Wound Care Basics: Types of Wounds

Wound care professionals need a baseline knowledge of the different types of wounds they encounter. Correctly diagnosing and treating the wound as well as any underlying causes, will give you and the patients you care for the best chance of success.

Types of wounds are classified as either acute or chronic. Let’s first look at acute wounds, which tend to move along the healing continuum normally and usually heal within six-eight weeks.

Types of acute wounds

Trauma wounds: Trauma wounds are caused by an injury such as a skin tear, puncture wound, burn, or bite, often due to an accident. A trauma wound is susceptible to infection which will create a problem with the normal healing process. Trauma wounds are often treatable at home or by a patient’s primary care physician. At times, a trauma wound may need the services of a wound care specialist. This is especially true if there is an underlying medical condition preventing normal healing.

Surgical wounds: Surgical wounds are created with precise, clean edges under a controlled environment and therefore are given an optimal chance of healing. Surgical wounds are closed in one of three ways — primary intention (closed by surgical glue, sutures, or staples), secondary intention (left open to heal by granulation), or tertiary intention (initially left open to granulate new tissue and later closed by a surgical procedure). If a surgical wound develops an infection or dehiscence, it will disrupt the normal healing process and can significantly prolong the healing time. If the healing is prolonged or complicated, the surgeon may reach out to a wound care specialist for assistance in healing these types of wounds.

Abscess: Abscesses are areas of infection that often need an incision and drainage procedure to heal, and treatment with antibiotics is often required. In some cases, open areas can be left in drained abscesses that will require regular dressing changes while the wound heals by secondary intention.

Types of chronic wounds

Chronic wounds have not moved along the normal healing continuum, causing normal healing process to stall. Identifying and treating the underlying cause of the stall is essential in restarting the healing process.

Diabetic wounds: According to the Centers for Disease Control and Prevention (CDC) more than 37 million people in the United States have diabetes, and a surprising number are undiagnosed. Diabetic wounds are particularly difficult to heal due to inadequate blood flow, peripheral neuropathy, sustained hyperglycemia, ongoing pressure to the wound site, and other possible factors. All of these issues must be addressed to achieve healing of this type of wound. Special footwear is often required to heal diabetic foot wounds, and the patient will also sometimes require special footwear to prevent healed ulcers from reopening or new ulcers from developing. Diabetic foot care education for the patient and their caregivers is an important factor in preventing future diabetic ulcers.

Pressure injuries: Pressure injuries are caused by sustained, unrelieved pressure to the tissues of the body causing ischemia to the area. While injuries of this type are normally over a bony prominence such as the coccyx, ischium, calcaneus, malleolus, and trochanter, they may also be caused by medical equipment such as endotracheal and catheter tubing. Most inpatient medical facilities use an approved skin assessment tool such as the Braden Scale. These tools are used to predict the likelihood of tissue breakdown of a patient on admission, at regular intervals, and when the patient’s condition changes. Specialized support surfaces on the patient’s bed and wheelchair are also an important part of the treatment plan for pressure injuries.

Radiation injuries: Skin injuries caused by radiation used during cancer treatments can be particularly difficult to heal due to damage to the skin layers, impaired cellular activity, and cell death. Radiation wounds may require treatment by a wound care specialist or plastic surgeon. Hyperbaric oxygen therapy (HBO) can be beneficial for this type of wound.

Venous ulcers: Venous ulcers are located on the lower leg area and are caused by venous insufficiency. A compromised venous system may be caused by multiple factors including venous reflux, obesity, lymphedema, a sedentary lifestyle, a long history of desk work, varicosities, a history of abdominal/pelvic surgery, and a history of IV drug use. Venous ulcers often require some level of compression to heal. This compression can be achieved by use of either tubular stockings, compression stockings, or compression wraps. Prior to applying compression wraps, care should be taken to ensure the patient has adequate arterial flow. Patients with a history of heart failure should have an ejection fraction above 30-35% and be relatively stable without the need of frequent diuretic medication changes.

Arterial ulcers: Arterial ulcers are usually located on the toes and malleolus. They are caused by a compromise in the arterial blood flow to the lower leg and foot. The most common cause of impeded blood flow is stenosis of the lower leg arteries. Damage to the microvasculature of the foot due to prolonged, untreated hypertension, uncontrolled diabetes, or a history of IV drug use can also cause poor arterial flow. Arterial ulcers may heal with time and patience if the stenosis is not significant, though care must be taken to avoid infection. More advanced cases of stenosis will require the assistance of a vascular surgeon to improve the arterial blood flow and give the wound a better chance of healing.

Understanding the basics

Wounds are often multifactorial and patient-specific making them each unique and often difficult to correctly diagnose and treat. Patients with wounds may have poor nutrition, prolonged hyperglycemia, compromised vasculature, unrelieved pressure, or a poor wound environment stalling the healing process. As a wound care clinician, assisting your clinical team in correctly diagnosing and treating the types of wounds your patient has will help connect the missing pieces of the puzzle and have your patient on their way to healing.