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Journal of Education, Health and Sport

The Management of chronic wounds: a current review for internal medicine physicians
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The Management of chronic wounds: a current review for internal medicine physicians

Authors

  • Sylwia Czesława Buczek Specialist Hospital of Śniadecki in Nowy Sącz, Młyńska 10, 33-300 Nowy Sącz, Poland https://orcid.org/0009-0004-3088-6655
  • Ewa Byjoś John Paul II Memorial City Hospital, Rycerska 4, 35-241 Rzeszów, Poland https://orcid.org/0009-0005-4759-156X
  • Katarzyna Fabiś Medical University of Lodz, al. Kościuszki 4, 90-419 Łódź, Poland https://orcid.org/0009-0004-6077-3168
  • Mateusz Zbylut Lower Silesian Center of Oncology, Pulmonology and Hematology, pl. Ludwika Hirszfelda 12, 53-413 Wrocław, Poland https://orcid.org/0009-0002-4666-5684
  • Patrycja Mateja Prelate J. Glowatzki District Hospital, Opolska 36A, 47-100 Strzelce Opolskie, Poland https://orcid.org/0009-0005-7665-1162
  • Weronika Mstowska Medical University of Lodz, al. Kościuszki 4, 90-419 Łódź, Poland https://orcid.org/0009-0003-4524-8106
  • Kamila Milewska Medical University of Lodz, al. Kościuszki 4, 90-419 Łódź, Poland https://orcid.org/0009-0007-2478-4347
  • Karolina Bury City Hospital of John Paul II in Rzeszow, St. Rycerska 4, 35-214 Rzeszów, Poland https://orcid.org/0009-0006-1871-1259
  • Katarzyna Młynarczyk City Hospital of John Paul II in Rzeszow, St. Rycerska 4, 35-214 Rzeszów, Poland https://orcid.org/0009-0006-1535-6837
  • Hanna Naliuka M. Kopernik Regional Multispecialty Center of Oncology and Traumatology, Pabianicka 62, 93-513 Łódź, Poland https://orcid.org/0009-0006-0133-1559

DOI:

https://doi.org/10.12775/JEHS.2026.88.68187

Keywords

chronic wounds, TIME, ulcers, internist, larval therapy

Abstract

Background: Chronic wounds are a growing clinical problem in older patients especially those with multimorbidity. Their healing is impaired by constant inflammation, skin cell dysfunction and bacterial biofilm presence.

Aim: The aim of this review article is to present the current management of chronic wounds in internal medicine practice.

Methodology: The study was conducted as a narrative review. A structured literature search was carried out using the following electronic databases: PubMed,Scopus, Web of Science, and Google Scholar. The search included publications released mainly between 2017 and 2025, in order to reflect current clinical practice and guideline recommendations.

Results: The reviewed literature and articles confirm that internal medicine doctors play a key role in the chronic wound treatment. Firstly, they should concentrate on the etiology of the wound. Comorbidities are also worth considering. The TIME strategy is a structured framework for dealing with wounds. Selected additional therapies are mentioned including negative pressure wound therapy and larval therapy which are used to improve debridement and reduction of bacterial biofilm. All of these actions contribute to reducing the risk of complications, hospitalizations and amputations.

Conclusion: Chronic wounds are still a complex and heterogeneous clinical problem. It requires an individualized diagnostic and therapeutic approach based on etiology. The internist actions are essential in early patient assessment, management of comorbidities and coordination of multidisciplinary care. In some cases advanced therapies such as negative pressure wound therapy or larval therapy need to be performed in order to achieve a better outcome.

