Understanding the Zebras of Wound Care: An Overview of Atypical Wounds

Elizabeth Ansert, DPM, MBA, MA; Anthony Tickner, DPM, FACCWS, FAPWCA, FAPWH; Donald Cohen, DPM; Weldon Murry, DPM; Samuel Gorelik, DPM


Wounds. 2022;34(5):124-134. 

In This Article


Atypical wounds have a poorer prognosis and slower healing rate than typical wounds (eg, vascular wounds, diabetes wounds). The estimated 1-year survival rate after diagnosis of calciphylaxis, for example, is approximately 46%.[82] Overall, for atypical ulcerations the average healing rate is 0.115 mm per day after identification and implementation of the appropriate treatment; this rate is slower than that for comparable ulcerations of a vascular etiology.[5] One key aspect of a better prognosis, lower cost of care, and better quality of life is early and appropriate diagnosis and treatment. Biopsies are often vital in wound care to identify and differentiate various wounds. Biopsies are recommended for atypical and recalcitrant wounds to identify the etiology. It is important to note that multiple characteristics or histologic features can overlap in a biopsy with atypical wounds. A biopsy will still require an understanding of the presentation of these different wounds.[82] A proper diagnosis for an atypical wound can greatly hasten wound closure, reduce the cost of care for the patient and the health care system by reducing the number of doctor visits, and improve the patient's quality of life.[82]

A new aspect of wound care involves the increased use of monoclonal antibodies for treatment.[23] Monoclonal antibodies have more specific targets and may have different adverse effects than other common medications.[23] For example, infliximab is used in the management of PG and atypical cancerous lesions. For etiologies that may be beyond the scope of expertise of a wound care specialist, such as malignant tumors, enlisting the help of other specialists or consultation with other wound experts is advised.