Most chronic wounds are caused by common wound pathologies including vascular disease (arterial and venous disease), neuropathy from diabetes mellitus, or prolonged pressure. A subset of patients have wounds caused by less common causes such as ulcerative skin diseases, cutaneous manifestations of systemic disease, malignancy and/or uncommon infections or inflammatory diseases among others. Diagnosing wound correctly is critical to both predict likely outcomes and to choose appropriate therapies. Most useful is the use of tissue biopsies which can be sent for histologic testing, tissue culture, or other testing to help direct further work- up. Taking a tissue sample (after local anesthesia) from the wound edge and wound bed can be performed simply in a clinic setting. Biopsying a wound is performed if clinical suspicion indicates because of an unusual appearance or unusual wound symptoms, if a wound is anatomically in an unusual location for a common chronic wound, or if a wound fails to improve with standard care. Histology will them suggest a path forward for further evaluation.
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