A refractory (hard-to-heal) wound is defined as any break in skin or mucosa that fails to move through an orderly reparative sequence and remains open beyond 4–6 weeks despite standard care. The wound itself and the surrounding tissues display a characteristic set of changes. Persistent open wound bedGranulation tissue is pale, flat or “pocket-like” instead of beefy red and raised; epithelial margins fail to advance and may become rolled or calloused . Excessive moisture or oozingContinuous serous or purulent discharge macerates perilesional skin, increases odour and demands frequent dressing changes . Pain and malodourDeep, throbbing pain is common; an unpleasant... Learn more