Plain-language answers to questions people ask us about wounds and healing. Search below, or browse the questions we have answered so far.

• Why is my wound not healing?

  A wound that is not improving can have several possible reasons, including problems with blood flow, infection, pressure on the area, or conditions such as diabetes. A wound care evaluation can help identify factors that may be affecting healing.

• How long should a wound take to heal?

  There is no single healing time that applies to every wound. It depends on the type of wound, its cause and your own health. Wound care teams measure wounds over time, because how a wound is changing tells them more than a fixed number of weeks would.

• When is a wound considered non-healing or chronic?

  There is no single universally accepted time cutoff that defines every chronic or non-healing wound. Different sources and clinical contexts use different definitions and benchmarks. What clinicians generally look at is whether a wound is making progress, alongside its type and cause.

• Why does my wound keep reopening?

  A wound that comes apart soon after it was closed and a wound that heals and then returns later are two different situations with different causes. Telling them apart is part of what a wound care evaluation is for.

• When should I see a wound care specialist?

  There is no single rule that says when to see a wound care specialist. A wound care center assesses a wound that is not healing by examining it, checking blood flow and working out why, and your own clinician is the right person to advise on your situation.

• How long is newly healed skin fragile?

  Skin that has closed is not the same as skin that has finished healing. The remodeling phase continues for months after a wound closes, and repaired skin ends up less strong than the skin around it.

• Can poor nutrition keep a wound from healing?

  A balanced diet supports healing, and inadequate intake of protein, fluids, energy and vitamins can affect it. What that means for any particular person is a question for their own clinician.

• Should I keep a wound covered or let it air out?

  Keep it covered. A wound should not be left exposed to the air, because the right dressing helps create the best healing environment. A clinician may tell you when a wound can be left uncovered — that instruction comes from them, not from a general rule.

• Can I use hydrogen peroxide on a wound?

  Don't use hydrogen peroxide or iodine cleansers on a pressure sore unless a provider tells you to, because they can damage the skin. There are specific situations where a surgeon does direct its use.

• Can I shower with an open wound?

  It depends on the wound, and the person treating it is the one who can answer for yours. For closed surgical incisions, the advice is detailed and specific, and it starts with your surgeon saying when showering is allowed.

• How often should I change my wound dressing?

  There is no general interval. It depends on the type of wound and the type of dressing, some dressings are designed to stay on for up to a week, and the person treating the wound sets the schedule.

• What should I clean a wound with?

  For several different wound types, the same advice comes up: mild soap and water, without scrubbing. Pressure sores at one stage are cleaned with saline instead, and hydrogen peroxide and iodine cleansers should be avoided unless a provider tells you to use them.

• Can I change my wound dressing myself?

  Often, yes. Many patients and family members help with wound care, but it needs to be discussed and planned with your health care professional first, and good hand hygiene is critical.

• How do I know if a wound is infected?

  An infected wound is one where bacteria are causing harm, not just present. Not every wound with fluid or smell is infected, and changes over time are what matter.

• What are the warning signs of wound infection?

  Warning signs differ by wound type, but most lists share redness, warmth or swelling, more drainage or pus, odor, more pain, and fever. The list that applies to you is the one for your kind of wound.

• Can an infected wound cause sepsis?

  Yes. Anyone with an infection could get sepsis, the body's extreme response to an infection. Sepsis is a life-threatening medical emergency, so get medical care right away if you think you might have it.

• Why is my wound black?

  Black tissue in a wound is something to act on, not something to interpret at home. With a leg ulcer, it's one of the signs that mean you should contact a doctor or nurse quickly for urgent assessment.

• Why are the edges of my wound turning black?

  Black edges around an injury are a sign of dead tissue. Contact your provider right away.

• Why is my heel purple even though the skin is not open?

  A pressure sore that develops in the tissue deep below the skin is called a deep tissue injury, and the area may be dark purple or maroon. This type of skin injury can quickly become a stage III or IV pressure sore.

• Why is my wound draining so much fluid?

  There's no set amount of drainage that counts as too much. What matters is change: more drainage than before is one of the signs of infection to contact your provider about.

• What does yellow drainage from a wound mean?

  Yellow drainage is one of the colors that should prompt you to contact a provider, along with thick, tan or green drainage and a bad smell. Not every wound with fluid is infected, but changes over time are important.

• Why is my bandage soaked every time I change it?

  Fluid leaking from a dressing and drainage that increases are both things to report. If your dressing soaks through at every change, the person who chose the dressing is the one to tell.

• When is a diabetic foot ulcer an emergency?

  There's no simple "emergency" label for a foot ulcer. Instead, specific findings mean you should contact your provider right away, such as a foot infection that becomes black and smelly, which can be a sign of gangrene.

• Can a diabetic foot ulcer lead to amputation?

  Yes. Gangrene and foot ulcers that do not get better with treatment can lead to an amputation. Certain findings should be reported to your provider right away.

• Why is my wound getting deeper instead of smaller?

  A wound that is getting larger or deeper is a change to contact your provider about. Finding out why is the job of an assessment.

• Why is my surgical incision opening weeks later?

  An incision can break open along all or part of its length, and a surgeon may choose not to close it again, letting it heal from the inside out. Contact your provider if the wound gets larger or deeper.

• Why does my ankle wound keep coming back?

  If you have had a venous leg ulcer, you are at risk of developing another one. The most important way to prevent one is to keep using your compression stocking, bandage or wrap.

• Why is the skin around my wound white and soggy?

