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Wound Types

Wound assessment and reporting

Wound healing is determined by the general health of your patient, so a comprehensive assessment of your patient is crucial when planning and evaluating treatment.

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Wound types

Leg ulcers

Four out of ten chronic wounds are venous leg ulcers.

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Diabetic foot ulcers

Diabetic foot ulcer infections increase the risk of amputation 155 times (1).

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1. Fogh et al. Wound Repair and Regeneration 2012;20: 815-821

2. Gottrup et al. Wound  Repair and Regeneration 2008;6:615-25

3. Palao I Domenech et al. Journal of Wound Care 2008;17(8):342-48

The three most common types of leg ulcers are:
  • Venous leg ulcers (70%)
  • Arterial leg ulcers (10%)
  • Mixed venous and arterial leg ulcers (10–15%)
Venous leg ulcers

Venous leg ulcers are caused either by dysfunction of the venous valves or an inadequate calf muscle pump. In both cases, blood isn’t sufficiently returned to the heart. This leads to higher venous pressure, which can cause edema. And an increased fluid level between cells can result in cell death, leading to ulcers. This is why compression therapy is an essential part of treating venous leg ulcers.

Venous leg ulcers are often located in the gaiter area of the leg and characterized by:

  • Irregular shape
  • Brown pigmentation in the peri-ulcer skin area (often with eczema)
  • Normal foot pulse

Venous leg ulcers are often painful, especially during daytime. Elevation of the leg can relieve some of the pain.

Wound Care for Health Care Professionals

Arterial ulcers

Arterial leg ulcers are caused by insufficient blood supply to the leg or feet due to arteriosclerosis. The condition reduces the supply of oxygen and nutrients to the cells, resulting in tissue death and, eventually, ulcers.
Patients with arterial ulcers should not be treated with compression therapy, but will often need vascular surgery.

Arterial ulcers are often located in the gaiter area and on the feet, and are characterized by:

  • Fairly regular shape
  • Atrophic, pale periwound skin
  • Weak foot pulse

Arterial ulcers can be very painful, especially at rest.

Mixed venous and arterial leg ulcers

Mixed venous and arterial leg ulcers are ulcers caused by both venous and arterial disease. The majority of patients diagnosed with mixed venous ulcers have ulcers of venous origin and develop arterial insufficiency over time.

Treatment needs

Venous leg ulcers should normally be treated with graduated compression therapy. However, not all patients can tolerate full compression. Mixed etiology ulcers are likely to require a reduced level of compression. Arterial leg ulcers should not be treated with compression therapy.

Wound dressings for leg ulcers should offer superior absorption and exudate management properties that enable them to absorb and retain exudate under compression bandages (venous leg ulcers). Suitable dressings include Biatain Silicone, Biatain Non-Adhesive.

A silver-releasing dressing, such as Biatain Ag or Biatain Silicone Ag, can help prevent or resolve wound infection.


1. Lavery et al. Diabetes Care 2006;29(6):1288–93 2

Up to 15% of diabetics are likely to develop a foot ulcer at some stage in their lives. Diabetic ulcers have a considerable negative impact on patients’ lives, and are highly susceptible to infection that all too often leads to amputation. This makes infection control of paramount importance in diabetic foot ulcer management.

Successfully managing a diabetic foot ulcer requires a comprehensive understanding of the wound: its cause, progression, risk, and treatment.

The main causes of diabetic foot ulcers are:

  • Neuropathy
  • Poor blood supply (ischemia)


Wound Care for Health Care Professionals

Neuropathy is the most common diabetic foot condition and is caused by damaged nerves in the lower extremity. The condition is permanent and can lead to loss of sensation, which increases the risk of accidental injuries, and painful feet. Treatment involves attention to feet, self-care and custom-made footwear.

Poor blood supply (ischemia)

Wound Care for Health Care Professionals

A very serious condition, ischemia, is the main reason for amputations. Ischemia is caused by impaired circulation, which can be due to arteriosclerosis or occlusion of tissue. Impaired circulation causes reduced pulse – the foot is cold and blue – and this leads to tissue death and the eventual development of an ulcer. Your patient may need vascular surgery.