References

1. Pastar I, et al. Molecular pathophysiology of chronic wounds. Cold Spring Harb Perspect Biol. 2023;15(2): a041243. https://doi.org/10.1101/cshperspect.a041243

2. Sussman G. An update on wound management. Aust Prescr. 2023;46(3):85–89. https://doi.org/10.18773/austprescr.2023.006

3. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017; 376:2367–2375. https://doi.org/10.1056/NEJMra1615439

4. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106–116.

https://doi.org/10.1080/07853890.2016.1231932

5. Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2023. https://doi.org/10.1002/dmrr.3657

6. Maeseneer M, et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022. https://doi.org/10.1016/j.ejvs.2021.12.024

7. European Wound Management Association. Atraumatic and effective management of chronic wounds. London: EWMA; 2022.

8. Bazaliński D, Banasiewicz T, editors. Wounds in the Practice of the Primary Care Physician and Nurse. Warsaw: Medical Tribune Polska; 2025. ISBN: 978-83-68323-1-4-6.

9. Normandin C, Williams A, et al. Negative pressure wound therapy: mechanisms of action and clinical applications. Wounds. 2021;33(10): E69–E76. https://doi.org/10.1055/s-0041-1731792

10. Chen L, Zhang S, et al. A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer. Ann Palliat Med. 2021. https://doi.org/10.21037/apm-21-2476

11. Moris D, Flores M, et al. Larval therapy and larval excretions/secretions: a potential treatment for biofilm in chronic wounds? A systematic review. Microorganisms. 2023;11(2):457. https://doi.org/10.3390/microorganisms11020457

12. Bazaliński D, Wiśniewska M, Kózka M, et al. Larval therapy in the treatment of chronic wounds – current state of knowledge. Wound Treatment. 2023;20(2):45–52. https://doi.org/10.60075/lr.v20i3.43

13. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6 Suppl):3S–125S.e40.

https://doi.org/10.1016/j.jvs.2019.02.016

14. European Society for Vascular Surgery. ESVS guidelines on the management of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2021;61(1):1–109.

15. American Diabetes Association. Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1): S1–S350. https://doi.org/10.2337/dc24-S002

16. Lim S, Chung R, Holloway S, et al. Modified compression therapy in mixed arterial-venous leg ulcers: an integrative review. Int Wound J. 2021. https://doi.org/10.1111/iwj.13585

17. National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management (NG158). London: NICE; 2020.

18. Hinchliffe RJ, Forsythe RO, Apelqvist J, et al. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020. https://doi.org/10.1002/dmrr.3276

19. Polish Diabetes Association. Clinical practice guidelines for the management of patients with diabetes. 2025.

20. Monteiro-Soares M, Russell D, Boyko EJ, et al. Diabetic foot ulcer classifications: a critical review. Diabetes Metab Res Rev. 2020. https://doi.org/10.1002/dmrr.3272

21. Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes. Diabetes Metab Res Rev. 2023. https://doi.org/10.1002/dmrr.3687

22. Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Vasc Surg. 2010. https://doi.org/10.1016/j.jvs.2010.06.007

23. Kottner J, Cuddigan J, et al. Prevention and treatment of pressure ulcers/injuries: protocol for the second update of the international Clinical Practice Guideline. J Tissue Viability. 2019. https://doi.org/10.1016/j.jtv.2019.01.001

24. Eriksson E, Liu PY. Chronic wounds: treatment consensus. Wound Repair Regen 2022. https://doi.org/10.1111/wrr.12994

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Published

2026-02-15

How to Cite

1.
BUCZEK, Sylwia Czesława, BYJOŚ, Ewa, FABIŚ, Katarzyna, ZBYLUT, Mateusz, MATEJA, Patrycja, MSTOWSKA, Weronika, MILEWSKA, Kamila, BURY, Karolina, MŁYNARCZYK, Katarzyna and NALIUKA, Hanna. The Management of chronic wounds: a current review for internal medicine physicians. Journal of Education, Health and Sport. Online. 15 February 2026. Vol. 88, p. 68187. [Accessed 16 February 2026]. DOI 10.12775/JEHS.2026.88.68187.
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Issue

Vol. 88 (2026)

Section

Medical Sciences

License

Copyright (c) 2026 Sylwia Czesława Buczek, Ewa Byjoś, Katarzyna Fabiś, Mateusz Zbylut, Patrycja Mateja, Weronika Mstowska, Kamila Milewska, Karolina Bury, Katarzyna Młynarczyk, Hanna Naliuka

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

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