There are two components to treating the chronic wound:

The first component is to correct the etiologic factors which caused the wound to become chronic in the first place.  Correction of malnutrition and improved control of chronic illnesses such as diabetes is required.  Improvement of perfusion is needed if hypoperfusion is a key component in the failure to heal.  Treating wound infection and excess bacterial burden is necessary.

Prevention of continued mechanical trauma by friction, shearing, pressure and repeated insults, is necessary.

The second component is improving the wound microenvironment such that wound healing can begin to heal again.  In other words, convert the chronic wound environment back into an acute wound environment which can progress to healing.

As with the hard to heal wound, control of surface exudates is necessary.  A variety of hydrogels and alginate are available.  Removal of necrotic tissue is required using sharp, blunt or enzymatic debridement.

If an increased bacterial load is present, use of a non-toxic topical antibiotic is indicated.  Systemic antibiotic would be needed for infection.  Moist wound healing needs to be maintained.

The addition of growth factors has been shown to be modestly effective in some types of wounds.  The presence of matrix proteases likely leads to increased breakdown.

The addition of matrix components including growth factors with application of a wound matrix dressing like OASIS® would close the wound and provide for moist wound healing.  Closure should decrease the chronic inflammation.  Repeat applications should markedly improve the wound  microenvironment, making it conducive to healing.