Open wounds in the skin are generally referred to as "ulcers" and can have a variety of etiologies. Ulcerative wound types include venous, arterial, diabetic neuropathic, and pressure. To identify ulcer types, these wounds should be examined thoroughly for their distinct characteristics such as location and shape, as well as in conjunction with other patient information, to ensure an accurate diagnosis and treatment plan.
Venous ulcers are commonly caused by chronic venous insufficiency or the improper functioning of the one-way valves in the veins that prevent the proper flow of blood back to the heart. Blood pools in the lower part of the legs, thereby increasing the pressure around the capillaries and preventing oxygen and nutrients from reaching muscle and skin tissue, a process that results in cell death and the formation of an ulcer.1
Venous ulcers commonly occur in individuals with a history of varicose veins, high blood pressure, blood clotting disorders, deep vein thrombosis, or heart failure. They may also occur in patients who are pregnant or who have experienced trauma, fractures, or injuries to the area.4
Arterial ulcers, sometimes referred to as ischemic ulcers, are commonly caused by blocked arteries that prevent the flow of oxygen and nutrients to tissue. As in venous ulcers, the lack of oxygen and nutrients causes cell death and the formation of an open wound. Characteristics1,2,4–6
Arterial ulcers commonly occur in older patients, patients with diabetes, or those with vasculitis, high cholesterol, and high blood pressure. Higher-risk patients may also have a history of smoking, kidney failure, atherosclerosis, or trauma to the area.4
Diabetic ulcers resemble arterial ulcers but are more commonly located over pressure points, such as the heels, plantar aspect, or the tips of the toes. They may also occur between the toes or over bony prominences that experience friction. Characteristics5,6
Diabetic ulcers often worsen because of the presence of neuropathy, which can increase mechanical stresses on the foot.
Pressure injuries commonly occur in individuals with limited mobility, such as those confined to bed rest or those who may need a wheelchair. The pressure is caused by the weight of the body being in one position for extended amounts of time or in conjunction with friction, shearing, and/or moisture. One or more extrinsic factors will eventually damage the surface of the skin. Left untreated, this damage will worsen, and an injury will develop. Pressure injuries are commonly classified into six stages. The staging system was developed to determine the tissue level of destruction. Characteristics
Identifying wound etiology is not always straightforward when looking at wound location and characteristics. Clinicians should remember to perform a thorough assessment involving the patient. Ask questions, and listen to your patient because that interaction may give you valuable information to help your patient heal their wound.
1. Ngan V. Leg ulcer. DermNet NZ; 2004. https://www.dermnetnz.org/topics/leg-ulcer/. Accessed November 29, 2019.
2. London Health Sciences Centre. Venous stasis and arterial ulcer comparison. 2019. https://www.lhsc.on.ca/wound-care-management/venous-stasis-arterial-ulc…. Accessed November 29, 2019.
3. Finlayson K, Miaskowski C, Alexander K, et al. Distinct wound healing and quality-of-life outcomes in subgroups of patients with venous leg ulcers with different symptom cluster experiences. J Pain Symptom Manage. 2017;53(5):871-879.
4. Healthline. Arterial and venous ulcers: what’s the difference? https://www.healthline.com/health/arterial-vs-venous-ulcers; 2018.
5. Cleveland Clinic. Leg and foot ulcers. 2019. https://my.clevelandclinic.org/health/diseases/17169-leg-and-foot-ulcers. Accessed November 29, 2019.
6. Gabriel A. Vascular ulcers. 2018. Medscape.com. .
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.