This document discusses atypical wounds, which are wounds with uncommon causes that do not respond to typical treatment. It defines atypical wounds and lists some main types, including pressure ulcers, venous leg ulcers, and diabetic foot ulcers. The document then discusses various etiologies of atypical wounds, such as infections, vasculopathies, inflammatory conditions, and malignancies. It provides examples of specific conditions for each category and considerations for treatment.

1. ATYPICAL WOUNDS
QURATULAIN MUGHAL
DOCTOR OF PHYSICAL THERAPY
IIRS
BATCH IV
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2.  DEFINITION
 TYPES OF ATYPICAL WOUNDS
 ETIOLOGIES OF ATYPICAL WOUNDS
 TREATMENT OPTIONS
TABLE OF CONTENTS
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3.  “Wounds resulting from uncommon etiologies called
atypical wounds.”
OR
 “Any wound that is not healing after 3 to 6 months of
appropriate treatment should raise the consideration
of an atypical wounds.”
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ATYPICAL WOUNDS

4.  Pressure ulcers due to prolonged pressure.
 Venous leg ulcers due to venous insufficiency.
 Diabetic foot ulcers due to complications of
longstanding diabetes mellitus.
 Arterial ulcers due to poor vascular supply.
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TYPES OF ATYPICAL WOUNDS

5.  They are less frequently encountered and less well
understood.
 Their prevalence has not been studied extensively.
 But it is estimated that at least 10% of the more than
500,000 leg ulcers in the United States may be due to
unusual causes.
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EPIDEMIOLOGY

6.  It is present in a location different from that of a
common chronic wound.
 Its appearance varies from that of a common chronic
wound.
 It does not respond to conventional therapy.
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A WOUND SHOULD BE EVALUATED
FOR AN ATYPICAL ETIOLOGY IF:

7. 1. Inflammatory causes
2. Infections
3. Vasculopathies
4. Metabolic and genetic causes
5. Malignancies
6. External causes
7. Drug-induced causes
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ETIOLOGIES OF ATYPICAL WOUNDS
Although not all-inclusive, this list presents some of the most commonly
encountered etiologies for an atypical wound.
Tissue samples are
mandatory for
atypical wounds

8.  Vasculitis
 Pyoderma gangrenosum (diagnostic test to confirm &
Curative treatment does not exist).
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1. INFLAMMATORY CAUSES

9. Infections
Medications
Chemicals
Foods
Connective
tissue and
other
inflammatory
diseases
Malignancies
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POTENTIAL ETIOLOGIES OF
VASCULITIS

10. DIAGNOSTIC TESTS FOR
VASCULITIS
To
determine
the etiology
of vasculitis.
To
determine
the extent
of disease.
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11. •Leg elevation
•Compression dressingsMild
•Systemic steroids
•Plasmapheresis
Extensive
or systemic
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VASCULITIS TREATMENT OPTIONS

12.  Atypical mycobacteria
 Buruli ulcer
 Deep fungal infections
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2. INFECTIONS
1. SPOROTRICHOSIS
2. CHROMOBLASTOMYCOSIS
3. PARACOCCIDIOIDOMYCOSIS
4. MYCETOMA
5. VIBRIO VULNIFICUS INFECTION
6. NECROTIZING FASCIITIS

13. 13
Deep fungal infections
SPOROTRICHOSIS
PARACOCCIDIOIDOMYCOSIS
MYCETOMA
VIBRIO VULNIFICUS
INFECTION
NECROTIZING FASCIITIS

14.  Age 50 and older
 Alcoholism
 Malignancy
 Malnutrition
 Obesity
 Renal failure
 Smoking
 Diabetes mellitus
 HypertensionSurgery
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PATIENTS AT RISK FOR
NECROTIZING FASCIITIS

15.  Cryoglobulinemia
 Cryofibrinogenemia
 Antiphospholipid antibody syndrome
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3. VASCULOPATHIES
Cryofibrinogenemia

16.  Calciphylaxis
 Sickle cell anemia
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4. METABOLIC AND GENETIC CAUSES

17. CALCIPHYLAXIS TREATMENT
MEDICAL TREATMENT
 Decreased calcium in dialysate
 Antibiotics
 Low phosphate diet
 Bisphosphonates
 Sodium thiosulfate
 Avoidance of challenging agents
 Avoidance of systemic steroids
 Anticoagulation
SURGICAL TREATMENT
 Parathyroidectomy
 Wound care and debridement
 Amputation
 Renal transplantation
 Skin grafting using either
autologous or tissue
engineered skin
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18.  Squamous cell carcinoma
 Basal cell carcinoma
 Lymphoma
 Kaposi’s sarcoma
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5. MALIGNANCIES

19.  Burns
 Bites
 Stings
 Radiation
 Factitial dermatitis
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6. EXTERNAL CAUSES

20.  COUMADIN NECROSIS
 EXTRAVASATION
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7. DRUG-INDUCED CAUSES

21.  Treat underlying disease
 Corticosteroid
 Immunosuppressant = Cyclosporine
 Systemic antibiotics
 Anaesthetic
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TREATMENT

22.  Control pain
 Necrotic tissue
 surgical debridement is contraindicated as it may
result in even worse ulceration
 Avoidance of trauma at dressing removal
 disturbance can generate an even greater
inflammatory response and stimulate deterioration.
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WOUND MANAGEMENT

23.  Negative pressure therapy
 may be used to assist debridement when the
disease is stable
 Debridement and skin grafting
 can be considered when condition is under
controlled
 surgery may reactive the disease
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WOUND MANAGEMENT

24. 24
REFERENCES

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