Hard-to-Heal Wounds in South Africa: Prevalence, Causes & Healing Patterns
Summary: This retrospective study examines the characteristics of 876 wounds in 460 individuals treated at a specialised wound care clinic in Kwazulu-Natal, South Africa. The research reports on prevalence, causes, and healing outcomes for different wound types under appropriate standard care.
Key Findings:
- Wound Types: Acute/traumatic wounds accounted for 50% of cases. Ulcers made up 38%—including 13% diabetic foot ulcers (DFUs), 12% venous leg ulcers (VLUs), and 11% pressure injuries (PIs). Atypical wounds represented 12%.
- Hard-to-Heal (HTH) Wounds: Defined as wounds with <40% closure after 4 weeks or requiring >12 weeks of care. These comprised 22% of patients, most commonly associated with diabetes (44%) or infection (43%).
- Referral Delay: Significant delays were noted—on average 9 weeks for DFUs, 23 weeks for PIs, and 48 weeks for VLUs—before presentation at specialized care.
- Healing Outcomes: Acute wounds generally healed within 4–5 weeks. Healing rates for chronic wounds varied, with many achieving closure over 4–12 weeks. Among DFUs and PIs, only two-thirds healed within 24 weeks.
- Amputations: Overall 2%, but higher in DFUs at 15%, mostly occurring before clinic referral.
Conclusion: High prevalence of chronic and HTH wounds, combined with delayed referrals, underscores the need to recognize wound management as a specialty and improve access to advanced care in South Africa.
Keywords:
hard-to-heal wounds,
diabetic foot ulcers,
venous leg ulcers,
pressure injuries,
South Africa,
healing trajectories,
wound prevalence