Outcomes Research—Measuring Wound Outcomes

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Author(s): 
Marco Romanelli, MD, PhD;Valentina Dini, MD; Maria Stefania Bertone, NT; Cinzia Brilli, RN

The measurement of cutaneous wounds in order to detect the progression of a disease is a routine part of medical practice. Although measurement technology has evolved continuously in all fields of medicine, its direct application to cutaneous disorders has increased recently.1 Only in the past decade has significant research been undertaken to further develop techniques specific to examining the skin. Advances in both the technology of imaging and computer systems have greatly supported this process and improved its clinical relevance.
Assessment of any wound should begin by determining the extent of the involved area. Because the extent of a wound changes dynamically, repeated systematic assessment is necessary. The total wound extent is based on the wound dimensions and the tissue level involved. The clinical evaluation of the extent of tissue involvement due to a skin lesion, and the way a lesion evolves over time, are often assessed according to the common sense and memory of the clinician. Evaluations are typically performed based on clinical experience, using very basic, low-tech equipment to make objective measurements. The determination of wound extent may be accomplished by either noninvasive or invasive technologies. Noninvasive wound assessment includes the measurement of perimeter, maximum dimensions of length, width, and depth, surface area, volume, and determination of tissue viability.2 A wound can be further described using various parameters, which include duration, blood flow, oxygen, hardness, inflammation, pain, and coexisting systemic factors. These parameters are clues to the definition of the cause, pathophysiology, and status of the wound, but the authors believe that a complete and detailed history and physical examination are also fundamental.

References: 

References

1. Romanelli M, Gaggio G, Piaggesi A, Coluccia M, Rizzello F. Technological advances in wound bed measurements. WOUNDS. 2002;14(2):58–66.
2. Mani R,Falanga V,Shearman CP,Sandeman D, eds.Chronic Wound Healing: Clinical Measurement and Basic Science. London, England: Harcourt Brace; 1999.
3. Olin JW, Beusterein KM, Childs MB, Seavey C, McHugh L, Griffiths RI. Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study. Vasc Med. 1999;4(1):1–7.
4. Bolton L, McNees P, van Rijswijk L, et al.Wound-healing outcomes using standardized assessment and care in clinical practice. JWOCN. 2004;31(2):65–71.
5. Bates-Jensen BM, Vredevoe DL, Brecht ML. Validity and reliability of the Pressure Sore Status Tool. Decubitus.1992;5(6):20–28.
6. Phillips TJ,Machado F,Trout R, et al. Prognostic indicators in venous ulcers. J Am Acad Dermatol. 2000;43(4):627–630.
7. Gelfand JM, Hoffstad O, Margolis DJ. Surrogate endpoints for the treatment of venous leg ulcers. J Invest Dermatol. 2002;119(6):1420–1425.
8. Kantor J, Margolis DJ.A multicentre study of percentage change in venous leg ulcer area as a prognostic index of healing at 24 weeks. Br J Dermatol. 2000;142(5):960–964.
9. van Rijswijk L, and the Multicenter Leg Ulcer Study Group. Full-thickness leg ulcers: patient demographics and predictors of healing. J Fam Pract. 1993;36(6):625–632.
10. Gilman TH. Parameter for measurement of wound closure. WOUNDS. 1990;2(3):95–101.
11. Margolis DJ.Wound healing assessment: the clinical utility of wound healing rates. Ostomy Wound Manage. 1994;40(8):20–27.
12. Kantor J, Margolis DJ. Efficacy and prognostic value of simple wound measurements. Arch Dermatol. 1998;134(12):1571–1574.
13. Falanga V, Sabolinski ML. Prognostic factors for healing of venous ulcers.WOUNDS. 2000;12(5 Suppl A):42A–46A.
14. Donohoe K, Falanga V. Healing rate as a prognostic indicator of complete healing: a reappraisal. WOUNDS. 2003;15(3):71–76.
15. Piaggesi A, Palumbo F,Tedeschi A, et al. Measurements in diabetic foot.WOUNDS. 2005;17(9):247–254.
16. Young MJ, Breddy JL,Veves A, Boulton AJ.The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care. 1994;17(6):557–560.
17. Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol. 1994;130(4):489–493.
18. Sheehan P, Jones P, Caselli A, Giurini JM,Veves A. Percent change in wound area of diabetic foot ulcers over a 4- week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879–1882.
19. Jude EB, Apelqvist J, Spraul M, Martini J; Silver Dressing Study Group. Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med. 2007;24(3):280–288.
20. Piaggesi A, Romanelli M, Schipani E, et al. Hardness of plantar skin in diabetic neuropathic feet. J Diabetes Complications. 1999;13(3):129–134.
21. van Rijswijk L, Polansky M. Predictors of time to healing deep pressure ulcers.WOUNDS. 1994;6(5):159–165.
22. Lyder CH, Yu C, Emerling J, et al. The Braden Scale for pressure ulcer risk: evaluating the predictive validity in Black and Latino/Hispanic elders. Appl Nurs Res. 1999;12(2):60–68.
23. Ohura T, Ohura N Jr. Pathogenetic mechanisms and classification of undermining in pressure ulcers—elucidation of relationship with deep tissue injuries.WOUNDS. 2006;18(12):329–339.
24. National Pressure Ulcer Advisory Panel: National Consensus Conference.Washington, DC: NPUAP; 1998.
25. Bates-Jensen BM. Indices to include in wound healing assessment. Adv Wound Care. 1995;8(4 Suppl):25–33.
26. Cooper R, Lawrence JC. The isolation and identification of bacteria from wounds. J Wound Care. 1996;5(7):335–340.
27. Haalboom JR. Pressure ulcers. Lancet. 1998;352(9127):581.
28. European Pressure Ulcer Advisory Board (EPUAP). Guidelines on the Treatment of Pressure Ulcers.Oxford, UK: EPUAP Review. 1999;2:31–33.
29. Dow G, Browne A, Sibbald RG. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy Wound Manage. 1999;45(8):23–40.
30. Lewis VL Jr, Bailey MH, Pultawski G, Kind G, Bashioum RW, Hendrix RW. The diagnosis of osteomyelitis in patients with pressure ulcers. Plast Recon Surg. 1988;81(2):229–232.
31. Darouiche RO, Landon GC, Klima M, Musher DM, Markowski J. Osteomyelitis associated with pressure sores. Arch Intern Med. 1994;154(7):753–758.

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