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


The recognition of atypical wounds and implementation of the specific treatment protocol for each type is imperative to improving clinical outcomes and wound healing. An uncommon etiology should be suspected when a wound does not show signs of healing with conventional care after 4 weeks, is associated with pain out of proportion to the clinical presentation, or exhibits an atypical clinical appearance.[6–8] In such instances, a biopsy should be performed, or advanced clinical techniques used to assess the wound etiology. Because of the limited availability of patients with atypical wounds, the literature concerning specific pathologies is limited. More research into each pathology is needed, as is a universally accepted treatment protocol. Although this review does not include all atypical etiologies, the authors hope that it spurs clinicians to earlier suspicion and investigation of atypical wounds to improve patient outcomes.