Though treatment of the different chronic wound types varies slightly, appropriate treatment seeks to address the problems at the root of chronic wounds, including ischemia, bacterial load, and imbalance of proteases. There is insufficient evidence to use silver-containing dressings or topical agents for the treatment of infected or contaminated chronic wounds. For infected wounds, the following antibiotics are often used (if organisms are susceptible) as oral therapy due to their high bioavailability and good penetration into soft tissues: ciprofloxacin, clindamycin, minocycline, linezolid, moxifloxacin, and trimethoprim-sulfamethoxazole. The challenge of any treatment is to address as many adverse factors as possible simultaneously, so each of them receives equal attention and does not continue to impede healing as the treatment progresses.
Preventing and treating infection To lower the bacterial count in wounds, therapists may use topical
antibiotics, which kill bacteria and can also help by keeping the wound environment moist, which is important for speeding the healing of chronic wounds. that rely on properties of
smart polymers sensitive to changes in humidity levels. The dressing delivers absorption or hydration as needed over each independent wound area and aids in the natural process of
autolytic debridement. It effectively removes liquefied slough and necrotic tissue, disintegrated bacterial
biofilm as well as harmful exudate components, known to slow the healing process. The treatment also reduces bacterial load by effective evacuation and immobilization of microorganisms from the wound bed, and subsequent chemical binding of available water that is necessary for their replication. Self-adaptive dressings protect periwound skin from extrinsic factors and infection while regulating moisture balance over vulnerable skin around the wound.
Treating trauma and painful wounds Persistent
chronic pain associated with non-healing wounds is caused by tissue (
nociceptive) or nerve (
neuropathic) damage and is influenced by dressing changes and chronic
inflammation. Chronic wounds take a long time to heal and patients can experience chronic wounds for many years. Chronic wound healing may be compromised by coexisting underlying conditions, such as
venous valve backflow,
peripheral vascular disease, uncontrolled edema and
diabetes mellitus. If wound
pain is not assessed and documented it may be ignored and/or not addressed properly. It is important to remember that increased wound pain may be an indicator of wound complications that need treatment, and therefore practitioners must constantly reassess the wound as well as the associated pain. Optimal management of wounds requires holistic assessment. Documentation of the patient's pain experience is critical and may range from the use of a patient diary, (which should be patient driven), to recording pain entirely by the healthcare professional or caregiver. Effective communication between the patient and the healthcare team is fundamental to this holistic approach. The more frequently healthcare professionals measure pain, the greater the likelihood of introducing or changing pain management practices. At present there are few local options for the treatment of persistent pain, whilst managing the exudate levels present in many chronic wounds. Important properties of such local options are that they provide an optimal wound healing environment, while providing a constant local low dose release of ibuprofen while worn. If local treatment does not provide adequate pain reduction, it may be necessary for patients with chronic painful wounds to be prescribed additional systemic treatment for the physical component of their pain. Clinicians should consult with their prescribing colleagues referring to the WHO pain relief ladder of systemic treatment options for guidance. For every pharmacological intervention there are possible benefits and adverse events that the prescribing clinician will need to consider in conjunction with the wound care treatment team.
Ischemia and hypoxia Blood vessels constrict in tissue that becomes cold and dilate in warm tissue, altering blood flow to the area. Thus keeping the tissues warm is probably necessary to fight both infection and ischemia. In addition to killing bacteria, higher oxygen content in tissues speeds growth factor production, fibroblast growth, and
angiogenesis.
Growth factors and hormones Since chronic wounds underexpress growth factors necessary for healing tissue, chronic wound healing may be speeded by replacing or stimulating those factors and by preventing the excessive formation of proteases like elastase that break them down. Another way is to spread onto the wound a gel of the patient's own
blood platelets, which then secrete growth factors such as
vascular endothelial growth factor (VEGF),
insulin-like growth factor 1–2 (IGF), PDGF,
transforming growth factor-β (TGF-β), and
epidermal growth factor (EGF). Since levels of
protease inhibitors are lowered in chronic wounds, some researchers are seeking ways to heal tissues by replacing these inhibitors in them.
Secretory leukocyte protease inhibitor (SLPI), which inhibits not only proteases but also inflammation and microorganisms like
viruses, bacteria, and
fungi, may prove to be an effective treatment. Research into
hormones and wound healing has shown
estrogen to speed wound healing in elderly humans and in animals that have had their
ovaries removed, possibly by preventing excess neutrophils from entering the wound and releasing elastase. Thus the use of estrogen is a future possibility for treating chronic wounds. ==Epidemiology==