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Signes mauvaise cicatrisation plaie.

What are the signs of poor wound healing?

Most injuries, regardless of their cause, heal without difficulty. However, for various reasons, the healing process does not always go as planned. Sometimes, a wound takes a long time to heal, does not improve, becomes infected, or completely stops healing. Therefore, it is important to pay attention to the signs of a chronic wound and to know whether your wound is healing correctly or not. In this article, we provide a list of signs of complicated healing.

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Slow and difficult healing: what are the signs?

A wound that is healing normally is red, warm, shiny, and possibly swollen. However, in some cases, the healing process is slow or difficult and presents certain distinct symptoms that should not be taken for granted.

  • A change in colour: all wounds of a colour other than red/pink do not heal normally. Indeed, when a wound turns black, it indicates the presence of necrotic tissue on the wound bed (non-viable tissue due to reduced blood supply), which hinders healing. If the wound appears yellowish, this signifies the presence of fibrinous tissue. This tissue is avascular and healing will only continue once it has been removed. Furthermore, these necrotic tissues can also harbour pathogenic microorganisms. On the other hand, if it is green, then your wound has contracted an infection that slows down the healing process.

  • An unusual odour: wounds should not have a noticeable smell, but if they emit a foul odour, this is a sign of a wound that is not healing. This distinct and unpleasant smell indicates dead tissue or an infection by anaerobic bacteria.

  • A significant swelling: if you notice that the area near the wound swells after the initial days, this is a sign of a bacterial infection, venous insufficiency, deep vein thrombosis or a lymphatic disorder.

  • Continuous bleeding: Bleeding is a natural phenomenon, but if the blood continues to flow after a certain period of time or despite direct pressure applied to the wound, you should consult a healthcare professional.

  • A compromise to the wound's periphery: Darkening of the skin around a wound's edges may indicate that the tissues are not receiving enough oxygen and are dying. Similarly, if the surrounding skin continues to be red, inflamed, and swollen, even after 4 to 5 days post-injury, this is a tell-tale sign of a fungal infection (intertrigo). Indeed, this area is prone to maceration and is the result of a combination of friction and stagnant moisture.

  • Wound discharge: An aqueous and clear yellow liquid is normal at the beginning of the healing process, but a purulent, thick, yellowish/greenish discharge with a pungent smell is a sign of a bacterial, viral or fungal infection at the wound site.

  • An escalating pain: it is normal to experience pain during the initial stages of the healing process or intermittently related to the removal of the dressing for example. However, prolonged or severe pain, or pain that persists even after the administration of a painkiller, is a sign of an underlying condition, such as ischemia, neuropathy, tissue oedema, chronic tissue damage, or an infection.

  • Fever: Following an injury, it is normal for a patient to experience a slight fever. However, a high and persistent fever, which may be associated with body aches, is a sign of infection.

If you are suffering from a wound that shows no signs of improvement or progress within the usual timeframe of four weeks, due to several underlying causes, and you exhibit any of these symptoms, do not hesitate to consult a doctor so they can assess the severity of the lesion and propose a treatment option. If left untreated, chronic wounds can lead to complications. Even minor injuries can become infected and turn out to be far worse than the initial wound.

Sources

  • HARDING K. G. & al. Wound assessment. BMJ (2006).

  • STAWICKI S. P. & al. Impaired wound healing. StatPearls (2022).

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