slowhealing

Slow healing, or delayed wound healing, describes wounds that take longer than expected to close or fail to progress through normal healing. It is a symptom, not a single disease, prompting evaluation for systemic or local factors. It is more common in older people and in those with chronic illnesses such as diabetes, vascular disease, immune suppression, or malnutrition.

Common contributors include poor blood flow (arterial or venous insufficiency), neuropathy, infection, mechanical stress or trauma, smoking, malnutrition, and medications such as corticosteroids.

Pathophysiology includes inadequate perfusion, persistent inflammation, excessive protease activity, and impaired collagen synthesis, hindering progression through the inflammatory, proliferative, and remodeling phases.

Common slow-healing wounds include diabetic foot ulcers, venous leg ulcers, arterial ulcers, pressure injuries, and post-surgical wounds in people with systemic risk factors.

Diagnosis relies on clinical exam, wound measurement, photography, and infection assessment. Laboratory and imaging tests may include HbA1c, nutrition markers, infection screens, and vascular studies such as the ankle-brachial index or duplex ultrasound to assess perfusion.

Management focuses on underlying conditions (glycemic control, smoking cessation, nutrition), appropriate wound care (cleansing, debridement, moisture-balanced dressings), infection management (cultures and targeted antibiotics), and wound-specific measures such as offloading for foot ulcers, compression for venous ulcers, and revascularization for arterial disease. Adequate nutrition supports healing.

Prognosis and prevention: healing improves with timely treatment of contributing factors; recurrence is common. Prevention includes risk-factor modification, proper footwear, regular wound surveillance, and addressing nutrition and hydration.

Research and future directions: biomaterials, growth factors, skin substitutes, negative-pressure therapy, and hyperbaric oxygen are being studied, with varying evidence by wound type.