Types of Wounds Healthcare Professionals Should Know

Millions of Americans suffer from chronic and non-healing wounds each year. These wounds may affect all ages, but most occur in older individuals in acute or long-term care facilities, those with diabetes, circulatory issues, or recovering from burns or surgeries.

But what’s often most concerning about chronic wounds is their severity and the impact they have on wound healing and most importantly, people. Nature Reviews reports that the 5-year mortality rate for this wound type, such as diabetic chronic ulcers, is 70%.

Additionally, quality of life is tremendously impacted by wounds, from patients with diabetic ulcers who must have limbs amputated to those in nursing homes dealing with pressure ulcers. This issue underscores the crucial role of caregivers and all stakeholders in the care continuum to prioritize and address chronic wounds.

When discussing wound types in this article, we are not referring to minor wounds, such as cuts and scapes, smaller puncture wounds or smaller infected wounds that may not make it to a wound specialist. Acute wounds, on the other hand, heal without complications in a predicted amount of time, distinguishing them from chronic wounds.

Because there are so many types of wounds and they can have a wide-ranging impact in terms of wound healing, a periodic review of the most common, their consequences, risk factors, and common wound management techniques is important. This guide with help you whether you’ve been in the industry for years or are just entering the world of wound care.

Chronic Wounds: A Definition

American Family Physician states that a chronic wound fails to progress through a normal, orderly, and timely repair sequence or that the repair process fails to restore anatomic and functional integrity after three months.

An open wound is considered chronic if it fails to show signs of wound improvement within the initial two weeks or has not completely healed in six weeks.  Most are open wounds and frequently contain or are at risk for necrotic tissue.

Peripheral vascular disease is a significant contributing factor to wounds that become chronic, particularly vascular ulcers.

While these are not uniformly slow when it comes to wound healing, they should be considered emergent, requiring quick judgment and prompt action. In the United States, 3 to 6 million chronic skin ulcers occur annually. While there are many types of potentially traumatic wounds if left untreated (such as a puncture wound or smaller penetrating wounds), let’s look at the five most common types seen by wound care providers today.

The Five Most Common Types of Wounds

Below is the five most common wound types, including surgical wounds and traumatic wounds.

Pressure Ulcers (Bedsores)

Pressure ulcers (PU), pressure injuries (PI), or decubitus ulcers result from prolonged pressure on the skin and underlying tissues, often due to immobility or poor positioning.  Pressure ulcers frequently occur in older or immobile patients, and often in hospitals and long-term care settings. The rate of PUs varies based on several factors; some facilities have very low rates, others higher. Recent reports put the rates in nursing homes around 8.5% (with some as low as 2.2 and as high as 28%), primarily for Stage I or II PIs.  Preventing Hospital Acquired Pressure Injuries (HAPIs) is also a concern. 

According to a study published in the American Journal of Critical Care, approximately 5.85% of critical care patients in US hospitals experience HAPIs. Clinicians should also take note of veteran statistics. Their PI rate is 4.1 per 1,000, approximately double the national average.

While all stats about PIs are noteworthy, the most important is that about 95% of pressure ulcers are preventable. CMS is so concerned about this condition that it penalizes post-acute and hospital facilities for the most severe—Stage III and IV pressure ulcers.

The primary causes of pressure ulcers include immobility, malnutrition, incontinence, and impaired circulation. Proper care includes offloading the affected area, wound care, and prevention strategies. It’s also crucial to regularly reposition patients’ pressure redistribution surfaces and control moisture in the area.

Technologies that help identify at-risk patients and monitor healing through digital devices are essential wound care solutions for this patient population. These aides can help identify at-risk wounds and those that are healing by providing early images of wound granulation.

Diabetic Foot Ulcers

Diabetic foot ulcers (DUs) are most commonly caused by poor circulation, high blood sugar (hyperglycemia), nerve damage, and irritation or wounds occurring on the feet. These factors contribute to skin tissue breakdown, leading to ulcers that can affect the feet and bones.

Recently, there’s been growing concern about the scope of DUs among people of color, economically disadvantaged, or with the inability to access quality care. In a concerning article, the American Journal of Managed Care found that African Americans are much more likely—four times more likely, to be exact—to experience diabetes-related amputation than white Americans in the United States. Overall, every 17 seconds, someone in the US is diagnosed with diabetes, and worldwide, every 30 seconds, a leg is amputated.

