Why does a chronic wound stop healing?
A chronic wound stops healing because it gets stuck in inflammation, the first stage of the wound healing process, and never moves on to rebuilding. Poor blood flow, high blood sugar, pressure and infection play a part. The book also names overactive enzymes and biofilm. Common chronic wound types include the diabetic foot ulcer, venous leg ulcers and pressure sores.
Key points
- A chronic wound is a wound that will not close. The book names three big chronic wound types: diabetic ulcers, venous leg ulcers and pressure sores.
- Normal wound healing moves from clean up to rebuild. In a chronic wound, the wound healing process gets stuck in inflammation.
- The cleanup cells never flip into rebuild mode. The book says they get locked in that inflammation setting.
- With a diabetic foot ulcer, high blood sugar slowly damages small blood vessels and nerves in the feet and legs, so a small injury can go unnoticed.
- Pressure sores form when pressure squeezes blood vessels between bone and a mattress or chair. When blood rushes back, it can set off more damage.
- Part of the wound healing pathology: enzymes that normally reshape tissue become overactive and break down new tissue before it settles in.
- Biofilm is a slimy shield bacteria build over themselves that hides them from antibiotics and immune cells.
- According to the book, chronic wound treatment starts with the basics: blood flow, blood sugar, infection and pressure relief come first.
- The book talks about PRP, donated birth tissue, mesenchymal stem cells from donated umbilical cord tissue, and exosomes as signals that may help push a stuck wound toward repair.
Chronic Wounds That Will Not Heal
Read the full transcript · Download the MP3 · Voices are AI-generated from a script based on the book.
What is a chronic wound? Types and examples
A chronic wound is one that just will not close. The book says these wounds hurt, can get infected and really limit how people get around. Cleaning the wound, removing dead tissue, antibiotics and pressure relief all remain essential parts of care.
Diabetic foot ulcer
According to the book, high blood sugar slowly damages the small blood vessels, especially in the feet and legs. Diabetes can also hurt the nerves, so people may not feel a minor injury until it has become a serious wound. That mix of weak circulation and less feeling is why these wounds can sneak up on people. Episode 10 covers how diabetes affects the body.
Pressure sores
Pressure sores form when someone stays lying or sitting in one spot too long. The pressure squeezes blood vessels between the bone and the surface underneath, cutting off blood flow. When the pressure comes off and blood rushes back, that sudden rush can create damaging molecules faster than the body can handle them. The book calls it a harmful cycle.
Venous leg ulcers
The book lists venous leg ulcers as the third common type of chronic wound. Like the others, they can stall because of poor circulation, ongoing inflammation and broken-down tissue repair.
Chronic wound healing stages: where the wound healing process gets stuck
Remember the delivery trucks from Episode 1? In a chronic wound, the trucks show up and never leave. The wound stays in the first stage, inflammation, instead of moving on to rebuild.
The cleanup crew never switches jobs
In normal healing, neutrophils arrive first and settle down within days, and macrophages take over. Macrophages clean up, then switch into rebuild mode. The book says that in a chronic wound this switch does not happen, so neutrophils stay active too long and macrophages stay locked in their inflammation setting.
Poor blood flow starves the wound
Not enough blood means not enough oxygen and nutrients reach the wound, and immune cells cannot arrive in large enough numbers. Infection can damage blood vessels further, which makes blood flow even worse. Low oxygen also forces cells to make energy less efficiently, which creates an acidic setting that slows healing.
Building and tearing down at the same time
Enzymes that normally help reshape tissue get overactive and break down new tissue before it can settle in. The natural controls on those enzymes are too weak. The episode compares it to building a sandcastle while the tide keeps coming in.
Biofilm: a shield for bacteria
Biofilm is when bacteria build a slimy shield over themselves. It hides them from antibiotics and from immune cells, which makes these infections hard to clear. The book says some compounds in regenerative therapies may help break down that shield so the bacteria are easier to clear.
What the book says about chronic wound treatment and regenerative medicine
This episode is education. The book talks about early research into regenerative tools that send signals to push a stuck wound out of inflammation and into repair mode. This goes alongside your regular doctor's care, not instead of it.
PRP and growth factors
PRP, or platelet-rich plasma, comes from your own blood and carries concentrated growth factors. These are messages that tell cells it is time to rebuild. The book says some of these signals can help grow new small blood vessels toward areas that are short on oxygen.
