What Is a Wound?

A wound is any break in the skin or deeper tissue caused by injury, surgery, or a disease process. Wounds range from small cuts and surgical incisions to pressure injuries, diabetic foot ulcers, and complex chronic ulcers that fail to heal. Understanding what a wound is, how wounds normally heal, and why some wounds stall helps clinicians choose the right tests and treatments and helps patients take useful steps to support recovery.

This plain-language guide explains wound types, the normal healing process, why some wounds become chronic, basic assessment points, and practical first steps for care.

Types of wounds

• Acute wounds: caused by sudden trauma (cuts, burns, surgical incisions). These typically move through an orderly healing process and close in days to weeks with appropriate care.

• Chronic wounds: wounds that fail to progress through normal healing within an expected time (commonly described as not improving after 4–12 weeks). Chronic wounds include diabetic foot ulcers, venous leg ulcers, and many pressure injuries. Chronic wounds often need specialist assessment.

• Pressure injuries (pressure ulcers): caused by prolonged pressure and shear, often over bony areas in immobile patients. These range from non-blanching redness to deep tissue loss.

• Neuropathic/diabetic foot ulcers: result from neuropathy, repetitive trauma, and often poor perfusion in people with diabetes. These are high-risk wounds because of infection and limb-loss risk.
  
  

Using the correct label (acute vs chronic, neuropathic vs ischemic) matters because it directs evaluation and management.

How wounds normally heal — the four overlapping phases

Wound healing is a coordinated, multi-cellular process usually described in four overlapping phases:

1. Hemostasis: immediate blood clotting to stop bleeding and form a provisional matrix.

2. Inflammation: immune cells clean debris and fight microbes; cytokines and growth factors orchestrate the next steps. This phase usually lasts days.

3. Proliferation: fibroblasts, endothelial cells, and keratinocytes build granulation tissue, new blood vessels form (angiogenesis), and the wound starts to contract and re-epithelialize. This phase can last weeks.

4. Remodeling (maturation): collagen reorganizes and the tissue gradually gains strength; this phase can continue for months.
   
   

Each phase depends on specific cells, nutrients, and a suitable wound environment. Interruptions in oxygen delivery, infection control, or nutrition can delay progress and push a wound into a chronic state.

What makes a wound “chronic”?

There isn’t a single universal cutoff, but wounds are often considered chronic when they do not show meaningful progress after several weeks of appropriate care (commonly 4–12 weeks), or when they lack a 20–40% reduction in area after 2–4 weeks of optimal therapy. Chronic wounds commonly share problems such as persistent inflammation, biofilm or repeated infection, poor perfusion (ischemia), neuropathy, or systemic issues like malnutrition and uncontrolled diabetes.

Chronic wounds are a major health burden in many countries and often require multidisciplinary care (vascular, infectious disease, podiatry, wound nursing, nutrition).

Basic wound assessment — what to check first

When you encounter a wound, a focused assessment saves time and guides treatment. Key items include:

• History: how and when the wound started, prior treatments, smoking, diabetes, vascular disease, medications (steroids, immunosuppressants).

• Appearance: size (length × width × depth), wound bed tissue (granulation, slough, necrosis), amount and type of exudate, odor, and surrounding skin condition. Photographing and measuring over time helps track progress.

• Perfusion and neuropathy: check pulses, consider ankle-brachial index (ABI) or toe pressures for suspected peripheral arterial disease, and test sensation for neuropathy in at-risk patients. Perfusion problems often explain stalled healing.

• Infection signs: local (increasing erythema, warmth, swelling, pain, purulence) or systemic signs (fever, tachycardia). When bone is suspected, consider probe-to-bone and imaging.

• Nutrition and systemic status: screen for unintentional weight loss, low protein intake, and other factors that impair repair.
  
  

These steps help decide whether the wound needs local care only or specialist referral.

Basic care principles

For many wounds, simple, evidence-based measures help set the stage for healing:

• Debridement: remove devitalized tissue and biofilm as appropriate (sharp, enzymatic, or autolytic methods) to expose healthy tissue.

• Moisture balance: use dressings that maintain a moist wound bed but manage heavy exudate.

• Infection control: treat invasive infection with systemic antibiotics and consider topical antimicrobials as adjuncts for high surface bioburden; obtain cultures appropriately when systemic therapy is considered.

• Address underlying causes: offload pressure for plantar ulcers, apply compression for venous disease, and refer for vascular assessment if ischemia is likely.

• Optimize nutrition and comorbidity management: ensure adequate protein and micronutrients and manage glucose in people with diabetes.
  
  

If a wound does not show measurable improvement after a reasonable trial of these measures, consider referral to a specialist wound clinic.

When to refer

Refer earlier for wounds that are large or deep, show signs of spreading infection, expose bone or tendon (possible osteomyelitis), or have poor perfusion. Also consider referral when a wound fails to reduce in size by a clinically meaningful amount after 2–4 weeks of optimized care. Multidisciplinary teams can coordinate revascularization, advanced dressings or grafts, and infection management.

Final thoughts

A wound is more than a skin break, it’s a local problem influenced by the patient’s overall health, blood flow, infection status, and nutrition. Most acute wounds heal through a predictable sequence of phases, but many wounds become chronic because one or more supporting elements are missing. Early assessment, simple evidence-based steps (debridement, moisture balance, infection control, and addressing comorbidities), and timely specialist referral when wounds stall can improve outcomes.

See also

Best Practices for Chronic Wound Care: How to Assess Foot Ulcers Effectively
How to Tell If a Wound Is Healing: Signs of Proper Wound Care Progress
Why Diabetic Foot Wounds Heal Slowly: Top Factors That Delay Recovery
How Often Should Wound Dressings Be Changed? Best Practices for Healing
Wound Care Guide: How to Tell Colonization from True Infection

More Information

For more information on the latest effective wound care, contact us to set up a time for a call.

Sources

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* This blog is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.