  Healthy tissue around a wound that gets too wet softens, and that can cause the wound to get bigger. Keep the dressing and the skin around it dry.

• What color wound drainage is normal?

  Some clear fluid oozing from a wound is normal in the early stage of healing, and it helps clean the area. Yellow or green pus, or a lot of clear fluid, are reasons to contact your provider.

• What is granulation tissue?

  Granulation tissue is the new tissue that fills in a wound during healing, with new skin forming over it. It is part of normal healing, not a problem.

• Why does my wound itch?

  As a wound continues to heal, you may notice that the area itches. Itching on its own is not a problem, but don't scratch the scab.

• Why is my dressing sticking to my wound?

  If a dressing sticks to the wound, moisten it gently with water and try again — unless your surgeon has told you to pull it off dry. Removing a stuck dressing by force takes tissue with it.

• How do I know which wound dressing to use?

  The dressing is chosen with the clinician treating your wound, based on an exam. The dressing and the change schedule are decided together.

• Can a wound be too wet under a dressing?

  Yes. The goal is to keep the wound moist but not soggy. Healthy tissue around a wound that gets too wet can soften, causing the wound to get bigger.

• What is a foam dressing used for?

  Foam dressings absorb wound fluid and give extra protection from knocks. They are used for wounds with moderate to heavy drainage, chronic wounds and pressure injuries, but whether one suits your wound is a decision for the clinician treating it.

• What is a hydrocolloid dressing used for?

  Hydrocolloids are dressings that slowly absorb fluid and form a gel. They are used for pressure wounds and wounds with minimal to moderate drainage, but not for necrotic or infected wounds.

• What is an alginate dressing used for?

  Alginates are seaweed-based dressings that form a gel, help stop bleeding, and are used for wounds producing moderate to heavy fluid. They can turn yellow or brown, which is easily mistaken for pus.

• What is a hydrogel dressing used for?

  Hydrogels are mostly water. They keep a wound moist and have a cooling effect that can reduce pain, and they are used for venous or arterial ulcers and surgical wounds — but not for heavily draining wounds.

• When should gauze be used on a wound?

  Gauze has a narrow use — the early stages of deeper wounds that need packing. It doesn't hold in moisture and can remove new tissue along with dead tissue at each change.

• Why is there a scab but the wound is still open underneath?

  A wound fills in from the bottom rather than sealing at the top. The scab protects the tissue underneath while new tissue grows in beneath it.

• Is it normal for a wound to sting or burn?

  Tenderness is part of the first few days of healing. Pain that increases or won't go away is something to report to your provider.

• Can I swim with an open wound?

  Don't swim until your provider tells you it is OK. After a cesarean section that is usually around three weeks, but that figure belongs to that operation, not to wounds in general.

• Can a family member change my wound dressing?

  Yes. Many patients and family members are actively involved in wound care, as long as it is discussed and planned with your healthcare professional first. One rule is specific to helping someone else: wear clean gloves.

• Can I use iodine on a wound?

  Don't use iodine cleansers on a pressure sore unless your provider directs you to, because they can damage the skin. Iodine-impregnated dressings are a separate thing, chosen by a clinician for infected wounds and not used on deep ones.

• What are silver dressings used for?

  Silver dressings fight a wide range of germs and are used on wounds with a surface infection or a high risk of infection. They are not for deep wounds, because silver ions cannot penetrate them.

• Is medical honey good for wounds?

  Honey is an alternative wound dressing option, and it is thought to work by drying out the wound and making it more acidic, which limits bacteria. This page can't tell you when it should or shouldn't be used — ask the person treating your wound.

• What is the best dressing for an open wound?

  There is no single best dressing. The choice is matched to your wound — how much fluid it produces, how deep it is, whether it is infected — and most of that is judged by examining it.

• Should a wound dressing keep the wound moist?

  Yes. A good dressing creates a warm, moist environment and keeps the wound moist but not soggy. The surrounding skin should stay dry, and a clinician may advise otherwise for a particular wound.

• What is a hydrofiber dressing used for?

  Hydrofiber is a variant of hydrocolloid dressing, not a separate type. Like hydrocolloids, it slowly absorbs fluid and forms a gel, and it's used for pressure wounds and light to moderate drainage — not for infected or necrotic wounds.

• Why is my foot sore not healing even though it doesn’t hurt?

  Diabetic foot ulcers are often painless because of decreased feeling in the feet, and the usual warning signs are often absent because of nerve damage. Foot ulcers may take weeks or even several months to heal.

• What is a venous leg ulcer?

  A venous leg ulcer is a shallow ulcer around the ankle that can be painful. It happens when leg veins are damaged or don't return blood to the heart as well as they should, and it is also called a venous stasis or varicose ulcer.

• What is a pressure sore?

  A pressure sore is an ulcer caused by pressure and/or shearing force, often over bony areas. Pressure sores are graded in four stages, with two more categories for sores whose depth can't be judged yet.

• Does smoking slow wound healing?

  Yes. Smoking reduces the amount of oxygen arriving at the wound, and scar tissue laid down afterward is of poorer quality. Smoking is one of the factors that impede healing.

• Does alcohol slow wound healing?

  Yes, excess alcohol will delay wound healing, so keep drinking in moderation. There's no set definition of "excess" or a set limit.

• What vitamins are important for wound healing?

  Vitamins A, B, C and E, along with iron, zinc, protein and carbohydrate, are what a well-balanced diet should include while a wound heals. They are part of a diet, not supplements.

