nonhealing

Nonhealing is a clinical term used to describe a wound or lesion that fails to progress through the normal stages of healing within a clinically expected time frame. Such wounds may remain open, continue to drain, or recur after temporary closure. The term is commonly applied in wound care, dermatology, and geriatrics.

Common forms include chronic wounds such as venous ulcers, arterial ulcers, diabetic foot ulcers, and pressure ulcers, but nonhealing can refer to poor healing after surgery or burns as well.

Causes are multifactorial and include systemic conditions (diabetes, vascular disease, malnutrition, anemia, immunosuppression, aging), local factors (infection, necrotic tissue, biofilm, foreign material), ischemia, and mechanical stress (repetitive pressure or trauma). Medications such as corticosteroids may impair healing.

Assessment involves history and examination of wound characteristics, measurement, assessment of perfusion, and screening for infection. Investigations may include imaging to detect deeper infection or osteomyelitis and vascular studies when ischemia is suspected.

Management focuses on addressing underlying causes, promoting a suitable wound bed, and protecting the surrounding skin. Key steps include debridement of nonviable tissue, infection control, moisture and temperature balance, adequate nutrition, and offloading or pressure relief when needed. In selected cases, advanced therapies such as negative-pressure wound therapy, topical antimicrobials, skin substitutes, or vascular intervention may be used.

The prognosis varies with cause and comorbidity. Without correction of contributing factors, nonhealing wounds carry risks of infection, deterioration, chronic pain, and, in the lower limbs, possible amputation.