What a non-healing wound is
A non-healing wound is one that has stopped making progress. Gateway arranges non-healing wound care in St. Louis and the Metro East with partner clinicians who can reassess the wound where you live.
The wound may have shrunk for a while and then stalled, closed and reopened, or stayed about the same for weeks or months. Clinicians often call these chronic wounds. The term describes a pattern, not a cause: it could be a pressure injury, a leg or foot ulcer, a surgical incision or an injury that never fully closed.
Wounds normally move through the stages described in how wounds heal. A stalled wound gets stuck partway. Signs include a size that does not change between visits, edges that look thick or rolled, and tissue that is pale or dull.
If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.
Why a wound stops healing
There is usually more than one reason. Barriers that clinicians commonly look for:
- Pressure or rubbing that has not been relieved
- Poor blood flow
- Swelling that has not been controlled
- Infection, or bacteria that slow repair without obvious signs
- Dead or unhealthy tissue left in the wound
- High blood sugar, low protein intake or dehydration
- Tobacco use, and some medications or treatments that slow repair
- A cause that was missed, such as an inflammatory condition or a skin cancer
- Practical problems: supplies running out, a dressing that is too hard to manage, or missed visits because of transportation
Our guide to why some wounds heal slowly goes through each one.
What the treating clinician considers
A reassessment starts with the history: how the wound began, how long it has been open, what has been tried and how the wound responded. Measurements over time matter more than any single visit, because they show the direction the wound is heading.
The clinician then looks for the cause and for barriers that have not been addressed. That may lead to circulation testing, lab work, a culture or a small tissue sample when a wound does not behave as expected. Some wounds turn out to be atypical or inflammatory wounds that need a different approach.
The clinician may then change the plan: removing unhealthy tissue, a different dressing, compression or pressure relief, a specialist referral, or therapies described on our advanced wound care page. What is appropriate is the clinician’s decision.
Non-healing wound care at home and in facilities
Seeing the wound where you live can reveal barriers a clinic visit misses: the chair you sleep in, the shoes by the door, how supplies are stored and who helps with dressings.
In skilled nursing, assisted living and memory care, the partner clinician reviews the wound with the nursing team and looks at what happens between visits, including repositioning, dressing changes and nutrition.
How primary care factors in
Diabetes, heart and kidney conditions, anemia, weight loss and circulation problems are all managed in primary care, and each affects how the body repairs skin.
Our guide to medications that can affect healing lists the common ones. Do not stop or change a medication on your own; ask the prescriber to review your list with the wound in mind. If you have no regular clinician, Gateway can arrange primary care and wound care together.
Changes to report and when to call 911
Tell the treating clinician about:
- Redness, warmth or swelling that is new or spreading
- More drainage, a change in its color, or a new odor
- New or increasing pain
- The wound getting larger or deeper, or new dark tissue
- Fever, chills or feeling generally unwell
- Bleeding that is new or happens easily
Call 911 for bleeding that will not stop with firm pressure, trouble breathing, chest pain, sudden confusion, or a limb that suddenly turns cold, pale or blue.
How Gateway helps arrange non-healing wound care
People with a long-standing wound have usually told the story to many offices. Gateway’s aim is to collect that history and get it to the treating clinician before the visit. Our checklist of wound care records to gather shows what helps most, and we can request records from earlier clinics, hospitals and home health agencies.
Call 314-325-0126 or request care online with a name and phone number only. You do not need a referral, and you do not have to leave your current clinician to ask for a second opinion wound review. We confirm visit availability for your location and care setting, schedule with a partner clinician, and follow up on orders and supplies.
Signs a wound is not healing
Every wound heals at its own pace, but some patterns mean it is time for a clinician to take a closer look:
- the wound is about the same size after two to four weeks of care
- it heals over and then opens again in the same place
- the edges are rolled, thickened or raised, or the base looks pale, gray or yellow instead of pink-red
- drainage is increasing, or there is a new smell
- pain is getting worse, or a wound that used to hurt has gone numb
- the skin around it is changing color, hardening or breaking down
None of these mean the wound will never heal. They mean the current plan is not working and something underneath needs to be found.
Common reasons wounds stall in older adults
A stalled wound almost always has a reason, and in older adults there is often more than one. The most common are poor blood flow to the legs and feet, blood sugar that runs high, swelling that has not been controlled, pressure that keeps landing on the same spot, low protein intake, infection, and medications such as steroids that slow tissue repair.
Finding the reason is the clinician's job. Our guides on why some wounds heal slowly, wound care and blood sugar and peripheral artery disease and foot wounds explain each one, and wound care for seniors covers how they add up in older adults.
Second opinion on a wound
If a wound has been treated for weeks without real progress, a second look from a different clinician can help. A fresh assessment may find a reason that was missed, or confirm the current plan and explain why healing is slow. Gateway can arrange a second opinion wound review at home or in senior living, and the findings are shared with the patient's existing doctors so nobody is working at cross purposes.
Visits may be made by a physician, a podiatrist (DPM) or a nurse practitioner, depending on the wound. See a wound care specialist who comes to your home.
Non-healing wound care by county
Gateway arranges visits for non-healing wounds at home and in senior living across Greater St. Louis and the Metro East. Choose your county:
Common questions
How long is too long for a wound to stay open?
There is no single cutoff, because wounds differ in size, cause and location. The trend is more useful than the calendar. A wound that is steadily getting smaller is on track even if progress is slow. A wound that has not clearly changed after several weeks of consistent care, or that is getting larger, is worth a reassessment.
Does a wound that will not heal always mean infection?
No. Infection is one possible reason, but pressure, poor blood flow, swelling and blood sugar are just as common, and several may be present together. A wound can also be infected without the classic redness and warmth, especially in people with diabetes or poor circulation, so it needs a clinician’s examination.
What should I have ready before the first visit?
A short written timeline helps: when the wound started, what caused it if you know, which dressings and treatments have been used and what happened with each. Add a current medication list, the names of clinicians and agencies involved, and any recent test results or discharge papers.
Can I get another opinion and keep my current wound clinic?
Yes. A second review does not require you to change clinicians. With your permission, findings can be shared with your current wound clinic, surgeon or primary care clinician so they can decide together what to adjust. Tell us which offices should receive the notes.
How long is too long for a wound to heal?
There is no single number, but a wound that has not clearly improved after two to four weeks of good care should be looked at again by a clinician. Waiting longer usually makes the underlying problem harder to fix.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.