• Is compression safe for every leg wound?

  No. Compression helps many venous ulcers but is not suitable in the same way for severe arterial disease. A blood flow test at the ankle or toes is used to check whether compression is safe.

• What is compression therapy for wounds?

  Compression means tight-fitting stockings or wraps that improve blood flow in veins, reducing swelling and aiding healing. It's the mainstay for venous leg ulcers, and it continues after the wound closes.

• What is wound debridement?

  Debridement means removing dead skin and tissue from a wound. It can be done surgically with sharp tools, or by methods including saline irrigation, wet-to-dry dressings, whirlpool baths or enzymes.

• What does an arterial ulcer look like?

  Ischemic ulcers, also called arterial ulcers, are dark red, yellow, gray or black sores with raised edges that look punched out. They are usually deep and don't bleed, but looks alone can't identify a wound.

• What is an arterial ulcer?

  An arterial leg ulcer usually occurs on the foot or lower leg. It can be small and sometimes deep, is often quite painful, and is caused by reduced arterial blood flow to the area.

• Where do arterial ulcers usually occur?

  Most ischemic (arterial) ulcers occur on the feet and legs. They may appear on the legs, ankles, toes, and between the toes, but location alone doesn't identify the type of wound.

• Why does my wound smell bad?

  A wound odor can come from the dressing, the healing process, or infection. Notice whether the smell comes with more fluid or more pain — not all wounds with a smell are infected.

• How are arterial ulcers different from venous ulcers?

  Venous ulcers are caused by high pressure in the leg veins, and ischemic (arterial) ulcers are caused by narrowed arteries. The treatments differ: compression is worn every day for venous ulcers, but for arterial ulcers, don't wear compression unless your provider tells you to.

• How can I prevent a venous ulcer from returning?

  The most important thing is to keep using your compression stocking, bandage or wrap, together with good skin care. Contact your healthcare professional if you notice any break in your skin.

• Should compression be used on an arterial ulcer?

  For ischemic (arterial) ulcers: Do not wear compression stockings or wraps unless told to by your provider. These may restrict blood flow.

• Can compression make an arterial wound worse?

  Compression stockings or wraps may restrict blood flow, so don't wear them on an ischemic (arterial) ulcer unless your provider says so. These wounds are caused by too little blood reaching the leg.

• Can smoking prevent an arterial wound from healing?

  Smoking can lead to narrowed arteries, the most common cause of ischemic (arterial) ulcers. It's more accurate to say smoking makes healing harder than that it stops healing outright, and quitting can improve blood flow and aid healing even after you have a wound.

• Can I walk with a venous leg ulcer?

  Yes. Walking is part of treating a venous ulcer: take a walk or exercise every day, because being active helps improve blood flow. The advice for a diabetic foot ulcer runs the other way, so which wound you have matters.

• Should I elevate my legs with a venous ulcer?

  Yes. Put your feet above your heart as often as possible, for example by lying down with your feet propped up on pillows. It's one of four things to do for a venous ulcer, along with daily compression, daily walking, and medicines as directed.

• What is venous insufficiency?

  Venous insufficiency is when the one-way valves in the leg veins become weak, or the veins become scarred and blocked, so blood flows backward and pools in the legs. It's the condition underneath a venous ulcer, not the wound itself.

• How often should someone in bed be repositioned?

  If you are in bed, you should move or be moved about every 2 hours. Pair that with pressure-relieving equipment such as pillows, foam cushions, booties or mattress pads, chosen with a provider.

• How often should someone in a wheelchair shift weight?

  If you are in a wheelchair, try to change your position every 15 minutes. Don't use donut-shaped or ring-shaped cushions, because they reduce blood flow to the area, which may cause sores.

• What kind of cushion helps prevent pressure sores?

  Pillows, foam cushions, booties or mattress pads (some water- or air-filled) help, and the right type depends on the wound and on bed versus wheelchair — choose it with your provider. Don't use donut or ring cushions.

• What kind of mattress helps prevent bedsores?

  There's no single mattress to recommend. Mattress pads, some water- or air-filled, are among the things used to reduce pressure, and the right choice depends on the wound and the setting — discuss it with your provider.

• How do I prevent another pressure injury?

  Prevention comes down to relieving pressure, avoiding friction, checking your skin every day, and looking after your general health. Preventing old wounds from coming back is one of the goals of wound center care.

• Can I walk on a diabetic foot ulcer?

  Sometimes putting pressure on a healing diabetic foot ulcer for even a few minutes can reverse the healing that happened up to that point. Special shoes, a brace, a cast, a wheelchair or crutches take the pressure off, and don't walk barefoot unless your provider says it's OK.

• What shoes should I wear with a diabetic foot ulcer?

  If your provider has prescribed special shoes, a brace or a cast, that comes first. Otherwise, wear canvas, leather or suede shoes with laces, Velcro or buckles that fit properly and are not tight, and avoid pointed or open toes, including high heels, flip-flops and sandals.

• How often should I check my feet if I have diabetes?

  Check your feet every day, including the tops, sides, soles, heels and between your toes, and ask someone else if you cannot see well. A provider should also check your feet at least once a year, and every 3 to 6 months if you have had a foot ulcer.

• Do I need special shoes after a diabetic foot ulcer heals?

  Ask your provider if you need special shoes that can give your feet more room. If you have had foot ulcers before, see your provider every 3 to 6 months.

• What happens at the first wound care appointment?

