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

Artefactual Ulcers

Artefactual ulcers are often self-inflicted to serve a psychological need for the patient. Typically, a diagnosis of exclusion, these ulcerations are seen in women in their second or third decade and can pose a difficult challenge for practitioners.[45,46] The ulcerations are often sharply demarcated, with geometric or unusual patterns[46] (Figure 8). The ulcers often are located on the face, trunk, and extremities but not on areas of the body that are harder to reach. Affected patients often connect to the medical field themselves through work or family members needing extensive care and may have a history of borderline personality disorder, eating disorders, or other mental illness.[45]

Figure 8.

Self-inflicted wounds of abdomen due to cutting with razor blades. Note the old and new wounds. Used with permission; Terry Treadwell, MD.

Psychiatric referral and therapy are the most important aspect of managing these ulcerations, with an emphasis on recognizing hidden stressors and on cognitive behavioral therapy.[45] Topical occlusive dressings and standard good wound care are also mainstays of treatment. Occlusive dressings have been shown to prevent further self-mutilation.[46]