Wound Care for Health Care Professionals

Diabetes can change the body’s ability to combat infection. Not only are the feet more prone to infection, it’s also harder to get rid of an infection once it’s there. So it’s crucial that you assess the patient regularly to prevent and react quickly to infections.

Treatment needs

  • Treat the underlying causes of a diabetic foot ulcer if possible
  • To support the healing process, use appropriate moist wound healing dressings with superior absorption and exudate management properties, such as Biatain Non-Adhesive foam dressing or Biatain Alginate dressing
  • A silver-releasing moist wound healing dressing, such as Biatain Ag, can help prevent or resolve wound infection

Pressure ulcers

Responsible for a two-fold increase in mortality rates (1), pressure ulcers demand timely, effective treatment.

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Acute wounds

Acute wounds must be treated promptly to stop bleeding and protect tissue.

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1. Brem and Lyder. The American Journal of Surgery 2004;188:9S–17S

2.  NPUAP-EPUAP Pressure Ulcer Prevention, Quick Reference Guide, 2010 (pdf)

3.  NPUAP-EPUAP Pressure Ulcer Treatment, Quick reference guide, 2009 (pdf)

4. Gottrup et al. Wound  Repair and Regeneration 2008;6:615-25

5. Palao I Domenech et al. Journal of Wound Care 2008;17(8):342-48

6. Fogh et al. Wound Repair and Regeneration 2012;20: 815-821

A pressure ulcer (decubitus ulcer) is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. This type of ulcer is the result of pressure, or pressure in combination with shear (2). The pressure prevents the blood from circulating properly, and causes cell death, tissue necrosis and the development of ulcers. Wheelchair users or people confined to a bed (for example, after surgery or an injury) are especially at risk.

Major cause of morbidity

Pressure ulcers are a major cause of morbidity and mortality, especially for people with impaired sensation, prolonged immobility, or advanced age. The most common places for pressure ulcers are over a bony prominence, such as elbows, heels, hips, ankles, shoulders, the back, and the back of the head.


Pressure ulcers are classified according to the degree of tissue damage observed. In 2009 the EPUAP-NPUAP advisory panel agreed upon four levels of injury (3):

Category/Stage I: Non-blanchable redness of intact skin

Wound Care for Health Care Professionals

Buttocks, Stage I, NPUAP copyright & used with permission.

Intact skin with nonblanchable erythema of a localized area, usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness or pain may also be present. Darkly pigmented skin may not have visible blanching.

Category/Stage II: Partial thickness skin loss or blister

Wound Care for Health Care Professionals

Buttocks, Stage II, NPUAP copyright & used with permission.
Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or serosanguinous filled blister.

Category/Stage III: Full thickness skin loss (fat visible)

Wound Care for Health Care Professionals

Ischium, Stage III, NPUAP copyright & used with permission.

Full thickness tissue loss. Subcutaneous fat may be visible, but no bone, tendon or muscle is exposed. Some slough may be present. May include undermining and tunneling.

Category/Stage IV: Full thickness tissue loss (muscle/bone visible)

Wound Care for Health Care Professionals

Sacral Coccyx, Stage IV, NPUAP copyright & used with permission.

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often include undermining and tunneling.

Category/Stage: Unstageable


Full thickness skin or tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Treatment needs (2,3)

  • Pressure must be relieved or removed by appropriate measures.
  • Wound care must be optimized by:
  1. Debridement of necrotic tissue
  2. Appropriate cleansing of wound and surrounding skin
  3. Use of appropriate moist wound healing dressings

Suitable wound dressings for pressure ulcers are foam or alginate dressings with superior absorption and exudate management properties, such as Biatain Silicone or Biatain Adhesive foam dressing or Biatain Alginate dressing. A silver-releasing dressing such as Biatain Ag can help prevent or resolve wound infection.

Download our tips for preventing, assessing and treating pressure ulcers:

Pressure ulcers – prevention and treatment: A Coloplast quick guide (pdf)


1. Enoch and Price 2004. (Pathophysiology Of Healing)
2.Winter. Nature 1962;193:293
3. Winter. Journal of Tissue Viability 2006;16(2):20-23

An acute wound is an injury that causes a break in the skin and sometimes the tissue. Acute wounds are classified into two principal types:

  • Acute traumatic wounds, such as abrasions, lacerations, penetrations or bites, and burns
  • Acute surgical wounds resulting from surgical incisions

Acute wounds – signs and symptoms

  • A cut or tear in the skin
  • Bleeding, swelling, pain, and/or difficulty moving the affected area
  • There may be dirt or foreign objects inside the wound
  • Exudate is normally clear
  • Large or deep, acute wounds with heavy bleeding need acute medical attention to stop bleeding and check for damage to vital organs or tissue.

