Wound care

Also called Chronic wounds, Leg ulcers

Around 3.8 million people treated for a wound each year in the UK. Most chronic wounds fail to heal for a findable reason.

What it is

Wound care consumes a substantial share of community nursing time and a large share of the NHS budget, and it is one of the areas where practice and evidence diverge most.

A wound that has not healed in four weeks is a chronic wound, and it almost always has a reason: poor blood supply, infection, pressure, poor nutrition, uncontrolled diabetes, or the wrong treatment applied consistently.

The commonest chronic wounds are venous leg ulcers, pressure ulcers, and diabetic foot ulcers. Each needs a different approach, and treating them alike is the commonest error.

Signs you might notice

A wound not measurably smaller after four weeks.

Increasing pain, smell, or exudate soaking through dressings faster than before.

Spreading redness, heat and swelling, which suggests cellulitis.

Black or yellow tissue in the wound bed. Undermined edges.

Feeling unwell, feverish or confused, which in an older person with a wound means think sepsis.

How it can affect day-to-day life

Venous leg ulcers are the clearest example of evidence not reaching practice. Compression therapy heals them; without compression they persist for years. Yet a large proportion of people with venous ulcers are not in adequate compression, usually because nobody has done the ankle brachial pressure index to check it is safe.

Pain is under-treated. Dressing changes on a chronic wound hurt, and pre-emptive analgesia is often not offered.

Living with a chronic wound is isolating: leakage, smell and immobility all keep people at home.

Supporting someone well

Ask what the cause is, not just what the dressing is. A wound that is not healing needs a reassessed diagnosis, not another product.

For a leg ulcer, ask whether an ABPI has been done and whether compression is in place. Those two questions change outcomes more than any dressing choice.

Offer pain relief before dressing changes, not after.

Feed people. Protein, calories, vitamin C and zinc are what build tissue, and malnutrition stalls healing completely.

Take photographs and measurements at each change, so progress is measured rather than remembered.

Never treat a diabetic foot ulcer casually. It needs specialist podiatry within 24 hours, because the pathway from ulcer to amputation is short.

Fiducia Together keeps wound assessments, photographs and skin integrity in the clinical record, so a wound that has not changed in six weeks is visible as a trend rather than as a series of separate dressing entries.

Where to get help

A district nurse or practice nurse manages most wounds. Ask for tissue viability referral for anything not healing.

Diabetic foot problems need urgent specialist assessment: ask for the multidisciplinary foot team.

Spreading redness, fever or feeling unwell needs same-day medical attention.