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.

“Keeps reopening” can describe two different situations, and they are not the same problem. One is a wound that was closed and then came apart. The other is a wound that healed completely and later returned. What lies behind each one differs, and so does what helps.

Wound dehiscence is the term for the first. StatPearls, a clinical reference available through NCBI Bookshelf, defines it as a partial or total separation of previously approximated wound edges, caused by a failure of proper wound healing. For surgical wounds, it describes this as typically occurring five to eight days after surgery, while healing is still in its early stages.

The same reference lists what makes dehiscence more likely: ischemia, infection, increased abdominal pressure, diabetes, malnutrition, smoking and obesity. Its broader list of risk factors for abnormal healing also includes necrotic tissue, glucocorticoid use and radiation exposure.

The second situation is recurrence: the wound healed, and then came back. The European Wound Management Association, in its patient Q&A, states that if you have had a venous leg ulcer you are at risk of developing another one. It describes the major risk factors for a pressure ulcer as pressure with reduced mobility, and for diabetic foot ulcers as poor blood supply, lack of sensation or trauma.

That distinction matters because what helps differs by wound. For venous leg ulcers, EWMA describes continuing therapeutic compression as the most important action to prevent an ulcer. For pressure ulcers it advises altering position frequently in bed and when in a chair or wheelchair, with regular inspection and care of the skin. For diabetic foot ulcers it advises inspecting your feet daily, and footwear that fits well and does not cause friction or extra heat.

There is also a reason a wound can look finished before it is. As EWMA puts it, a wound may be closed on the outside while it takes months before the inside is completely healed.

None of this identifies which of the two is happening with any particular wound. MedlinePlus describes wound care centers as places that treat wounds which are not healing, where the team examines and measures the wound, checks the blood flow in the area around it, and works out why it is not healing. That assessment is what separates a wound that came apart from one that has returned.

What to watch for

A wound that opens after it was closed, or returns after it had healed, is a change rather than a steady state. That is worth having assessed rather than watched.

MedlinePlus advises contacting your provider if you notice signs of infection, such as redness, swelling, pus or bleeding from the wound, pain that gets worse, fever, or chills.

The measures that reduce the chance of a wound returning are specific to the kind of wound — compression for venous leg ulcers, pressure relief and skin inspection for pressure ulcers, daily foot checks and well-fitting footwear for diabetic foot ulcers. EWMA advises checking with your healthcare professional for guidance on your own situation.

Wound Wizard is general education and cannot assess your wound or your situation. Your own clinician is the right person to ask about your wound.

What we look at

  • Examining and measuring the wound
  • Checking the blood flow in the area around the wound
  • Identifying the type of wound and what caused it
  • Working out why the wound is not healing
  • Building a treatment plan based on what they find

Sources

  1. Wound Dehiscence — StatPearls, NCBI Bookshelf, U.S. National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK551712/
  2. Wound Q&A for patients and relatives — European Wound Management Association https://ewma.org/resources-for-patients-private-carers/wound-qa-for-patients-and-relatives/
  3. Wound care centers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000739.htm