professional and use the pressure relieving items (e.g. mattress/cushion/heel protectors) that are selected for you by your healthcare team. Regular inspection and care of your skin care is also very important. If you (or your relative/carer) notice any skin discolouration on your pressure points, report and/or seek a further assessment form your healthcare team.   

The major risk factors for diabetic foot ulcers are poor blood supply, lack of sensation or trauma. It is therefore very important that you inspect your feet daily. If you see any shear, callus, skin break or change of skin colour, you should contact your healthcare professional. One of the most important issues in prevention of an ulcer are your shoes, which should be well fitting and not causing friction or extra heat, and thus sweating of the feet. Also be aware of preventing traumas. Remember to check your shoes to ensure that there is nothing inside before you put them on. It is advisable that whenever you go to buy new footwear, you should get your feet measured at the time to check that your foot shape has not altered (pressure points change) as a result of your medical condition.  Finally, you should be aware that very hot or cold temperatures (for example hot water, car heater or very cold weather) are potential risk factors that may lead to trauma, as lack of sensation in your feet means  you are not alerted to potential dangers (More detailed information about the diabetic foot can be wound at iwgdf.org).

If you have had a venous leg ulcer, you are at risk of developing another one. The most important action to prevent an ulcer is to continue to use your therapeutic compression stocking/bandage or device (e.g. wrap). Good skin care is also important. If you notice any break in your skin, please contact your healthcare professional.

Exercise is beneficial, but you should discuss this with your healthcare professional. If you see any shear, callus (thickened, hyperkeratotic skin, usually on the foot – see glossary), skin break or change of skin colour, you should contact your healthcare professional for advice. One of the most important issues in prevention of an ulcer are your shoes, which should be well fitting and not causing friction and extra heat, and thus sweating of feet. You should be aware that very hot or cold temperatures (for example hot water, car heater or very cold weather) are potential risk factors that may lead to trauma.

Sometimes it can, and it is therefore very important that you inform the healthcare professionals managing your wound care of any medication that you are taking at the first assessment and as soon as possible if you develop further medical conditions and further medications are prescribed.

Both chemotherapy and radiotherapy will affect healthy cells as well as cancer cells. This may have a negative effect on the wound healing. If concerned, do not hesitate to discuss the potential effects with your healthcare professional. 

Steroids will influence wound healing, especially if the doses are high and the medication has been prescribed for a long time. Patients with conditions requiring high dose steroids given for less than 10 days will have no remarkable effect on wound healing. If concerned, do not hesitate to discuss the potential effects with your healthcare professional. 

Some types of pain medication will affect your wound healing. If you are taking pain medication, you should discuss this with your healthcare professional.

Questions you may want to ask your healthcare professional

The answers to the following questions vary across countries. We can therefore not provide a generic answer, but advise that you ask your healthcare professional to answer these.

  • Are all dressings/treatment costs reimbursed?
  • Who will pay for my dressings?
  • When can I go back to work?

Please note that EWMA cannot provide replies concerning individual situations. Consult your healthcare professional if you have specific concerns or questions about your wound. 

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