There are several ways to treat DUs, starting with prevention through education all the way  to early diagnosis of diabetes. If a patient’s condition worsens, glycemic control and changes in diet, medication management, addressing arterial disease, and access to quality multidisciplinary wound care are vital. To treat patients in rural areas or those who have difficulty accessing care, including unhoused populations, the use of AI-powered wound imaging software is growing and shows positive outcomes.

Venous Ulcers

Venous ulcers affect 1 to 3% of the US population. According to Johns Hopkins Medicine, venous insufficiency occurs when leg veins are unable to pump blood back to the heart efficiently. As a result, blood pools in the lower legs, causing swelling, which can lead to venous ulcers. These ulcers typically appear between the mid-calf and ankle.

They often have irregular shapes and well-defined borders. Risk factors include patients who have damaged veins and whose blood flow isn’t properly managed, high blood pressure, obesity, and prolonged standing.  There is a wide range of therapies for this type of ulcer, including compression therapy, leg elevation, exercise, and quality wound care.

The most common treatments for venous ulcers include using compression stockings orbandages to improve blood flow, elevating legs, debridement, and surgery. Stem cells are showing some early promise as a new treatment for this condition, repairing damaged tissues and promoting healing. Additionally, some clinicians are exploring the emerging field of gene therapy as a treatment option. The NIH says it’s a treatment that modifies cells using specific genes to improve blood flow and reduce inflammation in chronic venous leg ulceration.

Arterial Ulcers

These ulcers are caused by reduced blood flow through one or more arteries. They typically occur when an artery becomes narrowed or blocked. The most common cause is atherosclerosis, which involves plaque buildup in the arteries.

Depending on which artery is affected, symptoms can vary; arterial insufficiency results in tissue ischemia (inadequate blood supply) and ulceration. Approximately 20% of all lower extremity ulcers in high-income countries are due to arterial insufficiency and most often occur in patients over 65.  While not as common of a factor as it once was, smoking increases the risk of developing atherosclerosis by 50%.

Care for arterial ulcers often includes referral to a vascular surgeon to address the underlying disease and routine sustained access to quality wound care providers.

Atypical Non-healing and Infected Wounds

Our last category of chronic wounds uses the moniker atypical and refers to chronic wounds of unknown origin that defy standard categorization. They are similar to venous or arterial ulcers and most often occur on lower limbs like knees or the sole of the foot. Most are open, contain necrotic tissue, and take prolonged periods of time to heal.

Some atypical wounds may be related to cancers like basal cell carcinoma.  A few are considered hereditary, such as epidermolysis bullosa, an inherited disease leading to very fragile skin and blisters that can easily rupture from something as simple as clothing or routine activities.

Multiple risk factors exist for atypical wounds, most associated with underlying health conditions. One of the most important steps to manage these wounds is for a biopsy to ensure diagnosis, followed by individualized assessment and treatment. Routine ongoing care is also crucial.

Rely on Trusted Wound Care Technology for Wound Healing

There are many other types of wounds, from those caused by insect bites, radiation, lifestyle, and even psychological issues. No matter their genesis, most benefit from two primary strategies. Wounds can be open, with exposed body tissue, or closed, with damage to tissue under intact skin.

The TIME approach to wound care was developed over a decade ago by the International Advisory Board for Wound Bed Preparation (WBP). “Their goal was to provide a structured framework for wound bed preparation, optimizing the management of open chronic wounds healing by secondary intention.” Closed wounds occur without any exposure to underlying tissue and organs, often caused by blunt trauma.

• T is for Tissue Debridement, removing necrotic tissue.
• I stands for Infection Control, addressing infection promptly.
• M represents Moisture Balance, done by maintaining optimal wound moisture.
• E stands for Edges of the Wound, ensuring wound edges are healthy. Penetrating wounds result from trauma that breaks through the full thickness of the skin, such as stab wounds and cuts.
• Advanced wound care technologies that use machine learning and AI to provide clinicians with the information and insights to diagnose and treat wounds better. A surgical wound is an incision made into the skin during any type of operation.

Wound care technology can help support these methods, whether by providing AI aids itself or by simplifying tracking the status and progress of wounds to streamline treatment and progress. Surgical wounds require careful post-operative care to prevent infection and complications.

Wound care is complex and can pose challenges. However, a multidisciplinary approach, supported by technology and fueled by a commitment to best practices, can significantly improve outcomes and quality of life for patients in need. Underlying tissue can be exposed in open wounds or damaged in closed wounds, and infection can spread to underlying tissue and bone.

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