Non healing wounds

Similar to abscesses, nonhealing wounds typically involve an underlying issue. These tend to appear in two different forms.

Incomplete granulation

If granulation tissue is not covering the wound and/or drainage is noted:

• foreign body – remnant from the original trauma or suture material from the repair

• lack of ventral drainage – a pocket or tract that is being forced to drain upwards
• sequestrum – fragment of bone serving as a foreign body
• damaged or decaying tissue – tendon fragments, etc
• flow of fluid (milk, synovial fluid, urine) – fluid flow acts to keep the pathway open

Evaluation includes ultrasonographical examination, wound probes and surgical exploration.

For most, treatment involves removing the foreign body and/or creating ventral drainage. En bloc resection of the entire tract may be performed if drainage is persistent but a source cannot be identified.

Incomplete epithelialization

If the granulation bed is complete but epithelialization has stalled, consider:

• motion – especially wounds over joints
• continued trauma

If the limb wound has covered in granulation tissue but not skin, skin grafting is recommended.  If the area is repeatedly traumatized, bandaging may be required (with concomitant proud flesh management).