Donated birth tissue
The book talks about donated amniotic and placental tissue. The body tends not to reject it, and it can be made into a thin membrane that sits on the wound like a protective dressing that also carries helpful proteins.
Stem cells and exosomes
Mesenchymal stem cells from donated umbilical cord tissue mostly work by sending out signals that may help calm inflammation. Exosomes are tiny messages between cells, and the book calls them the newest frontier in wound care. Because they are so small, the book says they can reach deep into wound tissue.
How it reaches the wound
It depends on the wound. For shallow wounds, the material can go right on top. For deeper wounds, the book says it may be injected around the edges and the base.
What has to be handled first
The book is honest that this approach is not for everybody. Some basics have to be sorted out before any of these signals can do their job.
- Blood flow: if circulation is very poor, the signals cannot even get there.
- Blood sugar: for people with diabetes, blood sugar control matters a great deal.
- Infection: any deep infection has to be treated first.
- Pressure: if you keep pressing on the spot, it will not close. Offloading and the right support surfaces or footwear come first.
Cleaning, pressure relief and the rest of standard wound care stay in place. This podcast is general education, not medical advice.
Chapter 11 in one line
A stuck wound needs its blockers handled first, and then these therapies may help get healing moving again.
Episode 11 transcript.
Read along, or skim the parts you care about most.
EliseOkay so, chapter eleven. And this one's about wounds that just... won't close?
GuideYeah. Chronic wounds.
EliseLike what, exactly?
GuideSo the book talks about three big ones. Diabetic ulcers, venous leg ulcers, and pressure sores.
ElisePressure sores, like from lying in bed too long?
GuideRight. Or sitting in one spot too long. And these are hard, you know, they hurt, they can get infected, and they really limit how people get around.
EliseMm-hm. So why do they get stuck?
GuideRemember the delivery trucks from chapter one? Inflammation?
EliseThe trucks, yes.
GuideSo in a chronic wound, the trucks show up... and they just never leave.
EliseOh no.
GuideThe wound gets stuck in that first phase. It never moves on to rebuilding.
EliseSo the cleanup crew never flips into rebuild mode?
GuideRight. The book says they get locked in that inflammation setting.
EliseAnd why does that happen?
GuideA few things, all feeding each other. Poor blood flow is a big one. Not enough oxygen, not enough nutrients getting to the wound.
EliseOkay.
GuideAnd with diabetes, the book says high blood sugar slowly damages the small blood vessels. Especially in the feet and legs.
EliseHuh.
GuideAnd it can hurt the nerves too. So people don't even feel a small injury until it's, like, a serious wound.
EliseWait, that's scary. You just... don't notice?
GuideRight. That's why it sneaks up on people.
EliseAnd pressure sores?
GuideSo the pressure squeezes the blood vessels between the bone and, like, the mattress. Cuts off the blood. Then when the pressure comes off and blood rushes back in—
EliseThat's good, right?
GuideYou'd think! But that sudden rush can actually set off more damage. The book calls it a harmful cycle.
EliseOkay, so it's not just one problem.
GuideNo, it's a pileup. And there's one more piece. Enzymes that normally help reshape tissue get overactive. They break down the new tissue before it can settle in.
EliseSo it builds a little and then it gets torn down again.
GuideExactly. Like building a sandcastle while the tide keeps coming in.
EliseUgh. Okay, so where does regenerative medicine come in?
GuideSo the book says the idea is to send signals that push the wound out of that stuck mode and into repair mode.
EliseSignals like what?
GuidePRP is one. Platelet-rich plasma, from your own blood. It carries concentrated growth factors, and those are basically messages telling cells, okay, time to rebuild.
EliseRight, we talked about that.
GuideYep. And some of those signals can help grow new little blood vessels toward the areas that aren't getting enough oxygen.
EliseOh, so it goes after the blood flow problem.
GuideThat's the idea. Then there's donated tissue. The book talks about amniotic and placental tissue.
EliseLike from a birth?
GuideYeah, donated birth tissue. The body tends not to reject it. And it can be made into a thin membrane that sits on the wound, sort of like a protective dressing that also carries helpful proteins.
EliseOh, that's clever. And stem cells?
