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Delayed Wound Healing

What is delayed wound healing?

Delayed wound healing happens when a wound or break in the skin takes longer than usual to heal. Wounds that heal slowly can be uncomfortable or painful or become infected. Slow wound healing can also delay other medical treatments.

Delayed wound healing could be caused by various factors. These include certain medical conditions, medicines or other treatments, poor blood supply, swelling, or infection. Infants and children have more sensitive skin than adults, so their wounds can be harder to heal.  

How wounds heal

The skin normally heals in several steps, which include:

  1. Bleeding and clotting: The blood vessels tighten to slow down the flow of blood. Platelets, a type of blood cell, become active and stick together, which slows and stops bleeding.
  2. Inflammation: White blood cells, part of the body’s immune system, travel to the wound to get rid of dead cells and germs. Immune cells also release substances to help new tissues grow and prevent infection.
  3. Skin repair and new tissue growth: New blood vessels, collagen, and skin cells begin to grow. This helps the edges of the wound pull together to close the wound.
  4. Strengthening: As the wound heals, the tissue becomes stronger. A scar may form. The amount of scarring depends on how large or deep the wound is. Scars may appear smaller or fade over time as your child grows. Even when skin heals properly, the damaged or scarred area may not be as strong as skin that was never injured.

Talk to your care team about what to expect during healing. The time it takes a wound to heal can depend on the type of wound, where it is located, how deep or large it is, and your child’s age and health. Knowing what to expect can help you watch for signs of delayed healing or other problems.

Symptoms of delayed wound healing

Signs and symptoms of delayed wound healing include: 

  • No change in wound size or appearance
  • Edges of the wound do not close
  • The wound bed looks dry or pale
  • Pain and swelling do not get better

Infection can be associated with slower healing. Signs and symptoms of infection include:

  • Redness, swelling, or warmth around the wound
  • Red-colored streaks around the wound or going away from it
  • Fluid or pus coming out of the wound
  • Bad smell or odor from the wound
  • Fever

Risk factors for delayed wound healing

Some medical conditions can delay wound healing or stop the wound from healing completely. These are:

Medicines and treatments that may cause wounds to heal more slowly include:

Lifestyle factors may also cause wound healing problems, such as:

  • Poor nutrition dont think this belongs here, see above
  • Stress
  • Alcohol use
  • Smoking or vaping

Staying in the same position for too long, or using certain medical equipment that presses against the skin can cause pressure injuries (sores) that may heal more slowly.

Cancer treatments and wound healing

Cancer treatments can delay wound healing. Cancer patients may have wounds from surgical incisions, pressure sores, devices like feeding tubes or central lines, and cuts or abrasions. Treatments, such as chemotherapy and radiation, may affect the skin and the healing process. These treatments can cause changes to the skin, blood cells, blood vessels, and immune system.

Ask your care team about your child’s risk of delayed wound healing. Watch for signs so that you can treat it early and care for the skin. Learn more about skin changes during cancer treatment.

Chemotherapy and wound healing

Chemotherapy can cause side effects that affect the skin and how well it heals. These include:

  • Skin irritation 
  • Sores and tissue damage around the IV site 
  • Lower blood flow to the wound site
  • Decrease in collagen (protein) that helps the skin heal
  • Decrease in skin strength
  • Poor healing

The effects of chemotherapy on wound healing depend on chemotherapy dose, frequency, and timing. The effects on wound healing may be worse if your child received multiple drugs or if chemotherapy was combined with other treatments.

Radiation therapy and wound healing

Radiation therapy can slow wound healing, especially if the wound is near the treatment area. Radiation effects on skin include:

  • Skin irritation, dryness, and flaking
  • Thinning of the skin
  • Decrease in skin strength
  • Thickening of skin and connective tissue (tissue fibrosis)
  • Damage to blood vessels and low blood flow
  • Poor healing

High or more frequent doses of radiation can increase the risk of delayed wound healing.

Diagnosis of delayed wound healing

A health care provider will do a physical exam to inspect the wound and see how well it is healing. Your child may need to visit the health care provider several times to check the wound. Other tests may be needed to rule out infection or other problems. Tests may include: 

Blood tests: Your health care provider may order blood tests such as a complete blood count or blood chemistry studies. These tests can check for infection or problems with the immune system.

Wound culture: If your health care provider suspects your child’s wound has an infection, they may take a sample of tissue and fluid from the wound to find out the type of infection.

Imaging tests: Your health care provider may order imaging tests to learn more about the wound and how well it is healing. Tests may include X-rays, ultrasound, bone scans, or MRI and CT scans. 

Treatment of delayed wound healing

Treatment of the wound will vary depending on your child’s needs and their health. Wound care may include:

  • Cleaning the wound 
  • Applying ointments and other products to keep the skin moist, act as a barrier, and kill germs that can cause infection
  • Covering the wound with a special dressing to protect it
  • Removing or adjusting things that put pressure on the skin  
  • Medicines to prevent or treat infection
  • Pain medicines or other pain management strategies to reduce discomfort

In some cases, patients may need surgery or other procedures to aid wound healing. Common procedures for wound care include:

  • Wound debridement to remove dead tissue and bacteria that cause infection
  • Surgery to repair tissue or close the wound, including skin grafting
  • Negative pressure wound therapy (wound vac) to remove fluid, reduce swelling, and help wounds heal
  • Oxygen therapy to bring needed oxygen to the wound for healing this is not a wound healing tactic. HBOT use is rare, and topical o2 is not evidence based

Tips for families

  • Talk to your care team about wound healing and what to expect if your child has a serious medical condition or is undergoing treatments such as chemotherapy or radiation or is taking steroid medicines.
  • Follow your care team’s instructions for wound care.
  • Protect wounds and fragile skin.
  • Check your child’s skin regularly. Watch for signs of infection or problems in healing. 
  • Make sure your child gets proper nutrition. This includes making sure your child’s diet has enough calories, protein, vitamins, and minerals. 

Contact your care team right away if you have concerns about how your child’s wound is healing or notice signs of infection.

Questions to ask the care team

  • How long should it normally take a wound like this to heal?
  • Is my child’s wound healing more slowly than expected?
  • Is my child at risk for delayed wound healing?
  • What tests does my child need? 
  • How should I clean and care for my child’s wound?
  • Are there things I can do to help my child’s wound heal faster?
  • Are there any activities my child should avoid until the wound heals?
  • What signs of infection or other problems should I watch for? 

Key points about delayed wound healing

  • Delayed wound healing occurs when a wound does not go through the usual stages of healing and takes longer than normal to heal.
  • It can be caused by certain medical conditions or treatments, decreased blood flow, infection, poor nutrition, or repeated irritation to the area.
  • Common signs of delayed healing include little or no improvement over time, pale or dry tissue, wound edges don’t close, and lack of new healthy tissue.
  • Wounds that heal slowly can be painful, become infected, affect daily activities, and delay medical treatments.
  • Proper wound care, good nutrition, and medical follow-up are important to promote recovery and treat any underlying issues.
  • Contact your care team if you have questions about wound care or notice signs of infection or other symptoms that worry you.

—
Reviewed: January 2026

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