  A wound care team will examine and measure your wound, check the blood flow around it, determine why it is not healing, and create a treatment plan. Treatment usually starts at the visit, with the wound cleaned and a dressing applied.

• How often will I need to visit a wound clinic?

  You will receive treatment at the wound center weekly or more often, depending on your treatment plan. Non-healing wounds may take months to heal.

• What tests might be done at a wound clinic?

  The main work is assessment rather than a set list of tests: examining and measuring the wound, checking the blood flow around it, and working out why it is not healing. If you have diabetes, your provider should also check your sensation with a monofilament and check your foot pulses.

• How does negative pressure wound therapy work?

  Negative pressure wound therapy pulls the air out of a closed dressing to create a vacuum, which improves blood flow and pulls out excess fluid. It is one of several treatments a wound center may recommend.

• What is hyperbaric oxygen therapy for wounds?

  You sit inside a special chamber where the air pressure is about two and a half times normal atmospheric pressure, which helps your blood carry more oxygen to organs and tissues. It can help some wounds heal faster.

• How does hyperbaric oxygen help wound healing?

  Oxygen is essential for healing, and some wounds are short of it because blood is not reaching the tissue. The pressure in a hyperbaric chamber helps your blood carry more oxygen to organs and tissues, which can help some wounds heal faster.

• What is enzymatic debridement?

  Enzymatic debridement means putting special chemicals, called enzymes, on the wound to dissolve dead tissue. It is one of several debridement methods, and you should never attempt debridement yourself.

• What medications can slow wound healing?

  Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and some chemotherapy medicines can slow healing. Don't stop or change a medicine because of a wound; that is a decision for the person who prescribed it.

• How does obesity affect wound healing?

  Obesity increases the risk of infection after surgery, and being overweight can put tension on stitches, which can make them break open. Obesity is also one of the risk factors for venous ulcers.

• Is itching a sign a wound is healing?

  Itching can be part of the stage where a scar forms, but itchy skin can also be an early sign of venous insufficiency. The sensation on its own does not tell you which it is.

• Should I keep moisturizing skin after a wound closes?

  Keep healthy skin clean and moisturized, and keep the skin of your lower legs well moisturized. The scar itself is different: do not rub it or apply anything to it without talking with your provider first.

• How should I care for a surgical incision at home?

  Follow your surgeon's instructions first. As a reminder: keep your hands clean, change the dressing as often as your surgeon says, do not apply antibiotic cream unless told to, do not pull at stitches or staples, and avoid tight clothing rubbing the incision.

• How long should a surgical wound drain?

  There's no set total time. Some drainage is expected, but contact your provider if drainage is not decreasing after 3 to 5 days, or if it increases or becomes thick, tan, green, yellow or foul smelling.

• Is redness around a surgical incision normal?

  Wounds in general are slightly swollen, red or pink, and tender for about 2 to 5 days. With a surgical incision, though, more redness or worsening redness is a reason to contact your surgeon.

• When is drainage from a surgical wound concerning?

  Contact your surgeon if drainage increases, or becomes thick, tan, green or yellow, or smells bad, which indicates pus. With wet-to-dry dressings, drainage that is not decreasing after 3 to 5 days is also a reason to call.

• Why did my surgical wound open up?

  Incisions sometimes break open, along the whole cut or part of it, and a surgeon may decide not to close it again. Infection, obesity, smoking, diabetes and some medicines can contribute, but a list of factors does not identify the cause in any one case.

• What is wound dehiscence?

  Dehiscence is a partial or total separation of wound edges that had been closed, due to a failure of proper wound healing. It typically occurs 5 to 8 days after surgery.

• Can a surgical wound heal from the inside out?

  Yes. A surgical wound left open heals from the inside to the outside, and the dressing keeps the skin from closing before the wound underneath fills in.

• What does it mean to pack a surgical wound?

  Packing means placing gauze or packing tape inside the wound, filling the wound and any spaces under the skin, then covering it with a dry dressing. It keeps the skin from closing before the wound underneath fills in.

• How often should packing be changed?

  There's no set frequency: your provider will tell you how often to change the dressing. Change it sooner if it becomes wet or soaked, and never reuse a dressing.

• Can I shower after surgery with an open incision?

  Your surgeon will tell you when it is OK, and usually it is fine to shower after 24 hours. Showers are better than baths because soaking the wound could cause it to reopen or become infected.

• When can I remove a surgical dressing?

  Your surgeon decides: you can leave the original dressing in place for as long as your surgeon says, and your surgeon will tell you when you can leave the wound uncovered. Change it sooner only if it becomes wet or soaked.

• What should I do if staples or stitches pull apart?

  Contact your provider right away if a wound has come open or the stitches or staples have come out too soon. Never pull at stitches or try to remove them yourself.

• Why does my incision smell bad?

  A bad smell from your incision is a reason to contact your provider. Along with drainage that is thick, tan, green or yellow, it's a sign of pus.

• When should a surgical wound be referred to wound care?

  A non-healing wound is one that has not started to heal in 2 weeks or has not completely healed in 6 weeks. Surgical wounds are among the common types treated at a wound care center.

• Can I wash a wound with soap and water?

  Yes. Gentle or mild soap and water is right for minor wounds, stage I pressure sores, open surgical wounds and wounds with wet-to-dry dressings. Avoid soap with antibacterial chemicals, which can damage wound tissue and slow healing.

• Is saline better than tap water for cleaning wounds?

  Neither is ranked above the other. Normal saline or mild soapy water can both be used for an open surgical wound, and for irrigation, use whichever your provider recommends.

