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Atypical Wounds: What Are They and How Do You Treat Them?


If you’ve been in long-term care for quite some time, it’s safe to say that you’re already familiar with common wounds that are categorized as either arterial, neuropathic or pressure. Ankle and foot ulcerations are treated quite differently, however, because they can be due to multiple causes.


It’s important to keep in mind that treating any underlying issues is key to wound healing which is why understanding atypical or unusual wounds is very important.


Below are some of the characteristics of an atypical wound:


  • Unusual location - a good example of this is a wound that looks to be venous in nature but doesn’t appear on a venous leg ulcer’s usual location.


  • Patient age - young patients are highly unlikely to develop peripheral arterial disease or toe gangrene.


  • Pain - patients who experience pain out of proportion to clinical appearance may have an atypical wound.


  • Asymmetry - a wound with irregular edges may be an indication that it is an atypical wound.


  • Pigmented lesions - This could be an indication that a malignant or inflammatory process is happening.


Types


Tophi Ulceration

These are chunks of uric acid crystals that form in and around joints and other parts of the body as a result of advanced gout. It can cause joints to become swollen while the skin that covers it gets stretched out, to the point of ulceration. This type of wound affects around 12% – 35% of people with gout.


Tophi can destroy bone and cartilage that can lead to chronic inflammation which can be both painful and debilitating. Usually easy to identify via a visual exam, it may sometimes require imaging or aspiration in order to confirm a diagnosis.


Treatment for this type of wound is often included as part of a gout treatment plan that aims to reduce uric acid through medications as well as lifestyle changes that include weight management and a diet low in foods that contain purines, such as veal, mussels, tuna, bacon, and beer. Topical treatments include collagen or silver infused dressings, depending on the wound drainage.


Charcot Foot

A charcot foot is a rare yet serious complication that usually affects patients with peripheral neuropathy, particularly those suffering from diabetes. This is a condition where the nerves in the lower legs and feet have been damaged, affecting the bones, joints, and soft tissues

of the foot or ankle. Such a condition may also increase the risk of deformity, neuropathy, pressure, and circulatory issues.


It is worth noting that deformity in any part of the foot can lead to skin ulcers because of the bone pressing against the shoe or the ground. They are often difficult to heal because of complications of diabetes, poor circulation in the feet, standing for long periods of time, and the development of infections. An infected ulcer that does not heal can lead to amputation of the foot or even the leg depending on the severity.


Treatment for this condition depends on the extent of the deformity, sometimes, even surgical intervention may be necessary. In its early stages, offloading may help prevent inflammation and stop the condition from getting worse.


Protected weight-bearing (walking in a walking boot) may also help prevent complications and avoid new deformities from happening. Topical treatment for this condition depends on full or partial thickness tissue type as well as drainage.


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