Conditions we treat
Different wounds fail for different reasons.
Explore the biology, mechanics, evaluation and treatment framework for the acute and chronic wounds managed through an advanced wound and reconstructive program.
A diagnostic framework
The wound is a symptom. The cause determines the treatment.
The legacy Klapper Wound site correctly separated common acute and chronic wounds, but a useful modern resource has to go further. A diabetic plantar ulcer, a venous ulcer, a pressure injury, an inflammatory ulcer and a traumatic avulsion can all be open wounds—yet the biology and mechanics are different enough that the treatment plans may be almost opposite.
This section is organized around the underlying problem: pressure, neuropathy, venous hypertension, impaired arterial inflow, infection, radiation damage, trauma, abnormal inflammation or failed surgical closure.
What every difficult wound assessment asks
Five questions before choosing a treatment.
- What caused the wound? Trauma, pressure, neuropathy, venous disease, ischemia, surgery, radiation or another process?
- Is the tissue perfused? Healing and reconstruction require sufficient blood flow.
- Is there infection or devitalized tissue? Source control may be necessary before closure.
- What force is keeping the wound open? Pressure, shear, edema, tension or repeated trauma?
- Is local wound care enough? Or does the anatomy require grafting, flap coverage or another reconstructive strategy?
Common questions
Questions about wound types
The most useful first step is understanding what kind of wound you are actually dealing with.
How do I know whether a wound is acute or chronic?
Acute wounds follow a recent injury or operation and are expected to move through normal healing. Chronic wounds fail to progress as expected because an underlying biological or mechanical barrier persists. The calendar alone does not define the problem.
Why can two wounds that look similar need completely different treatment?
The same surface appearance can result from different causes: venous hypertension, ischemia, pressure, neuropathy, infection, inflammatory disease, radiation injury or trauma. Correct treatment depends on the cause.
When should a nonhealing wound be biopsied?
Biopsy may be appropriate when the wound has atypical features, unusual pain, abnormal edges, rapid progression, recurrent breakdown or failure to respond despite appropriate treatment.
When does a wound become a reconstructive problem?
Reconstruction becomes relevant when there is substantial tissue loss, exposed bone/tendon/joint/nerve/vessel/hardware, unstable coverage, repeated failure or a defect that is unlikely to close durably with local wound care alone.
Can skin tears in older adults be serious?
Yes. Fragile-skin injuries can create large defects. Preserving avulsed skin may substantially reduce the area that must heal or be reconstructed.
What symptoms should prompt emergency assessment?
Uncontrolled bleeding, rapidly spreading redness or swelling, severe systemic illness, sudden cold or pale limb, rapidly progressive tissue discoloration, major crush injury or another immediately limb- or life-threatening problem should not wait for a routine wound appointment.