• Can I use alcohol on an open wound?

  No. Alcohol is one of the things not to use on an open surgical wound, because it can damage the wound tissue and slow healing. Unlike peroxide and iodine for pressure sores, there's no provider-directed exception.

• Can I use hydrogen peroxide every day on a wound?

  No. Peroxide is one of the things not to use on an open surgical wound, because it can damage wound tissue and slow healing. Don't use it on a pressure sore unless your provider directs it.

• Can I use iodine on an open wound?

  Don't use iodine on an open surgical wound, because it can damage wound tissue and slow healing. For pressure sores, don't use iodine cleansers unless your provider directs it.

• Should I scrub a wound to clean it?

  No. Don't rub or scrub a wound. Every cleaning and drying step should be gentle: soaking, dabbing, wiping and patting dry. When more is needed, the method is provider-directed irrigation, not force.

• How do I clean a wound that has packing in it?

  Follow an ordered sequence: remove the old packing with gloves on, clean the wound gently with warm water and soap and pat it dry, inspect it, then repack with saline-moistened gauze squeezed until it is not dripping and cover with a dry pad. Wash your hands and change gloves between stages.

• What should I do if dirt will not come out of a wound?

  There's no home method beyond gentle cleaning. Irrigate with a syringe only if your provider directs it, and never try debridement yourself, because a foreign body in a wound is one reason wounds don't heal.

• Should I rinse a wound in the shower?

  Sometimes. In some cases you can rinse a wound while showering, and after surgery you may gently rinse it if your surgeon gives the OK. Don't let it soak, because that could cause it to reopen or become infected.

• Can I use antibacterial soap inside a wound?

  No. Soap with antibacterial chemicals is one of the things not to use on an open surgical wound, because it can damage the wound tissue and slow healing. Use plain mild soap and water instead.

• How do I clean the skin around a wound without damaging it?

  Gently dab or wipe the surrounding skin with gauze soaked in saline or mild soapy water, removing drainage and dried blood, then pat it dry. Keep that skin dry, because healthy tissue that gets too wet softens and the wound can get bigger.

• Can I put peroxide on a wound that looks infected?

  No. Peroxide can damage wound tissue and slow healing, and there's no exception for a wound that looks infected. Signs of infection are a reason to contact your provider, not to change treatment at home.

• Why does dead tissue need to be removed?

  Dead tissue must be removed to help your wound heal. Dead skin over a sore also makes it hard to tell how deep the wound is, which leaves it unstageable.

• Does debridement hurt?

  There's no single answer. You may need general anesthesia, so you're asleep and pain-free, for debridement of a large wound, and the methods used differ a lot from one another.

• Why does my wound look bigger after debridement?

  A wound may seem bigger and deeper after debridement. Dead skin hides how deep a wound is, so removing it reveals the wound rather than enlarging it. Afterward the area should be red or pink.

• What is surgical debridement?

  Surgical debridement is the removal of dead tissue with sharp instruments. The provider cleans the skin, probes the wound for depth and foreign material, cuts away dead tissue, and cleans the wound. It may be done at the bedside, in an office, at a wound center, or in an operating room.

• What is autolytic debridement?

  Autolytic debridement is the most conservative form of debridement: the body's own cells and enzymes break down dead tissue, helped by a moist environment and moisture-retentive dressings. It affects only dead tissue and takes a few days.

• What is mechanical debridement?

  Mechanical debridement is a non-selective method that uses physical force, such as wet-to-dry dressings, pulsatile lavage or wound irrigation, and removes both dead tissue and living tissue. It's used for wounds with moderate to large amounts of dead tissue.

• When should a wound not be debrided?

  Debridement may not be appropriate for dry, intact eschar with no clinical evidence of underlying infection, such as an unstageable pressure ulcer on the sacrum, buttock or heel. The intact eschar serves as a biological covering over the skin underneath.

• Can I remove dead tissue from a wound myself?

  No. You should never try to do this yourself. A provider needs to do it to make sure it is done correctly and does not make the injury worse.

• What wounds qualify for hyperbaric oxygen therapy?

  There are 14 approved indications, set by the Undersea and Hyperbaric Medical Society. For wound healing, the named one is Wagner grade 3 diabetic wounds that have not responded to at least 30 days of conventional therapy.

• How long is a hyperbaric oxygen treatment?

  Sessions last around two hours daily, with two ten-minute oxygen breaks to prevent oxygen seizures, usually at a pressure of 2.4 atmospheres at 100% oxygen.

• How many hyperbaric treatments are usually needed?

  A typical course is 33 sessions, which can be extended if needed. Each session lasts around two hours and they are given daily, with the protocol set by the condition being treated.

• What are the side effects of hyperbaric oxygen therapy?

  The most common side effect is barotrauma, usually rupture or irritation of the eardrum. Rarer, more serious risks include a collapsed lung, burst small vessels, ear damage, oxygen seizures, fluid in the lungs, bleeding, and, at the catastrophic end, chamber fires.

• Who should not have hyperbaric oxygen therapy?

  The only true absolute contraindication is untreated pneumothorax. Relative ones include pulmonary blebs, emphysema with carbon dioxide retention, sinusitis, seizures, pregnancy, implanted devices such as pacemakers, epidural pumps, claustrophobia, and certain medicines.

• Can hyperbaric oxygen prevent amputation?

  Wound Wizard can't tell you that it does. The therapy may not help all patients but has been proven to benefit many with specific wound-healing problems, and preventing limb loss is a goal of wound center care as a whole, not of this one treatment.

