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I had an accident 2 months ago. The wound not healed. I want to test what are the test I would do please suggest
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investigations tests for chronic non-healing wound 2 months traumatic ulcer workup
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⚠️ Important Disclaimer
This is educational guidance only. Your wound looks serious - please see a doctor or wound care specialist urgently. A 2-month-old non-healing wound needs in-person evaluation.
What the Wound Looks Like
Based on the image, your wound shows:
- A central open ulceration with a linear fissure containing reddish-brown tissue (granulation tissue mixed with dried blood/slough)
- A thick ring of white-yellow slough (non-viable tissue) surrounding the center
- Heavy crusting and hyperkeratosis (thickened, scaly skin) around the edges
- Surrounding redness and inflammation (erythema)
- Signs of possible infection or an underlying condition preventing healing
A wound from an accident that has not healed in 2 months is called a chronic non-healing wound and requires a thorough investigation to find out why it is not healing.
Tests Your Doctor Will Likely Order
1. Blood Tests (Systemic Workup)
| Test | Why It's Done |
|---|---|
| Complete Blood Count (CBC) | Check for anemia, infection (raised WBC), low platelets |
| Random / Fasting Blood Sugar + HbA1c | Diabetes is the #1 cause of non-healing wounds |
| Serum Albumin & Pre-albumin | Assess nutritional status - low protein = poor healing |
| Kidney Function Tests (BUN, Creatinine) | Kidney disease impairs healing |
| Liver Function Tests | Liver disease affects clotting and protein synthesis |
| Coagulation Profile (PT, PTT, INR) | Check clotting ability |
| Thyroid Function (TSH, T3, T4) | Hypothyroidism slows wound healing |
| ESR / CRP | Markers of systemic inflammation or infection |
| Vitamin C, Zinc, Vitamin D levels | Deficiencies directly impair wound healing |
| HIV / Immunocompromised screen | Immune deficiency causes non-healing wounds |
2. Wound-Specific Tests
| Test | Why It's Done |
|---|---|
| Wound swab culture & sensitivity | Identifies bacteria causing infection and the right antibiotic |
| Deep tissue culture | More accurate than surface swab for deeper infections |
| Wound biopsy | Critical after 3 months - rules out squamous cell carcinoma, melanoma, or other skin cancers that can mimic a non-healing wound. Also diagnoses rare conditions like pyoderma gangrenosum or vasculitis |
| Fungal culture (KOH prep) | Fungal infections (e.g., blastomycosis, sporotrichosis) cause chronic wounds |
3. Vascular / Blood Flow Tests
| Test | Why It's Done |
|---|---|
| Ankle-Brachial Index (ABI) | Measures blood flow to the area - poor circulation = non-healing |
| Doppler Ultrasound | Checks arteries and veins supplying the wound area |
| Venous Duplex Scan | If the wound is on the leg, checks for venous insufficiency |
4. Imaging Studies
| Test | Why It's Done |
|---|---|
| X-ray of the area | Rules out underlying fracture, foreign bodies (glass, metal), or osteomyelitis (bone infection) |
| MRI or CT scan | If deep infection (osteomyelitis) or abscess is suspected |
| Bone Scan | If bone infection is strongly suspected |
5. Skin / Immunological Tests
| Test | Why It's Done |
|---|---|
| ANCA, ANA, RF (Autoimmune panel) | Autoimmune diseases like vasculitis can cause non-healing ulcers |
| Sickle Cell Screen (HPLC) | Sickle cell disease causes leg ulcers |
| Syphilis / VDRL | Syphilitic ulcers can appear chronic |
| TB skin test / Sputum culture | TB can cause skin ulcers |
Red Flags - See a Doctor Urgently If You Have:
- Fever, chills, or feeling generally unwell
- Increasing redness, warmth, or swelling spreading from the wound
- Foul-smelling discharge or pus
- Black/dead tissue in the wound
- Wound getting larger rather than smaller
- Numbness or loss of sensation around the wound
- The wound is over a joint and affects movement
Most Likely Reasons Your Wound Has Not Healed
Based on the appearance of your wound, the most common causes a doctor will investigate include:
- Uncontrolled diabetes (most common)
- Wound infection (bacterial or fungal)
- Poor blood supply (vascular disease)
- Malnutrition (low protein, low zinc/vitamin C)
- Foreign body still inside the wound
- Underlying bone infection (osteomyelitis)
- Rare: skin cancer developing in an old wound (Marjolin's ulcer)
- Autoimmune condition (pyoderma gangrenosum)
Please visit a wound care clinic, dermatologist, or general surgeon as soon as possible. The thick crusting and slough visible in your wound need professional debridement (cleaning), and the underlying cause must be treated for the wound to heal.
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