Treatment needs

Foreign objects should be removed from the wound and necrotic tissue debrided, as it can function as a base for infection and delay wound healing. Wound cleansing with Sea-Clens Wound Cleanser, may be appropriate.

Exudate production is part of the natural wound healing process (1), but the exudate needs to be managed appropriately. Exudate levels are often high during the inflammatory phase of wound healing, and leakage of exudate under the dressing can damage the surrounding skin. Wound exudate must be absorbed and managed by a dressing with moist wound healing properties. This supports the healing process and reduces scar formation. (2-3)

With appropriate care, smaller acute wounds will normally close within days or weeks depending on the size, depth and position of the wound.

Suitable dressings for acute wounds are dressings with superior absorption and exudate management properties that support a moist wound healing environment. These include Biatain Silicone, Biatain Adhesive or Comfeel. Where infection is present, Biatain Silicone Ag and Biatain Ag are appropriate choices.

Why do some acute wounds become chronic?

If a person has a condition affecting the circulation system and/or immune response, normal wound healing processes may be impaired, and the wound may become chronic. Chronic wounds are often defined by the underlying condition that prevents wound healing, such as venous leg ulcers, arterial leg ulcers, diabetic foot ulcers or pressure ulcers.

External Resources

For more information about Wound Care, you can contact the resources below.

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  • American Academy of Dermatology

The academy members include practicing dermatologists who are committed to excellence in patient care, medical and public education, research, professionalism and member services support . Learn more about this academy at

  • Association for Professionals in Infection Control and Epidemiology

APIC is a professional association dedicated to improving health and patient safety by reducing risks of infection and other adverse outcomes. Learn more about this association at

  • Association for the Advancement of Wound Care

AAWC is a non-profit association for anyone involved in wound care. Join in to learn more about wound care at


  • Diabetic Foot Study Group

The aim of the DFSG is to promote improvements in diabetic foot care. Read more about this group at

  • European Pressure Ulcer Advisory Panel

EPUAP works to lead and support all European countries in the efforts to prevent and treat pressure ulcers. You can learn more about their activities at

  • European Wound Management Association

The EWMA deals with all clinical and scientific issues related to wound healing. Each year, EWMA hosts one of the largest international events within wound management and wound healing in Europe. Learn more about this association at

  • International Working Group on the Diabetic Foot

IWGDF works to improve outcomes of diabetic foot problems and strengthen the communication between healthcare professionals. Learn more about their work at

  • International Association for the Study of Pain

IASP is the world's largest multidisciplinary organization working to support the study of pain and to translate that knowledge into improved pain relief worldwide. Read more about them at

  • National Pressure Ulcer Advisory Panel

NPUAP is an American organization working for the prevention and improved treatment of pressure ulcers. Read more at

  • Strategic Marketplace Initiative (SMI)

A consortium of executives representing healthcare providers; medical products, pharmaceuticals and supply chain distribution companies; and service businesses united to reengineer and advance the future of the healthcare supply chain for the purpose of improving the overall healthcare marketplace in the United States. Learn more by visiting

  • World Wide Wounds

World Wide Wounds is an electronic wound management journal dedicated to providing practical guidance and information on all aspects of wound management to healthcare professionals worldwide. Read the journal at

  • Wound Healing Society

The Wound Healing Society is a non-profit organization for clinical and basic scientists dedicated to improve the area of wound healing. Learn more about their activities at

  • Wound, Ostomy and Continence Nurses Society

The WOCN Society is a professional nursing society. It supports its members by promoting educational, clinical and research opportunities to advance the practice of expert healthcare to individuals with wounds, ostomies and incontinence. Read more about this society at

  • World Union of Wound Healing Societies

WUWHS is an international organization dedicated to improving the wound care standards for patients and the healthcare performance of professionals. It also works to ensure universal access in all healthcare systems. For more information go to



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