• Why might a diabetic wound be referred for hyperbaric oxygen?

  A specific indication is a Wagner grade 3 diabetic wound that hasn't responded to at least 30 days of conventional therapy. That's why a referral tends to come after a month of conventional treatment rather than at the start.

• Does hyperbaric oxygen therapy hurt?

  Wound Wizard can't tell you how a session will feel. The ears are the part under pressure, though: the most common complication is barotrauma, usually rupture or irritation of the eardrum.

• Do I need sterile gloves to change a dressing?

  No. Clean, non-sterile medical gloves are what's called for. What matters is changing them between stages of the dressing change.

• How important is handwashing before wound care?

  Very important. Take jewelry off, wet your hands under warm running water pointing downward, wash with soap for 15 to 30 seconds including under your nails, rinse, and dry with a clean towel (or use an alcohol-based cleanser), before and after every dressing change.

• How do I change a wound dressing for someone else?

  Follow the same steps as changing your own, with one addition: wear clean medical gloves, which do not need to be sterile. Wash your hands and change gloves between stages.

• Do I need gloves when caring for someone else’s wound?

  Yes. Changing a dressing for someone else is one of two situations that call for clean medical gloves, the other being an infected wound. They don't need to be sterile, but they should be changed between stages.

• How do I know if my loved one’s wound is getting worse?

  Take a deliberate look at every dressing change for increased redness, swelling or bad odor, and drainage that has become darker, thicker or foul smelling. Every one of those signs is a comparison, so what matters is a record of how the wound looked before.

• When should a caregiver call the wound clinic?

  Call for changes around the wound, changes in drainage, or fever or chills. Some signs call for contacting the provider right away, including a wound that has come open and bleeding that won't stop after 10 minutes of pressure.

• How do I dispose of used wound dressings safely?

  Put used dressings and supplies in a waterproof plastic bag, close it tightly, then double-bag it before putting it in the trash. Wash soiled laundry separately, and ask your provider whether to add bleach.

• How do I prevent spreading bacteria during wound care?

  Follow a set sequence: clean hands and a clean, prepared work surface before starting, gloves where needed, hands washed and gloves changed between every stage, the inside of the dressing untouched, used supplies double-bagged, and soiled laundry washed separately.

• What is the difference between a bedsore and a pressure ulcer?

  There is no difference. Pressure ulcer, bedsore and decubitus ulcer are different names for the same thing: an area of skin that breaks down when something keeps rubbing or pressing against it.

• What does a stage 1 pressure injury look like?

  Stage 1 is a reddened, painful area of skin that does not turn white when pressed, and the skin may be warm or cool, firm or soft. The skin is still intact, and it's a sign that a pressure ulcer may be forming.

• What does a stage 2 pressure injury look like?

  At stage 2, the skin blisters or forms an open sore, and the area around it may be red and irritated. The skin is no longer intact, which is the difference from stage 1.

• What does a stage 3 pressure injury look like?

  At stage 3, there's an open, sunken hole (a crater or ulcer), the tissue below the skin is damaged, and body fat may be visible in it. Most stage 3 and 4 sores will be treated by your provider.

• What does a stage 4 pressure injury look like?

  At stage 4, the pressure ulcer is so deep that there is damage to the muscle and bone, and sometimes to tendons and joints. It's the worst of the four stages, and most stage 3 and 4 sores will be treated by a provider.

• What is an unstageable pressure injury?

  An unstageable pressure injury is a sore covered in dead skin that is yellow, tan, green or brown, which makes it hard to tell how deep the sore is. It's about what can be seen, not a severity above stage 4.

• What is a deep tissue pressure injury?

  A deep tissue pressure injury develops in the tissue deep below the skin. The area may be dark purple or maroon, there may be a blood-filled blister under the skin, and it can quickly become a stage 3 or 4 sore.

• Where do pressure sores usually occur?

  Pressure sores usually occur on the buttocks, elbow, hips, heels, ankles, shoulders, back and the back of the head. They tend to form where skin covers bony areas with less tissue underneath to pad them.

• Should I use a donut cushion for a pressure sore?

  No. Donut-shaped or ring-shaped cushions reduce blood flow to the area, which may cause sores. Use pillows, foam cushions, booties or mattress pads instead, chosen with your provider.

• Can you massage around a pressure sore?

  No. Do not massage the skin near or on the ulcer, because this can cause more damage. That includes the skin around the sore, not only the sore itself.

• How do you keep a pressure sore dry if someone is incontinent?

  If needed, use a moisture barrier to protect the area from bodily fluids, and ask your provider what type to use. Not being able to control your bladder or bowels makes a pressure sore more likely.

• Can a stage 2 pressure sore heal at home?

  Often, yes. Stage 1 or 2 sores will often heal if cared for carefully: saline cleaning, a dressing chosen with your provider, pressure relief and repositioning, and daily skin checks. Most stage 3 and 4 sores will be treated by a provider.

• When does a pressure sore need professional wound care?

  There are three answers: by stage, because most stage III and IV sores are treated by a provider; by time, if a sore hasn't started to heal in 2 weeks or healed in 6; and right away for blisters, an open sore, or signs of infection.

• My mom has a sore on her tailbone. What should we do?

  Get it looked at, and relieve the pressure meanwhile. Contact a provider right away for blisters, an open sore or signs of infection; reposition about every 2 hours in bed and every 15 minutes in a chair; don't use ring cushions; and don't massage near the sore.

