A common question I get asked in the clinic is: “What’s the difference between ulcers and wounds?” The answer depends on who you ask. The simplest definition is that wounds are acute, and ulcers are chronic. If you cut yourself on your car door, that’s a wound. If it gets infected and doesn’t heal for a long time, it becomes an ulcer. Traditionally, an arbitrary line is drawn at 30 days. Using our car door example, on Day 1 through Day 29, it would be a wound. On Day 30, it becomes an ulcer. Obviously, this doesn’t perfectly match with what it physiologically going on in the body. In a future post, we will explore how Acute Wounds become Chronic Wounds (or Ulcers). For now, suffice it to say that our bodies are pretty good at knowing how to deal with a wound that has happened recently, and not so good at being able to deal with a wound that doesn’t heal within the first few weeks.
Another definition looks at type of wounds. Pressure Injuries, for example, are typically called ulcers, even on the first day they are discovered. Similarly, Venous Ulcers are rarely called Venous Wounds, even when the patient comes to the clinic as soon as they notice something wrong. This has more to do with tradition than physiology. Wounds that begin as an infection (such as a boil), are typically referred to as wounds, as are skin damage that has occurred due to trauma. Burns are typically referred to as “burn wounds” even when they take months or years to heal.
The bottom line is, there is no universally-accepted definition of when to refer to a particular type of damage to the skin as a Wound or an Ulcer.
For more information on Pressure Injuries, check out this web site: https://npiap.com
For more information on Venous Ulcers, this scholarly paper provides an in-depth review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144244/ Another resource, from Podiatry Today, also gives a good review, and aimed more at the public (but still very detailed).
-Tim Lapham, MD, CWS-P