In some cases, such as addiction to bed, diabetes or vascular insufficiency, especially in geriatric patients, wounds are called as chronic wound which do not heal for 6 weeks or more despite all care and treatment. Because of the difficulties in the blood circulation in the wound area, the oxygen, nutrients, wound healing cells which are required for for wound healing cannot move to the injured area. In this case, the healing does not occur and even the wound can be worsened. Healing process can be deteriorated due to reasons such as nutritional disorders, some drugs used, infection, insufficient care and neglect etc…


  1. Bed sores (Pressure ulcer, decubitus ulcer) – Local or localized skin and/or subcutaneous tissue damage, usually caused by alone or together combination of pressure or laceration especially on bone protrusions .(NPUAP-EPUAP)
  2. Diabetic foot injury – open wounds in feet caused by distortion in nerves and veins due to diabetes
  3. Arterial ulcers. arterial wounds which occurred by blockage in leg veins
  4. Venous ulcers – venous wounds which occurred by insufficiency of leg weins which is around ankle and on the leg.
  5. Surgical wounds or non-healing wounds after an accident – The wounds that ocur after surgical intervention and trauma.


Stage 1: Skin is intact with non-blanchable redness of a localized area usually over a bony prominence *
Stage 2: Although the staging system was designed only for pressure ulcers, the Stage II definition lacked clarity to differentiate true Stage II pressure ulcers from other wound etiologies, which pressure redistribution alone would not improve .*
Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. may include undermining and tunneling. *
Stage 4: Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.*



Treatment of chronic wounds is only possible with a professional approach. Especially effective patient and skin care can prevent bed sores. Positioning, the use of effective care products, adequate and balanced nutrition with abundant protein is very important for both preventing wound and rapid closing of wounds. Skin cleansing and care should be done with more care, the skin should not be too dry and should not remain wet. The bed-dependent patient should be surely observed for the skin integrity and risk of bed wound formation once a day. Measures should be taken when erythema is seen firstly (Stage 1).

For opened wounds, first of all, the physician should be consulted and the treatment and recommendations to be applied should be strictly followed. To take no action in the early stage of the treatment, and disruption of the treatment causes long-term treatment and this may causes loss of money and limb (Amputation). Therefore, it is very important to get professional support for people in the risk group. Daily monitoring of the patient and every change in skin integrity should be considered. Otherwise, the chance of treatment decreases and unnecessary time and money will be lost.

Right accurate analysis of the wound is essential in before treatment, because of such factors as diversity in professional products, application difficulties, access to treatment and cost. treatment process is affected by using the right product and method in the right place and time . For selecting correct treatment method, accurate staging of the wound, correct definition of exudate (discharge), cavity, infection, necrotic tissue features are necessary . The inclusion of the patient relatives to the treatment process is important in right resuming of treatment process



Necrotic tissues (necrosis) are structures that are frequently encountered in chronic wounds and are the result of the death of tissues in that region. Removal of necrotic tissues constitutes the first stage of treatment. Surgical debridement, autolytic or enzymatic debridement or biological debridement techniques are applied to clear these structures. Although biological debridement is not preferred because of the difficulty of application, surgical debridement cannot be performed due to the lack of surgical intervention or patient-related reasons. Autolytic debridement is a method that is widely used because of the easy application and safe, the lack of bleeding risk, no need of anesthesia and easy application in every environment. There are many autolytic debridement products that contain bromelain or collagenase, although their commercial forms vary.


Infection control (cleaning of biofilm):

Uncontrolled infection prevents the healing of the wounds but also affects the general condition of the patient. There are additional difficulties in general care due to exudate and bad smell. Applying of an effective infection control process is one of the important stages of the healing process.


Supporting granulation and epithelization:

Granulation should be supported after debridement of the wound bed and removal of the infection. At this stage, vacuum assisted closure (VAC) procedure is widely used in cavitated and abundant wounds. This method may remove exudate, at the same time, it increases blood circulation and nutrition, it is possible to accelerate the healing process due to the increase in vascularization and nutrition. However, the success of the system depends on the good cleaning of the wound bed, the quality of the applied material and the accuracy of the pressure. However, products should be used that increase the synthesis of collagen,help the fibroblast migration and help increasing the blood circulation in the region .


Finally, it is possible to completely close the wound, with products that support epithelization or surgical techniques such as graft and flaps.