EWMA 2021, 7-9 July

Atypical Wounds

Project period: 2018–2019


Introduction and aim

Atypical wounds are generally understood as wounds that cannot be defined under one of the primary non healing wound categories, such as venous, arterial, mixed or diabetic foot ulcers.

They present a broad spectrum of conditions or diseases caused by inflammation, infection, malignancy, chronic illnesses or genetic disorders. Atypical wounds can be suspected if the wound has an abnormal presentation or location and does not heal with a good treatment plan.

The prevalence of atypical wounds can be as high as 10 % of all wounds, and it is probable that many of these wounds are underdiagnosed. The aim of the document is to bring awareness of the clinical picture, diagnosis and treatment of these wounds. Typical challenges include considerable diagnostic delay and pro-longed healing times, e.g. for the inflammatory and vasculopathy wounds (such as pyoderma gangrenosum, an inflammatory neutrophilic disorder, and cutaneous vasculitis). In addition, many atypical wounds have an enormous impact on the life quality of the affected individuals.

With this document, EWMA wishes to focus on the atypical wounds which create the most challeging situations for clinicians and/or patients from a prevention, treatment and organisational perspective.



The main objectives of the EWMA Atypical Wounds project are to:

  • Provide an overview about wounds considered atypical, and present the diagnostic criteria, comorbidities and diagnostic tools for these wounds.
  • Present the available best documented treatment options. High-quality evidence is sparse, but retrospective and observational studies have been published and some randomized prospective studies for pyoderma gangrenosum and vasculitis are available.
  • Present the various treatment options for these wounds, such as immunosuppression, other modern wound healing therapies including Negative Pressure Wound Therapy (NPWT), and other advanced therapies which are increasingly playing an important role in the management of atypical wounds.