GuideSo, mesenchymal stem cells mostly work by sending out signals that may help calm the inflammation down. And exosomes, those tiny messages, the book calls them the newest frontier in wound care.
EliseHow do they actually get it into the wound?
GuideDepends on the wound. Shallow ones, it can go right on top. Deeper ones, the book says it may be injected around the edges and the base.
EliseMakes sense. Okay, what about infection? 'Cause that seems like the big worry.
GuideIt is. And here's a word I love. Biofilm.
EliseBiofilm?
GuideIt's when bacteria build, like, a slimy shield over themselves. It hides them from antibiotics and from your immune cells.
EliseGross. Like a little fort.
GuidePretty much. And the book says some of the compounds in these therapies may help break down that shield and make the bacteria easier to clear.
EliseOkay, so is this for everybody?
GuideNo, and I really like that the book is honest about this. There's stuff that has to be handled first.
EliseLike what?
GuideBlood flow. If circulation is really poor, those signals can't even get there. Blood sugar, for people with diabetes. Any deep infection has to be treated first. And pressure. If you keep pressing on the spot, it won't close, period.
EliseSo you can't just skip the basics.
GuideRight. And this goes alongside your regular doctor's care, not instead of it. Cleaning, pressure relief, all that stays.
EliseGot it. So sum up chapter eleven for me?
GuideA stuck wound needs its blockers handled first, and then these therapies may help get healing moving again.
EliseI like that. And, quick reminder, this is general info, not medical advice. Talk to your own provider.
GuideAlways.
This is general information, not medical advice. Talk to your own provider.
Frequently asked questions.
What is a chronic wound?
A chronic wound is a wound that does not move through normal healing and will not close. According to the book, the most common types are diabetic ulcers, venous leg ulcers and pressure sores.
What are the stages of wound healing, and where do chronic wounds get stuck?
Healing moves from clean up (inflammation) to rebuild to remodel. A chronic wound gets stuck in inflammation. The cleanup cells never switch into rebuild mode, so the wound cannot move forward.
Why are diabetic foot ulcers so hard to heal?
The book says high blood sugar slowly damages the small blood vessels and nerves in the feet and legs. Less blood flow slows healing, and less feeling means a small injury may not be noticed until it is serious.
What is biofilm in a wound?
Biofilm is a slimy shield that bacteria build over themselves. It hides them from antibiotics and immune cells. The book says some compounds in regenerative therapies may help break it down.
What goes wrong in wound healing pathology?
In a chronic wound, several problems feed each other. According to the book, cleanup cells stay locked in inflammation, poor blood flow starves the wound of oxygen and nutrients, overactive enzymes break down new tissue before it settles, and biofilm can shield bacteria from antibiotics and immune cells.
What does chronic wound treatment have to address first?
According to the book: blood flow, blood sugar for people with diabetes, any deep infection, and pressure on the wound. These go alongside your regular doctor's care, not instead of it.
Where is Beyond Stem Cells located?
Beyond Stem Cells is at 5912 S Cody St, Suite 201, Littleton, CO 80123, serving the Denver metro. This podcast is general education, not medical advice.
Want to learn more about the regenerative medicine ideas behind this episode? Read about regenerative medicine at Beyond Stem Cells, exosomes, mesenchymal stem cells, our medical team, how the body heals in Episode 1, type 1 vs type 2 diabetes in Episode 10, IRB-approved regenerative medicine in Littleton.
Further reading: National Institute of Diabetes and Digestive and Kidney Diseases: diabetes and foot problems.
Want the whole book? Get the free Beyond Stem Cells book.
Regenerative care in Littleton and the Denver metro.
Beyond Stem Cells sits just off S Cody St in Littleton, an easy drive from Ken Caryl, Highlands Ranch, Centennial, Englewood and Lakewood.
Questions about your own situation?
The podcast is general education. If you want to talk about your own health, request a consultation with our team.
Beyond Stem Cells · 5912 S Cody St, Suite 201, Littleton, CO 80123 · (833) 720-7836 · info@beyondstemcells.com
Medical disclaimer: This page is general education based on the book Beyond Stem Cells by John Comandari and Neville Campbell, MD. It is not medical advice. Individual results vary and no specific outcome is promised. Talk to your own provider about your situation.