• How does diabetes cause foot ulcers?

  It's a chain: diabetes can damage the nerves and blood vessels in the feet, causing numbness and reduced feeling; injuries are then more likely and may not be noticed; and damaged blood vessels mean they may not heal well. Pressure on one part of the foot is a further cause.

• Can a diabetic foot ulcer heal on its own?

  Untreated foot ulcers are the most common reason for toe, foot and leg amputations in people with diabetes. Follow your provider’s instructions on how to treat the ulcer.

• How long does a diabetic foot ulcer take to heal?

  It may take weeks or even several months. A wound is considered non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 — started and completely being two different tests.

• What does offloading mean for a diabetic foot ulcer?

  It means taking the weight off the ulcer. Special shoes, a brace, a cast, a wheelchair or crutches take pressure off the ulcer area to speed healing, and pressure for even a few minutes can reverse healing already gained.

• Why is my diabetic foot ulcer white, blue, or black?

  Contact your provider if your foot ulcer is very white, blue, or black. Wounds that are pale, purple, or black are less likely to heal, while a wound bed after debridement should be red or pink.

• What tests are done for a diabetic foot ulcer?

  The key checks are part of an exam rather than a list of tests: your sensation is tested with a monofilament, and your foot pulses are checked. At a wound center the wound is also measured and the blood flow around it checked.

• Do diabetic foot ulcers always hurt?

  No. Diabetic ulcers are often painless because of decreased feeling in the feet, and redness, warmth and tenderness are often absent because of nerve damage. That's why daily looking matters more than waiting to feel something.

• What dressing is used for a diabetic foot ulcer?

  Wet-to-dry dressings are often used first, and dressings containing medicine and skin substitutes are also options. Your provider may use different kinds; whichever is used, keep the ulcer clean and bandaged and the surrounding skin dry.

• Should a diabetic foot ulcer be kept moist?

  Moist on the wound, dry around it. A dressing keeps the wound moist, which promotes healing, but keep the dressing and the skin around the ulcer dry, because healthy tissue that gets too wet can soften and cause more foot problems.

• Can high blood sugar slow wound healing?

  Yes. Keeping blood sugar under good control helps you heal faster and helps your body fight infections, and diabetes is one of the factors that can slow or prevent healing.

• How can I prevent another diabetic foot ulcer?

  If you have had foot ulcers before, see your provider every 3 to 6 months. Add daily foot checks, washing and skin care, professional nail and callus care, footwear rules, stopping smoking and blood sugar control.

• Who should treat a diabetic foot ulcer?

  A provider oversees treatment, a podiatrist handles debridement, nails and calluses, and a wound care team of providers, nurses and physical therapists steps in if the ulcer is not healing. Daily checking, cleansing and offloading are your part.

• Why do venous ulcers happen near the ankle?

  Most venous ulcers occur on the leg, above the ankle. Weak or blocked vein valves let blood pool and raise pressure in the lower leg veins, though exactly why the ankle area is affected isn't something this page can explain.

• Why is the skin around my ankle brown?

  Dark red, purple, brown, hardened skin is an early sign of venous insufficiency. It means blood is pooling, with fluid and blood cells leaking out into the skin, and it shows up before any ulcer forms.

• Does compression help venous leg ulcers?

  Yes. Wear compression stockings or bandages every day as instructed; they help prevent blood from pooling, reduce swelling, help with healing, and reduce pain. But don't use compression on an arterial ulcer unless a provider says so.

• Can venous leg ulcers get infected?

  Yes. An infected venous ulcer may have a bad odor and pus may drain from it. Contact your provider for redness, increased warmth or swelling, more or cloudy drainage, bleeding, odor, fever or chills, or increased pain.

• Can varicose veins cause leg ulcers?

  Varicose veins are a risk factor for venous ulcers, and a cause of poor blood flow that can slow healing. The ulcer itself is caused by venous insufficiency, not by varicose veins directly.

• Why is my lower leg wound leaking clear fluid?

  Some clear fluid oozing from a healing wound is expected and helps clean the area. But excessive clear fluid is a sign of infection to report right away, and on a lower leg, fluid can leak into the tissues as part of venous insufficiency.

• Why is my leg swollen around the wound?

  Swelling can be an early sign of venous insufficiency, a feature of the skin around a venous ulcer, or a sign of infection when it is new or increased. Which it is decides what should be done about it.

• How long does a venous leg ulcer take to heal?

  There's no set timeline; this type of wound can be slow to heal. A wound that has not started to heal in 2 weeks, or not completely healed in 6, is considered non-healing.

• What dressings are used for venous leg ulcers?

  There's no one specific dressing for venous ulcers. Keep the wound clean and bandaged, and wear a compression stocking or bandages over the dressing, because the compression is the treatment. General dressing types include gels, foams, gauze and films.

• When should a draining leg wound be seen by a specialist?

  There are two answers. On drainage: when it's more than before, increasing, not decreasing after 3 to 5 days, or thick, tan, yellow, green or foul smelling. On time: when it has not started to heal in 2 weeks or completely healed in 6.

• What does poor circulation have to do with wound healing?

  Oxygen is essential for healing, and poor blood flow means tissues don't get enough nutrients and oxygen, so cells die and damaged tissue heals more slowly. Both clogged arteries and vein problems can be the cause, and they are treated differently.

• Can an arterial ulcer heal without improving blood flow?

