Table 3 Overview and description of common wound typesa
From: Evaluating polymeric biomaterials to improve next generation wound dressing design
Wound Type | Depth of Tissue Involvement | Wound Description | Common Location(s) of Wounds | Common Insufficiencies | Most Common Dressing(s) Utilized | Design Considerations | References |
|---|---|---|---|---|---|---|---|
Diabetic Ulcer | Epidermis, Dermis, Subcutaneous, Fascia, bones and joints | Often of neuropathic etiology. Progression of simple acute wound towards chronic wound due to vascular and nerves damage. Inadequate blood/oxygen/nutrients supply and waste removal. | Plantar aspect of foot, tip of toe, lateral or fifth metatarsal, lateral malleolus and other pressure points | • Vascular • Neurological (Somatic) • Epithelialization • Matrix Deposition • Bacteria and Biofilm Infection | • Saline soaked gauze or impregnated gauze with silver or other antimicrobial. • Foams, and hydrogels that aid in bacterial mitigation. • Non-adherent dressings most common. | Off-weighting neuropathic pressure points. Targeting the promotion of re-epithelialization and angiogenesis, while regulating inflammation and matrix deposition are key factors. Hydrogel-based dressings for the controlled delivery of drugs, growth factors, stem cells and immunomodulatory factors have shown promise. Needs vary with depth of penetration. | |
Pressure Ulcer | Epidermis, Dermis, Subcutaneous, Fascia | A localized chronic wound induced by chronic contact pressure to the skin or soft tissue site. Occurs at the site of a bony prominence or location of compression from a medical device, frequently in insensate area or with depressed level of consciousness. | Sites of bony prominences (e.g. heel, ischium, trochanter) | • Muscle Mass • Skin Atrophy • Epithelialization • Matrix Deposition • Bacteria and Biofilm Infection | • Saline soaked gauze. • Foams, hydrocolloids, and hydrogels that aid in bacterial mitigation and moisture control. • Often associated with a polyurethane or silicone film or superficial cover. • Negative pressure wound therapy often employed. | Targeting the promotion of re-epithelialization and matrix deposition with neotissue formation are key design factors. Offloading needs and depth of wound will also affect dressing design. Hydrogel and fibrous polymer based dressings for the controlled delivery of stem cells and stem cell derived byproducts appear promising. | |
Vascular Insufficiency Ulcer | Epidermis, Dermis, Subcutaneous, Fascia | Arterial insufficiency: Terminal digit necrosis. Marginating skin loss with poor quality subcutaneous base distal foreleg. Venous Insufficiency: Similar appearance distal foreleg but hemosiderin staining present. | Arterial: Terminal digits, distal foreleg. Venous: Distal foreleg | • Vascular • Epithelialization • Matrix Deposition • Bacteria and Biofilm Contamination • Exudate Control | • Alginate dressings or other absorptive dressings with hydrating features such as hydrocolloids and foams. • Incorporation of antimicrobial therapy is common. • Compression and elevation of leg is important in venous insufficiency | Targeting the promotion of angiogenesis and neotissue formation are key design factors as is the inclusion of compression in venous insufficiency. Biomaterial-based dressings and nanoparticle for the controlled delivery of pro-angiogenic factors, such as VEGF and FGF, have demonstrated benefit. Stem cell based therapies are also promising. | |
Burn | Epidermis, Dermis, Subcutaneous, Fascia, Muscle, Bone, Tendon, Ligaments, Deep soft tissue | Tissue damage induced by thermal energy. Removal of dead/necrotic tissue necessary. Prone to infection and bacterial propagation. Severity depends on agent (e.g. flame, electrical, chemical), depth, tissue structures involved, and total area of burn. All burns below dermis are "full thickness," third degree or beyond. | Anywhere | • Vascular and fluid loss • Neurological (Somatic and Autonomic) • Epithelialization • Matrix Deposition • Aggressive Bacterial Invasion • Moisture Control | • Moist semi-permeable or occlusive dressings often treated with silver or other antimicrobial. • Includes gauze, foams, and hydrogels often containing silver. • Skin grafting is common in severe cases. | Must provide moisture to wounds while mitigating bacterial propagation. Non-adherent dressing are preferred. Full thickness burns will require debridement and dressings which aid eschar removal. Early burn fluid loss require extensive use of pads and wraps. Delivery of biological compounds such as stem cells and growth factors have demonstrated the capacity to expedite and improve long term healing outcomes. Hydrogels are of specific interest. | |
Radiation Dermatitis | Epidermis, Dermis, Subcutaneous | Localized skin damaged due to radiation (therapeutic or incidental) results in decreased cellular proliferation and bioactive factor production (e.g. growth factors and cytokines). Damages matrix proteins (e.g. collagen). Shares characteristics with arterial insufficiency. | Anywhere (commonly sites of cancer therapy) | • Cellular proliferation • Epithelialization • Matrix Deposition • Prone to Bacterial Colonization • Increased Sensitivity to Topical Agents | • Saline soaked gauze dressings with silver or other antimicrobial compounds. • Impregnated gauze, hydrocolloid, of hydrogels. • Polyurethane foams and films dressings are also used. | Moisture donating dressings that have anti-radiation factors, such as amifostine, curcumin and corticosteroids, would provide benefits to wound outcomes. Additionally, hyaluronic acid based dressings have demonstrated enhanced wound outcomes. Depth of involvement varies from superficial to deep. Specially formulated, non-sensitizing creams beneficial in superficial radiation burns. | |
Penetrating Wound | Epidermis, Dermis, Subcutaneous, Fascia, Muscle, Bone, Tendon, Ligaments, Deep soft tissue | Wound induced via penetration of an object through the external skin barrier (e.g. gun shot or stab wound). Can be associated with foreign debris and structural damage to soft and hard tissue. | Anywhere | • Depends on tissue involvement • Often vascular and nerve damage can be present. | • Dependent on wound characteristics and tissue involvement. • Packing wounds with gauze and foams is often utilized if wounds are too large to be re-apposed. • Exudate, foreign material and debris removal and moisture control are important. • Film coverings are also common. | Dependent on depth of wound and tissue types involved. Malleable dressing materials and formable gel- and foam- based dressings are ideal for irregular contour of deep penetrating wounds. Hemostatic materials for wounds that continuously bleed to prevent exsanguination. | |
Complex Traumatic | Epidermis, Dermis, Subcutaneous, Fascia, Muscle, Bone, Tendon, Ligaments, Deep soft tissue | Result of traumatic event (e.g. car accident or military-based) where multiple tissues are almost always involved. Can be associated with foreign debris and structural damage to soft and hard tissue, in addition to vascular, nervous, and lymphatic damage. | Anywhere | • Depends on tissue involvement • Often vascular and nerve damage can be present • Lymphatics are also commonly involved with edema typically present | • Dependent on wound characteristics and tissue involvement. • Packing of wounds with gauze and foams or skin grafting can be utilized for larger wounds. • Exudate, foreign material and debris removal and moisture control are important. • Film coverings are also common. | Dependent on complexity of wounds and tissue types involved. Stem cells offer a heterogenous functionality that can aid in the regeneration of multiple tissue types. Malleable dressing materials and formable gel- and foam- based dressings are ideal for irregular contour of complex traumatic wounds. Materials that provide mechanical and dimensional stability ideal for structural damage of tissue. May be paired with negative pressure therapy. Tailoring release of bioactive factors depending on tissue involvement will provide control of tissue regeneration. |