Non-Healing Wounds & Ulcers

Successful treatment depends on identifying and correcting the underlying cause, not just dressing the surface.

Arterial ulcers

Arterial ulcers typically occur on the toes, heels or pressure points. They are often painful, dry and sharply defined, in a cool foot with weak or absent pulses. Restoring blood flow may be essential before healing can occur.

Venous ulcers

Venous ulcers usually develop around the lower calf or ankle, often with swelling, pigmentation, eczema and varicose veins. Compression is the cornerstone of treatment once adequate arterial circulation has been confirmed.

Diabetic and pressure ulcers

Neuropathy and pressure commonly cause ulcers under the foot or over bony prominences. Offloading and infection control are essential, and vascular assessment establishes whether reduced circulation is also contributing.

Features that should prompt urgent review include increasing size, persistent drainage, odour, spreading surrounding redness, marked swelling, severe pain, exposed deep tissue, blackened areas, fever, or repeated breakdown after apparent healing.

Rapid deterioration or signs of spreading infection with fever should be assessed the same day, through an emergency department or Triple Zero (000) if the patient is unwell.

Determining the cause

Assessment starts with the wound history and a search for the cause: pulses, venous signs, sensation, pressure points, medications, nutrition and conditions such as diabetes or autoimmune disease. Wound cultures and blood tests guide infection treatment, imaging is arranged when bone infection is suspected, and biopsy is considered for atypical or very longstanding wounds.

Circulation testing

Circulation is tested objectively with ankle and toe pressure measurements and duplex ultrasound. CT angiography maps arterial disease when revascularisation is being considered, and venous ultrasound identifies reflux or obstruction.

Wound care

Care may involve cleaning, debridement, moisture-balancing dressings and management of bacterial burden, with dressing choices adjusted as the wound evolves.

Compression

Compression bandaging or stockings reduce venous hypertension and swelling, but must not be applied at full strength until significant arterial disease has been excluded; compressing a severely ischaemic limb can cause real harm.

Revascularisation

Angioplasty, stenting or bypass surgery can restore enough circulation for an ischaemic wound to heal and for infection to be controlled. The approach, endovascular, open or combined, is selected on anatomy, urgency and durability for the individual patient.

Treating venous reflux

Endovenous ablation or sclerotherapy can support healing and reduce recurrence when superficial venous reflux is contributing to the ulcer.

Untreated ulcers can progress to cellulitis, bone infection, sepsis, chronic pain and limb loss, and treating the surface without correcting the circulation usually fails. After healing, ongoing skin care, appropriately fitted compression for venous disease and management of arterial risk factors reduce recurrence. Patients should re-present early if a healed area breaks down again.

A non-healing wound should be approached by identifying why repair has stalled. The consultation should clarify whether arterial disease, venous hypertension, diabetes, pressure, infection, inflammation or several factors are contributing. Objective circulation testing is particularly important before strong compression or major wound procedures are undertaken.

The treatment plan may combine dressings, debridement, pressure relief, infection management, compression and a procedure to improve arterial or venous circulation. Patients should understand which element is addressing the underlying cause and how progress will be measured. A wound that is becoming smaller, less inflamed and less exudative is generally moving in the right direction, whereas increasing pain, odour, redness, drainage or black tissue warrants prompt review.

Bring a list of dressings and antibiotics already used, along with photographs showing how the wound has changed over time. Even after healing, recurrence prevention may require compression, protective footwear, skin care, diabetes management or vascular surveillance. Treating the surface alone is rarely sufficient when the underlying circulation or pressure problem remains.

Yarra Vascular Surgeons investigates the vascular causes of chronic wounds with objective circulation testing and ultrasound, and offers arterial and venous intervention alongside structured wound care to give stalled ulcers the conditions they need to heal.

A wound that does not heal requires investigation of the underlying cause, including arterial disease, venous hypertension, diabetes, pressure and infection. Yarra Vascular Surgeons provides circulation testing, vascular ultrasound and access to arterial and venous intervention. Treating the vascular problem alongside appropriate wound care can improve healing prospects and reduce recurrence, infection and limb-threatening complications.