  To treat an ischemic ulcer, blood flow to your legs needs to be restored, with medicine or in some cases surgery. Wound care is important, but on its own it doesn't treat the cause.

• Why does my leg wound hurt more when I raise my leg?

  Aching pain that's often worse at night, pain that may go away when the leg is dangled down, and a leg that turns pale and cool when raised are symptoms of an ischemic ulcer, a wound caused by poor arterial blood flow. Elevation is advised for a different wound: venous ulcers.

• Why are my toes cold and pale with a foot wound?

  A leg that turns pale and cool to touch when raised is a symptom of an ischemic ulcer, caused by narrowed arteries reducing the supply of blood. If you have diabetes, contact your provider if a foot ulcer is very white, blue, or black.

• Why is the wound on my foot not healing?

  Three things make a foot wound hard to heal: reduced feeling, so injury and warning signs go unnoticed; continued pressure every time the foot is used; and reduced blood supply. All three can be present at once.

• Why is the wound on my heel not healing?

  The heel is at risk for pressure sores, ischemic ulcers and diabetic foot wounds, and each suggests a different reason it may not heal. A dry, intact dark area on a heel may also be deliberately left in place rather than removed.

• Why is the wound on my toe not healing?

  Toes and the spaces between them are common places for ischemic ulcers, caused by a reduced blood supply. Toes also need specific care with moisturizing, nail cutting and footwear, and you should contact a provider if a foot ulcer is very white, blue, or black.

• Why is the wound on my ankle not healing?

  The ankle is where all three major leg wound types meet — venous ulcers above the ankle, ischemic ulcers on legs and ankles, and pressure sores on ankles. They are treated in opposite directions, so what kind of wound it is comes before anything else.

• Why is the wound on my lower leg not healing?

  On a lower leg, venous insufficiency — blood pooling and raising pressure in the leg veins — keeps working against the wound while it tries to close. Treatment is aimed at the pressure: daily compression, elevation, walking and medicines.

• Why is the wound on my buttock not healing?

  The buttock is first on the list of places pressure sores form, and a wound there is loaded every time someone sits or lies back. Pressure relief is the treatment — repositioning every 15 minutes in a chair and about every 2 hours in bed, with equipment chosen with a provider.

• Why is the wound on my tailbone not healing?

  A tailbone wound sits under body weight over bone with little padding, so pressure relief is the treatment. The sacrum is also one of the places where a dry, intact dark covering may be deliberately left in place rather than removed.

• Why is the wound on my hip not healing?

  A hip wound is usually either a pressure sore, because hips are among the sites where pressure sores form in anyone lying on their side, or a surgical wound after hip surgery. The two have different causes, different things to report, and different treatment.

• Why is the wound on my back not healing?

  The back is a common place for pressure sores, and it is one you cannot see. Check your skin every day, and ask a caregiver or someone you trust to check the areas you cannot see.

• Why is the wound on my abdomen not healing?

  Most abdominal wounds are surgical. Dehiscence (the wound coming apart) typically happens 5 to 8 days after surgery, and increased abdominal pressure is one of its causes. A wound left open then heals from the inside out, often with packing.

• What does cellulitis around a wound look like?

  Cellulitis shows up as redness or inflammation that gets bigger as the infection spreads, a sore or rash that starts suddenly and grows quickly in the first 24 hours, pain or tenderness, warm skin, and a tight, glossy, stretched appearance — often with fever, chills and fatigue.

• What are signs a wound infection is spreading?

  Signs of spreading include redness or inflammation that gets bigger and a sore or rash that grows quickly in the first 24 hours. If you're already being treated, call right away for persistent fever, drowsiness, lethargy, blistering, or red streaks that spread.

• Is redness around a wound normal?

  A wound is often slightly swollen, red or pink, and tender for about 2 to 5 days, and a healthy wound bed is red or pink. But as a sign of infection, redness is about change — more redness, worsening redness, or redness that gets bigger as infection spreads.

• Does pus always mean a wound is infected?

  Pus is one of the signs of infection. It means drainage that is thick, tan, green or yellow, or smells bad. Some clear fluid oozing early in healing is expected; pus is not.

• Can a wound infection happen without fever?

  Yes. Fever is a sign of infection but never a required one — it's one item among several, and any of them is a reason to call. In people with diabetes or pressure ulcers, infection may cause less obvious signs.

• Why is my wound warm to the touch?

  Increased warmth is a sign of infection across several wound types, and warm skin in the area of redness is a symptom of cellulitis. But the skin around a venous ulcer may also be warm or hot in the ordinary course.

• Why is the skin around my wound getting harder?

  Increased firmness around a wound is a sign of infection for a diabetic foot ulcer, and a tight, glossy, stretched look is a symptom of cellulitis. Hardened, discolored skin on a lower leg can also be a sign that blood is pooling.

• Why did my wound suddenly become more painful?

  Increased pain is on every list of infection signs, across wound types. Tenderness in the first 2 to 5 days is ordinary, so what matters is a rise in pain — and pain that will not go away even after pain medicine means contact your provider right away.

• Can a wound infection get into the bone?

  Yes. Bone infection (osteomyelitis) is one of the complications of untreated cellulitis, and it is one of the reasons wounds do not heal well. This page doesn't give a symptom checklist for it — a wound that isn't healing is the finding to act on.

• Should a wound be cultured?

  There's no set rule for when. Culture of fluid or material inside the affected area, blood culture, a blood count and sometimes a biopsy are among the tests that may be ordered for cellulitis, and whether to do one is a clinical decision.