Acute vs Chronic Wounds: a Closer Look Inside the Wound

In previous articles, we have looked at the basic differences between chronic wounds and acute wounds and have considered some of the macroscopic factors that are responsible for the development of a chronic wound through abnormal wound healing. This article will look at some of the differences between the two types of wound on a cellular level, and consider the fundamental processes occurring within the wound itself.

Micro-Environments of Chronic Wounds

The wound micro-environments of the acute and chronic wound differ substantially. On a simplistic level, acute wounds have low levels of cytokines and matrix metalloproteases (MMPs) but high growth factor levels. Chronic wounds, by contrast, contain the same components but their relative proportions are reversed. This difference has a major impact on the wound and its ability to heal.

Growth factors, endogenously produced hormone-like substances that control cell growth, differentiation, and metabolism, are essential for wound repair because a ‘threshold’ level of growth factors is required to move the target cells into their reproductive cycle.


Cytokines are signaling proteins that have a major role inflammation. It appears to be the elevated cytokine levels in a wound that is responsible for the prolonged inflammatory phase that typifies a chronic wound.

Interestingly, while this imbalance is thought to be the cause of impaired healing, some researchers have suggested it may actually be a result of chronicity.

Molecular Understanding

Only by understanding the fundamental differences between chronic and acute wounds at the molecular level can we begin to develop strategies to change the underlying microenvironment of the wound and promote chronic wound healing.

To learn more about the differences in the microenvironment of acute and chronic wounds, and to explore effective ways to encourage a chronic wound to move through the normal phases of wound healing, consider becoming wound certified. A certification in wound care allows complex issues to be studied in greater depth, providing a more thorough understanding of underlying processes that improves wound care practices.

Learn More With Our Wound Care Education Options

Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.


  1. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
  2. Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3rd ed. St Louis, Missouri; Mosby Elsevier; 2007.

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