Abstract: Currently, most skin lesions are called wounds and primarily are divided into acute and chronic, the difference being the time period during which they have been in existence and/or their tendency to heal properly or not. Etiology is not taken into account when applying the definitions of chronic versus acute. The traditional definition of wounds and ulcers was based primarily on etiology, where a wound (now called an acute or surgical wound) was said to be caused by violence (eg, an outside force such as a bullet, a surgical incision) and an ulcer, presently called a chronic “wound,” was defined as being caused by some kind of internal etiology (eg, venous hypertension with its secondary consequences to skin integrity). Based on the differences in etiology and physiology, morbidity and mortality, therapeutic options and requirements, and other aspects of different types of skin lesions, this author proposes to reinstitute the “old” nomenclature. The traditional, non-medical definition of a wound according to many encyclopedias is “a break in the continuity of any bodily tissue due to violence, where violence is understood to encompass any action by an external agent.”1–3 The same encyclopedias mention inflammation, a gradual occurrence and/or chronic nature, and an internal factor in their definitions of an ulcer. However, in the medical community virtually all skin lesions now are called wounds (diabetic, venous, pressure, surgical, fungating carcinoma, traumatic, etc.). Generally, the term wound is not used in relation to the injuring mechanism anymore. Whether the primary tissue breakdown is internal or caused by an external force is not taken into account either, nor are other physiological aspects. A chronic wound is defined as one that has been in existence for more than 3 weeks or that has failed to proceed through an orderly and timely process to produce anatomic and functional integrity or proceed through the repair process without establishing a sustained and functional result.4 If an ulcer is defined as a gradual disturbance of tissues by an underlying (and thus internal) etiology/pathology and a wound (as in trauma) as an acute disturbance of tissues by an external force, the observed differences in appearance, demographics, anatomical locations, physiology and pathology, as well as the required medical interventions, possible medical options and outcomes become a great deal more logical. For the purposes of this commentary, a chronic lesion will be referred to as an “ulcer,” while the term “wound” will refer to trauma.
Wounds and Ulcers: Back to the Old Nomenclature
Issue: Volume 22 - Issue 11 - November 2010